Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.
Advertisement
Pediatric Research (2025)
Metrics details
Prolonged parental separation at young ages has significant adverse effects on development in left-behind-children (LBC). We aimed to compare mental health status, emotional and behavioural problems, and their association with socioemotional development between LBC and their counterparts.
Cross-sectional studies comparing LBC and non-LBC published from 2000 onwards were searched. Primary outcomes included depression, anxiety emotional and behavioural problems. Secondary outcomes included loneliness, self-harm, suicide, and risk-related behaviours. Quality of all included articles was assessed by Joanna Briggs Institute (JBI) critical appraisal. Data was analyzed by random model-based effect method.
78 observational studies comprising of 394,308 children aged 2–18 were included. Compared to NLBC, LBC had significantly more depression, anxiety, emotional and behavioural problems, conduct problems, self-harm, loneliness, peer bullying, attempts of smoking and alcohol consumption. Subgroup analyses found that younger LBC between the ages of 6 to 12 were at greater risks of poor mental health, emotional and behavioural problems.
Absent parental care prevents healthy socio-emotional development and hinder the formation of secure attachment. Poor social-emotional development leads to worse emotional resilience against psychological stressors, while LBC residing in rural areas also experience additional risk factors of low household income and poor access to mental health services.
Prolonged parental separation negatively influences mental health, especially in younger children between the ages 6 to 12.
Poor social-emotional development in left-behind children is associated with worse emotional resilience against psychological stressors.
Additional risk factors including residing in rural areas, low household income, and poor access to mental health services predisposes left-behind children to high risks of mental illness.
Timely support services targeted towards strengthening resilience factor such as learning better emotional and behavioural coping strategies and improving school and peer support to address increased risk of mental health problems are required for current left-behind children.
Left-behind children (LBC) are an expanding group of young individuals in their early childhood or adolescence exposed to long-term, work-related migration of one or both of their parents. Their wellbeing is being increasingly recognised as a prominent social, economic and health problem in many countries.1 The global prevalence of LBC is estimated to be more than 100 million.2 As a result of rapid urbanization in developing countries, a large number of rural residents from relatively poor, underdeveloped, and geographically isolated areas have chosen to migrate to cities for better job opportunities aimed to improve household income.3 Their children are left in the rural settings and their care is entrusted to grandparents, relatives or older siblings due to the high cost of living, schooling in cities and the long working hours.3
With improved household income, some studies showed positive effect of parental migration on overall wellbeing and development of LBC.4,5,6,7 However, a large proportion of epidemiological studies indicated the detriments of early and prolonged separation from parents on the development and mental health of LBC as compared to their counterparts of non-left-behind children (NLBC).
Studies conducted at countries with different income levels and demographic factors have indicated significant heterogeneity in the prevalence of emotional and behavioural problems in children, with an estimate from 5.5% to 18%.8,9,10 Multiple factors are thought to contribute to the development of these problems, including poverty, stressful school and family environments, negative life events, and living in rural areas.11 Left-behind children is a unique population vulnerable to emotional and behavioural problems as they are exposed to a range of risk factors associated with poor socioemotional development. Thus, LBC provides us with an important opportunity to assess the effect of aforementioned risk factors on emotional and behavioural problems.
Secure attachment formed between responsive and present caregivers and their child acts as the foundation for healthy socioemotional development.12 Children with healthy socioemotional development are more resilient against various psychological stressors that arise in social situations, as they are equipped with effective emotional and behavioural regulation strategies.13 In contrast, early and prolonged parental separation predisposes LBC to emotional and behavioural problems as secure attachment cannot be formed between LBC and their parents who are unable to respond timely to their needs.12,14,15 Thus, significantly higher prevalence of mental health problems, self-harm and suicidal ideation have been identified LBC than NLBC.16,17,18,19
To date, several meta-analyses have compared health outcomes, depression, and resilience of LBC to NLBC.2,20,21,22,23,24 However, a comprehensive analysis exploring individual parental migration experience and demographic characteristics on the manifestation of emotional and behavioural problems and depression in left-behind children have not yet been conducted. This meta-analysis aimed to compare prevalence of key mental health outcomes, and resilience factors among LBC and NLBC.
The review protocol was registered at Prospero (registration ID: CRD42021224069). A systemic research search conducted between November 2020 to April 2024 was performed using the following databases including MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO, and Web of Science.
Searches were confined to English literature published from 2000 onwards. Key terms searched have been described in appendix 1.
The criteria used to determine the inclusion of studies in the systematic review and meta-analysis were as follows: (1) Left-behind children were defined as exposure to parental migration by one or both parents for more than six months; (2) migration can be domestic or internal; (3) primary outcomes of interest were depression, anxiety, emotional and behavioural problems; secondary outcomes include loneliness, self-harm, suicide, and health-related behaviours; (4) each study must have a comparison group present; (5) participants were aged 18 and below. Studies were excluded if: (1) children also migrated with parents; (2) in left-behind group, parental migration exposure was defined as anything less than six months; (3) qualitative studies or interventional studies. We specifically excluded studies without a comparison group as the study aimed to compare mental health outcomes between left-behind and non-left behind children. Without a comparison group, differences in prevalence or severity of mental health outcomes could not be determined.
Title and abstracts of non-duplicated papers using the search strategy were independently screened by two researchers to identify studies that potentially met the inclusion criteria outlined above. Full text of potentially eligible studies was then independently. Study characteristics data were then extracted individually by two researchers for evidence synthesis and assessment of study quality. In case of disagreements on inclusion of studies or data extraction, a third author was consulted. Extracted data included: title, country, publication year, sample size, study design, study population (number of LBC and NLBC), participant demographics (including age, ratio of sex, duration of separation from parents), primary and secondary outcomes, and study quality assessment score.
The methodological quality of each study was assessed independently by two researchers using the Joanna Briggs Institute (JBI) critical appraisal. This tool is widely used for cross-sectional studies and meta-analyses in assessing the trustworthiness, relevance, and results of published papers.25 If JBI score was less than 5, then the study was considered for exclusion.
Outcome variables were reported as either continuous data or categorical data. Mean difference and effect size for continuous data variables such as depression score were analysed via random effects model. Categorical data outcomes were analysed in the form of risk ratios.
I² was used to assess heterogeneity. Egger regression analysis was conducted to assess publication bias, with further sensitivity analysis if publication bias was identified. Subgroup analyses were also conducted to identify additional factors that may explain any significant associations of poor mental health outcomes in LBC. All subgroup analyses were hypothesis driven. Parental migration status, where two parents have migrated has been significantly associated with worse child mental health outcomes amongst LBC in many previous studies.14 In terms of region of residence, LBC residing in rural regions have been found to have worse developmental outcomes due to worse access to healthcare and poor demographic factors such as lower household income and education.26 For mean age of child, being left-behind at younger ages have been shown to be a significant risk factor for worse mental health and socio-emotional and behavioural difficulties.27,28
We identified 2235 potential records. After removing 1482 duplicate studies, titles and abstracts of the remaining 753 studies were screened and 446 studies were excluded. Full-text reading of 307 studies was assessed for eligibility based on eligibility criteria and JBI score.
Of these, 229/307 (74.3%) were excluded. Detailed reasoning of excluded studies is presented in Fig. 1. After full-text assessments, 78 studies which met the eligibility criteria were included in this meta-analysis.
PRISMA flow chart of literature search.
Full details of the included studies are shown in Table 1. Of the 78 studies, 77 studies conducted research in a single country, while one study recruited participants from multiple countries.29 Sixty-nine studies recruited participants living in China, four studies from Indonesia,30,31,32,33 three in Romania,34,35,36 two in Thailand,31,37 one in Philippines31 and two in Vietnam.31 In terms of study design, 74 studies were cross-sectional in nature, three were cohort studies,38,39,40 and one study was longitudinal.
There was significant variation in the inclusion criteria and mental health assessment tools used for data collection across studies. Sixty-one studies data was collected using a questionnaire; four studies collected data by interviewing participants.41,42,43,44 Strengths and Difficulties questionnaire was the most commonly used survey.29,31,32,33,36,37,45,46,47,48,49
The total number of participants was 394,308 and the sample size of individual studies ranged from 22535 to 124,357.50 The estimated mean age of participants was 12.89 years, ranging from 6.51 years51 to 15.87.52 With 149,380 children identifying as ‘left-behind’, the LBC group accounted 37.9% of the study population.
As presented in Table 2 and Fig. 2, nineteen studies with a total of 177,205 participants measured depressive symptoms.12,40,44,49,50,51,53,54,55,56,57,58,59,60,61,62,63,64,65,66 LBC had significantly greater depressive symptoms when compared to NLBC, with a mean difference of 1.362 (95% CI: 0.066 to 2.659; p < 0.05). Heterogeneity was statistically significant (I2 = 99.845%, p < 0.001).
Forest plot for (a) Behavioural and emotional problems, (b) Conduct problems, (c) Strengths and difficulties questionnaire score, (d) Depression, (e) Smoking.
As presented in Table 3, subgroup analysis results found that younger LBC aged 6 to 12 had significantly worse depression level (MD = 1.281, 95% CI = 0.033 to 2.529, p < 0.05). No significant mean difference in depression scores between LBC and non-LBC is identified for children 13 years and older. Worse mean depression scores in LBC were only identified in studies that included current LBC (MD = 0.971, 95% CI = 0.163 to 1.779, p < 0.05). In terms of financial situation, children from a poorer household had significantly worse depression as compared to their NLBC counterparts (MD = 0.809, 95% CI = 0.590 to 1.027). Age of parental migration also influenced depression scores. Left-behind children whose parents migrated when they were under 7 years of age had significantly higher mean depression score compared to NLBC (MD = 0.656, 95% CI = 0.389, 0.924). However, parental migration when the child is 7 years or older did not significantly influence mean depression score in LBC.
Nine studies with a total of 29,284 participants investigated anxiety in children35,39,56,57,59,67,68,69 LBC had significantly greater anxiety than NLBC, with a mean difference of 1.471 (95% CI: 0.082 to 2.860, p < 0.05) (See Table 2). A small significant effect size of 0.919 (95% CI: 0.057 to 1.781, p < 0.05) was also identified. Heterogeneity for mean difference (I2 = 99.97%, p < 0.001) and effect size were statistically significant (I2 = 99.83%, p < 0.001).
Twenty-one with 61,951 participants investigated emotional and behavioural problems in LBC.1,29,31,33,34,37,40,45,47,49,53,54,62,68,70,71,72,73,74,75,76 Twelve studies measured behavioural and emotional problems as a continuous variable, while nine studies measured behavioural and emotional problems as a categorical variable. As presented in Table 2, LBC had more emotional and behavioural problems than NLBC, with a mean difference of 0.330 (95% CI = 0.191 to 0.469; p < 0.05) and effect size of 0.116 (95% CI = 0.048 to 0.185). Heterogeneity for mean difference (I2 = 90.34%, p < 0.05) was statistically significant. Similar results were identified in studies that measured emotional and behavioural problems as a categorical variable. The risk of having behavioural and emotional problems was also greater in LBC (RR = 1.803, 95% CI = 1.213 to 2.679) than NLBC.
Thirteen studies with 37,942 participants investigated conduct problems as a continuous variable,1,40,45,49,53,62,68,70,71,72,73,77 and six studies with 24,009 participants analysed it as a categorical variable.29,31,33,37,78,79 As a continuous variable, the prevalence of conduct problems was significantly greater in LBC than NLBC (MD: 0.108, 95% CI: 0.040 to 0.176; p < 0.05), but its effect size was minimal at 0.090 (95% CI: 0.060 to 0.120; p < 0.05). As a categorical variable, the risk of having conduct problems was not significantly greater in LBC compared to NLBC (RR: 1.256, 95% CI: 0.847 to 1.866; p > 0.05). Heterogeneity was only significant for mean difference (I2 = 63.69%, p < 0.001).
Subgroup analysis results for categorical variables were reported in Table 4. Younger LBC aged 6 to 12 years (RR = 1.439, 95% CI = 1.014 to 2.043, p < 0.05) were at greater risks of having behavioural and emotional problems as compared to older LBC 13 years and over (RR = 1.234, 95% CI = 1.063 to 1.433, p < 0.05). Similarly, a greater mean difference in emotional and behavioural problem scores was identified between younger LBC and NLBC aged 6 to 12 (MD = 0.404, 95% CI = 0.164 to 0.644, p < 0.05) as compared to older children 13 years or more (MD = 0.311, 95% CI = 0.134 to 0.488, p < 0.05). Based on region of residence, only studies that included LBC from rural regions (RR = 1.259, 95% CI = 1.063, 1.492, p < 0.05) had a greater risk of having behavioural and emotional problems as compared to their NLBC counterparts.
Similar subgroup analyses results for conduct problems as a continuous variable were found. At younger ages (MD = 0.207, 95% CI = 0.061 to 0.353, p < 0.05), a greater mean difference in conduct problems between LBC and NLBC was identified than studies with children with a mean age 13 years or more (MD = 0.077, 95% CI = 0.012 to 0.143, p < 0.05). Only studies that included current LBC resulted in significant mean differences in conduct problems between LBC and NLBC (MD = 0.127, 95% CI = 0.061, 0.194, p < 0.05).
Nine studies with a total of 50,495 participants explored loneliness as a continuous variable,10,40,49,68,70,80,81,82,83 and 5 studies with 22,303 participants measured loneliness as a categorical variable.19,30,44,74,79 No significant mean difference for loneliness experienced was found between LBC and non-LBC when measured as a continuous variable (MD: 0.868, 95% CI = −0.078 to 1.815; p > 0.05). However, a minor significant effect size of 0.131 (95% CI = 0.018 to 0.245, p < 0.05) was identified.
Five studies with a total of 147,013 participants explored suicide ideation and attempts,19,59,74,84. LBC had 2.323 times the risk (95% CI: 1.309 to 4.121; p < 0.05) of committing self-harm compared to NLBC. The heterogeneity was statistically significant (I2 = 94.85%, p < 0.001).
Seven studies with a total of 31,982 participants measured self-esteem.39,44,63,67,85,86,87 No significant differences in self-esteem were found between LBC and NLBC.
Nine studies with a total of 33,704 participants investigated parent-child relationships in the form of parental support.10,12,49,51,54,61,62,85,88 Parental support in this study was measured by parental responsiveness and sensitivity to needs of the child. Some scales used across different studies included the Parent-Child Relationship Scale (PCRS) and Family Adaptation and Cohesion Evaluation Scales.89,90 Parental support was significantly worse in LBC than NLBC with an effect size of −0.139 (95% CI = −0.264, −0.014, p < 0.05). The heterogeneity for effect size (I2 = 95.90%, p < 0.001) was statistically significant.
Ten studies with a total of 34,187 participants measured peer support,21,42,51,61,62,81,86,87,88,91 while six studies with a total of 14,567 participants measured school support.42,51,54,61,88,92 No significant differences in peer support and school support were found between LBC and NLBC.
Eleven studies with a total of 36202 participants explored peer bullying as a categorical variable.19,29,34,37,44,66,72,73,77,78,79 While thirteen studies measured peer bullying as a continuous variable.1,45,49,51,53,61,62,66,72,73,77,86 LBC were 1.466 times more likely (95% CI = 1.180 to 1.820; p < 0.05) to have experienced peer bullying compared to NLBC. As a continuous variable, LBC were significantly more likely to have experienced peer bullying compared to NLBC (MD: 0.150, 95% CI: 0.060 to 0.239; p < 0.05). The heterogeneity was statistically significant (I2 = 88.61%, p < 0.001).
Subgroup analysis revealed that significant mean differences in peer bullying between LBC and NLBC were only found in children aged 13 years or older (MD = 0166, 95% CI = 0.128 to 0.204, p < 0.05). Significant mean differences in peer bullying between LBC and NLBC were only identified from studies that sampled children residing in rural regions (MD = 0.172, 95% CI = 0.032 to 0.313, p < 0.05).
Four studies with a total of 21,940 measured prolonged screen time and internet addiction.57,63,74,93 No significant difference was identified in prolonged screen time and internet addiction between LBC and NLBC.
Six studies with a total of 31,666 participants investigated past attempts at drinking alcohol.41,62,74,86,91 LBC had 1.866 times the risk (95% CI = 1.030 to 3.381; p < 0.05) of having drunk alcohol previously compared to NLBC. The heterogeneity for smoking was statistically significant (I2 = 89.70%, p < 0.001). Although the risk for past attempts for drinking was significantly higher in LBC, no significant difference in risk for smoking was found between LBC and non-LBC.
Subgroup analysis revealed that LBC aged 6 to 12 were more likely to attempt smoking (RR = 1.207, 95% CI = 1.073 to 1.359, p < 0.05). No significant difference in attempt for smoking was identified for LBC and NLBC 13 years or older (RR = 1.049, 95% CI = 0.809 to 1.360, p < 0.05).
Egger test results in appendix 2 suggest publication bias is minimal for all outcome variables except parental support (Egger’s value = −5.071, p = 0.0007), loneliness (Egger’s value = 6.454, p = 0.006) and conduct problems (Egger’s value = 1.809, p = 0.0009). Sensitivity analysis was done on these variables by removing one study per time, the cumulative analysis suggested that the results are not due to any single study.
Compared to controls that were not left behind, LBC was found to have more depression, anxiety, behavioural and emotional problems, conduct problems, self-harm, loneliness, peer bullying, and smoking and alcohol consumption.
Worse mental health in LBC may be explained by poor socio-emotional development at younger ages due to poor support from parents and peers, along with negative peer interactions.94 Lack of communication and contact from parents often lead to disruptions in parent-child attachment and greater feelings of loneliness amongst LBC. Disrupted parent-child attachment has been associated with worse emotional coping and depression.14 Similar results were also identified in the current study with LBC being at greater risk of having depression, behavioural and emotional problems, conduct problems, committing self-harm, and engaging in risk behaviours. While secure attachments allow for health socio-emotional development, equipping children with better social skills and coping strategies, disturbances in parent-child attachment are associated with reduced emotional resilience and poor emotional coping against psychological stress.14 Lack of healthy emotional coping and resilience against psychological stress predisposes LBC to greater risks of emotional and behavioural problems, poor mental health outcomes and engagement in risk behaviours.
Our findings of poor parental support in LBC and its association with more emotional and behavioural problems add value to existing knowledge, indicating the importance of parental support as a positive resilient factor in forming secure attachments to reach healthy socioemotional development as described in the resilience framework.95,96,97 Findings from our study supported results of previous studies that suggested an absence of parental care and the lack of adult models to demonstrate healthy emotional and behavioural patterns compromise the mental health of children and lead to more unsafe practices.98,99,100 Hence, poor socio-emotional development can increase the risk of engagement in risk behaviours such as smoking and drinking as an unhealthy emotional coping strategy against psychological stress. Lack of communication and distance between parents and LBC may lead to delayed and inappropriate responses to their child’s needs, which may further aggravate feelings of loneliness and isolation in LBC.101 Results from previous and the current study consistently suggest the importance of parents providing emotional and behavioural support and adult role models guiding children.100
The influence of parent-child attachment, family dynamics and parenting practices on the development of healthy emotional and behavioural regulation in children has been well established.15 Young age at separation for LBC acts as another contributing risk factor for poor mental health outcomes. Subgroup analysis revealed that studies with a younger LBC (mean age between 6 to 12 years) were at greater risks of poor mental health outcomes, including having higher mean score in depression, behavioural, and emotional problems, smoking attempts, conduct problems, and self-harm. This confirmed that parental migration at younger ages has a more significant influence on children. Although previous studies have found significantly worse mental health in LBC across children of all ages, majority of the studies and reviews have indicated worse anxiety and depression amongst LBC separated with their parents at younger ages.27,28 Young children are especially sensitive to the detrimental effects of disturbed family dynamics and absence of parental figures as rapid social and emotional development occurs in early childhood.13 However, prolonged parental separation at any age can have significant long-term detrimental effects on child socioemotional development and mental health.14,26,27,28
Negative peer interactions in the form of increased peer bullying may also explain worse mental health outcome in LBC. Poor socio-emotional development that accumulates from a younger age can negatively influence a child’s peer interactions at school. In the current study, we found that LBC were at greater risks of peer bullying victimization as compared to their counterparts that were not left behind. This aligns with previous studies that found a greater prevalence of bullying in children and adolescents with emotional, behavioural and conduct problems.102 Children with emotional, behavioural, and conduct problems may have difficulties in behavioural and emotional self-regulation, leading to destructive tantrums and outbursts of temper loss, hindering their ability to engage in social opportunities to form friendships at school.96 Bullying victimization presents as another psychological stressor linked to anxiety, depression and suicidality amongst children and adolescents.103 Disturbances in family dynamics at home due to prolonged separation from parents coupled with peer bullying at school can severely hurt the mental health of LBC.
In addition to prolonged and early parental separation, LBC are often left-behind in rural regions with worse structural and environmental supporting factors, including worse access to mental health and social services in conjunction with families poor financial situation and low income.95 In our study, we found that LBC residing in rural regions had significantly worse emotional and behavioural problems, lower SDQ scores and experienced more peer bullying than non-LBC, while no significant differences were identified between LBC and non-LBC in children residing in urban regions. Previous studies have identified multiple shortcomings in mental health services in rural China.79 This included a lack of available mental health services in rural towns and villages and a lack of mental health training in teachers, which prevents them from identifying signs of mental illness in children and adolescents.79
To mitigate adverse effects of being left behind, different promising interventions to improve psychological resilience have been implemented and researched. Interventions including group psychological services aimed to help LBCs develop emotional management strategies and improve psychological capital qualities such as self-efficacy, optimism, and hope have significantly improved mental health in LBC.46,104 Furthermore, the importance of a supportive school environment through peer and teacher support also appeared to be positive resilient factor to improve mental health and academic achievement.105,106
One limitation of the study was that most included studies were conducted in China and Southeast Asia. Thus, while the author acknowledges that cultural factors may influence resilience, this could not be analysed in the current study. Comparisons between LBC in low-to-middle-income countries and high-income countries also could not be made due to the lack of studies from different countries limiting the generalisability of the study.
Prolonged parental separation negatively influenced mental health, especially in younger children between the ages 6 to 12. As improving household income is the primary reason prompting parental migration from rural regions into urban cities, policies to reduce inequalities in job opportunities are required. For current LBC, teachers and peers play an important role in providing social support for LBC. Furthermore, timely support targeted towards strengthening resilience factors including emotional management, interpersonal relationships, stress management and self-esteem development are required to improve the mental health of LBC.
Extracted data will be made available upon reasonable request.
Zhao, X. et al. Left-behind children in rural China experience higher levels of anxiety and poorer living conditions. Acta Paediatr. 103, 665–670 (2014).
PubMed Google Scholar
Fellmeth, G. et al. Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis. Lancet 392, 2567–2582 (2018).
PubMed PubMed Central Google Scholar
Ge, Y., Song, L., Clancy, R. F. & Qin, Y. Studies on left-behind children in China: reviewing paradigm shifts. N. Dir. Child Adolesc. Dev. 2019, 115–135 (2019).
Google Scholar
Qin, J. & Albin, B. The mental health of children left behind in rural China by migrating parents: a literature review. J. Public Ment. Health 9, 4–16 (2010).
Google Scholar
Mansuri, G. Migration, Sex Bias, and Child Growth in Rural Pakistan. World Bank policy research working paper (2006).
Ban, L. et al. Child feeding and stunting prevalence in left-behind children: a descriptive analysis of data from a central and western Chinese population. Int J. Public Health 62, 143–151 (2017).
PubMed Google Scholar
Wen, M. & Lin, D. H. Child development in rural China: children left behind by their migrant parents and children of nonmigrant families. Child Dev. 83, 120–136 (2012).
PubMed Google Scholar
Simpson, G. Us Children with Emotional and Behavioral Difficulties: Data from the 2001, 2002, and 2003 National Health Interview Surveys (US Department of Health and Human Services, Centers for Disease Control and …, 2005).
Barkmann, C. & Schulte-Markwort, M. Emotional and behavioral problems of children and adolescents in Germany. Soc. Psychiatry Psychiatr. Epidemiol. 40, 357–366 (2005).
PubMed Google Scholar
Ma, X., Yao, Y. & Zhao, X. Prevalence of behavioral problems and related family functioning among middle school students in an Eastern City of China. Asia‐Pacific Psychiatry 5, E1–E8 (2013).
PubMed Google Scholar
Wang, J. N., Liu, L. & Wang, L. Prevalence and associated factors of emotional and behavioural problems in Chinese school adolescents: a cross‐sectional survey. Child.: Care, Health Dev. 40, 319–326 (2014).
PubMed Google Scholar
Shao, J. J., Zhang, L., Ren, Y. N., Xiao, L. X. & Zhang, Q. H. Parent-child cohesion, basic psychological needs satisfaction, and emotional adaptation in left-behind children in China: an indirect effects model. Front. Psychol. 9, 1023(2018).
Mondi, C. F., Giovanelli, A. & Reynolds, A. J. Fostering socio-emotional learning through early childhood intervention. Int. J. Child Care Educ. Policy 15, 6 (2021).
Google Scholar
Lin, K., Ramos, S. & Sun, J. Urbanization, self-harm, and suicidal ideation in left-behind children and adolescents in China: a systematic review and meta-analysis. Curr. Opin. Psychiatry 37, 225–236 (2024).
PubMed Google Scholar
Morris, A. S., Silk, J. S., Steinberg, L., Myers, S. S. & Robinson, L. R. The role of the family context in the development of emotion regulation. Soc. Dev. 16, 361–388 (2007).
PubMed PubMed Central Google Scholar
Xiao, Y. et al. Self-harm behaviors, suicidal ideation, and associated factors among rural left-behind children in West China. Ann. Epidemiol. 42, 42–49 (2020).
PubMed Google Scholar
Foster, T., Gillespie, K. & McClelland, R. Mental disorders and suicide in Northern Ireland. Br. J. Psychiatry 170, 447–452 (1997).
CAS PubMed Google Scholar
Jones, P., Murray, R., Rodgers, B. & Marmot, M. Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344, 1398–1402 (1994).
CAS PubMed Google Scholar
Chang, H. et al. A comparative analysis of suicide attempts in left-behind children and non-left-behind children in rural China. PLOS ONE 12, e0178743 (2017).
PubMed PubMed Central Google Scholar
Ding, L., Yuen, L.-W., Buhs, E. S. & Newman, I. M. Depression among Chinese left-behind children: a systematic review and meta-analysis. Child. Care, Health Dev. 45, 189–197 (2019).
PubMed Google Scholar
Wang, Y.-Y. et al. The prevalence of depressive symptoms in ‘left-behind children’ in China: a meta-analysis of comparative studies and epidemiological surveys. J. Affect. Disord. 244, 209–216 (2019).
PubMed Google Scholar
Liang, Y., Wang, L. & Rui, G. Depression among left-behind children in China. J. Health Psychol. 22, 1897–1905 (2016).
PubMed Google Scholar
Dong, B. et al. The resilience status of Chinese left-behind children in rural areas: a meta-analysis. Psychol. Health Med. 24, 1–13 (2019).
PubMed Google Scholar
Zhang, J., Yan, L. & Yuan, Y. Rural-urban migration and mental health of Chinese migrant children: systematic review and meta-analysis. J. Affect. Disord. 257, 684–690 (2019).
PubMed Google Scholar
Munn, Z. et al. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid. Synth. 18, 2127–2133 (2020).
PubMed Google Scholar
Lin, K. et al. Quality of childcare and delayed child development in left-behind children in China. Pediatr. Res 95, 809–818 (2024).
PubMed Google Scholar
Liu, Z., Li, X. & Ge, X. Left too early: the effects of age at separation from parents on Chinese rural children’s symptoms of anxiety and depression. Am. J. Public Health 99, 2049–2054 (2009).
PubMed PubMed Central Google Scholar
Hui, L., Fu, E. & Jian-ren, Z. Effects of separation age and separation duration among left-behind children in China. Soc. Behav. Person. An Int. J. 43, 241–254 (2015).
Albin, B., Qin, J. & Hong, Z. Mental health in the left-behind children in the Fijian Province of China. J. Public Ment. Health 12, 21–31 (2013).
Google Scholar
Faisal, C. M. & Turnip, S. S. Predictors of loneliness among the left-behind children of migrant workers in Indonesia. J. Public Ment. Health 18, 49–57 (2019).
Google Scholar
Graham, E. & Jordan, L. P. Migrant parents and the psychological well-being of left-behind children in Southeast Asia. J. Marriage Fam. 73, 763–787 (2011).
PubMed PubMed Central Google Scholar
Sukamdi & Wattie, A. M. Tobacco use and exposure among children in migrant and non-migrant households in Java, Indonesia. Asian Pac. Migr. J. 22, 447–464 (2013).
CAS PubMed PubMed Central Google Scholar
Umami, R. & Turnip, S. S. Emotional and behavioral problems among left-behind children in Indonesia. Indian J. Psychol. Med. 41, 240–245 (2019).
PubMed PubMed Central Google Scholar
Botezat, A. & Pfeiffer, F. The impact of parental labour migration on left-behind children’s educational and psychosocial outcomes: evidence from Romania. Population Space Place 26, e2277 (2020).
Tomsa, R. & Jenaro, C. Children left behind in romania: anxiety and predictor variables. Psychol. Rep. 116, 485–512 (2015).
PubMed Google Scholar
Vanore, M., Mazzucato, V. & Siegel, M. Left behind’ but not left alone: parental migration & the psychosocial health of children in Moldova. Soc. Sci. Med. 132, 252–260 (2015).
PubMed Google Scholar
Adhikari, R. et al. The impact of parental migration on the mental health of children left behind. J. Immigr. Minor Health 16, 781–789 (2014).
PubMed Google Scholar
Luo, Y. et al. Resilience in rural left-behind middle school students in Yunyang County of the Three Gorges Area in China: A prospective cohort study. BMC Psychiatry 16, 77 (2016).
PubMed PubMed Central Google Scholar
Shi, Y. J., Bai, Y., Shen, Y. N., Kenny, K. & Rozelle, S. Effects of parental migration on mental health of left-behind children: evidence from Northwestern China. China World Econ. 24, 105–122 (2016).
Google Scholar
Wu, Y. L. et al. The risk and protective factors in the development of childhood social anxiety symptoms among Chinese Children. Psychiatry Res. 240, 103–109 (2016).
PubMed Google Scholar
Jiang, S. et al. Alcohol consumption is higher among left-behind Chinese children whose parents leave rural areas to work. Acta Paediatr. 104, 1298–1304 (2015).
PubMed Google Scholar
Jin, X., Chen, W., Sun, I. Y. & Liu, L. Physical health, school performance and delinquency: a comparative study of left-behind and non-left-behind children in rural China. Child Abus. Negl. 109, 104707 (2020).
Google Scholar
Qu, Y., Jiang, H., Zhang, N., Wang, D. & Guo, L. Prevalence of mental disorders in 6-16-year-old students in Sichuan Province, China. Int J. Environ. Res Public Health 12, 5090–5107 (2015).
PubMed PubMed Central Google Scholar
Tang, W. et al. Mental health and psychosocial problems among Chinese left-behind children: a cross-sectional comparative study. J. Affect. Disord. 241, 133–141 (2018).
PubMed Google Scholar
Fan, F., Su, L., Gill, M. K. & Birmaher, B. Emotional and behavioral problems of Chinese left-behind children: a preliminary study. Soc. Psychiatry Psychiatr. Epidemiol. 45, 655–664 (2010).
CAS PubMed Google Scholar
Wang, F. et al. Mental health among left-behind children in rural China in relation to parent-child communication. Int. J. Environ. Res. Public Health 16, 1855 (2019).
Wang, F. et al. Mental health and substance use in urban left-behind children in China: a growing problem. Children Youth Serv. Rev. 116, 105135 (2020).
Zhang, X., Li, M. J., Guo, L. & Zhu, Y. N. Mental health and its influencing factors among left-behind children in South China: a cross-sectional study. Bmc Public Health 19, 1725 (2019).
Zhao, J. X., Li, Q. Y., Wang, L. W., Lin, L. Y. & Zhang, W. X. Latent profile analysis of left-behind adolescents’ psychosocial adaptation in rural China. J. Youth Adolescence 48, 1146–1160 (2019).
Google Scholar
Wang, D. et al. Associations between family function and non-suicidal self-injury among Chinese urban adolescents with and without parental migration. Child Psychiatry Human Dev. (2023).
Zhou, Y. Y. et al. Interaction status, victimization and emotional distress of left-behind children: a national survey in China. Children Youth Serv. Rev. 118 (2020).
Lan, X. Y. & Radin, R. Direct and Interactive Effects of Peer Attachment and Grit on Mitigating Problem Behaviors among Urban Left-Behind Adolescents. J. Child Fam. Stud. 29, 250–260 (2020).
Google Scholar
Guang, Y. et al. Depressive symptoms and negative life events: what psycho-social factors protect or harm left-behind children in China? BMC Psychiatry 17, 402 (2017).
Guo, J. et al. Depression among migrant and left-behind children in China in relation to the quality of parent-child and teacher-child relationships. PLoS ONE 10 (2015).
Ling, H., Fu, E. & Zhang, J.-r Effects of Separation Age and Separation Duration among Left-Behind Children in China. Soc. Behav. Personality: Int. J. 43, 241–254 (2015).
Google Scholar
Man, Y., Mengmeng, L., Lezhi, L., Ting, M. & Jingping, Z. The psychological problems and related influential factors of left-behind adolescents (Lba) in Hunan, China: a cross sectional study. Int. J. Equity Health 16, e0145606 017).
Shen, M. et al. Parental migration patterns and risk of depression and anxiety disorder among rural children aged 10-18 years in China: a cross-sectional study. Bmj Open 5 (2015).
Tang, Z. What makes a difference to children’s health in rural China? Parental migration, remittances, and social support. Chin. Sociol. Rev. 49, 89–109 (2017).
Google Scholar
Wang, J. Y. et al. Mental health symptoms among rural adolescents with different parental migration experiences: a cross-sectional study in China. Psychiatry Res. 279, 222–230 (2019).
PubMed Google Scholar
Wu, Q. B., Lu, D. P. & Kang, M. Social capital and the mental health of children in rural China with different experiences of parental migration. Soc. Sci. Med. 132, 270–277 (2015).
PubMed Google Scholar
Yue, Z. S., Liang, Z., Wang, Q. & Chen, X. Y. The impact of parental migration on depression of children: new evidence from rural China. Chin. Sociol. Rev. 52, 364–388 (2020).
Google Scholar
Zhang, Q. et al. Migrate with parent(s) or not? Developmental outcomes between migrant and left-behind children from rural China. Child Indic. Res. 12, 1147–1166 (2018).
Google Scholar
Cai, J. J. et al. The association of parent-child communication with internet addiction in left-behind children in China: a cross-sectional study. Int. J. Public Health 66, 630700 (2021).
Zhao, G. L. et al. Health status and association with interpersonal relationships among Chinese children from urban migrant to rural left-behind. Front. Public Health 10 (2022).
Xie, Q. W. et al. Mental health problems amongst left-behind adolescents in China: serial mediation roles of parent-adolescent communication and school bullying victimisation. Br. J. Social Work 53, 994–1018 (2023).
Google Scholar
Xu, X. H., Sun, I. Y. & Wu, Y. N. Strain, depression, and deviant behavior among left-behind and non-left-behind adolescents in China. Int. Sociol. 38, 394–410 (2023).
Google Scholar
Xu, W., Yan, N., Chen, G., Zhang, X. & Feng, T. Parent–child separation: the relationship between separation and psychological adjustment among Chinese rural children. Qual. Life Res. 27, 913–921 (2018).
PubMed Google Scholar
Zhao, C., Wang, F., Li, L., Zhou, X. & Hesketh, T. Long-term impacts of parental migration on Chinese children’s psychosocial well-being: mitigating and exacerbating factors. Soc. Psychiatry Psychiatr. Epidemiol. 52, 669–677 (2017).
PubMed PubMed Central Google Scholar
Wang, M. M., Lou, J. X., Xie, X. L., Zhao, G. L. & Zhu, H. Parental migration and cyberbullying victimization among Chinese left-behind children: understanding the association and mediating factors. Front. Public Health 12, 1194940 (2024).
Xing, H. Y., Yu, W., Xu, F. J. & Chen, S. M. Influence of social support and rearing behavior on psychosocial health in left-behind children. Health Quality Life Outcomes 15, 13 (2017).
Wen, Y.-J. et al. The effect of left-behind phenomenon and physical neglect on behavioral problems of children. Child Abus. Negl. 88, 144–151 (2019).
Google Scholar
Akezhuoli, H. et al. Mother’s and father’s migrating in China: differing relations to mental health and risk behaviors among left-behind children. Front. Public Health 10, 894741 (2022).
Nguyen, D. B. & Nguyen, L. V. Mental health among left-behind children in Vietnam: role of resilience. Int. J. Mental Health 1–16 (2022).
Gao, Y. et al. The impact of parental migration on health status and health behaviours among left behind adolescent school children in China. BMC Public Health 10, 56 (2010).
PubMed PubMed Central Google Scholar
Hu, H. W. et al. A comparative study of behavior problems among left-behind children, migrant children and local children. Int. J. Environ. Res. Public Health 15, 655 (2018).
Tang, W. et al. Mental health and psychosocial problems among Chinese left-behind children: a cross-sectional comparative study. J. Affect Disord. 241, 133–141 (2018).
PubMed Google Scholar
Wang, F. et al. Impact of parental divorce versus separation due to migration on mental health and self-injury of Chinese children: a cross sectional survey. Child Adolesc. Psychiatry Mental Health 15 (2021).
Chen, M. & Chan, K. L. Parental absence, child victimization, and psychological well-being in rural China. Child Abus. Negl. 59, 45–54 (2016).
Google Scholar
Wang, F., Lu, J., Lin, L. & Zhou, X. Mental health and risk behaviors of children in rural China with different patterns of parental migration: a cross-sectional study. Child Adolesc. Psychiatry Ment. Health 13, 39 (2019).
PubMed PubMed Central Google Scholar
Jia, Z. & Tian, W. Loneliness of left-behind children: a cross-sectional survey in a sample of rural China. Child Care Health Dev. 36, 812–817 (2010).
PubMed Google Scholar
Peng, C. et al. Association between internet addiction and suicidal ideation, suicide plans, and suicide attempts among Chinese adolescents with and without parental migration. Comput. Hum. Behav. 125, 106949 (2021).
Google Scholar
Ma, Y. et al. Association of the labor migration of parents with nonsuicidal self-injury and suicidality among their offspring in China. Jama Network Open 4, e2133596 (2021).
Wu, D. H., Liu, M. H., Li, D. & Yin, H. Z. The longitudinal relationship between loneliness and both social anxiety and mobile phone addiction among rural left-behind children: a cross-lagged panel analysis. J. Adolesc. 96, 969-982 (2024).
Fu, M., Xue, Y., Zhou, W. & Yuan, T. F. Parental absence predicts suicide ideation through emotional disorders. PLoS One 12, e0188823 (2017).
PubMed PubMed Central Google Scholar
Gao, F. et al. The status of pro-social tendency of left-behind adolescents in China: how family function and self-esteem affect pro-social tendencies. Front. Psychol. 10, 1202 (2019).
PubMed PubMed Central Google Scholar
Wang, C. D. C., Hayslip, B., Sun, Q. & Zhu, W. Grandparents as the primary care providers for their grandchildren: a cross-cultural comparison of Chinese and U.S. samples. Int. J. Aging Hum. Dev. 89, 331–355 (2019).
CAS PubMed Google Scholar
Cui, S. et al. Self-esteem, social support and coping strategies of left-behind children in rural China, and the intermediary role of subjective support: a cross-sectional survey. BMC Psychiatry 21, 158 (2021).
PubMed PubMed Central Google Scholar
Wen, M., Su, S., Li, X. & Lin, D. Positive youth development in rural China: the role of parental migration. Soc. Sci. Med. 132, 261-269 (2014).
Quintigliano, M., Fortunato, A., Lauriola, M. & Speranza, A. M. Parent-child relationship scale (P-Crs): a valid and clinically sensitive tool for assessing the parent-child relationship. Infant Ment. Health J. 44, 92–99 (2023).
PubMed Google Scholar
Alexander, B. B., Johnson, S. B. & Carter, R. L. A psychometric study of the family adaptability and cohesion evaluation scales. J. Abnorm. Child Psychol. 12, 199–207 (1984).
CAS PubMed Google Scholar
Wang, Q., Wang, H. & Liu, X. Loneliness, non-suicidal self-injury, and friendship quality among Chinese left-behind adolescents: the role of parent-child cohesion. J. Affect. Disord. 271, 193–200 (2020).
PubMed Google Scholar
Deng, N., Bi, H. & Zhao, J. Maternal psychological control and rural left-behind children’s anxiety: the moderating role of externalizing problem behavior and teacher support. Front. Psychol. 12, 624372 (2021).
Zhang, H., Zhou, H. & Cao, R. Bullying Victimization among Left-Behind Children in Rural China: Prevalence and Associated Risk Factors. J. Interpers. violence 36, NP8414–NP8430 (2021).
PubMed Google Scholar
Mo, X., Shi, G., Zhang, Y., Xu, X. & Ji, C. How to promote the social–emotional competence of rural left-behind children? An empirical study based on propensity score matching. Front. Psychol. 14, 1052693 (2023).
Deirdre, G. et al. What factors are associated with resilient outcomes in children exposed to social adversity? A systematic review. BMJ Open 9, e024870 (2019).
Google Scholar
Butler, N. et al. The contributing role of family, school, and peer supportive relationships in protecting the mental wellbeing of children and adolescents. Sch. Ment. Health 14, 776–788 (2022).
Google Scholar
Masten, A. S. & Palmer, A. R. in Handbook of Parenting 156-188 (Routledge, 2019).
Schoppe, S. J., Mangelsdorf, S. C. & Frosch, C. A. Coparenting, family process, and family structure: implications for preschoolers’ externalizing behavior problems. J. Fam. Psychol. 15, 526 (2001).
CAS PubMed Google Scholar
Li, X., Yang, S. & Wang, M. Comparison of personality characteristics and behavior problems of the divorce family’s children. Chin. J. Health Psychol. 13, 375–376 (2005).
Google Scholar
Votruba‐Drzal, E., Coley, R. L., Maldonado‐Carreño, C., Li‐Grining, C. P. & Chase‐Lansdale, P. L. Child care and the development of behavior problems among economically disadvantaged children in middle childhood. Child Dev. 81, 1460–1474 (2010).
PubMed PubMed Central Google Scholar
Shuang, M. et al. Relationship between parent-child attachment and depression among migrant children and left-behind children in China. Public Health 204, 1–8 (2022).
CAS PubMed Google Scholar
Iyanda, A. E. Bullying victimization of children with mental, emotional, and developmental or behavioral (Medb) disorders in the United States. J. Child Adolesc. Trauma 15, 221–233 (2022).
PubMed Google Scholar
Zhang, X., Ra, C. K., Zhang, D., Zhang, Y. & MacLeod, K. E. The impact of school social support and bullying victimization on psychological distress among California adolescents. Calif. J. Health Promot 14, 56–67 (2016).
PubMed PubMed Central Google Scholar
Liang, L., Xiao, Q. & Yang, Y. The psychological capital of left-behind university students: a description and intervention study from China. Front Psychol. 9, 2438 (2018).
PubMed PubMed Central Google Scholar
Fan, X. & Lu, M. Testing the effect of perceived social support on left-behind children’s mental well-being in mainland China: the mediation role of resilience. Child. Youth Serv. Rev. 109, 104695 (2020).
Google Scholar
Zhao, K., Chen, N., Liu, G., Lun, Z. & Wang, X. School climate and left-behind children’s achievement motivation: the mediating role of learning adaptability and the moderating role of teacher support. Front. Psychol. 14, 1040214 (2023).
PubMed PubMed Central Google Scholar
Chen, X. J. Parental migration, caretaking arrangement, and children’s delinquent behavior in rural China. Asian J. Criminol. 12, 281–302 (2017).
Google Scholar
Chen, X. & Hesketh, T. Educational aspirations and expectations of adolescents in rural China: determinants, mental health and academic outcomes. Int. J. Environ. Res. Public Health 18, 11524 (2021).
Gao, Y., Li, L. P., Chan, E. Y. Y., Lau, J. & Griffiths, S. M. Parental migration, self-efficacy and cigarette smoking among rural adolescents in South China. Plos One 8, e57569 (2013).
Huang, Y. et al. Health-related quality of life of the rural-China left-behind children or adolescents and influential factors: a cross-sectional study. Health Qual. Life Outcomes 13, 29 (2015).
PubMed PubMed Central Google Scholar
Li, B., Hu, T. & Tang, W. J. The effects of peer bullying and poverty on suicidality in Chinese left behind adolescents: the mediating role of psychotic-like experiences. Early Intervention Psychiatry 16, 1217–1229 (2022).
Google Scholar
Lu, Y., Yeung, W. J. J. & Treiman, D. J. Parental migration and children’s psychological and cognitive development in China: differences and mediating mechanisms. Chin. Sociol. Rev. 52, 337–363 (2020).
PubMed PubMed Central Google Scholar
Wang, Y., Zhang, M. & Chen, H. Self-injury among left-behind adolescents in rural China: the role of parental migration and parent-child attachment. Front. Psychol. 9, 2672 (2018).
PubMed Google Scholar
Xu, J. Y. et al. Characteristics of parent-child separation related to bullying involvement among left-behind children in China. J. Soc. Person. Relation. 41 (2024).
Zhang, N., Bécares, L. & Chandola, T. Does the timing of parental migration matter for child growth? A life course study on left-behind children in rural China. BMC Public Health 15, 966 (2015).
PubMed PubMed Central Google Scholar
Zhao, J., Liu, X. & Zhang, W. Peer rejection, peer acceptance and psychological adjustment of left-behind children: the roles of parental cohesion and children’s cultural beliefs about adversity. Acta Psychol. Sinica 45, 797–810 (2013).
Download references
Open Access funding enabled and organized by CAUL and its Member Institutions.
Rural Health Research Institute, Charles Sturt University, Sydney, NSW, Australia
Kelly Lin & Jing Sun
School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
Kelly Lin, Leona Mak, Jinxuan Cai, Stephen Jiang, Nawaal Fayyaz, Simon Broadley & Jing Sun
Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
Simon Broadley
Data Science Institute, University of Technology, Sydney, NSW, Australia
Jing Sun
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
K.L. extracted and analysed data, drafted and submitted the manuscript. L.M. extracted data and designed the study. J.C., N.F., and S.J. helped with paper screening and data extraction. J.S. supervised and revised the manuscript.
Correspondence to Jing Sun.
The authors declare no competing interests.
Participant consent was not required for this study as data were extracted from published studies.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Reprints and permissions
Lin, K., Mak, L., Cai, J. et al. Urbanisation and mental health in left-behind children: systematic review and meta-analysis using resilience framework. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-03894-5
Download citation
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41390-025-03894-5
Anyone you share the following link with will be able to read this content:
Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative
Advertisement
© 2025 Springer Nature Limited