Anxiety in Rural Chinese Children and Adolescents: Comparisons across Provinces and among Subgroups

Hongyan Liu,Emma Auden,Scott Rozelle,Yaojiang Shi

doi:10.3390/ijerph15102087

Abstract

China’s competitive education system has produced notably high learning outcomes, but they may be costly. One potential cost is high levels of anxiety. China has launched several initiatives aimed at improving student mental health. However, little is known about how effective these programs and policies are. The goal of this paper was to examine anxiety levels among children and adolescents in rural China, and to identify which subpopulations were particularly vulnerable to anxiety. Data were aggregated from 10 different school-level surveys conducted in rural areas of five provinces between 2008 and 2015. In total, 50,361 students were evaluated using the 100-item, nine-subcategory Mental Health Test (a variation of the Children’s Manifest Anxiety Scale). Seven percent of students were at risk for overall anxiety. However, over half of students were at risk for at least one subcategory of anxiety. Students at higher risk for anxiety included students from poorer counties and families, female students, secondary school students, and students with lower levels of academic performance. Many students in rural China are at risk for anxiety, and certain student subpopulations are particularly vulnerable. We suggest that China’s government review and update student mental health programs and policies.

Highlights

Over the past several decades, China has developed a competitive education system that produces notably high learning outcomes
Across all of the schools surveyed from all 10 experiments, we found that 7% of students scored 56 points or higher on the Mental Health Test (MHT), meaning they were over the cutoff indicating high risk for overall anxiety and a need for counseling
We found that learning anxiety appeared to be driving the high prevalence of anxiety risk in our samples of rural schools

Summary

Introduction

Over the past several decades, China has developed a competitive education system that produces notably high learning outcomes. The strength of the education system can be illustrated by the country’s performance on international standardized evaluations, such as the Organisation for Economic Co-operation and Development (OECD)’s Program for International Student Assessment (PISA). When the PISA was administered in 2012, students from Shanghai, China outperformed students from 64 other countries in all subject areas tested [1]. These outcomes, may come at a cost. One cost that is beginning to concern China’s educators is the high incidence of anxiety among students [2]. Untreated anxiety can become a chronic condition that has been linked with academic failure, unemployment, and even early death [4]

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