Multifaceted determinants of depressive symptoms in children migrating back from urban to rural areas: An ecological systems theory approach.

Background: While many studies have examined mental health and influencing factors of rural Chinese children who migrated back from urban areas, holistic exploration of multifaceted determinants of their depressive symptoms is lacking; this study, drawing on Bronfenbrenner's ecological systems theory and the process-person-context-time (PPCT) model, investigated multilevel factors' impact on such symptoms and gender differences. Methods: A cross-sectional survey was conducted in 2022 in Nanling County (Anhui Province) in China. A sample of 859 school students in grades 5-9 completed assessments measuring their depressive symptoms (using the Children's Depression Inventory, CDI) and different blocks of variables (CONTEXT, PERSON, and PROCESS). The association was examined using hierarchical logistic regression, entering blocks sequentially. Furthermore, we have explored the gender differences. Results: Among 859 participants included in the current study, depressive symptoms were found in 258 (30.03%) of them, and females suffered more. A more favorable family social context and better personal characteristics of the children were associated with lower odds of depressive symptoms. Better mother-child communication and school belongings significantly related to a lower risk of depressive symptoms, while father-child communication only played a role for males. Conclusions: Good parent-child communication and a sense of school belonging can protect the mental health of rural children migrating back from urban areas. These research findings highlight the importance of families and schools working together to tackle this challenge of urban-rural migration, moreover, children from disadvantaged families may need extra assistance.