Exploring childhood separation anxiety in resource-limited contexts: a mixed-methods study with children and caregivers

Separation anxiety (SA) is a common childhood experience that, when persistent, can interfere with development and elevate the risk for future anxiety disorders. However, research on SA in Low- and Middle-Income Countries (LMICs) remains scarce, especially among rural children with limited access to mental health services. We examined age and gender differences in SA scores among Colombian children from rural, low-income households, alongside caregivers’ experiences and strategies for managing their children’s anxiety. We employed a sequential explanatory mixed-methods design in which 202 children (aged 8–12) completed the Spence Children’s Anxiety Scale (SCAS) to assess SA and overall anxiety, followed by semi-structured interviews with 12 caregivers of children with high SA scores. Quantitative data were analysed using a 2 × 4 ANOVA (gender × age) and qualitative responses were examined using thematic analysis. Twelve-year-olds reported higher overall anxiety, with girls showing higher SA than boys at ages 10 and 12. Caregiver accounts echoed elevated separation concerns while describing a broader range of emotional responses, including anger and withdrawal, and highlighting the emotional and practical demands of caring for children with high SA. These findings highlight the importance of early recognition of anxiety symptoms and preventive support for children experiencing SA and their caregivers. Expanding access to school-based screening and caregiver psychoeducation programmes may support earlier detection and management of childhood anxiety.