Individual, Family, and Social Determinants of Depression Among Left-behind Children and Non-Left-behind Children in Rural China: A Comparative Analysis

Background and Purpose: Existing studies often conclude that the mental health of left-behind children (LBC) is worse than their non-LBC counterparts (e.g., Tang et al., 2018). Research indicates that LBC’s mental health is associated with a wide array of individual, family, and social factors (e.g., Wang et al., 2019). However, the differential effects of these factors have rarely been studied with a sample of both LBC and non-LBC. To bridge the gap, this study investigated the individual, family, and social determinants of depression among a sample of both LBC and non-LBC in rural China.

Methods: Data were collected in Nanzheng and Dali, two rural counties of Shaanxi province in western China. Multi-stage sampling was used to identify 19 elementary schools and all the 5th-grade students at these schools (usually one or two classes from each school). This study analyzed both caregiver and child data, resulting in a dataset that included 1,200 children (the vast majority aged 10 to 12), with 626 non-LBC and 574 LBC (at least one parent currently worked away from home).

Our dependent variable is depression, measured by the Children’s Depression Inventory (Kovacs, 1992). Independent variables include a wide range of family, school, and social factors that were all measured using standardized questionnaires. We also included several child (age, sex, self-rated health) and parent (educational attainment and years working away from home) characteristics and the sampling region as control variables.

Results: Among non-LBC, significant predictors included children’s self-rated health (b = -.03, p = .001), parent-child conflict (b = .05, p < .001), being bullied at school (b = .04, p < .001), general support from caregivers (b = -.11, p < .001), emotional support from friends (b = -.03, p = .001), and emotional support from teachers (b = -.05, p < .001), explaining 30% of the variance in depression. Among LBC, significant predictors included self-rated health (b = -.03, p = .001), being bullied at school (b = .05, p < .001), caregiver support (b = -.08, p < .001), and parent-child communication (b = -.04, p = .009), explaining 22% of the variance in depression. Two interaction effects were found significant: the one between the left-behind status and parent-child communication and the one between the left-behind status and emotional support from friends. Further probing indicated a significantly negative effect of parent-child communication on depression only among LBC (b = -.04, p = .002) and a significantly negative effect of emotional support from friends on depression only among non-LBC (b = -.03, p = .002).

Conclusion: The left-behind status is a threat to the mental health of children living in rural China. Including a wide range of individual, family, and social determinants, this study deepens our understanding of this issue by pinpointing the protective effect of parent-child communication and the exacerbating effect of the lack of emotional support from friends among LBC. In the future, social work researchers and practitioners need to consider the salient effects of these factors when striving to support this population.