| BackgroudSince its major economic reform in the 1980s,China has experienced dramatic urbanization and industrialization,leading rural workers to move to urban areas and creating a large migrating population.At the same time,choices for migrant parents in relation to their children are difficult in China,because of the way in which the Chinese government controls rural-urban migration,mainly through the household registration system.Migrants and their children are allowed only limited access to education,health,and other public services in destination cities,resulting in the issue of "left-behind children(LBC)." In past few decades,the number of the LBC has increased dramatically.In 2010,there were about 61 million LBC,comprising 37.7%of all rural children in China.As a socially vulnerable group,LBC can not enjoy typical family support,education and care.Their rights and interests have been seriously undermined,which have brought about a series of social problems.In the field of public health,the psychological and behavioral problems of LBC have become an impotant focus of research.AimIn order to better understand the effect of parental migration on children's psychological and behavior,this study compares the psychological and behavioral problems of rural children(current-LBC,previous-LBC and never-LBC)and their related influences.This study looks at the validity and feasibility of a psychological intervention program for LBC in rural communities,and provides an evidence-based foundation for the formulation of policies for children's health and well-being.MethodsThis study uses a combination of quantitative and qualitative methods.For the quantitative approach,strength and difficulties questionnaire(SDQ)and self-made scale were used to measure children's psychological and behavior problems.For the qualitative approach,semi-structured interviews were used.(1)Quantitative survey(cross-sectional survey):Multi-stage stratified cluster sampling method was used to select three counties in Zhejiang Province and two counties in Guizhou Province according to the number,geographical distribution and economic conditions of left-behind children.A total of 2746 children(1438 current-LBC,712 previous-LBC,and never-LBC)were sampled.For data analysis,the appropriate independent variables were selected by univariate analysis,and then included in children's psychological and behavioral models.Specific variables were based on the dependent variable type,and the continuous dependent variables were analyzed by multiple linear regression analysis.The binary dependent variables were analyzed by unconditional logistic regression analysis.(2)Quantitative survey(intervention assessment):Multi-stage stratified cluster sampling method was used to select 40 rural villages in three counties of Zhejiang Province as the location for LBC intervention programs,20 intervention villages and 20 control villages.The intervention spans three years(May 2015 to May 2018,but this study covers only May 2015 to May 2016).The number of baseline samples was 389,including 202 in the intervention group and 187 in the control group.The number of samples after intervention was 222,including 117 in the intervention group and 105 in the control group.For data analysis,only LBC involved in both the baseline survey(0 months)and post-intervention(12 months)were included in the analysis.With the intervention group and control group,we compared baseline socio-demographic characteristics,pre-intervention mental health scores,and changes in post-intervention mental health scores.(3)Qualitative interviews:We used thematic framework analysis to understand the living conditions of LBC,their experiences and mental health status,as well as the reasons why parents'left their children behind and how they weighed its pros and cons.ResultsCross-sectional survey analysis showed that:(1)There were statistically significant differences in children's grade distribution,family economic status,Parents,education,and parents' work among the three groups of current-LBC,previous-LBC and never-LBC.(2)There were statistically significant differences in the emotional symptoms,peer problems and total difficulties scores among the three groups of children.Current-LBC scored significantly higher in emotional problems compared with never-LBC,Previous-LBC scored significantly higher in peer-related problems compared with never-LBC,current-LBC and previous-LBC had significantly higher scores of total difficulties than never-LBC.There was significant difference between the three groups in the abnormal rate of total difficulties.The prevalence of abnormal rate regarding total difficulties was significantly higher in current-LBC compared to never-LBC.(3)Regression analysis showed that the experience of being left behind or previously left behind are associated with children's emotional issues;the experience of being previously left-behind are associated with social issues;the experience of being left behind or previously left behind is positively correlated with their total difficulties score;gender,age,family economic circumstances,and geographic location were important contributors.(4)There were statistically significant differences in smoking,drinking,skipping school,exam cheating and gambling behavior among the three groups of children.Current-LBC and previous-LBC reported significantly higher rates in smoking or skipping class compared to never-LBC.Previous-LBC reported significantly higher rates in drinking alcohol,cheating on exams and gambling compared to never-LBC.(5)Left-behind children's experiences are associated with drinking behavior;left-behind and formerly left-behind children's experiences are associated with skipping school.Quantitative survey(intervention assessment)found that:(1)There was no significant difference in the socio-demographic characteristics(gender,age,parental education,etc.)of the LBC in the intervention group versus the control group.(2)There were no statistically significant differences in the mental health scores of the pre-intervention groups of children(0 months).(3)There was no statistically significant difference in the mental health scores between the intervention group and the control group before and after intervention.The qualitative interviews found that:(1)The primary reasons for leaving children behind include personal or family factors and societal factors.(2)The situation of the LBC is in line with principles of "from close relations to mere acquaintances".(3)Children are left-behind for a long period of time and therefore have trouble communicating with their parents.(4)The experiences of left-behind have a negative impact on their mental health and growth.ConclusionParents' absence in the household is an important risk factor for children's mental health,whether they are currently left-behind or previously left-behind;gender,age,family economic status and geographic location are important factors of this phenomenon;formerly left-behind children's experiences are related to behavioral problems.As the mental health intervention program for children left behind in rural areas is ongoing,its effects are yet to be determined. |
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