Impact of parental migration on psychosocial well-being of children left behind: a qualitative study in rural China

Parental Migration and the Social and Mental Well-Being Challenges among Indonesian Left-Behind Children: A Qualitative Study

Parental labour migration, of either one or both parents, has been associated with various challenges among left-behind children (LBC). However, there is a limited understanding of the LBC's own views and experiences of social and mental well-being and how the new daily life circumstances they encounter following their parents' migration impact them. This study aimed to understand the influence of parental migration and its aftermath on the social and mental well-being of adolescents (referred to as LBC) in two rural districts in Indonesia. Employing a qualitative design, data were collected through individual in-depth interviews with LBC (n = 24) aged 14 to 18 years, recruited using the snowball sampling technique. Data were thematically analysed, guided by a qualitative data analysis framework. The findings showed that parental migration negatively impacted the social well-being of LBC. This impact was reflected in negative labelling from friends and changes in familial roles which influenced their social interactions and activities with peers. Parental migration was also associated with challenges to the mental well-being of LBC. These manifested in the LBC experiencing fractured emotional bonds, leading to negative emotions, including stress, anxiety, sadness, depression, frustration, loss of motivation, and self-imposed isolation, which were associated with their parents' migration and abrupt disruptions in parent-child communication. The transition to new life situations with caregivers after parental migration and the dynamics within the caregivers' households were additional factors that detrimentally affected their mental well-being. Unmet basic needs and educational needs due to financial hardships faced by mothers and caregivers further exacerbated mental health challenges for the children. The findings indicate the importance and improvement of policies and interventions in Indonesia (e.g., counselling services, non-cash food assistance, family hope program, direct cash assistance) that cover and address the diverse needs of mothers or caregivers and the LBC.

Nutritional status of children left behind by migrant parents: Evidence from a survey in rural Anhui, eastern China

We aimed to explore and analyse the dietary intake patterns of 3-6 year-old children left behind by one or both parents and to assess their associations with body mass index (BMI) and the prevalence of childhood anaemia in rural Anhui, eastern China. We used random cluster sampling to recruit rural children aged 3-6 years in two rural areas in Anhui province. Sociodemographic information and dietary intake were collected by self-reported questionnaires. Height, weight and prevalence of anaemia were measured by trained nurses blinded to parental migration status. Factor analysis was applied to determine that major dietary patterns, binary logistic regression and generalised linear regression were used to explore the associations between anaemia and BMI Z-score with dietary patterns. Of 1720 children aged 3-6 years, 236 were left by both parents and 388 were left by a single parent. The prevalence of stunting and underweight among left-behind children with migration of both parents (BLBC) was significantly higher than that of non-left-behind children (NLBC). Three dietary patterns-"grain-vegetable," "meat-egg" and "fast food-sweet"-were identified in our study, and the total variance explained was 46.9%. The meat-egg dietary pattern was associated with a decreased risk of anaemia after adjustment for confounding factors in the left-behind children with migration of both parents (BLBC), left-behind children with single parent migration (SLBC) and non-left-behind children (NLBC) groups. After adjusting for confounding factors, the fast food-sweet dietary pattern was found to be associated with an increased risk of anaemia (OR [95% CI]: Q4: 2.21 [1.14, 4.57], p = 0.034). In addition, children with obesity had a lower intake of vegetables and fruits (β = -0.08, 95% CI: -0.13, -0.02) compared with children with a normal weight. In conclusion, there are correlations between different types of parental migration and children's nutritional status in rural Anhui. The meat-egg dietary pattern may have a preventive effect on anaemia in comparison with other dietary patterns, irrespective of whether children are left behind or not. Children with overweight and obesity had a higher intake of pork and red meat and snacks compared with children with normal BMI.

Vulnerable conditions syndemic, depression, and suicidal ideation among school children in China: cross-sectional census findings

BACKGROUND

Mental health issues (depression and suicidal ideation) are increasingly common in children and emerge as escalating public health concerns. The syndemics that underline the importance of risk factor clustering provides a framework for intervention, but there is a lack of research on syndemics involving the adverse interactions of children's mental health problems. This study therefore examined the cumulative and synergistic effects of vulnerable conditions on depression and suicidal ideation among children in China.

METHODS

A mental health screening census of students in grades 5-12 was conducted from November 2022 to January 2023 in Nanling County, Anhui Province, China. The prevalence and co-occurrence of vulnerable conditions (unfavorable parental marital status, left-behind experience, bullying victimization, and self-harm behavior), depression, and suicidal ideation and the cumulative and synergistic effects of vulnerable conditions on depression and suicidal ideation were explored.

RESULTS

Nearly a quarter of students (24.8%) reported at least two syndemic conditions. Overall, the prevalence of depression and suicidal ideation were 20.2% and 24.2% respectively. The odds of depression and suicidal ideation were higher for children with one or more vulnerable conditions and were ten times higher for children with three or more vulnerable conditions compared with those without any vulnerable condition. These four vulnerable conditions can increase the odds of depression and suicidal ideation by interacting synergistically with each other.

CONCLUSION

Our findings signal the importance of addressing mental health syndemics among children in China by simultaneously considering concurrent vulnerable conditions.

Associations of latent patterns of parent‒child communication with communication quality and mental health outcomes among Chinese left-behind children

BACKGROUND

Parent‒child communication in migrant families is essential to family bonds and the mental health of left-behind children (LBC). Little is known about the different patterns of communication between migrant parents and LBC and associated communication quality and mental health outcomes.

METHODS

A sample of 2,183 Chinese children (mean age = 12.95 ± 1.29 years) from Anhui province, including LBC whose parents had both migrated (n = 1,025) and children whose parents had never migrated (never-LBC, n = 1,158), was analyzed. With the LBC sample, latent class analysis was applied to identify the patterns of parent‒child communication. Multinomial logistic regression analysis was conducted to assess the associations between the sociodemographic variables and class membership of LBC. Analysis of covariance and chi-square tests were used to compare communication quality and mental health outcome differences among the classes of LBC and between each of the classes and never-LBC.

RESULTS

Five latent classes of communication formed through different media or channels between migrant parents and their LBC were identified. Higher household economic status (OR = 2.81, p < 0.05) was associated with adequate communication. LBC in Class 1, defined by frequent technologically-mediated and face-to-face communication, had a significantly higher quality of communication with their migrant parents (F = 8.92, p < 0.001) and better mental health than those in other latent classes; these children did not have significantly worse mental health outcomes compared to never -LBC.

CONCLUSIONS

Facilitating multichannel parent‒child communication is a practical way of reducing mental health inequities between LBC and their peers.

Effects of parental migration on early childhood development of left-behind children in Bangladesh: Evidence from a nationally representative survey

BACKGROUND

In Bangladesh, as in other low- and middle-income countries, parents frequently migrate to other areas, often for employment opportunities, leaving their children behind with the hope that their earnings will contribute to securing a better future for them. However, the absence of parents due to migration can have negative implications for the well-being of these left-behind children. Despite the existence of studies investigating this phenomenon, the evidence thus far has produced inconclusive findings, with no specific data available from Bangladesh. Therefore, the objective of this study was to examine the effects of parental migration on the early childhood development of left-behind children in Bangladesh.

METHODS

The present study utilized data from the Bangladesh Multiple Indicator Cluster Survey (MICS) conducted in 2019. A sample of 8,833 children aged 3-4 years was included in the analysis. The Early Childhood Development Index (ECDI) and its individual domains served as the outcome variables of interest. The primary explanatory variables considered in the analysis were father migration, mother migration, migration of both parents, and migration of either parent. To assess the association between the outcomes and explanatory variables, multilevel logistic regression analysis was employed, controlling for relevant covariates.

RESULTS

Approximately 29% of all children in the study were not developmentally on track, as measured by the ECDI. When examining the individual domains of the ECDI, only 9% of the total children demonstrated developmental progress in the learning domain. Regarding the association between parental migration and ECDI outcomes, we observed a 26% decrease in the likelihood of overall ECDI among children with a migrated father (OR: 0.74, 95% CI: 0.54-0.93). This decrease became even more pronounced, reaching 37% (OR: 0.63, 95% CI: 0.48-0.97), among children with both parents migrated, compared to children with neither parent migrated.

CONCLUSION

The findings of this study indicate that parental migration, especially when both parents are involved, has a substantial negative impact on the likelihood of achieving favourable ECDI outcomes for children in Bangladesh. To ensure the optimal development of children with migrating parents, it is crucial to strengthen early childhood development education programs and implement robust social safety nets. These efforts should specifically target the unique needs and challenges faced by children with migrated parents, providing them with the necessary support and resources for their holistic development.

Finding Balance with Music: Music Therapy as a Tool for Recovery and Increasing Welfare for Orphans of COVID-19 Victims

Music therapy can effectively address children's psychological, emotional, cognitive, and social needs. Music therapy can provide a safe and supportive environment for children to process their emotions and deal with the grief of losing a parent.

Non-suicidal self-injury and professional psychological help-seeking among Chinese left-behind children: prevalence and influencing factors

BACKGROUND

Non-suicidal self-injury (NSSI) is a risk factor for suicide. This study aimed to investigate the prevalence of NSSI and professional psychological help-seeking status and influencing factors among left-behind children (LBC) in China.

METHODS

We implemented a population-based cross-sectional study in participants aged 10-18 years. Sociodemographic characteristics, NSSI, help-seeking status and coping style were measured by self-reported questionnaires. A total of 16,866 valid questionnaires were collected, including 6096 LBC. Binary logistic regression models were used to analyze the factors influencing NSSI and professional psychological help-seeking.

RESULTS

The incidence of NSSI among LBC was 4.6%, significantly higher than that of non-left-behind children (NLBC). This incidence was higher among girls. Moreover, 53.9% of LBC with NSSI did not receive any treatment and only 22.0% sought professional psychological help. LBC often adopt emotion-oriented coping styles, specifically, those with NSSI. LBC with NSSI who seek professional help tend to adopt problem-oriented coping styles. Logistic regression analysis revealed that girls, learning stage, single-parent, remarried families, patience, and emotional venting were risk factors for NSSI in LBC, while problem-solving and social support seeking were protective factors. Moreover, problem-solving was also a predictor for seeking professional psychological help, patience will prevent it.

LIMITATIONS

This was an online survey.

CONCLUSIONS

The prevalence of NSSI in LBC is high. Gender, grade, family structure, and coping style affect the occurrence of NSSI among LBC. Only a few LBC with NSSI seek professional psychological help, while the coping style will affect the help-seeking behavior.

The gender gap in adolescents' emotional and behavioural problems in Georgia: a cross-sectional study using Achenbach's Youth Self Report

BACKGROUND

Adolescents, particularly girls, are vulnerable to mental health disorders. Knowledge about young people's mental health in Eastern European countries is limited. This study is the first to investigate adolescents' self-reported emotional and behavioural problems in Georgia from a public mental health perspective.

METHODS

This study utilized Achenbach's Youth Self-Reported syndrome scales among 933 adolescents studying from grades 7-12 in 18 public schools in Georgia. We compared the gender-specific results with each other and with the Achenbach's Normative Sample using two-sample t-tests. Linear regression was used to assess associations between internalizing and externalizing problems and individual as well as demographic characteristics such as parental migration experience (being 'left-behind' or 'staying behind').

RESULTS

The study found that girls obtained higher scores than boys in Youth Self-Reported empirical syndrome scales and the internalizing broadband scale. Rule-breaking behaviour was the only syndrome scale where boys scored higher. Compared to Achenbach's Normative Sample, adolescents in Georgia scored higher on all scales. Regression analyses showed that illnesses, having fewer than three close friends, problems at school, and worse relationships with peers/siblings/parents (compared to peers) were associated with higher internalizing and externalizing problems scores in both genders. Performing household chores, living with only one parent, or having a migrant parent showed no associations in either gender.

CONCLUSION

Emotional and behavioural difficulties of adolescents in Georgia, especially girls, require attention. Having close friends, developing strong relationships with family members, and a supportive school environment could help mitigate emotional and behavioural problems among adolescents in Georgia.

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.

Adverse childhood experiences and deviant behaviors among Chinese rural emerging adults: the role of social support

BACKGROUND

ACEs hurt subsequent physical and mental health outcomes. However, still little has been known about the rate of ACEs among rural Chinese emerging adults and the different buffering effects of the three types of social support on different kinds of ACEs. This study described the rate of ACEs among Chinese rural emerging adults, examined the relationship between ACEs and deviant behaviors, and tested the moderating effect of three different sources of perceived social support on this relationship. We hope these results will be helpful in further interventions.

METHODS

We used the second wave of a longitudinal survey that included ACEs variables in 2018. A total of 1031 emerging adults aged 18 to 25 participated in the current study.

RESULTS

we found that (1) the rate of abuse, neglect, and household dysfunction was 10.0, 30.0, and 24.9%, respectively among Chinese rural emerging adults; (2) abuse and household dysfunction experience were significantly and positively associated with deviant behaviors; (3) friend support moderated the relationship between three types of ACEs and deviant behaviors. Other support moderated the relationship between abuse/household dysfunction and deviant behaviors.

CONCLUSIONS

ACEs could increase the risk of deviant behaviors. Perceived friend support could reduce the negative effect of three types of ACEs. Other support could reduce the negative impact of abuse and household dysfunction. These results suggest that reducing ACEs to make children's family environments safer and enhancing social support for emerging adults from rural areas are beneficial, which could prevent or reduce their deviant behaviors.

Parental migration and left-behind children in Georgia - school teachers' experience and perception: a qualitative study

INTRODUCTION

Georgia, like other Eastern European countries, showed a dramatic increase of international labour emigration after becoming independent in 1991. The collapse of the Soviet Union caused economic instability, unemployment and poverty resulting in labour migration. Since then, thousands of children have been left behind in the care of extended family members while their parents work abroad. The aim of this study is to explore schoolteachers' perceptions on parental migration and left-behind children (LBC) in Georgia as schoolteachers are the main contact persons for LBC and their caregivers.  METHODS: We conducted six focus-group discussions with public school teachers, namely class-tutors and six in-depth interviews with school principals from two migrant sending regions. We applied reflexive thematic analysis to systematically analyse the data and identify main and sub-themes. The contextual model of family stress underpins this study.

RESULTS

We identified the following themes expressed by both, teachers, and school principals: social and economic impact of migrant labour and relationships between schools and migrant families. School teachers and principals acknowledged some positive aspects of migrant labour, but primarily perceived parental migration as a negative experience for children leading to problems in mental health, well-being, and academic performance. Structural factors, lack of support and lack of community involvement were expressed to further worsen the situation. Teachers saw themselves as one of the main supporters for LBC while they described the role of caregivers ranging from caring to unhelpful or even destructive. School principals stated mitigating the situation by regular meetings with class tutors, extra-tutoring for LBC, psychological counselling, and developing/enacting internal guidelines.

CONCLUSIONS

Our findings suggest that LBCs and transnational families could benefit from the provision of psychological services at schools.

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.

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.

Assessment of Effect of Perceived Social Support on School Readiness, Mental Wellbeing, and Self-Esteem: Mediating Role of Psychological Resilience

Objective of this study is to investigate the impact of perceived social support on the self-esteem, mental wellbeing, and school readiness of left-behind (LB) children. It further aims at understanding the mediating role of psychological resilience between the relationships of perceived social support and self-esteem, mental wellbeing, and school readiness. For this purpose, population frame of the LB children between the ages of 8-12 years in Mainland China was taken. The sample size of 335 was taken to reach the findings through partial least square (PLS) structural equation modeling. The SmartPLS has been used to analyze the data. The results obtained in this study have shown that the perceived social support plays a very significant role in enhancing the mental wellbeing, self-esteem, and school readiness of the LB children. It has also been found that the perceived social support plays a positive role in the psychological resilience. Furthermore, it has also been found that the psychological resilience is an important predictor of self-esteem and school readiness. Further, the psychological resilience has proved to be significant mediator between the relationship of the perceived social support and self-esteem; and also between the relationship of the perceived social support and school readiness.

The Impact of Parental External Labour Migration on the Social Sustainability of the Next Generation in Developing Countries

Migration is a frequent phenomenon in the current European context. It is culturally differentiated according to every country, and it has a major role in the social sustainability of families and the next generation. This paper aimed to determine the impact of parents leaving to work abroad on the lives of their left-at-home children. This gives rise to a new phenomenon of “social orphans”. This research was carried out with the participation of eight adults who, during their childhood, had a parent who went to work abroad for a period of more than one month. The research tool used was the semi-structured interview guide. The research found that the main reason for parents leaving was the precarious financial situation of their families and their need to support their children (materially, educationally, and financially). The research results showed that the resulting greater financial stability did not guarantee that family ties would develop in a positive direction. More than half of the respondents reported a worsening of relationships with family members and experienced major psycho-emotional deprivation. The family has been negatively impacted in the social sustainability of the next generation.

Externalizing Behavior Problems Among Hui Ethnicity Left-Behind Children in Rural China: A Cross-Sectional Study

OBJECTIVE

This study aimed to investigate the prevalence of externalizing behavior problems (EBPs) and its influencing factors among Hui left-behind children (LBC) in rural China.

METHODS

A cross-sectional study was conducted among school students from the southern rural areas in Ningxia, China (2012-2013). The general self-made questionnaire, Egma Minnen av Bardndosna Uppforstran, Eysenck Personality Questionnaire (for Children), Piers-Harris Children's Self-Concept Scale, and Achenbach's Child Behavior Checklist (for parents) were used to investigate the related information. Binary logistic regressions were conducted.

RESULTS

The prevalence of EBPs in boys Hui LBC was significantly higher than that of non-LBC (12.37% vs. 6.84%, χ2=4.09, and p=0.04). Multivariate logistic regression analysis showed that low self-awareness of behavior (odds ratio [OR]=29.78), introversion (OR=21.67) and intermediate personality (OR=15.83), poor academic performance (OR=11.65) and both parent migrating (OR=2.73) were the risk factors for the EBPs of Hui LBC, while middle and high father refusal and denial (OR=0.11, OR=0.09) were their protective factors.

CONCLUSION

Our findings suggest that both parent migrating is a potential risk factor for EBPs among Hui LBC. Hui boys LBC should be paid more attention when formulating relevant policies.

Childhood Separation From Parents and Self-Harm in Adolescence: A Cross-Sectional Study in Mainland China

As the prevalence of self-harm among adolescents in Chinese escalates, finding out the potential risk factors associated with self-harm behaviors has aroused much attention. This study aims to explore the association between parent-child separation and series of self-harm (SH) subtypes among Chinese adolescents. We survey a total of 4,928 middle school students aged from 12 to 18 years at school. Parent-child separation was investigated from four dimensions-occurrence of parental separation, separation status, age at first separation and duration of separation. Self-harm series are deemed as five subtypes-highly lethal self-harm, less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviors with latent damage and psychological self-harm. Multivariate logistic regression is used to explore the associations between parent-child separation and different subtypes of self-harm among adolescents. Paternal separation is associated with each type of self-harm whilst maternal separation is not correlated with highly lethal self-harm. Except for highly lethal self-harm, the other four subtypes of self-harm demonstrate a relation with both length of paternal separation and maternal separation with aOR ranging from 1.02 to 1.06. Individuals who suffer parental separation prior to the age of three were at a higher risk for four types of less-lethal self-harm. The association of parent-child separation with self-harm deserves our attention, and future research is needed to identify the underlying mechanisms.

Associations between PTSD symptoms and other psychiatric symptoms among college students exposed to childhood sexual abuse: a network analysis

Background: Childhood sexual abuse (CSA) is one of the prevalent forms of trauma experienced during childhood and adolescence. Previous research underscores its associations with depression, anxiety, post-traumatic stress disorder (PTSD), and psychosis. Objective: This study examined symptom connections between depression, anxiety, PTSD, and psychosis while simultaneously investigating whether these connections differed by gender among CSA survivors. Methods: A large-scale, cross-sectional study among 96,218 college students was conducted in China. Participants' CSA was measured by the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Participants' PTSD, psychosis, depression, and anxiety were measured by the Trauma Screening Questionnaire (TSQ), the Psychosis Screener (PS), the nine-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Network analysis was used to explore the potential associations between these symptoms and to compare the sex differences in the symptoms model. Results: Among participants who suffered from CSA, females were more likely from left-behind households, while males were more likely from households with a high annual income (P < .001, Cohen's W = 0.07). In addition, compared to male victims, female victims were more likely to report depression, anxiety, and PTSD (P < .001, Cohen's d≈0.2), while male victims were more likely to report psychosis (P < .001, Cohen's d = 0.36). Results from network estimation showed that psychosis, depression, anxiety, and PTSD symptoms were positively correlated. Moreover, psychosis had a stronger connection with PTSD symptoms, including hypervigilance, intrusive thoughts, and physiological and emotional reactivity. Conclusions: The current study explores the associations between PTSD symptoms and psychiatric symptoms among college students exposed to CSA using a network analysis approach. These crucial symptoms of PTSD may have potential connections to psychosis. Target intervention and strategy should be developed to improve mental health and quality of life among these CSA victims. Furthermore, longitudinal studies are warranted to advance our understanding of PTSD and psychosis.

Association of the Labor Migration of Parents With Nonsuicidal Self-injury and Suicidality Among Their Offspring in China

IMPORTANCE

The labor migration of parents in China often leaves children behind, which may be adversely associated with children's health. However, few studies have assessed the association of parental migration with nonsuicidal self-injury (NSSI) or with suicidality among their offspring.

OBJECTIVE

To examine the associations of parental labor migration with NSSI and with suicidality as well as potential differential associations by sex among offspring left behind.

DESIGN, SETTING, AND PARTICIPANTS

This nationwide cross-sectional study was conducted from February to October 2015 among individuals aged 11 to 20 years from 45 public middle and high schools across 5 provinces of China. Data analysis was performed from November 1, 2020, to March 1, 2021.

EXPOSURES

Parental labor migration, including parental migration status (yes vs no), migration pattern (father, mother, or both), and the child's age at the initial parent-child separation.

MAIN OUTCOMES AND MEASURES

Less frequent (1-4 episodes) NSSI, more frequent (≥5 episodes) NSSI, suicidal ideation, and suicide attempt in the past year were measured using validated questionnaires. Multinomial or binomial logistic regression analyses were used separately to estimate adjusted odds ratios (aORs) and 95% CIs of the associations between parental migration and NSSI, suicidal ideation, or suicide attempt. Potential covariates (demographic, family-level, and psychological characteristics) were adjusted for in 3 sequential models.

RESULTS

A total of 15 312 participants (7904 male [51.6%] and 7408 female [48.4%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) were included. Of those participants, 5963 (23.3%) experienced parental migration. The 12-month prevalence of less frequent NSSI was 17.2% (2635 of 15 312), the 12-month prevalence of more frequent NSSI was 11.6% (1783 of 15 312), the 12-month prevalence of suicidal ideation was 15.2% (2335 of 15 312), and the 12-month prevalence of suicide attempt was 3.5% (535 of 15 312). Parental migration was associated with less frequent NSSI (adjusted odds ratio [aOR], 1.13; 95% CI, 1.03-1.24); no significant association of parental migration with more frequent NSSI (aOR, 1.01; 95% CI, 0.90-1.13), suicidal ideation (aOR, 1.00; 95% CI, 0.90-1.10), or suicide attempt (aOR, 1.09; 95% CI, 0.90-1.33) was identified. Compared with children whose parents did not migrate, the aOR for less frequent NSSI for participants whose father migrated was 1.18 (95% CI, 1.06-1.31), and the aOR for less frequent NSSI for participants having both parents migrate was 1.12 (95% CI, 1.01-1.28). Compared with children whose parents did not migrate, participants who experienced initial separation from 1 or both parents at preschool age had an aOR for less frequent NSSI of 1.16 (95% CI, 1.03-1.31). No sex disparities were found in these associations except for participants who experienced initial separation from 1 or both migrant parents at preschool age, for which the aOR for more frequent NSSI was higher among male (aOR, 1.27; 95% CI, 1.04-1.55) than female (aOR, 0.96; 95% CI, 0.77-1.19) participants.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that parental migration, mainly of the father or of both parents, or an initial separation of children at preschool age from 1 or both parents who migrated was associated with higher odds of experiencing 1 to 4 NSSI episodes in 1 year among offspring. Overall, the associations of parental migration with NSSI and suicidality were similar between male and female participants.

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.

Effect of Social Support on the Psychological Adjustment of Chinese Left-Behind Rural Children: A Moderated Mediation Model

There are tens of millions of children left behind by one or both rural-to-urban migrant parents (left-behind children, LBC) in rural China. Compared to non-left-behind children (NLBC), LBC are disadvantaged in psychological adjustment. Research has shown social support can help LBC grow up healthily, but the plausible mechanisms linking support to adjustment remain unclear. The present study investigated the mediating role of basic psychological need satisfaction (BPNS) in the above relationship, as well as whether the predictive pathways of support on adjustment and BPNS were moderated by resilience in a sample of 692 LBC and 264 NLBC. Structural equation modeling indicated social support positively predicted LBC's psychological adjustment, which was completely mediated by BPNS. In addition, the mediating effect was weaker for LBC with higher levels of resilience, which indicated resilience was a necessary asset for LBC's growth amid the adversity of low social support.

Family Structure, Family Instability, and Child Psychological Well-Being in the Context of Migration: Evidence From Sequence Analysis in China

This study conceptualizes parental migration as a dynamic family process that exposes children to parental absence and family instability. Using detailed migration histories, this study identifies the left-behind trajectories of rural Chinese children throughout childhood (age 1-12) and examines the impact on psychological well-being (N = 3,961). Results indicate heterogeneity in children's experience of parental migration, which is characterized by both persistence (prolonged parental absence) and instability (repeated parental migration). A quarter of rural children experienced prolonged parental migration, and for half of these, by both parents. Another 50% of rural children experienced repeated parental migration. Children continuously left behind by both parents and children who experienced substantial family instability both fared worse in psychological development than those in stable two-parent families.

Pubertal recalibration of cortisol reactivity following early life parent-child separation

BACKGROUND

The hypothalamic-pituitary-adrenocortical (HPA) axis had been proved to calibrate to early-life adversity and puberty may reverse the calibration. This study examines the consequences of prolonged parent-child separation on HPA axis reactivity and the pubertal recalibration hypothesis.

METHODS

Totally of 144 participants aged 8.75 to 15.25 (mean age 12.50 years, SD: 1.32) were enrolled from rural areas of Chizhou city, Anhui Province of China in 2019. Data on parent-child separation was collected from parents. Self-reported Peterson Pubertal Development Scale was used to assess pubertal maturation and HPA axis stress reactivity was measured using the Trier Social Stress Test for Children.

RESULTS

For children at early stage of puberty, childhood parent-child separation experiences were associated with blunted HPA axis reactivity (B = -1.888, p = 0.034); while for those at later stage of puberty, HPA axis reactivity was similar between children experienced early childhood separation and those without separation (AUCi: B = -0.426, p = 0.878). In contrast, for children experienced persistent parent-child separation, blunted HPA axis reactivity was observed (all p < 0.05).

LIMITATIONS

Due to the cross-sectional nature of this study, conclusions about causality remain speculative.

CONCLUSIONS

The effect of parent-child separation on dysregulation of HPA axis acts in a time-dependent manner. This finding provides support for the pubertal recalibration hypothesis suggesting that a focus of improving environment in adolescence would help those individuals reared initially in non-supportive conditions.

Attachment, Psychological Wellbeing, and Educational Development among Child Members of Transnational Families

OBJECTIVE

The current research investigated attachment styles, psychological wellbeing, and academic development among children in transnational family arrangements in Zimbabwe.

METHODS

Purposive sampling was employed to select 57 children in transnational family arrangements and 41 children in conventional two-parent households aged between 8 and 14 years. Attachment Style Classification Questionnaire for latency-age children, Stirling Children's Well-being Scale, Strengths and Difficulties Questionnaire, and Questionnaire for Evaluation of Development and Behavior were applied.

RESULTS

The results revealed that there were no significant differences in attachment styles, conduct problems, hyperactivity, and academic development between the transnational and conventional family groups. Social desirability and prosocial behavior were significantly lower in the transnational group. Children with both parents as migrants had significantly lower scores for psychological wellbeing and higher scores for emotional symptoms and literacy problems than children with one migrant parent or conventional families.

CONCLUSION

There was no difference in attachment styles and academic development, which may be a reflection of the strength of the extended family in substituting parental care. However, children in transnational family arrangements scored poorly on the prosocial subscale of psychological wellbeing, which is associated with family cohesion. Parental migration negatively impacts family cohesion, especially when both parents migrate. When both parents migrate, the children exhibited emotional symptoms, literacy problems, poor prosocial behaviors, and poor psychological wellbeing because children receive reduced social support. This study reveals that a child's age at the parent's departure, family cohesion, and economic security are integral to ensuring the wellbeing of children in transnational family arrangements.

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.

Community-Based Intervention to Improve the Well-Being of Children Left Behind by Migrant Parents in Rural China

In rural China around 60 million left-behind children (LBC) experience prolonged separation from migrant worker parents. They are vulnerable to a range of psychosocial problems. The aim of this study was to determine whether a community-based intervention consisting of Children’s Centres can improve psychosocial well-being and school performance of these children. The intervention was carried out in 20 villages, for children aged 7 to 15 years, irrespective of left-behind status. Nine hundred and twenty children, 438 LBC and 256 children living with parents (RC) attended the Centres. At follow-up after one year, there were improvements compared to baseline in total difficulties (measured with the Strengths and Difficulties Questionnaire) in children left behind by both parents (p = 0.009), children left behind by one parent (p = 0.008) and RC (p = 0.05). Postintervention school performance significantly improved in both categories of LBC (p < 0.001), but not RC (p = 0.07); social support score increased in both categories of LBC (p < 0.001) and RC (p = 0.01). Findings from interviews with key stakeholders were overwhelmingly positive about the impacts. With strong local leadership and community motivation, a low-cost intervention can improve children’s psychosocial well-being in these settings. Allowing communities to adapt the model to their own situation fosters local ownership, commitment, with benefits for children, parents, carers, and communities.

Association between prolonged separation from parents and allostatic load among children in China

OBJECTIVE

To capture the association of exposure to prolonged separation from both parents early in life and allostatic load (AL), a measure of biological multi-system dysregulation.

METHODS

We used data from 557 7-12-year-old children enrolled in rural area of Chizhou city, Anhui Province, China. We computed an AL score based on eleven biomarkers representing four regulatory systems: immune/inflammatory system (high sensitivity C-reactive protein); metabolic system (body mass index; high density lipoprotein; low density lipoprotein, total cholesterol; triglycerides; fasting glucose; glycated hemoglobin; insulin) and cardiovascular system (systolic and diastolic blood pressure). Child's experiences of parent-child separation were collected a brief online questionnaire by parents of children.

RESULTS

More than 1 in 3 of our participants separated with both parents at age 6 or younger and nearly 1 in 10 persistently separated from both parents after birth. The AL score was significantly higher among children separated from both parents during early childhood (3.25 ± 1.98) or persistently since birth (3.48 ± 1.92), compared with those who did not separated from both parents (2.34 ± 1.53, F = 12.992, P<0.001). After adjustment of demographic covariates, body mass index as well as parent frequency of communication and parental warmth, children who separated from both parents in early childhood (β = 0.84, 95%CI:0.40, 1.28, P < 0.001) or persistently into adolescence (β = 1.27, 95%CI:0.43, 2.12, P = 0.003) evinced the highest levels of AL.

CONCLUSION

This study is the first to show an association between prolonged parent-child separation and physiological wear-and-tear as measured by AL, which provides potential insights into the biological mechanisms underpinning long-term health outcomes in contexts of parent-child separation.

Relaxation in the Chinese Hukou System: Effects on Psychosocial Wellbeing of Children Affected by Migration

The hukou household registration system in China is being relaxed in small and medium-sized cities, which makes it easier for migrant worker parents to take their children with them to cities for work. The aim of this study was determine the potential impact on psychological well-being of this change for children by migration and hukou status. We conducted a cross-sectional survey using the Chinese version of the Strengths and Difficulties Questionnaire (SDQ) in urban and migrant schools in the capital, Hangzhou, and in schools in two rural counties of Zhejiang Province. Completed questionnaires were obtained from 2965 children, aged 10 to 15: 867 urban children with urban hukou, 625 migrant children with rural hukou, 695 rural children with rural hukou living with parents, and 778 left behind children. The crude SDQ scores showed that children directly affected by migration (migrant children and left behind children) were most at risk of psychological problems; urban and rural children living with their parents in their accustomed environment were least vulnerable. After adjustment for confounders, migrant children were the most vulnerable to psychological problems. Given that migration with children is on the increase, efforts should be made to improve conditions in urban areas for these children, and especially to ensure access to urban public schools.

Latent profile analysis of anxiety disorder among left-behind children in rural Southern China: a cross-sectional study

OBJECTIVES

Previous studies have used latent profile analysis (LPA) to examine rural left-behind children's anxiety. Further study is needed to identify the heterogeneous characteristics of rural left-behind children's anxiety and explore the related factors.

SETTING

A cross-sectional survey using a school-based sample was conducted in January 2018 in Qingxin district, Qingyuan city, Guangdong province.

PARTICIPANTS

1026 left-behind children (effective response rate of the questionnaire: 95.39%).

MAIN OUTCOME MEASURES

Profile latent classes (LC) and anxiety disorder.

RESULTS

The LPA identified three anxiety LC: 'low anxiety' (56.6%), 'medium anxiety' (34.8%) and 'severe anxiety' (8.6%). The multinomial logistic regression model was used to predict the relationship between personal, family, school factors and anxiety. We found that the variables directly related to lower anxiety classes included age (12-14 years), harmonious or fair relationship with classmates, no neglect, harmonious parental relationship and the duration of mother migration <6 months.

CONCLUSIONS

These findings suggested the need for careful consideration of differences in anxieties among rural left-behind children. Identifying latent subgroups may provide an empirical basis for teachers and public health practitioners to implement anxiety intervention efforts.

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.