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

I am better because of your expectation: Examining how left-behind status moderates the mediation effect of perceived parental educational expectation on cognitive ability among Chinese rural students

BACKGROUND

Chinese rural students have been documented to have relatively delayed cognitive development. From an ecological system perspective, empirical studies have identified the significant effect of the proximal environment on Chinese rural students' cognitive development. Yet, little do we know the mechanism behind that. More importantly, how the mechanism differs among rural students with different left-behind characteristics remains obscure.

METHODS

Drawing longitudinal data from a nationally representative survey, this study examines the interrelations between rural students' parental educational expectation perception, their own educational expectation, and cognitive ability. Two models were examined using path analysis. The first mediation model tests the mediating effect of educational expectation between the association of parental educational expectation perception and cognitive ability, while the second moderated mediation identifies the moderating effect of rural students' left-behind status on the association between their parental educational expectation perception and educational expectation.

RESULTS

The first mediation analysis reveals that rural students' perception of parental educational expectation is positively correlated with their educational expectation, which further positively correlated with their cognitive ability. The following moderated mediation analysis suggests that students' left-behind status significantly moderated the effect of their perceived parental educational expectations on their own educational expectation.

CONCLUSIONS

Chinese rural students' perception of parental educational expectation affects their cognitive ability through their own educational expectations. The number of migrant parents within a family further moderates the indirect effect of education expectation.

A systematic review of the association between parent-child communication and adolescent mental health

Background

This systematic review addresses how adolescent-rated parent-child communication (PCC) quality is related to adolescent mental health.

Methods

We performed a systematic literature search in Medline and APA PsycInfo, including peer-reviewed quantitative studies examining associations between adolescent-rated dyadic PCC quality and general as well as specific measures of adolescent mental health. Qualitative and case studies were excluded, as were studies reporting only parent-rated communication quality or instruments assessing other constructs than dyadic PCC. We screened 5314 articles, of which 37 were included in the review. We assessed study quality with the Mixed Methods Appraisal Tool.

Results

We synthesized the findings in a table and narratively, reporting the main outcomes organized according to mental health constructs. The included studies were mainly cross-sectional. The results showed that adolescent-rated PCC quality is negatively associated with mental health constructs, demonstrating small to large effects across different mental health constructs and populations. The associations were found for general mental health and specific domains, including depression, anxiety, psychosis, suicidal ideation, post-traumatic stress symptoms, and addictive internet use/gaming.

Conclusions

The findings demonstrate that PCC is a relevant variable to consider in assessing adolescent mental health and preventive efforts. Limitations include the exclusive focus on adolescent-reported PCC questionnaires since parent- and observer-rated instruments may lead to different results. Also, PCC is related to other constructs, such as dyadic relationships, that were not included in this review. We conclude that PCC is a relevant variable to consider in mental health research. Our findings suggest that PCC may be considered in mental health practice, both in terms of assessing its quality and potentially by tailoring interventions to enhance PCC. These may represent a mean to promote adolescent mental health.

Association Between Parental Absence and Depressive Symptoms in Adolescence: Evidence From a National Household Longitudinal Survey

Longitudinal evidence demonstrating the association between parental absence and depressive symptoms in adolescence is limited. The present study aimed to explore this relationship in a Chinese national representative sample. This research was based on the China Family Panel Studies and included 1481 subjects. Depressive symptoms were assessed using the self-reported Center for Epidemiologic Studies Depression questionnaire. A multiple logistic regression model with a generalized estimating equation was used to test the association between parental absence and adolescent depressive symptoms. In the baseline year, 2012, 29.03% and 43.75% of adolescents had maternal and paternal absence, respectively. The prevalence of depressive symptoms increased from 23.23% to 28.12% in subsequent years. After controlling for covariates, maternal absence was positively associated with depressive symptoms (odds ratio 1.69, 95% confidence interval 1.06-2.68). Maternal absence led to depression in adolescents. It may be beneficial for adolescents with depression to spend more time with their mothers.

Daily social support and school belonging among rural Chinese adolescents: Variations by parental migration

"Left-behind" children refer to those who live in rural areas but have parents migrating to urban areas for work. They are at increased risk for developmental problems and family dysfunction. However, we currently know little regarding their support systems at school. Using daily data over five school days from 90 adolescents (Mage  = 13.70) in rural China, this study investigated daily associations linking teacher and peer support to school belonging, and how these associations varied by parental migration. Teacher but not peer support was positively associated with same-day school belonging. However, this association was attenuated for adolescents with longer duration and history of parental migration. The findings highlighted the importance of considering school settings and within-group variations for left-behind adolescents.

Parental migration and cyberbullying victimization among Chinese left-behind children: understanding the association and mediating factors

Introduction

Parental absence is greatly associated with school bullying victimization of left-behind children (LBC) in migrant families. With the increasing popularity of the Internet, little is known about the association between parental migration and cyberbullying victimization, and potential mediators.

Methods

We conducted a cross-sectional study in Anhui and Zhejiang Province, China, in 2020. With a sample of 792 currently left-behind children (CLBC), 541 previously left-behind children (PLBC), and 628 never left-behind children (NLBC), path analysis was used to explore the association between parental migration and cyberbullying victimization among children, while considering the independent and sequential mediating roles of parent-child communication, and time spent online.

Results

The prevalence of cyberbullying victimization was 29.3% among CLBC, 29.2% among PLBC, and 23.4% among NLBC. Path analysis showed that current left-behind status was positively associated with cyberbullying victimization among children (p = 0.024). Furthermore, current left-behind status was associated with worse parent-child communication, which, in turn, predicted a higher prevalence of cyberbullying victimization [95% CI = (0.007, 0.036)]. Similarly, the previous left-behind experience was associated with worse parent-child communication, which, in turn, predicted a higher prevalence of cyberbullying victimization [95% CI = (0.013, 0.043)]. Current left-behind status was associated with increased time spent online, which, in turn, predicted a higher prevalence of cyberbullying victimization [95% CI = (0.013, 0.038)]. Additionally, the current left-behind status positively predicted cyberbullying victimization among children through the serial mediating roles of parent-child communication and time spent online [95% CI = (0.001, 0.006)]. Similarly, previous left-behind experience positively predicted cyberbullying victimization among children through the serial mediating roles of parent-child communication and time spent online [95% CI = (0.002, 0.007)].

Discussion

We propose that to protect CLBC and PLBC from cyberbullying victimization, it is of great importance for migrant parents to regulate children's time spent online and promote daily parent-child communication.

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.

Trajectories of psychosocial environmental factors and their associations with asthma symptom trajectories among children in Australia

INTRODUCTION

Several psychosocial factors, such as maternal mental health and parents' financial hardship, are associated with asthma symptoms among children. So, we aim to investigate the changing patterns of important psychosocial environmental factors and their associations with asthma symptom trajectories among children in Australia.

METHODS

We considered asthma symptoms as wheezing (outcome) and psychosocial environmental factors (exposures) from 0/1 year to 14/15 years of the participants from the "Longitudinal Study of Australian Children (LSAC)" for this study. We used group-based trajectory modeling to identify the trajectory groups for both exposure and outcome variables. Associations between psychosocial factors and three distinct asthma symptom trajectories were assessed by multivariable logistic regression.

RESULTS

We included 3917 children from the LSAC birth cohort in our study. We identified distinct trajectories for maternal depression, parents' financial hardship, parents' stressful life events and parents' availability to their children from birth to 14/15 years of age. Compared to the "low/no" asthma symptom trajectory group, children exposed to a "moderate & increasing" maternal depression, "moderate & declining" parents' financial hardship, and "moderate & increasing" parents' stressful life events were significantly associated (relative risk ratio [RRR]: 1.55, 95% confidence interval [CI]: 1.27, 1.91; RRR: 1.40, 95%; CI: 1.15, 1.70; RRR: 1.77, 95%; CI: 1.45, 2.16) with "persistent high" asthma symptom trajectory.

CONCLUSION

Several psychosocial factors that are potential stressors for mental health increase the risk of having an adverse asthma symptom trajectory during childhood. Further attention should be given to reducing exposure to maternal depression, parents' financial hardship, and parents' stressful live events for long-term asthma control in children.

Long-term effects of the left-behind experience on health and its mechanisms: Empirical evidence from China

Previous studies have primarily focused on the contemporaneous, short-term and medium-term effects of the childhood left-behind experience on subsequent health, but ignored its long-term effects and the mediating mechanisms of health outcomes. Using nationally representative data from the 2018 China Labor-force Dynamic Survey, this study uses self-rated health as a measure of health outcomes to examine the long-term effects of the left-behind experience and elucidate the underlying mechanisms that contribute to health inequality from a life-course perspective. The results show: (1) the childhood left-behind experience exerts a long-term negative impact on self-rated health in adulthood, and this impact persists and does not fade over time after ending the left-behind status; (2) the influence of the childhood left-behind experience on self-rated health demonstrates a cumulative disadvantage effect, with longer duration of being left-behind resulting in greater negative impacts; additionally, there's a critical window effect, with earlier left-behind experience leading to more significant negative outcomes; (3) the experience of being left behind during childhood has a negative impact and threshold effect on social trust in adulthood, meaning that the left-behind experience negatively affects social trust, but the duration of being left behind doesn't exacerbate this reduction; and (4) social trust is a key mediating factor between left-behind experiences and health, explaining 8.70% of this effect, and explaining 12.15% and 7.71% of mediation effects for adults with left-behind experience in middle and primary school stages, respectively.

The Relationship between Parent-Offspring Communication and the School Adaptation of Leftover Children in Overseas Countries: The Mediating Role of Companionship and the Moderating Role of a Sense of Safety

BACKGROUND

In the diasporic eastern coastal region of China, leftover children are a unique group of children; their social adaptation challenges are more prominent due to transnational separation from parents. This study explores the relationship between parent-offspring communication and school adaptation among leftover children.

METHODS

We administered questionnaires to 957 children from six schools in June and December of 2022. All students in the sample were randomly selected from within the classrooms. In total, 561 (47.95% female, mean age = 12.84, SD = 0.95) of them were leftover children. Self-report questionnaires on communication with their parents, school adaptation, companionship, and feelings of safety were used in this investigation We subsequently used SPSS software and the PROCESS plugin to analyze the relationships between variables.

RESULTS

A significant and positive relationship was found between parent-offspring communication and school adaptation in leftover children. Companionship mediated this effect. Additionally, the impact of parent-offspring communication on companionship was moderated by a sense of safety.

CONCLUSIONS

The study concluded that parent-offspring communication, school adaptation, companionship, and a sense of safety were all positively correlated. In addition, companionship partially mediated the relationship between parent-offspring communication and school adaptation. Moreover, a sense of safety played a moderating role. These conclusions can provide empirical support for improving the school adaptation of leftover children.

A Systematic Review of Parent-Child Communication Measures: Instruments and Their Psychometric Properties

Parent-child communication represents an important variable in clinical child and family psychology due to its association with a variety of psychosocial outcomes. To give an overview of instruments designed to measure the quality of parent-child communication from the child's (8-21 years) perspective and to assess the psychometric quality of these instruments, we performed a systematic literature search in Medline and PsycInfo (last: February 25, 2022). Peer-reviewed journal articles published in English with a child-rated instrument measuring the quality of parent-child communication were included. Initial screening for eligibility and inclusion, subsequent data extraction, and quality assessment were conducted by couples of review team members. Based on the screening of 5115 articles, 106 studies reported in 126 papers were included. We identified 12 parent-child communication instruments across the studies. The Parent-Adolescent Communication Scale (PACS) was used in 75% of the studies. On average, the evidence for psychometric quality of the instruments was low. Few instruments were used in clinical and at-risk samples. Several instruments are available to rate parent-child communication from the child's perspective. However, their psychometric evidence is limited and the theoretical foundation is largely undocumented. This review has limitations with regard to selection criteria and language bias.Registration PROSPERO: CRD42021255264.

The Development of Emotion Understanding among Five- and Six-Year-Old Left-Behind Children in Rural China

The left-behind children (LBC), separated from their mother/father or parents for a long period of time, have long been discussed as a subject of concern in China. Existing research has concluded that rural children who did not migrate with parents are subject to emotional risks. In the present study, the purpose is to study the impact of parental migration on early emotional understanding. Purposeful sampling was used to recruit 180 children aged five to six years in rural areas of Guangdong province, including LBC and non-left-behind children (NLBC). Their level of emotional understanding (EU) was assessed by the emotional comprehension test (TEC) adapted to the Chinese context. The results showed that, on the three levels (External, Internal, Reflective) of emotional understanding, LBC aged five- to six- years old scored significantly lower than NLBC as counterparts. On the whole, the emotional comprehension ability of preschool LBC was significantly lower than that of NLBC. However, there were no significant differences within LBC nurtured by single parents, grandparents, and other relatives. This study confirmed that parental migration in early childhood considerably impacted rural LBC's emotional understanding and affectional adjustment, which provided a significant basis for increasing parental care and early childhood companionship in rural areas.

Social anxiety and depression symptoms in Chinese left-behind children after the lifting of COVID-19 lockdown: A network analysis

BACKGROUND

Returning to social life after the lifting of COVID-19 lockdown may increase risk of social anxiety, which is highly co-morbid with depression. However, few studies have reported the association between them.

AIMS

To explore the complex relationship between social anxiety and depression symptoms in left-behind children after the lifting of the COVID-19 lockdown.

METHODS

A cross-sectional survey was conducted 6 months after the lockdown removal. A total of 3,107 left-behind children completed the survey with a mean age of 13.33 and a response rate of 87.77%. Depression and social anxiety severity were assessed by the DSM-5 Patient Health Questionnaire for Adolescents and the DSM-5 Social Anxiety Disorder Questionnaire, respectively. The symptom-level association between the two disorders was examined using network analysis.

RESULTS

After the lifting of COVID-19 lockdown, the prevalence of depression and social anxiety in left-behind children was 19.57% and 12.36%, respectively, with a co-morbidity rate of 8.98%. Network analysis showed that "Social tension" and "Social avoidance" had the greatest expected influence; "Humiliation" and "Motor" were bridge symptom nodes in the network. The directed acyclic graph indicated that "Social fright" was at the upstream of all symptoms.

CONCLUSION

Attention should be paid to social anxiety symptoms in left-behind children after the lifting of COVID-19 lockdown. Prevention and intervention measures should be taken promptly to reduce the comorbidity of social anxiety and depression symptoms in the left-behind children after the lifting of lockdown.

Social Identity, Core Self-Evaluation, School Adaptation, and Mental Health Problems in Migrant Children in China: A Chain Mediation Model

(1) Background: The present study investigated the relationships between social identity, core self-evaluation, school adaptation, and mental health problems in migrant children, and the mechanism underlying these relationships; (2) Methods: The participants were migrant middle school students in China. Data analysis was conducted using SPSS version 26. A survey comprising the social identity scale, core self-evaluation scale, school adaptation scale, and mental health scale MMHI-60 was deployed; (3) Results: Findings indicated a significant and negative association between social identity and mental health problems, and such an association was sequentially mediated by core self-evaluation and school adaptation. Furthermore, core self-evaluation and school adaptation played a chain mediation role between social identity and migrant children's mental health problems; (4) Conclusions: It is crucial to improve social identity, core self-evaluation, and school adaptation to reduce mental health problems among this population. Therefore, the research results provide a new direction for promoting the development of mental health education for migrant workers and their children in China.

Psychological Resilience among Left-Behind Children in a Rural Area of Eastern China

Childhood is an important period for individuals’ psychological development. Due to long-term separation from the parents, left-behind children (LBC) more easily develop deviation in cognition and abnormal personality. In this study, we aimed to explore the status of psychological resilience among LBC in a rural area of eastern China. We carried out a cross-sectional survey including middle and high school students from Qingyuan County of Zhejiang Province. Psychological resilience was measured using a modified scale developed for Chinese children. Data from a total of 1086 participants were collected, and the mean ± standard deviation score of psychological resilience was 4.11 ± 0.42. Multivariable linear regression analyses revealed that being a class leader (p = 0.010) and having high self-evaluation of academic performance (p < 0.001) were related with psychological resilience. Moreover, high contact frequency between parents and children (p = 0.019) was associated with better psychological resilience among LBC. In conclusion, we found that being a class leader and having high self-evaluation of academic performance were associated with better psychological resilience among the children in this rural area and contact between parent and child was an essential factor associated with psychological resilience among LBC.

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.

Exploring psychological resilience of entrepreneurial college students for post-pandemic pedagogy: The mediating role of self-efficacy

The psychological impact of the COVID-19 epidemic on college students is an important topic. With the entry of the post-epidemic era, how universities can better improve students’ psychological resilience in teaching is the research topic of this article. In the form of a questionnaire survey, some entrepreneurial college students investigated the loneliness and psychological resilience of college students after the outbreak of the epidemic and explored the role of self-efficacy in it. The data is collected online through cooperation with an entrepreneurial event, and the participating students are asked for background information such as colleges, grade, and majors. After collecting this information, they answered a series of simplified scale questions about loneliness, self-efficacy, and psychological resilience. In the end, a total of 200 questionnaires from different universities were collected, and the structural equation model was used to explore the role of self-efficacy. The results show that: loneliness has a significant negative effect on Self-efficacy, β = -0.292, p &lt; 0.001; Self-efficacy has a significant positive effect on psychological resilience, β = 0.556, p &lt; 0.0 01; loneliness has a significant negative effect on psychological resilience, β = -0.244, p &lt; 0.01. Self-Efficacy has a significant intermediate effect in loneliness and psychological resilience, with an effective value of -0.111 and p &lt; 0.01. The results show that this exploratory survey finds it important to provide targeted personal self-efficacy improvement activities for college students with a strong sense of loneliness and to combine school and family education organically to help college students form a healthy and upward mentality to better cope with the unknown and troubles caused by the epidemic, which will help improve the psychological resilience of college students in the epidemic.

Behavioral Strengths and Difficulties and Their Associations with Academic Performance in Math among Rural Youth in China

Behavioral strengths and difficulties among children and adolescents may be significantly associated with their academic performance; however, the evidence on this issue for rural youth in developing contexts is limited. This study explored the prevalence and correlates of mental health from three specific dimensions—internalizing problems, externalizing problems, and prosocial behavior—measured by the Strengths and Difficulties Questionnaire (SDQ), and the association of these dimensions with academic performance in math among a sample of 1500 students in rural China. Our findings indicated that students in rural China had worse behavioral difficulties and poorer prosocial skills when compared to most past studies conducted inside and outside of China. In addition, total difficulties and prosocial scores on the SDQ were significantly associated with student math test scores, as students whose externalizing, internalizing, and prosocial scores were in the abnormal range scored lower in math by 0.35 SD, 0.23 SD, and 0.33 SD, respectively. The results add to the growing body of empirical evidence related to the links between social environment, mental health, and academic performance in developing countries, highlighting the importance of students’ mental health for their academic performance, and of understanding risk factors in the social environment among rural youth in developing countries.

The Impact of Parent-Child Attachment on School Adjustment in Left-behind Children Due to Transnational Parenting: The Mediating Role of Peer Relationships

In China’s eastern coastal areas, the transnational parenting of left-behind children creates a distinct form of left-behind child. Previous research has indicated that children who have been left behind have a low degree of school adjustment. The major purpose of this research was to investigate the impact of parent–child attachment on school adjustment in children left behind by migrant parents, as well as the mediating role of peer relationships in this process. The parent–child attachment section of the Inventory of Parent and Peer Attachment (IPPA), the Adaptation subscale of the Adolescent Mental Health Quality Questionnaire—Chinese Version (AMHQQ-C), and the Student Peer Relationship Scale (SPRC) were used to survey 405 left-behind children in grades 3–6 of seven elementary schools in the hometowns of overseas Chinese parents from Zhejiang Province. It was discovered that, compared to non-left-behind children, left-behind children showed lower levels of parent–child attachment and school adjustment, while peer relationships appeared polarized. In addition, parent–child attachment and peer relationships considerably predicted the level of school adjustment in children left behind due to transnational parenting. More importantly, the mediation analysis revealed a partial mediating effect of peer relationships on the linkages between parent–child attachment and school adjustment among children who were left behind in transnational foster care.

The relationship between online courses and mental health among Chinese children

BACKGROUND

Previous studies on the association of online courses and mental health were mainly conducted in universities, and no study investigated the relationship between characteristics of online courses and children's mental health in primary and secondary school. This study aimed to explore the association of online courses and children's mental health in primary and secondary school.

METHODS

A cross-sectional study was conducted through an online survey among 540 primary and secondary school students and their parents in the eastern, central and western region of China from April to May in 2020. Children's mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ). Borderline mental health problems (SDQ total difficulties score ≥ 16) and mental health problems (SDQ total difficulties score ≥ 20) were defined according to Goodman's standard. Multivariable linear and logistic regression models were used to examine the association between online courses and children's mental health.

RESULTS

Compared with those who did not have problems of online courses, children having the difficulty in understanding the content of online courses had a higher SDQ total difficulties score [β = 1.80, 95% confidence interval (CI): 0.89, 2.71] and a higher risk of borderline mental health problems [odds ratio (OR) = 1.93, 95%CI: 1.07, 3.49], while device or internet connection problems were not significantly associated with children's mental health. Compared with children who had live courses, those having video-recorded courses had a higher SDQ total difficulties score (β = 0.90, 95%CI: 0.01, 1.80). Children who spent more than 4 h on online courses had a higher SDQ total difficulties score than those of less than or equal to 4 h (β = 0.95, 95%CI: 0.09, 1.81).

CONCLUSION

We found that online courses with inappropriate characteristics were associated with children's mental health. The findings called for the efforts to optimize the online courses and improve children's mental health.

The roles of parental absence, life skills and personality traits in mental health status among adolescents in rural China

PROBLEM

Mental health issues in adolescents are public health concerns worldwide including China. However, there is a lack of research examining the role of parental absence status, life skills, and personality traits on the mental health of adolescents in rural China.

METHOD

The purpose of this cross-sectional study was to examine the role of parental absence status, life skills, and personality traits on the mental health of adolescents in rural China. This study used self-developed demographic questionnaire, Mental Health Test (MHT), Middle School Student Life Skills Rating Scale, and Eysenck Personality Questionnaire. Binary logistic regression analyses were performed to examine the associated factors on different domains of MHT.

RESULTS

Adolescents in rural China reported high proportion of mental health disorders (MHDs), including learning anxiety, sensitiveness, self-accusation, and physical symptoms tendency. Although 75.6% experienced parental absence, this was not associated with MHT after controlling for all other variables. Better mental health was correlated with life skills including communication skills, interpersonal morality, self-efficacy, and stress coping. The instability-neuroticism personality trait was positively associated with MHDs.

DISCUSSION

Adolescents in rural China reported high positive rates of MHDs. Communication skills, interpersonal morality, self-efficacy, ability to cope with stress and Instability-neuroticism were important associated factors of MHDs.

APPLICATION TO PRACTICE

Life skills and personality are two important factors that should be considered when assessing the mental health status of adolescents and formulating interventions.

Health Status and Association With Interpersonal Relationships Among Chinese Children From Urban Migrant to Rural Left-Behind

Background

To date, numerous studies have examined the health status of Chinese left-behind children and migrant children. However, the impact of children's diverse migration/left-behind experiences on their health is still unclear.

Methods

A cross-sectional survey was conducted in 2020 in Nanling country (Anhui province) and Kaihua country (Zhejiang province) in China. School children from grade 5 to 8 reported their socio-demographic, interpersonal relationships, self-rated health, suicidal ideation, and depression. Participants were divided into four groups based on their migrant patterns, namely rural left-behind children with previous migration experience (ME-LBC), rural children with previous migration experience (ME-NLBC), rural left-behind children without migration experience (LBC), and rural children without migration experience (NLBC).

Results

Among 2,323 participants included in the present study, there were 336 ME-LBC (14.5%), 283 ME-NLBC (12.2%), 561 LBC (24.1%) and 1,143 NLBC (49.2%). Compared with NLBC, ME-LBC reported significantly poorer self-rated health (OR = 0.72, 95% CI [0.53-0.97], p < 0.05), higher risk of depression (β = 0.90, 95% CI [0.02-1.77], p < 0.05) with adjustment of socio-demographic and interpersonal relationships. There was no significant difference in suicidal ideation among different groups of children. The better interpersonal relationship was associated with a better self-rated health, and lower prevalence of depression and suicidal intention.

Conclusions

Compared to ordinary rural children, ME-LBC tended to experience higher levels of depression and poorer self-rated health. These research findings imply developing intervention programs about psychological adjustment tailored to different migrant patterns of Chinese rural children. The keys might be to strengthen the relationships with peer and teacher in school and improve the quality of parent-child communication in family for LBC.

Do Social Pensions Affect the Physical and Mental Health of Rural Children in China? An Intergenerational Care Perspective

Research Purpose: This study aimed to explore the effect of China’s New Rural Pension (NRP) on the physical and mental health of rural children from the perspective of intergenerational care, and to examine whether family childcare types and the child’s gender affect the relationships between social pensions and the physical and mental health of rural children. Methods: We used data from the 2016 China Family Panel Studies (CFPS) of the China Social Science Survey Center, a nationally representative sample at the individual, family, and county levels from 25 provinces (cities and districts) in China. A total of 2142 sets of valid samples of children, the elderly, family economic and social conditions, and basic family information were retained after data screening. The regression discontinuity (RD) method was employed for the statistical analyses. Results: The NRP had a significant effect on both the mental health (β = −2.818, p < 0.1) and physical health (β = −2.214, p < 0.1) of rural children. This effect varied with the family childcare type and child’s gender. Conclusions: We reveal a positive effect of the NRP on the physical and mental health of rural children. Therefore, the establishment of a social pension system may be used as an effective approach to enhance the health of rural children. The impact of the NRP on the physical and mental health of children differs with the family childcare type and their gender, which should be taken into consideration when using social pensions to enhance child health.

The state of mental health care in China

Over the past few years there have been considerable changes in China's mental health service system. This review provides an overview of the development of mental health services in China, including epidemiological data on psychiatric disorders, utilisation of mental health services, models of mental health service delivery, mental health resources and workforce, mental health policy framework and financial issues. We consider cultural and social factors including the involvement of family members in patient care, urbanisation and internal migration as well as the application of traditional Chinese medicine, which provides implications for mental health research and practice. Additionally, we also discuss major challenges and conclude by providing some specific recommendations on improving mental health services in China.

Perceived Stress, Social Support, Emotional Intelligence, and Post-Stress Growth among Chinese Left-Behind Children: A Moderated Mediation Model

Background: Several previous studies have revealed a negative impact of perceived stress on post-stress growth. Nevertheless, the potential mediating and moderating mechanisms are unclear, particularly for left-behind children in China. Therefore, this study aims to investigate the negative relationship between perceived stress and post-stress growth, the mediating effect of social support, as well as the moderating effect of emotional intelligence in a sample of Chinese left-behind children. Methods: A sample of 837 Chinese students in elementary and middle school was collected for this study. The Perceived Stress Scale, the Social Support Scale, the Emotional Intelligence Scale, and the Post-Stress Growth Scale were employed to examine them. The data were analyzed using SPSS 25.0 software. Results: The results indicate a significant negative association between perceived stress and post-stress growth. Among perceived stress and social support, the former acted as a mediator, while the latter as a moderator. This study sheds light on the post-stress growth of Chinese left-behind children. The findings validated a model of moderated mediation that shows the relationship between perceived stress, emotional intelligence, social support, and post-stress growth. Conclusion: This study confirmed that social support is one of the most important factors among left-behind children, from perceived stress to post-stress growth. Furthermore, the study reveals that emotional intelligence can adjust the relationship between perceived stress and social support to post-stress growth. Therefore, for both family education and school education, the result provides a new direction.

Impact of parental divorce versus separation due to migration on mental health and self-injury of Chinese children: a cross sectional survey

BACKGROUND

There has been an increasing prevalence of parental separation in China due to divorce or migration for work in recent decades. However, few studies have compared the impacts of these two types of separation on children's mental health. This study aimed to investigate how parental divorce and parental migration impact children's mental health and self-injurious thoughts and behaviors (SITB), while considering positive factors, including parent-adolescent communication and psychological resilience.

METHODS

We randomly recruited participants in grades 5-8 from 18 schools in 2 counties in Anhui Province. A self-administered questionnaire was conducted to measure children's mental health, SITB, parent-adolescent communication, psychological resilience, and socio-demographic characteristics.

RESULTS

Data from 1026 children with both parents migrating (BLBC), 1322 children with one parent migrating (SLBC), 475 children living in a divorced family (DC) and 1160 children with non-migrating parents (NLBC) were included. Regression model results showed that, compared to the other three groups (BLBC, SLBC, NLBC), DC exhibited higher internalizing problems (p < 0.05), higher externalizing problems (p < 0.01), less prosocial behaviors (p < 0.05), and higher rates of suicidal ideation (SI) (p < 0.05) and non-suicidal self-injury (NSSI) behaviors (p < 0.05) when adjusting for social-demographic variables. However, when further adjusting for parent-adolescent communication and psychological resilience, DC no longer had higher levels of internalizing problems, externalizing problems, NSSI and SI than left-behind groups (BLBC, SLBC).

CONCLUSIONS

The experience of separation from divorced parents had stronger negative effects on the mental health of children than was observed in LBC. The Chinese government should design special policy frameworks that provide support to DC.

Will Smog Cause Mental Health Problems? Indication from a Microsurvey of 35 Major Cities in China

Using the survey data of 21,861 participants from 35 major cities in China in 2018 and 2019, the effect of air quality on participants’ mental health was empirically tested based on the ordered probit model. The results showed that smog can significantly influence the mental health of participants. The better the air quality, the better the participants’ mental health, while poor air quality results in poor mental health. The older and higher-paid participants demonstrated poorer mental health. Additionally, for different health conditions, the air quality had different effects on the participants’ mental health. The healthier the participants, the more sensitive their mental health to changes in air pollution; the poorer the physical condition of the participants, the less sensitive their mental health to changes in air quality. Therefore, we need to more comprehensively and scientifically understand the effect of air quality on health. We need to pay attention not only to the adverse effects of smog on participants’ physical health, but also to its effects on participants’ mental health to improve both the physical and mental health of participants by improving the air quality.

The Association of Parent-Child Communication With Internet Addiction in Left-Behind Children in China: A Cross-Sectional Study

Objective: Internet addiction has emerged as a growing concern worldwide. This study aimed to compare the prevalence of Internet addiction between left-behind children (LBC) and non-left-behind children (non-LBC), and explore the role of paternal and maternal parent-child communication on LBC.

Methods: We conducted a cross-sectional survey in rural areas in Anhui, China. The complete data were available from 699 LBC and 740 non-LBC. Multivariable logistic regression was used to examine 1) whether LBC were more likely to develop Internet addiction, and 2) the association between parent-child communication and Internet addiction among LBC.

Results: LBC had a higher likelihood to report Internet addiction when compared to non-LBC (OR = 2.03, 95%CI = 1.43–2.88, p < 0.001). Among LBC, parent-child communication (both mother-child and father-child) was protective factor for children’s Internet addiction. The role of mother-child communication played well among male LBC.

Conclusions: The lack of parental supervision may lead to Internet addiction. It is highly recommended for migrant parents to improve the quality of communication with their children. Also, gender-matching effects should be considered in the relationship between children’s behavior and parental factors.

Grandparent-child cohesion, friendship quality, and left-behind children's positive/negative affect in rural China

This study examined the roles of grandparent-child cohesion and friendship quality in left-behind children's positive and negative affect compared with non-left-behind children. Data from 557 participants indicated that grandparent-child cohesion and friendship quality predicted children's emotional adaptation. Friend trust and support and intimate exchange had a stronger predictive effect on positive affect among non-left-behind children. Moreover, the interaction effects between grandparent-child cohesion and friendship quality on children's positive affect supported the reinforcement model, while the interaction effects on negative affect supported the reinforcement model among left-behind children but supported the compensation model among non-left-behind children.

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.

Psychometric properties and measurement invariance of the emotion regulation questionnaire in Chinese left-behind children

Left-behind children (LBC) is a group of children who live without their parents and receive less parental care and education. Compared with non-left-behind children (NLBC), LBC are more likely to develop emotional or behavior problems. This study aimed to explore the psychometric properties and measurement invariance of the Chinese version of the Emotion Regulation Questionnaire (ERQ) in Chinese LBC. A sample of 2960 middle school students (44.35% male, 55.28% female; age: 12 to 20 years) including LBC (n = 1365) and NLBC (n = 1595) was used. The exploratory factor analysis (EFA); confirmatory factor analyses (CFA); tests of measurement invariance; t-tests of gender and left-behind experience differences; tests of reliability and convergent, discriminant, and criterion validity were conducted. The results showed that two factors were extracted, and the CFA replicated the original two-factor structure (S-Bχ2/df ≈ 106.778/34, P < .001, CFI = .948, TLI = .932, RMSEA = .056 [.044, .068]). The measurement invariance of the ERQ across genders, LBC and NLBC was also confirmed. Males use expressive suppression (ES) significantly more than females (t = 2.63, p < .01), and LBC use ES significantly more than NLBC (t = 2.11, p < .05). The internal consistency coefficients for ES and cognitive reappraisal (CR) were acceptable, and the test-retest reliability was .62 and .68, respectively. Good convergent, discriminant and criterion validity were also demonstrated. It can be concluded that the ERQ is a valid measure for investigating the use of two different emotion regulation strategies among Chinese left-behind children.

Prevalence and Correlates of Mental Health Problems among Chinese Adolescents with Frequent Peer Victimization Experiences

This study investigated the prevalence and correlates of mental health outcomes, particularly depression, anxiety, and insomnia, in adolescents with frequent peer victimization experiences (FPVEs). In this cross-sectional study, 490 adolescents reported having FPVEs (prevalence, 4.2%; mean age, 13.40 ± 1.38 years old; 52.2% male) completed a series of surveys to evaluate their demographic factors and mental health status. The results showed that the prevalence of depression, anxiety, and insomnia were 50.3%, 33.8%, and 40.2%, respectively. Older age, being female, being left behind, and more adverse childhood experiences were correlated with more symptoms of depression, anxiety, and insomnia among adolescents with FPVEs. At the same time, social support and self-compassion were good for ameliorating these mental health problems. Implications for intervention programs designed to improve the mental health of adolescents with FPVEs were also discussed.

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.

Self-esteem, social support and coping strategies of left-behind children in rural China, and the intermediary role of subjective support:a cross-sectional survey

BACKGROUND

Negative coping strategies and behavioral problems are common among Chinese left-behind children, which are relate to a variety of negative consequences. At this stage of development, the relevant factors of coping strategies need to be further studied, in which social support and self-esteem are worthy of our attention. The aim of this study is to detect the current situation of self-esteem, social support, and coping styles of left-behind children (LBC) in rural China.

METHODS

322 children from 3 schools in China enrolled in this study, including 236 LBC and 86 non-left-behind children (NLBC) to assess self-esteem, social support and coping strategies.

RESULTS

The LBC group had lower self-esteem score and lower total social support (subjective support, objective support and support-seeking behavior) than the NLBC group. In terms of coping strategies, the LBC group was lower than the NLBC group in problem-solving and rationalization. The self-esteem score in LBC was significant positive associated with the subjective support score, objective support score, problem-solving and help-seeking score. In addition, self-esteem has significant mediating effect between subjective support and problem-solving, subjective support and help-seeking, respectively.

CONCLUSIONS

The finding indicate that Chinese LBC's self-esteem and social support need to be improved. Given the significant correlativity between self-esteem, subjective support and coping strategy, it is necessary to promote Chinese LBC's self-esteem and social support, especially subjective support.

Psychoanalytic infant observation in China-The mental health of children separated from parents

Through the lens of psychoanalytic infant observation, the authors introduce some characteristics of Chinese urban families, most of which have grandparents to participate in the caretaking of infants. In some cases, infants may be separated from parents. These phenomena are understood in terms of cultural, political, social, economic and psychological dimensions. The observational frame is compared to the clinical frame and the patient's handling of the frame throws light to his/her internal world. In some cases, this internal world may be populated by absent objects. Related mental health difficulties are illustrated by two clinical vignettes of adult patients who experienced long-term parental absence in childhood.

Different Trajectories of Panic and the Associated Factors among Unmarried Chinese during the COVID-19 Pandemic

BACKGROUND

A large number of the population experienced panic during the pandemic of the coronavirus disease 2019 (COVID-19) in China. The current study explored the trajectory of panic and its associated factors to develop promising strategies for controlling the global spread of COVID-19 and improving the mental health emergency management.

METHODS

A total of 812 unmarried adults (aged from 18 to 42 years, M = 23.3, SD = 3.45) from all over China participated online in our investigation. A Growth Mixture Model (GMM) was developed and analysed.

RESULTS

Three classes of trajectories for panic were identified: the "continuous decline group (CDG)", the "continuous low group (CLG)," and the "continuous high group (CHG)". With reference to the CDG, people in the CHG were more sensitive to social factors. With reference to the CDG, people in the CLG were more likely to possess some of the following traits: being men, in Hubei Province (center of the pandemic), with a lower income, and less sensitive towards social factors and individual factors. With reference to the CLG, people in the CHG were more likely to be women, located outside of Hubei Province, and more sensitive to social factors, family factors, and individual factors.

CONCLUSION

Social factors, family factors, and individual factors predicted the different trajectories of panic.

Parent-Child Discrepancies in Reports of Exposure to Violence/Pornography on Mobile Devices and the Impact on Children's Psychosocial Adjustment

This study assessed the discrepancies between reports from parents and children concerning children's exposure to violence/pornography on mobile devices and the impact on the psychosocial adjustment of children. Data were obtained from a sample of 2,230 parent-child dyads recruited from 16 elementary schools (1,140 dyads) in Taiwan and 9 schools (1,090 dyads) in China. A self-administered questionnaire was used. The results showed that about 30 percent of children reported being exposed to violence on mobile devices. Approximately 70 percent of their parents were unaware of their child's exposure to violence on mobile devices. About 16 percent of children reported exposure to pornography on mobile devices, and 80 percent of their parents were unaware of this exposure. Multinomial logistic regression results showed that after controlling for parent and child sociodemographic variables, factors related to parental unawareness of child exposure to violence on mobile devices included a child's ownership of mobile devices, smartphone/tablet use time, a lower level of parental understanding, and a residence in China or in a rural area, whereas the parent-child relationship and a child's smartphone/tablet use time were associated with parents who were unaware of their child's exposure to pornography. Multiple regression results showed that children who were living with household poverty, had a poor parent-child relationship, spent much time using a smartphone/tablet, and with parents who were unaware of their exposure to violence/pornography on mobile devices were more likely to have emotional and behavioral problems.

Effect of Parental Migration on the Intellectual and Physical Development of Early School-Aged Children in Rural China

Objective: The purpose of this study is to estimate the effect of parent migration on intellectual and physical development of early school-aged children in rural China. Design: setting and participants: The present cross-sectional study participants were a subset from a controlled, cluster-randomized, double-blind trial. From October 2012 to September 2013, the offspring of women who participated in a large trial were examined in the present study. Wechsler intelligence scale for children (WISC-IV) in which validity and reliability were shown to be satisfactory was used to measure the intellectual function and trained anthropometrists measured weight and height of children using standard procedures. Results: The mean difference of FSIQ scores between non-migration and both-parent migration groups was −3.68 (95%CI: −5.49, −1.87). After adjusting for the confounders, the mean difference of full-scale IQ between non-migration and both-parent migration group was −1.97 (95%CI: −3.92, −0.01), the mean differences of perceptual reasoning index and processing speed index were −2.41 (95%CI: −4.50, −0.31) and −2.39 (95%CI: −4.42, −0.35) between two groups respectively. Conclusion: Our results emphasized the impairment of both-parental migration in intellectual function (FSIQ, PRI, PSI) of children. These findings have important policy implications for the Chinese government to prevent the impairment of left-behind children. Further research is required to clarify the mechanisms by which both-parental migration influence the impairment in intellectual function of children.

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.

Emotional and Behavioral Problems Among 3- to 5-Year-Olds Left-Behind Children in Poor Rural Areas of Hunan Province: A Cross-Sectional Study

The term left-behind children (LBC) refers to underage children who have been separated from their father/mother or parents for a long period of time. At present, there are few studies on the emotional and behavioral problems of three- to five-year-old LBC in poor rural areas of China. In this study, random cluster sampling was used to recruit caregivers of left-behind children (CLBC) aged three to five years in two poor rural areas in Hunan Province. General demographic data of LBC and their caregivers were collected via face-to-face questionnaires. Children’s emotional and behavioral problems were assessed by the Strength and Difficulties Questionnaire (SDQ). Among 557 LBC, the prevalence of a total difficulties score in an abnormal/borderline range was 27.6–50.6%. The most common problem of LBC was hyperactivity, with a rate of 33.6%. Compared with boys, girls had more emotional problems (p < 0.05) and fewer hyperactivity disorders (p < 0.01). Factors related to the emotional and behavioral problems of LBC were the LBC’s age, the number of sick people at home, and the CLBC’s willingness to take care of the LBC. The detection rate of emotional and behavioral problems of three- to five-year-old LBC in poor rural areas is higher than that of children of the same age in urban areas and Western developed countries. There were gender differences in hyperactivity and emotional symptoms. Poor care will increase the risk of children’s emotional and behavioral abnormalities.