title: Cross-sectional study on the relationship between life events and mental health of secondary school students in Shanghai, China.
abstract: BACKGROUND
  The relationship of demographic factors and negative life events to the mental health of mainland Chinese school students has not been fully explored.
  
  
  OBJECTIVE
  Assess the prevalence of different types of life stressors among secondary school students and identify the demographic characteristics and types of life events that are most closely associated with perceived psychological difficulties in these students.
  
  
  METHODS
  This cross-sectional study administered two self-completion questionnaires to a stratified random cluster sample of 1818 students from four secondary schools in two districts of Shanghai: the Strengths and Difficulties Questionnaire (SDQ) and an abbreviated version of the Adolescent Self-rating Life Events Checklist (ASLEC) that assesses 11 negative life events.
  
  
  RESULTS
  Academic stress (74%), criticism from others (66%), family conflict (29%) and peer bullying & discrimination or interpersonal conflict (26%) were the most frequently reported negative life events, but their prevalence varied significantly by gender, type of school and urban versus rural residence. Similarly the level of reported psychological stress associated with life events, the total perceived psychological difficulty, and the level of pro-social behavior in the students varied significantly between different groups of students. Multivariate linear regression analysis identified the following independent predictors of high perceived psychological difficulty in the prior 6 months (in order of importance): high total stress score from negative life events in the prior year, experiencing peer bullying & discrimination or interpersonal conflict, not experiencing the death of a family member, male gender, attending a school in a rural district, and not suffering from a major disease or physical impairment. The independent predictors of a high level of pro-social behavior were high total stress score from negative life events, attending an urban school, female gender, attending a regular-tier school (vs. a high-tier school), experiencing peer bullying & discrimination or interpersonal conflict, not experiencing the death of a family member, and attending a middle school (vs. a high school).
  
  
  CONCLUSIONS
  Negative life events are one of many factors associated with perceived stress and level of pro-social behavior in secondary school students. Prospective studies are needed to clarify the causal pathways that connect stress with negative life events in students and to develop and test cohort-specific interventions aimed at decreasing stress and increasing pro-social behaviors.
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Linlin
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Fan
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yasong
authors.initials: Y
authors.lastname: Du