Objective   To investigate the prevalence and influencing factors of aggressive behavior among rural left-behind school children in China.

  Methods   With multistage stratified random cluster sampling, 20 747 rural primary and high school students were selected in 5 provinces across China. Buss-Warren Aggression Questionnaire–Revised Chinese Version (BWAQ-RC) and the Resilience Scale for Chinese Adolescents were used to assess aggressive behavior and psychological resilience of the participants between November 2014 and May 2015.

  Results   The mean age of the participants was 13.71±2.51 years and there were 5 483 (26.4%) left-behind and 15 264 (73.6%) non-left-behind school children. Significantly higher overall and domain BWAQ-RC scores were derived among the left-behind school children than among the non-left-behind school children (P < 0.001 for all). In psychological resilience assessment, the left-behind school children identified with aggressive behavior showed significantly lower total score and domain scores for family support, help-seeking, and emotional control, but a higher domain score for goal planning than those without aggressive behaviors (P < 0.001 for all). Multivariate linear regression analysis demonstrated that psychological resilience, being cared primarily by father or mother, and low family income were protective factors for aggressive behavior, whereas with the main caregiver'sdoting, rudeness or inconstant parenting were risk factors among the rural left-behind school children.

  Conclusion   Aggressivebehavior is more prevalent among left-behind school children than among non-left-behind school children in rural China. Psychological resilience is a protective factor against aggressive behavior in the rural left-behind school children.