Influence of social support and rearing behavior on psychosocial health in left-behind children

As a result of rapid economic development and urbanization over the last three decades in China, surging numbers of rural-to-urban migrant workers are a unique phenomenon [1]. The nationwide migrant population has reached 245 million at the end of 2013, more than 1/6 of the total population, based on the 2014 Report on China’s Migrant Population Development [2]. Due to limitation of income level, housing conditions, urban educational policy and so on, many migrants are prone to leave their children in the countryside under the care of relatives and friends. These children are usually called “left-behind children” (LBC). The report released on May 2013 by China Women’s Federation indicated that over 61 million LBC in Chinese rural area, accounted for 21.88% of all national children, the increase number reached 2.42 million during five years [3].

Compared to non-left-behind children, due to their parents’ absence, LBC encountered more difficulties such as education interruption, nutrition deficiency and psychological confusion, and showed more psychological problems, less pro-social behaviors, greater communication difficulties like sensitivity, low self-esteem, proneness to violations and failure to comply disciplinary [4‐6]. Shaoxing city, which locates in eastern China, has attracted a large number of migrant workers, especially in developed towns (Maan, Qianqing et al.). On the other hand, some local farmers migrate to the bigger developed cities such as Shanghai, Kunming, Hangzhou and the like, especially from underdeveloped towns (Jidong, Wangtan et al.), looking for higher family income.

Liu et al. [7] discovered that the positive rate of LBC’s psychological problems was significantly higher than that of NLBC’s. A large-scale study based on 8627 rural pupils chosen from 10 provinces showed that children living with parents had the best academic performances and LBC with only one of the parents working out performed the worst, especially those who only lived with father [8]. Huang et al. [9] found that 3 groups ranging from low to high mental health level were LBC. Stay-at-home experience cannot only influence the mental health of LBC but also continue to influence that of children who had been once left at home.

Most of these investigations suggest that the main influential factors to mental health included family relationship, family education, social network, personality trait, coping style and so on [10‐12]. Previous studies reported that there were significant positive correlation between social support and mental health in LBC [7, 10, 11, 13]. According to the evidence literature shows, the parenting style reported by the subject is an important pathogenic factor, albeit non-specific, influencing individual vulnerability to mental illness [14‐17].

In this study, psychosocial health of LBC was assessed by comparing with NLBC. Whether social support and rearing behavior affect psychosocial health of LBC was analyzed by investigation.

Children are highly dependent on social welfare, and they need access to education, basic health care, entertainment and family care, which are indispensable to their growth. Due to limitation of city policy, the cost of raising children of migrants has greatly increased in the city. On the other hand, the situation of migrants themselves is very hard-- low wages and long working hours, which hampers to foster their children in the city. So they have to leave their children at home [25]. Left-behind children phenomenon is the result of large-scale labor migration between the rural and urban social system. Because of the growth environment has been systemic damage or defects in physical and mental health, learning and socialization, etc., LBC are faced with many problems [26]. Childhood is not only the first stage of life development, but also the most critical period of rapid physical and mental development. Due to the absence of parents, other guardian such as grandfather, grandmother, uncle, auntie and so on, often paid more attention to physical health (personal safety, food, clothes et al.) rather than changes on their mood and emotion. No opportunity to communicate with their families deeply affected LBC’s psychological health. LBC were often lack of security sense and had poor interpersonal communication skills [26, 27]. There is some evidence that the living situation of the Chinese LBC is getting worse [27‐29] and these children are experiencing significant mental health problems, such as anxiety and behavioral problems [5, 28, 30, 31].

Our results indicated that LBC’s psychological health was much lower compared to NLBC’s. This finding corresponded to the results reported by similar studies [4, 9, 32, 33]. Jia et al. found that LBC reported poorer health-related quality of life than NLBC due to psychological dysfunction [4]. Compared with NLBC, LBC had great impairment in related factors of psychological health such as social support and rearing behavior. The scores of general support and subjective support of LBC were significantly lower than those of NLBC’s, which was similar with other studies [34, 35]. The guardian of LBC adopt less active forms,giving less emotional warmth,more likely to use the severely negative way like rejection or punishment compared to the guardian of NLBC.

A study showed that the detection rate of psychological problem was high in LBC, reached 57.14% based on the Middle School Students’ Mental Health Scale, there were significant differences in some psychological domains between gender, guardian (mother or father or others) and the time of whose parents had been out [36]. The positive rate of LBC’s psychological problems was 81.8%, significantly higher than that of NLBC’s (18.2%, P < 0.05) [25].

The present results revealed the main factor that influenced psychological health was subjective support. A positive correlation was found between the subjective support and psychological (Table 3), which was similar with other study [35, 37]. The effect of subjective support ranked first in the included variables (Table 4). The subjective support score of LBC with both parents going out was significant lower than that of those with only one parent going out (24.87 ± 4.27 vs. 26.06 ± 4.04, t = 2.556, p = 0.011). Social support impose certain effect on psychological health of left-behind children,it should attract more social concerns [7]. Social support is a function of social relationships provided by members within a social network, which is generally related to the number of or contact frequency with family members, relatives, friends, and classmates. High socioeconomic status families are capable to provide a large number of ancillary conditions and social support, such as adequate food and nutrition, parental care and attention, good learning conditions. However children of low socioeconomic status are deficient on these resources. LBC are a typical low socioeconomic status in the social life in China today [31]. Due to the distance with parents, it is more difficult for LBC to seek help. Although schools and society pay more attention to them than before, LBC still get relatively little concern and limited social support, so we should take efforts to provide enough support.

Another factor that might have contributed to the differences in psychological health was rearing behavior. Rearing behavior from father, mother or other watchers in the family system had impacts on the level of mental health for LBC [9]. In the early childhood mental development stage, parents are the most important roles to help children establish a correct outlook of judgment and value of right and wrong. Due to the lack of parental care and family love, LBC will inevitably lose their balance when they feel the differences between NLBC. Sometimes aggressive behavior will take place in order to keep the balance of their psychology [38]. The other guardians will be responsible for more things because of parents’ absence. Except for taking care of children, they also do farm work, care for the elderly losing self-care ability, so that they are exhausted and vulnerable to scold and punish the children rather than encouragement and praise. Moreover, such as inter-generational care, which grandparents take, is always a sense of difficulty, after all, the rural elderly in low educational level and backward concept, always pay more attention to adaptation rather than education, material rather than mental. So under the rearing model, it is easy for children to form excessive self or timid psychological characteristics [9]. One study found that, there was significant difference of mental health between LBC and NLBC, mainly in three aspects including anxiety, allergic tendencies and impulses propensity. In other words, the experience of staying at home influenced children’s mental health in the future [9].

Psychological health was also affected by general health status (Table 4). Compared to bad general health status, psychological health level of self-reported good general health status is higher in LBC. General health status has a positive effect on psychological health. One study showed that mental health and physical health were closely related, often sick people, who were prone to anger, liked to blame someone else. However healthy people were able to maintain a good mood, a healthy attitude, and a better social adaptability [39].

In brief psychological health of LBC was worse than NLBC’s, weak social support and traditional rearing behavior further aggravating their psychological health problem. Parents, guardian, school teachers and community workers should keep in good touch, pay close attention to the LBC’s physical and mental health. Except for encouraging LBC maintain telephone or internet contact with parents weekly or daily, the support network of various forms also should be established, including family, school and community, to jointly promote healthy growth of LBC.

The findings of this study highlighted the differences of psychological health, social support and rearing behavior between the left-behind children and non-left-behind children. This analysis provided additional evidence supporting that psychological health, general social support, subjective support and emotional warmth in LBC were lower than that in NLBC, but the score of rejection were higher compared to NLBC’s. A positive correlation was found between psychological health and social support, as well as a negative correlation between psychological health and rearing behavior (rejection, overprotection). The main influential factors on psychological health were subjective support, rejection and general health status.