Chinese Left-behind Children Research Articles

Association between bullying victimization and mental health problems among Chinese left-behind children: a cross-sectional study from the adolescence mental health promotion cohort

Association between bullying victimization and mental health problems among Chinese left-behind children: a cross-sectional study from the adolescence mental health promotion cohort

Interventions for left-behind children in Mainland China: A scoping review

BackgroundAs the discussion of Chinese left-behind children (LBC) continues, intervention programs dedicated to this population increase and diversify. While reviews have summarized intervention programs promoting LBC’s health and psychological wellbeing, there is no synthesis depicting a comprehensive picture. This scoping review systematically examines interventions tackling LBC’s various issues and identifies their design and foci. MethodWe performed a systematic literature search to extract intervention studies from four English (i.e., Web of Science, Scopus, Embase, & PsycINFO) and one Chinese (i.e., CNKI) database. The quality of the studies was assessed using the Mixed Methods Assessment Tool (MMAT). Two main rounds of deductive coding were performed on Nvivo 12 plus to identify the design and foci of the interventions. ResultsThirty-three articles were identified for our final review. Twenty-six were published in Chinese and seven in English. Existing interventions have tackled multiple psychological, social, physical, developmental, and sexual problems or needs of Chinese rural left-behind children. Among them, LBC’s psychological wellbeing has drawn the most attention. The majority of the reviewed studies performed a randomized controlled trial (N=20). Quantitative evaluation is prevalent, with only one study applying a purely qualitative evaluation. In addition, only two studies adopted validated interventions, while the others are self-designed. ConclusionsThe review results indicate several gaps in intervention studies for LBC. First, many existing interventions have considered LBC’s psychological and social wellbeing, while little effort has been paid to address their educational and intellectual development. Further, while existing interventions are concerned with LBC’s temporary needs, their long-term life planning, as well as their current self-efficacy and self-concept driving their actions towards future self, were neglected. As for the intervention design, empirically validated interventions are recommended for future studies for their verified efficacy and evidence-based standardized practice. In addition, a qualitative evaluation should be considered because it might be more powerful in eliciting realistic and viable solutions to improve the effectiveness and reliability of the interventions from the participants.

Depressive disorders in Chinese left-behind children and adolescents from Yunnan province: prevalence and association with self-harm behaviors

BackgroundThe prevalence of clinically diagnosed depressive disorders (DD) in Chinese left-behind children (LBC) remains unknown. We aim to estimate the prevalence of DD, discuss the associations between DD and self-harm (SH) behaviors in a large representative sample of Chinese LBCs chosen from Yunnan province.MethodsA total of 5462 LBCs were selected from the most recent datasets of the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a mega population-based two-phase cross-sectional survey. Weighted prevalence rates and designed Logistic regression were adopted to estimate the prevalence of DD and the association between DD and SH.ResultsThe weighted prevalence of lifetime and current DD were 4.22% (95% CI: 3.13-6.00%) and 3.84% (95% CI: 2.85-5.00%) in Chinese LBCs. Higher lifetime and current DD prevalence rates were observed in girls and those reported adverse parental marital status and SH behaviors. The absence of DD was associated with significantly decreased odds of SH behavior (OR = 0.06), repetitive SH (OR = 0.09), using multiple SH methods (OR = 0.09), and severe SH (OR = 0.15). Subsequently performed stratified analyses identified prominent effect modification by sex and age, as a stronger association between DD and SH was found in girls (OR = 0.02 versus OR = 0.07 in boys) and younger adolescents (OR = 0.08 versus OR = 0.22 in older adolescents).ConclusionThe prevalence of DD was high in Chinese LBCs. DD was associated with prominently increased risk of SH behaviors in LBCs. Attention and intervention are needed in this vulnerable population.

The association between expressive suppression and anxiety in Chinese left-behind children in middle school: serial mediation roles of psychological resilience and self-esteem

BackgroundLeft-behind children (LBC) have become a special population to be concerned due to the negative consequences of parental absence during their physical and psychological development in China. Expressive suppression (ES) is a response-focused emotion regulation and may be frequently used by LBC to suppress their emotions resulting in different forms of internalizing problems. The objective of the present study was to investigate the role of ES as an emotion regulation strategy on anxiety in Chinese left-behind children in middle school (LBC-MS) by considering the mediating role(s) of psychological resilience and self-esteem.Methods820 middle school students aged between 12 and 17 years from a middle school in Xiangtan, Hunan Province, participated in the study. Screen for Child Anxiety Related Emotional Disorders (SCARED), Emotion Regulation Questionnaire (ERQ), Resilience Scale for Chinese Adolescents (RSCA), and Rosenberg Self-Esteem Scale (SES) were administered. Variables measured using the above scales in left-behind children in middle school (LBC-MS) and non-left-behind children in middle school (non-LBC-MS) were compared, and descriptive statistics were used to present the overall characteristics. Then the PROCESS macro of SPSS was used to conduct regression-based statistical mediation for the data of 211 left-behind children.ResultsThis study revealed that LBC-MS had higher anxiety and ES scores and lower psychological resilience and self-esteem scores than non-LBC-MS (Ps < 0.01). ES was found positively associated with anxiety in LBC-MS and negatively associated with psychological resilience and self-esteem (Ps < 0.05 − 0.01). Specifically, both psychological resilience and self-esteem significantly mediated the association between ES and anxiety, accounting for 7.50% and 10.68%, respectively, of the total associations. Moreover, psychological resilience and self-esteem had a chain mediating effect between ES and anxiety in LBC-MS.ConclusionThe findings indicated that LBC-MS in China may frequently engage in the use of ES which correlated with higher level of anxiety. Psychological interventions should be dedicated to this underserved group. Intervention approaches that improve emotion regulation strategies (i.e., decrease the use of ES) and increase psychological resilience and self-esteem may help to alleviate anxiety in LBC-MS.

Effects of Empathy on Loneliness Among Rural Left-Behind Children in China: The Chain-Mediated Roles of Social Anxiety and Psychological Resilience.

Loneliness is a prevalent issue among rural left-behind children in China, adversely affecting their physical and mental well-being, as well as social stability. However, the influencing factors and potential mechanisms of loneliness have not yet been fully clarified. This study aims to validate the mediating roles of social anxiety and psychological resilience by examining the association between affective/cognitive empathy and loneliness among Chinese rural left-behind children. This cross-sectional survey employed a convenience sampling approach among Chinese left-behind children. A total of 540 participants aged 6 to 11 years old (Average age = 8.54, SD = 1.682) from 3 primary schools in Hunan Province completed the Children's Loneliness Scale, Social Anxiety Scale for Children, The Chinese version of Connor-Davidson Resilience Scale, and Basic Empathy Scale. Data analysis was conducted using SPSS 27.0, Origin 2020, and Mplus 8.3. Pearson correlation analyses suggested strong significant correlations among affective/cognitive empathy, loneliness, social anxiety, and psychological resilience. Path analyses indicated that the chain mediation effect size of social anxiety and psychological resilience was 0.016 between affective empathy and loneliness, while the chain mediation effect size between cognitive empathy and loneliness was -0.011. Affective empathy positively correlates with loneliness among Chinese left-behind children through social anxiety and resilience, while cognitive empathy negatively correlates with loneliness. These findings suggest that left-behind children should enhance their cognitive empathy and psychological resilience to reduce their social anxiety, thereby mitigating their loneliness.

Fostering resilience and post-traumatic growth in overseas Chinese left-behind children: The role of autonomy, competence, and relatedness.

This study examines the impact of parental migration on the psychological well-being and development of left-behind children (LBCs) in Zhejiang, China, within the broader context of the country's rural transformations and urban migration. It investigates how intellectual and relational engagement (RE), autonomy (AUT), competence (COM), and relatedness (RES) contribute to resilience (REL) and post-traumatic growth (PTG) in these children, reflecting on the shift from viewing parental separation merely as a source of trauma to recognizing its potential to foster significant personal growth. Utilizing a cross-sectional design, the research was conducted in April and May 2023 with 1348 LBCs from a total sample of 4049 students inZhejiang. A two-step random, stratified, cluster-based sampling strategy was employed, and structural equation modeling was used to examine the hypothesized relationships among the constructs. The statistical analysis demonstrated significant positive effects of intellectual engagement (IE), AUT, COM, and RE on both REL and PTG (p<.05 for all). IE strongly correlated with AUT (r=.68, p<.001) and COM (r=.71, p<.001), enhancing REL and facilitating PTG. Additionally, the presence of secure and consistent relationships was identified as crucial for maintaining psychological well-being, with high correlation coefficients (r>.60) underscoring their importance. Notably, REL was found to moderate the relationships among RES, COM, and PTG, highlighting its critical role in the psychological adaptation of left-behind children. The study underscores the importance of nurturing intellectual and REs, AUT, and COM to enhance psychological REL and well-being among LBAs. These elements are crucial for supporting the mental health and developmental needs of children facing the challenges of parental migration. The findings advocate for targeted interventions that can address the unique needs of this vulnerable population, emphasizing the potential for growth and adaptation despite adversities.

Increasing self-esteem among left-behind children in China: a cross-temporal meta-analysis from 2006 to 2020

BackgroundSelf-esteem serves as a fundamental indicator for assessing the mental health of left-behind children in China. Previous studies have placed more emphasis on investigating its current situation, while overlooking its dynamic changes with social development.MethodsThis research project used the approach of cross-temporal meta-analysis to analyze 72 papers that used the Rosenberg Self-esteem Scale, ranging from 2006 to 2020(date of data collection) and covering 29,835 left-behind children, to delve into the diachronic changes and influencing factors of self-esteem of left-behind children over the years.ResultsThe outcomes demonstrated that: (1) The self-esteem scores of Chinese left-behind children increased from 30.74 in 2006 to 32.7 in 2020. (2) The level of self-esteem among left-behind children was significantly correlated with social indicators (economic conditions and educational level) for the actual year, 3 years prior, or 5 years prior to the self-esteem data collection.ConclusionsThe level of self-esteem of left-behind children has been rising between 2006 and 2020. In addition, it is noteworthy that social development had a significant influence on predicting changes in the self-esteem of left-behind children.

Factor structure and measurement invariance of the Depression anxiety stress scale (DASS-21) in Chinese left-behind and non-left-behind children: an exploratory structural equation modeling approach

BackgroundComprehensive data has shown that adolescents often suffer from depression, anxiety, and low self-esteem, and are in a particularly fragile stage of psychological, physiological, and social development. Left-behind children in particular tend to have significantly higher, state anxiety and depression compared to non-left-behind children. The Depression, Anxiety, and Stress Scale (DASS-21) is an effective tool for evaluating depression, anxiety, and stress, and is used to measure levels of depression, anxiety, and stress in groups from a variety of backgrounds. The purpose of this study was to determine the effectiveness, reliability, and measurement invariance of the DASS-21 in Chinese left-behind children.MethodThe test and re-test method was used (N = 676), and the exploratory structural equation model (Mplus v.8.3) used to verify basic measurement models. For measurement invariance, the configural, weak, strong, and strict models were tested. The reliability of the DASS-21 was also tested using the collected data.ResultsAnalysis results showed that the DASS-21 had a stable three-factor structure in the sample of left-behind children in China. The measurement invariance test showed that gender and time not only had strong invariance, but also strict invariance. The results of cross left and non-left invariance indicated a lack of strict invariance. Finally, the McDonald’s omega coefficient of the DASS-21 total scale was 0.864, and the internal consistency of each subscale was also good.ConclusionsThe DASS-21 is shown to be an effective and reliable tool for measuring depression, anxiety and stress in Chinese left-behind children.

Trajectories of peer victimization among left-behind children in rural China: The role of positive school climate.

Left-behind children are likely to experience peer victimization, which can have detrimental consequences in their developmental outcomes. Yet, limited longitudinal research have examined peer victimization trajectories over time or the factors associated with left-behind children in China. The purpose of the present study was to examine what, if any, distinct trajectories of peer victimization exist among left-behind children and whether these trajectories are related to school climate, left-behind status, and their interactions. Participants were 853 Chinese left-behind children (Mage = 14.25, SD = 2.39; 43.4% girls) who participated in a four-wave longitudinal study conducted in rural China. Participants reported school climate (indexed by safety and order, acceptance and support, equality and fairness, autonomy and cooperation) at T1 and peer victimization across T1 to T4 spanning 2 years. Latent class growth analyses identified four peer victimization trajectories, including a stably low-decreasing group, a moderate-decreasing group, a high-decreasing group, and an increasing group. Multinomial logistic regression analyses revealed that children who perceived more positive school climate were more likely to exhibit a stably low-decreasing trajectory compared to the other three groups. In addition, among left-behind children who perceived more positive school climate, children with single-parent migrating were more likely to be members of the stably low-decreasing group as compared to those with both-parent migrating. Peer victimization among left-behind children is a concern especially for those who were left behind by both parents and perceived less positive school climate. Targeted school-based interventions and services focused on reducing peer victimization and improving school climate are needed for left-behind children, especially those with both-parent migrating.

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

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. 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. 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)]. 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

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

Research on the Educational Plight Faced by Rural Left-behind Children in China

Due to the rapid development of Chinas cities and the increasing inequality between urban and rural areas, Chinese left-behind children have been neglected by society for a long time, which should make their educational plight a worthwhile issue to be explored. The research utilizes literature review to discuss some reasons for those childrens educational plights they are facing. Various researches from other authors is drawn to probe into more dimensions of the factors. Then, the result is presented that there are three aspects among that deeply influence the quality of education the rural left-behind children are receiving, including parents, society and news media. In short, the departure of parents makes children suffer from unhealthy mental conditions and fail to gain adequate cognitive knowledge, leading to their trouble in receiving high-quality education. Moreover, the vicious characteristics of rural society which delivers backward ideologies is also a culprit that prevents them from getting the same education as urban children. Lastly, the one-sided coverage of those children by news media shapes them as pure victims or threatening people, letting others keep away and refuse to help them and also causing childrens wrong perceptions of themselves and their living environments. As to the research conclusion, their difficulties in education should be paid more attention and the relevant institutions are supposed to take action to drop them out of such plight.

Unhealthy Eating Habits and Insomnia Symptoms are Associated with Internet Addiction in Chinese Left-Behind Children: The Gender Difference.

This study aimed to evaluate the associations between unhealthy eating habits and insomnia symptoms with Internet addiction (IA) among Chinese left-behind children (LBC) based on potential gender difference. This cross-sectional study was conducted in junior high schools from an economically disadvantaged area of China in May 2020. Participants were asked to complete the information and scales of socio-demographic characteristics, eating habits (the frequency of eating carbohydrates, fruits, vegetables, protein, and breakfast), insomnia severity and IA. A total of 3156 LBCs (43.9% males and 56.1% females, aged 14.2 years in average) were used for final analyses. Associations between eating habits and insomnia symptoms with IA were analyzed by generalized linear model with binary logistic regression. The study found that left-behind children (LBCs) had unhealthy eating habits, particularly among females. Females reported more insomnia symptoms than males. The prevalence of IA was similar across genders. Consuming fewer fruits and vegetables and skipping breakfast were linked to increased IA risk, especially in females. Insomnia was significantly associated with higher IA risk in both genders. In LBCs, unhealthy eating and sleep were notably linked to IA, especially in females. Addressing these factors might reduce the prevalence of IA among LBCs.

A Comparison of the Resilience, Anxiety, and Life Satisfaction of Chinese Left-Behind Children and International Students

The present study compared the resilience level, anxiety level, and life satisfaction level of Chinese left-behind children (LBC) and international students (IS) between 11 and 15 years old and investigated the relationships between these three variables and physical activity (PA). Chinese LBC (n = 86) from Guiyang City, Guizhou Province, China and Chinese IS (n = 60) in Vancouver, Canada filled out a survey that measured their resilience level, anxiety level, life satisfaction level, the duration and frequency of PA of different types and intensities in various domains, PA Enjoyment, and participants’ attitudes toward PA. In addition, 10 participants were randomly chosen to participate in an interview after completing the survey. The survey results showed that IS possessed higher resilience level and life satisfaction level than LBC, and both groups had no significant difference in anxiety level; LBC engaged in more PA than IS. Besides, resilience level was positively related to the amount of light PA in household or yard work domain as well as PA enjoyment; anxiety level was negatively related to PA enjoyment as well as annual household income; life satisfaction was positively related to the total amount of PA across all domains as well as PA enjoyment. Participants also mentioned in the interviews the effectiveness of PA in distracting them from worries and other negative emotions, which in turn helped reduce their anxiety and improve their resilience and life satisfaction. Therefore, participating in more PA could be a promising way to improve resilience level and life satisfaction level or reduce anxiety level for the two groups.

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

This study aimed to examine attentional bias (AB) for sad and social rejection words in Chinese left-behind children (LBC) with depression. We investigated both stimulus specificity and components of AB in different groups using a cross-sectional design. Data were drawn from a school assessment of depression and anxiety, from which we selected LBC with depression (n = 40), LBC without depression (n = 33), a control group with depression (n = 31), and a control group without depression (n = 37). AB was measured with a dot-probe task covering two stimulus types (sad and rejection). The analysis of AB scores revealed a significant three-way interaction (LBC × depression × word type), F(1, 137) = 4.00, p = 0.047, η2 = 0.028, with depressed non-LBC exhibiting a significant depression × word type interaction, F(1, 66) = 4.67, p = 0.034, η2 = 0.066, while the depression × word type interaction was not significant in LBC, F(1, 71) = 0.18, p = 0.675, η2 = 0.002. Depressed children living with their parents showed AB towards sad words but not rejection words, while depressed LBC showed greater AB towards both rejection and sad words. The findings provide evidence that an AB towards sad information is critically involved in the depressed LBC. Compared with non-LBC depressed individuals, an AB for rejection may be involved as a risk factor in the LBC. It sheds light on the effective intervention programmes for LBC's depression and have important practical significance for reducing depression and improving the mental health of LBC.

What makes left-behind children resilient? And how? The role of hope on the resilience of Chinese left-behind children

Left-behind children (LBC) in China, of which there are 40 million, are a significant concern due to reported mental health issues including depression. Recent research has shown the negative correlation between resilience and the poor mental health outcomes of LBC, but the underlying mechanisms of this resilience have remained unclear. This study utilized the Risk and Resilience framework and conceptualized that resilience is an outcome of the absence of depressive symptoms when protective factors mitigate the negative impact of risk factors. This study examined whether protective factors were correlated with a reduction in the association between risk factors and LBC’s depressive symptoms, thereby contributing to LBC’s resilience. Participants were recruited from first and second-year middle school students in Henan province, aged 11–15 years (N = 841). Researchers delivered the questionnaires to the classrooms. Logistic regression analyses were conducted to examine the association between hope and depressive symptoms as well as to examine the moderating role of hope on the correlations between risk factors and depressive symptoms. The same analyses were stratified by gender. Hope was negatively correlated with LBC’s depressive symptoms. For males, there was a significant interaction between hope and stressful life events, but the interaction was not significant for females. The results suggest that LBC boys’ resilience can improve if hope mitigates the negative impact of stressful life events on LBC’s depressive symptoms.

The Source of the Emotional Construction of Chinese Left-behind Children-Themed Films

As an intermediate medium of storage medium, the film becomes the image of linguistic significance due to the addition of emotional elements. As a form of video art, meanwhile, the theme of Chinese left-behind children itself has strong vitality, which makes Chinese left-behind children themed films have natural emotional attributes in emotional expression. As an art form combining visual and auditory, Chinese left-behind children films mainly come from three aspects: first, the left-behind children films themselves; second, the emotions of left-behind children film filmmakers, and finally, the emotions of left-behind children film audiences.

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

BackgroundNon-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.MethodsWe 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.ResultsThe 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.LimitationsThis was an online survey.ConclusionsThe 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.

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

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

School adjustment and bullying of Chinese left-behind children: Mediating role of social support

Bullying has become a social concern in schools in China, and school adjustment is an important factor affecting bullying. We explored the mediating role of social support in the relationship between school adjustment and bullying among 600 left-behind children in junior middle schools in Shandong Province, China. The students completed the School Adjustment Scale, the Multidimensional Scale of Perceived Social Support, and the Junior High School Bullying Questionnaire. Results showed significant differences in school adjustment, social support, and bullying between the children of families where only one parent had migrated to the city for work, and children of families where both parents had done so. School adjustment, social support, and bullying were significantly correlated among the left-behind children. Social support played a mediating role in the relationship between the school adjustment and bullying of these children. The results provide references for school teachers and family members to reduce bullying of left-behind children.