Prevalence and associated factors of adolescent psychological abuse, neglect in Western China a multi-center cross-sectional study

ABSTRACT

Background: The western region of China has a dense population, relatively underdeveloped economy, and a significant number of left-behind children. Currently, the prevalence of adolescent psychological abuse, neglect, and the factors associated with these issues in the region remain unclear. This study aims to evaluate the current status of adolescent psychological abuse and neglect and its associated factors in this region.

Methods: Data were collected from 50 schools in western China through cluster sampling to target adolescents aged 12 to 18. A comprehensive survey form was used to collect socio-demographic characteristics of adolescents. The Child Psychological Abuse and Neglect Scale was employed to assess the current psychological abuse and neglect of adolescents. Independent samples t-tests were used for inter-group comparisons. A Directed Acyclic Graph was constructed for controlling confounding variables. Subsequently, binary logistic regression analysis was performed, and a nomogram risk factors model was developed using R Studio.

Results: This study included 12,743 teenagers, with an average age of 15.53(±1.39) years. Among them, 4,965 individuals, accounting for 39.0%, reported experiences of psychological abuse, while 4,167 individuals, accounting for 32.7%, reported experiences of neglect. The rates of psychological abuse and neglect in adolescents are influenced by gender, grade, left-behind experience, parental marital status, and living on campus (P < .05).

Conclusion: Adolescents in western China exhibit higher rates of psychological abuse and neglect compared to those in the eastern and northern regions of China. Gender, grade, left-behind experience, and family factors significantly influence the psychological abuse and neglect of adolescents.

HIGHLIGHTS

• This study is the first large-scale, multi-centre, cross-sectional analysis of psychological abuse and neglect among youth in Western China, a region with relatively underdeveloped economic and social conditions.

• This article fills in the gap in the region’s research on psychological abuse and neglect by addressing the issues of small sample size, limited coverage, and a lack of variables included.

• This provides a crucial theoretical foundation for enhancing the mental well-being of youth in this region and preventing psychological and mental illnesses among youth.

Antecedentes: La región occidental de China tiene una población densa, una economía relativamente subdesarrollada y un número significativo de niños abandonados. Actualmente, la prevalencia del abuso psicológico y la negligencia en adolescentes, así como los factores asociados a estos problemas en la región, siguen sin estar claros. Este estudio tiene como objetivo evaluar el estado actual del abuso psicológico y la negligencia en adolescentes y los factores asociados en esta región.

Métodos: Se recopilaron datos de 50 escuelas en el oeste de China mediante un muestreo por conglomerados, dirigido a adolescentes de 12 a 18 años. Se utilizó un formulario de encuesta integral para recopilar características sociodemográficas de los adolescentes. Se empleó la Escala de Abuso Psicológico y Negligencia Infantil para evaluar el abuso psicológico y la negligencia actuales en los adolescentes. Se utilizaron t-test en muestras independientes para comparaciones entre grupos. Se construyó un Gráfico Acíclico Dirigido para controlar las variables de confusión. Posteriormente, se realizó un análisis de regresión logística binaria y se desarrolló un modelo de factores de riesgo de nomograma utilizando R Studio.

Resultados: Este estudio incluyó a 12.743 adolescentes, con una edad promedio de 15.53(±1.39) años. De ellos, 4.965 individuos, que representan el 39.0%, informaron experiencias de abuso psicológico, mientras que 4.167 individuos, que representan el 32.7%, informaron experiencias de negligencia. Las tasas de abuso psicológico y negligencia en adolescentes están influenciadas por el género, el grado, la experiencia de abandono, el estado civil de los padres y vivir en el campus (P < 0.05).

Conclusión: Los adolescentes en el oeste de China presentan tasas más altas de abuso psicológico y negligencia en comparación con aquellos en las regiones del este y norte de China. El género, el grado escolar, la experiencia de abandono y los factores familiares influyen significativamente en el abuso psicológico y la negligencia en los adolescentes.

KEYWORDS:

• Child abuse
• child neglect
• teenages
• prevalence
• psychological abuse
• neglect

PALABRAS CLAVE:

• Abuso infantil
• negligencia infantil
• adolescentes
• prevalencia
• abuso psicológico
• negligencia

1. Introduction

Child abuse, including abuse (physical, emotional and sexual) and neglect (psychological and physical), It occurs when individuals who are responsible for the care, supervision, and guidance of children cause actual or potential harm to them, which affects their health, dignity, growth, development, and survival. This harm can manifest in various forms, such as physical abuse, psychological abuse, sexual abuse, neglect, and economic exploitation. These actions present a considerable public health challenge and have adverse effects on the physical and mental well-being of children and adolescents (Zeanah & Humphreys, 2018).

The most prevalent type is psychological abuse and neglect, with psychological abuse also known as mental maltreatment or emotional abuse. Psychological abuse includes caregivers’ failure to create a supportive and nurturing environment, along with behaviours that harm children’s emotional well-being and development. These behaviours include restricting children’s actions, verbal abuse, threats, intimidation, discrimination, rejection, and other forms of non-physical hostile behaviour. Neglect refers to parents’ responsibility to provide support in areas like health, education, emotional well-being, nutrition, housing, and safety, but failing to do so for the child’s overall growth and development (Mahram et al., 2013). The characteristics of psychological abuse and neglect, which are less apparent than physical abuse, often do not receive sufficient attention from society and families. Nonetheless, both psychological abuse and neglect lead to various negative consequences. These include internalising behaviours such as social and cognitive problems (Kobulsky et al., 2018; Salzmann et al., 2022; Strathearn et al., 2020), post-traumatic stress disorder (PTSD) (Maguire et al., 2015), anxiety, and depression (Häuser et al., 2011; Maguire et al., 2015; Mwakanyamale & Yizhen, 2019). Additionally, externalising behaviours such as engaging in risky behaviours (DeJong et al., 2022; Strathearn et al., 2020), developing unhealthy habits (DeJong et al., 2022; Kobulsky et al., 2018; Salzmann et al., 2022),and exhibiting less prosocial behaviour can also be observed (Maguire et al., 2015). Importantly, these adverse effects can persist into adolescence and young adulthood (Strathearn et al., 2020).

The prevalence rates of abuse issues are high on a global scale, with a range of 22% to 60% for psychological abuse and neglect (Häuser et al., 2011; Mahram et al., 2013; Mwakanyamale & Yizhen, 2019; van der Kooij et al., 2015; Zelviene et al., 2020). In China, the prevalence rates for psychological abuse and neglect range from 21% to 45% (Chen et al., 2022; Fang et al., 2015; Fung et al., 2020). A survey conducted in Hong Kong revealed that approximately 43.3% of respondents reported experiencing psychological abuse during their childhood, while 44.5% reported experiencing neglect (Fung et al., 2020). A study conducted in Jiangsu Province, located in eastern China, reported a 25.66% prevalence rate of psychological abuse (Chen et al., 2022), In parallel, a study in Hebei Province, in the northern region of China, identified a 38.5% incidence of psychological abuse among female vocational school students (Zhen & Shulan, 2017). However, the prevalence of psychological abuse and neglect among children and adolescents in underdeveloped areas of western China has yet to be clearly determined.

Various risk factors contribute to psychological abuse and neglect, including inadequate parenting skills among caregivers, (Campbell & Hibbard, 2014), lack of familial warmth and cohesion (Wark et al., 2003), changes in family structure (e.g. single-parent households and remarriage), economic challenges faced by families, parents’ educational and occupational backgrounds (Chen et al., 2022; Sidebotham et al., 2006). caregivers’ mental health issues, and substance abuse (Coelho et al., 2018; Kimber & MacMillan, 2017) and experience of being left behind (Fellmeth et al., 2018). ‘Experience of being left behind’ refers to children under 18 who were left in their household registration place for six months or more due to one or both parents engaging in migrant work, making it impossible to live with them (Chengrong et al., 2012).

The economic and social development in the western region of China is lacking, characterised by a high number of children and adolescents and relatively low levels of education. The significant migration of urban and rural labour forces has led to a substantial increase in the number of children left behind (Ahlers, 2019; Wang et al., 2020). However, there has been limited research conducted on the psychological abuse and neglect experienced by adolescents in this region (Guofang et al., 2022; Yafei & Yan, 2021; Zhou et al., 2019). The existing studies suffer from small sample sizes, limited coverage, a scarcity of included variables, and a lack of representativeness in the obtained results. Given the aforementioned research background, the objective of this study is to assess the prevalence of child psychological abuse and neglect in the western region of China. Furthermore, it aims to investigate the factors that influence child psychological abuse and neglect in this region. The ultimate goal is to enhance the mental health of adolescents in the area and provide crucial references for preventing adolescent mental disorders.

2. Methods

2.1. Survey and inclusion criteria

This cross-sectional study assesses the mental health of adolescents using a two-sided testing approach with α = 0.05 and allowable error δ = 0.6. Based on the latest survey data in our country, the overall prevalence of mental disorders among children and adolescents is 26%. The minimum sample size of 7214 cases was calculated using PASS15 software. After accounting for a potential 20% data loss, the adjusted minimum sample size is 8657 cases.

This multicenter cross-sectional survey was conducted from July 2021 to July 2022, targeting students aged 12 to 18 in 50 schools located in the western region of China, including various locations like Nanchong, Neijiang, and Luzhou. The survey was carried out using a cluster sampling method and a questionnaire. The survey was conducted using the Wenjuanxing website (https://www.wjx.cn) as a platform for distribution. Both participants and their parents were provided with information about the study’s objectives before proceeding to complete the questionnaire. After obtaining consent from both the parents and the students participating in the testing, the students proceed to sign informed consent forms and subsequently fill out the questionnaires. The research protocol has received ethical approval from the Ethics Committee of North Sichuan Medical College.

The data collection for this project is divided into two phases. In the first phase, researchers mastered themselves with the research procedures and questionnaire content, and underwent training on the completion requirements. Furthermore, they communicated with the head teacher of the observed class to discuss the research objectives and questionnaire content. Upon reaching a unanimous agreement, the researchers proceeded to distribute the questionnaires. In the second stage, two researchers collected and reviewed the completed results, exporting them from the WJX platform into an Excel spreadsheet. Prior to data analysis, missing values, obvious outliers, and cases inconsistent with the research question were excluded, ensuring that only data meeting the inclusion criteria were included for analysis. The research team comprises practicing physicians from the Department of Mental Health at the Affiliated Hospital of North Sichuan Medical College and postgraduate students specialising in psychiatry at the same hospital. Before the investigation, they underwent systematic training to familiarise themselves with the procedures, content, and subsequent processes, strictly adhering to the Standard Operating Procedures (SOP). The research protocol has received ethical approval from the Ethics Committee of North Sichuan Medical College.

A total of 14,210 questionnaires were collected in this survey, with 12,743 valid questionnaires and 1,467 invalid questionnaires (cases with missing values, obviously fictional values, or inconsistent answers to the questions). The questionnaire validity rate is 89.7% (Figures 1 and 2).

Figure 1. Flowchart of sample selection.

Figure 2. Directed acyclic graph (DAG) of risk factors for psychological abuse and neglect.

2.2. Data collection and measurement

The survey explores the social demographics of the participants, encompassing their age, gender, grade level, experience of being left behind, ongoing experience of being left behind, living conditions, parents’ marital status, living environment, parental educational background, parental occupation, campus residency, only-child status, and regular medication intake.

2.3. Child psychological abuse and neglect scale, CPANS

The Child Psychological Abuse and Neglect Scale (CPANS) was developed by Deng Yunlong et al. (Xianlu et al., 2007) as a retrospective measurement tool intended for use with Chinese individuals. The survey assesses an individual’s experiences of psychological abuse during their childhood (below 18 years old), encompassing family abuse, neglect, and treatment from caregivers. It comprises 31 items and encompasses two sub-scales: the psychological abuse scale and the neglect scale. The psychological abuse scale comprises 14 items distributed across three dimensions: interference, intimidation, and scolding. For instance, some items include ‘Parents publicly list my various shortcomings’ and ‘Parents unexpectedly scold me’. Additionally, the neglect scale includes 17 items categorised into physical/supervisory neglect, educational neglect, and emotional neglect. For example, items such as ‘Parents show no concern for changes in my academic performance’ and ‘Parents do not forbid me from drinking alcohol’ are included. A five-point scoring system (ranging from 0 to 4) was employed, with the final score for each sub-scale calculated as the average total score of its constituent items. A score of ≥1 point on the psychological abuse scale was deemed to indicate the presence of psychological abuse, and a score of ≥1 point on the neglect scale was deemed to indicate the presence of neglect. The CPANS total scale demonstrates high internal consistency reliability (Cronbach’s alpha = 0.921). Additionally, the psychological abuse subscale exhibits a reliability coefficient of 0.794, while the neglect subscale indicates a reliability coefficient of 0.820. The internal consistency reliabilities for the three dimensions of psychological abuse and neglect range from 0.756 to 0.830 and 0.698 to 0.803, respectively. The scale also demonstrated a validity coefficient of 0.971. The authors responsible authorised the development of this questionnaire.

2.4. Statistical analysis

Data analysis is performed using SPSS 26.0. The K-S test is utilised to assess the normal distribution of measurement data, whereas descriptive statistics are employed to describe and compare general characteristics. The study employed the independent samples t-test to conduct between-group comparisons. Constructing a directed acyclic graph (DAG) to identify clinically significant risk factors for adolescent psychological abuse and neglect in the field of psychology. Binary logistic regression analysis was conducted to identify risk factors using the ‘rms’ package in R studio 4.3.1. A nomogram model was constructed. All tests were two-tailed, and the significance level was set at p < .05.

3. Result

The survey findings showed that boys accounted for 53.2% (6781/12743) of the participants, while girls accounted for 46.8% (5962/12743). The average age of the participants was 15.53 ± 1.39 years. Middle school students comprised 57.9% (7375/12743) of the sample, whereas high school students accounted 42.1% (5368/12743). Single-factor regression analysis revealed that the prevalence of psychological abuse during childhood was 39.0% (4965/12743). Various factors, such as gender, grade, living conditions, parents’ marital status, father’s education level, mother’s education level, residency in a boarding school, long-term medication use, experiences of being left-behind, and continued experience of being left-behind, were identified as predictors for the occurrence of psychological abuse in childhood (P < .05). The prevalence of neglect during childhood was 32.7% (4167/12743). Similarly, various factors, including grade, living conditions, parents’ marital status, father’s education level, mother’s education level, occupations of both parents, residency in a boarding school, long-term medication use, experiences of being left-behind, and continued experience of being left-behind, were found to be predictors for the occurrence of psychological abuse and neglect in childhood (P < .05)(see Tables 1 and 2).

Table 1. Demographic differences between child abuse.

	Mode	Total	Abuse or not		χ^2 / Z	P
			Not N(%)	YES N(%)
Age		15.503 ± 1.397	15.080 ± 1.422	15.009 ± 1.359	33.039	<.001
Gender	Boys	6781(53.2)	4202(62.0)	2579(38.0)	5.448	.020
	Girls	5962(46.8)	3574(59.9)	2388(40.1)
Grade	Junior high school	7375(57.9)	4588(62.2)	2787(37.8)	10.396	.001
	High school	5368(42.1)	3188(59.4)	2180(40.6)
Family member	Living with parents	3557(27.9)	2288(64.3)	1269(35.7)	25.046	<.001
	Live with grandparents	5263(41.3)	3114(59.2)	2149(40.8)
	Live with others	750(5.9)	447(59.6)	303(40.4)
	Living with mother	2697(21.2)	1644(61.0)	1053(39.0)
	Living with father	476(3.7)	283(59.5)	193(40.5)
Parental marital status	At marriage	10849(85.1)	6769(62.4)	4080(37.6)	57.913	<.001
	After the divorce raised by mother	467(3.7)	244(52.2)	223(47.8)
	After the divorce raised by father	1427(11.2)	763(53.5)	664(46.5)
Home place	Urban	3596(28.2)	2194(61.0)	1402(39.0)	0.00	.989
	Rural area	9147(71.8)	5582(61.0)	3565(39.0)
Paternal education	Primary school	4113(32.3)	2395(58.2)	1718(41.8)	27.267	<.001
	Middle school	7944(62.3)	4920(61.9)	3024(38.1)
	College or above	686(5.4)	461(67.2)	225(32.8)
Maternal education	Primary education or below	5482(43.0)	3231(58.9)	2251(41.1)	25.377	<.001
	Secondary education	6688(52.5)	4155(62.1)	2533(37.9)
	Associate’s degree or equivalent	573(4.5)	390(68.1)	183(31.9)
Father’s work	Farmers	2152(16.9)	1277(59.3)	875(40.7)	3.356	.340
	Workers	9271(72.8)	5681(61.3)	3590(38.7)
	Merchant	1159(9.1)	717(61.9)	442(38.1)
	Civil servant	161(1.3)	101(62.7)	60(37.3)
Mother’s work	farmers	3556(27.9)	2192(61.6)	1364(38.4)	4.043	.257
	workers	7852(61.6)	4758(60.6)	3094(39.4)
	Merchant	1220(9.6)	747(61.2)	473(38.8)
	Civil servant	115(0.9)	79(68.7)	36(31.3)
Whether in residence	Yes	7358(57.7)	4622(62.8)	2736(37.2)	23.567	<.001
	No	5385(42.3)	3154(58.6)	2231(41.4)
Whether the Only child	Yes	1730(13.6)	1031(59.7)	699(40.3)	1.652	.203
	No	11013(86.4)	6745(61.2)	4268(38.8)
Whether long-term medication	Yes	274(2.2)	101(36.9)	173(63.1)	68.722	<.001
	No	12469(97.8)	7675(61.6)	4794(38.4)
Left-behind children	Yes	8454(66.3)	4894(57.9)	3560(42.1)	103.588	<.001
	No	4289(33.7)	2882(67.2)	1407(32.8)
Continue to stay	Yes	5265(41.3)	2989(56.8)	2276(43.2)	68.152	.000
	No	7478(58.7)	4787(64.0)	2691(36.0)

Table 2. Demographic differences between child neglect.

Mode		Total	Neglect or not		χ^2 / Z	P
			Not N(%)	YES N(%)
Age		15.503 ± 1.397	15.027 ± 1.416	15.102 ± 1.357	7.463	.006
Gender	Boys	6781(53.2)	4598(67.8)	2183(32.2)	1.911	.167
	Girls	5962(46.8)	3974(66.7)	1988(33.3)
Grade	Junior high school	7375(57.9)	5021(68.1)	2354(31.9)	5.256	.022
	High school	5368(42.1)	3551(66.2)	1817(33.8)
Family member	Living with parents	3557(27.9)	2487(69.9)	1070(30.1)	33.379	<.001
	Live with grandparents	5263(41.3)	3492(66.3)	1771(33.7)
	Live with others	750(5.9)	479(63.9)	271(36.1)
	Living with mother	2697(21.2)	1834(68.0)	863(32.0)
	Living with father	476(3.7)	280(58.8)	196(41.2)
Parental marital status	At marriage	10849(85.1)	7462(68.8)	3387(31.2)	78.455	<.001
	After the divorce raised by mother	467(3.7)	288(61.7)	179(38.3)
	After the divorce raised by father	1427(11.2)	822(57.6)	605(42.4)
Home place	Urban	3596(28.2)	2457(68.3)	1139(31.7)	2.545	.111
	Rural area	9147(71.8)	6115(66.9)	3032(33.1)
Paternal education	Primary school	4113(32.3)	2618(63.7)	1495(36.3)	51.107	<.001
	Middle school	7944(62.3)	5435(68.4)	2509(31.6)
	College or above	686(5.4)	519(75.7)	167(24.3)
Maternal education	Primary education or below	5482(43.0)	3536(64.5)	1946(35.5)	40.970	<.001
	Secondary education	6688(52.5)	4609(68.9)	2079(31.1)
	Associate’s degree or equivalent	573(4.5)	427(74.5)	146(25.5)
Father’s work	Farmers	2152(16.9)	1371(63.7)	781(36.3)	19.759	<.001
	Workers	9271(72.8)	6269(67.6)	3002(32.4)
	Merchant	1159(9.1)	816(70.4)	343(29.6)
	Civil servant	161(1.3)	116(72.0)	45(28.0)
Mother’s work	farmers	3556(27.9)	2361(66.4)	1195(33.6)	10.203	.017
	workers	7852(61.6)	5268(67.1)	2584(32.9)
	Merchant	1220(9.6)	855(70.1)	365(29.9)
	Civil servant	115(0.9)	88(76.5)	27(23.5)
Whether in residence	Yes	7358(57.7)	5042(68.5)	2316(31.5)	12.470	<.001
	No	5385(42.3)	3530(65.6)	1855(34.4)
Whether the Only child	Yes	1730(13.6)	1141(66.0)	589(34.0)	1.571	.210
	No	11013(86.4)	7431(67.5)	3582(32.5)
Whether long-term medication	Yes	274(2.2)	114(41.6)	160(58.4)	83.755	<.001
	No	12469(97.8)	8458(67.8)	4011(32.2)
Left-behind children	Yes	8454(66.3)	5484(64.9)	2970(35.1)	65.687	<.001
	No	4289(33.7)	3088(72.0)	1201(28.0)
Continue to stay	Yes	5265(41.3)	3328(63.2)	1937(36.8)	67.115	.000
	No	7478(58.7)	5244(70.1)	2234(29.9)

This article illustrates a directed acyclic graph (DAG) on psychology abuse and neglect. By incorporating substantial prior knowledge into the DAG, it becomes feasible to visualise intricate causal relationships, thereby reducing the influence of irrelevant factors to a greater extent. Additionally, this approach helps prevent overfitting of prediction models and simplifies the process of predictive modelling. After adjusting for confounding variables using a DAG graph, binary logistic regression analysis was performed with the main variables from Table 1 as independent variables, while whether abuseand whether neglect served as the dependent variables. The findings demonstrated that gender, grade, left-behind experience, and the decision to continue staying behind are independent risk factors for psychological abuse (P < .05) (see Table 3). Grade, left-behind experience, and the decision to continue staying behind are factors that have an independent impact onneglect (P < .05) (see Table 4).

Table 3. Psychological abuse of binary logistic regression analysis.

		B	SE	Wales	P-value	OR	95%CI
Constant		−0.565	0.054	110.987	<.001	0.568
Gender	Girls Boys	0.074	0.037	4.070	.044	1.077	1.002～1.158
Grade	High school Junior high school	0.193	0.039	24.901	<.001	1.212	1.124～1.308
Left-behind children	Yes No	0.283	0.046	37.479	<.001	1.327	1.212～1.453
Continue to stay	Yes No	0.156	0.043	12.966	<.001	1.169	1.074～1.273
Parental marital status	At marriage			43.914	.000
	After the divorce raised by mother	0.401	0.096	17.456	<.001	1.493	1.237～1.801
	After the divorce raised by father	0.317	0.058	29.912	<.001	1.373	1.226～1.538
Father’s educational level	Primary education or below			9.910	.007
	Secondary education	−0.125	0.043	8.516	.004	0.883	0.812～0.960
	Associate’s degree or equivalent	−0.206	0.101	4.181	.041	0.813	0.667～0.991
Mother’s educational level	Primary education or below			10.959	.004
	Secondary education	−0.105	0.041	6.595	.010	0.901	0.831～0.975
	Associate’s degree or equivalent	−0.289	0.108	7.133	.008	0.749	0.606～0.926
Whether in residence	Yes No	−0.267	0.039	48.097	<.001	0.765	0.710～0.826

Table 4. Neglect of binary logistic regression analysis.

		B	SE	Wales	P-value	OR	95%CI
constant		−0.542	0.061	79.452	<.001	0.581
Grade	High school Junior high school	0.166	0.040	17.012	<.001	1.181	1.091～1.278
Left-behind children	Yes No	0.217	0.049	19.466	<.001	1.243	1.128～1.369
Continue to stay	Yes No	0.214	0.045	22.289	<.001	1.238	1.133～1.353
Parental marital status	At marriage			64.322	.000
	After the divorce raised by mother	0.323	0.099	10.727	<.001	1.382	1.139～1.676
	After the divorce raised by father	0.446	0.059	57.388	<.001	1.562	1.392～1.753
Father’s educational level	Primary education or below			16.559	.000
	Secondary education	−0.142	0.044	10.244	<.001	0.868	0.796～0.946
	Associate’s degree or equivalent	−0.377	0.112	11.374	<.001	0.686	0.551～0.854
Mother’s educational level	Primary education or below			14.514	.000
	Secondary education	−0.146	0.042	11.895	<.001	0.864	0.795～0.939
	Associate’s degree or equivalent	−0.282	0.116	5.898	.015	0.755	0.601～0.947
Whether in residence	Yes No	−0.234	0.040	34.139	<.001	0.791	0.731～0.856
Father’s work	Farmers			28.473	.000
	Workers	−0.272	0.053	26.895	<.001	0.761	0.687～0.844
	Merchant	−0.285	0.082	12.075	<.001	0.752	0.641～0.883
	Civil servant	−0.041	0.193	0.046	.830	0.960	0.658～1.400

This study integrates statistically significant factors into a multivariable logistic regression analysis model. Additionally, we developed a nomogram model using the ‘rms’ package in R studio (R4.3.1) to forecast the incidence of psychological abuse and neglect among adolescents (refer to Figures 3 and 4). The line graph is based on a scale of 0 to 100, where each regression coefficient is converted to points proportionally. These points are then summed based on the independent variables to calculate the total score and position it on the scale. This model is utilised for assessing the risk of adolescents facing psychological abuse and neglect. The total score range for risk assessment is 0–550 points, corresponding to a risk rate range of 0.3–0.5 as depicted in Figures 3 and 4. Sum the scores of the first row corresponding to each indicator vertically to derive the total score, and then position it on the scale. This provides a more intuitive estimation of the likelihood of adolescents experiencing psychological abuse and neglect. A higher total score indicates a greater risk coefficient for adolescents facing psychological abuse and neglect. For example, a female junior high school student living with her father after her parents’ divorce. The girl stays at school because her father is frequently absent due to work commitments. Both parents have completed elementary school education. Both parents are worker. As per the nomogram model, the estimated total risk score for adolescent psychological abuse is 303 points, with an approximate likelihood of 47% for psychological abuse to occur. For neglect, the total risk score is 348 points, with an approximate probability of 47%.

Figure 3. A nomogram model predicts the risk of psychological abuse in adolescents.

Figure 4. A nomogram model predicts the risk of neglect in adolescents.

4. Discussion

This is the first large-scale, multi-centre cross-sectional study conducted in the economically and socially underdeveloped western regions of China, specifically investigating adolescent psychological abuse and neglect. The findings suggest that adolescents in western China have higher rates of psychological abuse and neglect compared to those in the eastern and norther regions (Chen et al., 2022; Zhen & Shulan, 2017). This region shows a relatively high occurrence of adolescent psychological abuse and neglect, attributed to factors such as high school attendance, experiencing being left behind, parental divorce, low parental education, and attending non-residential schools.

This survey was carried out in the economically disadvantaged western region of China. In comparison to the northern regions of China, Western China has a relatively low urbanisation rate, high population density, and slower economic development, accompanied by limited cultural and educational resources, a significant presence of migrant workers, and the prominent issue of left-behind children. Many children and teenagers in Western China either live with their grandparents or stay at school, which may lead to visible instances of psychological abuse and neglect. Research indicates a strong link between poverty and child abuse (Brown et al., 1998; Vanderminden et al., 2019), with economic disadvantage also raising the likelihood of divorce (Jalovaara, 2001). Therefore, we suggest that the heightened prevalence of mental health problems in children and adolescents in this region may be attributed to various factors such as restricted educational opportunities due to the underdeveloped economy, unstable family dynamics, and a substantial number of left-behind children.

This study revealed a higher prevalence of psychological abuse in females compared to males, consistent with previous research findings (Arnow et al., 2011; Charak & Koota, 2014; Shuangshuang et al., 2018; Musa et al., 2018). This occurrence could be attributed to the traditional favouring of boys over girls, particularly in impoverished circumstances where families have limited resources. Parents tend to allocate more resources to their sons, resulting in their daughters being burdened with additional household chores, deprived of educational opportunities, and receiving less parental care. Moreover, parents may exert stronger control over their daughters (Xia et al., 2004). Consequently, this unequal treatment increases the susceptibility of girls to psychological abuse (Coˆelho et al., 2018; Wang et al., 2019).

Our study has found that the experience of being left-behind has a significant impact on the psychological abuse and neglect that adolescents experience. This finding is consistent with previous research (Man et al., 2017; Wen et al., 2021). Firstly, the western region of China is a major area for labour export, and as a result, there has been a substantial increase in the population of left-behind children. This increase has led to higher rates of psychological abuse and neglect. Left-behind children, compared to those who are not separated from their parents, are more vulnerable to issues such as depression, anxiety, and suicidal ideation due to the prolonged absence of parental companionship and care (Fellmeth et al., 2018). Secondly, the absence of parents places the responsibility of primary caregiving on grandparents for most left-behind children. However, there is often a significant age and cultural generation gap between these two groups, hindering effective communication and leaving the grandparents unable to protect their grandchildren against psychological health risks (Zhao et al., 2018). Furthermore, a considerable proportion of elderly individuals have poor health status, meaning that many young individuals not only fail to receive care from their grandparents but also shoulder the responsibility of providing reciprocal care in return (Musil, 1998).

This study revealed that the levels of psychological abuse and neglect among high school students are greater than those among middle school students, contrary to previous research findings (Larson et al., 2002; Shuangshuang et al., 2018), According to Reed W. Larson et al., the level of happiness among teenagers tends to stabilise during late adolescence (Larson et al., 2002). This observation can be attributed to cultural variations across different countries. Chinese teenagers in the seventh and twelfth grades are preoccupied with preparing for and taking important examinations such as the high school entrance examination or college entrance examination. Since junior high school is still part of the compulsory nine-year education stage, it is widely believed that the college entrance examination has significant implications for the future of young people. Consequently, high school students face immense academic pressure, including limited class time, a heavy workload, and numerous examination tasks (Tang et al., 2019). On the other hand, as high school students mature and accumulate more knowledge, their comprehension and expression abilities improve. They also become better equipped to understand and report abuse behaviours (Tonmyr et al., 2012).

This study demonstrates that parental marital status significantly influences children’s experience of psychological abuse and neglect. Adolescents from divorced families display significantly higher rates of maltreatment, consistent with previous research (Tullius et al., 2022; Witt et al., 2019). In traditional Chinese culture, mothers take on the primary role in child care at home (Eek & Axmon, 2015; Huang et al., 2020; Parks-Stamm et al., 2021). Furthermore, mothers provide a comforting presence that helps ease tensions in the father-son relationship (Wang, 2019). The father’s presence is noticeably less prominent compared to the mother’s (Eek & Axmon, 2015; Huang et al., 2020; Parks-Stamm et al., 2021), typically assuming a role associated with strict discipline (Brown et al., 1998). Following parental divorce, the mother’s level of involvement diminishes (Musa et al., 2018). Fathers who live alone with their children for extended periods may face challenges in communicating and educating their children (Shin et al., 2010). Furthermore, single-mother families experience heightened economic pressure due to a lack of economies of scale available to two-parent households. Consequently, single mothers may need to devote more time to work (Bastaits et al., 2018), increasing the risk of experiencing negative emotions and resorting to punitive measures when dealing with their adolescents’ negative emotions. Various factors in Chinese society may contribute to the increased occurrence of mental problems among adolescents, including a negative attitude towards divorce (Dong et al., 2002), and limited parenting experience among young parents (Brown et al., 1998; Hua et al., 2014).

The increasing academic workload leads parents to impose additional demands on their children’s academic performance, potentially strengthening the parent–child bond. Conversely, living in dormitories offers greater independence, allowing individuals to create a sense of separation from challenging familial situations (Wang, 2019). Residing on campus can assist individuals in creating distance from unfavourable family circumstances (Weng et al., 2018). Additionally, studies have demonstrated that temporary detachment of adolescents from their parents, whether physical or emotional, plays a crucial role in their overall personality development (Campbell et al., 1984; Weng et al., 2018).

The present study revealed a noteworthy association between parents’ occupation and educational level, and adolescent psychological abuse and neglect, which is consistent with earlier research findings (Brown et al., 1998; Torvik et al., 2020). Parents with higher educational qualifications possess the ability to improve living conditions and educational strategies (Van der Geest et al., 2017), Moreover, the father’s occupation plays a role in psychological neglect, potentially due to the common situation where the father’s income serves as the primary means of family support (Boe et al., 2018).

Various factors, such as female adolescence, experiences of being left behind, and family environment, contribute to varying degrees of psychological abuse and neglect among adolescents in this region. Therefore, it is crucial to implement a series of intervention measures to address this issue. For instance, the government can modify social policies and establish relevant laws and regulations to address situations where guardians have the ability but fail to fulfil their responsibilities or engage in malicious violations. It is also important to train professionals who can regularly visit parents’ homes and provide education and support in child development, child care, and parenting skills. Schools can organise appropriate mental health programmes and involve psychology professionals to promote the development of social and emotional skills among adolescents. Additionally, psychiatrists can conduct informative lectures on mental health issues to promote preventive measures and raise awareness, and so on.

4.1. Limitations of the study

Firstly, this survey is conducted online, potentially introducing memory and information biases. Secondly, Future research needs more longitudinal studies on the factors contributing to psychological trauma and neglect. In the field of psychological abuse and neglect, the unique geographical environment of western China and measurement scales tailored specifically for the Chinese population have led to limitations in the generalizability of our research results.

5. Conclusion

This study examines the prevalence of psychological abuse and neglect among adolescents in western China, along with the contributing factors. Proposed measures to reduce the incidence of psychological abuse and neglect in this region include improving economic conditions, giving priority to female adolescents, enhancing the living conditions of left-behind children, and improving marital and family situations.

Acknowledgements

We want to express our gratitude to all school and personnel which involves in this work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was financially supported by the Bureau of Science and Technology Nanchong Municipality (Investigator Grant: 20SXQT0056), and the Project of the North Sichuan Medical College [grant number CBY22-QNB04], and the Project of the Fourteenth Five- Year Plan for Social Science Research of Nanchong City in 2022 [grant number NC22C346].