Depression in left-behind children: a network analysis and chained mediation of attachment and emotion regulation

Abstract Background Urbanization has swelled the ranks of left-behind children (LBC), whose mental health — especially depression — now draws mounting global concern. Previous studies have shown that LBC are more prone to develop insecure parental attachments and tend to adopt maladaptive emotion regulation strategies, both established predictors of depression. Objective Investigate the specific pathways through which attachment and emotion regulation mediate the impact of left-behind experiences on depression. Participants and setting In three middle schools in Qiqihar, a total of 1,125 children aged 12–17 were sampled, including 573 LBC and 552 non‑left‑behind children (NLBC). Methods The questionnaire survey includes a Left-behind Status Questionnaire, the Inventory of Parent and Peer Attachment (IPPA), the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA), and the Children’s Depression Inventory (CDI). Results (1) LBC scored significantly lower than NLBC in maternal attachment, paternal attachment, and cognitive reappraisal, while scoring significantly higher in expressive suppression and depression; (2) LBC showed network structure distinct from NLBC, with maternal attachment showing lower centrality and weaker coupling with paternal attachment; (3) LBC with both parents absent showed network structure and global strength distinct from NLBC, along with weaker maternal-paternal attachment correlation; (4) all four mediating pathways exhibited significant chain effects. Conclusions (1) Left-behind experiences are associated with weakened parent-child attachment, reduced cognitive reappraisal, increased expressive suppression, and a heightened risk of depression; (2) In LBC, maternal attachment shows lower centrality, and the coupling between maternal and paternal attachment is significantly weaker, indicating a less coordinated parental attachment system. (3) The absence of both parents has a far greater effect on reshaping children’s psychological networks than the absence of the father alone. (4) parent-child attachment and emotion regulation mediated the association between left-behind experiences and depression.