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Mental health status, and suicidal thoughts and behaviors of migrant children in eastern coastal China in comparison to urban children: A cross-sectional survey

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Lu et al. Child Adolesc Psychiatry Ment Health (2018) 12:13
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Child and Adolescent Psychiatry
and Mental Health
Open Access

RESEARCH ARTICLE

Mental health status, and suicidal
thoughts and behaviors of migrant children
in eastern coastal China in comparison to urban
children: a cross‑sectional survey
Jingjing Lu1†, Feng Wang1†, Pengfei Chai2, Dongshuo Wang3, Lu Li1* and Xudong Zhou1*

Abstract 
Purpose:  Although adolescents’ mental health problems and self-injurious thoughts and behaviors (SITBs) have
been a serious public health concern worldwide, descriptions of risk factors for SITBs often fail to take migration into
account. There are roughly 35.8 million migrant children in China who, with their parents, moved from original rural
residence to urban areas. Little is known about migrant children’s mental health status and levels of SITBs. This study
aims to explore the mental health status and SITBs of migrant children living in eastern coastal China in comparison to
their urban counterparts.
Methods:  This study was a cross-sectional survey conducted in 13 schools. Mental health status and SITBs were
measured via self-administered questionnaires. Associations between strengths and difficulties questionnaire outcomes and SITBs were investigated.
Results:  Data from 4217 students (1858 migrant children and 2359 urban children) were collected. After controlling
for gender, age, family economic status, parent’s education level and parents’ marital status, migrant children scored
higher for total difficulties (p < 0.001) and externalizing problems (p < 0.001) than did urban children and reported
higher rates of suicidal ideation (p < 0.05) and self-injurious behaviors (p < 0.05).
Conclusions:  Migrant children, compared with urban children, have a higher risk of externalizing problems and
SITBs. It is urgent to address these problems by providing both mental health services at migrant-exclusive schools
and equitable education and social welfare to migrant children.
Keywords:  Migrant children, SDQ, Suicide ideation, Self-injurious behavior


Background
Since the mid-1980s when China started to implement
the reform and opening-up policy, a growing number of
people have migrated from rural to urban areas in search
of better jobs and living conditions. In recent years, an
increasing number of migrant workers have made the

*Correspondence: ;

Jingjing Lu and Feng Wang are co-first authors
1
The Institute of Social and Family Medicine, School of Public Health,
Zhejiang University, 866 Yuhangtang Rd., Hangzhou 310058, Zhejiang,
People’s Republic of China
Full list of author information is available at the end of the article

choice to raise their children in cities, creating a new generation of migrant children.
In China, migrant children are defined as “children
under 18 who have left their original residence and
migrated to a big city for at least 6 months” [1]. According to the most recent statistics, the number of migrant
children in China aged between 0 and 17 years is about
35.80 million [2], and this number continues to grow [3].
Because of the Hukou, China’s system of household registration, most migrant children are unable to enroll in
public schools or utilize the same social welfare provided
to urban children. Unregistered schools specifically set
up for migrant children, usually called migrant-exclusive

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Lu et al. Child Adolesc Psychiatry Ment Health (2018) 12:13

schools, are typically small and often lack qualified teachers, standard teaching materials and adequate sanitation
facilities [4]. A minority of migrant children can attend
public schools due to regional policies, for example,
if their parents migrated to a city because of a regional
labor-importing policy. However, these migrant children
may be socially excluded in their classrooms, treated
unjustly by their teachers and discriminated against
by the parents of their urban classmates [5]. As such,
migrant children experience inequitable health conditions, both physically and mentally, in the process of
adapting to a new environment, making them extremely
vulnerable.
Because of these precarious circumstances, there is
great concern regarding the health condition of migrant
children, but only limited data at the population-level
have been collected regarding the mental health status
of migrant children using standardized tools in China.
Although the strengths and difficulties questionnaire
(SDQ) is a standardized measure of mental health in
children and adolescents, with established reliability
and validity [6, 7], studies of the mental health status
of migrant children using SDQ in China are rarely conducted. Existing studies on the subject reported mixed
results. One study conducted in Guangdong found that
migrant children scored significantly higher in every
SDQ outcome compared to normative scores in China
[8]. Another study conducted in Hubei found that

migrant children only reported significantly higher scores
in emotional symptoms, conduct problems, hyperactivity
and peer problems [9] when compared to urban children.
Meanwhile, when compared to rural left-behind children who were still living in rural areas, migrant children
reported significantly lower scores in emotional symptoms and total difficulties [10].
Despite these studies demonstrating the detrimental
effect of migrant status on children’s mental health, gaps
remain in the existing literature; these studies had small
sample sizes, and did not include an appropriate comparison group to verify the impact of migrant status on
mental health.
Another concern regarding migrant children and adolescents’ health conditions is self-injurious thoughts
and behaviors (SITBs), which is a serious public health
concern worldwide [11]. In children and adolescents,
two particular types of SITBs are notable: suicidal ideation, referring to thoughts of ending one’s own life, and
non-suicidal self-injury (NSSI), defined as the direct and
deliberate destruction of one’s body tissue without the
intent to die [12]. Previous international studies have
already confirmed migrant status as a risk factor for suicidal ideation [13] and self-injurious behaviors [14]. In
China, it is estimated that between 14.01 and 26.03% of

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children and adolescents report suicidal ideation [15, 16];
however, studies investigating this phenomenon seldom
investigate the impact of migrant status on these behaviors in children and adolescents [17]. Only one study
[18], conducted in Shanghai, examined the prevalence of
suicidal ideation in migrant adolescents, and found the
rate to be 36.80%, without a comparison to their urban
counterparts.
The present study aims to investigate the mental health

status of migrant children living in eastern coastal China
in comparison to their urban counterparts, and SITBs
among this sample. Based on the aforementioned review
of the literature, two major hypotheses were developed:
firstly, compared to urban children, migrant children
would score significantly higher in all SDQ outcomes
and secondly, migrant children would report significantly
more SITBs.

Methods
Sample

A cross-sectional survey was conducted in a migrant
receiving urban city, the Yinzhou district of Ningbo, Zhejiang Province, between May and June 2013. The region
has an estimated population of 136 million, of whom
46.60% are migrants. There are two kinds of schools
available for migrant children: migrant-exclusive schools,
utilized by the majority of migrant children; and public
schools, utilized by migrant children whose parents are
relatively socio-economically advantaged. As roughly
30% of migrant children in this area attend public
schools, 5  migrants’ schools and 8 public schools were
randomly selected from the school roster of the District
Education Bureau to ensure the comparability of sample
size between the two groups.
In each school, all selected students were between
grades 5 and 9. Across the 13 schools, 4217 students
(1858 migrant children and 2359 urban children) out of
4409 eligible enrolled students completed the questionnaire, representing a response rate of 95.65%.
Procedure


Study information was sent to the head of each school
and the District Education Bureau by mail, and approvals from both parties were obtained. Information packs
(an information letter and a consent form) were distributed to parents by school staff to gain verifiable parental
consent. The study was performed during lunch breaks
and course recesses, during which students with parental consent were assessed collectively by two well-trained
investigators. Before filling out the questionnaire, students’ verbal agreement to participate was obtained after
a simplified study introduction given by the investigators. The questionnaire was strictly self-administrated by


Lu et al. Child Adolesc Psychiatry Ment Health (2018) 12:13

students under investigators’ uniform instruction, and
teachers were off-site to ensure anonymity.
The study was approved by the Ethics Committee of
Zhejiang University (Ref no. ZGL201412-2).
Measures
Socio‑demographics

Socio-demographic characteristics included: age, gender, migrant status, family economic status, parents’
education level and parents’ marital status. Family economic status was measured by possession of a number of
household items, such as an air conditioner, refrigerator,
washing machine, computer and private car [19, 20]. This
variable was then coded as low- (zero to two item), moderate- (three to four items), and high-income (five items).
Parents’ education level referred to the highest education
level of one parent.
The strengths and difficulties questionnaire

Child psycho-social wellbeing was measured with the
self-reported version of the strengths and difficulties

questionnaire (SDQ), which has been validated in China
[21]. The SDQ consists of five subscales: emotional
symptoms, conduct problems, hyperactivity, peer problems and prosocial behavior; each subscale contains five
items in the form of statements requiring a response via
a three-point Likert response scale: 1 (not true); 2 (somewhat true); or 3 (certainly true) [6]. The Cronbach’s alpha
for the emotional symptoms in this study was 0.76; 0.72
for the conduct problems; 0.77 for the hyperactivity; 0.67
for the peer problems; and 0.79 for the prosocial behavior. Emotional symptoms and peer problems were combined to form a single “internalizing” subscale, conduct
problems and hyperactivity were combined to form a
single “externalizing” subscale, and the third subscale,
“prosocial behavior,” remained unchanged. The total difficulties score was calculated by adding the scores of the
internalizing and externalizing subscales. Higher scores
on the total difficulties, internalizing and externalizing
subscales represent higher levels of psychological problems; while higher scores on the prosocial behavior subscale represent lower levels of psychological problems.
Self‑injurious thoughts and behaviors (SITBs)

SITBs, including non-suicidal self-injury, suicidal
thoughts, suicide attempts and death by suicide, are
widely used to obtain information regarding adolescent
suicidality [22]. In this study, the SITBs we assessed were
suicidal ideation and non-suicidal self-injury. These two
items were assessed with the following questions: “Did
you have suicidal thoughts during the past 2  weeks?”
and “Did you hurt yourself deliberately during the past
year?” The following statements were identified as a “yes”

Page 3 of 7

answer for suicidal ideation: “During the last 2  weeks,
I had thoughts of killing myself ” and “During the last

2  weeks, I had thoughts of killing myself but I wouldn’t
carry them out”. The following statements were identified
as a “yes” answer for self-injurious behaviors: “During the
past year, I hurt myself deliberately once” and “During
the past year, I hurt myself deliberately more than once”.
Data analysis

Chi square tests and t-tests were conducted to compare sample characteristics between migrant and urban
children. Multiple linear regression and binary logistic
regressions models were applied to examine the associations between the psycho-social outcomes and migranturban status. Suicidal ideation and self-injurious behavior
and SDQ outcomes were included as dependent variables
and migrant-urban status was examined as an independent variable. Analyses were adjusted for age, gender, family economic status, parents’ education level and parents’
marital status. All analyses were performed using SPSS
20.0 version and assumed a statistical significance level of
p < 0.05.

Results
Table  1 presents the differences in socio-demographic
characteristics and the psychological outcomes between
migrant children and urban children. There were significantly more males among migrant children (55.90%) than
urban children (49.04%). The mean age of migrant children was 13.67 (SD  =  1.52) and the mean age of urban
children was 13.92 (SD  =  1.30). Migrant children had a
generally lower family economic status (χ2  =  1031.00;
p  <  0.001), with parents who were less educated compared to urban children (χ2  =  576.80; p  <  0.001). Compared to urban children’s parents (6.45%), fewer migrant
children’s parents (4.29%) were divorced (χ2  =  9.24;
p < 0.01).
Migrant children had significantly higher mean scores
for total difficulties (t  =  47.84, p  <  0.001), internalizing
problems (t  =  65.81; p  <  0.001) and externalizing problems (t = 81.15; p < 0.001), and lower mean scores on the
prosocial behavior scale (t = 53.35; p < 0.001) compared

to urban children. Migrant children reported significantly higher rates of self-injurious behaviors (χ2 = 4.86;
p < 0.05).
Table  2 shows the linear regression analyses of SDQ
outcomes and the binary logistic regression analyses of
SITBs outcomes. After controlling for gender, age, family economic status, parent’s education level and parents’
marital status, migrant children scored higher for total
difficulties (β = 0.46; 95% CI = 0.06, 0.85; p < 0.05) and
externalizing problems (β  =  0.50; 95% CI  =  0.26, 0.74;
p  <  0.001) than did urban children. Migrant children


Lu et al. Child Adolesc Psychiatry Ment Health (2018) 12:13

Page 4 of 7

Table 1  The social-demographic characteristics, SDQ and SITBs of migrant compared to urban children
Migrant children
n = 1858 N (%)

Urban children
n = 2359 N (%)

χ2 or t

p value

Gender
 Male

966 (55.90)


1100 (49.04)

 Female

762 (44.10)

1143 (50.96)

Age, mean (SD)

13.67 (1.52)

13.92 (1.30)

Family economic status
 Poor

566 (31.03)

53 (2.26)

 Fair

821 (45.01)

711 (30.35)

 Wealthy


437 (23.96)

1579 (67.39)

319 (17.68)

89 (3.90)

1100 (60.98)

975 (42.71)

329 (18.24)

754 (33.03)

56 (3.10)

465 (20.37)

79 (4.29)

151 (6.45)

Parents’ education level
 Illiteracy or primary school
 Middle school
 High school
 College or above
Are your parents divorced?

 Yes
 No
Total difficulties, mean (SD)

1761 (95.71)

2189 (93.55)

12.28 (5.19)

11.12 (5.56)

18.41

< 0.001

34.23

< 0.001

1031.00

< 0.001

576.80

< 0.001

9.24


0.003

47.84

< 0.001

Emotional symptoms, mean (SD)

3.09 (2.00)

3.03 (2.12)

7.40

0.007

Conduct problems, mean (SD)

2.43 (1.63)

2.18 (1.60)

4.43

0.035

Hyperactivity, mean (SD)

3.92 (2.16)


3.36 (2.20)

6.17

0.013

Peer problems, mean (SD)

2.84 (1.60)

2.55 (1.65)

2.73

0.098

Prosocial behavior, mean (SD)

6.93 (2.02)

7.39 (2.10)

53.35

< 0.001

Internalizing problems, mean (SD)

5.93 (2.88)


5.58 (3.06)

65.81

< 0.001

Internalizing problems (> 8)

326 (17.55)

418 (17.72)

0.02

0.903

Externalizing problems, mean (SD)

6.35 (3.30)

5.54 (3.30)

81.15

< 0.001

1796 (96.66)

2231 (94.57)


10.54

0.001

1.70

0.200

4.86

0.030

Externalizing problems (> 10)
Suicidal ideation
 Yes

492 (26.67)

584 (24.89)

 No

1353 (73.33)

1762 (75.11)

 Yes

189 (10.47)


193 (8.45)

 No

1616 (89.53)

2091 (91.55)

Self-injuries behavior

reported significantly higher rates of suicidal ideation
(OR = 1.23; 95% CI = 1.03, 1.46; p < 0.05) and self-injurious behaviors (OR = 1.32; 95% CI = 1.01, 1.72; p < 0.05).

Discussion
As China’s economy grows, migrant populations will
continue to expand. Migration is a carefully weighed
family decision [23]. While migrant children may benefit
from staying with their parents, their well-being may be
harmed from limited access to social welfare and other
social services [24]. This study sought to explore the
mental health status and SITBs in migrant children living in eastern coastal China in comparison to their urban
counterparts. We found that migrant children, compared

to urban children, are more likely to experience externalizing problems (conduct problems and hyperactivity) and
SITBs (suicidal thoughts and behaviors).
Partly in line with our first hypothesis, after controlling for socio-demographic variables, migrant children
reported higher mean scores in total difficulties and
externalizing problems (conduct problems and hyperactivity) compared to urban children but not in internalizing problems (emotional symptoms and peer problems).
Low familial socioeconomic status (SES) is one of the
several environmental adversities that has been found

to increase the risk of mental health problems in this age
group [25, 26]. Coleman [27] has proposed that three
types of capital influence youth’s well-being: parents who


0.36 (0.23,
0.49)***

0.08 (0.03,
0.12)**

 Female

Age

− 0.19 (− 0.40,
0.02)

− 0.24 (− 0.46,
− 0.02)*

1.00

− 0.43 (− 0.64,
− 0.22)***

− 0.78 (− 1.06,
− 0.50)***

1.00


0.26 (− 0.02,
0.54)

 Fair

 Wealthy

 Illiteracy/primary school

 Middle school

 College or
above

 Married

 Divorced

− 0.45 (− 0.69,
− 0.22)***

* p < 0.05, ** p < 0.01, *** p < 0.001

Parental martial status

 High school

Parents’ education level


1.00

 Poor

Family economic status

1.00

 Male

0.36 (0.14,
0.57)**

1.00

− 0.40 (− 0.61,
− 0.18)***

− 0.24 (− 0.42,
− 0.06)**

− 0.26 (− 0.42,
− 0.09)**

1.00

− 0.30 (− 0.20,
0.14)

0.05 (− 0.11,

0.21)

1.00

0.02 (− 0.02,
0.06)

− 0.40 (− 0.49,
− 0.29)***

1.00

0.58 (0.29,
0.88)***

1.00

− 0.82 (− 1.11,
− 0.53)***

− 0.44 (− 0.68,
− 0.19)***

− 0.33 (− 0.55,
− 0.11)**

1.00

− 0.20 (− 0.43,
0.03)


− 0.04 (− 0.25,
0.18)

1.00

0.17 (0.12,
0.22)***

− 0.45 (− 0.59,
− 0.32)***

1.00

0.15 (0.03, 0.27)* 0.35 (0.19,
0.51)***

Gender

1.00

− 0.09 (− 0.24,
0.07)

 Migrant children

1.00

Conduct prob- Hyperactivity
lems

β (95% CI)
β (95% CI)

 Urban children 1.00

Group

Emotional
symptoms
β (95% CI)

0.15 (− 0.07,
0.37)

1.00

− 0.61 (− 0.83,
− 0.39)***

− 0.34 (− 0.52,
− 0.15)***

− 0.27 (− 0.43,
− 0.10)**

1.00

− 0.38 (− 0.55,
− 0.21)***


− 0.19 (− 0.35,
− 0.03)*

1.00

0.01 (− 0.03,
0.04)

− 0.36 (− 0.46,
− 0.25)***

1.00

0.04 (− 0.08,
0.16)

1.00

Peer problems
β (95% CI)

− 0.85 (− 1.00,
− 0.64)***

1.00

0.50 (0.26,
0.74)***

1.00


Externalizing
problems
β (95% CI)

1.00

− 1.22 (− 1.65,
− 0.77)***

− 0.68 (− 1.05,
− 0.31)***

− 0.59 (− 0.91,
− 0.26)**

1.00

− 0.23 (− 0.58,
0.12)

0.02 (− 0.31,
0.34)

1.00

0.41 (0.01, 0.82)* 0.94 (0.50,
1.38)***

1.00


− 1.39 (− 1.79,
− 0.99)***

− 0.79 (− 1.13,
− 0.45)***

− 0.69 (− 0.99,
− 0.39)***

1.00

− 0.62 (− 0.93,
− 0.30)**

− 0.38 (− 0.68,
− 0.09)*

1.00

0.08 (0.01, 0.15)* 0.19 (0.12,
0.27)***

0.01 (− 0.18,
0.19)

1.00

− 0.05 (− 0.27,
17)


1.00

Internalizing
problems
β (95% CI)

− 0.12 (− 0.39,
0.16)

1.00

0.77 (0.50,
1.04)***

0.49 (0.26,
0.72)***

0.32 (0.11,
0.52)**

1.00

0.50 (0.29,
0.72)***

0.17 (− 0.03,
0.38)

1.00


− 0.01 (− 0.05,
0.04)

0.61 (0.48,
0.74)***

1.00

− 0.10 (− 0.25,
0.05)

1.00

Prosocial
behavior
β (95% CI)

1.00

Suicidal ideation
OR (95% CI)

1.00

Self-injurious
behavior
OR (95% CI)

1.35 (0.63,

2.08)***

1.00

− 2.60 (− 3.32,
− 1.88)***

− 1.47 (− 2.07,
− 0.86)***

− 1.28 (− 1.82,
− 0.74)***

1.00

− 0.85 (− 1.42,
− 0.28)**

− 0.36 (− 0.89,
0.17)

1.00

0.27 (0.15,
0.39)***

− 0.84 (− 1.17,
− 0.51)***

1.00


0.83 (0.59, 1.17)

1.00

1.11 (1.02, 1.20)*

1.09 (0.87, 1.36)

1.00

1.70 (1.27,
2.28)***

1.00

0.74 (0.54, 1.02)

0.68 (0.53,
0.88)**

0.68 (0.54,
0.85)**

1.00

1.32 (0.86, 2.04)

1.00


0.90 (0.58, 1.40)

0.69 (0.47, 1.02)

0.73 (0.53, 1.01)

1.00

1.29 (1.01, 1.65)* 1.07 (0.74, 1.54)

1.09 (0.87, 1.38)

1.00

1.22 (1.16,
1.29)***

1.11 (0.97, 1.30)

1.00

0.46 (0.06, 0.85)* 1.23 (1.03, 1.46)* 1.32 (1.01, 1.72)*

1.00

Total difficulties
β (95% CI)

Table 2  Regression coefficients for SDQ outcomes and SITBs on children group with adjustment for socio-demographic characteristics


Lu et al. Child Adolesc Psychiatry Ment Health (2018) 12:13
Page 5 of 7


Lu et al. Child Adolesc Psychiatry Ment Health (2018) 12:13

are educated (human capital) are assumed to have a better economic status (financial capital) and are more likely
to be communicative with their children (social capital).
Under this framework, our findings suggest that better
family economic status and parental education levels can
mitigate against the adverse psychological experiences
caused by migration with parents, indicating that material and family support can work as important factors
supporting children’s psychological well-being. Essentially, migrant children from lower-income families with
less-educated parents are susceptible to additional risks
for psychosocial disadvantages.
Previous studies also have suggested that SES is more
closely related to the externalizing than to the internalizing domain [28, 29]. As a possible explanation for this,
some scholars suggest that, as children age, they become
more exposed to influences outside of the family, which
may reduce their internalizing problems [30]. Migrant
and urban children in our study were close in age and
lived in similar neighborhoods, which may explain why
migrant children in our study didn’t report higher mean
scores of internalizing problems (emotional symptoms
and peer problems) than did their urban counterparts.
Previous studies have suggested that externalizing
problems (conduct problems [31, 32] and hyperactivity
[33]) in youth are associated with low family cohesion
and the low intellectual/cultural orientation of the family.
Families with low levels of intellectual/cultural orientation can only offer limited opportunities for socialization

and access to community resources to their children,
which may increase children’s externalizing problems
[34]. Likewise, the strong negative influence of parental
divorce highlights the importance of family cohesion on
children’s mental health [35]. Parental divorce will impair
the bonds between family members, which may exert
negative influences on a child’s development of children.
After adjusting for relevant variables, migrant children reported significantly higher rates of suicidal ideation and self-injurious behaviors than did urban children
in the present study, supporting our second hypothesis.
As noted, externalizing problems are associated with
SITBs in adolescents [36, 37]. The risk of suicide is 30–50
times higher in populations with SITBs than in the general population [38]. Thus, migrant children with suicidal
ideation or non-suicidal self-injurious behaviors are at
high risk for suicide. In recent years, a growing number of scholars have argued that the existing measures
being implemented for youth suicide prevention do not
have the same efficiency in migrant children as they do
in urban children [39], as migrant workers are too busy
to take care of their children [40] and migrant-exclusive
schools are usually under-provisioned. Therefore, to prevent suicide among migrant children more effectively,

Page 6 of 7

greater importance should be attached to their SITBs
and appropriate follow up management should be
implemented.
Several limitations in the present study were identified
when interpreting the study findings, in light of its design
and methodological characteristics. Firstly, the sample
size was large, yet the study was conducted in a single district within one eastern coastal city of China. Therefore,
it is inappropriate to extrapolate the results to the whole

country. Secondly, to understand the condition of mental
health and SITBs of migrant children, more factors should
be taken into consideration, including domestic violence
and parents’ history of mental illness. Adolescents who
have experienced family violence were at higher risk of
developing externalising problems [41]. Since young children may be reluctant to answer some of these questions,
we didn’t include them in the questionnaire. Thirdly, our
exclusive reliance on adolescents’ self-reporting may
result in the under-reporting of mental health problems
[6]. Consequently, mental health problems and SITBs may
be underestimated in the present study.

Conclusion
A comparison of the migrant children and urban children reveals that migrant children are highly likely to face
externalizing problems (conduct problems and hyperactivity) and SITBs (suicidal thoughts and behaviors).
Actions should be taken to identify migrant children’s
externalizing problems and SITBs, improve the communication between teachers and parents, and provide mental
health services at migrant-exclusive schools. The migration policy should be changed to improve access to equitable education and social welfare for migrant children.
Abbreviations
SDQ: strengths and difficulties questionnaire; SITBs: self-injurious thoughts and
behaviors; NSSI: non-suicidal self-injurious; SES: socioeconomic status.
Authors’ contributions
JL analyzed and interpreted the data; and drafted the manuscript. FW and
DW drafted the manuscript. PC participated in the coordination of the study.
LL participated in critical review of the manuscript; and participated in the
conception and design of the study. XZ participated in critical review of the
manuscript; and participated in the conception, design and coordination of
the study. All authors read and approved the final manuscript.
Author details
1

 The Institute of Social and Family Medicine, School of Public Health, Zhejiang
University, 866 Yuhangtang Rd., Hangzhou 310058, Zhejiang, People’s Republic
of China. 2 Yinzhou District CDC, 1221 Xueshi Rd., Ningbo 315199, Zhejiang,
People’s Republic of China. 3 Oxford Road, SG16 Samuel Alexander Building,
Manchester M13 9PL, UK.
Acknowledgements
Not applicable.
Competing interests
The authors declare that they have no competing interests.


Lu et al. Child Adolesc Psychiatry Ment Health (2018) 12:13

Availability of data and materials
The data-sets analyzed during this study are available from the corresponding
author on reasonable request.
Consent for publication
Not applicable.
Ethics approval and consent to participate
The study was approved by the Ethics Committee of Zhejiang University (Ref
No. ZGL201412-2). Signed parental consent for student participation was
obtained. Additionally, student verbal agreement to participate was required
at the time of data collection.
Funding
The survey was conducted with funding from Zhejiang University Zijin Talent
Project and infrastructure support from Yinzhou District CDC. Funders had
no role in study design; collection, analysis and interpretation of data; and in
writing the manuscript.

Publisher’s Note


Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Received: 20 June 2017 Accepted: 23 January 2018

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