Skip to main content

Advertisement

SpringerLink
Log in

The prevalence of behavioral and emotional problems among Chinese school children and adolescents aged 6–16: a national survey

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Improving the mental health of children and adolescents is a critical priority in China. However, only minimal information is available concerning the prevalence of mental disorders. In the present study, a two-stage national survey has been completed in five regions of China. In the first stage, data from the Achenbach Child Behavior Checklist (CBCL) were collected for each participant to identify the prevalence of the behavioral and emotional problems in China. A multistage cluster stratified random sampling design was used, and a total of 71,929 individuals aged 6–16 years were collected. In this large cohort, 36,893 (49.86%) were males, and 49,015 (66.24%) were living in urban communities. Overall, 17.6% (90% confidence interval 17.4%, 17.9%) of the children and adolescents were identified as having behavioral and emotional problems. Moreover, age and sex effect was found for the CBCL scores. The boys’ cohort had a higher prevalence of behavioral and emotional problems than girls (18.6% versus 16.6%). In the older cohort aged 12–16, the prevalence was higher than for the younger cohort aged 6–11 (19.0% versus 15.9%). Notably, it seems that the prevalence of the behavioral and emotional problems for children and adolescents had a rise in the past 30 years, but the scarcity of pediatric psychiatrists in China needs to be addressed. To reduce the behavioral and emotional problems, the whole society, including mental health providers, educators, and parents, needs to focus on and pay more attention to it. It will have long-term benefits for China.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Global Burden of Disease Pediatrics C, Kyu HH, Pinho C, Wagner JA, Brown JC, Bertozzi-Villa A, Charlson FJ, Coffeng LE, Dandona L, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming TD, Forouzanfar MH, Graetz N, Guinovart C, Haagsma J, Higashi H, Kassebaum NJ, Larson HJ, Lim SS, Mokdad AH, Moradi-Lakeh M, Odell SV, Roth GA, Serina PT, Stanaway JD, Misganaw A, Whiteford HA, Wolock TM, Wulf Hanson S, Abd-Allah F, Abera SF, Abu-Raddad LJ, AlBuhairan FS, Amare AT, Antonio CA, Artaman A, Barker-Collo SL, Barrero LH, Benjet C, Bensenor IM, Bhutta ZA, Bikbov B, Brazinova A, Campos-Nonato I, Castaneda-Orjuela CA, Catala-Lopez F, Chowdhury R, Cooper C, Crump JA, Dandona R, Degenhardt L, Dellavalle RP, Dharmaratne SD, Faraon EJ, Feigin VL, Furst T, Geleijnse JM, Gessner BD, Gibney KB, Goto A, Gunnell D, Hankey GJ, Hay RJ, Hornberger JC, Hosgood HD, Hu G, Jacobsen KH, Jayaraman SP, Jeemon P, Jonas JB, Karch A, Kim D, Kim S, Kokubo Y, Kuate Defo B, Kucuk Bicer B, Kumar GA, Larsson A, Leasher JL, Leung R, Li Y, Lipshultz SE, Lopez AD, Lotufo PA, Lunevicius R, Lyons RA, Majdan M, Malekzadeh R, Mashal T, Mason-Jones AJ, Melaku YA, Memish ZA, Mendoza W, Miller TR, Mock CN, Murray J, Nolte S, Oh IH, Olusanya BO, Ortblad KF, Park EK, Paternina Caicedo AJ, Patten SB, Patton GC, Pereira DM, Perico N, Piel FB, Polinder S, Popova S, Pourmalek F, Quistberg DA, Remuzzi G, Rodriguez A, Rojas-Rueda D, Rothenbacher D, Rothstein DH, Sanabria J, Santos IS, Schwebel DC, Sepanlou SG, Shaheen A, Shiri R, Shiue I, Skirbekk V, Sliwa K, Sreeramareddy CT, Stein DJ, Steiner TJ, Stovner LJ, Sykes BL, Tabb KM, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Towbin JA, Ukwaja KN, Vasankari T, Venketasubramanian N, Vlassov VV, Vollset SE, Weiderpass E, Weintraub RG, Werdecker A, Wilkinson JD, Woldeyohannes SM, Wolfe CD, Yano Y, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, El Sayed ZM, Naghavi M, Murray CJ, Vos T (2016) Global and National burden of diseases and injuries among children and adolescents between 1990 and 2013: findings from the global burden of disease 2013 study. JAMA pediatrics 170(3):267–287. https://doi.org/10.1001/jamapediatrics.2015.4276

    Article  Google Scholar 

  2. Li XR, Wang MX (1993) Prevalence of mental disorders among children and adolescents aged 6–16 in Hunan province. Hunan Yi Ke Da Xue Xue Bao 18(1):43–46 (In Chinese)

    Google Scholar 

  3. Guan BQ, Luo XR, Deng YL, Wei Z, Ye HS, Yuan XH, Ning ZJ, Yang W, Ding J (2010) Prevalence of psychiatric disorders in primary and middle school students in Hunan Province. Zhongguo dang dai er ke za zhi (Chinese Journal of Contemporary Pediatrics) 12(2):123–127 (In Chinese)

    Google Scholar 

  4. Zhang WF (2010) Prevalence of psychiatric disorders among 6–17 year old school children in Liaoning province. Master Thesis, Dalian Medical University, Dalian, China (In Chinese)

  5. Xin RE, Zhang ZX (1992) Investigate on 24013 city children's behavioral problems in 26 units of 22 provinces. Shanghai Arch Psychiatr 4:47–55 (In Chinese)

    Google Scholar 

  6. Ivanova MY, Dobrean A, Dopfner M, Erol N, Fombonne E, Fonseca AC, Frigerio A, Grietens H, Hannesdottir H, Kanbayashi Y, Lambert M, Achenbach TM, Larsson B, Leung P, Liu X, Minaei A, Mulatu MS, Novik TS, Oh KJ, Roussos A, Sawyer M, Simsek Z, Dumenci L, Steinhausen HC, Metzke CW, Wolanczyk T, Yang HJ, Zilber N, Zukauskiene R, Verhulst FC, Rescorla LA, Almqvist F, Weintraub S, Bilenberg N, Bird H, Chen WJ (2007) Testing the 8-syndrome structure of the child behavior checklist in 30 societies. J Clin Child Adolesc Psychol 36(3):405–417. https://doi.org/10.1080/15374410701444363

    Article  PubMed  Google Scholar 

  7. Bao Q-S, Ci-Yong Lu, Song H, Wang M, Ling W, Chen W-Q, Deng X-Q, Hao Y-T, Rao S (2009) Behavioural development of school-aged children who live around a multi-metal sulphide mine in Guangdong province, China: a cross-sectional study. BMC Public Health 9(1):217. https://doi.org/10.1186/1471-2458-9-217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Dedrick RF, Tan TX, Marfo K (2008) Factor structure of the child behavior checklist/6-18 in a sample of girls adopted from China. Psychol Assess 20(1):70

    Article  Google Scholar 

  9. Shen XN, Wang YZ (2007) The meta-analysis about children’s behavioral and emotional problem in China. Chin Med J Metall Ind 24:6 (In Chinese)

    Google Scholar 

  10. Liu X, Kurita H, Guo C, Miyake Y, Ze J, Cao H (1999) Prevalence and risk factors of behavioral and emotional problems among Chinese children aged 6 through 11 years. J Am Acad Child Adolesc Psychiatry 38(6):708–715. https://doi.org/10.1097/00004583-199906000-00018

    Article  CAS  PubMed  Google Scholar 

  11. Rescorla L, Achenbach T, Ivanova MY, Dumenci L, Almqvist F, Bilenberg N, Erol N (2007) Behavioral and emotional problems reported by parents of children ages 6–16 in 31 societies. J Emot Behav Disord 15(3):130–142. https://doi.org/10.1177/10634266070150030101

    Article  Google Scholar 

  12. UNICEF (2017) Population Status of Children in China in 2015: Facts and Figures. https://www.unicef.cn/en/publications/comprehensive/3210.html . Accessed 27 Sept 2017

  13. Bai Y, Zhang L, Liu C, Shi Y, Mo D, Rozelle S (2018) Effect of parental migration on the academic performance of left behind children in North Western China. J Dev Stud 54(7):1154–1170. https://doi.org/10.1080/00220388.2017.1333108

    Article  Google Scholar 

  14. Fan X, Lu M (2020) 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. https://doi.org/10.1016/j.childyouth.2019.104695

    Article  Google Scholar 

  15. Hu BY, Wu H, Winsler A, Fan X, Song Z (2020) Parent migration and rural preschool children's early academic and social skill trajectories in China: are ‘left-behind’ children really left behind? Early Child Res Q 51:317–328. https://doi.org/10.1016/j.ecresq.2019.12.011

    Article  Google Scholar 

  16. Warnick EM, Bracken MB, Kasl S (2008) Screening efficiency of the child behavior checklist and strengths and difficulties questionnaire: a systematic review. Child Adolesc Mental Health 13(3):140–147. https://doi.org/10.1111/j.1475-3588.2007.00461.x

    Article  Google Scholar 

  17. Achenbach TM (1991) Manual for child behavior checklist/4–18 and 1991 Profile. University of Vermont, Department of Psychiatry, Burlington

    Google Scholar 

  18. Achenbach TM, Rescorla L (2001) Manual for the ASEBA School-Age Forms & Profiles: An Integrated System of Multi-informant Assessment. University of Vermont, Research Center for Children, Youth & Families, Burlington, VT

    Google Scholar 

  19. NUICEF (2011) The State of the World's Children 2011: Adolescence-An Age of Opportunity. https://www.unicef.org/sowc2011. Accessed 20 September 2012.

  20. Liu X, Sun Z, Neiderhiser JM, Uchiyama M, Okawa M, Rogan W (2001) Behavioral and emotional problems in Chinese adolescents: parent and teacher reports. J Am Acad Child Adolesc Psychiatry 40(7):828–836. https://doi.org/10.1097/00004583-200107000-00018

    Article  CAS  PubMed  Google Scholar 

  21. Rescorla LA, Althoff RR, Ivanova MY, Achenbach TM (2019) Effects of society and culture on parents' ratings of children's mental health problems in 45 societies. Eur Child Adolesc Psychiatry. https://doi.org/10.1007/s00787-018-01268-3

    Article  PubMed  Google Scholar 

  22. Rescorla L, Ivanova MY, Achenbach TM, Begovac I, Chahed M, Drugli MB, Hewitt N (2012) International epidemiology of child and adolescent psychopathology II: integration and applications of dimensional findings from 44 societies. J Am Acad Child Adolesc Psychiatry 51(12):1273–1283. https://doi.org/10.1016/j.jaac.2012.09.012

    Article  PubMed  Google Scholar 

  23. Wu JL, Pan J (2019) The scarcity of child psychiatrists in China. Lancet Psychiatry 6(4):286–287. https://doi.org/10.1016/S2215-0366(19)30099-9

    Article  PubMed  Google Scholar 

  24. China NboSo. (2012) The Sixth National Population Census: Tabulation on the 2010 Population Census of the People’s Republic of China. https://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm. Accessed 22 July 2012.

  25. Xu WM, Tang JL, De WU, Xu XY, Yang L (2007) Research on present situation of behavior disorders of leftbehind children in the countryside of Anhui Province. J Appl Clin Pediatr 22:852 (In Chinese)

    Google Scholar 

  26. Zhang L, Zhang JH, Luan JZ (2012) Behavior problem characteristics of migrant children in Baiyun district of Guangzhou. Chin Gen Pract 15:2950–2952 (In Chinese)

    Google Scholar 

  27. Qin YY, Zhongping Z (2014) Much? Difficult? Tired?—a survey research on Primary and Middle School Students School Workload in China. Curric Teach Mater Method 4:42–49 (In Chinese)

    Google Scholar 

  28. Bhargava A, Tan X (2018) A longitudinal analysis of internal migration, divorce and well-being in China. J Biosoc Sci 50(5):723. https://doi.org/10.1017/S0021932018000056

    Article  PubMed  Google Scholar 

  29. Gudmundsen GR, Rhew IC, McCauley E, Kim J, Vander Stoep A (2018) Emergence of depressive symptoms from Kindergarten to Sixth Grade. J Clin Child Adoles Psychol Off J Soc Clin Child Adolesc Psychol Am Psychol Assoc Div 53:1–15. https://doi.org/10.1080/15374416.2017.1410823

    Article  Google Scholar 

  30. Fang X, Fry DA, Ji K, Finkelhor D, Chen J, Lannen P, Dunne MP (2015) The burden of child maltreatment in China: a systematic review. Bull World Health Organ 93(3):176–185C. https://doi.org/10.2471/BLT.14.140970

    Article  PubMed  PubMed Central  Google Scholar 

  31. Thapar A, Collishaw S, Pine DS, Thapar AK (2012) Depression in adolescence. Lancet 379(9820):1056–1067. https://doi.org/10.1016/S0140-6736(11)60871-4

    Article  PubMed  PubMed Central  Google Scholar 

  32. LeMoult J, Ordaz SJ, Kircanski K, Singh MK, Gotlib IH (2015) Predicting first onset of depression in young girls: interaction of diurnal cortisol and negative life events. J Abnorm Psychol 124(4):850–859. https://doi.org/10.1037/abn0000087

    Article  PubMed  PubMed Central  Google Scholar 

  33. Achenbach TM, Becker A, Döpfner M, Heiervang E, Roessner V, Steinhausen HC, Rothenberger A (2008) Multicultural assessment of child and adolescent psychopathology with ASEBA and SDQ instruments: research findings, applications, and future directions. J Child Psychol Psychiatry 49(3):251–275. https://doi.org/10.1111/j.1469-7610.2007.01867.x

    Article  PubMed  Google Scholar 

  34. Zukauskiene R, Ignataviciene K, Daukantaite D (2003) Subscales scores of the Lithuanian version of CBCL. Eur Child Adolesc Psychiatry 12(3):136–143. https://doi.org/10.1007/s00787-003-0321-7

    Article  CAS  PubMed  Google Scholar 

  35. Schmeck K, Poustka F, Döpfner M, Plück J, Berner W, Lehmkuhl G, Lehmkuhl U (2001) Discriminant validity of the child behaviour checklist CBCL-4/18 in German samples. Eur Child Adolesc Psychiatry 10(4):240–247. https://doi.org/10.1007/s007870170013

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the National Key Technology R&D Program of China (Project identification code: 2012BAI01B02). Beijing Anding Hospital, Capital Medical University.

Author information

Author notes

  1. Yi Zheng and Ying Li contributed equally to this study.

Authors and Affiliations

  1. Beijing Children’s Hospital, National Center for Children Healthy, Capital Medical University, 56 Nanlishi Road, Beijing, 100101, China

    Yonghua Cui & Ying Li

  2. Child Study Center, Yale University School of Medicine, New Haven, CT, USA

    Fenghua Li & James F. Leckman

  3. Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China

    Lanting Guo

  4. Nanjing Brain Hospital, Nanjing, China

    Xiaoyan Ke

  5. Sixth Hospital, Peking University, Beijing, China

    Jing Liu

  6. Beijing Anding Hospital, Capital Medical University, 5 Ankang Hutong, Beijing, 100101, China

    Yi Zheng

Authors
  1. Yonghua Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fenghua Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James F. Leckman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lanting Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaoyan Ke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jing Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yi Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ying Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yi Zheng or Ying Li.

Ethics declarations

Conflict of interest

The authors declared that they had no conflict of interest with respect to their authorship or the publication of this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 25 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cui, Y., Li, F., Leckman, J.F. et al. The prevalence of behavioral and emotional problems among Chinese school children and adolescents aged 6–16: a national survey. Eur Child Adolesc Psychiatry 30, 233–241 (2021). https://doi.org/10.1007/s00787-020-01507-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-020-01507-6

Keywords

Search

Navigation