Childhood Trauma among Primary Students in Shenzhen City: Prevalence, Risk factors, and Relationship with Anxiety Symptoms

Childhood Trauma among Primary Students in Shenzhen City: Prevalence, Risk factors, and Relationship with Anxiety Symptoms | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Childhood Trauma among Primary Students in Shenzhen City: Prevalence, Risk factors, and Relationship with Anxiety Symptoms Xiujin Lin, Jianbo Liu, Zhenpeng Xue, Jianchang Xu, Ling Lin, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7701193/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background There is relatively little research on the prevalence of childhood trauma in Chinese children. Thus, this study aimed to investigate the prevalence of childhood trauma, its effect on anxiety, and other relevant factors influencing anxiety. Methods Socio-demographic characteristics, Childhood Psychological Trauma Questionnaire (CPTQ), and Conners Parent Symptom Questionnaire (PSQ) were obtained from 12704 students recruited from 14 primary schools in Shenzhen. Rates of anxiety were compared between students experiencing different types of childhood trauma. Logistic regression was used to test the relationship between anxiety and childhood trauma. Results In the overall sample, the prevalence of the various types of childhood trauma ranged from 1.6–52.9%. The prevalence of anxiety in children experiencing various types of childhood trauma ranged from 3.47–17.48%. Logistic regression confirmed that childhood trauma was a strong predictor of anxiety (all odds ratios (ORs)>1.69). Notably, the different types of childhood trauma showed a dose-dependent relationship with anxiety risk. Various factors, such as gender and age, increased the risk of anxiety in children experiencing any type of childhood trauma (all ORs>1.370). Conclusions Our findings support that childhood trauma is a strong predictor of anxiety. Mental healthcare professionals should consider the role of childhood trauma in the management of anxiety and mental illnesses—especially among female patients. childhood trauma anxiety symptoms primary students prevalence risk factors Introduction Childhood trauma is a serious social and public health problem worldwide[ 1 ]. Childhood trauma can be distinguished into five types, namely physical abuse (PA), sexual abuse (SA), emotional abuse (EA), physical neglect (PN), and emotional neglect (EN) [ 2 ]. In recent years, it has been reported that childhood trauma increases the risk of psychopathology in adults [ 3 ]. Moreover, childhood trauma poses a huge burden on families and society [ 4 ]. A previous study found that child abuse is responsible for an average of 1.88% of GDP economic loss in East Asia and the Pacific [ 5 ]. The prevalence of childhood trauma is generally high in different populations. For example, a recent meta-analysis reported pooled prevalence rates of EA, PA, SA, PN, and EN were 30.0%, 20.0%, 12.0%, 47.0%, and 44.0%, respectively among Chinese middle school students [ 6 ]. Another meta-analysis of studies that reported that the prevalence of mild or higher PA was 43.1% in China [ 7 ]. Using the Childhood Trauma Questionnaire (CTQ) by Bernstein et al. [ 8 ], Guo et al. found that the prevalence rates of mild or higher EA, PA, SA, EN, and PN were 3.5%, 1.4%, 1.6%, 20%, and 27.3%, respectively, among Chinese adolescents [ 9 ]. Several studies have reported a higher prevalence of childhood trauma in adults with mental disorders relative to the general population, for example, a study of adults with major depressive disorder and bipolar disorder found that the pooled prevalence of moderate-to-extreme childhood maltreatment in these two groups was 33.0% and 30.0% for EA, 17.0% and 18.0% for PA, 19.0% and 22.0% for SA, 37.0% and 31.0% for EN, and 31% and 30.0% for PN, respectively, when assessed using CTQ [ 10 ]. In addition, the prevalence of moderate-to-extreme childhood maltreatment assessed by CTQ in youth aged 14 to 26 years who have attempted suicide ranges from 16.8% (SA) to 45.2% (EA) [ 11 ]. There were 17.4% for EA, 20.2%for PA, 26.6% for SA, 70.1% for EN and 85.1% for PN in secondary school students in China[ 12 ]. Notably, most previous studies focus on the prevalence of childhood trauma in adults or youth or adolescents or secondary school students; by contrast, the prevalence of childhood trauma in primary students is rarely reported. In addition, most of the previous studies were conducted by adults to recollect childhood trauma using reliable questionnaire such as the Bernstein CTQ[ 13 ]. In order to more objectively assess the childhood trauma experienced by children, we use parent-reported questionnaires to assess childhood trauma in primary students. Evidence suggests that the prevalence of childhood trauma is influenced by several risk factors. First, previous studies have suggested that family socio-economic status is negatively correlated with childhood trauma in children and adolescents [ 14 , 15 ]. Previous studies have found gender differences in the prevalence of childhood trauma in patients with mental illnesses. For example, Shah et al. found that the prevalence of childhood trauma in female patients with mental illness was 2.8-fold higher than that in male patients [ 16 ]. Similarly, girls who reported experiencing one or more type of childhood maltreatment had a higher risk of sleep disturbance than boys [ 17 ]. Furthermore, Researchers have also found that parents' education level [ 18 ] and being a left-behind child[ 19 ] impact the prevalence of childhood trauma. These risk factors of childhood trauma are well established. However, there is a dearth of knowledge about whether these risk factors have similar effects on maltreatment in children with anxiety. This study will contribute to filling this gap in knowledge. The long-standing negative effect of childhood maltreatment on individual’s mental health is well documented, especially regarding mood disorders such as anxiety and depression. For example, recent studies have found that Childhood trauma is a significant predictor of anxiety and depression[ 20 ], as well as physical multimorbidity in adulthood [ 21 ]. Childhood abuse can lead to anxiety and depression in adulthood which due to its effects on fear circuits in the brain [ 20 , 22 ]. Notably, these studies examined the effect of childhood trauma on anxiety among adult samples; however, there are few such studies in children [ 23 , 24 ]. In light of the above-described research gaps, the present study aimed to explore the prevalence and effects of childhood trauma in Chinese children. Thus, the main objectives were to assess the prevalence of childhood trauma and to examine the association between childhood trauma and anxiety in school-age Chinese children. In addition, we explored risk factors associated with childhood trauma. Exploring these risk factor can help healthcare workers take effective measures to both prevent abuse and help children cope with trauma during the early stages. Moreover, greater understanding of childhood trauma will help inform the establishment of mental health programs in schools. Method 2.1. Participants and procedures We conducted a cross-sectional study of all students from grade 1 to 6 enrolled at 14 primary schools in Shenzhen. Cluster sampling was applied for all students at all 14 primary schools. A total of 17400 anonymous questionnaires were distributed to students from September to December of 2019 and completed by students’ parents at home. The students submitted the completed questionnaires to their teacher on the second day. Finally, the teacher gave all of the questionnaires to the researcher. Of the total questionnaires distributed, 14723 (84.61%) were recovered. Lastly, a questionnaire was considered invalid if over 5% of responses were missing. Questionnaires with completed responses for the Childhood Psychological Trauma Questionnaire (CPTQ) (parents’ version) and Conners Parent Symptom Questionnaire (PSQ) were included in the analysis. Ultimately, the final sample comprised 12704 students with an average age of 8.9 ± 1.9 years (range: 6–14 years) with completed questionnaires and socio-demographic characteristics, which are needed for this study. There were 6972 boys and 5666 girls (gender was missing for 66 students (0.5%)), and 8767 students were an only child (response missing for 70 students (0.6%)). All students and their parents in the study voluntarily participated and provided informed consent before participating. This study was approved by the ethics committee of Shenzhen Kangning Hospital (approval no. 2019-k009-01-1). All procedures in this study were conducted in accordance with the ethical principles of the Declaration of Helsinki. 2.2 Measures Demographic variables included gender, age, whether they were a single child, family income, the child’s academic performance. Additional information such as witnessing domestic violence, level of learning stress, whether the child grew up in Shenzhen, whether their father or mother worked away from home, whether the student was criticized by teachers, and the student’s relationships with classmates, teachers, and family. Childhood Psychological Trauma Questionnaire (CPTQ) This scale was adapted from Janssen et al.’s semi-structured interview questionnaire to evaluate childhood trauma lifetime occurrence [ 25 ]. The scale was filled out by parents. Four items were used to measure four domains of childhood trauma, including EN, EA, PA, and SA. EN included that the parents did not listen to their child’s demands and ignored their problems, and that the child felt they did not receive support and attention from their family. EA included that the child was scolded by their family, treated worse than their siblings, or experienced unjust punishment or blackmail. PA included the child being beaten, kicked, or experiencing other forms of PA). SA items related to the child being forced into sexual contact or being forced to touch another person's body [ 25 ]. Each item was scored from 1 to 5 based on the frequency of the described trauma, with 1 = Never and 5 = Very often = 5). Thus, a higher score indicated greater childhood trauma. The maximum possible score was 20. A score of two or more for each item was defined as childhood trauma. In the current study, the cut-off score of EN, EA, PA or SA was > 1 point. participants experiencing ≥3 types of trauma are considered to have experienced multiple traumas. The Cronbach’s α was 0.60. Conners Parent Symptom Questionnaire (PSQ) This questionnaire [ 26 ] was filled out by children's parents to evaluate behavioral problems in children, including conduct disorder (12 items), learning problems (4 items), psychosomatic disorder (5 items), hyperactivity-impulsivity (3 items), anxiety (4 items), and ADHD (10 items). For this study, anxiety subscale was used. The Cronbach’s α of this scale was 0.969 [ 27 ]. The internal consistency coefficient of the anxiety factor in this study was 0.79. Anxiety was defined as an anxiety factor score at least 2 standard deviations (SD) above the mean [ 27 ]. Thus, in the present study, a score of 1.13 or higher in males and 1.04 or higher in females was defined as abnormal anxiety. 2.3 Statistical analysis Statistical analysis was performed using SPSS Version 21.0 (IBM, Chicago, IL, USA). The rates of childhood trauma and anxiety are reported as a percentage (%) with 95% confidence intervals (CIs). Logistic regression was used to test the relationship between anxiety and childhood trauma with the odds ratio (OR) and 95% CIs. P -values < 0.05 were considered statistically significant. Results 3.1 Prevalence of childhood trauma and relation to demographic characteristics Of the 12704 participants, 4043 (31.8%) had suffered EN, 2613 (20.6%) had suffered EA, 4595 (36.2%) had suffered PA, and 206 (1.6%) had suffered SA. A total of 6720 (52.9%) participants had experienced any type of trauma and 1346 (10.6%) had experienced multiple types of childhood trauma. The frequency distribution of different types of childhood trauma is shown in Supplementary Fig. S1 . The prevalence of trauma exposure by different demographic characteristics is shown in Table 1 . As shown, participants tended to be male, students aged 9–11 or 12–14, those who did not grow up in Shenzhen, students with average-to-high learning stress, students who had witnessed domestic violence, students who had a father or mother who worked away from home for one year, students who were sometimes or always criticized by teachers, and students with average-to-bad relationships with their classmates, teachers, or families (all ORs ≥ 1.15, P<0.05). Detailed results are shown in Table 1 and Supplementary Table 2. Table 1 Multivariate logistic regression for determining risk factors of childhood trauma. Group EN Adjusted odds ratio(95%CI) EA Adjusted odds ratio(95%CI) PA Adjusted odds ratio(95%CI) SA Adjusted odds ratio(95%CI) gender male Reference Reference Reference Reference female 1.16(1.07–1.26) 0.10(0.90–1.10) 0.76(0.70–0.83) 0.68(0.49–0.94) age 6–8 Reference Reference Reference Reference 9–11 0.89(0.81–0.97) 1.21(1.10–1.34) 1.05(0.96–1.14) 2.03(1.41–2.93) 12–14 0.95(0.81–1.12) 1.10(0.91–1.32) 0.93(0.80–1.10) 3.00(1.81–4.96) Single-child Yes Reference Reference Reference Reference No 1.002(0.921.07) 0.85(0.76–0.94) 0.96(0.88–1.05) 1.01(0.73–1.41) Grew up in Shenzhen Yes Reference Reference Reference Reference No 1.02(0.94–1.11) 1.15(1.04–1.27) 1.15(1.06–1.25) 1.18(0.86–1.61) Family income Good Reference Reference Reference Reference Average 1.11(0.97–1.26) 0.78(0.68–0.90) 1.06(0.96–1.20) 0.52(0.36–0.76) Bad 1.09(0.89–1.34) 0.87(0.70–1.09) 1.34(1.10–1.64) 0.54(0.28–1.05) Learning stress No Reference Reference Reference Reference Average 1.74(1.40–2.15) 1.21(0.96–1.53) 1.48(1.22–1.79) 0.56(0.31–1.02) great 2.47(1.98–3.09) 1.89(1.48–2.41) 2.04(1.672.49) 0.65(-.35 − 1.20) Academic performance Good Reference Reference Reference Reference Average 0.93(0.85–1.03) 0.85(0.76–0.96) 0.86(0.78–0.94) 0.95(0.65–1.38) Bad 0.93(0.81–1.06) 0.95(0.82–1.11) 0.90(0.79–1.02) 1.11(0.70–1.76) Witnessing domestic violence No Reference Reference Reference Reference Yes 2.01(1.83–2.21) 2.41(2.18–2.67) 2.22(2.03–2.44) 2.74(2.01–3.74) Father worked away from home No Reference Reference Reference Reference ≤ 1 year 1.35(1.21–1.50) 1.48(1.31–1.67) 1.45(1.31–1.61) 1.73(1.21–2.47) >1years 1.63(1.35–1.96) 1.91(1.56–2.34) 1.51(1.26–1.82) 1.65(0.88–3.09) Mother worked away from home No Reference Reference Reference Reference ≤ 1 year 1.47(1.28–1.69) 1.33(1.14–1.55) 1.19(1.03–1.36) 1.39(0.90–2.14) >1years 1.08(0.84–1.41) 1.12(0.84–1.48) 1.49(1.16–1.93) 0.97(0.39–2.38) Criticized by teachers No Reference Reference Reference Reference Sometimes 1.86(1.66–2.10) 1.63(1.41–1.88) 1.91(1.71–2.14) 1.71(1.00-2.94) Always 1.76(1.18–2.61) 1.41(0.89–2.23) 2.29(1.56–3.35) 3.14(1.13–8.71) relationship with classmates good Reference Reference Reference Reference general 1.24(1.10–1.39) 1.14(1.001-1.30) 1.12(1.002–1.26) 1.32(0.88–1.97) relationship with teacher bad 1.90(1.39–2.59) 1.49(1.08–2.05) 1.72(1.26–2.35) 1.77(0.85–3.67) good Reference Reference Reference Reference general 1.29(1.16–1.43) 1.26(1.12–1.42) 1.25(1.12–1.39) 1.00(0.67–1.48) bad 1.09(0.76–1.56) 1.28(0.88–1.86) 1.39(0.97-2.00) 2.04(0.97–4.30) relationship with families good Reference Reference Reference Reference general 2.21(1.87–2.61) 1.94(1.64–2.31) 1.51(1.28–1.78) 1.28(0.79–2.09) bad 1.87(1.25–2.80) 2.05(1.37–3.08) 1.42(0.94–2.13) 2.24(1.01–4.95) Note: EA: emotional abuse; PA: physical abuse SA: sexual abuse; EN: emotional neglect. 3.2 Prevalence of anxiety in students experiencing different types of childhood trauma Of the total sample, 500 students (3.94%, 95% CI 3.61–4.29%) had anxiety symptoms. As shown in Table 2 , the prevalence rates of anxiety symptoms in children experiencing EN, EA, PA, SA, and any trauma were 7.72%, 8.8%, 6.29%, 17.48%, and 6.00%, respectively. Furthermore, the prevalence rates of anxiety symptoms in children exposed to one, two, or multiple types of childhood trauma were 3.47%, 6.32%, and 11.89%, respectively. Table 2 The prevalence of anxiety in children with different types of childhood trauma Group N n Prevalence ( 95%CI) EN No 8661 188 2.17(1.88–2.5) Yes 4043 312 7.72(6.93–8.58) EA No 10091 270 2.68(2.38–3.01) Yes 2613 230 8.8(7.78–9.95) PA No 8109 211 2.6(2.28–2.97) Yes 4594 289 6.29(5.62–7.03) SA No 12498 464 3.71(3.4–4.06) Yes 206 36 17.48(12.9-23.24) Any trauma No 5984 97 1.62(1.33–1.97) Yes 6720 403 6.00(5.45–6.59) 1 type trauma Yes 3397 118 3.47(2.91–4.14) 2 types trauma Yes 1977 125 6.32(5.33–7.48) ≥ 3 types trauma Yes 1346 160 11.89(10.27–13.73) Note: N: total number of children; n: number of children with anxiety reporting different types of childhood trauma; EA: emotional abuse; PA: physical abuse SA: sexual abuse; EN: emotional neglect. 3.3 The effect of type of childhood trauma on anxiety symptoms After adjusting for gender, age, single-child status, family income, academic performance, witnessing domestic violence, learning stress, growing up in Shenzhen, a father or mother working away from home, criticism by teachers, and relationships with classmates, teachers, and families, the logistic regression results showed that students who experienced EN were 2.6 times more likely to report anxiety symptoms (95%CI: 2.11–3.20) than whose were had not experienced EN. Exposure to EA (OR = 2.249, 95%CI: 1.83–2.77), PA (OR = 1.78, 95%CI: 1.45–2.19), SA (OR = 2.786, 95%CI: 1.77–4.37), or any type of trauma (OR = 2.726, 95%CI:2.12–3.51) positively increased anxiety symptoms risk relative to no such exposure (see Table 3 ). Table 3 Multivariate regression of the association between the number of types of childhood trauma and anxiety according to gender. Group Any trauma EN EA PA SA Total samples P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 OR 2.726 2.602 2.249 1.78 2.786 95%CI (2.12–3.51) (2.11–3.20) (1.83–2.77) (1.45–2.19) (1.77–4.37) Male P < 0.001 < 0.001 < 0.001 0.001 0.03 OR 2.312 2.377 2.07 1.685 2.033 95%CI (1.61–3.31) (1.77–3.20) (1.54–2.79) (1.25–2.27) (1.07–3.86) Female P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 OR 3.21 2.881 2.468 1.91 2.733 95%CI (2.26–4.57) (2.15–3.86) (1.85–3.30) (1.44–2.54) (1.76–4.26) Note: Adjusted for gender (Gender was not controlled in gender subgroup analysis), age, single-child, income, academic performance, witnessing domestic violence, learning stress, grep up in Shenzhen, Out-father, Out-mother, critic by teacher, And relationships with classmates, teachers and families, P: p-values; OR: odds ratio; EA: emotional abuse; PA: physical abuse SA: sexual abuse; EN: emotional neglect. After adjusting for the above confounding factors (except gender), the gender subgroup analysis showed that male students who experienced EN (OR = 2.377, 95%CI: 1.77–3.20), EA (OR = 2.07, 95%CI: 1.54–2.79), PA (OR = 1.685, 95%CI: 1.25–2.27 ), SA (OR = 2.033, 95%CI: 1.07–3.86), or any type of trauma (OR = 2.312, 95%CI: 1.61–3.31 ) had an increased anxiety symptoms risk relative to no such exposure; among female students, EN (OR = 2.881, 95%CI: 2.15–3.86), EA (OR = 2.468, 95%CI: 1.85–3.30), PA (OR = 1.91, 95%CI: 1.44–2.54 ), SA (OR = 2.733, 95%CI: 1.76–4.26), and any type of trauma (OR = 3.21, 95%CI: 2.26–4.57) all positively increased anxiety symptoms risk relative to no such exposure (see Table 3 ). Table 3 shows that the different types of childhood trauma had a stronger association with the risk of developing anxiety symptoms in female students than in male students. 3.4 Association between the number of types of childhood trauma and anxiety symptoms As above, we used a multivariate regression model to explore the relationship of the number of types of childhood trauma with anxiety symptoms. The results showed that exposure to one type of trauma (OR = 1.94, 95%CI: 1.45–2.60), two types of trauma (OR = 2.96, 95%CI: 2.19–4.00), and multiple types of trauma (OR = 4.585, 95%CI: 3.39–6.21) positively increased the anxiety symptoms risk relative to no exposure to childhood trauma (see Table 4 ). Table 4 Different numbers of child trauma types predicted anxiety in multivariate regression models Group P OR 95%CI Total samples No Reference Reference Reference 1 type trauma < 0.001 1.94 (1.45–2.60) 2 types trauma < 0.001 2.96 (2.19-4.00) ≥ 3 types trauma < 0.001 4.585 (3.39–6.21) Male No Reference Reference Reference 1 type trauma 0.021 1.65 (1.08–2.51) 2 types trauma < 0.001 2.51 (1.63–3.86) ≥ 3 types trauma < 0.001 3.79 (2.46–5.84) Female No Reference Reference Reference 1 type trauma < 0.001 2.273 (1.51–3.43) 2 types trauma < 0.001 3.436 (2.25–5.24) ≥ 3 types trauma < 0.001 5.613 (3.66–8.62) Note: Adjusted for gender, age, Single-child, income, academic performance, witnessing domestic violence, learning stress, studying in Shenzhen with parents, Father or mother worked away from home, criticism by teacher, and relationships with classmates, teachers, and families; P: p-value; OR: odds ratio; EA: emotional abuse; PA: physical abuse SA: sexual abuse; EN: emotional neglect. In the gender subgroup analysis, we found that male students exposed to one type of trauma (OR = 1.65, 95%CI: 1.08–2.51), two types of trauma (OR = 2.51, 95%CI: 1.63–3.86), and multiple types of childhood trauma (OR = 3.79, 95%CI: 2.46–5.84 had an increased anxiety symptoms risk relative to those without childhood trauma; among female students, one type of trauma (OR = 2.273, 95%CI: 1.51–3.43), two types of trauma (OR = 3.436, 95%CI: 2.25–5.24), and multiple types of childhood trauma (OR = 5.613, 95%CI: 3.66–8.62) increased the risk of developing anxiety symptoms relative to no such exposure (see Table 4 ). 3.5 Multivariate logistic regression to determine risk factors for anxiety symptoms in children exposed to childhood trauma Next, we explored the risk factors for anxiety symptoms among children exposed to childhood trauma. As shown in Table 5 , risk was significantly increased for who were female, students aged 9–11 and 12–14, students who had witnessed domestic violence, students who had a father who worked away from home for one year, students who were frequently criticized by teachers, and students with average-to-bad relationships with their teachers or families (all ORs ≥ 1.37, P<0.05). Table 5 Multivariate logistic regression for determining risk factors for anxiety in children with childhood trauma Group N %(95%CI) Adjusted odds ratio(95%CI) gender male 3814 5.09(4.43–5.83) Reference female 2862 7.16(6.27–8.17) 1.64(1.32–2.05) age 6–8 2719 4.27(3.57–5.09) Reference 9–11 3124 7.11(6.26–8.06) 1.50(1.17–1.92) 12–14 527 9.68(7.44–12.5) 1.94(1.34–2.82) Single-child Yes 4641 6.1(5.45–6.82) Reference No 2038 5.74(4.81–6.84) 1.02(0.80–1.30) Grew up in Shenzhen Yes 4148 5.69(5.02–6.44) Reference No 2504 6.43(5.53–7.46) 1.25(1.00-1.57) Family income Good 825 7.88(6.23–9.92) Reference Average 5379 5.39(4.82–6.03) 0.66(0.49–0.90) Bad 477 9.64(7.31–12.62) 0.76(0.48–1.20) Learning stress No 275 5.09(3.06–8.36) Reference Average 4047 4.35(3.76–5.02) 0.85(0.46–1.55) Great 2371 8.86(7.78–10.07) 1.54(0.84–2.82) Academic performance Good 2089 4.88(4.04–5.89) Reference Average 3244 5.8(5.04–6.65) 0.97(0.74–1.27) Bad 1306 8.12(6.76–9.72) 0.92(0.66–1.30) Witnessing domestic violence No 4499 4.8(4.21–5.47) Reference Yes 2181 8.48(7.38–9.73) 1.37(1.10–1.71) Father worked away from home No 4439 5.16(4.55–5.85) Reference ≤ 1 year 1705 7.68(6.51–9.04) 1.38(1.06–1.79) >1years 543 7.55(5.61–10.08) 1.19(0.76–1.86) Mother worked away from home No 5560 5.67(5.09–6.3) Reference ≤ 1 year 839 7.75(6.12–9.75) 1.02(0.73–1.42) >1years 278 7.19(4.71–10.85) 1.06(0.58–1.92) Criticked by teacher No 884 4.98(3.73–6.62) Reference Sometimes 5708 5.94(5.36–6.58) 1.13(0.79–1.62) Always 85 18.82(11.93–28.41) 2.92(1.39–6.12) Relationship with classmates Good 4966 4.27(3.74–4.87) Reference General 1535 9.71(8.32–11.29) 2.06(1.58–2.69) Bad 179 20.67(15.38–27.19) 3.05(1.91–4.88) Relationship with teacher Good 4607 4.75(4.18–5.41) Reference General 1954 7.78(6.67–9.05) 1.08(0.83–1.42) Bad 126 23.02(16.53–31.1) 1.81(1.04–3.14) Relationship with families Good 5975 4.92(4.4–5.5) Reference General 612 13.89(11.37–16.85) 1.91(1.41–2.57) Bad 99 22.22(15.16–31.36) 2.36(1.33–4.17) Discussion Prevalence of childhood trauma This is the first study to measure childhood trauma during childhood in Chinese students using parent reports. The prevalence rates of EN, EA, PA, and SA in students aged 6–14 in Shenzhen were found to be 31.8%, 20.6%, 36.2%, and 1.6%, respectively. These rates differ from those reported in previous studies. For example, the prevalence rates of low-to-severe EN, EA, PA, and SA in Chinese students aged 12–15 using the CTQ were reported as 22.8%, 10.6%, 7.1%, and 11.0%, respectively [ 28 ]. Among 463 Chinese college students, 49.0% reported at least one type of psychological abuse and 54.4% experienced at least one type of psychological neglect as assessed by the Childhood Psychological Abuse and Neglect Scale [ 29 ]. In the current study, 52.9% of students had experienced any type of trauma and 10.6% had experienced multiple types (≥3) of trauma. A previous cross-sectional survey involving 608 participants found that 47% had experienced at least one type of trauma and about 23% had experienced multiple traumas assessed by the Life Event Checklist (LEC) [ 30 ]. The inconsistencies in the reported prevalence rates of childhood trauma can be explained by several factors. Firstly, prevalence estimates may vary widely when different tools are used to assess maltreatment/trauma. Second, the age range of students in the current study is 6 to 14 years, whereas previous studies mainly focused on individuals over 12 years old. Third, exploring by proxy traumatic events by parents (that part of them may be the bullier) may have reporting biases and underestimate the frequencies of the traumatic events. To obtain a more homogenous estimate of prevalence, an effective tool for assessing childhood trauma before the age of 12 should be used in future studies. Risk factors for childhood trauma Logistic regression showed that being female and growing up in Shenzhen were protective factors against PA. Even when different assessment methods of maltreatment were used, the risk factors of childhood trauma were similar. For example, using the CTQ, birthplace and male gender were associated with more serious PA [ 31 ]. Similarly, in a clinical study in Egypt, female psychiatric outpatients reported lower rates of PA and SA than male patients [ 32 ]. The current study found that being age 9–11 increases the risk of EA and multiple types of childhood trauma, whereas being age 12–14 increases the risk of SA. These results are in line with previous studies that the incidence of childhood trauma is higher in adolescents than in younger children [ 24 , 33 , 34 ]. we should focus on these age groups to minimize or ameliorate childhood trauma. We also found that children with average-to-high learning stress, criticism by teachers, and average-to-bad relationships with classmates and teachers had increased types of childhood trauma, which suggests that good relationships, more encouragement, and less learning stress can reduce childhood trauma. Moreover, a nurturing home environment is an important factor for a child’s social-emotional development. In the current study, students who had witnessed domestic violence, who had a parent working away from home, or who had average-to-bad relationships with their families had higher rates of different types of childhood trauma. These findings are consistent with previous studies showing that a harmonious relationship with parents negatively predicts childhood trauma [ 35 ]. Thus, lower exposure to domestic violence and a good relationship with parents can decrease childhood trauma [ 36 ]. These confounding factors must be controlled for when analyzing the relationship between childhood trauma and anxiety symptoms. Prevalence of anxiety symptoms in children experiencing different types and numbers of childhood trauma This study aimed to assess the effects of trauma during childhood in Chinese students. The prevalence rates of anxiety symptoms in children exposed to EN, EA, PA, SA, or any type of trauma were 7.72%, 8.8%, 6.29%, 17.48%, and 6.00%, respectively; all of these rates are significantly higher than those in children without childhood trauma (1.62%). Few studies have compared the prevalence of anxiety symptoms in children with childhood trauma measured during childhood. However, our results are in line with previous studies reporting the effect of childhood trauma measured during adulthood on anxiety symptoms. Li et al. found that childhood trauma is significantly associated with social anxiety in adolescents [ 37 ]. Similarly, childhood trauma was reported to be significantly higher in individuals with social anxiety compared to controls [ 38 ]. In the present study, the prevalence rates of anxiety symptoms in children with one, two, and multiple types of trauma were 3.47%, 6.32%, and 11.89%, respectively. In another study, 81% of adolescent inpatients reported experiencing at least one type of childhood trauma assessed by the Childhood Trauma Chart Review Scale [ 39 ]. Taken together, these findings may suggest that, the more types of childhood trauma an individual experiences, the higher the risk of anxiety symptoms. The relationship between different types of childhood trauma and anxiety symptoms To further explore the effect of childhood trauma (measured by CPTQ) on anxiety symptoms, we conducted a multivariate logistic regression analysis. We found that childhood trauma strongly associated anxiety symptoms after controlling for multiple confounding factors. A previous study suggested that subtypes of childhood trauma assessed by the CTQ predict anxiety symptoms in the general population [ 40 ]. Among Chinese college students, individuals with more childhood trauma were found to have more severe social anxiety [ 37 ]. In a clinical study, Kuo et al. found that EA and EN assessed by the CTQ were associated with the severity of anxiety in adults [ 41 ]. Different types of childhood trauma assessed by the CTQ appear to have a significant influence on anxiety in adults[ 42 ]. Lee et al. found that "childhood trauma" assessed by the Adverse Childhood Experiences (ACEs) scale was associated with increased anxiety risk in young adulthood [ 43 ]. Although these studies used different instruments (e.g., CTQ and ACEs) to measure trauma at different ages, our findings extend the evidence of the association between childhood trauma and anxiety symptoms. The relationship between the number of types of childhood trauma on anxiety symptoms The current study reported that childhood trauma measured during childhood has a dose-dependent relationship with anxiety symptoms. We found that one, two, and multiple types of trauma increased anxiety symptoms risk 1.94-fold, 2.96-fold, and 4.585-fold, respectively, compared to no childhood trauma. Similar results have been reported in studies of adults. For example, adults who report exposure to many trauma types have an increased anxiety symptoms risk [ 30 , 44 ]. Multiple types of trauma have also been shown to damage mental health [ 45 , 46 ]. Overall, these results suggest that the effect of childhood trauma and multiple traumas on anxiety symptoms is consistent across different ages and cultures. Gender difference in the effects of childhood maltreatment on anxiety symptoms Our results showed that the types and number of childhood trauma have a greater impact on anxiety symptoms among female students than male students. This result is in line with a recent studies, which indicated that childhood maltreatment assessed by different tools had a stronger association with anxiety symptoms in adult females than adult males [ 47 , 48 ]. Similarly, adolescent girls with more trauma exposure are reported to have more serious mental health and behavioral problems [ 49 ]. Our gender-specific results may motivate future studies of the effects of childhood trauma on anxiety symptoms. Furthermore, this result indicates that female students need greater protection to avoid anxiety symptoms due to childhood trauma. Such interventions, for instance, cognitive behavioral therapy, trauma re-processing and treatment modality for trauma-exposed children are available to delay or block the accumulation of childhood trauma [ 50 , 51 ] . Potential mechanisms of the relationship between childhood trauma and anxiety symptoms The relationship between childhood trauma and anxiety symptoms may be due to changes in the brain. Preclinical research indicates that trauma has a strong influence on brain development, especially in children and adolescents [ 52 , 53 ]. Individuals with a history of childhood trauma show reductions in white matter volume [ 54 ]. Emerging evidence suggests that exposure to childhood trauma is related to neurobiological changes, such as dysfunction of the hypothalamus-pituitary-adrenal axis (HPA axis) [ 55 ], oxytocin dysregulation[ 20 , 56 ], abnormal brain structure[ 57 ] and abnormal GABA system function[ 58 ]—especially in children—which may underlie the increased risk of anxiety symptoms. Repetitive negative thinking[ 59 ], dysfunctional metacognitions[ 60 ] and resilience and trait mindfulness[ 61 ] might mediate or moderate the relationship between exposure to childhood trauma and psychological diseases in adulthood. Childhood trauma would be related to the accumulation of developmental precursors of major psychiatric disorders[ 23 ]. These mechanisms support a physiological basis for the relationship between childhood trauma and anxiety symptoms, although further studies directly testing this hypothesis are needed. Our findings may provide leads for interventions targeting the early mechanisms underlying the established relation between childhood trauma and adult psychiatric disorders. Risk factors for anxiety symptoms in children with childhood trauma In the present study, we found a strong relationship between childhood trauma and anxiety symptoms. We then analyzed the potential risk factors for anxiety symptoms in children exposed to childhood trauma. The risk factors for anxiety symptoms in children exposed to trauma were found to be female gender, age 9–11 or 12–14 years, witnessing domestic violence, having a parent working away from home for one year, criticism by teachers, and average-to-bad relationship with classmates, teachers, and families. These results suggest that earlier screening and intervention programs for childhood trauma can help reduce anxiety symptoms. Studies investigating what programs are most effective for preventing anxiety symptoms in students are needed. This study is subject to several limitations. First, the data might have been affected by recall bias. In addition, the prevalence of trauma may have been underestimated because the CPTQ was completed by parents. In the future, more effective evaluation tools will be needed for such research. Second, we did not use a clinical tool to diagnose anxiety symptoms. Thus, these results may not be clinically meaningful. Third, the results of this study are based on cross-sectional data analysis. Longitudinal data are needed to further verify the relationship between childhood trauma and anxiety symptoms. Conclusions This study estimated the effect of childhood trauma measured during childhood on anxiety symptoms in primary and secondary school students. We found high rates of EN, EA, PA, and SA among Chinese children, although data collection was limited to one province. Socio-demographic characteristics, such as age, learning stress, and exposure to domestic violence, increased childhood trauma risk. A high prevalence of anxiety symptoms in children with childhood trauma was found. Moreover, our findings indicated that childhood trauma was a risk factor of anxiety symptoms. Notably, this study reported a dose-dependent relationship between exposure to different types of childhood trauma and anxiety symptoms during childhood. Our results also showed that the type and number of childhood trauma had a greater impact on anxiety symptoms in female students than in male students. In addition, being female, being aged 9–11 or 12–14 years, witnessing domestic violence, having a parent working away from home for one-year, frequent criticism by teachers, and average-to-bad relationships with classmates, teachers, and families further increased the risk of anxiety symptoms in children experiencing any childhood trauma. This study can provide insights into trauma backgrounds, the effects of childhood trauma on anxiety symptoms, and demographic predictors of anxiety symptoms. Mental healthcare should increase the focus on childhood trauma as part of the management of mental illnesses. In addition, further research should focus on developing prevention programs as well as intervention programs to address common childhood trauma. Abbreviations PA physical abuse SA sexual abuse EA emotional abuse PA physical neglect EN emotional neglect CTQ Childhood Trauma Questionnaire PTSD post-traumatic stress disorder CPTQ Childhood Psychological Trauma Questionnaire PSQ Conners Parent Symptom Questionnaire LEC Life Event Checklist (LEC) ACE Adverse Childhood Experiences HPA hypothalamus-pituitary-adrenal CI confidence intervals OR odds ratio Declarations Informed Consent This study was approved by the ethics committee of Shenzhen Kangning Hospital (approval no. 2019-k009-01-1). All methods were carried out in accordance with relevant guidelines and regulations. All students and their parents in the study voluntarily participated and provided informed consent before participating. All procedures in this study were conducted in accordance with the ethical principles of the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed for the current study are available from the corresponding author by request. Competing interests The authors declare that they have no conflicts of interest. Funding : This study was supported by the Guangdong Basic and Applied Basic Research Foundation (2019A1515110047, Jianbo Liu), Sanming Project of Medicine in Shenzhen (SZSM201612079, Jianping Lu). Authors' contributions Xiujin Lin was responsible for field investigations, writing paper, and manuscript revisions; Jianbo Liu was responsible for data analysis and manuscript revisions; Zhenpeng Xue was responsible for field investigations; Jianchang Xu was responsible for field investigations; Ling Lin was responsible for field investigations; Yumeng Sun was responsible for manuscript revisions; Jianping Lu was responsible for conducting the research, and manuscript revisions. Acknowledgements Not applicable. Authors' information (optional) Not applicable. References Dube SRJCA, Neglect. Continuing conversations about adverse childhood experiences (ACEs) screening: A public health perspective. S014521341830111X; 2018. Organization WH. Child maltreatment. https://wwwwhoint/news-room/fact-sheets/detail/child-maltreatment 2016(4 ). Dalbudak E, Evren CJNJP. The impact of childhood traumas, depressive and anxiety symptoms on the relationship between borderline personality features and symptoms of adult attention deficit hyperactivity disorder in Turkish university students. 2015, 69(1):1–6. Gilbert R, Widom C, Browne K, Fergusson D, Webb E, Janson SJL. Burden and consequences of child maltreatment in high-income countries. 2009, 373(9657):68–81. Fang X, Fry D, Brown D, Mercy J, Dunne M, Butchart A, Corso P, Maynzyuk K, Dzhygyr Y, Chen Y et al. The burden of child maltreatment in the East Asia and Pacific region. 2015, 42:146–162. Wang L, Cheng H, Qu Y, Zhang Y, Cui Q. Zou HJSp, epidemiology p: The prevalence of child maltreatment among Chinese primary and middle school students: a systematic review and meta-analysis. 2020, 55(9):1105–19. Ji K, Finkelhor DJCAN. A meta-analysis of child physical abuse prevalence in China. 2015, 43:61–72. Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, Sapareto E, Ruggiero J. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994;151(8):1132–6. Guo L, Xu Y, Deng J, Gao X, Huang G, Huang J, Deng X, Zhang WH, Lu CJA. Associations between childhood maltreatment and non-medical use of prescription drugs among Chinese adolescents. 2017. Zhang S, Lin X, Yang T, Zhang S, Pan Y, Lu J, Liu JJJ. Prevalence of childhood trauma among adults with affective disorder using the Childhood Trauma Questionnaire: A meta-analysis. 2020, 276:546–54. Hadland SE, Wood E, Dong H, Marshall BDL, Kerr T, Montaner JS, DeBeck K. Suicide attempts and childhood maltreatment among street youth: A prospective cohort study. Pediatrics. 2015;136(3):440–9. Hou W, Wen Y, Wang X, Zhao X, Li X, Wang C. Effects of childhood trauma on personality in rural secondary school students in Chinese. J Psychiatry. 2017;30(6):401–4. B JAS ADPB, C MDN, D EW, F DPE FTAE. E JS, G LH, H MM, H DDJCA : Development and validation of a brief screening version of the Childhood Trauma Questionnaire. 2003, 27(2):169–90. Wei J, Shi J, Zhang M, Ding H, Kang C, Wang K, Wang Y, Gong Y, Wang S, Shao N, et al. [Childhood trauma and its correlation with resilience among primary and middle school students in Wuhan city in 2015]. Wei sheng yan jiu = J hygiene Res. 2019;48(5):717–27. Rafaiee R, Mohseni F. Akbarian NJijhrb, addiction: Prevalence of Child Abuse and Correlations with Family Factors Among Elementary School-aged Children. 2021, In Press(In Press). Shah S, Mackinnon A, Galletly C, Carr V, McGrath J, Stain H, Castle D, Harvey C, Sweeney S. Morgan VJSr: Prevalence and impact of childhood abuse in people with a psychotic illness. Data second Australian Natl Surv Psychos. 2014;159(1):20–6. Xiao D, Wang T, Huang Y, Wang W, Zhao M, Zhang WH, Guo L, Lu C. Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents. J Affect Disord. 2020;265:595–602. Thornberry TP, Matsuda M, Greenman SJ, Augustyn MB, Henry KL, Smith CA, Ireland TOJCA. Neglect: Adolescent risk factors for child maltreatment. 2014, 38(4):706–22. Duan Z, Feng Y, Xu S, Gao D, Ji Y, Sun X, Chen R, Wang Y. The role of childhood left-behind experience on childhood trauma exposure and mental health outcomes: a propensity score matching (PSM) analysis. J Public Health. 2023;45(4):785–93. Lussier AA, Smith BJ, Fisher J, Luo M, Cerutti J, Schneper L, Smith T, Cecil CAM, Felix JF, Mitchell CJNMH. DNA methylation mediates the link between adversity and depressive symptoms. 2024. Otten D, Schalinski I, Fegert JM, Jud A, Brähler E, Bürgin D, Clemens V. Child Maltreatment Characteristics and Adult Physical Multimorbidity in Germany. JAMA Netw open. 2025;8(1):e2456050. Herringa RJ, Birn RM, Ruttle PL, Burghy CA. Essex MJJPotNAoeotUSoA: Childhood maltreatment is associated with altered fear circuitry and increased internalizing symptoms by late adolescence. 2013, 110(47):19119–24. Nicolas B, Julia GB, Valérie J, Hélène D, Alexandre B, Michel MJSBO. Childhood Trauma May Increase Risk of Psychosis and Mood Disorder in Genetically High-risk Children and Adolescents by Enhancing the Accumulation of Risk Indicators. 2022(1):1. Flaherty EG, Thompson R, Dubowitz H, Harvey EM, English DJ, Proctor LJ, Runyan DK. Adverse childhood experiences and child health in early adolescence. JAMA Pediatr. 2013;167(7):622–9. Janssen I, Krabbendam L, Bakb M. M, W. H, Vollebergh: Childhood abuse as a risk factor for psychotic experiences. Acta psychiatrica Scandinavica 2004. Xiangdong W, Xilin W, Hong M. Handbook of mental health assessment scale in Chinese [M]. Chin J mental health 1993:52–3. Juan F, Yasong D, Liwei W. Norms of The Conners Parent Symptom Questionnaire in Chinese Urban Children in Chinese [M]. Shanghai J psychiatry 2005(06):5–7. Shen L, Zhang Y, Liang W, Zhang Y. Investigation of child maltreatment: Survey among junior school pupils in Henan province of China. Asia-Pacific Psychiatry 2013. Cuiping W. Relationship between Psychological Abuse,Neglect during Childhood and Social Physical Anxiety of College Students and Mediating Effect of Negative Physical Self. Chinese General Practice 2017(4). Trang T, Hanh D, Ignacio, Correa-Velez. Michael, Dunne: Trauma Exposure and Mental Health Problems Among Adults in Central Vietnam: A Randomized Cross-Sectional Survey. Front Psychiatry 2019. Jingying S. A Comparative Study on Childhood Abuse and Self-esteem of City and Countryside Children. China J Health Psychol 2013. Amr M, El-Wasify M, Ah A-G, Rees S. Gender differences in patients with social phobia in Egypt. arab J psychiatry 2013. Al-Eissa MA, Saleheen HN, Al-Wallan NS, AlKashan MY, AlSubaie NJ, Almuneef MA. Prevalence of Sexual Abuse Among Secondary School Students in Saudi Arabia. Violence Vict. 2018;33(5):855–70. Lee RY, Oxford ML, Sonney J, Enquobahrie DA, Cato, KDJJoa. The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents. 2022(94-):94. zhang M, Guili W, Yanfei X. Study on related factors and psychological influence of childhood abuse among high school students in Chinese. Chin J child health care. 2007;15(1):30–1. Fisher D. Preventing Childhood Trauma Resulting From Exposure to Domestic Violence. Preventing School Failure; 1999. Li Y, Tang H, Dong W, Lu G, Chen C. Association between childhood trauma and social anxiety in adolescents: The mediating role of self-compassion and loneliness. Child Abuse Negl. 2024;158:107109. Maria M, Max B. Social anxiety in first-episode psychosis: The role of childhood trauma and adult attachment. J Affect Disord 2014. Weine SM, Becker DF, Levy KN, Edell WS, Mcglashan TH. Childhood trauma histories in adolescent inpatients. J Trauma Stress. 1997;10(2):291–8. Fan N, Fan H, Luo R, Wang Y, Yan Y, Yang X, Wang M, Dou Y, Ni R, Wei J, et al. The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China. Sci Rep. 2024;14(1):9797. Kuo J, Goldin P, Werner K, Heimberg R, Gross J. Childhood trauma and current psychological functioning in adults with social anxiety disorder. J Anxiety Disord. 2011;25(4):467–73. Alnassar JS, Juruena MF, Macare C, Perkins AM, Young AH. Effect of childhood emotional abuse on depression and anxiety in adulthood is partially mediated by neuroticism: Evidence from a large online sample. J Affect Disord. 2024;359:158–63. Lee H, Kim Y, Terry J. Adverse childhood experiences (ACEs) on mental disorders in young adulthood: Latent classes and community violence exposure. Prev Med. 2020;134:106039–. Chiu HTS, Low DCW, Chan AHT, Meiser-Stedman R. Relationship between anxiety sensitivity and post-traumatic stress symptoms in trauma-exposed adults: A meta-analysis. J Anxiety Disord. 2024;103:102857. Mcchesney GC, Adamson G, Shevlin M. Service use patterns and mental health symptoms among adolescents exposed to multiple types of trauma. J Adolesc 2015. Grant E, Bowman A, Johnson L. Effectiveness of interventions for psychological distress following traumatic injury: A systematic review. Injury. 2024;56(2):112090. Gottschall S, Lee J, Edge, MCJJots. Adverse childhood experiences and mental health in military recruits: Exploring gender as a moderator. 2022(2):35. Prachason T, Mutlu I, Fusar-Poli L, Menne-Lothmann C, Decoster J, van Winkel R, Collip D, Delespaul P, De Hert M, Derom C, et al. Gender differences in the associations between childhood adversity and psychopathology in the general population. Soc Psychiatry Psychiatr Epidemiol. 2024;59(5):847–58. Auslander W, Schutz A, Threlfall JM, Gerke DR, Dunn J. Types of Traumas Experienced By Adolescent Girls Involved in Child Welfare: Relationship to Mental Health and Behavioral Problems. In: Society for Social Work & Research Conference : 2014; 2014. Cohen JA, Mannarino AP. Trauma-Focused Cognitive Behavioral Therapy for Children and Families. Child Adolesc Psychiatr Clin N Am. 2022;31(1):133–47. Dorsey S, McLaughlin KA, Kerns SEU, Harrison JP, Lambert HK, Briggs EC, Revillion Cox J, Amaya-Jackson L. Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events. J Clin child Adolesc psychology: official J Soc Clin Child Adolesc Psychol Am Psychol Association Div. 2017;53(3):303–30. Rinne-Albers MAW, Wee… NJAvd: Neuroimaging in children, adolescents and young adults with psychological trauma. European Child & Adolescent Psychiatry 2013, 22(12):745–755. Hinojosa CA, George GC, Ben-Zion Z. Neuroimaging of posttraumatic stress disorder in adults and youth: progress over the last decade on three leading questions of the field. Mol Psychiatry. 2024;29(10):3223–44. Daniels JK, Lamke JP, Gaebler M, Walter H, Scheel M. White matter integrity and its relationship to PTSD and childhood trauma–a systematic review and meta-analysis. Depress Anxiety. 2013;30(3):207–16. B BPA, C VK, E RK DFM. The role of childhood maltreatment in cortisol in the hypothalamic–pituitary–adrenal (HPA) axis in methamphetamine-dependent individuals with and without depression comorbidity and suicide attempts. J Affect Disord. 2020;263:274–81. Byrd AL, Tung I, Manuck SD, Vine V, Horner M, Hipwell AE, Stepp SD. An interaction between early threat exposure and the oxytocin receptor in females: Disorder-specific versus general risk for psychopathology and social-emotional mediators. Dev Psychopathol. 2021;33(4):1248–63. Bick J, Nelson CA. Early Adverse Experiences and the Developing Brain. Neuropsychopharmacology: official publication Am Coll Neuropsychopharmacol. 2016;41(1):177–96. Nikolaus S, Antke C, Beu M, Müller H-WJRN. Cortical GABA, striatal dopamine and midbrain serotonin as the key players in compulsive and anxiety disorders–results from in vivo imaging studies. 2010, 21(2):119–40. Mansueto G, Cavallo C, Palmieri S, Ruggiero GM, Sassaroli S, Caselli G. Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review. Clin Psychol Psychother. 2021;28(3):557–68. Mansueto G, van Nierop M, Schruers K, Alizadeh BZ, Bartels-Velthuis AA, van Beveren NJ, Bruggeman R, Cahn W, de Haan L, Delespaul P, et al. The role of cognitive functioning in the relationship between childhood trauma and a mixed phenotype of affective-anxious-psychotic symptoms in psychotic disorders. Schizophr Res. 2018;192:262–8. Chen J, Zhang C, Wang Y, Liu X, Xu WJPH, Medicine. A longitudinal study of childhood trauma impacting on negative emotional symptoms among college students: a moderated mediation analysis. 2021(3):1–18. Additional Declarations No competing interests reported. Supplementary Files Supplementalinformation.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7701193","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":552078678,"identity":"ea672aba-a5f8-452d-aceb-9c8e3278f259","order_by":0,"name":"Xiujin Lin","email":"","orcid":"","institution":"Guangzhou University","correspondingAuthor":false,"prefix":"","firstName":"Xiujin","middleName":"","lastName":"Lin","suffix":""},{"id":552078679,"identity":"bff52832-89aa-4615-b7f9-3a229c946627","order_by":1,"name":"Jianbo Liu","email":"","orcid":"","institution":"Shenzhen KangNing Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jianbo","middleName":"","lastName":"Liu","suffix":""},{"id":552078680,"identity":"c188f37c-3a65-4b5c-8e52-91f903b1fb37","order_by":2,"name":"Zhenpeng Xue","email":"","orcid":"","institution":"Shenzhen KangNing Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhenpeng","middleName":"","lastName":"Xue","suffix":""},{"id":552078681,"identity":"67e604dc-e3df-44c0-a88e-f77bfda29e81","order_by":3,"name":"Jianchang Xu","email":"","orcid":"","institution":"Shenzhen KangNing Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jianchang","middleName":"","lastName":"Xu","suffix":""},{"id":552078682,"identity":"9753c828-00ee-46c2-a8cf-0060389c2417","order_by":4,"name":"Ling Lin","email":"","orcid":"","institution":"Shenzhen KangNing Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ling","middleName":"","lastName":"Lin","suffix":""},{"id":552078683,"identity":"6d5e4cc5-be2f-46d7-8080-4ce2494319ac","order_by":5,"name":"Yumeng Sun","email":"","orcid":"","institution":"Shenzhen KangNing Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yumeng","middleName":"","lastName":"Sun","suffix":""},{"id":552078684,"identity":"14518e9c-ef4b-48ca-8888-c649f5ca951c","order_by":6,"name":"Jianping Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIie3PsQrCMBCA4QuBdom6Zmpf4SBQK4rPYhA6iQiODioFJ8HVx3ATNyWoSx9AcHR0yeggaKOgW9NRMD+ELPdxCYDL9ZPRCXA0d340toIShHwJWQ4SUY58FjKtpBWEi92Mx4N2v+5X1LWFtAO+2q+KCG5zwrE7bKTVpNlDrw8sSU6FhEwNoXKlWCR6yIbAWVRIwpQYMn6TGLmc2AgcXkQZIi6AaCeYkTTmeJSblEVkjh3h2f4SLtTuzO8jua5lQt/uj6Dmq0Pxw/IoN+sAPHODZxs3Ef0mVJeZdrlcrv/rCUsJQ7LlJf2NAAAAAElFTkSuQmCC","orcid":"","institution":"Shenzhen KangNing Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jianping","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2025-09-24 08:23:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7701193/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7701193/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97183782,"identity":"7e33174d-4c7d-47c5-8809-81274e1d5ac7","added_by":"auto","created_at":"2025-12-01 16:58:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":134435,"visible":true,"origin":"","legend":"","description":"","filename":"RevisedmanuscriptChildhoodtraumawithanxietyamongChinesechildren.docx","url":"https://assets-eu.researchsquare.com/files/rs-7701193/v1/4c0bd42ed6c3f30a5c8a83ee.docx"},{"id":97183780,"identity":"e1a42d99-f273-4b09-aff1-8ef8e10f6db0","added_by":"auto","created_at":"2025-12-01 16:58:56","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8227,"visible":true,"origin":"","legend":"","description":"","filename":"e1ee02e632ff46d1b5e89f1e6fb00ca1.json","url":"https://assets-eu.researchsquare.com/files/rs-7701193/v1/e9a23908a0136ce8774ada7f.json"},{"id":97250262,"identity":"cfc365e2-b204-4ed3-8747-3583391d732f","added_by":"auto","created_at":"2025-12-02 13:14:11","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67896,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementalinformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-7701193/v1/a32d51cade2630681fbb6ee3.docx"},{"id":97183785,"identity":"fd021906-13ca-4b2c-8a24-66b6fc669af6","added_by":"auto","created_at":"2025-12-01 16:58:56","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":197522,"visible":true,"origin":"","legend":"","description":"","filename":"e1ee02e632ff46d1b5e89f1e6fb00ca11enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7701193/v1/5a8a28f99abb6e7ec53b0091.xml"},{"id":97183786,"identity":"beb93d0e-a13e-4b26-8cdb-923cf5413670","added_by":"auto","created_at":"2025-12-01 16:58:56","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":193252,"visible":true,"origin":"","legend":"","description":"","filename":"e1ee02e632ff46d1b5e89f1e6fb00ca11structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7701193/v1/027d529f464806ddf1eb4a30.xml"},{"id":97183784,"identity":"73b94e70-87da-4c4f-9b75-3fc43595912f","added_by":"auto","created_at":"2025-12-01 16:58:56","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":205337,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7701193/v1/4953798566b3bffb7a6b4756.html"},{"id":97761423,"identity":"6c2a2b61-0d29-40dd-9c99-d7ec0b53d294","added_by":"auto","created_at":"2025-12-09 05:54:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2033709,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7701193/v1/9319bbc6-06d6-4b03-8667-c54b2eaa6218.pdf"},{"id":97183781,"identity":"ce06111a-127d-4bd7-a514-12044ac286a2","added_by":"auto","created_at":"2025-12-01 16:58:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":67896,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementalinformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-7701193/v1/252ab10dfd359f988e9cb776.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Childhood Trauma among Primary Students in Shenzhen City: Prevalence, Risk factors, and Relationship with Anxiety Symptoms","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChildhood trauma is a serious social and public health problem worldwide[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Childhood trauma can be distinguished into five types, namely physical abuse (PA), sexual abuse (SA), emotional abuse (EA), physical neglect (PN), and emotional neglect (EN) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In recent years, it has been reported that childhood trauma increases the risk of psychopathology in adults [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, childhood trauma poses a huge burden on families and society [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A previous study found that child abuse is responsible for an average of 1.88% of GDP economic loss in East Asia and the Pacific [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe prevalence of childhood trauma is generally high in different populations. For example, a recent meta-analysis reported pooled prevalence rates of EA, PA, SA, PN, and EN were 30.0%, 20.0%, 12.0%, 47.0%, and 44.0%, respectively among Chinese middle school students [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Another meta-analysis of studies that reported that the prevalence of mild or higher PA was 43.1% in China [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Using the Childhood Trauma Questionnaire (CTQ) by Bernstein et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], Guo et al. found that the prevalence rates of mild or higher EA, PA, SA, EN, and PN were 3.5%, 1.4%, 1.6%, 20%, and 27.3%, respectively, among Chinese adolescents [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Several studies have reported a higher prevalence of childhood trauma in adults with mental disorders relative to the general population, for example, a study of adults with major depressive disorder and bipolar disorder found that the pooled prevalence of moderate-to-extreme childhood maltreatment in these two groups was 33.0% and 30.0% for EA, 17.0% and 18.0% for PA, 19.0% and 22.0% for SA, 37.0% and 31.0% for EN, and 31% and 30.0% for PN, respectively, when assessed using CTQ [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition, the prevalence of moderate-to-extreme childhood maltreatment assessed by CTQ in youth aged 14 to 26 years who have attempted suicide ranges from 16.8% (SA) to 45.2% (EA) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. There were 17.4% for EA, 20.2%for PA, 26.6% for SA, 70.1% for EN and 85.1% for PN in secondary school students in China[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Notably, most previous studies focus on the prevalence of childhood trauma in adults or youth or adolescents or secondary school students; by contrast, the prevalence of childhood trauma in primary students is rarely reported. In addition, most of the previous studies were conducted by adults to recollect childhood trauma using reliable questionnaire such as the Bernstein CTQ[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In order to more objectively assess the childhood trauma experienced by children, we use parent-reported questionnaires to assess childhood trauma in primary students.\u003c/p\u003e\u003cp\u003eEvidence suggests that the prevalence of childhood trauma is influenced by several risk factors. First, previous studies have suggested that family socio-economic status is negatively correlated with childhood trauma in children and adolescents [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Previous studies have found gender differences in the prevalence of childhood trauma in patients with mental illnesses. For example, Shah et al. found that the prevalence of childhood trauma in female patients with mental illness was 2.8-fold higher than that in male patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, girls who reported experiencing one or more type of childhood maltreatment had a higher risk of sleep disturbance than boys [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Furthermore, Researchers have also found that parents' education level [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and being a left-behind child[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] impact the prevalence of childhood trauma. These risk factors of childhood trauma are well established. However, there is a dearth of knowledge about whether these risk factors have similar effects on maltreatment in children with anxiety. This study will contribute to filling this gap in knowledge.\u003c/p\u003e\u003cp\u003eThe long-standing negative effect of childhood maltreatment on individual\u0026rsquo;s mental health is well documented, especially regarding mood disorders such as anxiety and depression. For example, recent studies have found that Childhood trauma is a significant predictor of anxiety and depression[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], as well as physical multimorbidity in adulthood [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Childhood abuse can lead to anxiety and depression in adulthood which due to its effects on fear circuits in the brain [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Notably, these studies examined the effect of childhood trauma on anxiety among adult samples; however, there are few such studies in children [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn light of the above-described research gaps, the present study aimed to explore the prevalence and effects of childhood trauma in Chinese children. Thus, the main objectives were to assess the prevalence of childhood trauma and to examine the association between childhood trauma and anxiety in school-age Chinese children. In addition, we explored risk factors associated with childhood trauma. Exploring these risk factor can help healthcare workers take effective measures to both prevent abuse and help children cope with trauma during the early stages. Moreover, greater understanding of childhood trauma will help inform the establishment of mental health programs in schools.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cb\u003e2.1. Participants and procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe conducted a cross-sectional study of all students from grade 1 to 6 enrolled at 14 primary schools in Shenzhen. Cluster sampling was applied for all students at all 14 primary schools. A total of 17400 anonymous questionnaires were distributed to students from September to December of 2019 and completed by students\u0026rsquo; parents at home. The students submitted the completed questionnaires to their teacher on the second day. Finally, the teacher gave all of the questionnaires to the researcher. Of the total questionnaires distributed, 14723 (84.61%) were recovered. Lastly, a questionnaire was considered invalid if over 5% of responses were missing. Questionnaires with completed responses for the Childhood Psychological Trauma Questionnaire (CPTQ) (parents\u0026rsquo; version) and Conners Parent Symptom Questionnaire (PSQ) were included in the analysis. Ultimately, the final sample comprised 12704 students with an average age of 8.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 years (range: 6\u0026ndash;14 years) with completed questionnaires and socio-demographic characteristics, which are needed for this study. There were 6972 boys and 5666 girls (gender was missing for 66 students (0.5%)), and 8767 students were an only child (response missing for 70 students (0.6%)). All students and their parents in the study voluntarily participated and provided informed consent before participating. This study was approved by the ethics committee of Shenzhen Kangning Hospital (approval no. 2019-k009-01-1). All procedures in this study were conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.2 Measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDemographic variables included gender, age, whether they were a single child, family income, the child\u0026rsquo;s academic performance. Additional information such as witnessing domestic violence, level of learning stress, whether the child grew up in Shenzhen, whether their father or mother worked away from home, whether the student was criticized by teachers, and the student\u0026rsquo;s relationships with classmates, teachers, and family.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eChildhood Psychological Trauma Questionnaire (CPTQ)\u003c/strong\u003e\u003cp\u003eThis scale was adapted from Janssen et al.\u0026rsquo;s semi-structured interview questionnaire to evaluate childhood trauma lifetime occurrence [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The scale was filled out by parents. Four items were used to measure four domains of childhood trauma, including EN, EA, PA, and SA. EN included that the parents did not listen to their child\u0026rsquo;s demands and ignored their problems, and that the child felt they did not receive support and attention from their family. EA included that the child was scolded by their family, treated worse than their siblings, or experienced unjust punishment or blackmail. PA included the child being beaten, kicked, or experiencing other forms of PA). SA items related to the child being forced into sexual contact or being forced to touch another person's body [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Each item was scored from 1 to 5 based on the frequency of the described trauma, with 1\u0026thinsp;=\u0026thinsp;Never and 5\u0026thinsp;=\u0026thinsp;Very often\u0026thinsp;=\u0026thinsp;5). Thus, a higher score indicated greater childhood trauma. The maximum possible score was 20. A score of two or more for each item was defined as childhood trauma. In the current study, the cut-off score of EN, EA, PA or SA was \u0026gt;\u0026thinsp;1 point. participants experiencing \u0026ge;3 types of trauma are considered to have experienced multiple traumas. The Cronbach\u0026rsquo;s α was 0.60.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConners Parent Symptom Questionnaire (PSQ)\u003c/strong\u003e\u003cp\u003eThis questionnaire [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] was filled out by children's parents to evaluate behavioral problems in children, including conduct disorder (12 items), learning problems (4 items), psychosomatic disorder (5 items), hyperactivity-impulsivity (3 items), anxiety (4 items), and ADHD (10 items). For this study, anxiety subscale was used. The Cronbach\u0026rsquo;s α of this scale was 0.969 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The internal consistency coefficient of the anxiety factor in this study was 0.79. Anxiety was defined as an anxiety factor score at least 2 standard deviations (SD) above the mean [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Thus, in the present study, a score of 1.13 or higher in males and 1.04 or higher in females was defined as abnormal anxiety.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.3 Statistical analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStatistical analysis was performed using SPSS Version 21.0 (IBM, Chicago, IL, USA). The rates of childhood trauma and anxiety are reported as a percentage (%) with 95% confidence intervals (CIs). Logistic regression was used to test the relationship between anxiety and childhood trauma with the odds ratio (OR) and 95% CIs. \u003cem\u003eP\u003c/em\u003e-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003e3.1 Prevalence of childhood trauma and relation to demographic characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the 12704 participants, 4043 (31.8%) had suffered EN, 2613 (20.6%) had suffered EA, 4595 (36.2%) had suffered PA, and 206 (1.6%) had suffered SA. A total of 6720 (52.9%) participants had experienced any type of trauma and 1346 (10.6%) had experienced multiple types of childhood trauma. The frequency distribution of different types of childhood trauma is shown in Supplementary Fig. \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e. The prevalence of trauma exposure by different demographic characteristics is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. As shown, participants tended to be male, students aged 9\u0026ndash;11 or 12\u0026ndash;14, those who did not grow up in Shenzhen, students with average-to-high learning stress, students who had witnessed domestic violence, students who had a father or mother who worked away from home for one year, students who were sometimes or always criticized by teachers, and students with average-to-bad relationships with their classmates, teachers, or families (all ORs\u0026thinsp;\u0026ge;\u0026thinsp;1.15, P\u0026lt;0.05). Detailed results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Supplementary Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate logistic regression for determining risk factors of childhood trauma.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEN\u003c/p\u003e\u003cp\u003eAdjusted odds ratio(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEA\u003c/p\u003e\u003cp\u003eAdjusted odds ratio(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePA\u003c/p\u003e\u003cp\u003eAdjusted odds ratio(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSA\u003c/p\u003e\u003cp\u003eAdjusted odds ratio(95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.16(1.07\u0026ndash;1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10(0.90\u0026ndash;1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.76(0.70\u0026ndash;0.83)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.68(0.49\u0026ndash;0.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.89(0.81\u0026ndash;0.97)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.21(1.10\u0026ndash;1.34)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.05(0.96\u0026ndash;1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.03(1.41\u0026ndash;2.93)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.95(0.81\u0026ndash;1.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.10(0.91\u0026ndash;1.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.93(0.80\u0026ndash;1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e3.00(1.81\u0026ndash;4.96)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle-child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.002(0.921.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.85(0.76\u0026ndash;0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.96(0.88\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.01(0.73\u0026ndash;1.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrew up in Shenzhen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.02(0.94\u0026ndash;1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.15(1.04\u0026ndash;1.27)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.15(1.06\u0026ndash;1.25)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.18(0.86\u0026ndash;1.61)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.11(0.97\u0026ndash;1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.78(0.68\u0026ndash;0.90)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.06(0.96\u0026ndash;1.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.52(0.36\u0026ndash;0.76)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.09(0.89\u0026ndash;1.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.87(0.70\u0026ndash;1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.34(1.10\u0026ndash;1.64)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.54(0.28\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLearning stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.74(1.40\u0026ndash;2.15)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.21(0.96\u0026ndash;1.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.48(1.22\u0026ndash;1.79)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.56(0.31\u0026ndash;1.02)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egreat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.47(1.98\u0026ndash;3.09)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.89(1.48\u0026ndash;2.41)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.04(1.672.49)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.65(-.35\u0026thinsp;\u0026minus;\u0026thinsp;1.20)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic performance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.93(0.85\u0026ndash;1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.85(0.76\u0026ndash;0.96)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.86(0.78\u0026ndash;0.94)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.95(0.65\u0026ndash;1.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.93(0.81\u0026ndash;1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.95(0.82\u0026ndash;1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.90(0.79\u0026ndash;1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.11(0.70\u0026ndash;1.76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWitnessing domestic violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.01(1.83\u0026ndash;2.21)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.41(2.18\u0026ndash;2.67)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.22(2.03\u0026ndash;2.44)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.74(2.01\u0026ndash;3.74)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFather worked away from home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.35(1.21\u0026ndash;1.50)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.48(1.31\u0026ndash;1.67)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.45(1.31\u0026ndash;1.61)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.73(1.21\u0026ndash;2.47)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;1years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.63(1.35\u0026ndash;1.96)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.91(1.56\u0026ndash;2.34)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.51(1.26\u0026ndash;1.82)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.65(0.88\u0026ndash;3.09)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother worked away from home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.47(1.28\u0026ndash;1.69)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.33(1.14\u0026ndash;1.55)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.19(1.03\u0026ndash;1.36)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.39(0.90\u0026ndash;2.14)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;1years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.08(0.84\u0026ndash;1.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12(0.84\u0026ndash;1.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.49(1.16\u0026ndash;1.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.97(0.39\u0026ndash;2.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCriticized by teachers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSometimes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.86(1.66\u0026ndash;2.10)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.63(1.41\u0026ndash;1.88)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.91(1.71\u0026ndash;2.14)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.71(1.00-2.94)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.76(1.18\u0026ndash;2.61)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.41(0.89\u0026ndash;2.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.29(1.56\u0026ndash;3.35)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e3.14(1.13\u0026ndash;8.71)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003erelationship with classmates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.24(1.10\u0026ndash;1.39)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.14(1.001-1.30)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.12(1.002\u0026ndash;1.26)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.32(0.88\u0026ndash;1.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003erelationship with teacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ebad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.90(1.39\u0026ndash;2.59)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.49(1.08\u0026ndash;2.05)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.72(1.26\u0026ndash;2.35)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.77(0.85\u0026ndash;3.67)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.29(1.16\u0026ndash;1.43)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.26(1.12\u0026ndash;1.42)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.25(1.12\u0026ndash;1.39)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00(0.67\u0026ndash;1.48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ebad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.09(0.76\u0026ndash;1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.28(0.88\u0026ndash;1.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.39(0.97-2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.04(0.97\u0026ndash;4.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003erelationship with families\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.21(1.87\u0026ndash;2.61)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.94(1.64\u0026ndash;2.31)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.51(1.28\u0026ndash;1.78)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.28(0.79\u0026ndash;2.09)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ebad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.87(1.25\u0026ndash;2.80)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.05(1.37\u0026ndash;3.08)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.42(0.94\u0026ndash;2.13)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.24(1.01\u0026ndash;4.95)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: EA: emotional abuse; PA: physical abuse SA: sexual abuse; EN: emotional neglect.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.2 Prevalence of anxiety in students experiencing different types of childhood trauma\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the total sample, 500 students (3.94%, 95% CI 3.61\u0026ndash;4.29%) had anxiety symptoms. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the prevalence rates of anxiety symptoms in children experiencing EN, EA, PA, SA, and any trauma were 7.72%, 8.8%, 6.29%, 17.48%, and 6.00%, respectively. Furthermore, the prevalence rates of anxiety symptoms in children exposed to one, two, or multiple types of childhood trauma were 3.47%, 6.32%, and 11.89%, respectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe prevalence of anxiety in children with different types of childhood trauma\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePrevalence \u003cem\u003e(\u003c/em\u003e95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.17(1.88\u0026ndash;2.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.72(6.93\u0026ndash;8.58)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e270\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.68(2.38\u0026ndash;3.01)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2613\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.8(7.78\u0026ndash;9.95)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.6(2.28\u0026ndash;2.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.29(5.62\u0026ndash;7.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12498\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.71(3.4\u0026ndash;4.06)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e17.48(12.9-23.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAny trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5984\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.62(1.33\u0026ndash;1.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e403\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.00(5.45\u0026ndash;6.59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 type trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.47(2.91\u0026ndash;4.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 types trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1977\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.32(5.33\u0026ndash;7.48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3 types trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.89(10.27\u0026ndash;13.73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: N: total number of children; n: number of children with anxiety reporting different types of childhood trauma; EA: emotional abuse; PA: physical abuse SA: sexual abuse; EN: emotional neglect.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.3 The effect of type of childhood trauma on anxiety symptoms\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAfter adjusting for gender, age, single-child status, family income, academic performance, witnessing domestic violence, learning stress, growing up in Shenzhen, a father or mother working away from home, criticism by teachers, and relationships with classmates, teachers, and families, the logistic regression results showed that students who experienced EN were 2.6 times more likely to report anxiety symptoms (95%CI: 2.11\u0026ndash;3.20) than whose were had not experienced EN. Exposure to EA (OR\u0026thinsp;=\u0026thinsp;2.249, 95%CI: 1.83\u0026ndash;2.77), PA (OR\u0026thinsp;=\u0026thinsp;1.78, 95%CI: 1.45\u0026ndash;2.19), SA (OR\u0026thinsp;=\u0026thinsp;2.786, 95%CI: 1.77\u0026ndash;4.37), or any type of trauma (OR\u0026thinsp;=\u0026thinsp;2.726, 95%CI:2.12\u0026ndash;3.51) positively increased anxiety symptoms risk relative to no such exposure (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate regression of the association between the number of types of childhood trauma and anxiety according to gender.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAny trauma\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal samples\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.602\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.786\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e(2.12\u0026ndash;3.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(2.11\u0026ndash;3.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e(1.83\u0026ndash;2.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(1.45\u0026ndash;2.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e(1.77\u0026ndash;4.37)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e(1.61\u0026ndash;3.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(1.77\u0026ndash;3.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e(1.54\u0026ndash;2.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(1.25\u0026ndash;2.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e(1.07\u0026ndash;3.86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.881\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.468\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.733\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e(2.26\u0026ndash;4.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(2.15\u0026ndash;3.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e(1.85\u0026ndash;3.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(1.44\u0026ndash;2.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e(1.76\u0026ndash;4.26)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: Adjusted for gender (Gender was not controlled in gender subgroup analysis), age, single-child, income, academic performance, witnessing domestic violence, learning stress, grep up in Shenzhen, Out-father, Out-mother, critic by teacher, And relationships with classmates, teachers and families, P: p-values; OR: odds ratio; EA: emotional abuse; PA: physical abuse SA: sexual abuse; EN: emotional neglect.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAfter adjusting for the above confounding factors (except gender), the gender subgroup analysis showed that male students who experienced EN (OR\u0026thinsp;=\u0026thinsp;2.377, 95%CI: 1.77\u0026ndash;3.20), EA (OR\u0026thinsp;=\u0026thinsp;2.07, 95%CI: 1.54\u0026ndash;2.79), PA (OR\u0026thinsp;=\u0026thinsp;1.685, 95%CI: 1.25\u0026ndash;2.27 ), SA (OR\u0026thinsp;=\u0026thinsp;2.033, 95%CI: 1.07\u0026ndash;3.86), or any type of trauma (OR\u0026thinsp;=\u0026thinsp;2.312, 95%CI: 1.61\u0026ndash;3.31 ) had an increased anxiety symptoms risk relative to no such exposure; among female students, EN (OR\u0026thinsp;=\u0026thinsp;2.881, 95%CI: 2.15\u0026ndash;3.86), EA (OR\u0026thinsp;=\u0026thinsp;2.468, 95%CI: 1.85\u0026ndash;3.30), PA (OR\u0026thinsp;=\u0026thinsp;1.91, 95%CI: 1.44\u0026ndash;2.54 ), SA (OR\u0026thinsp;=\u0026thinsp;2.733, 95%CI: 1.76\u0026ndash;4.26), and any type of trauma (OR\u0026thinsp;=\u0026thinsp;3.21, 95%CI: 2.26\u0026ndash;4.57) all positively increased anxiety symptoms risk relative to no such exposure (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the different types of childhood trauma had a stronger association with the risk of developing anxiety symptoms in female students than in male students.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.4 Association between the number of types of childhood trauma and anxiety symptoms\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs above, we used a multivariate regression model to explore the relationship of the number of types of childhood trauma with anxiety symptoms. The results showed that exposure to one type of trauma (OR\u0026thinsp;=\u0026thinsp;1.94, 95%CI: 1.45\u0026ndash;2.60), two types of trauma (OR\u0026thinsp;=\u0026thinsp;2.96, 95%CI: 2.19\u0026ndash;4.00), and multiple types of trauma (OR\u0026thinsp;=\u0026thinsp;4.585, 95%CI: 3.39\u0026ndash;6.21) positively increased the anxiety symptoms risk relative to no exposure to childhood trauma (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDifferent numbers of child trauma types predicted anxiety in multivariate regression models\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal samples\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 type trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(1.45\u0026ndash;2.60)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 types trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(2.19-4.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3 types trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.585\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(3.39\u0026ndash;6.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 type trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(1.08\u0026ndash;2.51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 types trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(1.63\u0026ndash;3.86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3 types trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(2.46\u0026ndash;5.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 type trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(1.51\u0026ndash;3.43)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 types trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.436\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(2.25\u0026ndash;5.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3 types trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.613\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(3.66\u0026ndash;8.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: Adjusted for gender, age, Single-child, income, academic performance, witnessing domestic violence, learning stress, studying in Shenzhen with parents, Father or mother worked away from home, criticism by teacher, and relationships with classmates, teachers, and families; P: p-value; OR: odds ratio; EA: emotional abuse; PA: physical abuse SA: sexual abuse; EN: emotional neglect.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the gender subgroup analysis, we found that male students exposed to one type of trauma (OR\u0026thinsp;=\u0026thinsp;1.65, 95%CI: 1.08\u0026ndash;2.51), two types of trauma (OR\u0026thinsp;=\u0026thinsp;2.51, 95%CI: 1.63\u0026ndash;3.86), and multiple types of childhood trauma (OR\u0026thinsp;=\u0026thinsp;3.79, 95%CI: 2.46\u0026ndash;5.84 had an increased anxiety symptoms risk relative to those without childhood trauma; among female students, one type of trauma (OR\u0026thinsp;=\u0026thinsp;2.273, 95%CI: 1.51\u0026ndash;3.43), two types of trauma (OR\u0026thinsp;=\u0026thinsp;3.436, 95%CI: 2.25\u0026ndash;5.24), and multiple types of childhood trauma (OR\u0026thinsp;=\u0026thinsp;5.613, 95%CI: 3.66\u0026ndash;8.62) increased the risk of developing anxiety symptoms relative to no such exposure (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.5 Multivariate logistic regression to determine risk factors for anxiety symptoms in children exposed to childhood trauma\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNext, we explored the risk factors for anxiety symptoms among children exposed to childhood trauma. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, risk was significantly increased for who were female, students aged 9\u0026ndash;11 and 12\u0026ndash;14, students who had witnessed domestic violence, students who had a father who worked away from home for one year, students who were frequently criticized by teachers, and students with average-to-bad relationships with their teachers or families (all ORs\u0026thinsp;\u0026ge;\u0026thinsp;1.37, P\u0026lt;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate logistic regression for determining risk factors for anxiety in children with childhood trauma\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAdjusted odds ratio(95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3814\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.09(4.43\u0026ndash;5.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2862\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.16(6.27\u0026ndash;8.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.64(1.32\u0026ndash;2.05)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2719\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.27(3.57\u0026ndash;5.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.11(6.26\u0026ndash;8.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.50(1.17\u0026ndash;1.92)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e527\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.68(7.44\u0026ndash;12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.94(1.34\u0026ndash;2.82)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle-child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4641\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.1(5.45\u0026ndash;6.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.74(4.81\u0026ndash;6.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.02(0.80\u0026ndash;1.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrew up in Shenzhen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.69(5.02\u0026ndash;6.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.43(5.53\u0026ndash;7.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.25(1.00-1.57)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e825\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.88(6.23\u0026ndash;9.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5379\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.39(4.82\u0026ndash;6.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.66(0.49\u0026ndash;0.90)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.64(7.31\u0026ndash;12.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.76(0.48\u0026ndash;1.20)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLearning stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e275\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.09(3.06\u0026ndash;8.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.35(3.76\u0026ndash;5.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.85(0.46\u0026ndash;1.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGreat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.86(7.78\u0026ndash;10.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.54(0.84\u0026ndash;2.82)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic performance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.88(4.04\u0026ndash;5.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.8(5.04\u0026ndash;6.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.97(0.74\u0026ndash;1.27)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.12(6.76\u0026ndash;9.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.92(0.66\u0026ndash;1.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWitnessing domestic violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4499\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.8(4.21\u0026ndash;5.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.48(7.38\u0026ndash;9.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.37(1.10\u0026ndash;1.71)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFather worked away from home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.16(4.55\u0026ndash;5.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.68(6.51\u0026ndash;9.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.38(1.06\u0026ndash;1.79)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;1years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e543\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.55(5.61\u0026ndash;10.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.19(0.76\u0026ndash;1.86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother worked away from home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5560\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.67(5.09\u0026ndash;6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e839\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.75(6.12\u0026ndash;9.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.02(0.73\u0026ndash;1.42)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;1years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.19(4.71\u0026ndash;10.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.06(0.58\u0026ndash;1.92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCriticked by teacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e884\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.98(3.73\u0026ndash;6.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSometimes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5708\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.94(5.36\u0026ndash;6.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.13(0.79\u0026ndash;1.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.82(11.93\u0026ndash;28.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.92(1.39\u0026ndash;6.12)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship with classmates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.27(3.74\u0026ndash;4.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.71(8.32\u0026ndash;11.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.06(1.58\u0026ndash;2.69)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.67(15.38\u0026ndash;27.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.05(1.91\u0026ndash;4.88)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship with teacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4607\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.75(4.18\u0026ndash;5.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1954\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.78(6.67\u0026ndash;9.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.08(0.83\u0026ndash;1.42)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.02(16.53\u0026ndash;31.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.81(1.04\u0026ndash;3.14)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship with families\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5975\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.92(4.4\u0026ndash;5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.89(11.37\u0026ndash;16.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.91(1.41\u0026ndash;2.57)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22.22(15.16\u0026ndash;31.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.36(1.33\u0026ndash;4.17)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of childhood trauma\u003c/h2\u003e\u003cp\u003eThis is the first study to measure childhood trauma during childhood in Chinese students using parent reports. The prevalence rates of EN, EA, PA, and SA in students aged 6\u0026ndash;14 in Shenzhen were found to be 31.8%, 20.6%, 36.2%, and 1.6%, respectively. These rates differ from those reported in previous studies. For example, the prevalence rates of low-to-severe EN, EA, PA, and SA in Chinese students aged 12\u0026ndash;15 using the CTQ were reported as 22.8%, 10.6%, 7.1%, and 11.0%, respectively [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Among 463 Chinese college students, 49.0% reported at least one type of psychological abuse and 54.4% experienced at least one type of psychological neglect as assessed by the Childhood Psychological Abuse and Neglect Scale [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the current study, 52.9% of students had experienced any type of trauma and 10.6% had experienced multiple types (\u0026ge;3) of trauma. A previous cross-sectional survey involving 608 participants found that 47% had experienced at least one type of trauma and about 23% had experienced multiple traumas assessed by the Life Event Checklist (LEC) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The inconsistencies in the reported prevalence rates of childhood trauma can be explained by several factors. Firstly, prevalence estimates may vary widely when different tools are used to assess maltreatment/trauma. Second, the age range of students in the current study is 6 to 14 years, whereas previous studies mainly focused on individuals over 12 years old. Third, exploring by proxy traumatic events by parents (that part of them may be the bullier) may have reporting biases and underestimate the frequencies of the traumatic events. To obtain a more homogenous estimate of prevalence, an effective tool for assessing childhood trauma before the age of 12 should be used in future studies.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRisk factors for childhood trauma\u003c/h3\u003e\n\u003cp\u003eLogistic regression showed that being female and growing up in Shenzhen were protective factors against PA. Even when different assessment methods of maltreatment were used, the risk factors of childhood trauma were similar. For example, using the CTQ, birthplace and male gender were associated with more serious PA [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Similarly, in a clinical study in Egypt, female psychiatric outpatients reported lower rates of PA and SA than male patients [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The current study found that being age 9\u0026ndash;11 increases the risk of EA and multiple types of childhood trauma, whereas being age 12\u0026ndash;14 increases the risk of SA. These results are in line with previous studies that the incidence of childhood trauma is higher in adolescents than in younger children [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. we should focus on these age groups to minimize or ameliorate childhood trauma. We also found that children with average-to-high learning stress, criticism by teachers, and average-to-bad relationships with classmates and teachers had increased types of childhood trauma, which suggests that good relationships, more encouragement, and less learning stress can reduce childhood trauma. Moreover, a nurturing home environment is an important factor for a child\u0026rsquo;s social-emotional development. In the current study, students who had witnessed domestic violence, who had a parent working away from home, or who had average-to-bad relationships with their families had higher rates of different types of childhood trauma. These findings are consistent with previous studies showing that a harmonious relationship with parents negatively predicts childhood trauma [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Thus, lower exposure to domestic violence and a good relationship with parents can decrease childhood trauma [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. These confounding factors must be controlled for when analyzing the relationship between childhood trauma and anxiety symptoms.\u003c/p\u003e\n\u003ch3\u003ePrevalence of anxiety symptoms in children experiencing different types and numbers of childhood trauma\u003c/h3\u003e\n\u003cp\u003eThis study aimed to assess the effects of trauma during childhood in Chinese students. The prevalence rates of anxiety symptoms in children exposed to EN, EA, PA, SA, or any type of trauma were 7.72%, 8.8%, 6.29%, 17.48%, and 6.00%, respectively; all of these rates are significantly higher than those in children without childhood trauma (1.62%). Few studies have compared the prevalence of anxiety symptoms in children with childhood trauma measured during childhood. However, our results are in line with previous studies reporting the effect of childhood trauma measured during adulthood on anxiety symptoms. Li et al. found that childhood trauma is significantly associated with social anxiety in adolescents [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Similarly, childhood trauma was reported to be significantly higher in individuals with social anxiety compared to controls [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In the present study, the prevalence rates of anxiety symptoms in children with one, two, and multiple types of trauma were 3.47%, 6.32%, and 11.89%, respectively. In another study, 81% of adolescent inpatients reported experiencing at least one type of childhood trauma assessed by the Childhood Trauma Chart Review Scale [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Taken together, these findings may suggest that, the more types of childhood trauma an individual experiences, the higher the risk of anxiety symptoms.\u003c/p\u003e\n\u003ch3\u003eThe relationship between different types of childhood trauma and anxiety symptoms\u003c/h3\u003e\n\u003cp\u003eTo further explore the effect of childhood trauma (measured by CPTQ) on anxiety symptoms, we conducted a multivariate logistic regression analysis. We found that childhood trauma strongly associated anxiety symptoms after controlling for multiple confounding factors. A previous study suggested that subtypes of childhood trauma assessed by the CTQ predict anxiety symptoms in the general population [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Among Chinese college students, individuals with more childhood trauma were found to have more severe social anxiety [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In a clinical study, Kuo et al. found that EA and EN assessed by the CTQ were associated with the severity of anxiety in adults [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Different types of childhood trauma assessed by the CTQ appear to have a significant influence on anxiety in adults[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Lee et al. found that \"childhood trauma\" assessed by the Adverse Childhood Experiences (ACEs) scale was associated with increased anxiety risk in young adulthood [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Although these studies used different instruments (e.g., CTQ and ACEs) to measure trauma at different ages, our findings extend the evidence of the association between childhood trauma and anxiety symptoms.\u003c/p\u003e\n\u003ch3\u003eThe relationship between the number of types of childhood trauma on anxiety symptoms\u003c/h3\u003e\n\u003cp\u003eThe current study reported that childhood trauma measured during childhood has a dose-dependent relationship with anxiety symptoms. We found that one, two, and multiple types of trauma increased anxiety symptoms risk 1.94-fold, 2.96-fold, and 4.585-fold, respectively, compared to no childhood trauma. Similar results have been reported in studies of adults. For example, adults who report exposure to many trauma types have an increased anxiety symptoms risk [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Multiple types of trauma have also been shown to damage mental health [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Overall, these results suggest that the effect of childhood trauma and multiple traumas on anxiety symptoms is consistent across different ages and cultures.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eGender difference in the effects of childhood maltreatment on anxiety symptoms\u003c/h2\u003e\u003cp\u003eOur results showed that the types and number of childhood trauma have a greater impact on anxiety symptoms among female students than male students. This result is in line with a recent studies, which indicated that childhood maltreatment assessed by different tools had a stronger association with anxiety symptoms in adult females than adult males [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Similarly, adolescent girls with more trauma exposure are reported to have more serious mental health and behavioral problems [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Our gender-specific results may motivate future studies of the effects of childhood trauma on anxiety symptoms. Furthermore, this result indicates that female students need greater protection to avoid anxiety symptoms due to childhood trauma. Such interventions, for instance, cognitive behavioral therapy, trauma re-processing and treatment modality for trauma-exposed children are available to delay or block the accumulation of childhood trauma [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] .\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePotential mechanisms of the relationship between childhood trauma and anxiety symptoms\u003c/h3\u003e\n\u003cp\u003eThe relationship between childhood trauma and anxiety symptoms may be due to changes in the brain. Preclinical research indicates that trauma has a strong influence on brain development, especially in children and adolescents [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Individuals with a history of childhood trauma show reductions in white matter volume [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Emerging evidence suggests that exposure to childhood trauma is related to neurobiological changes, such as dysfunction of the hypothalamus-pituitary-adrenal axis (HPA axis) [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], oxytocin dysregulation[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], abnormal brain structure[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e] and abnormal GABA system function[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]\u0026mdash;especially in children\u0026mdash;which may underlie the increased risk of anxiety symptoms. Repetitive negative thinking[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e], dysfunctional metacognitions[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e] and resilience and trait mindfulness[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e] might mediate or moderate the relationship between exposure to childhood trauma and psychological diseases in adulthood. Childhood trauma would be related to the accumulation of developmental precursors of major psychiatric disorders[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These mechanisms support a physiological basis for the relationship between childhood trauma and anxiety symptoms, although further studies directly testing this hypothesis are needed. Our findings may provide leads for interventions targeting the early mechanisms underlying the established relation between childhood trauma and adult psychiatric disorders.\u003c/p\u003e\n\u003ch3\u003e\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cb\u003eRisk factors for anxiety symptoms in children with childhood trauma\u003c/b\u003e\u003c/div\u003e\u003cp\u003eIn the present study, we found a strong relationship between childhood trauma and anxiety symptoms. We then analyzed the potential risk factors for anxiety symptoms in children exposed to childhood trauma. The risk factors for anxiety symptoms in children exposed to trauma were found to be female gender, age 9\u0026ndash;11 or 12\u0026ndash;14 years, witnessing domestic violence, having a parent working away from home for one year, criticism by teachers, and average-to-bad relationship with classmates, teachers, and families.\u003c/p\u003e\u003cp\u003eThese results suggest that earlier screening and intervention programs for childhood trauma can help reduce anxiety symptoms. Studies investigating what programs are most effective for preventing anxiety symptoms in students are needed.\u003c/p\u003e\u003cp\u003eThis study is subject to several limitations. First, the data might have been affected by recall bias. In addition, the prevalence of trauma may have been underestimated because the CPTQ was completed by parents. In the future, more effective evaluation tools will be needed for such research. Second, we did not use a clinical tool to diagnose anxiety symptoms. Thus, these results may not be clinically meaningful. Third, the results of this study are based on cross-sectional data analysis. Longitudinal data are needed to further verify the relationship between childhood trauma and anxiety symptoms.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study estimated the effect of childhood trauma measured during childhood on anxiety symptoms in primary and secondary school students. We found high rates of EN, EA, PA, and SA among Chinese children, although data collection was limited to one province. Socio-demographic characteristics, such as age, learning stress, and exposure to domestic violence, increased childhood trauma risk. A high prevalence of anxiety symptoms in children with childhood trauma was found. Moreover, our findings indicated that childhood trauma was a risk factor of anxiety symptoms. Notably, this study reported a dose-dependent relationship between exposure to different types of childhood trauma and anxiety symptoms during childhood. Our results also showed that the type and number of childhood trauma had a greater impact on anxiety symptoms in female students than in male students. In addition, being female, being aged 9\u0026ndash;11 or 12\u0026ndash;14 years, witnessing domestic violence, having a parent working away from home for one-year, frequent criticism by teachers, and average-to-bad relationships with classmates, teachers, and families further increased the risk of anxiety symptoms in children experiencing any childhood trauma. This study can provide insights into trauma backgrounds, the effects of childhood trauma on anxiety symptoms, and demographic predictors of anxiety symptoms. Mental healthcare should increase the focus on childhood trauma as part of the management of mental illnesses. In addition, further research should focus on developing prevention programs as well as intervention programs to address common childhood trauma.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ephysical abuse\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esexual abuse\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eemotional abuse\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ephysical neglect\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eemotional neglect\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCTQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChildhood Trauma Questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePTSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epost-traumatic stress disorder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCPTQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChildhood Psychological Trauma Questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePSQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConners Parent Symptom Questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLEC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLife Event Checklist (LEC)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eACE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdverse Childhood Experiences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHPA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehypothalamus-pituitary-adrenal\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003econfidence intervals\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eodds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of Shenzhen Kangning Hospital (approval no. 2019-k009-01-1). All methods were carried out in accordance with relevant guidelines and regulations. All students and their parents in the study voluntarily participated and provided informed consent before participating.\u0026nbsp;All procedures in this study were conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed for the current study are available from the corresponding author by request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Guangdong Basic and Applied Basic Research Foundation (2019A1515110047, Jianbo Liu), Sanming Project of Medicine in Shenzhen (SZSM201612079, Jianping Lu).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiujin Lin was responsible for field investigations, writing paper, and manuscript revisions; Jianbo Liu was responsible for data analysis and manuscript revisions; \u0026nbsp; Zhenpeng Xue was responsible for field investigations; Jianchang Xu was responsible for field investigations; Ling Lin was responsible for field investigations; Yumeng Sun was responsible for manuscript revisions; Jianping Lu was responsible for conducting the research, and manuscript revisions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDube SRJCA, Neglect. Continuing conversations about adverse childhood experiences (ACEs) screening: A public health perspective. S014521341830111X; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. Child maltreatment. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://wwwwhoint/news-room/fact-sheets/detail/child-maltreatment 2016(4\u003c/span\u003e\u003cspan address=\"https://wwwwhoint/news-room/fact-sheets/detail/child-maltreatment 2016(4\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalbudak E, Evren CJNJP. The impact of childhood traumas, depressive and anxiety symptoms on the relationship between borderline personality features and symptoms of adult attention deficit hyperactivity disorder in Turkish university students. 2015, 69(1):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGilbert R, Widom C, Browne K, Fergusson D, Webb E, Janson SJL. Burden and consequences of child maltreatment in high-income countries. 2009, 373(9657):68\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFang X, Fry D, Brown D, Mercy J, Dunne M, Butchart A, Corso P, Maynzyuk K, Dzhygyr Y, Chen Y et al. The burden of child maltreatment in the East Asia and Pacific region. 2015, 42:146\u0026ndash;162.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang L, Cheng H, Qu Y, Zhang Y, Cui Q. Zou HJSp, epidemiology p: The prevalence of child maltreatment among Chinese primary and middle school students: a systematic review and meta-analysis. 2020, 55(9):1105\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJi K, Finkelhor DJCAN. A meta-analysis of child physical abuse prevalence in China. 2015, 43:61\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, Sapareto E, Ruggiero J. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994;151(8):1132\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo L, Xu Y, Deng J, Gao X, Huang G, Huang J, Deng X, Zhang WH, Lu CJA. Associations between childhood maltreatment and non-medical use of prescription drugs among Chinese adolescents. 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang S, Lin X, Yang T, Zhang S, Pan Y, Lu J, Liu JJJ. Prevalence of childhood trauma among adults with affective disorder using the Childhood Trauma Questionnaire: A meta-analysis. 2020, 276:546\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHadland SE, Wood E, Dong H, Marshall BDL, Kerr T, Montaner JS, DeBeck K. Suicide attempts and childhood maltreatment among street youth: A prospective cohort study. Pediatrics. 2015;136(3):440\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHou W, Wen Y, Wang X, Zhao X, Li X, Wang C. Effects of childhood trauma on personality in rural secondary school students in Chinese. J Psychiatry. 2017;30(6):401\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eB JAS ADPB, C MDN, D EW, F DPE FTAE. E JS, G LH, H MM, H DDJCA : Development and validation of a brief screening version of the Childhood Trauma Questionnaire. 2003, 27(2):169\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWei J, Shi J, Zhang M, Ding H, Kang C, Wang K, Wang Y, Gong Y, Wang S, Shao N, et al. [Childhood trauma and its correlation with resilience among primary and middle school students in Wuhan city in 2015]. Wei sheng yan jiu = J hygiene Res. 2019;48(5):717\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRafaiee R, Mohseni F. Akbarian NJijhrb, addiction: Prevalence of Child Abuse and Correlations with Family Factors Among Elementary School-aged Children. 2021, In Press(In Press).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah S, Mackinnon A, Galletly C, Carr V, McGrath J, Stain H, Castle D, Harvey C, Sweeney S. Morgan VJSr: Prevalence and impact of childhood abuse in people with a psychotic illness. Data second Australian Natl Surv Psychos. 2014;159(1):20\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiao D, Wang T, Huang Y, Wang W, Zhao M, Zhang WH, Guo L, Lu C. Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents. J Affect Disord. 2020;265:595\u0026ndash;602.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThornberry TP, Matsuda M, Greenman SJ, Augustyn MB, Henry KL, Smith CA, Ireland TOJCA. Neglect: Adolescent risk factors for child maltreatment. 2014, 38(4):706\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDuan Z, Feng Y, Xu S, Gao D, Ji Y, Sun X, Chen R, Wang Y. The role of childhood left-behind experience on childhood trauma exposure and mental health outcomes: a propensity score matching (PSM) analysis. J Public Health. 2023;45(4):785\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLussier AA, Smith BJ, Fisher J, Luo M, Cerutti J, Schneper L, Smith T, Cecil CAM, Felix JF, Mitchell CJNMH. DNA methylation mediates the link between adversity and depressive symptoms. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOtten D, Schalinski I, Fegert JM, Jud A, Br\u0026auml;hler E, B\u0026uuml;rgin D, Clemens V. Child Maltreatment Characteristics and Adult Physical Multimorbidity in Germany. JAMA Netw open. 2025;8(1):e2456050.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHerringa RJ, Birn RM, Ruttle PL, Burghy CA. Essex MJJPotNAoeotUSoA: Childhood maltreatment is associated with altered fear circuitry and increased internalizing symptoms by late adolescence. 2013, 110(47):19119\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNicolas B, Julia GB, Val\u0026eacute;rie J, H\u0026eacute;l\u0026egrave;ne D, Alexandre B, Michel MJSBO. Childhood Trauma May Increase Risk of Psychosis and Mood Disorder in Genetically High-risk Children and Adolescents by Enhancing the Accumulation of Risk Indicators. 2022(1):1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFlaherty EG, Thompson R, Dubowitz H, Harvey EM, English DJ, Proctor LJ, Runyan DK. Adverse childhood experiences and child health in early adolescence. JAMA Pediatr. 2013;167(7):622\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJanssen I, Krabbendam L, Bakb M. M, W. H, Vollebergh: Childhood abuse as a risk factor for psychotic experiences. Acta psychiatrica Scandinavica 2004.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiangdong W, Xilin W, Hong M. Handbook of mental health assessment scale in Chinese [M]. Chin J mental health 1993:52\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJuan F, Yasong D, Liwei W. Norms of The Conners Parent Symptom Questionnaire in Chinese Urban Children in Chinese [M]. Shanghai J psychiatry 2005(06):5\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShen L, Zhang Y, Liang W, Zhang Y. Investigation of child maltreatment: Survey among junior school pupils in Henan province of China. Asia-Pacific Psychiatry 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCuiping W. Relationship between Psychological Abuse,Neglect during Childhood and Social Physical Anxiety of College Students and Mediating Effect of Negative Physical Self. \u003cem\u003eChinese General Practice\u003c/em\u003e 2017(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTrang T, Hanh D, Ignacio, Correa-Velez. Michael, Dunne: Trauma Exposure and Mental Health Problems Among Adults in Central Vietnam: A Randomized Cross-Sectional Survey. Front Psychiatry 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJingying S. A Comparative Study on Childhood Abuse and Self-esteem of City and Countryside Children. China J Health Psychol 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmr M, El-Wasify M, Ah A-G, Rees S. Gender differences in patients with social phobia in Egypt. arab J psychiatry 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Eissa MA, Saleheen HN, Al-Wallan NS, AlKashan MY, AlSubaie NJ, Almuneef MA. Prevalence of Sexual Abuse Among Secondary School Students in Saudi Arabia. Violence Vict. 2018;33(5):855\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee RY, Oxford ML, Sonney J, Enquobahrie DA, Cato, KDJJoa. The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents. 2022(94-):94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ezhang M, Guili W, Yanfei X. Study on related factors and psychological influence of childhood abuse among high school students in Chinese. Chin J child health care. 2007;15(1):30\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFisher D. Preventing Childhood Trauma Resulting From Exposure to Domestic Violence. Preventing School Failure; 1999.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Y, Tang H, Dong W, Lu G, Chen C. Association between childhood trauma and social anxiety in adolescents: The mediating role of self-compassion and loneliness. Child Abuse Negl. 2024;158:107109.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaria M, Max B. Social anxiety in first-episode psychosis: The role of childhood trauma and adult attachment. J Affect Disord 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeine SM, Becker DF, Levy KN, Edell WS, Mcglashan TH. Childhood trauma histories in adolescent inpatients. J Trauma Stress. 1997;10(2):291\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFan N, Fan H, Luo R, Wang Y, Yan Y, Yang X, Wang M, Dou Y, Ni R, Wei J, et al. The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China. Sci Rep. 2024;14(1):9797.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuo J, Goldin P, Werner K, Heimberg R, Gross J. Childhood trauma and current psychological functioning in adults with social anxiety disorder. J Anxiety Disord. 2011;25(4):467\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlnassar JS, Juruena MF, Macare C, Perkins AM, Young AH. Effect of childhood emotional abuse on depression and anxiety in adulthood is partially mediated by neuroticism: Evidence from a large online sample. J Affect Disord. 2024;359:158\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee H, Kim Y, Terry J. Adverse childhood experiences (ACEs) on mental disorders in young adulthood: Latent classes and community violence exposure. Prev Med. 2020;134:106039\u0026ndash;.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChiu HTS, Low DCW, Chan AHT, Meiser-Stedman R. Relationship between anxiety sensitivity and post-traumatic stress symptoms in trauma-exposed adults: A meta-analysis. J Anxiety Disord. 2024;103:102857.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcchesney GC, Adamson G, Shevlin M. Service use patterns and mental health symptoms among adolescents exposed to multiple types of trauma. J Adolesc 2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrant E, Bowman A, Johnson L. Effectiveness of interventions for psychological distress following traumatic injury: A systematic review. Injury. 2024;56(2):112090.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGottschall S, Lee J, Edge, MCJJots. Adverse childhood experiences and mental health in military recruits: Exploring gender as a moderator. 2022(2):35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrachason T, Mutlu I, Fusar-Poli L, Menne-Lothmann C, Decoster J, van Winkel R, Collip D, Delespaul P, De Hert M, Derom C, et al. Gender differences in the associations between childhood adversity and psychopathology in the general population. Soc Psychiatry Psychiatr Epidemiol. 2024;59(5):847\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAuslander W, Schutz A, Threlfall JM, Gerke DR, Dunn J. Types of Traumas Experienced By Adolescent Girls Involved in Child Welfare: Relationship to Mental Health and Behavioral Problems. In: \u003cem\u003eSociety for Social Work \u0026amp; Research Conference\u003c/em\u003e: 2014; 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCohen JA, Mannarino AP. Trauma-Focused Cognitive Behavioral Therapy for Children and Families. Child Adolesc Psychiatr Clin N Am. 2022;31(1):133\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDorsey S, McLaughlin KA, Kerns SEU, Harrison JP, Lambert HK, Briggs EC, Revillion Cox J, Amaya-Jackson L. Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events. J Clin child Adolesc psychology: official J Soc Clin Child Adolesc Psychol Am Psychol Association Div. 2017;53(3):303\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRinne-Albers MAW, Wee\u0026hellip; NJAvd: Neuroimaging in children, adolescents and young adults with psychological trauma. \u003cem\u003eEuropean Child \u0026amp; Adolescent Psychiatry\u003c/em\u003e 2013, 22(12):745\u0026ndash;755.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHinojosa CA, George GC, Ben-Zion Z. Neuroimaging of posttraumatic stress disorder in adults and youth: progress over the last decade on three leading questions of the field. Mol Psychiatry. 2024;29(10):3223\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDaniels JK, Lamke JP, Gaebler M, Walter H, Scheel M. White matter integrity and its relationship to PTSD and childhood trauma\u0026ndash;a systematic review and meta-analysis. Depress Anxiety. 2013;30(3):207\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eB BPA, C VK, E RK DFM. The role of childhood maltreatment in cortisol in the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal (HPA) axis in methamphetamine-dependent individuals with and without depression comorbidity and suicide attempts. J Affect Disord. 2020;263:274\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eByrd AL, Tung I, Manuck SD, Vine V, Horner M, Hipwell AE, Stepp SD. An interaction between early threat exposure and the oxytocin receptor in females: Disorder-specific versus general risk for psychopathology and social-emotional mediators. Dev Psychopathol. 2021;33(4):1248\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBick J, Nelson CA. Early Adverse Experiences and the Developing Brain. Neuropsychopharmacology: official publication Am Coll Neuropsychopharmacol. 2016;41(1):177\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNikolaus S, Antke C, Beu M, M\u0026uuml;ller H-WJRN. Cortical GABA, striatal dopamine and midbrain serotonin as the key players in compulsive and anxiety disorders\u0026ndash;results from in vivo imaging studies. 2010, 21(2):119\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMansueto G, Cavallo C, Palmieri S, Ruggiero GM, Sassaroli S, Caselli G. Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review. Clin Psychol Psychother. 2021;28(3):557\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMansueto G, van Nierop M, Schruers K, Alizadeh BZ, Bartels-Velthuis AA, van Beveren NJ, Bruggeman R, Cahn W, de Haan L, Delespaul P, et al. The role of cognitive functioning in the relationship between childhood trauma and a mixed phenotype of affective-anxious-psychotic symptoms in psychotic disorders. Schizophr Res. 2018;192:262\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen J, Zhang C, Wang Y, Liu X, Xu WJPH, Medicine. A longitudinal study of childhood trauma impacting on negative emotional symptoms among college students: a moderated mediation analysis. 2021(3):1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"childhood trauma, anxiety symptoms, primary students, prevalence, risk factors","lastPublishedDoi":"10.21203/rs.3.rs-7701193/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7701193/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThere is relatively little research on the prevalence of childhood trauma in Chinese children. Thus, this study aimed to investigate the prevalence of childhood trauma, its effect on anxiety, and other relevant factors influencing anxiety.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e Socio-demographic characteristics, Childhood Psychological Trauma Questionnaire (CPTQ), and Conners Parent Symptom Questionnaire (PSQ) were obtained from 12704 students recruited from 14 primary schools in Shenzhen. Rates of anxiety were compared between students experiencing different types of childhood trauma. Logistic regression was used to test the relationship between anxiety and childhood trauma.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn the overall sample, the prevalence of the various types of childhood trauma ranged from 1.6\u0026ndash;52.9%. The prevalence of anxiety in children experiencing various types of childhood trauma ranged from 3.47\u0026ndash;17.48%. Logistic regression confirmed that childhood trauma was a strong predictor of anxiety (all odds ratios (ORs)\u0026gt;1.69). Notably, the different types of childhood trauma showed a dose-dependent relationship with anxiety risk. Various factors, such as gender and age, increased the risk of anxiety in children experiencing any type of childhood trauma (all ORs\u0026gt;1.370).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eOur findings support that childhood trauma is a strong predictor of anxiety. Mental healthcare professionals should consider the role of childhood trauma in the management of anxiety and mental illnesses\u0026mdash;especially among female patients.\u003c/p\u003e","manuscriptTitle":"Childhood Trauma among Primary Students in Shenzhen City: Prevalence, Risk factors, and Relationship with Anxiety Symptoms","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 16:58:52","doi":"10.21203/rs.3.rs-7701193/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"574208c4-747a-43f2-ac4a-9561d7b41ab3","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-09T05:53:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 16:58:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7701193","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7701193","identity":"rs-7701193","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}