This research found that 187 out of 955 hui children had internalizing behavior problems (IBPs), with a prevalence of 19.58%. Among the 383 hui LBC, 83 persons had IBP, with a prevalence of 21.7%. A total of 104 out of 572 hui nationality non-LBC had IBP, with a prevalence of 18.2%. The prevalence of IBP was not significantly different between hui nationality LBC and non-LBC. However, our findings showed that male hui nationality LBC was more likely to have a higher prevalence than non-LBC. In terms of the prevalence of IBP, the prevalence of hui nationality LBC was 21.7%, which was significantly higher than 6.3% of school-age children in rural areas of Harbin reported by Wu Lijie et al and higher than 15.19% of the prevalence of IBP in LBC reported by Hu H et al. Our results also showed that there was no significant difference in the prevalence of IBP between boys and girls of hui LBC, which was inconsistent with previous research results that suggested that girls were higher than boys [6, 36]. We analyzed that it could be related to differences in ethnic cultural and social development.
In this study, it was found that among Hui nationality LBC aged 6–11 years old, the top three prevalences of CBCL-specific syndromes in male subjects were IBP (17.9%), depression (14.3%), and schizoid (8.9%). The top three prevalences of CBCL-specific syndromes in female subjects were IBP (17.2%), schizoid obsessive (12.1%), and somatic complaints (8.6%). There was no significant difference in the prevalence of specific syndromes and IBP between hui nationality LBC and non-LBC aged 6 ~ 11 years, which was not consistent with that reported by Liu shumiao et al.
Among the LBC of hui nationality aged 12–16 years old, the top three prevalences of CBCL-specific syndromes among male students were IBP (23.9%), somatic complaints (13.8%), and hostility (11.6%). The top three prevalences of CBCL-specific syndromes for girls were IBP (22.9%), schizoid (18.3%), depressed-withdrawal (7.6%), and immaturity (7.6%). This study found that with increasing age, the prevalence of IBP in male hui nationality LBC showed an increasing trend, while the prevalence in female hui nationality LBC showed no increasing trend. In other words, hui left-behind children aged 12–16 have the phenomenon of comorbidity between externalizing and internalizing behavior problems, especially for boys.
Our study results show that hui nationality LBC in low age groups are less likely to have IBP. The reason is that children at this age stage 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 male hui nationality LBC aged 12–16 years old had higher scores on schizoid, somatic complaints, uncommunicative, obsessive-compulsive, and IBP than those of non-LBC, indicating that older male hui LBC were more likely to have behavioral problems, which was consistent with that reported by Wei-min Xu. The reason may be related to the boy’s different physiological characteristics, personality traits and family education environment. After entering junior high school, because 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, suggesting that we should focus on senior hui nationality LBC.
The results of univariate analysis showed that children’s gender, caregiver’s education level, parents’ education level, parents' divorce, frequency of contact with teachers, and parents' working outside situation did not seem to affect the IBP of hui nationality LBC, which is inconsistent with the existing research[41, 42]. The analysis suggests that they may play an indirect role by influencing the development of children's personality and self-consciousness. However, the research found that behavior, anxiety, popularity, happiness and satisfaction, total score of self-concept, father punishment and strictness, father favoring subjects, mother refusal and denial, mother punishment and strictness, mother favoring subjects, extroversion-introversion personality and neuroticism were related to the IBP of Hui left-behind children.
Multivariate analysis showed that the more mothers preferred subjects, the more neurotic the children were (above the middle score), which was an independent risk factor for the IBPs of hui left-behind children, which was not completely consistent with the independent factors influencing the incidence of overall behavioral problems of Hui left-behind children in our study.
This study results show that the negative parenting styles, such as the more mothers prefer subjects, the more likely Hui nationality LBC are to have IBP. The more unstable children's emotions are, the more likely they are to have IBP dominated by anxiety and depression, etc. The analysis suggests that overindulgence of children by mothers may lead to children's lack of self-restraint and independence, thus leading to children's behavior deviating from the normal range. Family is not only an important cultural carrier but is also 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. Hui culture is an ethnic culture formed on the basis of Islamic culture and traditional Chinese culture. Mosque, market and Hui community are interlinked and interdependent, which constitute three important links of Hui life: worship, commerce and residence. In families with plenty of time and a strong religious atmosphere, most Muslim young people can enrich their understanding of the religion they believe through religious activities consciously guided or contacted by parents' words and deeds because religious parents are more likely to manifest their religious values and beliefs through their daily interactions with their children. This culture subtly influences Hui children through family and social education, making them no longer adhere to their own views in the face of conflicts with others but unconsciously compromise. With the deepening of China's reform and opening up, the construction of the market economy and the influx of a large number of labor forces into cities, the pattern of mosque, market and Hui community has been destroyed. This will affect the family education mode and religious belief system of Hui children, resulting in confusion, anxiety and depression.
Our study had several limitations. First, due to the limitations of the conditions, the selected sample population was single, involving only 5 township schools in 2 project demonstration counties, which limited the extensibility of the study results and affected the external validity of this study. Second, we collected information from caregivers or parents about children's behavioral problems, which might lead to bias. Third, 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, the research object of this paper is mainly left-behind children in school, not considering other children dropping out of school. At the same time, 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 IBP over time in hui nationality LBC. Furthermore, the CBCL is adopted as a screening scale in this survey. Therefore, the prevalence of IBP and CBCL syndromes of hui nationality LBC cannot be used as the basis for the diagnosis of children's emotional and behavioral problems. Therefore, to provide more compelling evidence concerning influencing factors on IBP of hui nationality LBC, a longitudinal and prospective study is recommended to explore the mechanism of how these risk factors lead to IBP at the individual and group levels.