Abstract: Objective To examine the status and influence factors of mental health among rural left-behind school children.Methods With convenience sampling,1 925 pupils of grade 6,junior and high school students were recruited from 6 primary and high schools at two towns of Macheng municipality of Hubei province and were self-administered anonymously with a general questionnaire,Health Kids Resilience Assessment (HKRA),and Mental Health Inventory of Middle-School Students (MMHI-60)in September 2012.Results The total MMHI-60 score was 128.58±39.25 for the 725 (37.66% of all students surveyed) left-behind school children and 127.76±37.2 for the 1 200 (62.34%) non-left-behind school children,without significant difference.The left-behind school children identified with mental health problems showed significantly lower MMHI-60 total score and domain scores than the non-left-behind school children (P<0.05 for all),except for scores of social ability and goal and ambition domain.Among the left-behind school children,those not missing their parents had a lower mental health status,with the highest MMHI-60 total score (153.58±44.88),and those presenting positive attitude towards their parents' migrant working had a better mental health status,with the lowest MMHI-60 total score (121.18±38.04).The MMHI-60 total score differed among the left-behind school children with different amount of monthly pocket money and those with the monthly pocket money of less than 50 RMB yuan had the lowest MMHI-60 total score (125.53±41.19),suggesting that they had a better mental health status.Multivariate analyses showed that grade of study,the attitude towards their parents' migrant working,and psychological resilience were major influencing factors for mental health among the left-behind school children.Conclusion Psychological resilience is a protective factor for mental health;whereas,being at higher grade of study and negative attitude towards their parents' migrant working are risk factors for mental health among rural left-behind school children.