The association of sex and attitudes towards parental migration with anxiety symptoms in left-behind children: a large-scale cross-sectional study

Background: Left-behind children (LBC) in China, especially in ethnic minority regions, face unique psychosocial challenges due to parental migration, with anxiety symptoms (AS) among the most common mental health issues. This study examined the prevalence of AS in LBC, explored associated socio-demographic and left-behind characteristics, and identified independent risk factors. Methods: A cross-sectional study was conducted among 856 students aged 7-17 years from three counties in southern Yunnan Province, with 829 included in the final analysis. Socio-demographic and left-behind information was collected via self-administered questionnaires. AS were assessed using the Screen for Child Anxiety-Related Emotional Disorders (SCARED). Group comparisons used t-tests, Mann-Whitney U tests, and chi-square tests. Logistic regression identified independent risk factors, and multivariate linear regression examined associations with SCARED scores. Results: AS prevalence was higher in LBC than non-LBC (44.21% vs. 22.75%; χ² = 28.170, P < 0.001; OR = 2.285, 95% CI: 1.658-3.149). Among LBC, females and children with neutral or opposed attitudes toward parental migration were more likely to report AS. Logistic regression confirmed female sex (B = 0.663, OR = 1.940, 95%CI=1.377-2.732) and neutral attitude toward migration (B = 0.740, OR = 2.096, 95%CI=1.338-3.283) as independent risk factors. Higher SCARED scores were additionally associated with less frequent communication with migrant parents (B = 1.996), neutral/opposed attitudes (B = 1.880), and lack of a help-seeking figure (B = 3.020). Conclusion: LBC have a 2.285-fold higher AS prevalence than non-LBC. Female sex, neutral/opposed attitudes toward parental migration, reduced parental communication, and insufficient social support exacerbate anxiety severity, highlighting the need for targeted interventions.