To explore the effect of self-esteem on depression of left-behind children in rural areas, and to investigate the mediating effect of social anxiety and loneliness.

A total of 779 rural left-behind children (422 boys and 357 girls) in northern Jiangsu were selected by cluster random sampling. A questionnaire survey was conducted with the use of self-esteem scale, social anxiety scale for children, children’s loneliness scale and center for epidemiologic studies depression scale. The multiple mediating effects were analyzed by structural equation model test.

The self-esteem of left-behind children in rural areas was negatively correlated with social anxiety, loneliness, and depression (r=-0.38, -0.27, and -0.43, P <0.001), while social anxiety was positively correlated with loneliness and depression of left-behind children (r=0.25 and 0.50,P < 0.001). There was a positive correlation between loneliness and depression of left-behind children (r= 0.28, P < 0.001). Multiple mediating effect model analysis showed that social anxiety and loneliness could independently mediate the relationship between self-esteem and depression of left-behind children in rural areas, and the mediating effect values were -0.079(95%CI: -0.131 to -0.017) and -0.165 (95%CI: -0.253 to -0.110), respectively. It also played a chain mediating role through the intermediary chain of “social anxiety-loneliness”, and the mediating effect value was -0.124 (95%CI: -0.177 to -0.092).

The self-esteem of rural left-behind children can significantly reduce the level of social anxiety and loneliness, thus reducing the risk of depression of left-behind children.