| ObjectiveThe preschool age is a critical sensitive period for development of brain,behavior habits,personality,and ability among children.Their psychological and behavioral patterns and social skills develop rapidly,which would affect the later development.Excellent psychological resilience is an important reflection of successful adaptation of childhood development,especially important for children in adversity.There are relatively few studies on the psychological resilience among preschool children from China and other countries.At present,the development problem of children in rural areas in China is still prominent,and the health problems among preschool children in rural areas still need further attention.This cross-sectional and longitudinal studies were conducted in northern(the north area of the Huai River),middle(the area between the Huai River and Yangtze River),and southern(the south area of the Yangtze River)rural areas of Anhui province using validated assessment tools to explore the status and change of psychological resilience and its individual internal and external associated factors among preschool children.Furthermore,the association between psychological resilience and salivary cortisol was also analyzed.Results would provide references of the psychological resilience interventions and further identify the role of HPA axis in the development of psychological resilience as well as its biomarkers in preschool children.MethodsPart one: Totally 26 kindergartens in rural areas of Fuyang,Hefei,and Maanshan in Anhui province were included applying the convenient sampling method from September 2019 to January 2020.General social-demographic characteristics,basic information of parents and family,diet and health status,lifestyle,abuse experiences,psychological and behavioral status,and psychological resilience among preschool children were assessed using the self-designed Preschool Children's Physical and Psychological Health and Related Life Experiences Questionnaires.Psychological resilience was assessed using the Chinese version of the Devereux Early Childhood Assessment for Preschoolers,Second Edition(DECA-P2).Epi Data 3.1 software was used to establish the database.SPSS 23.0 software was used for statistical analysis.The two-independent-samples t test or analysis of variance was used for comparison of psychological resilience between the different groups.Spearman correlation analysis was used to analyze the correlation between variables.The multivariate linear regression analysis was used to analyze the associated factors of psychological resilience.Part two: Children in primary and middle classes of kindergartens in the cross-sectional survey conducted in September 2019 to January 2020 were included in the cohort study.The follow-up survey began in October 2020,and a total of 1196 eligible follow-up questionnaires were collected until December 2020.The same questionnaire,which was applied in baseline survey,was used to collect the data among preschool children.The univariate and multivariate generalized estimating equation(GEE)model was used to investigate the associated factors of preschool children's psychological resilience in longitudinal study.The multivariate logistic regression model was used to analyze the associated factors of different change patterns of psychological resilience during the follow-up.Part three: Children in one kindergarten in Changfeng county were included in this study by cluster sampling method.The psychological resilience and socio-demographic variables were collected.Saliva samples at waking up in the morning,30 minutes after waking up,and before sleeping in the evening on a school day were collected.The enzyme linked immunosorbent assay(ELISA)was used for determination of saliva cortisol concentration.The difference of salivary cortisol concentration in groups with different psychological resilience was compared by using the t test or repeated measures analysis of variance.ResultsPart one: A total of 3636 eligible questionnaires were collected in the cross-sectional survey,and the overall effective response rate was 95.63%.Among them,1970 were males and 1666 were females.There were 1463 left-behind children and 2173non-left-behind children.The total mean score of psychological resilience was 38.9±8.0,and the mean scores on dimensions of initiative,self-regulation,and attachment/relationship were 40.1 ± 8.8,44.1 ± 9.0,and 36.5 ± 8.6,respectively.The number of preschool children with high,moderate and low levels of psychological resilience were 62(1.7%),1294(35.6%),and 2280(62.7%),respectively.Results from multivariate linear regression analysis showed that there were significantly positive correlations between overall psychological resilience and older age,fathers with college degree or above,the Maanshan area,daily outdoor activities with 4 hours and above,family monthly income more than 5000 yuan,and prosocial behavior;on the contrary,there were significantly negative correlations between overall psychological resilience and mothers with calm emotion during pregnancy,instruction of solid food after 6months of age,more sleeping problems,family dysfunction,parents' occasionally inconsistent attitude toward discipline,scolding education,and difficulty problems.In terms of the three dimensions,there were significantly positive correlations between initiative dimension and the Maanshan area,fathers with college degree or above,mother's age of 35 years and above,daily outdoor activities with 4 hours and above,family monthly income more than 10000 yuan,and prosocial behavior.Initiative dimension was significantly negatively correlated with left-behind,mothers with calm emotion during pregnancy,instruction of solid food after 6 months of age,more sleeping problems,family dysfunction,parents' occasionally inconsistent attitude towards discipline,scolding education,and difficult problems.As to self-regulation dimension,results indicated that self-regulation dimension were significantly positively correlated with the older age,Maanshan area,better eating behavior habits,family monthly income between 5000 to 10000 yuan,and prosocial behaviors;oppositely,self-regulation dimension were significantly negatively correlated with instruction of solid food after 12 months of age,more sleeping problems,family dysfunction,parents' occasionally inconsistent attitude toward discipline,scolding education,verbal abuse,and difficult problems.Besides,there were significantly positive correlations between attachment/relationship dimension and left-behind,fathers with college degree and above,mothers with high school degree and above,family monthly income more than5000 yuan,verbal abuse,and prosocial behavior;conversely,attachment/relationship dimension was significantly negatively correlated with the Fuyang area,single-child in family,mothers with calm emotion during pregnancy,instruction of solid food between6 to 12 months of age,better eating behavior habits,more sleeping problems,family dysfunction,and difficult problems.Part two: Totally 1196 follow-up samples included 663 males and 533 females.The total score of psychological resilience significantly increased from 40.1±8.1 at baseline to 41.5±8.6 at one year follow-up(P<0.001).As to the different dimensions,the scores on the dimensions of initiative and self-regulation significantly increased during the follow-up(P<0.001).However,the score on the dimension of attachment/relationship remained relatively stable during the follow-up(P=0.486).A total of 764(63.9%)children had consistent psychological resilience levels according to cut-off values during the follow-up;while psychological resilience levels altered among 36.1%children.The majority(87.0%)of 23 children with higher psychological resilience level at baseline turned to moderate or lower levels at follow-up;of the 484 children with moderate level of psychological resilience at baseline,3.9% and 33.9%,respectively,turned to higher and lower levels;while 33.2% of 689 children with lower psychological resilience level at baseline turned to moderate or higher levels at follow-up.During the follow-up period,the Typical pattern,the Increasing pattern,the Declining pattern,and the Low level pattern accounted for 28.1%,19.1%,14.3%,and38.5%,respectively.There was no statistically significant difference in psychological resilience scores during the follow-up among left-behind children,while the psychological resilience scores of non-left-behind children increased significantly during the follow-up.The multivariate GEE analysis showed that the single-child in family,mother with age 35 years old and above,and prosocial behavior were positive predictors of the overall psychological resilience of preschool children;on the contrary,mothers with calm emotion during pregnancy,more sleeping problems,parents' occasionally inconsistent attitude toward discipline,scolding education,difficult problems,and guardians' anxiety symptoms were negative predictors of overall psychological resilience of preschool children.As to different change patterns of psychological resilience,the single-child in family,mothers with college degree or above,family monthly income more than 5000 yuan,prosocial behavior were significantly positive associated with Typical pattern;contrarily,mothers with calm emotion during pregnancy and difficult problems were significantly negative associated with the Typical pattern.Besides,cesarean section,instruction of solid food between 6to 12 months of age,and guardians' anxiety symptoms were significantly negatively correlated with the Increasing pattern.There were significant negative correlations of the fathers with college degree or above,family monthly income of 5000 to 10000 yuan,and the prosocial behavior with Declining pattern.Part three: A total of 50 preschool children completed the saliva collection at all the three time points.There were 32 males and 18 females.The salivary cortisol concentration of higher overall psychological resilience group had a tendency of “more rapid awakening response and faster daily recovery”.However,there was no significant difference in the daytime saliva cortisol concentration between the higher and lower overall psychological resilience groups.For different collection time points,the difference was statistically significant in salivary cortisol concentration at 30 minutes after awakening between the higher and lower initiative dimension score groups(P=0.043).Besides,there was no significant difference in cortisol awakening response(CAR),diurnal cortisol slope(DCS),and area under curve(AUC)between the higher and lower psychological resilience groups.ConclusionsThe higher and moderate levels of psychological resilience just accounted for 37.3% of preschool children in rural areas of Anhui province,and the psychological resilience among most of rural preschool children needs to be further strengthened and improved.Psychological resilience among preschool children was the dynamic and changeable process.Overall psychological resilience of children significantly increased during the follow-up,but the development of different dimensions might be inconsistent.Many individual internal and external factors in the perinatal period and the growth process of children were associated to their psychological resilience.From the perspective of longitudinal development,the single-child in family,parents with higher educational level,older age of mothers,higher family monthly income,and more prosocial behaviors might be the protective factors for the overall psychological resilience of preschool children.Relatively,cesarean section,maternal poor mood during pregnancy,late instruction of solid food,more sleep problems,parents' inconsistent attitude toward discipline,scolding education,more difficult problems,and guardians with more anxiety symptoms might be the adverse factors for the overall psychological resilience among preschool children.In order to improve the physical and psychological health of preschool children,it is necessary to take into full consideration the individual characteristics and adopt comprehensive measures combining family,school,and society factors to implement the psychological resilience interventions.Besides,this study did not find the obvious association between psychological resilience and salivary cortisol among preschool children.However,the significant association shown in several indicators or dimensions needs to be further confirmed by the larger sample. |
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