Mental health status of secondary school students: a meta-analysis of comparative studies between one-child and multi-child families in China

Wei Zhang^1,2*Pan Chen^1,2Shu-Ying Rao^1,2Yuan-Yuan Jiang^1,2Zhaohui Su³Teris Cheung⁴Chee H Ng⁵Yu-Tao Xiang^1,2Gang Wang⁶

• ¹Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao, Macao, SAR China
• ²Centre for Cognitive and Brain Sciences, University of Macau, Macau, Shanghai Municipality, China
• ³School of Public Health, Southeast University, Nanjing, Jiangsu Province, China
• ⁴School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
• ⁵Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Australia
• ⁶Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China

Mental health problems are common among secondary school students. However, when comparing one-child and multi-child families, the findings on the mental health of students are mixed. Therefore, we conducted a meta-analysis to compare the mental health status between secondary school students from one-child and multi-child families in China. Relevant studies using standard instruments on mental health (e.g., the Middle School Student Mental Health Scale; MSSMHS and the Mental Health Test; MHT) were searched in PubMed, Web of Science, PsycINFO, China National Knowledge Infrastructure (CNKI), and Wanfang. A random-effects model was employed to compute the pooled effect size. Subgroup analyses for categorical variables and meta-regression analyses for continuous variables were carried out to examine the potential moderators of group differences. We identified 39 studies, which included 11,889 secondary school students from one-child families and 13,795 from multi-child families. No significant difference in mental health was found between students from one-child and multi-child families. However, significant group differences were observed in certain MHT domains, including Learning Anxiety [95% confidence interval (CI): -0.19; 0.00, I² = 0.0%, P = 0.04], Social Anxiety (95% CI:-0.25; 0.00, I² = 45.8%, P = 0.04), Tendency Towards Self-Blame (95% CI: -0.23; -0.07, I² = 0.0%, P < 0.01) and Allergic Tendencies (95% CI: -0.25; -0.01, I² =43.5%, P = 0.04). This meta-analysis did not show significant differences in mental health between students from one-child and multi-child families. Future research should investigate the influence of socio-demographic factors, such as gender and place of residence, on this population’s mental health.