Decomposition and comparative analysis of the differences in anxiety symptoms in preschool children with only and non-only children: a cross-sectional study
7 affiliations
- 1Department of Pediatrics, Shenzhen Longhua District Maternity and Child Health Hospital
- 2School of Public Health, Southern Medical University
- 3School of Health Management, Southern Medical University
- 4Drug and Cosmetics Supervision and Administration Section, Lianyungang Market Supervision Administration
- 5Shenzhen Longhua Maternity and Child Healthcare Hospital
- 6The Seventh Affiliated Hospital, Sun Yat-sen University
- 7School of Public Health, Sun Yat-sen University
Abstract
Background: Against the backdrop of family structure transformation and increasing attention to child mental health, anxiety symptoms in preschool children have become an important public health issue. Anxiety symptoms not only affect early emotional regulation and social adaptation but may also have sustained impacts on subsequent psychological development. In the context of China’s unique population policy, significant differences exist between only children and non-only children in terms of family resource allocation, parent-child interactions, and developmental environment, which may further influence the manifestation of childhood anxiety symptoms.
Objective: This study aims to compare the differences in the detection rates of anxiety symptoms between only-child and non-only-child preschool children, identify the differential effects of individual, family, and neurobehavioral factors on the two groups, and quantify the contributions of various factors to between-group differences using the Fairlie decomposition model, thereby providing empirical evidence for targeted child mental health intervention strategies.
Methods: This cross-sectional study was based on data from the 2022 Longhua Child Cohort Study in Shenzhen, China. A total of 67,779 preschool children aged 3–6 years (46,565 only children; 21,214 non-only children) were included and divided into two groups according to only-child status. Anxiety symptoms were assessed using the Chinese version of the Spence Preschool Anxiety Scale (SPAS, cutoff ≥48). Sociodemographic characteristics, ADHD symptoms, and emotional and behavioral problems were also collected. Chi-square tests and multivariate logistic regression were used to analyze associated factors, and the Fairlie decomposition model was applied to decompose between-group differences and quantify the contribution of each factor to the disparity in anxiety symptoms.
Results: The overall detection rate of anxiety symptoms in preschool children was 3.48%, with only-children showing a slightly higher rate (3.6%) than non-only children (3.3%, P = 0.027). Although the difference reached statistical significance, the absolute magnitude of the difference was small. Multivariate logistic regression revealed that higher maternal education level (OR = 0.710–0.751) and higher household income (OR = 0.426–0.623) were both associated with a decreased risk of anxiety symptoms. In contrast, female sex (OR = 1.224–1.276), positive ADHD symptoms (OR≈2.53), and abnormal SDQ total difficulties scores (OR≈18.28) were associated with an increased risk of anxiety, serving as risk factors for anxiety symptoms. Fairlie decomposition results showed that 39.8% of the total difference in anxiety symptoms between the two groups could be explained by observed variables, with emotional and behavioral problems contributing the most (41.43%), followed by ADHD symptoms (17.93%) and gender (3.42%). Meanwhile, maternal education level and household income exhibited significant negative contributions (-19.67%and-5.91%, respectively), suggesting that higher socioeconomic status served as a “protective buffer” against anxiety risk for only children. The remaining 60.2% of the difference may be attributable to unobserved factors.
Conclusion: There was a statistically significant difference in the detection rate of anxiety symptoms between only-child and non-only-child preschool children. This disparity was influenced by multiple factors, including children’s emotional and behavioral problems, ADHD symptoms, and family socioeconomic factors. However, the practical significance of this difference still requires further interpretation in conjunction with additional family environmental variables. In light of the differing mental health needs of children from diverse family structures, this study recommends establishing a mental health monitoring system centered on SDQ screening, implementing differentiated family education guidance tailored to different family structures, and promoting a collaborative mental health support system involving kindergartens, families, and communities.
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BibTeX
@article{xie2026decomposition,
title = {{Decomposition and comparative analysis of the differences in anxiety symptoms in preschool children with only and non-only children: a cross-sectional study}},
author = {Yuying Xie and Wenyu Wang and Yusupujiang Tuersun and Xiaona Yin and Qiang Zhou and Zhenning Liang and Shasha Peng and Xun Li and Junfang Huang},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1877032},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1877032/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Decomposition and comparative analysis of the differences in anxiety symptoms in preschool children with only and non-only children: a cross-sectional study
AU - Yuying Xie
AU - Wenyu Wang
AU - Yusupujiang Tuersun
AU - Xiaona Yin
AU - Qiang Zhou
AU - Zhenning Liang
AU - Shasha Peng
AU - Xun Li
AU - Junfang Huang
PY - 2026
DA - 2026/10/14
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1877032
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1877032/full
AB - Background: Against the backdrop of family structure transformation and increasing attention to child mental health, anxiety symptoms in preschool children have become an important public health issue. Anxiety symptoms not only affect early emotional regulation and social adaptation but may also have sustained impacts on subsequent psychological development. In the context of China’s unique population policy, significant differences exist between only children and non-only children in terms of family resource allocation, parent-child interactions, and developmental environment, which may further influence the manifestation of childhood anxiety symptoms. Objective: This study aims to compare the differences in the detection rates of anxiety symptoms between only-child and non-only-child preschool children, identify the differential effects of individual, family, and neurobehavioral factors on the two groups, and quantify the contributions of various factors to between-group differences using the Fairlie decomposition model, thereby providing empirical evidence for targeted child mental health intervention strategies. Methods: This cross-sectional study was based on data from the 2022 Longhua Child Cohort Study in Shenzhen, China. A total of 67,779 preschool children aged 3–6 years (46,565 only children; 21,214 non-only children) were included and divided into two groups according to only-child status. Anxiety symptoms were assessed using the Chinese version of the Spence Preschool Anxiety Scale (SPAS, cutoff ≥48). Sociodemographic characteristics, ADHD symptoms, and emotional and behavioral problems were also collected. Chi-square tests and multivariate logistic regression were used to analyze associated factors, and the Fairlie decomposition model was applied to decompose between-group differences and quantify the contribution of each factor to the disparity in anxiety symptoms. Results: The overall detection rate of anxiety symptoms in preschool children was 3.48%, with only-children showing a slightly higher rate (3.6%) than non-only children (3.3%, P = 0.027). Although the difference reached statistical significance, the absolute magnitude of the difference was small. Multivariate logistic regression revealed that higher maternal education level (OR = 0.710–0.751) and higher household income (OR = 0.426–0.623) were both associated with a decreased risk of anxiety symptoms. In contrast, female sex (OR = 1.224–1.276), positive ADHD symptoms (OR≈2.53), and abnormal SDQ total difficulties scores (OR≈18.28) were associated with an increased risk of anxiety, serving as risk factors for anxiety symptoms. Fairlie decomposition results showed that 39.8% of the total difference in anxiety symptoms between the two groups could be explained by observed variables, with emotional and behavioral problems contributing the most (41.43%), followed by ADHD symptoms (17.93%) and gender (3.42%). Meanwhile, maternal education level and household income exhibited significant negative contributions (-19.67%and-5.91%, respectively), suggesting that higher socioeconomic status served as a “protective buffer” against anxiety risk for only children. The remaining 60.2% of the difference may be attributable to unobserved factors. Conclusion: There was a statistically significant difference in the detection rate of anxiety symptoms between only-child and non-only-child preschool children. This disparity was influenced by multiple factors, including children’s emotional and behavioral problems, ADHD symptoms, and family socioeconomic factors. However, the practical significance of this difference still requires further interpretation in conjunction with additional family environmental variables. In light of the differing mental health needs of children from diverse family structures, this study recommends establishing a mental health monitoring system centered on SDQ screening, implementing differentiated family education guidance tailored to different family structures, and promoting a collaborative mental health support system involving kindergartens, families, and communities.
SN - 1664-0640
ER -