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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Psychol . 2026 Mar 10;14:546. doi: 10.1186/s40359-026-04335-6 Search in PMC Search in PubMed View in NLM Catalog Add to search Associations between parent-child attachment and psychotic-like experiences among adolescents in rural China: The moderating role of parental migration Heqiong Hu Heqiong Hu 1 College of Education, Hunan Agricultural University, Changsha, China Find articles by Heqiong Hu 1, # , Jiaojian Dai Jiaojian Dai 2 School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, Guangdong Emergency Response Technology Research Center for Psychological Assistance in Emergencies, South China Normal University, Guangzhou, China Find articles by Jiaojian Dai 2, # , Bingna Xu Bingna Xu 3 School of Marxism, Zhejiang University, Hangzhou, China Find articles by Bingna Xu 3 , Mingze Sun Mingze Sun 4 Department of Social Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China Find articles by Mingze Sun 4, ✉ , Dongfang Wang Dongfang Wang 2 School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, Guangdong Emergency Response Technology Research Center for Psychological Assistance in Emergencies, South China Normal University, Guangzhou, China Find articles by Dongfang Wang 2, ✉ Author information Article notes Copyright and License information 1 College of Education, Hunan Agricultural University, Changsha, China 2 School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, Guangdong Emergency Response Technology Research Center for Psychological Assistance in Emergencies, South China Normal University, Guangzhou, China 3 School of Marxism, Zhejiang University, Hangzhou, China 4 Department of Social Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China ✉ Corresponding author. # Contributed equally. Received 2025 Sep 25; Accepted 2026 Mar 6; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13088796 PMID: 41808234 Abstract Background Poor parent-child attachment has been associated with an increased risk of psychological problems. This study examined the relationship between parent-child attachment and psychotic-like experiences (PLEs) among adolescents in rural China, with particular attention to those affected by parental migration. Methods A total of 4209 rural adolescents were recruited via an online survey. Participants completed the 15-item positive subscale of the Community Assessment of Psychic Experiences (CAPE-P15), Inventory of Parent and Peer Attachment (IPPA) and a self-developed demographic questionnaire. Mediation analysis was performed to examine the associations between parental migration, parent-child attachment, and PLEs. Results Left-behind children (LBC) exhibited higher PLE frequency and distress, alongside lower parent-child attachment, compared to their non-LBC counterparts. After adjusting for confounders, both mother-child and father-child attachment showed negative correlations with PLE frequency and distress. Notably, the association between mother-child attachment and PLE frequency varied by parental migration status: the negative correlation between mother-child attachment and PLE frequency was weaker among LBC compared with non-LBC. Conclusions Adolescents experiencing parental migration represent a key subpopulation for future PLE prevention and intervention efforts. Mother-child attachment should be prioritized as a critical component in developing effective prevention strategies, particularly for LBC. Keywords: Mother-child attachment, father-child attachment, parental migration, psychotic-like experiences, rural adolescents Introduction Adolescence is a critical period for the development of psychosis, with nearly half of lifetime psychopathology emerging during mid-adolescence [ 1 , 2 ]. Ample evidence has shown that early-onset psychosis in adolescence is more severe than adult-onset psychosis [ 3 , 4 ]. Psychotic-like experiences (PLEs) are widely conceptualized as experiences that resemble the positive symptoms of psychosis without necessarily causing significant distress or functional impairment [ 5 ]; they are most common during childhood and adolescence. For example, a meta-analysis indicates that 17% of children aged 9–12 and 7.5% of adolescents aged 13–18 report PLEs [ 6 ], rates notably higher than those observed in adults (5.8%) [ 7 ]. A recent survey of Chinese adolescents revealed that nearly half of them reported experiencing PLEs in the past month, with 15.4% having frequent PLEs [ 8 ]. Based on the psychosis proneness-persistence-impairment framework [ 9 ], both genetic factors and environmental risks can contribute to the development of biological and psychological vulnerability. This could lead to the persistence of common yet temporary developmental PLEs, potentially resulting in unfavorable outcomes. Indeed, numerous studies have shown that PLEs in childhood are associated with an increased likelihood of later psychotic disorders [ 10 , 11 ], non-psychotic disorders [ 12 ], and even suicidal behavior [ 13 ]. Moreover, studies show that PLE frequency and distress are strongly and positively correlated [ 14 , 15 ], and PLEs accompanied by high levels of psychological distress may further elevate the risk of psychosis [ 16 ]. Integrating the frequency and distress dimensions could therefore provide a more sensitive assessment of PLEs. Yet most existing studies have measured only how often PLEs occur, while largely neglecting the degree of distress they entail. Therefore, simultaneously assessing the frequency and distress level of PLEs and exploring the influential factors may help identify clinically high-risk or ultra-high-risk groups, thus shedding light on the prevention of mental disorders. The traditional nuclear or joint family has long been the dominant household structure in China, with children typically coresiding with their parents [ 17 ]. However, rapid industrialization and urbanization over the past few decades have prompted millions of parents to migrate in search of better employment and living conditions, thereby creating a large population of left-behind children and adolescents (LBC). According to the United Nations Children’s Fund [ 18 ], there were 28.3 million LBC in urban areas and 40.5 million in rural areas in 2018; each of these children had at least one parent who had migrated to an urban center for six months or longer. Accumulating evidence indicates that LBC constitute a “vulnerable group” who exhibit elevated rates of psychopathology [ 19 ]. A meta-analysis of 111 studies reported that, relative to their non-LBC counterparts, LBC are at greater risk of both internalizing and externalizing problems [ 20 ]. The association between parental migration and PLEs has received less attention than have other mental health outcomes. Although several studies have attempted to clarify the mechanisms linking parental migration to adolescent PLEs, the findings remain inconsistent: some documented a higher prevalence of PLEs among LBC [ 21 , 22 ], whereas others reported no elevated risk [ 15 ]. These inconsistent findings may stem from different parental migration patterns (e.g., absence of one parent vs. that of both parents) or residence status (e.g., urban vs. rural left-behind children). A recent large-scale study observed a modestly higher prevalence of PLEs among urban LBC, but the effect of parental migration was weak [ 22 ]. Consequently, further investigation is required to obtain a comprehensive understanding of PLEs and their determinants within the LBC population. Theoretically, parental migration influences adolescent mental health either directly or indirectly through interactions with various environmental factors [ 23 ]. In contrast to traditional nuclear or joint families, migrant households are characterized by the absence of parents, which limits the breadth and depth of parent-child communication and interaction. Parent-child attachment is universally defined as the emotional bond between parent and child, formed and strengthened through communication and interaction [ 24 ]. This suggests that the parent-child attachment among LBC is more vulnerable to disruption. According to Bowlby’s attachment theory [ 25 ], secure parent-child attachment provides emotional stability and a sense of safety necessary for healthy development, and also serves as a protective factor against mental health problems during adolescence. Regarding the intersection between attachment theory and psychopathology, attachment insecurity may non-specifically increase vulnerability to disorders such as mood and personality disorders via several pathways involving effects on compromised self-representation, emotion regulation, and interpersonal functioning [ 26 ]. Indeed, a large body of literature has demonstrated that insecure attachment is associated with a range of adverse mental health outcomes among adolescents [ 27 , 28 ]. A recent study found that adolescents with insecure attachment are at elevated risk of PLEs, whereas secure attachment relationships serve a protective role [ 29 ]. However, it remains unclear whether different types of parent–child attachment (e.g., mother–child vs. father–child attachment) are associated with PLEs in adolescents. Adolescents with left-behind experiences additionally demonstrate significantly lower levels of parent–child attachment levels relative to their non-left-behind counterparts [ 30 ]. The Conservation of Resources (COR) theory posits that the more abundant an individual’s resources, the stronger their adaptive capacity; conversely, insufficient resources lead to a range of maladaptive stress-related problems [ 31 ]. Parental absence may erode secure parent–child attachment and thereby heighten mental-health risk [ 32 ]. Consequently, the association between parent–child attachment and PLEs may be moderated by parental migration. Specifically, we hypothesize that compared with adolescents without left-behind experience, those with such experiences report a lower level of parent–child attachment, which may in turn exert a stronger influence on PLEs. In this study, we seek to examine the association between parent-child attachment and psychotic-like experiences (PLEs) among rural adolescents in China, comparing those with and without parental migration. The study aims to address the following research questions: (1) Are there significant differences in the frequency and severity of PLEs between left-behind children (LBC) and non-LBC adolescents in rural areas? (2) Are mother-child attachment (MA) and father-child attachment (FA) associated with PLEs? (3) Does parental migration moderate the association between parent-child attachment and PLEs among adolescents? Materials and methods Study design and participants A convenience sample of 4265 participants was recruited between December 2021 and July 2022 from one junior high school in Zhangzhou and one senior high school in Shaoguan, China. Shaoguan City is located in the northern part of Guangdong Province and is a relatively underdeveloped region within the province. It is also one of the primary labor-exporting areas in Guangdong Province. Zhangzhou City is located in the southeastern part of Fujian Province, and exhibits a significantly higher level of economic development than Shaoguan. Its labor force transfer is characterized by the coexistence of local urbanization and labor out-migration. Before the web-based survey, either the head teacher or the psychology teacher sent an invitation letter via WeChat. Students and their guardians who agreed to participate signed an electronic informed-consent form. Participants completed the survey by either clicking a web link or scanning a QR code on a computer or mobile device. Our study complied with the principles of the revised Declaration of Helsinki and was approved by the Ethics Committee of the School of Psychology, South China Normal University. To ensure data quality, we excluded participants who (1) completed the survey in < 5 min, (2) reported any current severe physical illness or psychiatric disorder, and (3) were from single-parent families, as the study examines both MA and FA. Fifty-six participants were excluded, yielding a final analytic sample of 4,209 adolescents. Both schools were located in rural areas, and according to school records, all participants’ possessed rural household registration (hukou) status. Measures Social-demographic characteristics Self-reported sample characteristics were collected, including: sex assigned at birth (1- boys; 2-girls), boarding at school (1-yes; 2- no), single child status (1-yes; 2- no), stable family income (1-yes; 2- no), family history of mental disorders (1-yes; 2- no), and left-behind child status (1-yes; 2-no). LBC refers to children who reside in their original place of household registration but have not cohabited with their parents for more than six months, due to the migration of one or both parents [ 18 ]. The type of LBC (single/ both parents’ absence) was also collected. PLEs The assessment of the frequency and distress of PLEs was conducted through the 15-item positive subscale of the Community Assessment of Psychic Experiences (CAPE-P15) [ 33 ]. The frequency and distress subscales both consist of 15 items, which were clustered into three dimensions: persecutory ideation (5 items), bizarre experiences (7 items), and perceptual abnormalities (3 items). Each item was assessed using a four-point Likert scale, from 1 (‘never’), 2 (‘sometimes’), 3 (‘often’), to 4 (‘nearly always’) for frequency (PF), and from 1 (‘not distressed’), 2 (‘a bit distressed’), 3 (‘quite distressed’), to 4 (‘very distressed’) for distress (PD). The average score of the CAPE-P15 was computed, with a higher score reflecting higher frequency or greater distress in the past month. Cut-off points of 1.57 (sensitivity of 79.2% and specificity of 73.8%) for frequency scores and 1.17 (sensitivity of 87.5% and specificity of 61.9%) for distress scores were found to best identify genuine PLEs [ 34 ]. The CAPE-P15 has shown adequate psychometric properties among Chinese adolescents [ 14 , 35 ]. In the present sample, Cronbach’s α was 0.86 for PF (LBC = 0.84; non-LBC = 0.87) and 0.87 for PD (LBC = 0.86; non-LBC = 0.88). Parent-child attachment We measured parent-child attachment through the Inventory of Parent and Peer Attachment (IPPA) [ 36 ]. It includes three subscales: MA, FA, and peer attachment (PA). The MA and FA subscales both consist of 25 items, which were clustered into three dimensions: trust (10 items), communication (8 items), and alienation (7 items). Each item was rated on a five-point Likert scale, from 1 (‘never true’), 2 (‘seldom true’), 3 (‘sometimes true’), 4 (‘often true’), to 5 (‘always true’). When calculating the total parent–child attachment score, the alienation dimension was reverse-scored and then summed with the trust and communication dimensions. The IPPA has demonstrated satisfactory applicability in Chinese adolescent sample [ 37 ]. In this study, Cronbach’s α was 0.80 for MA (LBC = 0.80; non-LBC = 0.80) and 0.81 for FA (LBC = 0.82; non-LBC = 0.81). Statistical analysis The statistical analyses were conducted using SPSS 24.0. Categorical variables were presented as frequencies [N(%)], whereas continuous variables were summarized using means (SDs). This study defined LBC as individuals who had resided separately from one or both parents for more than six months before reaching 16 years of age [ 18 ]. The χ 2 test was employed to assess the differences in the prevalence of PLEs between LBC and non-LBC groups, as well as between LBC with one migrating parent and LBC with both parents having migrated. The independent sample t-test was used to examine differences in PLEs between parental migration groups, as well as the differences in parent-child attachment scores between PLE groups (PLEs vs. non-PLEs). Pearson’s correlation coefficient was used to investigate the connection between the parent-child attachment and PLEs within the whole sample. Additionally, the moderation hypotheses were tested using the PROCESS macro, which performed 5,000 bootstrap iterations to estimate effect sizes [ 38 ]. Four moderation effects were tested using Model 1 after standardizing all continuous variables: two types of parent-child attachment (MA and FA) were regarded as independent variables, parental migration (yes [defined as either or both parents being absent]/no) as the moderator, and frequency/distress of PLEs (PF and PD) as outcomes, respectively. Sample characteristics (e.g., age, sex, boarding status, single-child status, stable family income, and family history of mental disorders) were included in all analyses as covariates. Simple slope analyses were conducted to decompose all significant interaction effects. Results Description of the sample The final analysis of this study included 4209 adolescents. The participants were between 10 and 17 years old, with a mean age of 12.90 years (SD = 1.22). The distribution of boys and girls was approximately balanced (45.9% vs. 54.1%). Detailed sample characteristics are shown in Table 1 . Table 1. Descriptive statistics of social-demographic variables [N(%)] Characteristics Total ( N = 4209) LBC ( N = 1027) Non-LBC ( N = 3182) P Age, years[M(SD)] 12.90(1.22) 13.26(1.38) 12.79(1.13) < 0.001 Sex < 0.001 Boys 1930(45.9) 408(39.7) 1522(47.8) Girls 2279(54.1) 619(60.3) 1660(52.2) Boarding at school (yes) 980(23.3) 349(34.0) 631(19.8) < 0.001 Single child family (yes) 1201(28.5) 223(21.7) 978(30.7) < 0.001 Stable family income (yes) 3843(91.3) 849(82.7) 2994(94.1) < 0.001 Family history of mental disorders (yes) 111(2.6) 39(3.8) 72(2.3) 0.010 One parents migrating 592(14.1) - - Both parents migrating 435(10.3) - - Open in a new tab LBC left-behind children Among 1027 LBC (24.4%), 14.1% of LBC had one parent migrating, and 10.3% of LBC experienced both parents migrating. Main information of LBC and non-LBC groups were displayed in Table 1 . The two groups were significantly different in terms of age, sex, boarding at school, single-child family, stable family income, and family history of mental disorders. Parent-child attachment and PLEs among LBC and non-LBC LBC reported lower scores on MA and FA, while reporting higher scores on PF and PD, compared to Non-LBC (all p < 0.001, see Table 2 ). In this sample, the prevalence rates of genuine PF and PD were 36.9% and 38.5%, respectively. LBC reported higher proportions of both genuine PF and PD than non-LBC (all p < 0.001). Among LBC, those with both parents migrating tended to have higher prevalence rate of genuine PF and PD than LBC with only one parent migrating; however, no significant between-group differences were observed in parent-child attachment. Table 2. The difference of parent-child attachment and PLEs between LBC and non-LBC Characteristics Total ( N = 4209) LBC Non-LBC ( N = 3182) p d Total ( N = 1027) One parents migrating ( N = 592) Both parents migrating ( N = 435) P c MA score, M(SD) 80.02(12.97) 78.50(12.87) 78.80(12.85) 78.09(12.91) 0.379 80.51(12.96) < 0.001 Trust 32.65(7.17) 32.09(7.27) 32.04(7.24) 32.16(7.32) 0.788 32.84(7.12) 0.004 Communication 23.16(5.45) 22.71(5.38) 22.89(5.34) 22.48(5.44) 0.228 23.30(5.47) 0.003 Alienation 17.80(4.60) 18.30(4.64) 18.12(4.59) 18.55(4.71) 0.144 17.63(4.57) < 0.001 FA score, M(SD) 79.26(13.78) 77.96(13.81) 78.18(14.15) 77.66(13.34) 0.557 79.68(13.75) < 0.001 Trust 32.32(7.76) 31.86(7.92) 31.83(8.08) 31.91(7.70) 0.866 32.47(7.70) 0.028 Communication 22.59(5.99) 22.13(6.01) 22.19(6.17) 22.04(5.79) 0.678 22.74(5.98) 0.004 Alienation 17.65(4.83) 18.03(4.93) 17.84(5.00) 18.28(4.84) 0.158 17.53(4.79) 0.004 PF, score, M(SD) 1.42(0.39) 1.57(0.38) 1.54(0.38) 1.61(0.37) 0.003 1.50(0.39) < 0.001 PD score, M(SD) 1.31(0.35) 1.37(0.37) 1.34(0.37) 1.41(0.38) 0.001 1.29(0.35) < 0.001 PF, N(%) a 1553(36.9) 447(43.5) 235(39.7) 212(48.7) 0.004 1107(34.8) < 0.001 PD, N(%) b 1622(38.5) 469(45.7) 243(41.0) 226(52.0) < 0.001 1152(36.2) < 0.001 Open in a new tab The Alienation dimension displays the raw scores before reverse scoring LBC left-behind children, MA mother-child attachment, FA father-child attachment, PF Frequency of PLEs, PD Distress of PLEs, PLEs psychotic-like experiences a PF: Frequency of PLEs, calculated using the frequency subscale of CAPE-P15, with a clinical cut-off average score of 1.30 b PD: Distress of PLEs calculated using the distress subscale of CAPE-P15, with a clinical cut-off average score of 1.30 c LBC with one migrating parent vs. LBC with both migrating parents d LBC vs. Non-LBC Testing the moderating role of parental migration The differences in parent-child attachment among PLEs groups are shown in Table 3 . Adolescents with PLEs were observed to have lower scores on MA and FA than those without PLEs. PF and PD scores were both negatively correlated with MA, FA, and their two dimensions (trust and communication), and positively correlated with the alienation dimension (see Table 4 ). Table 3. Differences in parent-child attachment between adolescents with PLEs and those without PLEs [M(SD)] PF a PD b Yes ( N = 1553) No ( N = 2656) p Yes ( N = 1622) No ( N = 2587) p MA score 78.23(12.51) 83.61(13.14) < 0.001 77.02(12.41) 81.90(12.96) < 0.001 Trust 32.02(6.93) 33.93(7.46) < 0.001 31.50(6.93) 33.38(7.22) < 0.001 Communication 22.87(5.25) 23.74(5.80) < 0.001 22.68(5.17) 23.46(5.61) < 0.001 Alienation 18.66(4.30) 16.07(4.68) < 0.001 19.16(4.30) 16.94(4.57) < 0.001 FA score 77.56(13.44) 82.67(13.83) < 0.001 76.49(13.38) 81.00(13.74) < 0.001 Trust 31.70(7.61) 33.57(7.92) < 0.001 31.29(7.56) 32.97(7.82) < 0.001 Communication 22.26(5.76) 23.25(6.38) < 0.001 22.05(5.73) 22.93(6.13) < 0.001 Alienation 18.40(4.60) 16.15(4.94) < 0.001 18.85(4.61) 16.90(4.81) < 0.001 Open in a new tab The Alienation dimension displays the raw scores before reverse scoring a PF, Frequency of PLEs calculated using the frequency subscale of CAPE-P15, with a clinical cut-off average score of 1.30 b PD, Distress of PLEs calculated using the distress subscale of CAPE-P15, with a clinical cut-off average score of 1.30 MA = mother-child attachment; FA = father-child attachment; PLEs=psychotic-like experiences *** p < 0.001 Table 4. Correlations between parent-child attachment and PLEs [r] MA score PF score PD score -0.25 *** -0.23 *** Trust -0.17 *** -0.16 *** Communication -0.11 *** -0.10 *** Alienation 0.31 *** 0.28 *** FA score -0.21 *** -0.20 *** Trust -0.15 *** -0.14 *** Communication -0.10 *** -0.10 *** Alienation 0.24 *** 0.22 *** Open in a new tab The Alienation dimension displays the raw scores before reverse scoring MA mother-child attachment, FA father-child attachment, PF Frequency of PLEs, PD Distress of PLEs, PLEs psychotic-like experiences *** p < 0.001 Table 5 shows that parental migration, MA, and FA were associated with modest yet significant main effects on PF and PD after controlling for potential confounders. The interaction between parental migration and MA was associated with PF ( p = 0.010), while the interaction between parental migration and FA was not ( p = 0.223). The interactions between parental migration and MA ( p = 0.075) or FA ( p = 0.813) did not show significant associations with PD. Furthermore, simple slope analyses indicated a stronger association between MA and PF in the non-LBC group (b = -0.27, p < 0.001, 95% CI = -0.31, -0.24) compared with the LBC group (b = -0.18, p < 0.001, 95% CI = -0.24, -0.12). These findings suggest that, compared with non-LBC, the negative correlation between MA and the frequency of PLEs is weaker in LBC (see Fig. 1 ). We also examined the moderating role of parental migration in the relationships between different dimensions of MA and PF. Results indicated that parental migration moderated the associations of both trust and communication with PF, but did not moderate the association between alienation and PF (see Table 6 ). Table 5. The association between parent-child attachment and PLEs differs by parental migration status # PF PD b 95%CI b 95%CI MA as the predictor Parental migration 0.08 * 0.01, 0.15 0.09 * 0.02, 0.16 MA -0.27 *** -0.31, -0.24 -0.24 *** -0.27, -0.2 Parental migration × MA 0.09 * 0.02, 0.16 0.06 -0.01, 0.13 FA as the predictor Parental migration 0.09 ** 0.02, 0.16 0.10 ** 0.03,0.17 FA -0.22 *** -0.26, -0.19 -0.20 *** -0.23, -0.16 Parental migration × FA 0.04 -0.03, 0.11 0.01 -0.06, 0.08 Open in a new tab All continuous variables were standardized # Adjusting for other social-demographic variables: age, gender, boarding at school, single child status, family income status, and family history of mental disorders MA mother-child attachment, FA father-child attachment, PF Frequency of PLEs, PD Distress of PLEs, PLEs psychotic-like experiences * p < 0.05; ** p < 0.01; *** p < 0.001 Fig. 1. Open in a new tab Interaction between MA and parental migration predicting frequency of PLEs. MA = mother-child attachment; PLEs=psychotic-like experiences Table 6. The association between MA and PF differs by parental migration status # b 95%CI Maternal trust as the predictor Parental migration 0.10 ** 0.03, 0.17 Trust -0.20 *** -0.23, -0.17 Parental migration × Trust 0.11 ** 0.04, 0.18 Maternal communication as the predictor Parental migration 0.11 ** 0.04, 0.18 Communication -0.13 *** -0.17, -0.10 Parental migration × Communication 0.10 ** 0.03, 0.17 Maternal alienation as the predictor Parental migration 0.08 * 0.01, 0.15 Alienation 0.30 *** 0.26, 0.33 Parental migration × Alienation 0.01 -0.05, 0.08 Open in a new tab All continuous variables were standardized The Alienation dimension displays the raw scores before reverse scoring # Adjusting for other social-demographic variables: age, gender, boarding at school, single child status, family income status, and family history of mental disorders MA mother-child attachment, PF Frequency of PLEs * p < 0.05; ** p < 0.01; *** p < 0.001 Discussion This study is the first to examine how parent-child attachment relates to PLEs among rural adolescents while accounting for parental migration status. We found that LBC reported higher levels of PLEs and lower levels of parent-child attachment than non-LBC. Parental migration and low levels of parent-child attachment were associated with increased frequency and severity of PLEs. Moreover, parental migration moderated the association between MA and the frequency of PLEs. As hypothesized, parental migration was associated with elevated levels of PLEs among adolescents, consistent with previous work [ 21 ]. Poor mental health outcomes among LBC may be attributable to higher levels of loneliness [ 39 ] and lower self-concept [ 40 ]. Another study reported that LBC, who lack parental care, experience more abuse and bullying at school, which increases the risk of mental health problems [ 41 ]. Several demographic characteristics of LBC in our sample, such as a lower percentage of stable family income and a higher proportion of family history of mental disorders, were also linked to the emergence of PLEs [ 15 ]. These findings also revealed a relationship between the likelihood of PLEs and left-behind status: adolescents whose parents have both migrated report more frequent and more intense PLEs than those with only one parent migrating. This pattern echoes findings regarding other psychological difficulties among LBC [ 32 , 42 ], suggesting that having both parents migrate may be more detrimental to adolescent mental health than having only one parent migrate, and underscoring the need for finer distinctions when classifying LBC. Our data suggest that LBC report lower levels of parent-child attachment, consistent with previous findings [ 30 ]. Parental migration not only results in physical parent–child separation but also markedly reduces opportunities for family communication, parental involvement, and affective expression [ 43 ]. Consequently, LBC experience greater difficulty expressing emotions, as they lack direct, personal exchanges with their parents. The absence of parental emotional responsiveness can intensify children’s feelings of loneliness and impede the development of strong, intimate emotional bonds [ 42 ]. Parental migration further undermines the effectiveness of family communication [ 19 ]. Migrant parents often lack sufficient time and energy to engage in telephone conversations with their children because of demanding work schedules. A nationwide survey in China revealed that, when migrant parents do call, conversations typically focus on academic achievement, obedience to parents, grandparents, or teachers, and reminders to safeguard physical health; children’s psychological and emotional needs are seldom addressed [ 44 ]. In turn, children rarely disclose emotional difficulties to their parents. Our results also demonstrate that both MA and FA exhibited significant negative associations with the frequency and severity of PLEs. This finding can be explained by attachment theory [ 25 ], which posits that poor parent–child attachment is associated with behavioral difficulties and psychopathology during adolescence. Several empirical studies corroborate this view: adolescents who enjoy secure attachment bonds with their parents are more likely to develop positive coping strategies for stress [ 45 ] and build resilience [ 46 ], both of which serve as protective factors against PLEs. Secure parent–child attachment also facilitates effective emotion regulation [ 47 ], thereby decreasing the likelihood of psychological and behavioral problems. However, parental migration exhibited a moderating effect exclusively on the relationship between MA and the frequency of PLEs. Specifically, MA demonstrated a reduced protective effect on PLE frequency among LBC compared to their non-LBC counterparts, specifically concerning the dimensions of maternal trust and communication. Rural Chinese families typically adopt a “men work outside, women stay inside” pattern: fathers provide financial support, while mothers rear the children and supply emotional support [ 32 , 48 ]. Previous studies have shown that the mother’s absence may raise concerns about inadequate care within the family [ 49 , 50 ]. When only one parent migrates, the father usually works away while the mother remains at home [ 32 , 48 ]. We speculate that these left-behind mothers experience heightened psychological strain: prolonged separation from their husbands deprives them of spousal support; they must simultaneously care for elderly relatives and discipline their children alone; and many families have multiple children, further increasing maternal burden. Thus, although higher MA still reduces PLE risk, parental migration attenuates this protective effect. In this study, the interaction effect between FA and parental migration on PLEs was not significant, suggesting that FA is negatively associated with PLEs among adolescents regardless of parental-migration status. In traditional Chinese families, a “strict-father, kind-mother” division of labor was common, leading children to interact with their fathers less frequently than with their mothers [ 42 ]. FA emerges later than MA [ 51 ]; rather than serving to meet the child’s emotional needs, it primarily offers spiritual guidance [ 52 ]. Consequently, the association between FA and adolescent mental health is unlikely to be substantially moderated by parental migration. Consistent with this finding, Wang et al. observed an interaction between MA and parental migration on adolescent self-injury, whereas FA showed only a main effect [ 32 ]. Furthermore, due to the use of convenience sampling and self-report measures, the findings of this study may be subject to sampling bias; replication with more representative samples is therefore recommended. Implications This study provides evidence-based recommendations for preventing PLEs among Chinese adolescents and promoting the psychological well-being of LBC. LBC constitute a high-risk group that warrants focused attention, especially when both parents migrate. The cultivation of strong and positive parent–child relationships may play a critical role in preventing and mitigating PLEs among adolescents. For example, family-centred approaches and parent-training programmes—such as parenting-focused mindfulness interventions—not only improve parent–child relationships and maintain parental warmth, but also equip parents with skills to recognise and address their children’s maladaptive symptoms [ 53 , 54 ]. In addition, migrant parents can use online tools to increase both the frequency and quality of interactions with their children, devoting greater attention to meeting their psychological needs during these communications [ 55 ]. Furthermore, school-based interventions that foster a positive school climate—by reducing bullying and enhancing peer support—may help prevent mental health problems, including PLEs, among LBC [ 8 , 56 ]. Limitations There are several limitations that need to be considered. First, due to the cross-sectional design, our findings limit our ability to draw conclusions about the potential causal relationship between parent-child attachment and PLEs. Previous studies suggested that disruption in parent-child attachment can lead to lasting negative psychological consequences and impact [ 57 ]. Conversely, early PLEs may heighten psychological sensitivity [ 9 ], potentially blunting the perception of parental support and, consequently, weakening parent–child attachment. The cross-sectional design also limits the ability to capture the history and duration of parental migration. Thus, further longitudinal investigations are needed to gain a deeper understanding of the association between parent-child attachment and PLEs. Second, all data were collected through self-report. Under teacher supervision during the online survey, adolescents may have been susceptible to social desirability bias, potentially concealing or exaggerating their true feelings and thereby introducing reporting bias. Third, our study did not take into account several potential confounding factors, including the duration of parental migration, the frequency of parent–child communication, and the type of primary caregiver or coresident arrangement. Notably, based on the criteria for defining LBC in this study, the duration of separation from parents must exceed 6 months [ 18 ], which may have resulted in a small subset of participants who were currently separated from their parents but for a shorter duration not being categorized as LBC. Given that parent-child attachment is sensitive to current interaction patterns, this brief separation may also have influenced adolescents’ perceptions of parent-child attachment, thereby introducing bias into the results of the current study. Moreover, at the time of this survey China was in the normalization phase of pandemic prevention and control. Exposure to pandemic-related stressors could lead adolescents to experience cognitive, emotional, and physical exhaustion, potentially intensifying tension within the parent–child relationship [ 58 ]. Consequently, such stress might, to some extent, moderate the influence of parent–child attachment on PLEs. Previous studies have also shown that PLEs among adolescents were elevated during the COVID-19 lockdown [ 59 , 60 ]; thus, the present findings need to be interpreted with caution. Additionally, all participants were initially selected from rural regions, and convenience sampling may introduce selection bias; thus, it remains unclear whether the results can be generalized to adolescents nationwide, particularly those residing in urban areas. Finally, given that PLEs may change as adolescents develop [ 9 ], future research should map the phenotypic features of PLEs in early, middle, and late adolescence, and examine whether parental migration and parent–child attachment exert stage-specific effects on PLEs within each developmental period. Conclusion Regardless of parental migration status, parent-child attachment is significantly and negatively linked to PLEs among Chinese rural adolescents. Compared with non-LBC adolescents, LBC exhibited a weaker negative association between MA and PLEs. Concerning the prevention and intervention of PLEs, parent-child attachment should be carefully considered. Regardless of whether parents migrate, both mothers and fathers should prioritize communication with their children. We also recommend greater emphasis on the psychological well-being of mothers of LBC and encourage greater paternal involvement. Acknowledgements The authors want to express their sincere gratitude to all participants for participating in the study. Authors’ contributions HH: Conceptualization, Methodology, and Writing - original draft. JD: Conceptualization, Methodology, Formal analysis, and Writing - original draft. BX: Conceptualization and Writing - review & editing. MS: Conceptualization, Methodology, and Writing - original draft & review. DW: Conceptualization, Data curation, Methodology, Funding acquisition, and Writing - original draft & review. Funding This research was funded by National Natural Science Foundation of China (32500974), Philosophy and Social Science Planning Project of Guangdong Province (GD25YXL16), the 14th Five-Year Plan Philosophy and Social Science Research Projects of Guangzhou (2025GZQN16), Social Science Fund of Zhejiang Province (25BMHZ074YB), MOE (Ministry of Education in China) Major Project of Philosophy and Social Sciences Research (2025JZDZ024), and Striving for the First-Class, Improving Weak Links and Highlighting Features (SIH) Key Discipline for Psychology in South China Normal University. Data availability The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate This study was approved by the Human Research Ethics Committee of South China Normal University. The survey was under the principle of voluntary participation. 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Data Availability Statement The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request. Articles from BMC Psychology are provided here courtesy of BMC ACTIONS View on publisher site PDF (1.0 MB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top