Depressive symptoms and negative life events: What psycho-social factors protect or harm left-behind children in China?

Exploring the relationship between depressive symptoms, problematic smartphone use, and cumulative risk factors in nursing students: A cross sectional study

BACKGROUND

No single risk factor is decisive in shaping an individual's healthy development. This study aimed to analyze the relationship between depressive symptoms and a cumulative risk index comprising individual, family, and social variables among nursing students.

METHODS

We enrolled 1716 Chinese nursing students from three universities in a paperless survey that assessed a range of individual, family, and social risk factors associated with depressive symptoms. Multiple risk analysis was conducted to create a composite risk score for each individual. A test for trend was employed to assess the relationship between the multiple risk classification and depressive symptoms individually. Additionally, a 2-step cluster analysis and χ2 tests were used to examine the relationship between the different clusters and the level of depressive symptoms.

RESULTS

The mean scores of depressive symptoms increased significantly as the number of risk factors increased, regardless of their combination. As the number of risk factors increased, the proportion of nursing students in the normal group decreased, while the proportion in the group with depressive symptoms of varying severity tended to increase (P < 0.001). A high-risk cluster characterized by poor sleep quality combined with problematic smartphone use was associated with higher levels of depressive symptoms (P < 0.001).

CONCLUSION

Based on these findings that cumulative exposure to multiple risk factors is more harmful than cumulative exposure to fewer risk factors, then interventions that isolate only one risk factor are less likely to be effective than those that are multifaceted.

Associations between left-behind children's characteristics and psychological symptoms: a cross-sectional study from China

BACKGROUND

Parent-child separation poses a significant challenge for left-behind children (LBC). However, limited empirical evidence exists regarding the correlation between left-behind characteristics and the psychological symptoms of LBC. This study investigated psychological symptoms among LBC and explored associations between left-behind characteristics and those symptoms.

METHODS

Using stratified cluster sampling, 1,832 LBC aged 13-18 years from three cities in East China were selected for analysis. Participants' depression and anxiety symptoms were assessed with the Patient Health Questionnaire 9 and the General Anxiety Disorder 7, respectively. Chi-square tests were used to compare differences in detection rates of psychological symptoms among LBC in different groups. Binary logistic regression analysis was used to infer associations between left-behind characteristics and psychological symptoms.

RESULTS

Depression and anxiety symptoms were detected in 32.86% and 33.24%, respectively, of participating LBC. Univariate analysis showed statistically significant differences in detection rates of depression symptoms by sex, grade, and timing of parent-child separation. Statistically significant differences were observed in anxiety symptom rates by sex, grade, type of caregiver, and timing of mother-child separation. Multivariate analysis indicated a positive association between LBC's anxiety symptoms and mother-child separation that occurred during post-primary school, and type of caregiver (father only or mother only). Our findings confirm a positive association between left-behind characteristics and anxiety symptoms among LBC.

CONCLUSION

The timing of mother-child separation and type of caregiver are potential risk factors for the development of anxiety symptoms in this population.

Developmental trajectory of depressive symptoms among left-behind adolescents: The effects of parent-adolescent separation and parent-adolescent cohesion

INTRODUCTION

Left-behind adolescents are vulnerable to depressive symptoms under the context of parent-adolescent separation. However, limited knowledge is available regarding left-behind adolescents' depression trajectory and the protective resources against it. The aim of this longitudinal study was to investigate the depression trajectory and its association with parent-adolescent separation (left-behind status, age of separation and duration of separation) and parent-adolescent cohesion (father-adolescent cohesion, mother-adolescent cohesion) among left-behind adolescents.

METHODS

The participants were 1,107 left-behind adolescents (Mage = 13.23 ± 0.86 years at T1; 45.17% girls; 38.48% both-parent migrant adolescents, 61.52% father-only migrant adolescents) from two rural areas of Shandong Province in China, who were participated in assessment at three time points with 6 months apart from November 2014 to November 2015.

RESULTS

The results indicated that the trajectory of left-behind adolescents' depression symptoms showed a decreasing trend. Both-parent migrant adolescents reported a higher initial level of depressive symptoms than father-only migrant adolescents. Duration of separation positively predicted the initial level of left-behind adolescents' depressive symptoms. Mother-adolescent cohesion negatively predicted the initial level and positively predicted the change rate of left-behind adolescents' depressive symptoms. Moreover, mother-adolescent and father-adolescent cohesion buffered the negative effect of parent-adolescent separation on the initial level of left-behind adolescents' depressive symptoms.

CONCLUSIONS

These findings highlight the protective role of parent-adolescent cohesion for left-behind adolescents, having important implications for interventions targeted toward mitigating the detrimental influence of parent-adolescent separation on left-behind adolescents' depression trajectory.

Psychological Flexibility Profiles and Mental Health Among University Students with Left-Behind Experience: A Latent Profile Analysis

The left-behind experience as an adverse childhood experience has a negative impact on the mental health of university students. Psychological inflexibility mediated the relationship between adverse childhood experiences and mental disorders, but no similar findings were drawn in psychological flexibility (PF). More research is needed to understand the relationship between PF and mental health of university students with left-behind experience. To investigate the relationship between PF profiles and mental health and sleep quality of university students with left-behind experience based on latent profile analysis. A sample of 1988 Chinese university students with left-behind experience were recruited to complete an online survey. Participants provided demographic information and completed validated measures of PF and mental health. Latent profile analysis was used to identify patterns of PF, and logistic regression analysis was used to examine the relationships among these variables. We found four PF profiles among participants, with the largest number being the moderately flexible profile (n = 808, 40.6%). The level of PF was positively correlated with mental health and sleep quality (all P < 0.001). Females, being left behind at a young age and for a long time, and having little contact with parents were associated with low PF (all P < 0.05). Our study highlights the importance of focusing on the PF of university students with left-behind experience and left-behind children, and the need for interventions to improve their PF and thus their mental health.

Family Environmental Risk and Perceived Stress in Adolescent Depressive Symptoms: A Network Analysis

This study, grounded in the Process-Person-Context-Time framework, investigates the complex interplay of family environmental factors and their influence on adolescent depressive symptoms, focusing on the role of 'perceived stress'. Using network analysis, we examined data from 735 junior high students (52.1% female adolescents) from three provinces in China (Jiangsu, Shandong, and Henan), with an average age of 13.81 ± 0.92 years, ranging from 12 to 16 years, exploring the relationships between depressive symptoms, perceived stress, and seven family risk factors. The analysis identified three distinct communities. The incorporation of perceived stress led to its integration into a community that included depressive symptoms, parental restrictive monitoring, and family economic strain. Perceived stress emerged as the strongest predictor of depressive symptoms, surpassing parental restrictive monitoring. Furthermore, it overtook depressive symptoms as the node with the strongest bridging connection within its community. These findings underscore the importance of interventions targeting both family conditions and the internal processing of these stressors by adolescents, especially in challenging family environments, to mitigate the risk of depression and promote resilience.

Attentional bias for rejection and sad words in Chinese left-behind children with depression

BACKGROUND

This study aimed to examine attentional bias (AB) for sad and social rejection words in Chinese left-behind children (LBC) with depression.

METHOD

We investigated both stimulus specificity and components of AB in different groups using a cross-sectional design. Data were drawn from a school assessment of depression and anxiety, from which we selected LBC with depression (n = 40), LBC without depression (n = 33), a control group with depression (n = 31), and a control group without depression (n = 37). AB was measured with a dot-probe task covering two stimulus types (sad and rejection).

RESULTS

The analysis of AB scores revealed a significant three-way interaction (LBC × depression × word type), F(1, 137) = 4.00, p = 0.047, η2 = 0.028, with depressed non-LBC exhibiting a significant depression × word type interaction, F(1, 66) = 4.67, p = 0.034, η2 = 0.066, while the depression × word type interaction was not significant in LBC, F(1, 71) = 0.18, p = 0.675, η2 = 0.002. Depressed children living with their parents showed AB towards sad words but not rejection words, while depressed LBC showed greater AB towards both rejection and sad words.

CONCLUSIONS

The findings provide evidence that an AB towards sad information is critically involved in the depressed LBC. Compared with non-LBC depressed individuals, an AB for rejection may be involved as a risk factor in the LBC. It sheds light on the effective intervention programmes for LBC's depression and have important practical significance for reducing depression and improving the mental health of LBC.

How does parent-child attachment influence left-behind children's loneliness and depression: The mediating roles of peer attachment and teacher-student relationship

BACKGROUND

Loneliness and depression are common emotional problems among left-behind children, and these emotional problems may have a high correlation with attachment relationships.

AIMS

This study aimed to investigate the effects of parent-child attachment on left-behind children's loneliness and depression and the mediating roles of peer attachment and teacher-student relationship and their gender differences.

METHODS

Using two waves of data, 614 left-behind children participated in the longitudinal study by completing a series of relevant questionnaire two times (spaced 6 months).

RESULTS

The results showed that (1) both father-child attachment and mother-child attachment could negatively predict the loneliness and depression of left-behind children. Further, mother-child attachment has a greater predictive effect on loneliness. (2) Peer attachment played a mediating role in parent-child attachment and left-behind children's loneliness; teacher-student relationship played a mediating role in parent-child attachment and left-behind children's loneliness and depression. (3) The scores of girls were higher than those of boys in the four types of attachment relationships; the mediating role of teacher-student relationship between parent-child attachment and depression was significant only among boys.

CONCLUSIONS

This study explored the factors that may have impacts on left-behind children's loneliness and depression as well as its potential mechanism and their gender differences based on the perspective of multiple-attachment theory. These results emphasize the important role of close parent-child attachment in reducing loneliness and depression among left-behind children, as well as the necessary mediating role of peer attachment and teacher-student relationships. These findings provide some valuable recommendations for preventing left-behind children's loneliness and depression.

A serial mediation model of negative life events on school adjustment of left-behind adolescents in rural china: the central role of hope and gratitude

Adjustment difficulties of school students are common and their school adjustment has gained wide concern in recent years. Negative life events (NLEs) hope, and gratitude have been associated with school adjustment. However, the potential effect of NLEs on hope and gratitude and whether hope and gratitude mediate the association between NLEs and school adjustment among high students have not been studied. Thus, this study aims to investigate the association between NLEs, hope and gratitude, and school adjustment in high school students in China. Additionally, the study aims to examine the mediating role of hope and gratitude in the association between NLEs and school adjustment. A total of 700 junior high school students in Guangxi Province (336 boys, 364 girls, M age = 15 years) completed the questionnaire. The results indicated significant mediating effects of hope and gratitude in the sequential positive association between NLEs and school adjustment. Furthermore, this study unraveled the complexity of the link between NLEs and school adjustment with the combination of hope and gratitude. The findings emphasized the importance of fostering hope and gratitude in left-behind adolescents to combat the negative consequences of NLEs. The study is also one of the first to investigate a serial mediation model to determine which NLEs influence Chinese left-behind adolescents' school adjustment.

Unintentional injury and its associated factors among left-behind children: a cross-sectional study

BACKGROUND

Unintentional injuries among children and adolescents are a major public health problem worldwide. These injuries not only have negative effects on children's physiology and psychology, but also bring huge economic losses and social burdens to families and society. Unintentional injuries are the leading cause of disability and death among Chinese adolescents, and left-behind children (LBC) are more prone to experience unintentional injury. The purpose of this study was to evaluate the type and incidence of unintentional injury among Chinese children and adolescents and explore the influences of personal and environmental factors by comparing the differences between LBC and not left-behind children (NLBC).

METHODS

This cross-sectional study was conducted in January and February 2019. Additionally, 2786 children and adolescents from 10 to 19 years old in Liaoning Province in China were collected in the form of self-filled questionnaires, including Unintentional Injury Investigation, Unintentional Injury Perception Questionnaire, Multidimensional Subhealth Questionnaire of Adolescent (MSQA), Negative life events, "My Class" questionnaire and Bullying/victim Questionnaire. Multiple logistic regression analysis was used to explore the factors associated with unintentional injury among children and adolescents. Binary logistic regression analysis was used to explore the factors affecting unintentional injuries between LBC and NLBC.

RESULTS

The top three unintentional injuries were falling injuries (29.7%), sprains (27.2%) and burns and scalds (20.3%) in our study population. The incidence of unintentional injuries in LBC was higher than that in NLBC. Burn and scalds, cutting injury and animal bites in LBC were higher than those in NLBC. The results show that junior high school students (odds ratio (OR) = 1.296, CI = 1.066-1.574) were more likely to report multiple unintentional injuries than primary school students. Girls (OR = 1.252, CI = 1.042-1.504) had higher odds of reporting multiple unintentional injuries. The odds of multiple injuries in children and adolescents with low levels of unintentional injury perception were higher than those in children and adolescents with high levels of unintentional injury perception (OR = 1.321, C = 1.013-1.568). Children and adolescents with a higher levels of mental health symptoms (OR = 1.442, CI = 1.193-1.744) had higher odds of reporting multiple unintentional injuries. Compared with teenagers who had never experienced negative life events, teenagers who had experienced negative life events many times (OR = 2.724, CI = 2.121-3.499) were more likely to suffer unintentional injuries many times. Low-level discipline and order (OR = 1.277, CI = 1.036-1.574) had higher odds of reporting multiple unintentional injuries. In-school adolescents who were bullied were more likely to report being injured multiple times than their counterparts who were not bullied (OR = 2.340, CI = 1.925-2.845). Low levels of unintentional injury perception, experienced negative life events and bullying had greater impacts on LBC than on NLBC.

CONCLUSION

The survey found that the incidence of at least one unintentional injury was 64.8%. School level, sex, unintentional injury perception, subhealth, negative life events, discipline and order and bullying were associated with incidents of unintentional injury. Compared with NLBC, LBC had a higher incidence of unintentional injury, and special attention should be given to this group.

Research and Diagnostic Algorithmic Rules (RADAR) and RADAR Plots for the First Episode of Major Depressive Disorder: Effects of Childhood and Recent Adverse Experiences on Suicidal Behaviors, Neurocognition and Phenome Features

Recent studies have proposed valid precision models and valid Research and Diagnostic Algorithmic Rules (RADAR) for recurrent major depressive disorder (MDD). The aim of the current study was to construct precision models and RADAR scores in patients experiencing first-episode MDD and to examine whether adverse childhood experiences (ACE) and negative life events (NLE) are associated with suicidal behaviors (SB), cognitive impairment, and phenome RADAR scores. This study recruited 90 patients with major depressive disorder (MDD) in an acute phase, of whom 71 showed a first-episode MDD (FEM), and 40 controls. We constructed RADAR scores for ACE; NLE encountered in the last year; SB; and severity of depression, anxiety, chronic fatigue, and physiosomatic symptoms using the Hamilton Depression and Anxiety Rating Scales and the FibroFatigue scale. The partial least squares analysis showed that in FEM, one latent vector (labeled the phenome of FEM) could be extracted from depressive, anxiety, fatigue, physiosomatic, melancholia, and insomnia symptoms, SB, and cognitive impairments. The latter were conceptualized as a latent vector extracted from the Verbal Fluency Test, the Mini-Mental State Examination, and ratings of memory and judgement, indicating a generalized cognitive decline (G-CoDe). We found that 60.8% of the variance in the FEM phenome was explained by the cumulative effects of NLE and ACE, in particular emotional neglect and, to a lesser extent, physical abuse. In conclusion, the RADAR scores and plots constructed here should be used in research and clinical settings, rather than the binary diagnosis of MDD based on the DSM-5 or ICD.

Resilience to depression: Implication for psychological vaccination

From the vulnerability perspective, we often ask the question "why someone suffers from depression?" Despite outstanding achievements along this line, we still face high occurrence or recurrence and unsatisfied therapeutic efficacy of depression, suggesting that solely focusing on vulnerability perspective is insufficient to prevent and cure depression. Importantly, although experiencing same adversity, most people do not suffer from depression but manifest certain resilience, which could be used to prevent and cure depression, however, the systematic review is still lack. Here, we propose the concept "resilience to depression" to emphasize resilient diathesis against depression, by asking the question "why someone is exempted from depression?" Research evidence of resilience to depression has been reviewed systematically: positive cognitive style (clear purpose in life, hopefulness, et al.), positive emotion (emotional stability, et al.), adaptive behavior (extraversion, internal self-control, et al.), strong social interaction (gratitude and love, et al.), and neural foundation (dopamine circuit, et al.). Inspired by these evidence, "psychological vaccination" could be achieved by well-known real-world natural-stress vaccination (mild, controllable, and adaptive of stress, with help from parents or leaders) or newly developed "clinical vaccination" (positive activity intervention for current depression, preventive cognitive therapy for remitted depression, et al.), both of which aim to enhance the resilient psychological diathesis against depression, through events or training. Potential neural circuit vaccination was further discussed. This review calls for directing attention to resilient diathesis against depression, which offers a new thinking "psychological vaccination" in both prevention and therapy of depression.

Examining the Latent Dimensions of Social Anxiety Disorder

While the body of literature has investigated the latent dimensions of Social Anxiety Disorder (SAD), only few have directly anchored in the DSM-5 SAD symptoms. Similarly, a continuing issue on measuring mental health disorders pertains to whether a symptom's frequency, intensity, or both, are appropriate and sufficient indicators of severity. To address this gap, the present study developed and validated a DSM-5-based measurement tool, the Social Anxiety Symptom Severity Inventory (SASSI), which assesses both the intensity (intensity of disturbance) and frequency (frequency of occurrence) of SAD symptoms. In study 1 (n = 6458, college students), the results revealed a two-factor structure using exploratory structural equation modeling. In study 2 (n = 425, left-behind emerging adults), confirmatory factor analysis, measurement invariance testing, and latent class analysis were used. Findings demonstrated the importance of using both frequency and intensity of symptoms in assessing SAD severity. Moreover, a five-class solution best fitted the sample. Studies 1 and 2 demonstrated the good psychometric properties of SASSI and filled an important gap among available measures in assessing SAD severity through symptom frequency and intensity.

Mediating roles of perceived social support and sense of security in the relationship between negative life events and life satisfaction among left-behind children: A cross-sectional study

Objective

Life satisfaction is closely related to the quality of life. Previous studies showed that left-behind children have low life satisfaction levels due to their separation from their parents. Therefore, it is significant to explore the risk factors and protective factors of left-behind children's life satisfaction to improve their life quality. Therefore, the purpose of this study was to determine the mediating roles of perceived social support and sense of security in the relationship between negative life events and life satisfaction among left-behind children.

Methods

A survey was conducted on 281 left-behind children in rural Shandong, China using negative life events, perceived social support, a sense of security, and life satisfaction scales.

Results

Negative life events had a negative impact on life satisfaction (β = -0.34, p = 0.001). In addition, not only does social support mediate between negative life events and life satisfaction (β = -0.21, p = 0.001), but also in between, security (β = -0.05, p = 0.030). Moreover, social support and security act as a chain intermediary between negative life events and life satisfaction (β = -0.03, p = 0.010), with an indirect effect share of 4.76%.

Conclusion

Negative life events could directly or indirectly affect the life satisfaction of left-behind children through the chain-mediating effects of perceived social support or the sense of security alone. Perceived social support and the sense of security are two important targets for further improving the life satisfaction of LBC.

Life events and depression among children and adolescents in southwest China: a two-stage moderated mediation model of social support and cognitive styles

BACKGROUND

According to data from the National Health Commission in 2018, more than 30 million children and adolescents in China suffered from mental health problems of varying degrees, with depression accounting for the largest proportion. Life events occur at every stage of child and adolescent development. Many studies have found a relationship between life events and depression in children and adolescents, but few studies have further explored the mediating and moderating variables that influence this relationship. Based on theoretical and empirical research on social support and cognitive styles, this study established a two-stage moderated mediating model to test whether social support mediates life events to depression, and cognitive style moderates the two mediating pathways.

METHODS

We recruited 3540 participants from primary and secondary schools in Chongqing and collected 2814 valid data. All the participants completed self-report measures of life events, depression, social support and cognitive styles. The moderated mediation model was examined using SPSS PROCESS model 58.

RESULTS

(1) There were significant positive correlations between life events and depression. (2) Social support mediates the relationship between life events and depression in children and adolescents. (3) Cognitive style moderates life events to social support and social support to depression.

LIMITATIONS

This is a cross-sectional study and the questionnaire is self-reported.

CONCLUSIONS

In children and adolescents, life events can influence depression through the mediating role of social support and cognitive styles could moderate its two mediating pathways.

Long-term effects of left-behind experience on adult depression: Social trust as mediating factor

Background

Despite much attention paid to the mental health of left-behind children, there has not been sufficient research on whether and how left-behind experiences have long-term effects on adults among the general population. This paper aims to evaluate the long-term effects of left-behind experience on adult psychological depression.

Methods

By using the China Labor-force Dynamics Survey in 2018 (CLDS 2018), we assessed depression by the Center for Epidemiological Studies, Depression Scale (CES-D) and used a cut-off score of 20 for detecting depression (Yes = 1, No = 0). The Binomial logistic regression was used to compare the odds ratio across groups. We used the KHB method in the mediation analysis, to measure the indirect effect of social trust on the relationship between left-behind experience and depression.

Results

The rate of depression (χ2 = 17.94, p < 0.001) for the children who have left-behind experience (LBE) (10.87%) was higher than the children who have non-left-behind experience (N-LBE) (6.37%). The rate of social trust (χ2 = 27.51, p < 0.001) of LBE (65.70%) was lower than N-LBE (75.05%). Compared with the other three groups, left-behind experience occurred in preschool (OR = 2.07, p < 0.001, 95% CI = [1.45, 2.97]) was more likely to suffer from depression. The indirect effect of social trust (OR = 1.06, p < 0.01, 95% CI = [1.02, 1.10]) is significantly on the relationship between LBE and psychological depression, with the total effect (OR = 1.71, p < 0.001, 95% CI = [1.27, 2.31]) and direct effect (OR = 1.62, p < 0.01, 95% CI = [1.20, 2.18]) are both significantly. The proportion of indirect effect in the total effect is 10.69%.

Conclusion

The left-behind experience that occurred in childhood has a significantly negative effect on adult psychological depression, in which preschool left-behind experience played the most critical role. Social trust is the mediating factor associated with left-behind experience and psychological depression. To mitigate the long-term effects of the left-behind experience on psychological depression, parents need to be prudent about the decision-making of migration in the preschool stage of their children. and subsequent policies should strengthen social work targeting vulnerable youth groups especially those with left-behind experience at an early age in terms of their psychological depression.

Why Is Maternal Control Harmful? The Relation between Maternal Control, Insecure Attachment and Antisocial Personality Disorder Features in Chinese College Students: A Sequential Mediation Model

BACKGROUND

Previous work has indicated that a negative parenting style is associated with antisocial personality disorder features in Chinese college students, yet few studies have explored the unique role of negative mothering in children's antisocial personality disorder.

METHODS

The current study mainly examined the sequential mediation effect of parental antipathy and neglect (PAN) and mother negative loving (a form of insecure attachment) in the association between mother control and adulthood antisocial personality disorder features (ASPD features) in the framework of attachment theory and cognitive-behavioral theory. A community sample of 1547 Chinese college students filled in the Parental Bonding Instrument, the Childhood Experience of Care and Abuse Questionnaire, the Adult Attachment Questionnaire and the Personality Diagnostic Questionnaire-4+.

RESULTS

A sequential mediation model analysis showed that maternal control significantly predicted PAN, mother negative loving, as well as ASPD features.

CONCLUSIONS

Mother control and mother negative loving appear to advance on the development and exacerbation of ASPD features in college students.

Child Neglect and Life Satisfaction among Left-behind Children in Rural China: The Roles of Self-compassion and Gratitude

Child neglect is a social problem that causes great concern and affects the long-term well-being of left-behind rural Chinese children against the backdrop of their parents having to leave them in the care of others for extended periods while they have to go and work in cities. However, previous studies have disproportionally focused on the negative processes through which child neglect may influence their life satisfaction. Guided by positive psychology, this study examined the role of self-compassion and gratitude on the association between child neglect and life satisfaction. Our research questionnaire Likert survey used a sample of 1,091 left-behind children and 754 non left-behind children from Shanxi Province and Hunan Province. The results indicated that left-behind children reported a higher level of child neglect, and that child neglect was negatively associated with left-behind children's life satisfaction through decreased self-compassion and gratitude. The implications of these findings are that policy measures and interventions that focus on increasing the self-compassion and gratitude of neglected left-behind children may have a positive effect on their life satisfaction.

Life events and parent style for mental health in children: a cross-sectional study

BACKGROUND

Life events and parenting styles might play an important role in children's mental health.

AIMS

This study aims to explore how life events and parenting styles influence children's mental health based on a Chinese sample.

METHODS

A total of 3535 participants had at least one mental disorder (positive group), while a total of 3561 participants had no mental disorders (negative group). The Child Behavior Checklist (CBCL), Adolescent Self-Rating Life Events Check List (ASLEC) and Egna Minnen Beträffande Uppfostran (EMBU) were used for screening these two groups.

RESULTS

CBCL total scores differed significantly by sex in the Positive group according to the Mann-Whitney tests (Z = -5.40, p < 0.001). Multiple regression analyses showed that the dimensions of punishment (p = 0.014) and other (p = 0.048) in the ASLEC scale can significantly predict CBCL total scores in the Positive group. Sex, age and overprotection from the father were risk factors (p < 0.001) according to binary logistic regression.

CONCLUSIONS

Life events and parenting styles may have impacts on mental health. Fathers play a very important role in children's growth. Punitive education and fathers' overprotection might be risk factors for children's mental health.

IMPACT

It is a large sample (3535) study of Chinese children and adolescents It provides evidence that life events and parenting styles have impacts on mental health and that fathers play a very important role in children's growth. It is conducive to the development of interventions for the mental health of children and adolescents.

Childhood adversities and mental health problems: A systematic review

The number of mental health problems in children and adolescents has been increasing. One of the causes of mental health problems is trauma in the family, such as childhood adversities. The aim of this study was to review the relationship between childhood adversities and mental health problems. The method in this study was a systematic review using three databases: CINAHL, PubMed, and SCOPUS. The results of the review were reported according to the PRISMA guidelines. The keywords used in this study were mental health or mental illness or mental disorder or psychiatric illness AND adolescents or teenagers or teenagers or youth AND parental divorce or parental separation OR parental death or parental loss or parentally bereaved. The inclusion criteria for the articles were English language and published from 2017 to 2021. This study recorded 477 articles, screened according to the topic, and then the final articles were 35. The results of the systematic review showed evidence that childhood adversities were related to mental health problems according to the ICD-10 diagnosis, ADHD and personality disorders, depression, post-traumatic, smoking behavior, and alcohol abuse, and distress. Interventions for children with childhood adversities were needed to prevent mental health disorders.

A prospective study of peer victimization and depressive symptoms among left-behind children in rural China: the mediating effect of stressful life events

BACKGROUND

The Ministry of Civil Affairs of the People's Republic of China reported that in 2018, 6.97 million left-behind children (LBC), children who live in rural areas away from their parents, were being cared for by grandparents, relatives, elder siblings, or often living alone. Their parents have migrated to cities for better income opportunities. While a number of studies have detailed elevated depressive symptoms among LBC, relatively little is known about the causes of poorer mental health in LBC.

METHODS

This study used longitudinal data to examine associations between peer victimization, stressful life events, and depressive symptom severity in LBC from four randomly-selected middle schools in Guizhou Province, China. A total of 862 children aged 11-18 years, with 472 LBC (54.76%) and 390 non-left-behind children (NLBC) (45.24%), were included in the analysis. T-test was used to compare the depressive symptoms, peer victimization, and stressful life events between LBC and NLBC at baseline and follow-up (6 months later). Multivariable linear regression models were used to examine the mediation effect of follow-up stressful life events on the relationship between baseline peer victimization and follow-up depressive symptoms among LBC.

RESULTS

Results suggested that LBC had higher peer victimization and stressful life events than NLBC (β = 1.28, p = 0.04), and peer victimization and stressful life events at baseline were associated with increased follow-up depressive symptoms among LBC (Peer victimization: β = 0.25, p < 0.0001; Stressful life events: β = 0.15, p < 0.001). Peer victimization affected depressive symptoms partially through stressful life events for female LBC and completely through stressful life events for male LBC, controlling for age, perceived socioeconomic status, and school.

CONCLUSIONS

This study highlights the vulnerability of LBC exhibiting negative mental health outcomes as they were found to experience more peer victimization and feel more stressed when stressful life events happened, compared with NLBC. Results of this study suggested that protecting LBC from peer victimization experiences can potentially prevent LBC from experiencing an increased impact of other stressful life events, thus decreasing the likelihood of their depressive symptoms. Intervention design should consider the different mediating effects of stressful life events on the relationship between peer victimization and depressive symptoms among female and male LBC.

Mother's and Father's Migrating in China: Differing Relations to Mental Health and Risk Behaviors Among Left-Behind Children

Background

In China, the figure for left-behind children (LBC) of migrants stood at 68. 77 million in 2015. Despite being seen as a whole in the last few decades, LBC today differ broadly in parental migrating status. This study focused on LBC with both parents migrating (BLBC), LBC with only mothers migrating (MLBC), LBC with only fathers migrating (FLBC), and previous LBC with one or both parents migrating (PLBC), separately. We aimed at exploring the extent to which LBC were being affected by each migrant parent on both mental health and risk behaviors.

Methods

Data from 4,832 children were collected by a school-based survey in both rural and urban areas of China's Anhui province. Each participant anonymously completed a self-administered questionnaire containing the sociodemographics, the Strength and Difficulties Questionnaire (SDQ), the items from the Youth Risk Behavior Surveillance System (YRBSS), and Young's Internet Addiction Test for Chinese (YIAT-C). Data were analyzed using one-way ANOVA and the Chi-squared test. Associations were estimated by multiple linear regression and logistic regression analyses adjusted for several confounders.

Results

The results suggested that BLBC (p &lt; 0.001), MLBC (p &lt; 0.05), FLBC (p &lt; 0.01), and PLBC (p &lt; 0.001) significantly scored higher for total difficulties along with emotional symptoms and conduct problems than never left-behind children (NLBC). Besides, BLBC, FLBC, and PLBC further reported a significantly higher rate of smoking (p &lt; 0.001, p &lt; 0.01, and p &lt; 0.001, respectively) and drinking (p &lt; 0.01, p &lt; 0.05, and p &lt; 0.01, respectively) than did NLBC. Also, MLBC appeared higher risks of smoking problems [OR = 2.31, 95% CI (1.45–3.69), p &lt; 0.001] and the internet addiction [OR = 2.15, 95% CI (1.24–3.72), p &lt; 0.01], when compared to NLBC.

Conclusions

The findings provided insight into LBC within the different contexts of parental migrations and contributed to a better understanding of their specific and potentially persistent health risks. Correspondingly, the study highlighted the implications for differentiating LBC to capture the more vulnerable group and tailored interventions to prioritize.

The chain mediating role of cognitive styles and alienation between life events and depression among rural left-behind children in poor areas in Southwest China

BACKGROUND

Compared with no-left-behind children, left-behind children show more psychological and behavioral problems, among which depression is the most common and most influential psychological problem in childhood. Many studies have documented the impact of life events on depression among left-behind children, but few studies have focus on the mediating mechanisms behind this relationship. Based on theoretical and empirical research on cognitive style and alienation, this study constructed a chain mediation model to test whether cognitive style and alienation play a mediating role in life events and depression of left-behind children.

METHODS

We recruited 13,035 participants from 25 districts and counties in Chongqing. After screening, 5127 questionnaires of left-behind children were included in the data analysis. They all completed self-report measures of demographic information, life events, cognitive styles, alienation and depression. We used SIF, CDI, ASLEC, CCSQ and IAP to collect the information of the variables and used the SPSS to analyze the data.

RESULTS

(1) There were significant positive correlations among life events and depression. (2) Left-behind children's depression was affected by life events through 3 different pathways: the mediating role of cognitive styles, the mediating role of alienation, and the chain mediating role of both cognitive styles and alienation.

LIMITATIONS

This is a cross-sectional study and the data used in our study is self-reported.

CONCLUSIONS

Cognitive styles and alienation could mediate the association between life events and depression among left-behind children.

Correlation between reduced telomere length and behavioural and emotional problems in left-behind children in a rural area in China

Evidence shows that being left behind experience (LBE) during childhood may increase the risks of poor psychopathological outcomes. However, it is unclear to what extent the mental health is affected by the LBE. Telomere length (TL), one of the most extensively studied biological markers of cellular ageing, provides a valuable tool for exploring the potential effects of parent-child separation on psychological problems by integrating genetic and environmental factors. In this study, a total of 613 children (mean age = 10.77, SD = 1.92) were recruited from the rural area of Deyang, Sichuan Province, China. We used a self-designed questionnaire to assess LBE, and collected psychopathological outcomes by using the Piers-Harris Children's Self-concept Scale, the Teacher's Report Form 6/18 and the Youth Self-Report 11/18. Terminal restriction fragment analysis was used to measure TL in peripheral blood leukocytes. Analyses revealed that 342 out of 613 participants (55.79%) were Left-behind children. LBE was observed to associated with shorter TL, lower self-esteem, and increased behavioural and emotional problems. The cumulative effects of LBE may be reflected by greater altered telomere homeostasis, decreased self-esteem, and worsened behavioural and emotional problems. The association of the total time of being left behind with self-esteem and behavioural and emotional problems was significantly mediated by altered telomere homeostasis, with estimated effects of 14.19%, 47.95% and 45.13%, respectively. The LBE in childhood, especially prolonged parent-child separation, increases the risk of mental health problems in childhood and adolescence.

Life-Events Mediate the Prediction of Parental Alienation on Depression in Rural Left-Behind Children: A Longitudinal Study

OBJECTIVES

Long-time separation with parents during early life, such as left-behind children (LBC, one or both of whose parents are leaving for work for at least a period of 6 months), may contribute to high alienation toward parents and endanger their mental health (e.g., depression). However, the dynamic status of depression and potential prediction of alienation on depression in LBC remained largely unknown. This study aimed to examine the dynamic status of depression, prediction of alienation toward parents on later depression in rural LBC, and a potential mediation of life-events.

METHODS

A total of 877 LBC in rural areas of China were recruited and surveyed at five time-points (baseline, T0: 1-month, T1: 3-months, T2: 6-months, T3: 12-months, T4) with the Inventory of Alienation Toward Parents, Childhood Depression Inventory, and Adolescent Self-Rating Life-Events Checklist. The Hierarchical Linear Model (HLM) and Hayes's PROCESS macro model were conducted to estimate the developmental trend and hierarchical predictors of depression.

RESULTS

The left-behind children aged 9-years old experienced higher depression than the children with other ages. At baseline, the children in the family atmosphere of frequent quarrels and compulsive parenting style reported a higher level of alienation toward parents, life-events, and depression. Alienation toward parents, life-events, and depression were positively and moderately correlated with each other (r = 0.14 ~ 0.64). The HLM model depicted a linear decline in depression, alienation, and life-events with an average rate of 0.23, 0.24, and 0.86, respectively, during the five time-points. Also, T0 alienation toward parents and T0 life-events positively predicted the developmental trajectory of depression over time, and T0 life-events positively predicted the descendant rate of depression. Notably, life-events mediated the prediction of baseline alienation toward parents on T4 depression in LBC.

CONCLUSION

This study is among the first to reveal that alienation toward parents predicts the developmental trajectory of later depression in LBC. The findings that life-events mediate the prediction of alienation on later depression further suggest the importance of family and social factors in the occurrence of depression in LBC. The findings warrant the necessity to consider the family and social factors when evaluating and reducing risks for mental health problems in LBC, i.e., relationship with parents (especially alienation toward parents) and life-events need further attention.

The Neglect of Left-Behind Children in China: A Meta-Analysis

OBJECTIVE

To evaluate the neglect of left-behind children (LBC) in China.

METHOD

Participants: Children separated from one or both parents for at least 6 months. Intervention: Trauma of separation. Comparison: Non-left-behind children (NLBC). Outcomes: Neglect rates and severity. Only case-control studies were included.

RESULTS

Thirteen studies were included; there were 18,688 LBC in a large sample (N = 42,003) of children aged 0-18 years in China. The overall neglect rate was significantly higher in LBC compared to NLBC (odds ratio [OR] = 1.58, 95% confidence interval [CI] = [1.50, 1.67], p < .01) based on the Chinese Rural Child Neglected Evaluation Model (CRCNEM) and the Parents-Child Conflict Tactics Scales (OR = 1.44, 95% CI [1.35, 1.54], p < .01). The overall neglect severity in LBC was also significantly higher than NLBC (SMD = 0.31, 95% CI [0.28, 0.33], p < .01). The same trends were observed in sex subgroups. With regard to subtypes, LBC were significantly more likely to have emotional neglect (OR = 2.29, 95% CI [1.88, 2.78], p < .01), medical neglect (OR = 1.79, 95% CI [1.62, 1.98], p < .01), physical neglect (OR = 1.75, 95% CI [1.60, 1.91], p < .01), security neglect (OR = 1.52, 95% CI [1.32, 1.75], p < .01), educational neglect (OR = 1.50, 95% CI [1.31, 1.72], p < .01), and social neglect (OR = 1.33, 95% CI [1.18, 1.51], p < .01). Furthermore, LBC had significantly higher severity in medical neglect (SMD = 0.31, 95% CI [0.27, 0.35], p < .01), emotional neglect (SMD = 0.28, 95% CI [0.24, 0.32], p < .01), physical neglect (SMD = 0.24, 95% CI [0.18, 0.29], p < .01), security neglect (SMD = 0.26, 95% CI [0.23, 0.29], p < .01), educational neglect (SMD = 0.25, 95% CI [0.20, 0.31], p < .01), and social neglect (SMD = 0.25, 95% CI [0.10, 0.40], p < .01).

CONCLUSION

The neglect rates and severity in LBC in China were both significantly higher than those in NLBC. There was a strong association between neglect and LBC. Public policy changes are urgently needed to improve the dire situation and the well-being of the LBC.

Sustained effects of left-behind experience during childhood on mental health in Chinese university undergraduates

Rapid industrialization and urbanization in China have resulted in labor migrants leaving children behind. For left-behind children (LBC), disrupted parental attachment may increase the risk of psychiatric morbidity in adulthood. To investigate psychopathological consequences for university students who were LBC and to estimate the effects of one or both parents being migrants, the duration of left-behind experience, and parental absence during critical periods of growth on psychiatric morbidity. We conducted an annual survey of all freshmen at a Chinese university from 2014 to 2018. The questionnaire collected information on left-behind experiences and psychiatric morbidity using standardized self-report instruments. Regression coefficients derived from logistic regression were used to measure the associations among total time left behind, absence of one parent or both parents, age when left behind and psychopathological consequences. A total of 42,505 students were included. Students who were LBC had more psychopathology, including depression, anxiety, somatoform disorder, obsessive-compulsive disorder, self-reported suicide attempts and deliberate self-harm, than those who were not. Students for whom one or both parents were migrants showed a greater risk of psychiatric morbidity. The risk of psychiatric morbidity increased with the length of parental absence. Left-behind experience during childhood represents sustained impacts for university students into early adulthood. The higher prevalence of psychiatric morbidity in young adults who experienced the absence of one or both of their parents, especially in their early childhood, suggests that other factors besides attachment, such as protection from other risks, are important and that further research is necessary.

The Influence of Discrepancies between Parents' Educational Aspirations and Children's Educational Expectations on Depressive Symptoms of Left-Behind Children in Rural China: The Mediating Role of Self-Efficacy

Although long-term separation has made discrepancies between parents’ educational aspirations and children’s own educational expectations among families with left-behind children (LBC), limited researches on the influence of these discrepancies on children’s mental health are carried out at present. Based on China Family Panel Studies (CFPS) conducted in 2018, we selected 875 LBC aged 9~15 as the sample, explored the influence of the direction and degree of these discrepancies on LBC’s depressive symptoms by hierarchical regression, and examined the mediating role of children’s academic self-efficacy and mediation effect pathway with Baron and Kenny method and Bootstrap mediation analysis methods. Results showed that LBC’s mental health was worse when parents’ educational aspirations were higher than their children’s educational expectations, compared to that without discrepancies. The degree of such discrepancies was negatively associated with LBC’s mental health. In the relationship between the direction of discrepancies and LBC’s depressive symptoms, academic self-efficacy played a mediating role partially. In addition, the study indicated that mothers played a significant role in the development of LBC’s mental health. These findings also provided critical evidence for the intervention practice of LBC’s mental health.

Environmental Risk Factors and Their Different Effects in Depressive Symptoms of Left-Behind Children in Rural China Compared with Non-Left-Behind Children

In China, 61 million children were left behind in rural areas as a result of massive urbanization and migration of parents from the countryside to the cities in search of economic opportunities. This study explores the effects of environmental risk factors (i.e., peer victimization, perceived discrimination, and stressful life events) on depressive symptoms of left-behind children (LBC) and examines whether these risk factors have a higher impact on LBC compared with that of non-left-behind children (NLBC). Data collected involve 1548 first and second-year middle school students. Logistic regressions were conducted to examine the associations between environmental risk factors and LBC's depressive symptoms, the moderating effect of the parental separation duration on these associations, and to compare if the risk factors had a higher impact on LBC's depressive symptoms than on those of NLBC. Peer victimization is associated with an increased likelihood of depressive symptoms for LBC who were left behind for more than five years. Finally, stressful life events have a higher impact on LBC's depressive symptoms, while peer victimization has a higher impact on NLBC's depressive symptoms. The results suggest that stressful life events are an important risk factor that puts LBC at a disadvantage in terms of their mental health.

The interactions between childhood adversities and recent stress were associated with early-adulthood depression among Chinese undergraduate students

BACKGROUND

It is widely acknowledged that childhood adversities (CAs) and recent stress are potential risk factors for adult depression. However, the mechanism(s) by which interactions of CAs with recent stress affect adult depression remain unclear.

AIMS

To investigate the predictive association of the interaction among CAs and recent stress with early-adult depression.

METHOD

We conducted an annual survey of all freshmen for the period of 2016-2018 in a Chinese comprehensive university, with a sample size of 23,206. An online questionnaire including standardized self-report instruments was used to assess sociodemographic factors, childhood experiences of left-behind (CELB), and maltreatments (CEMTs) including beating (CEB), neglect (CEN), sexual abuse (CESA), recent stress, and current depression (measured by the 9-item Patient Health Questionnaire).

RESULTS

The correlation of Individual CAs and recent stress was significant. In addition to their significant independent/direct incremental effects, all surveyed CAs were associated with increased severity of early-adult depression, and increased frequency of clinically significant depression (CSD), through significant associations with recent stress (mediation effect). History of CEMTs including CEB, CEN, and CESA significantly increased the effects of recent stress on depression (moderation effect).

CONCLUSIONS

Chinese undergraduate students reported frequent history of exposure to CAs, which increased the likelihood of depression in early adulthood, not only directly but also through the increasing the likelihood (mediation effect) and impact (moderation effect) of recent stress on depression. These novel findings may help to extend our understanding of environmental determinants of depression, and to guide further research, clinical practice, and policy in this context.

Network analysis of the relationship between negative life events and depressive symptoms in the left-behind children

BACKGROUND

There are 68.77 million left-behind children in China, who are at a great risk of depression associated with negative life events. Our study aims to investigate the most central symptoms of depression in left-behind children and the relationship between depressive symptoms and negative life events using network analysis.

METHOD

A cross-sectional data set (N = 7255) was used, which included children and adolescents aged 7 to 17. Network analysis was used to evaluate: 1) the most central symptoms among the items included in Child Depression Inventory (CDI) of the left-behind children; 2) bridge symptoms between depressive disorder and Adolescent Self-Rating Life Events Check List (ASLEC) of the left-behind children; 3) differences in networks of depressive disorders between left-behind and non-left-behind children, and 4) differences in the network of depression and negative life events between left-behind and non-left-behind children. The stability and centrality indices of the network were also evaluated in the study.

RESULTS

The most central symptoms in the CDI among the left-behind children included self-hatred, crying, fatigue, and sadness. The items with the highest bridge strength centrality in the CDI-ASLEC network included academic stress, discrimination, and school performance decrement. Higher bridge strength values indicate a greater risk of contagion to other communities. The connections in the CDI-ASLEC network are denser in the left-behind children than in non-left-behind children.

LIMITATIONS

The study which was conducted based on cross-sectional data shows that network analysis can only make undirected estimation, but not causal inferences.

CONCLUSIONS

We identified the core symptoms of depression and the bridge symptoms between negative life events and depression in the left-behind children. These findings suggest that more attention should be paid to self-hatred, sadness, and fatigue in the treatment of depression in left-behind children. Intervention for academic stress and discrimination of the left-behind children may help to reduce the contagion of negative life events to depression symptoms.

Effect of mental resilience of left-behind children on self-esteem and emotional processing bias and social coping styles

BACKGROUND

The long-term separation of parents and children as well as the incomplete family structure affect the mental health development of left-behind children and the formation of healthy personality, good interpersonal relationships and positive coping styles in adulthood. At present, there is insufficient empirical investigations on the mental resilience of left-behind children.

OBJECTIVE

It is aimed to understand the mental health of left-behind children and explore the characteristics of mental resilience, self-esteem and emotional processing bias, as well as social coping styles.

METHODS

The random sampling method is used to select the left-behind children as the research subject. The general demographic information questionnaire, RSCA (Resilience Scale for Chinese Adolescent), emotional self-rating scale, SES (Self-Esteem Scale), and coping style questionnaire are used for the survey. Also, the experiments on cognitive processing bias effects of self-esteem and emotion are further carried out.

RESULTS

There are differences in demographic variables in mental resilience, self-esteem level, emotional level, and social coping styles. The low mental resilience group shows a processing bias towards low praise words, while the high mental resilience group shows a processing bias towards high praise words. At a low level of self-esteem, there is an interaction between mental resilience and self-esteem on low praise words. Mental resilience has a significant effect on the cognitive processing bias of emotion. Under the induction of positive emotions, the high mental resilience group responds significantly more slowly to the negative words than the low mental resilience group. Under the induction of negative emotions, the high mental resilience group responds significantly faster to the negative words than the low mental resilience group.

CONCLUSIONS

Promoting the mental health education of left-behind children can start from enhancing positive emotions, reducing negative emotions, developing high self-esteem, and improving mature coping styles.

Caesarean section and offspring's emotional development: Sex differences and the role of key neurotransmitters

Increasing caesarean section (CS) rates are of global concern not only for health care providers but also from a more general public health point of view. Growing concern on the association between CS and offspring's neurodevelopmental outcomes have been raised in recent years, but the effect of CS on offspring's emotional development is rarely reported. By using mice models, we have set up two groups, ie. offspring born via CS and in-fostered by dams with vaginal delivery (VD), and offspring born via VD and in-fostered by their non-biological mothers. Depression-like behavioral was evaluated by sucrose preference test and forced swimming test, and anxiety-like behavioral was evaluated by open-field test and elevated plus maze test, respectively during offspring's adolescence and adulthood. Offspring's prefrontal cortex was collected for HE staining and assessment for DA, HVA, 5-HT, 5-HIAA. It was found that offspring born of CS have anxiety-like and depression-like behaviors in adolescence and adulthood. Male offspring was sensitive to be depressive and female offspring tended to be anxious. Although no significant sex difference was observed, there existed edema and nuclear retraction of neurons in the prefrontal cortex in offspring via CS during adolescence and adulthood. Compared with offspring born via VD, offspring through CS had shown higher DA and HVA levels while lower 5-HT and 5-HIAA levels in adolescence and adulthood, and this difference was observed in female offspring. The findings highlight the sex-specific effect of CS on offspring's emotional development. Variations in key neurotransmitters in the prefrontal cortex may partly explain the association between CS and offspring's emotional symptoms.

Left-Behind Children, Parent-Child Communication and Psychological Resilience: A Structural Equation Modeling Analysis

This study aims to examine the role of parental migration status and parent communication in the psychological and related behavioral status of left-behind children and their psychological resilience. A cross-sectional survey was conducted in Anhui Province of China, and a questionnaire survey was conducted with 1992 teens using the Chinese version of the Parent-Adolescent Communication Scale (PACS), Connor-Davidson Resilience Scale (CD-RISC), and Strength and Difficulties Questionnaires (SDQ). Compared with the never left-behind group, left behind children had relatively lower PACS, CD-RISC and SDQ scores. Absence of parents is related with poorer psychological resilience, while good parent communication is related with better psychological resilience. Better psychological resilience is related to fewer psychological problems regardless of parental migration status. Currently left-behind status demonstrated a negative influence on psychological resilience, while never left-behind status had a positive effect. Interventions are needed to enhance psychological resilience of left-behind children to prevent psychological and related behavioral problems.

Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion

BACKGROUND

School closures due to the COVID-19 outbreak have affected 87% of the world's students physically, socially, and psychologically, yet rigorous investigation into their mental health during this period is still lacking.

METHODS

A cross-sectional online survey of 4-342 primary and secondary school students from Shanghai, China was conducted during March 13-23, 2020. Besides demographic information, psychological distress (including depression, anxiety, and stress), life satisfaction, perceived impact of home quarantine, and parent-child discussions on COVID-19 were assessed.

RESULTS

The three most prevalent symptoms were: anxiety (24.9%), depression (19.7%), and stress (15.2%). Participants were generally satisfied with life and 21.4% became more satisfied with life during school closures. Senior grades were positively correlated with psychopathological symptoms and negatively associated with life satisfaction, whereas the perceived benefit from home quarantine and parent-child discussions on COVID-19 were negatively correlated with psychopathological symptoms and positively correlated with life satisfaction. Among participants who perceived no benefit from home quarantine, those who had discussions with their parents about COVID-19 experienced less depression, anxiety, and stress.

LIMITATIONS

Limitations included the inability to infer the casual relationship, no parental report for mental health of children aged 6 to 9, and the inadequate measurement of parent-child discussion.

CONCLUSIONS

Mental health problems and resilience co-existed in children and adolescents during the COVID-19 outbreak. Given the important role of parent-child discussions, open communication between parents and children about the pandemic should be encouraged to help children and adolescents cope with mental health problems in public health crisis.

Community-Based Family Workshop Intervention Improved the Social Adaptation of Left-Behind Children in Rural China

Purpose: With the rapidly developing economy in China, there are more than 50 million left-behind children (LBC) in rural China, whose social adaptation has become a public concern. Thus, the current study aimed to investigate the effect of community-based family workshop intervention on social adaptation among rural LBC in China. Methods: A cluster randomized trial was conducted with 104 LBC, in which 66 LBC-caregivers dyads received guidance from community-based family workshop for 6 months, while the controls (LBC n = 38) received routinely parenting guidance. Social adaptation of the children was assessed by the Strength and Difficulties Questionnaire (SDQ) at the beginning and the end of the intervention. Findings: Compared with controls, results showed remarkable improvement on emotional symptoms (P = 0.050), peer problems (P = 0.050), and total difficulties score (TDS, P = 0.040) in the intervention group, especially those aged 3-6 years. Moreover, SDQ score of TDS (P = 0.039), peer problems (P = 0.013), and hyperactivity-inattention (P = 0.023) decreased after intervention in boys aged 3-6 years, while emotional symptoms (P = 0.048) in girls. Finally, improvement on peer problems (P = 0.005) was observed in participants with high TDS. Conclusions: The findings suggest that community-based family workshop intervention can improve social adaptation of rural LBC. Moreover, this effect was different in boys and girls and also affected by age and baseline total difficulties. The results indicated that community-based family workshop intervention can be implemented in rural China to improve mental and behavioral health among LBC in the future.

Moving More and Sitting Less as Healthy Lifestyle Behaviors are Protective Factors for Insomnia, Depression, and Anxiety Among Adolescents During the COVID-19 Pandemic

PURPOSE

This study aimed to investigate associations of physical activity time (PAT) and sitting time (ST) independently and jointly with insomnia, depressive and anxiety symptoms among Chinese adolescents in the context of COVID-19.

METHODS

A cross-sectional study including 965 adolescents (mean age = 15.26, SD = 0.46) was conducted in May 2020. PAT, ST and the symptoms of insomnia, depression and anxiety were assessed with the International Physical Activity Questionnaire Short Form, the Youth Self-Rating Insomnia Scales, the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder scale via an online survey platform. Logistic regression was used to analyze the association between COVID-19-related fear, PAT, ST and combinations of PAT and ST with insomnia, depressive and anxiety symptoms.

RESULTS

COVID-19-related fear was associated with higher odds of insomnia, depressive and anxiety symptoms. PAT was associated with lower odds of insomnia and depressive symptoms, while ST was associated with higher odds of these three symptoms. After combining PAT and ST, the group with both low PAT and high ST was set as the referent. For insomnia, groups with low ST reported significantly lower odds of symptoms. For depression, groups with high PAT and/or low ST reported lower odds of symptoms. Regarding anxiety, only the group with both high PAT and low ST reported lower odds of symptoms. Generally, group with both high PAT and low ST reported lower odds of the three symptoms than the referent.

CONCLUSION

COVID-19-related fear was a risk factor for developing insomnia, depressive and anxiety symptoms among Chinese adolescents. Fortunately, moving more and sitting less were good for sleep and mental health in Chinese adolescents during the pandemic. Educators should help adolescents to be more physically active in their daily life in the primary prevention of adolescent insomnia, depression and anxiety.

Prevalence of depression among Chinese university students: a systematic review and meta-analysis

Estimates of the depression prevalence among Chinese university students vary considerably across studies. This systematic review and meta-analysis aimed to comprehensively analyze the depression prevalence among Chinese university students. We searched four electronic databases with the search terms of depression, China, university student, and questionnaire. Studies reporting depression among Chinese university students were included in the analysis. Two reviewers independently extracted the data and assessed the qualities of the studies. The package of “meta” in R Foundation for Statistical Computing was used to calculate an overall proportion in a random-effects model with 95% confidence intervals. Subgroup analysis was conducted to analyze the influencing factors on the depression prevalence. Any conflict in the data analysis was discussed by all the reviewers. A total of 113 studies were included in the meta-analysis. The overall prevalence of depression among Chinese university students was shown to be 28.4% (n = 185,787), with 95%CI from 25.7 to 31.2%. The overall depression prevalence among Chinese university students was still relatively high. More efforts need to be done to provide better mental healthcare to university students in China.

Mental health literacy about depression among rural left-behind children in China: a comparative and cross-sectional study

BACKGROUND

Mental health literacy (MHL) is vital for raising mental health awareness, reducing stigma, and improving health-related decision making, which may have lifelong consequences for patients with mental disorders.

AIMS

To examine MHL about depression among rural left-behind children (LBC) in China and explore differences between LBC and non-left-behind children (NLBC).

METHODS

A total of 3456 rural school children (mean age = 13.02 years) in fourth to ninth grades who were living in Sichuan, Anhui, and Henan provinces were surveyed in April and July 2018 using stratified random cluster sampling.

RESULTS

More NLBC correctly recognized depression compared with LBC (p < 0.05). The most common sources of mental health information were the TV and the Internet. LBC felt more uneasy if they asked for help (p < 0.01). Statistical differences in help-seeking barriers were observed between LBC and NLBC (p < 0.05).

CONCLUSIONS

Respondents showed low levels of depression-related MHL compared with peer groups in other countries, LBC showed lower MHL than NLBC in terms of the correct recognition rate of depression, attitude toward seeking help, etc. More school-based interventions should be implemented in rural schools, and parent involvement and digital-based educational strategies should be considered.

The impacts of parent-child communication on left-behind children's mental health and suicidal ideation: A cross sectional study in Anhui

This study aimed to investigate the impact of previous maternal migration experiences on left-behind children's (LBC) mental health status and suicidal ideation, and the possible mediating role of parent-child communication. A cross-sectional study among rural children was conducted in Anhui, China, in 2018. LBC who self-reported that (a) their fathers were migrants and (b) they were living with their mothers at the time of the survey were included in this study. The participants were then divided into two subgroups by previous maternal migration experience. Previous maternal migration was associated with worse mental health and a higher prevalence of suicidal ideation among LBC compared with their peers. Healthy communication between children and parents fully mediates the adverse effects caused by previous maternal migration experiences on mental health among LBC, and communication with mother partially mediates the association with suicidal ideation. Communication classes for returning parents offered jointly by governments and schools could be an effective way to mitigate the impacts of maternal migration on child mental health and should be studied.

Associations between screen time, negative life events, and emotional and behavioral problems among Chinese children and adolescents

BACKGROUND

Mental health problems among children and adolescents are a pressing public health issue. This study aimed to investigate the associations between screen time (ST), negative life events (NLEs), and emotional and behavioral problems (EBPs) among Chinese children and adolescents.

METHODS

A total of 5959 boys and girls from 14 elementary and junior high schools of four cities in China were included in this study. EBPs were assessed by the Strengths and Difficulties Questionnaire (SDQ), NLEs were evaluated by the Adolescent Self-Rating Life Events Checklist (ASLEC), and ST data were obtained through self-reporting. Descriptive analyses, chi-squared tests, and logistic regression were performed using SPSS 23.0.

RESULTS

There were significant associations between ST/NLEs and EBPs. Participants with high exposure to ST or NLEs were more likely to have EBPs than those with low exposure to ST or NLEs. The simultaneous associations of ST and NLEs on EBPs were stronger than those of ST or NLEs, individually.

LIMITATIONS

This was a cross-sectional research study; therefore, it could not judge causality or direction. ST and NLEs were retrospective and might have recall biases.

CONCLUSIONS

Our results showed positive associations between ST, NLEs, and EBPs. The results indicate that interventions should be considered to decrease ST and NLEs for children and adolescents.

Psychosocial risk factors associated with depressive symptoms among adolescents in secondary schools in mainland china: A systematic review and meta-analysis

BACKGROUND

The objective of the study is to systematically estimate the effect size of psychosocial risk factors for depressive symptoms among adolescents in secondary schools in mainland China.

METHOD

A literature search was conducted in both English and Chinese databases. This meta-analysis used a random-effects model to estimate the effect size.

RESULTS

Fifteen psychosocial risk factors were identified in a total of 164 articles. The results revealed the absolute value of effect size ranging from 0.16 to 0.43. Among them, poor parent-child communication (r = 0.43), negative life events (r = 0.40), academic pressure (r = 0.40), abuse (r = 0.33), poor family functioning (r = 0.33), bullying (r = 0.32), and poor family cohesion (r = 0.32) were associated with depression with a medium to large effect. Moderator analysis shows that grade, study quality, mean age, and gender were significant moderators of at least one factor for depression.

LIMITATIONS

Limitations included the heterogeneity which is largely unexplained, and the inability to investigate the interactions of different factors and to determine the direction of causal relationships between psychosocial factors and depression in the present meta-analysis.

CONCLUSIONS

This study suggests that family-related factors and school-related factors may be significantly associated with depressive symptoms in Chinese secondary school students. Further research is needed to develop effective strategies to modify these factors in depression prevention programmes.

Functional health literacy among left-behind students in senior high schools in an ethnic minority area: A cross-sectional study

To verify the validity of functional health literacy scale and analyze what influences functional health literacy.Using convenience sampling method based on cross-sectional data to select 589 left-behind senior high-school students in an ethnic minority area, using the functional health literacy scale.The scale results were relatively strong, and the absolute fitness index, value-added fitness index, and simple fitness index reached the fitness standards. The overall functional health literacy score was (0.65 ± 0.12), which falls within the upper middle class. Gender(t = 2.40, P < .05), ethnicity (t = 4.28, P < .001), place of residence (t =  = 4.51, P < .001), mother's education level (F = 3.608, P < .05), self-assessment of grades for 1 year (F = 25.781, P < .001), and whether the participant liked the health education content (F = 9.416, P < .001) had impacts on overall functional health literacy.The study results show that relatively satisfactory reliability and validity and can be applied further analysis for improving students functional health literacy levels.

The Mediating Role of Resilience and Self-Esteem Between Life Events and Coping Styles Among Rural Left-Behind Adolescents in China: A Cross-Sectional Study

Objective: This study aims to explore the association between life events and coping styles, and how resilience and self-esteem mediate the association. Methods: A cross-sectional study was conducted among 981 left-behind adolescents (LBAs) in five junior high schools in Hunan Province, China, from April 13 to April 20, 2020. We utilized self-designed sociodemographic questionnaire, Adolescent Self-Rating Life Events Checklist, Resilience Scale Chinese Adolescent, Rosenberg Self-Esteem Scale, and Simplified Coping Style Questionnaire to assess the mental health of LBAs. Statistic description, Pearson correlation analysis, and structural equation model were adopted to analyze the data. Results: Results revealed that life events could negatively predict resilience (β = -0.29, P < 0.001) and self-esteem (β = -0.39, P < 0.001) and positively predict LBAs' positive coping style (β = 0.28, P < 0.001) and negative coping style (β = 0.21, P < 0.001). Self-esteem could also positively predict the resilience of LBAs (β = 0.62, P < 0.001); resilience could negatively predict the negative coping style (β = -0.21, P < 0.001) and positively predict the positive coping style (β = 0.79, P < 0.001). Life events not only have direct effects on negative coping style (β = 0.21) and positive coping style (β = 0.28) but also have indirect effects on coping styles by affecting resilience (β = -0.29) and self-esteem (β = -0.39). The total effect of life events on coping styles was 0.32, where 34.37% was mediated by resilience and self-esteem. Conclusion: We proved that resilience and self-esteem mediated most of the effects of life events on coping styles. The findings had important implications for interventions to promote mental health of LBAs, particularly the enhancement of resilience and self-esteem.

Mental health and its influencing factors among left-behind children in South China: a cross-sectional study

BACKGROUND

With rapid development of China's economy, there were over 68.7 million left-behind children (LBC) in China whose mental health has become a problem of public concern. The present cross-sectional study aimed to investigate the status of mental health and its associated factors of LBC aged 3-16 years old in both rural and urban areas.

METHODS

A total of 4187 children (aged 3-16), including 1471 LBC and 2716 non-left-behind children (NLBC), were recruited from 50 communities (22 in urban areas and 28 in rural areas) in Guangdong, China in August, 2014. The mental health problems were assessed using the Strength and Difficulties Questionnaire (SDQ).

RESULTS

No statistically significant difference of SDQ subscales scores about difficulties were found between LBC and NLBC on the whole participants as well as in rural areas or in urban areas within the same age group after adjustments were made (all p > 0.05). However, compared with NLBC in the same areas, urban LBC tended to have higher prosocial behaviours scores, while rural LBC had the lowest prosocial behaviours scores not only in the whole age group but also in different age subgroups (p < 0.05). Besides, compared with urban LBC, rural LBC were not worse in SDQ subscales scores except for prosocial behaviour at 7-9 age group (p = 0.003). Furthermore, higher paternal educational level and longer duration of parental absence, were associated with less difficulties in both rural and urban LBC. Besides, shorter duration of talk per-time but higher communication frequency were associated with less difficulties in rural LBC.

CONCLUSIONS

The present study demonstrated that in general, no difference of mental health problems were found between LBC and NLBC. Besides, longer duration of parental absence, shorter duration of talk per time but more communication frequency, and higher paternal educational level tend to have better development of mental health. The findings reinforce the importance of the stability of caregivers and the effective parent-child communication for Chinese rural LBC.

Mental health status compared among rural-to-urban migrant, urban and rural school-age children in Guangdong Province, China

BACKGROUND

Previous research has documented mental health status among rural-to-urban migrant children (labeled as "migrant children" henceforth) and urban children. However, the findings remain unclear. In addition, far less attention has been paid to rural children's psychological outcomes. The purpose of this study was to compare mental health status among migrant, urban and rural school-age children in Guangdong Province, China.

METHODS

This was a cross-sectional study involving 372 migrant, 254 urban and 268 rural children selected respectively from 3 private schools, 4 public schools and 2 village schools in Guangdong Province, China. Participants provided their socio-demographic information and completed the Strengths and Difficulties Questionnaire (SDQ) to assess mental health. One-way analyses of variance (ANOVAs) and Bonferroni post hoc test were used to evaluate SDQ scores differences. A multiple linear regression analysis was conducted to measure mental health differences among children after controlling for socio-demographics. Chi-square analyses were used to assess differences in the prevalence of mental health problems among children.

RESULTS

Bonferroni post hoc test showed that migrant and rural children reported significantly higher scores than urban peers in emotional symptoms, hyperactivity/inattention and total difficulties score (p < 0.01). In addition, migrant children reported a higher peer problems score compared to urban children (p < 0.001). In multiple linear regression analysis, rural and migrant children reported significantly a higher total difficulties score than urban children (p = 0.046 and 0.024, respectively). Additionally, female gender, having insurance, seldom communicating with parents, and higher monthly household income were negatively associated with a higher total difficulties score. Conversely, children's father with secondary education was positively associated with a higher total difficulties score. The prevalence of mental health problems among rural, migrant and urban children were 26.5, 18.8 and 15.0% (χ2 = 11.41, p = 0.003), respectively.

CONCLUSIONS

Rural and migrant children reported poorer mental health than urban children. Female gender, having insurance, seldom communicating with parents, and higher monthly household income were associated with better mental health of children. However, children's father with secondary education was associated with poorer mental health of children. Given the different effects of socio-demographics, further support might be provided accordingly to improve the mental health of school-age children.

The mediating role of resilience and self-esteem between negative life events and positive social adjustment among left-behind adolescents in China: a cross-sectional study

BACKGROUND

In China, adolescents are frequently left behind by their parents. A great deal of scientific evidence demonstrates considerable psychological and social impacts that negative life events may have on adolescents who are left behind. While a direct relationship between negative life events and psychological and social effects has been observed, indirect effects have yet to be examined. Therefore, the objective of this study was to determine the association between negative life events and positive social adjustment and how resilience and self-esteem mediate this association.

METHODS

A cross-sectional study was carried out in the provinces of Shandong, Henan, and Sichuan in China. A questionnaire was distributed to 4716 left-behind adolescents in ten middle/high schools. We performed Bayesian estimations in structural equation modeling using the Markov Chain Monte Carlo algorithm to test our hypotheses.

RESULTS

Negative life events were significantly related to resilience (r_s = - 0.402), self-esteem (r_s = - 0.292), and positive social adjustment (r_s = - 0.239). Positive social adjustment was directly affected by resilience (β = 0.639) and self-esteem (β = 0.448). Negative life events were not only directly related to positive social adjustment (β = - 0.187, 95% credible interval: - 0.233 ~ - 0.139), but also showed an indirect effect on positive social adjustment (β = - 0.541, 95% credible interval: - 0.583 ~ - 0.501) through resilience (β = - 0.370) and self-esteem (β = - 0.171). The total effect of negative life events on positive social adjustment was - 0.728, where 74.31% was mediated by resilience and self-esteem. The indirect effect of negative life events on positive social adjustment through resilience and self-esteem was 2.893 times more than the direct effect.

CONCLUSIONS

Resilience and self-esteem mediated most of the effect of negative life events on positive social adjustment. Interventions should be developed to improve the social adjustment of adolescents who are left behind, particularly the enhancement of resilience and self-esteem.