This study results showed that 95 out of 955 hui children had externalizing behavior problems, with a prevalence of 9.95%. Among the 383 hui LBC, 46 persons had EBP, with a prevalence of 12.01%. 49 out of 572 hui nationality non-LBC had EBP, with a prevalence of 8.57%. The prevalence of EBP was not statistically significant difference between hui nationality LBC and non-LBC. However, this study[37] found that the overall prevalence of behavioral problems of hui nationality LBC (25.1%) was significantly higher than that of hui nationality non-LBC (20.5%).The results was lower than the prevalence 41.3% reported by Wei-min Xu[8], But higher than 12.97% reported from China's 22 provinces to investigate children's behavior problems [38], and 17.6% of Xu Jing reported [39], also higher than 10.49% of shui LBC’s behavior problem prevalence reported by Guo GW[40] .In terms of the prevalence of EBP, the prevalence of hui nationality LBC was 12.01%, which was significantly higher than 4.03% of school-age children in rural areas of Harbin reported by Wu LJ et al[41]. We analyzed that it could be related to ethnic cultural differences, different scales of use and differences in social development, but it was close to 13.2% of the prevalence of EBP in LBC reported by Hu H et al[42]. This study also found that there was no significant difference in the prevalence of EBP between boys and girls of hui LBC, which was consistent with the existing research results[41].
In this study, it was found that among hui nationality LBC aged 6–11 years old, the top four prevalence of CBCL specific syndromes of male subjects were: depression(14.3%),schizoid(8.9%),obsessive-compulsive(7.1%),uncommunicative(7.1%)and EBP(7.1%). The top four prevalence of CBCL specific syndromes of female subjects were EBP (13.8%), schizoid-obsessive (12.1%), cruelty (10.3%) and somatic complaints (8.6%). There was no significant difference in prevalence of specific syndromes and EBP between hui nationality LBC and non-LBC aged 6 ~ 11, which was not consistent with that reported by liu SM et al[43].
Among hui nationality LBC aged 12–16 years old, the top four prevalence of CBCL specific syndromes of male students was: obsessive-compulsive (14.5%), somatic complaints (13.8%), EBP (13.0%) and hostility (11.6%). The top four prevalence of CBCL specific syndromes for female was schizoid (18.3%), EBP (12.6%), cruelty (9.2%), depression (7.6%) and immaturity (7.6%). This study found that with the growth of age, the prevalence of EBP of hui nationality male LBC showed an increasing trend, while the prevalence of hui nationality female LBC showed no increasing trend, but it was found that hui nationality female LBC aged 12–16 had significantly higher EBP than female non-LBC. This study suggest that children aged 12–16 with EBP not only may negatively affect their outside world, but also may be psychologically suffering internally. In other words, hui left-behind children aged 12–16 have the phenomenon of co-morbidity between externalizing and internalizing behavior problems[44], especially boys.
This study found that the score of hyperactivity factor of hui nationality LBC aged 6–11 years old was significantly lower than that of hui non-LBC, and there were no significant statistically difference in other factors of CBCL and EBP of hui nationality LBC compared with non-LBC. This was worthy of our attention, our study indicated that hui nationality LBC in low age groups might lead to their behavior convergence due to far away from parents and their inferiority complex. Another reason is that children at this age are in primary school. Because they are far away from their parents, they learn and master certain interpersonal skills. Compared with the psychological rebellion of middle school students when they entered adolescence, primary school students had simple and peaceful psychology and relatively few behavioral problems.
Our study showed that hui nationality male LBC aged 12–16 years old had higher scores on schizoid, somatic complaints, uncommunicative, obsessive-compulsive, hostility, delinquent, aggression, hyperactivity and externalizing behavior problems than those of male non-LBC, indicating that older hui male LBC were more likely to have behavioral problems, which was consistent with that reported by Wei-min Xu[8]. The reason may be related to boy’s different physiological characteristics, personality traits and family education environment. Our study also found that female hui nationality LBC aged 12–16 years old got higher scores in aggression, cruelty and EBP than those of non-LBC, suggesting that the behavior problems of the older hui nationality female LBC were mainly characterized by aggression and cruelty, and indicating that hui girls LBC were prone to externalizing behavior problems due to lack of family affection after entering adolescence. Thus, hui nationality LBC aged 12–16 are faced with a wider range of problems, including internalizing problems such as somatic complaints, depression and schizoid, as well as externalizing behavior problems such as delinquent, hyperactivity and aggression. After entering junior high school, because of parents and teachers pay too much attention to children's academic performance, children's learning pressure becomes larger, which may have an impact on their psychology.
In addition, due to parents' migrant work, lack of parental care and discipline, the older they get, the greater their psychological needs will be.
This was consistent with the increasing trend of emotional and behavioral problems in the process of children entering adolescence[
45], suggesting that we should focus on hui nationality senior LBC, which was inconsistent with existing studies[
41], and it was analyzed that our research objects were different from theirs.
The above results revealed that there were more behavioral problems among hui nationality LBC aged 12 ~ 16 years old, which were worthy of our attention.
The results of univariate analysis showed that children's gender, caregiver’s education level, parents' education level, parents divorced and only child had no effect on EBP of hui nationality LBC, which was in line with the previous research results[46],but was inconsistent with the existing study reported that parents divorced may exacerbate the negative effects of parental migration[47]. However, the frequency of contact with teachers, academic performance, and parents' working out situation seemed to have an influence, but they were not independent influences in multivariate analysis, which was quite inconsistent with the existing studies at home and abroad[48–51]. The possible reason is that the subjects of this study are Hui nationality left behind children in poor mountainous areas who influenced by the religious culture of Hui nationality, the culture of Hui nationality may have a certain regulatory effect on internalizing behavior problems, or it may be related to the small sample size of this study. These results suggest that they may play an indirect role in children's personality development and self-concept development.
The results of multivariate analysis showed that low behavior score, introversion and intermediate personality were the risk factors for EBP of hui nationality LBC, while intermediate type of mother refusal and denial was the protective factor for EBP of hui nationality LBC. This result indicated that the low score of self-concept behavior tended to cause hui nationality LBC to have higher EBP, which was consistent with the existing research[52]that pointed out a significant negative correlation between behavioral problems and self-concept. Our research also revealed that negative parenting styles, such as too much or too little maternal refusal and denial, will increase the EBP of hui nationality LBC, which was consistent with the positive correlation between EBP and authoritarian parenting style reported by Zhu WF et al[53]. Family is not only an important cultural carrier, but also is the first learning setting children are exposed to. Parental rearing style is considered a specific educational medium through which Chinese culture and social values are passed on to children. As a result of the impact that traditional Chinese culture and the education system have on parents, a hierarchy still exists between parents and children in most Chinese families.
On the one hand, If a child’s behavior goes against the will of the caregiver, rejection or punishment may occur.
Previous studies[
54,
55] suggested that corporal punishment by parents was strongly associated with later children externalizing behavior ,such as aggression, criminality and antisocial behavior. On the other hand, hui nationality culture is a kind of national culture formed on basis of Hui culture and Chinese traditional culture. Mosque, market and Hui community are interrelated and interdependent, and constitute three important links of Hui life: worship, commerce and residence[
56]. In families with plenty of time and a strong religious atmosphere, most hui children can enrich their understanding of the religion they believe in, either through the conscious guidance of elders' words and deeds or through the religious activities they are exposed to. Hui people believe in Islam and are deeply influenced by Islamic culture. They emphasize obedience in the ethical norms of their daily life. This culture has exerted a subtle influence on Hui children through family and social education, making them unconsciously compromise instead of insisting on their own opinions when confronted with conflicts between their own and others'. With the deepening of China's reform and opening up, the construction of market economy and the influx of a large number of labor force into cities, this pattern has been damaged[
57], so that these left-behind children can't inherit the characteristics of the hui culture, become more aggressive and indiscipline. Our study suggested that only moderate denial by mothers might have a protective effect on the development of EBP in hui nationality LBC, and that parent-based intervention had been proved to be effective in improving children's EBP[
58]. Moreover, children learn moral values and social conventions through a process of socialization, much of which involves parenting styles[
59], and it has been proved that moral education can promote the moral development of adolescents and hopefully reduce their EBP[
60].
Our research had several limitations. Firstly, due to the limited conditions, the sample population was single, involving only five township schools in two project demonstration counties, which limited the scalability of the research results and affected the external validity of this study. Secondly, we collected information from caregivers or parents about children's behavioral problems, which might lead to bias. Thirdly, the scores of the nationwide norm sample used in this study were collected through an epidemiology survey in 1992. It might lead to limitations when we used it to assess children’s behavioral problems in current studies, as China has undergone dramatic development in the past decades. Finally, this survey is a cross-sectional study, and it is impossible to obtain detailed information about the complete development process and the overall trends of EBP over time in hui nationality LBC. Furthermore, the CBCL is adopted as a screening scale in this survey. Therefore, the prevalence of EBP and CBCL syndromes of hui nationality LBC cannot be used as the basis for the diagnosis of children's emotional and behavioral problems. In order to provide more compelling evidence concerning influencing factors on EBP of hui nationality LBC, a longitudinal and prospective study is recommended to explore the mechanism of how these risk factors lead to EBP at individual and group levels.