Health-related quality of life of “left-behind children”: a cross-sectional survey in rural China

Association of early parent-child separation with depression, social and academic performance in adolescence and early adulthood: a prospective cohort study

OBJECTIVE

The present study aimed to investigate the long-term effects of parent-child separation during infancy and early childhood on depression, social relationships including parent-child and peer relationships, and academic performance during adolescence and early adulthood.

METHODS

Data from the China Family Panel Studies (CFPS) were analyzed, which included a sample of 3829 children aged 4-15 years from 25 provinces over a period of 8 years. The study examined the association between early parent-child separation and outcomes related to depression, social and academic performance, comparing outcomes between individuals with and without early separation experiences. A series of subgroup analyses were conducted to further explore these associations.

RESULTS

Parent-child separation lasting 3 months or longer was found to be associated with moderate to severe levels of depression and impaired social relationships during adolescence and early adulthood, particularly among males, adolescents, urban dwellers, and those with less educated mothers. Children who experienced parent-child separation for 3 months or longer showed a positive correlation between separation duration and depression. Short-term separations under 3 months did not show this association. The duration of separation also had a negative correlation with parent-child and peer relationships, as well as academic performance.

CONCLUSION

Early parent-child separation has significant adverse effects on the mental health, social and academic performance of adolescents and early adulthood, especially among males, adolescents, urban residents, and those with lower maternal education. The severity of depression was found to be related to the duration of separation, highlighting the importance of minimizing separation to less than 3 months for children under the age of 3. These findings underscore the critical role of early parental care and the need for targeted interventions for high-risk populations.

The role of childhood left-behind experience on childhood trauma exposure and mental health outcomes: a propensity score matching (PSM) analysis

BACKGROUND

China has a significant number of left-behind families. This study focuses on the long-term effects of childhood left-behind experience on different type of childhood trauma and mental health outcomes in later life development.

METHODS

participants were 67 795 Chinese young adults. Psychosocial characteristics were screened by sleep quality, the nine-item Patient Health Questionnaire for depressive symptoms, the generalized anxiety disorder-7 for anxiety symptoms, trauma screening questionnaire for post-traumatic stress, a short form of the Childhood Trauma Questionnaire for childhood trauma. Propensity score matching (PSM) and multivariate linear regression were applied to analyze the data.

RESULTS

the results of the post-PSM analysis showed that the distributions of propensity scores for the two groups were approximately equal. And the total sample size in post-analysis dropped to 2358 (Nnuclear family = 1179, Nleft-behind family = 1179), with unmatched cases excluded. Post-matching results showed that the students from left-behind family were significantly associated with severer post-traumatic stress (b = 0.39, 95% CI = [0.15, 0.62]), loneliness (b = 0.29, 95% CI = [0.16, 0.42]), depressive symptoms (b = 0.44, 95% CI = [0.06, 0.82]) and CTQ-physical neglect (b = 0.34, 95% CI = [0.11, 0.58]).

CONCLUSION

our study showed that childhood left-behind experiences are tightly related to childhood trauma experience and mental health issues (post-traumatic stress, loneliness and depression) in late adolescents.

To assess and compare the mental health of current-left-behind children, previous-left-behind children with never-left-behind children

The study's goal was to compare the mental health of children who are now left-behind (current-LBC) to children who have never been left-behind (never-LBC). Recruits were culled from rural Chinese schools. The Strengths and Difficulties Questionnaire (SDQ) and the Parent-Adolescent Communication Scale (PACS) were used to examine participants' migratory status, mental health, and parent-child communication (PACS). A total of 2,000 current-, 500 previous-, and 300 never-LBCs in had complete data readily accessible for research and analysis. A number of mental health issues, such as emotional symptoms, conduct, and hyperactivity issues as well as overall challenges were considerably increased when all confounding factors were taken into account in the analysis. Our findings also showed a substantial link between children's overall issues and their inability to effectively communicate with parents. Children suffer long-term consequences as a result of their parents' frequent moves. The mental health of children is closely linked to the quality of communication between parents and children. Migrant parents' ability to comprehend and communicate with their children is critical to their children's development, according to the findings of this study.

Internal Migration and Depression Among Junior High School Students in China: A Comparison Between Migrant and Left-Behind Children

Using data from the China Education Panel Survey (CEPS), which was a nationally representative sample of junior high school students, this study examined the association of internal migration with depression among migrant and left-behind children, while exploring the moderating effect of gender difference and the mediating effects of social relationships. The results showed that migrant children had a significantly lower level of depression than left-behind children. Further, the difference in mental health between migrant children and left-behind children was more prominent for boys than girls. The mechanism analyses indicated that compared to left-behind children, internal migration positively predicted parent–child relationships and peer relationships of migrant children, which in turn reduced their depressive symptoms. Although migrant children suffered from a higher level of teacher discrimination than their left-behind counterparts, it had no significant relationship with depression after controlling for children’s social relationships with parents and peers. Our findings suggested that migrating with parents was helpful to reduce children’s depressive symptoms in comparison with being left behind. Therefore, actions should be implemented to reduce the occurrence of involuntary parent–child separation and the prevalence of children’s depressive disorders due to institutional constraints. In addition, necessary treatments are needed to improve the psychological wellbeing of disadvantaged children, especially among left-behind children with mental illness.

Parental migration and non-cognitive abilities of left-behind children in rural China: Causal effects by an instrumental variable approach

BACKGROUND

Extensive research has confirmed the disadvantages of left-behind children in the development of human capital in rural China; however, evidence is limited on non-cognitive abilities, especially in the identification of causal effects. In recent years, the role of non-cognitive abilities on children has become increasingly prominent.

OBJECTIVE

This study identifies the causal effects of parental migration and the decline of non-cognitive of left-behind children and explores the potential mechanisms.

PARTICIPANTS AND SETTING

The participants were 4636 rural students in the seventh and ninth grades of 43 secondary schools from 26 counties based on the China Education Panel Survey (CEPS) in the 2013-2014 academic year.

METHOD

We adopt an endogenous treatment effect model with the instrumental variable (IV) to identify the causal effects by constructing a comprehensive index to measure children's non-cognitive abilities based on the Big Five Personality Model.

RESULTS

Parental migration is significantly detrimental to non-cognitive abilities of rural left-behind children. Worse, except for agreeableness, the score of rural left-behind children in the other four sub-items is significantly lower. The negative impact of parental migration is partially explained by the fewer shadow education, the reduction in parent-child interactions, and the parental education participation, especially parent-child interactions in a major position.

CONCLUSION

Our findings are consistent with previous studies and further provide evidence that parental migration is the cause of the decline of non-cognitive abilities of rural left-behind children. These results indicate that it is necessary to formulate some public policies to focus on the neglected non-cognitive abilities of left-behind children.

Attention Deficit Hyperactivity Disorder (ADHD) among elementary students in rural China: Prevalence, correlates, and consequences

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China.

METHODS

Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV.

RESULTS

The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs = 2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR = 0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01).

LIMITATIONS

The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample.

CONCLUSIONS

ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.

Association of Child Mental Health with Child and Family Characteristics in Rural China: A Cross-Sectional Analysis

Assessing the mental health problems encountered by school children and understanding the contributing factors are crucial to inform strategies aimed at improving mental health in low-resource contexts. However, few studies have investigated the mental health problems among disadvantaged children in poorer countries. This study examines the prevalence of mental health problems in rural China and their association with child and family characteristics. The study uses survey data from 9696 children in 120 rural primary schools and measures child mental health using the Strengths and Difficulties Questionnaire (SDQ). Overall, 17.9% of the sample children were found to be in the abnormal range of the SDQ total difficulties scores. The mean score was 12.93 (SD = 4.94). Abnormal scores were associated with child and family characteristics, including older child age (Odds Ratio, OR = 0.704, 95% CI: 0.611, 0.810; p < 0.001), gender (OR = 1.235, 95% CI: 1.112, 1.371; p < 0.001), and academic performance (OR = 0.421, 95% CI: 0.369, 0.480; p < 0.001). Reading time was found to be protective for mental health. Risk factors include excessive screen time (OR = 1.685, 95% CI: 1.409, 2.016; p < 0.001) and being bullied (OR = 3.695, 95% CI: 3.301, 4.136; p < 0.001). Our study suggests that future mental health illness prevention programs in rural China should consider targeting different aspects of children's social contexts.

Relationship Between Childhood Left-Behind Experience and Quality of Life Among Chinese University Freshmen: Place of Origin Matters

Background: Childhood left-behind experience (LBE) has a long-term detrimental effect on the mental health of Chinese University students, but it remains unclear whether childhood LBE negatively impacts the quality of life (QOL) of University students and whether the LBE-QOL association differs between students of rural origin and students of urban origin. This study examined the LBE-QOL relationship and the interactive effect between LBE and place of origin on QOL among Chinese University freshmen. Methods: By using a two-stage random cluster sampling approach, a total of 5,033 freshmen were recruited from two comprehensive universities. The students completed an online, self-administered questionnaire that included sociodemographic variables, a 2-week physical morbidity assessment, and assessments of depressive symptoms, academic stress, and QOL. The Chinese six-item QOL scale was used to assess QOL. Multiple linear regression was used to test the independent LBE-QOL association and the interaction between LBE and place of origin. Results: Students with childhood LBE had significantly lower QOL scores than those without LBE (60.1 ± 13.1 vs. 64.3 ± 11.7, p < 0.001). After adjusting for the potential confounding effects of other sociodemographic variables, 2-week physical morbidity, depressive symptoms, and academic stress, childhood LBE was significantly associated with a lower QOL score (β: -3.022, p < 0.001) and the LBE-place of origin interaction was still significantly associated with the QOL score (β: -2.413, p < 0.001). Overall, compared to non-LBE, LBE was associated with a QOL score decrease of 5.93 among freshmen of urban origin and of 3.01 among freshmen of rural origin. Conclusion: In Chinese University freshmen, childhood LBE is independently associated with poor QOL, and the LBE-QOL association is greater among freshmen from urban backgrounds than among freshmen from rural backgrounds.

The impacts of maternal separation experience and its pattern on depression and dysfunctional attitude in middle school students in rural China

BACKGROUND

In China, because of the growth of economically driven rural-to-urban migration, there are lots of children in rural area who are separating or have separation experience with their parents. Until now, few studies focused on solely maternal separation and no research studied whether its pattern will affect children's later psychological status.

AIM

The aim of this study was to determine whether early or late maternal separation affects depression and dysfunctional attitude in middle school students and what is the role of cumulative duration and meeting frequency.

METHODS

Maternal separation experience was obtained by using questionnaires. We got early maternal separation group first. Then, late maternal separation and control group were obtained with the same number by matching grade, sex and family socioeconomic status. All the students in the three groups completed the scales of Children's Depression Inventory (CDI) and Dysfunctional Attitude Scale (DAS).

RESULTS

Both CDI and DAS scores of early separation group are higher than the other two groups. When we split the data by sex, only females presented the same results. When cumulative duration is short, there is significant difference in both scores of CDI and DAS among the three groups, which showed the scores of early separation group are higher than the other two groups. When the cumulative duration is long, there is no significant difference among the three groups. When meeting frequency is high, there is no significant difference among the three groups. When it is low, there is significant difference among the three groups, which showed the CDI and DAS scores of early separation group are higher than the other two groups. Furthermore, the same results are also found in females.

CONCLUSION

Early maternal separation may exert negative influence on student's depression and dysfunctional attitude. The sex, cumulative duration and meeting frequency may also play important roles in the effect.

The Influence of Left-Behind Experience on College Students' Mental Health: A Cross-Sectional Comparative Study

China’s rapid development and urbanization have created large numbers of migrant laborers, with increasing numbers of young adults and couples migrating from rural areas to large cities. As a result, a large number of children have become left-behind children (LBC), who were left behind in their hometown and cared for by one parent, grandparents, relatives or friends. Some of these LBC have a chance to be college students, who are called college students with left-behind experience. Some studies have indicated that the absence of these college students’ parents during childhood may cause them to have some mental health problems. Therefore, we want to examine the effects of left-behind experience on college students’ mental health and compare the prevalence of mental health problems in left-behind students and control students (without left-behind experience). For this purpose, a cross-sectional comparative survey was conducted in a coastal city of Shandong province, Eastern China. First, 1605 college students from three universities (national admissions) were recruited, including 312 students with left-behind experience and 1293 controls. Their mental health level was measured using Symptom Check-list 90 (containing ten dimensions: somatization, obsessive-compulsion (OCD), interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, psychoticism, and other symptoms). The results showed that left-behind experience was a significant risk factor for the mental health problems of college students (OR = 2.27, 95%CI: 1.73 to 2.97). A comparison of the two groups, after controlling the confounding factors using the coarsened exact matching (CEM) algorithm, showed that the prevalence of mental health problems was 35.69% (n = 311) among the left-behind students, while it was 19.68% (n = 1194) among the controls. The two groups were significantly different in terms of these ten dimensions of the SCL-90 scale (p < 0.001), and the prevalence of each dimension among the left-behind students was consistently higher than that among the controls. In addition, different left-behind experiences and social supports during childhood had different effects on mental health problems.

Knowledge and behavior regarding pesticide use: a survey among caregivers of children aged 1-6 years from rural China

Little is known about pesticide exposure risks for children in rural areas in China, many of whom have been left behind by migrant workers. To survey caregivers of children in rural China and assess their pesticide use and disposal methods, the measures were used to protect the children and their perceptions of the adverse effects of pesticides on children's health. Three or four villages in each of Xinhua, Gongan and Sansui Counties in China were selected by random cluster sampling. The main caregivers of children aged 1-6 years were surveyed in face-to-face interviews. The questionnaire used was adapted from the World Health Organization "Exposure to Pesticides: Standard Protocol" survey and similar studies. The study included 464 caregivers (mean age, 46.4 years), who were most commonly the children's grandparents (65.3%). Among the caregivers, 41.9% were educated to middle school level or higher, 45.4% had a household income < 297 USD, and 29.7% had received education/training about pesticide use/adverse health effects in children. The score for caregivers' knowledge of the adverse effects of pesticides on children's health was higher in those who had received education/training (5.1 ± 2.6 vs. 3.4 ± 2.5, P < 0.001). Factors associated with unsafe behaviors during pesticide use included grandparent as the caregiver (odds ratio [OR] 0.551; 95% confidence interval [95% CI] 0.368-0.824; P = 0.004), annual income < 297 USD (OR 0.580; 95% CI 0.395-0.853; P = 0.006), and insufficient health-related education/training (OR 0.436; 95% CI 0.286-0.665; P < 0.001). Improved education and training are needed to promote the safe use of pesticides by caregivers of children in rural China.

Household Split, Income, and Migrants’ Life Satisfaction: Social Problems Caused by Rapid Urbanization in China

Household split between rural and urban areas has become an important social issue in China’s urbanization process. This study analysed the influence of household split on migrants’ life satisfaction and the differences between inter- and intra-provincial migrants. Using the data of the 2014 China Migrants Dynamic Survey, we found that the life satisfaction of inter-provincial migrants was significantly lower than that of intra-provincial migrants. For inter-provincial migrants, the life satisfaction of those who moved to the city with underaged children was significantly lower than that of those who left their children in their hometown. Moreover, the life satisfaction of migrants who were concerned about childcare in the hometown was significantly lower than that of those who did not worry about it. Chinese migrants face a dilemma: bringing their family members to the city despite the lack of social welfare support or leaving them in the hometown worrying about family care. We also found that family income does not have a significant moderating effect on the decline in life satisfaction owing to concerns about childcare in the hometown. Future policy concerning China’s population should create external conditions for migrants to accomplish family reunion.

Mental Health among Left-Behind Children in Rural China in Relation to Parent-Child Communication

In China, there are an estimated 41 million left-behind children (LBC). The objective of this study was to examine the mental health of current-left-behind children (current-LBC) and previous-left-behind children (previous-LBC) as compared to never-left-behind children (never-LBC), while considering factors like parent-child communication. Children were recruited from schools in rural areas of Anhui province in eastern China. Participants completed a questionnaire focusing on migration status, mental health, and parent-child communication, measured with the validated Strengths and Difficulties Questionnaire (SDQ) and Parent–Adolescent Communication Scale (PACS). Full data were available for 1251 current-, 473 previous-, and 268 never-LBC in Anhui province. After adjusting for all confounding variables, the results showed that both current and previous parental migration was associated with significantly higher mental health difficulties, including aspects of emotional symptoms, conduct problems, hyperactivity, and total difficulties. Additionally, we found that difficulties communicating with parents were strongly associated with the presence of greater total difficulties in children. Parental migration has an independent, long-lasting negative effect on children. Poor parent-child communication is strongly associated with children’s mental health. These results indicate that parent–child communication is important for the development of children, and interventions are needed to improve migrant parents’ understanding and communication skills with their children.

Influence of earthquake exposure and left-behind status on severity of post-traumatic stress disorder and depression in Chinese adolescents

In the Longmenshan seismic fault zone in the Sichuan province of China, many children and adolescents have been exposed to the 2008 Wenchuan earthquake and/or the 2013 Lushan earthquake, and many are left alone for extended periods by parents who migrate to larger cities for work. We wished to examine how these two kinds of trauma-earthquake exposure and left-behind status-influence severity of post-traumatic stress disorder (PTSD) and depressive reactions. A cross-sectional survey of 2447 adolescents aged 13-18 at 11 schools in three cities in the Longmenshan fault zone was conducted in 2016. Potential relationships of scores on the Children's Revised Impact of Event Scale (CRIES-13) and the Depression Self-Rating Scale (KADS-6) with severity of PTSD and depression symptoms were explored using ANOVA and multiple hierarchical linear regression. Prevalence of post-traumatic stress and depression symptoms were higher among left-behind children than among those not left behind, and both types of symptoms were more severe in children exposed to both earthquakes than in children exposed only to the Lushan earthquake. Our results suggest that earthquake exposure is a strong risk factor for PTSD, whereas being left behind is a strong risk factor for depression.

Anxiety, happiness and self-esteem of western Chinese left-behind children

China's unprecedented economic boom has led a massive number of children left-behind by their peasant parents who have immigrated to urban areas in search of work. In current study, we explored how being left behind is associated with children's positive emotions and negative psychological traits by examining the differences in levels of happiness, self-esteem and anxiety between left-behind children (LBC) and non-LBC. A total of 448 students (aged 7-16) from three schools in Sichuan Province in China responded to the questionnaire. Fourteen teachers of LBC were invited to one-to-one interviews for in depth responses to LBC's behaviors and psychological well-being. The results revealed that non-LBC showed a higher level of happiness (t=-0.21, df=258, p<0.01) and a lower level of anxiety (t=1.41, df=406, p<0.05) than LBC children. Among LBC, low grade children (primary school grades 3 and 4) reported a lower level of happiness (t=-0.73, df=216, p<0.01) and self-esteem (t=-0.24, df=191, p<0.01) than their older counterparts (primary school grades 5 and 6). The teachers' accounts confirmed the statistical results that LBC suffered from the deprivation of parental care. According to the teachers, as LBC grew older, they developed an understanding of their own circumstances and came to appreciate their parents' decisions. With appropriate and adequate support provided to both LBC and the caretakers around them such as relatives and teachers, it may be possible to reduce the adverse impacts of parental deprivation on LBC.

Parent-child separation: the relationship between separation and psychological adjustment among Chinese rural children

PURPOSE

The current study aimed to explore the characteristics of psychological adjustment among Chinese left-behind children (LBC) in rural areas, and to examine the association between separation duration from parent/parents (SDP) and children's psychological adjustment and the extent to which personality mediates this hypothesized link.

METHODS

We surveyed 534 rural children and adolescents aged 10-17 years at school (440 LBC and 94 non-LBC) in 2013, who were selected for participation using stratified cluster sampling from two counties in Chongqing, China. Measures used included socio-demographic variables, age at the commencement and end of the separation from parents, the revised Chinese Juvenile Eysenck Personality Questionnaire, and the Adolescent Psychological Adaptability Scale.

RESULTS

Most children (82.4%) had experienced separation from parents. t test results showed a marginally significant difference (p = .08) in psychological adjustment between LBC (mean = 64.44, SD = 8.62) and non-LBC (mean = 66.16, SD = 9.26). LBC's mean SDP was 5.64 years (SD = 3.90). Correlation analysis showed that children's SDP was negatively associated with psychological adjustment. Structural equation modeling showed that neuroticism, but not extraversion or psychoticism, fully mediated the link between children's SDP and psychological adjustment.

CONCLUSION

Personality (neuroticism) is one of the mediating pathways through which long-term SDP may predict poor psychological adjustment among children. Given the detrimental impact of long-term SDP, interventions should target the mediating pathway to buffer against the negative impact of parental separation on the affected rural children and to improve their mental health.

Left-behind adolescents' hopes and fears for the future in rural China

The present study examined the contents of future hopes and fears among Chinese adolescents left behind by one or both of their rural-to-urban migrant parents compared to those from rural and urban nonmigrant families. Data from 1083 participants (50.2% boys; M_age = 13.50 years; SD = 1.06) indicated that adolescents reported future hopes and fears in a variety of life domains, including future education, academics, occupation, marriage and family, parents' and relatives' wellbeing, interpersonal relationships, leisure activities, wealth and self-related issues. Adolescents from both-parent-migrant families reported more hopes and fears for interpersonal relationships and more fears for parents' and relatives' wellbeing than other adolescents. Moreover, boys from migrant families reported more hopes for occupation and fewer hopes for interpersonal relationships than girls from migrant families, whereas no gender differences were found among adolescents from nonmigrant families. These results suggest the important roles of parental migration in adolescents' future thinking.

Psychological adjustment and behaviours in children of migrant workers in China

BACKGROUND

In China, there are around 274 million rural-urban migrants, an estimated 61 million children left behind in rural areas by parents, and 29 million children who accompany their parents to cities. The aim of this study was to compare the psychosocial adjustment and behaviours of left-behind children and migrant children.

METHODS

Full data were available for 761 left-behind children and 1,392 migrant children aged 11 to 17 in Zhejiang Province, eastern China. Participants completed a questionnaire focusing on migration status, risks behaviours, and psychological well-being, measured with the Strengths and Difficulties Questionnaire.

RESULTS

There were more left behind girls and more urban migrant boys (p < .001). The mean scores on the Strengths and Difficulties Questionnaire were all higher in left-behind children than migrant children: for emotional symptoms (3.82 vs. 3.03, p < .001), conduct problems (2.55 vs. 2.41, p = .048), hyperactivity (4.25 vs. 3.81, p < .001), and total difficulties (13.46 vs. 12.00, p = .020), whereas the prosocial score was lower (6.68 vs. 6.90, p < .001), all indicating lower levels of well-being in left-behind children. Overall, 11.4% of left-behind children and 8.8% of migrant children scored in the abnormal range for total difficulties. Left behind girls were particularly vulnerable to emotional problems. Left-behind children were more likely to admit to stealing and cheating on exams, but there were no differences in other risks behaviours, such as smoking and drinking.

CONCLUSIONS

Migration with parents, rather than separation from parents, was associated with better psychological well-being and fewer behavioural problems. Our findings have relevance for migrant parents in helping to inform decisions about where to raise their children as well as for policymakers in countries where migration is a major issue. When children are left behind, models of community support need to be considered, especially for those who are most vulnerable.

Differences in perceived causes of childhood obesity between migrant and local communities in China: A qualitative study

In developing countries, obesity traditionally affectsmore affluent children, butis spreading to a wider social group. Understanding the perceivedcontributors can provide valuable insights to plan preventive interventions. We exploreddifferences in the perceived causes of childhood obesity between local and migrant communities in a major Chinese city. We conducted 20 focus groups (137 parents, grandparents, school teachers) and 11semi-structured interviews with school Principals from migrant and local communities in Guangzhou. Data were transcribed and analysed using a thematic approach. We found that Lack of influence from grandparents, who were perceived to promote obesogenic behaviorin local children, fewer opportunities for unhealthy snacking and less pressure for academic attainment leading to moreactive play were interpreted as potential "protective" factors among migrant children. Nevertheless, two perceived causes of obesity were more pronounced in migrant than local children: lack of parental monitoring after-school andunsafe neighborhoods limiting physical-activity. Two barriers that restricted child physical activity were only found in the migrant community: limited home space, and cultural differences, inhabitinginteractive play with local children. Future interventions should consider uniquedeterminants of obesity in children from different social backgrounds, with tailored strategies to prevent further rise of the epidemic.

The Relationship between Parenting Styles and Adolescents' Social Anxiety in Migrant Families: A Study in Guangdong, China

Previous studies indicated that parenting styles were important influencing factors for the development of children’s well-being. It is known that mass migration to the cities in China will affect family relations. However, few studies focused on the relationship between parenting styles and adolescents’ mental health in migrant families. Thus, this study aimed to investigate how parenting styles could affect adolescent’s social anxiety in migrant families. A total number of 1,345 adolescents in migrant families from four non-government-funded junior middle schools in Guangdong province formed the research sample. Parenting styles were measured using short-form of the Egna Minnen Beträffande Uppfostran, and social anxiety was evaluated using Social Anxiety Subscale of Self-Consciousness Scale. The results showed that emotional warmth, overprotection and rejection were significantly more often perceived from mothers than from fathers. Significant group differences between high social anxiety group and low social anxiety group were found in both father’s rearing styles and mother’s rearing styles. Furthermore, in migrant families, paternal emotional warmth could decrease adolescents’ social anxiety, whereas maternal overprotection could increase it.

Influence of social support and rearing behavior on psychosocial health in left-behind children

BACKGROUND

The purpose of this study is to examine psychological health of left-behind children (LBC), social support and rearing behavior towards LBC as well as their correlations in the city of Shaoxing, China.

METHODS

By stratified sampling, 401 LBC and 527 non-left-behind children (NLBC) had completed the questionnaires in 2014. Spearman's correlation was performed to clarify the relationship between psychological health, social support and rearing behavior in LBC. Multiple linear regression analytical methods were used to identify the variables that were associated with psychological health.

RESULTS

Compared to NLBC, LBC got lower scores in psychological health, general social support, subjective support and emotional warmth, but higher in rejection. Psychological health was positively correlated with social support, and negatively with rearing behavior (rejection, overprotection) in LBC. It was also closely connected with the subjective support, rejection and general health status.

CONCLUSION

These data show that LBC suffer significant impairment on psychological health, and receive less social support and worse rearing behavior than NLBC. Psychological health may be affected by subjective support, rejection, and general health status. Urgent government assessment and support from the community, school, mental health systems are warranted.

The alienation of affection toward parents and influential factors in Chinese left-behind children

OBJECTIVE

Although alienation toward parents is important for children (for current mental health status or later interpersonal relationships in adulthood), it is undervalued and even lacks a standardized tool of assessment. Moreover, the large number of left-behind children in China is a cause of public concern. However, their experienced alienation toward their parents remains unclear, which may be important for early detection or intervention for behavioral problems in this population. Hence, the current study aimed to develop an alienation inventory for children and then use it to investigate the experienced alienation toward parents in Chinese left-behind children.

METHODS

Two studies were carried out. Study 1 was designed to develop a standard inventory of alienation toward parents (IAP). In study 2, 8361 children and adolescents (6704 of them were left-behind status) of the Chongqing area, aged between 8 and 19 years old, were recruited for investigation. All participants were surveyed with a standard sociodemographic questionnaire, children's cognitive style questionnaire, children's depression inventory, adolescent self-rating life events checklist, and newly built IAP in study 1.

RESULTS

In study 1, we developed a two-component (communication and emotional distance) and 18-item (9 items for maternal or paternal form, respectively) IAP questionnaire. In study 2, exploratory factor analysis indicated an expected two-factor structure of IAP, which was confirmed by confirmatory factor analysis. The Cronbach's alpha coefficients showed a good reliability (0.887 and 0.821 for maternal and paternal form, respectively). Children with absent mother experienced the highest alienation toward parents. Boys as well as children aged 8-10 years old experienced higher alienation toward parents. Poor communication with parents (sparse or no connection), level of left-behind condition (parents divorced, been far away from parents), and psychosocial vulnerability (stressful life events, negative cognitive style) were risk factors of alienation toward parents.

CONCLUSIONS

The current study develops a two-factor (communication and emotional distance) IAP, which offers a reliable tool to assess experienced alienation of affection toward parents in children aged between 8 and 19 years old. Our result is the first investigation of experienced alienation and potential influential factors in Chinese left-behind children. The findings that children with absent mother experience higher alienation toward parents, as well as three recognized risk factors for alienation of affection toward parents (poor communication with absent parents, worse left-behind condition, and psychosocial vulnerability), give valuable guidance for parents who intend to leave or who are already leaving as well as for government policymaking.

Resilience as moderator of the relationship between left-behind experience and mental health of Chinese adolescents

BACKGROUND

In China, since the rural labor, leaving their children in the hometown to other caregivers is a trend that has been increasing, and the impact of parental absence on the well-being of left-behind children is increasingly drawing attention in the Chinese society. However, there is a lack of study on the potential impacts of being left behind on later psychosocial outcomes in adolescence and associated protective factors.

AIM

This study was conducted on a large sample of Chinese college students to test the moderating effect of resilience between left-behind experience and mental health problems.

METHODS

The Connor-Davidson Resilience Scale and Symptom Checklist as well as a self-reported questionnaire about left-behind experience designed by the authors were adopted for a survey with 2,968 Chinese college students as respondents.

RESULTS

Totally, 1,063 students (35.8%) had 1 year or more left-behind experience. Compared to those who had no left-behind experience, the students who had left-behind experience were rated lower on resilience score and higher on mental health problem score. Mental health problems had a negative correlation with resilience. Regression analysis showed that resilience moderated left-behind experience and mental health problems.

CONCLUSION

Individuals with left-behind experience are more vulnerable to mental health problems. Promoting resilience may be helpful for prevention of mental health problems in college students with left-behind experience.

Parental migration patterns and risk of depression and anxiety disorder among rural children aged 10-18 years in China: a cross-sectional study

OBJECTIVES

This study aims to explore the prevalence of depression and anxiety in left-behind children, and to identify patterns of parents' migration and relative factors associated with depression and anxiety risk in this population.

SETTING

A cross-sectional survey using a school-based sample was conducted in Puyang, Hebei, North China in December 2012.

PARTICIPANTS

2283 students aged 10-18 years.

MAIN OUTCOME MEASURES

Parental migration status, depression and anxiety disorder.

RESULTS

61.2% of participants were left-behind children. The prevalence rate of depression among left-behind children with both parents migrating (14.2%) was higher than that of children with one parent migrating (11.7%) and no parent migrating (12.6%). The prevalence rate of anxiety disorder for children with no parent migrating (25.1%) was higher than that for children living with one or neither parent (22.2% and 22.0%). The risk factors for depression were low-level social support (OR=3.46, 95% CI 2.00 to 6.01), average academic performance (OR=2.37, 95% CI 1.7 to 3.3) and low academic performance (OR=3.01, 95% CI 1.92 to 4.72), staying up late (OR=1.67, 95% CI 1.17 to 2.39), having difficulty falling asleep (OR=2.04, 95% CI 1.48 to 2.82) and being an only child (OR=1.73, 95% CI 1.04 to 2.89). The factors associated with anxiety disorder were being female (OR=2.09, 95% CI 1.64 to 2.66), being in high school (OR=1.8, 95% CI 1.38 to 2.36), physical abuse (OR=1.5, 95% CI 1.04 to 2.15), having difficulty falling asleep (OR=1.67, 95% CI 1.33 to 2.10) and low-level social support (OR=2.17, 95% CI 1.44 to 3.28) and middle-level social support (OR=1.82, 95% CI 1.3 to 2.56).

CONCLUSIONS

Parents' migration was not associated with depression and anxiety in rural children aged 10-18 years, but academic performance at school, sleep problems and lack of social support were associated with depression and anxiety.

Urban-rural disparities in child nutrition-related health outcomes in China: The role of hukou policy

BACKGROUND

Hukou is the household registration system in China that determines eligibility for various welfare benefits, such as health care, education, housing, and employment. The hukou system may lead to nutritional and health disparities in China. We aim at examining the role of the hukou system in affecting urban-rural disparities in child nutrition, and disentangling the institutional effect of hukou from the effect of urban/rural residence on child nutrition-related health outcomes.

METHODS

This study uses data from the China Health and Nutrition Survey 1993-2009 with a sample of 9616 children under the age of 18. We compute height-for-age z-score and weight-for-age z-score for children. We use both descriptive statistics and multiple regression techniques to study the levels and significance of the association between child nutrition-related health outcomes and hukou type.

RESULTS

Children with urban hukou have 0.25 (P < 0.01) higher height z-scores and 0.15 (P < 0.01) higher weight z-scores than children with rural hukou, and this difference by urban vs. rural hukou status is larger than the difference in height and weight (0.23 and 0.09, respectively) by urban vs. rural residence. Controlling for place of residence, children with urban hukou had 0.18 higher height z-scores and 0.17 (P < 0.01) higher weight z-scores than children with rural hukou.

CONCLUSIONS

The hukou system exacerbates urban-rural disparities in child nutrition-related health outcomes independent of the well-known disparity stemming from urban-rural residence. Fortunately, however, child health disparities due to hukou have been declining since 2000.

Child Development in the Face of Rural-to-Urban Migration in China

In the last 30 years, China has undergone one of the largest rural-to-urban migrations in human history, with many children left behind because of parental migration. We present a meta-analytic review of empirical studies on Chinese children’s rural-to-urban migration and on rural children left behind because of parental migration. We examine how these events relate to children’s emotional, social, and academic developmental outcomes. We include publications in English and in Chinese to uncover and quantify a part of the research literature that has been inaccessible to most Western scholars in the field of child and family studies. Overall, both migrant children and children left behind by migrant parents in China show significantly less favorable functioning across domains than other Chinese children. It appears that, similar to processes found in other parts of the world, the experience of economic and acculturation stress as well as disrupted parent–child relations constitute a risk for nonoptimal child functioning in the Chinese context. Further, we found evidence for publication bias against studies showing less favorable development for migrant children and children left behind. We discuss the results in terms of challenges to Chinese society and to future empirical research on Chinese family life.

Do different parenting patterns impact the health and physical growth of 'left-behind' preschool-aged children? A cross-sectional study in rural China

BACKGROUND

Many migrants from rural China seek work in urban areas and leave their children in their home villages to be raised by relatives. These children are often referred to as 'left-behind children'. Parental migration tends to have a profound impact on a child's growth. This study sought to assess the prevalence of illness and malnutrition among children in rural areas raised with different parenting patterns and to explore factors affecting their health and development.

METHOD

A cross-sectional survey was conducted to examine the physical health of children raised with different parenting patterns and to explore associated risk factors. In total, this study examined 735 children ages 3-6 years in eight rural villages in two counties of Shandong Province. Their primary caregivers were interviewed with a semi-structured questionnaire. Anthropometric measurements of the children were taken and their nutritional status was determined according to WHO Child Growth Standards.

RESULTS

This study found a relatively high prevalence of wasting, overweight and obesity among left-behind children. After potential confounders were controlled for, the parenting pattern, annual household income and health literacy of the primary caregiver significantly influenced the health and developmental indicators of children.

CONCLUSIONS

This study highlighted the impact of the characteristics of the primary caregiver on a child's health and development and the importance of practical interventions for preschool-aged children who are left behind and raised with different parenting patterns.

Parent-child cohesion, friend companionship and left-behind children's emotional adaptation in rural China

Using cross-sectional data from rural left-behind children aged 10-17 years in the Henan Province of China, the present study examined the roles of father-child cohesion, mother-child cohesion, and friend companionship in emotional adaptation (loneliness, depression, and life satisfaction) among children left behind by both of their rural-to-urban migrant parents compared to those with only a migrating father. The results indicated that the children with two migrating parents were disadvantaged according to their demonstration of depression but not in loneliness or life satisfaction. Both parent-child cohesion and friend companionship were directly associated with, to varying extents, the left-behind children's emotional outcomes. Moreover, friend companionship moderated the association between father-child cohesion and emotional outcomes among children with two migrating parents, but the moderating effects of friend companionship did not exist among children with only a migrating father. The implications of these findings for interventions directed at left-behind children are discussed.

Current state and recent developments of child psychiatry in China

China has a population of 1.3 billion, of which 238 million are children under age 15. The rapid economic development and social reforms that have taken place in recent years all had a great influence on child and adolescent mental health. Though a nationwide prevalence study for child and adolescent mental disorders in China is lacking, several regional studies have shown the prevalence of mental disorders in children to be close to the worldwide prevalence of 20%. This article reviews the current status of Chinese child psychiatry, the prevalence of specific disorders in China and the influence of culture on the diagnosis and treatment of child and adolescent mental disorders. Several important social issues are also explored in detail, including the one child policy and left-behind children of migrating workers. Changes in family structures along with the growing competitions in life have weakened the traditional social support system. As a result childhood behavioral problems, mood disorders in young college students, substance abuse and youth suicide are all increasing in China. Many who suffer from mental disorders are not adequately cared for because the scarcity of qualified service providers and pathways to care. This article also lists some challenges and possible solutions, including the multidisciplinary and culture sensitive service model for child mental health. Relevant laws, policies and regulations are also introduced.

Children left behind in romania: anxiety and predictor variables

Children left behind while their parents immigrate or travel for employment are becoming a widespread phenomenon for economic reasons, creating potentially stressful and inadequate developmental support for a substantial portion of some countries' working class populations. This study assessed the emotional status and coping skills of two matched samples of 163 Romanian children left behind and 163 comparable children living with their parents. The State-Trait Anxiety Inventory for Children, the Anger Expression Scale for Children, the Short Mood and Feelings Questionnaire, and the Children's Coping Strategies Checklist were utilized. Higher anxiety and depression were observed in left-behind children compared to the control group living with parents. Hierarchical multiple regression supported the relevance of coping strategies, controlled for sociodemographic characteristics, to help explain anxiety in left-behind children. Strategies to promote psychological health and general well being are discussed.

Health-related quality of life of the rural-China left-behind children or adolescents and influential factors: a cross-sectional study

BACKGROUND

Due to sustained export of labor service, the left-behind children/ adolescents in rural areas of China have become a group that can no longer be neglected. However, even up to this day, little is known about the health-related quality of life (HRQoL) of the left-behind children/adolescents, particularly in Midwest China. This study aims at investigating their living condition and analyzing the influential factors of their HRQoL.

METHODS

A cross-sectional study based on households was conducted and 1363 children or adolescents from rural areas of 6 provinces in China, among whom 608 were left-behind and 755 were non-left-behind, were enrolled in a multistage sampling. HRQoL was revealed using the Pediatric Quality of Life Inventory (PedsQL). Differences in scores were analyzed using rank sum tests, and multivariate analyses were conducted with multiple linear regression.

RESULTS

There was a total of 608 (44.61%) left-behind children or adolescents, and they scored significantly lower in terms of the HRQoL synthesis scores (F = 6.14, P < 0.05), Physical Functioning (H = 33.18, P < 0.05), Emotional Functioning (H = 24.99, P < 0.05) and Social Functioning (H = 12.24, P < 0.05), compared with the non-left-behind. Multiple linear regressions indicated that age and mother's final academic qualification were in positive correlation with the HRQoL of the left-behind children, while mother's longer migrant working time and less frequent visits, and being reared by uncle/aunt etc., were potential risk factors for the left-behind children.

CONCLUSIONS

The HRQoL scores of left-behind children or adolescents were significantly lower than those of their counterparts both in the physical and the psychological domains. Influential factors should be considered when relevant policies are being made and intervening practices are being undertaken in the future, so as to improve the HRQoL of the left-behind children or adolescents.

Disability in post-earthquake Haiti: prevalence and inequality in access to services

PURPOSE

To assess the prevalence of disability and service needs in post-earthquake Haiti, and to compare the inclusion and living conditions of people with disabilities to those without disabilities.

METHODS

A population-based prevalence survey of disability was undertaken in 2012 in Port-au-Prince region, which was at the centre of the earthquake in 2010. Sixty clusters of 50 people aged 5 + years were selected with probability proportionate to size sampling and screened for disability (Washington Group short set questionnaire). A case-control study was undertaken, nested within the survey, matching cases to controls by age, gender and cluster. There was additional case finding to identify further children with disabilities. Information was collected on: socioeconomic status, education, livelihood, health, activities, participation and barriers.

RESULTS

The prevalence of disability was 4.1% (3.4-4.7%) across 3132 eligible individuals. The earthquake was the second leading cause of disability. Disability was more common with increasing age, but unrelated to poverty. Large gaps existed in access of services for people with disabilities. Adults with disabilities were less likely to be literate or work and more likely to visit health services than adults without disabilities. Children with disabilities were less likely to be currently enrolled at school compared to controls. Children and adults with disabilities reported more activity limitations and participation restriction.

CONCLUSION

Further focus is needed to improve inclusion of people with disabilities in post-earthquake Haiti to ensure that their rights are fulfilled.

IMPLICATIONS FOR REHABILITATION

Almost one in six households in this region of Haiti included a person with a disability, and the earthquake was the second leading cause of disability. Fewer than half of people who reported needing medical rehabilitation had received this service. The leading reported barriers to the uptake of health services included financial constraints (50%) and difficulties with transport (40%). People with disabilities did not participate equally in education or employment and had poorer access to health care.

Positive youth development in rural China: the role of parental migration

This study examined how parental rural-to-urban migration may affect left-behind children's development in rural China. We used two-wave data collected on 864 rural youth age 10-17 years in the Guangxi Province, China in 2010. We tested psychometric properties of a positive youth development (PYD) model theorized and corroborated in the US, compared a range of developmental outcomes among rural youth by their parental migration status, and explored the mediating role of family economic and social resources in observed associations between developmental outcomes and parental migration. The results showed the PYD model had some international validity although modifications would be needed to make it more suitable to Chinese settings. Little difference in the PYD outcomes was detected by parental migration status. On other outcomes (i.e., self-rated health, school grades, educational aspirations, problem behavior), positive influences of parental migration were observed. Increased income but not social resources in migrant families helped explain some of these patterns. The take-home message from this study is that parental migration is not necessarily an injurious situation for youth development. To advance our knowledge about the developmental significance of parental migration for rural Chinese youth, we urgently need large-scale representative surveys to collect comprehensive and longitudinal information about rural children's developmental trajectories and their multilevel social contexts to identify key resources of PYD in order to better help migrant and non-migrant families nurture thriving youth in rural China.

China's rural public health system performance: a cross-sectional study

Background

In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China's rural public health system performance.

Methods

The data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region.

Results

China's rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%.

Conclusions

The implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.

Mental health among left-behind preschool-aged children: preliminary survey of its status and associated risk factors in rural China

OBJECTIVE

A large proportion of preschoolers have been left behind due to parental migration in rural China. We conducted a preliminary cross-sectional survey to investigate the mental health of these left-behind preschool-aged children (LBPC) and associated risk factors.

METHODS

A total of 750 LBPC, comprising 217 and 433 children left behind as a result of migration of either or both parents, respectively, and 100 controls were enrolled from two counties in Anhui province, China. Their caregivers completed questionnaires on demographics, the Family Support Scale, the Parenting Self-efficacy Scale and the Preschool-aged Child Mental Health Scale.

RESULTS

There were no significant differences in mental outcomes among the three groups. However, male LBPC who were younger, fostered by caregivers with lower levels of life satisfaction and parenting efficacy, and came from poorer families with less social support, experienced more mental health problems than other children.

CONCLUSIONS

LBPC did not have worse mental well-being than their control counterparts, but some subpopulations were at potential risk of mental health problems compared with other LBPC. More research on other underlying factors and strategies to prevent the development of psychopathology is urgently needed.

Psychological adjustment among left-behind children in rural China: the role of parental migration and parent-child communication

BACKGROUND

Left-behind children refer to those rural children who are under 18 years of age and are left at home when both or one of their parents migrate to urban area for work. Recent findings showed that left-behind children were disadvantaged by developmental, emotional and social problems.

METHOD

A sample of 1165 rural children and adolescents were recruited to examine the characteristics of left-behind children and explore the differences in psychological adjustment (including satisfaction, loneliness and happiness) by patterns of parental migration (i.e. no parent migrating, one parent migrating or two parents migrating) and the level of parent-child communication in rural China.

RESULTS

(1) Compared with children with one parent migrating, children with two parents migrating were separated from their parents at younger ages, for longer periods, and saw their migrant parents less frequently. (2) Children with two parents migrating reported the lowest level of satisfaction among the three groups of rural children. Both groups of children with one or two parents migrating experienced more loneliness compared with children with no parent migrating. There were no significant differences in school satisfaction and happiness among the three groups. (3) The children who reported a higher level of parent-child communication also reported a higher level of life and school satisfaction and happiness, and no differences in loneliness were found by levels of parent-child communication.

CONCLUSIONS

These results indicate that loneliness was the most common and important experience of left-behind children. Parent-child communication is important for the development of all rural children, including those who were left behind by their migrant parents.

Separation and reunification: the experiences of adolescents living in transnational families

There are increasing numbers of mothers as well as fathers who engage in long-term migration to support their children and other family members in their home countries. In this article, the current state of the literature about children and adolescents left at home in these transnational families is surveyed and reviewed. The article reviews the effects on children of the process of separation from parents, the impact of gifts and remittances home, communication with distant parents and the quality of life with their substitute caregivers. The effects of immigration in late childhood or adolescence on these separated children are examined, as well as what is known about the processes of adaptation and family reunification, including migration traumas, impact of gender, and educational outcomes. Suggestions are given for pediatric clinicians working with reunifying families. Gaps in the literature are highlighted and the need for research into factors that promote successful family re-engagement and overall adaptation upon reunification.

Depression risk of 'left-behind children' in rural China

The study aims to explore the risk of depression in left-behind children in grades four-six in rural China and to identify the factors associated with increased depression risk in this population. In Hubei Xiantao, a school-based sample of 1000 children was recruited with 875 children (590 left-behind children, 285 controls) providing all relevant information. The adjusted mean children's depression inventory (CDI) score of left-behind children was significantly higher than that of controls (P<0.01). Left-behind children's depression risk rate was much higher than control's (P<0.01). Left-behind children had a higher likelihood of depression risk than controls (migrant fathers: adjusted odds ratio (OR)=3.42, 95% confidence interval (CI)=1.86-6.28; migrant mothers: OR=2.62, 95% CI=1.10-6.22; migrant parents: OR=2.73, 95% CI=1.77-4.20). Respondents with low socioeconomic status (SES) (OR=2.64, 95% CI=1.42-4.93) had a higher likelihood of depression risk than the middle SES cohort. With middle levels of social support as the referent, respondents with low levels of social support (OR=5.86, 95% CI=3.90-8.79) had a higher likelihood of depression risk; respondents with high levels of social support (OR=0.50, 95% CI=0.29-0.86) had a lower likelihood of depression risk. The results indicate that the left-behind children are at greater risk for developing depression.