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  • Participants of the current study were 4513 children from rural areas in Yancheng, China. Before we conducted our study, we sent our study proposal to all primary and middle schools in rural areas in Yancheng, including 55 primary schools and 67 middle schools. Yancheng, is an area that is relatively backward in economy in Jiangsu Province, China and many adults in rural areas in Yancheng had migrated to cities to seek livelihoods, with their children left at home. Nineteen schools, including 12 primary schools and 7 middle schools responded and agreed to help coordinate recruiting participants in their schools for our study. Under the schoolteachers’ help, our researchers went to all classes from Grade 3 to Grade 9 in each school, expressing the study purpose to the students and letting the students to bring the consent form to their guardians. We excluded students under Grade 3 because these students did not have the basic reading ability to answer our questionnaire. We had also excluded the children who had mental deficiencies based on the information provided by the schoolteachers. The participation of our study was entirely voluntary. We involved the students as our participants only after we got the signature of their guardians and their own. Response rates in the 19 schools ranged from 82.7% to 96.3%. Ethical approval for the study was obtained from the Ethics Committee of Nanjing Normal University (China). Finally, 4513 children participated in our study. Ages of the participants were from 9 to 17 years old (M = 12.38). Among these children, 8.3% were at Grade 3, 17.7% were at Grade 4, 18.1% were at Grade 5, 17.3% were at Grade 6, 16.0% were at Grade7, 13.5% were at Grade 8, and 8.6% were at Grade 9 students. Moreover, 52.7% children were females and 47.3% were males. Among the children that participated in the current study, there were 2416 (53.5%) non-left-behind children and 1997 (46.5%) left-behind children. Furthermore, among the left-behind children, 1003 children were living only with mother (father absence group), 132 were living only with father (mother absence group), 962 were living without the care of either parent (both-parents absence group). All participants responded to a questionnaire comprised of a) a range of questions concerning demographic information, including age, gender, school, grade, social economic status (SES), and the status of parental presence, b) the Center for Epidemiological Studies Depression Scale for Children (CES-DC) [17], c) the Multidimensional Anxiety Scale for Children (MASC) [18], d) a question regarding respondents’ suicide ideation. The SES of children was assessed by asking the children that which financial level of their family was at in comparison with fellow students—lower than average, average, or higher than average [19]. To detect the suicide ideation, children were asked by one question that whether or not they had the thoughts of killing themselves in the past two weeks [20–21]. All the inventories used in our study were translated into Chinese before being administered to participants. We performed the translation and back-translation process to ensure that the contents of the inventories were accurately translated (see S1 File for our Chinese version questionnaire). The study utilized the CES-DC to evaluate children’s depression level [17]. The CES-DC has 20 items and all times are scored by a 4-point Likert scale, with 1 indicating “not at all” and 4 indicating “a lot”. Examples of the items are: “during the past one week, I felt like I was too tired to do things” and “during the past one week, I had a good time (reversely scored)”. The inventory was a uni-dimentional scale and the higher scores represents increasing level of depression. The CES-DS has been broadly adopted in previous empirical studies and been reported with satisfactory psychometric properties [22–24]. In the current study, the reliability of the inventory was .87. The MASC was adopted to test children’s status of anxiety [18]. The MASC consists of 39 items, which are divided into four subscales—social anxiety, harm avoidance, isolation anxiety, and physical anxiety. Examples of items are: “I worry about other people laughing at me” (social anxiety), “I get scared when my parents go away” (isolation anxiety), “I try to do everything exactly right” (harm avoidance), and “I get dizzy or faint feelings” (physical anxiety). The MASC has been widely adopted to test the anxiety status of children in empirical studies and been validated across cultures [18, 25–26]. In the current study, the four-dimension structure of the MASC was further validated by exploratory factor analysis. It was found that items corresponding to the six types of anxieties were successfully identified from the MASC and the four factors accounted for 47.95% variance in the data. Furthermore, the reliabilities of the inventory were .83, .65, .71, and .87, respectively, for the subscales of social anxiety, harm avoidance, isolation anxiety, and physical anxiety. With respect to data analyses, first, psychometric properties the CES-DC and the MASC were evaluated by exploratory factor analysis and Cronbach’s alpha test. Second, descriptive statistics were carried out to investigate the statistical distributions of the continuous variables (e.g., depression, social anxiety, harm avoidance) and to test the prevalence of suicide ideation among children with different status of parental absence. Third, logistic regression was conducted to test the relationship between parental-absence status and suicide ideations with demographic factors being controlled. Fourth, ANOVA and post hoc analyses with Bonferroni correction were performed to examine the difference of depression and anxiety levels across children with different parental-absence status. Fifth, simple mediation models were established for evaluating the roles of depression and anxiety in the association of parental-absence status to suicide ideation [27–28]. All data analyses were performed in SPSS 19. The SPSS PROCESS was utilized particularly to test the indirect effects of parental-absence status to suicide ideation through depression or anxiety [28].
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