Anxiety in Rural Chinese Children and Adolescents: Comparisons across Provinces and among Subgroups

China's competitive education system has produced notably high learning outcomes, but they may be costly. One potential cost is high levels of anxiety. China has launched several initiatives aimed at improving student mental health. However, little is known about how effective these programs and policies are. The goal of this paper was to examine anxiety levels among children and adolescents in rural China, and to identify which subpopulations were particularly vulnerable to anxiety. Data were aggregated from 10 different school-level surveys conducted in rural areas of five provinces between 2008 and 2015. In total, 50,361 students were evaluated using the 100-item, nine-subcategory Mental Health Test (a variation of the Children's Manifest Anxiety Scale). Seven percent of students were at risk for overall anxiety. However, over half of students were at risk for at least one subcategory of anxiety. Students at higher risk for anxiety included students from poorer counties and families, female students, secondary school students, and students with lower levels of academic performance. Many students in rural China are at risk for anxiety, and certain student subpopulations are particularly vulnerable. We suggest that China's government review and update student mental health programs and policies.