Exploring the mental health issues of left-behind children based on propensity score matching: the parallel mediating role of psychological abuse and neglect

The underdeveloped western region of China, where most of the country’s migrant workers originate, has many children who remain at home while their parents work elsewhere. These left-behind children often suffer from significant psychological issues, including depression, anxiety, stress, and sleep quality problems. The pathways through which being left behind leads to these mental health challenges are not well understood. This study employs Propensity Score Matching (PSM) to adjust for confounders and investigate the mediating effects of psychological abuse and neglect on these mental health issues. The study surveyed 17 middle schools in western China using convenience cluster sampling. It gathered data on demographics, the Child Psychological Abuse and Neglect Scale (CPANS), the Depression Anxiety Stress Scale (DASS-21), and the Pittsburgh Sleep Quality Index (PSQI). PSM was used to compare left-behind children with their peers. Statistical tests included Pearson’s chi-squared and bivariate correlation analysis, and mediation was assessed. A cohort of 12,192 adolescents (mean age = 15.1 ± 1.41 years) was enrolled in this study. Participants with left-behind experiences displayed significantly higher prevalence rates of psychological abuse, neglect, and mental health relative to their non-left-behind counterparts (p < 0.05). Following PSM to balance potential confounders, 3,741 matched pairs were successfully yielded. Within these matched cohorts, adolescents with left-behind experiences also demonstrated significantly elevated rates across all measured adverse outcomes (p < 0.05). Correlation analysis showed strong associations between left-behind experiences and psychological issues. Mediation analysis revealed that psychological abuse and neglect are significant mediators in the relationship between left-behind experiences and mental health outcomes. The study suggests that left-behind experiences negatively impact adolescent mental health, acting through mechanisms of psychological abuse and neglect.