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This study tests whether maladaptive habits and adjustment disorders mediate the link between separation anxiety and depression in primary school students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In November 2022, we conducted a cross-sectional survey of 4474 students from elementary schools in Qionghai and Dongfang cities, Hainan Province, China, using stratified cluster sampling. Parents completed the Mental Health Rate Scale for Pupils. Data were analyzed with SPSS 22.0 (descriptive statistics, analysis of variance, correlations), AMOS 26.0 (structural equation modeling [SEM]), and Mplus 8.3 (latent class analysis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>SEM revealed that 12.2% of participants met criteria for depression. Students with separation anxiety had 4.5\u20135.0 times higher odds of depression compared to those without separation anxiety (95% confidence interval [CI]: 3.8\u20136.2). Mediation analysis indicated that maladaptive habits and adjustment difficulties partially mediated this association, with stronger indirect effects observed in older grades (Grades 5 and 6: \u03b2 = 0.32, 95% CI: 0.24\u20130.41 vs. Grades 3 and 4: \u03b2 = 0.21, 95% CI: 0.15\u20130.28).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These findings suggest that early identification of maladaptive coping patterns in children with separation anxiety could improve mental health outcomes. We recommend integrating \u201csecure separation\u201d education strategies into teacher training programs and school counseling services, including structured transition activities and separation rituals, to support children\u2019s emotional adjustment during school transitions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10445463251407896","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T07:26:22Z","timestamp":1766733982000},"page":"174-182","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Maladaptive Behaviors and Adjustment Disorders in Linking Separation Anxiety to Depression in Primary School Students"],"prefix":"10.1177","volume":"36","author":[{"given":"Jing","family":"Zhang","sequence":"first","affiliation":[{"name":"Psychological Counseling and Treatment Center, Hainan Provincial Anning Hospital, Haikou, China."},{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medicine, Hainan Medical University, Haikou, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chanyuan","family":"Pan","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University, Haikou, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1117-8299","authenticated-orcid":false,"given":"Guankui","family":"Du","sequence":"additional","affiliation":[{"name":"Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medicine, Hainan Medical University, Haikou, China."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"e_1_3_7_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-109"},{"key":"e_1_3_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2006.05.013"},{"key":"e_1_3_7_4_1","volume-title":"Download Self Efficacy the Exercise of Control Albert Bandura","author":"Bandura A","year":"2019","unstructured":"Bandura A. 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