Left-Behind Experience and Behavior Problems Among Adolescents: Multiple Mediating Effects of Social Support and Sleep Quality

Menglin Ge,1– 3,* Meng Yang,1– 3,* Xuanlian Sheng,1– 3,* Ling Zhang,2,3 Kai Zhang,1– 3 Ruochen Zhou,1– 3 Mengting Ye,1– 3 Panpan Cao,1– 3 Yehuan Sun,2,4,5 Xiaoqin Zhou1– 3 1School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China; 2Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China; 3Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China; 4Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei City, People’s Republic of China; 5Center for Evidence-Based Practice, Anhui Medical University, Hefei City, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaoqin Zhou, Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China, Tel +8613865913378, Email zhouxqlulu@126.com Yehuan Sun, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei City, People’s Republic of China, Email sun611007@163.comPurpose: Adolescence has always been a period prone to behavior problems. Some studies have shown that left-behind experience, social support, and sleep quality are all crucial factors influencing behavior problems, but the mechanisms of how they are influenced are unclear. This cross-sectional study investigated the prevalence of behavior problems among school-aged adolescents and explored the mediating role of social support and sleep quality in the association between left-behind experience and behavior problems.Patients and Methods: A total of 738 school adolescent students completed this questionnaire. We collected basic information about the participants using a general demographic scale and assessed their sleep quality, social support, and behavioral problems using the Pittsburgh Sleep Quality Index scale, Social Support Rating Scale, and Strengths and Difficulties Questionnaire. The multiple mediating effects of sleep quality and social support were examined by path analysis.Results: Among 738 school-aged adolescent students who completed the survey, a total of 198 students had behavior problems, with an overall prevalence of 26.8%. In the multiple mediation model, the mediation effect of social support and sleep quality on left-behind experience to behavior problems was 56.7% (direct effect: standardized estimate=0.946, indirect effect: standardized estimate=1.239). The model was a saturated model, and fit was no longer considered.Conclusion: We found that social support and sleep quality had a series of multiple mediating effects in the pathway from left-behind experience to behavior problems, and both significantly moderated behavior problems. Therefore, we suggest that we should pay more attention to students’ psychological status and improve their use of social support for left-behind adolescents, in addition to giving more external social support. And paying attention to their sleep problems to reduce the occurrence of behavior problems, considering that their psychological development is not mature.Keywords: adolescents, left-behind experience, behavior problems, social support, sleep quality