Depression, social support and associated factors among women living in rural China: a cross-sectional study

Association between digital engagement and urban-rural disparities in Chinese women's depressive symptoms: A national-level cross-sectional study

Objectives

This study aims to investigate the impact of digital engagement on urban-rural disparities in depressive symptoms among Chinese women.

Methods

Using a dataset from the China Family Panel Studies (CFPS) wave 2020, this study analyzes the impact of digital engagement on the urban-rural disparity in women's depressive symptoms using multiple linear regression and recentered influence function (RIF) models. Furthermore, the extent to which digital engagement affects the urban-rural disparity in women's depressive symptoms was calculated using the RIF decomposition method.

Results

Analysis showed that rural women had significantly higher levels of depressive symptoms compared to urban women; digital engagement significantly reduced women's depressive symptoms levels and mitigated the urban-rural disparity for women with moderate to high levels of depressive symptoms, and the mitigating effect was stronger for the highly depressed sample, but still widened the urban-rural disparity in women's depressive symptoms overall. In addition, the results of the RIF decomposition showed that digital engagement explained 28.28% of the urban-rural disparity in women's depressive symptoms.

Conclusion

There is a significant disparity in depressive symptoms levels between urban and rural women in China. Digital engagement reduces women's depressive symptoms, but it also widens the depressive symptoms disparity between urban and rural women overall. Digital engagement is potentially positive for reducing women's depressive symptoms.

Early stimulation and responsive care: A mediator of caregivers' depression on the suspected developmental delay of left-behind children in China

BACKGROUND

Due to multiple factors, left-behind children in rural areas suffer from neurodevelopment delay and their caregivers suffer from depressive symptoms. This study aimed to analyze the effect of caregivers' depressive symptoms on left-behind children's neurodevelopment, with early stimulation and responsive care mediating.

METHODS

We conducted a cross-sectional survey in five counties in China. A total of 904 left-behind children aged 0-3 and their primary caregivers were enrolled. The Zung Self-rating Depression Scale (ZSDS) was used to measure caregivers' depressive symptoms. The Ages and Stages questionnaires-third edition (ASQ-3), which contains five domains: communication (CM), gross motor (GM), fine motor (FM), problem-solving (CG), and personal social (PS), was used to screen children for suspected developmental delay (SDD).

RESULTS

31.4 % of left-behind children suffered from SDD, while 39.7 % of left-behind children's caregivers experienced depressive symptoms. Caregivers' ZSDS scores were positively correlated with the SDD on four domains (FM, GM, CG, and PS), while Early stimulation and responsive care was negatively correlated with the SDD on four domains (CM, FM, CG, and PS).

LIMITATIONS

The cross-sectional design limited the ability to ascertain causal relations. Besides, the findings may not be generalized to all regions of China due to the heterogeneity of the study population.

CONCLUSIONS

Left-behind children under three years old in rural China were at high risk of SDD, while a substantial proportion of their caregivers had depressive symptoms. Caregivers' depressive symptoms may negatively affect the SDD of left-behind children through caregivers providing less early stimulation and responsive care.

The impact of women's off-farm employment on depressive symptoms: Evidence from rural China

While China's economy has grown rapidly in recent decades, urban-rural inequalities in mental health have persisted, and depression is more prevalent among rural women. Using a nationally-representative survey data in China, this paper investigates the impact of women's off-farm employment on their depressive symptoms. Results from instrumental variable and individual fixed effects estimation show that women's participation in off-farm employment leads to a significant reduction in depressive symptoms. We further take into account the confounding effects of working conditions, and the main results are robust. Moreover, off-farm employment enhances women's mental health mainly through pathways including increased absolute income, higher self-perceived relative income, more frequent healthy behaviors, increased likelihood of health investment, and obtaining more formal social support. Further evidence suggests that the depression-reducing effect of off-farm employment is more effective for those with more severe depressive symptoms, middle-aged and elderly persons, and women with lower body mass index. The findings have important implications for preventing depressive disorders and improving mental health in China and other developing countries.

Impact of an Early Childhood Development Intervention on the Mental Health of Female Caregivers: Evidence from a Randomized Controlled Trial

Investing in early childhood development is an effective way to enhance human capital accumulation. Caregivers' mental health is one of the most important factors influencing children's development. Previous studies have found that mental health issues in caregivers are widespread all over the world, especially in low- and middle-income countries. In this study, we explored the effects of the "Integrated Program for Early Childhood Development" on the mental health of female caregivers in Southwest China through a randomized intervention trial, with infants aged 5-25 months and their caregivers as the target subjects. The heterogeneity of the effects of different characteristics of the caregivers and the mechanism of the intervention effect were also analyzed. Primary caregivers were provided comprehensive early development interventions for the children in the treatment group via bi-weekly home visiting activities and monthly family group activities. The results showed that the prevalence of depression, anxiety, and stress symptoms among female caregivers in this rural area were 32%, 42%, and 30%, respectively. Whether the child was breastfed, parent's age, parent's education level, primary caregiver type, the ratio of the number of months the mother was at home full time to the child's age, the grandmother's rearing ability, and the family asset index were the factors influencing the mental health of female caregivers. The intervention significantly increased the proportion of depressive symptoms in 28% of the grandmothers. It significantly reduced the anxiety symptoms of daughters-in-law not from the local town, while the social interactions of both local and non-local daughters-in-law were significantly improved.

Prevalence and predictors of depressive symptoms among married Egyptian women: a multicenter primary healthcare study

BACKGROUND

Depression affects about 3.8% of the world's population. Although marriage may contribute to subjective well-being, some marital variables could increase women's risk for depression. This study aimed to determine the prevalence of depressive symptoms and their correlates among married females attending primary healthcare facilities.

METHODS

A cross-sectional study was conducted on a purposive sample of 371 married women at the primary healthcare centers, Assiut Governorate, Upper Egypt. In this study, an interviewer-administered questionnaire was used for data collection. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and marital satisfaction using the ENRICH Marital Satisfaction Scale (EMS). Standardized measurements of weight and height were performed.

RESULTS

According to the PHQ-9 diagnostic criteria, the prevalence of depressive symptoms among the studied married females was 30.2%. The significant predictors of depressive symptoms were advanced husbands' ages, living with an extended family, exposure to spousal verbal violence, high body weight, and low marital satisfaction levels.

CONCLUSIONS

Approximately one-third of married Egyptian women experienced depressive symptoms. In addition to high body weight, some social and marital factors contributed to the increase in women's vulnerability to depressive symptoms. Egyptian primary healthcare physicians should be trained to identify females with depressive symptoms and refer them to specialists if need be. To combat depression in women, it may be helpful to construct qualified marital counseling centers. This may improve marital satisfaction, decrease the negative consequences of spousal violence, and ensure the value of independence for new families.

[Relationship between social support and depression among older people from elderly care social organizations in Anhui Province, China]

OBJECTIVE

To examine the relationship between absent social support and depression among older adults from elderly care social organizations in Anhui Province, China.

METHODS

A cross-sectional study using a multi-stage stratified random sampling method was conducted in six selected cities of Anhui Province, China. A linear regression model was employed to estimate the association between absent social support and depression.

RESULTS

All in all, 1167 older people were included. Social support and the three dimensions studied were all negatively correlated with depression. These findings suggest that older people from elderly care organizations, who reported higher social support, were less likely to develop depression. This association also existed after stratified analysis in different areas: household (urban/rural), age and gender.

DISCUSSION

A higher level of social support was correlated with lower chances of experiencing depression. These findings are consistent with the majority of previous literature having reported on social support among elderly populations. However, some of our findings differ from those of other studies.

CONCLUSIONS

Our study suggests that improved social support could help to prevent depression among older adults.

Prevalence, causes, and impact of self-reported vision impairment among older people in China: Findings from the China health and retirement longitudinal study

This article investigated the prevalence, causes, and impact of self-reported vision impairment among older people in China. A total of 12,910 participants aged ⩾50 years were included in this study from China Health and Retirement Longitudinal Study (CHARLS) over the periods of 2011, 2013, and 2015. All data were reported by participants via a self-reported questionnaire. Distance vision was assessed by asking if they could see the face of a person on the other side of the street. Near vision was assessed by asking if they could read ordinary newspaper. Depressive symptoms were evaluated by 10-item Center for Epidemiological Studies Depression Scale. The analysis method included the χ2 – square distribution test and multiple regression analysis. This article first found that prevalence of self-reported vision impairment was much higher in rural than in urban areas; in urban areas, females had a greater chance of being affected than males, and for both sexes, it increases with increasing age. Second, some factors found are significantly associated with increased vision impairment rates, include increasing age, female gender, rural residents, elementary-level education, unmarried individuals, and non-agricultural occupations. Third, the leading cause of vision impairment was a refractive error and the most common causes of vision impairment include cataracts and glaucoma. Fourth, vision impairment was significantly associated with falls and depressive symptoms and has a negative effect on the quality of life of older Chinese. The article concluded that older people with self-reported vision impairment were relatively low and it is majorly caused by refractive error. Older people with distance vision impairment and near vision impairment were more likely to report falls and depressive symptoms in the future. In line with these findings, a couple of policy recommendations for further research were made.

Factors associated with symptoms of poor mental health among women factory workers in China's supply chain

OBJECTIVE

Foreign direct investment (FDI) to China has motivated increased labor migration to export processing zones (EPZs). Work environments with high occupational stress, such as production line jobs typical in EPZs, have been associated with adverse mental health symptoms.

METHODS

A cross-sectional survey that examined occupational stress and symptoms of poor mental health was implemented among Chinese women factory workers in three electronic factories in the Tianjin Economic-Technological Development Area. Symptoms of mental health measured in the survey were hopelessness, depression, not feeling useful or needed, and trouble concentrating. Crude and adjusted prevalence odds ratios and their 95% confidence intervals were calculated with logistic regression.

RESULTS

Responses were collected from 696 women factory workers. Participants were aged 18-56 years (mean 28 ± 5.8), 66% of whom were married and 25% of whom were migrants. Nearly 50% of participants reported at least one symptom of poor mental health. After adjusting for covariates associated with each outcome in the bivariate analysis, high job strain was associated with hopelessness (OR 2.68, 95% CI 1.58, 4.56), not feeling useful (OR 2.05, 95% CI 1.22, 3.43), and feeling depressed (OR 1.78, 95% CI 1.16, 2.72).

CONCLUSION

This study expands on the international body of research on the well-being of women working in the global supply chain and provides evidence on the associations between occupational stressors, migration, and social support on symptoms of poor mental health among women workers. Future research to better understand and improve psychological health and to prevent suicide among workers in China's factories is critical to improve the health of China's labor force.

"Whose Fault Is It?" How Rural Chinese Women Explain Intimate Partner Violence: A Qualitative Study

Women are often the victims of intimate partner violence (IPV). Though China has established its first statute against domestic violence, the service developments for victims fall behind. It is important to assess community members' perceptions of what causes IPV to create interventions to prevent and address IPV. This study completed the Short Explanatory Model Interview (SEMI) among a subset sample from a large epidemiology study in rural Sichuan China. The social ecological model was applied to analyze qualitative interviews. Among 339 participants, the average age was 46.01 ± 12.42 years old. There were 31.86% of them had been educated, 14.75% of them had migrant worker partners, and 49.26% of them had experienced violence from their partners in the last year. There were 252 participants attributed IPV to individual factors, and they primarily discussed the social characteristics, behaviors, personalities or even health problems of the husband or the wife in the vignette. Under this theme, there were 86 participants blaming the victim for being anxious, social disconnectedness or lazy; and there were 166 participants blaming to the perpetrator being abusive, irresponsibility, lack of understanding, and cheating. There were 44 women believed the cause was relational, in which there were 41 participants attributed the problem to the broken relationship between the couple and three participants attributed to the lack of support. There were 28 participants believed the cause was communal and societal, such as being poor, family problems, fate, and believed IPV was a common scene. There were 15 participants could not identify the cause of IPV. These participants usually provided very brief responses and barely had insight on violent behaviors or confidence in discussing the cause. Our findings offer a direction for understanding the rural Chinese women's beliefs about the etiology of IPV to better develop interventions which must consider raising a public awareness campaign about the risk factors of IPV and focus on reducing self-blame among victims.

Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol

INTRODUCTION

The postdischarge suicide risk among psychiatric patients is significantly higher than it is among patients with other diseases and general population. The brief contact interventions (BCIs) are recommended to decrease suicide risk in areas with limited mental health service resources like China. This study aims to develop a postdischarge suicide intervention strategy based on BCIs and evaluate its implementability under the implementation outcome framework.

METHODS AND ANALYSIS

This study will invite psychiatric patients and family members, clinical and community mental health service providers as the community team to develop a postdischarge suicide intervention strategy. The study will recruit 312 patients with psychotic symptoms and 312 patients with major depressive disorder discharged from Shenzhen Kangning Hospital (SKH) in a Sequential Multiple Assignment Randomised Trial. Participants will be initially randomised into two intervention groups to receive BCIs monthly and weekly, and they will be rerandomised into three intervention groups to receive BCIs monthly, biweekly and weekly at 3 months after discharge according to the change of their suicide risk. Follow-ups are scheduled at 1, 3, 6 and 12 months after discharge. With the intention-to-treat approach, generalised estimating equation and survival analysis will be applied. This study will also collect qualitative and quantitative information on implementation and service outcomes from the community team.

ETHICS/DISSEMINATION

This study has received ethical approval from the Ethics Committee Review Board of SKH. All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations. A project report will be submitted to the National Natural Science Foundation of China as the concluding report of this funded project, and to the mental health authorities in the Shenzhen to refine and apply evidence-based and pragmatic interventions into health systems for postdischarge suicide prevention.

TRIAL REGISTRATION NUMBER

NCT04907669.

Food security mediates the decrease in women's depressive symptoms in a participatory nutrition-sensitive agroecology intervention in rural Tanzania

OBJECTIVE

To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women's depressive symptoms.

DESIGN

We used annual longitudinal data (four time points) from a cluster-randomised effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project. Structural equation modelling estimation of total, natural direct and natural indirect effects was used to investigate food security's role in the intervention's impact on women's risk of probable depression (Center for Epidemiologic Studies Depression Scale > 17) across 3 years.

SETTING

Rural Singida, Tanzania.

PARTICIPANTS

548 food insecure, married, smallholder women farmers with children < 1 year old at baseline.

RESULTS

At baseline, one-third of the women in each group had probable depression (Control: 32·0 %, Intervention: 31·9 %, P difference = 0·97). The intervention lowered the odds of probable depression by 43 % (OR = 0·57, 95 % CI: 0·43, 0·70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0·90, 95 % CI: 0·83, 0·95).

CONCLUSIONS

This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women's depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e. improvements in mental health; changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women's well-being in farming communities.

Implementing a New Tool to Predict the Risk of Intimate Partner Violence in Rural China

Most of current scales for assessing intimate partner violence (IPV) were developed for Western populations. The Chinese Risk Assessment Tool for Victims (CRAT-V) was a new scale evaluating the risk of IPV, which was developed based on Chinese populations in the context of Chinese culture. To determine whether the CRAT-V could add further value to research involving IPV and violence against women in rural China, we sought to implement the CRAT-V and to explore its factor structure among a rural population in the mainland of China. This study included women from rural Sichuan Province of China, who aged 16 years and older, had been living locally for at least 2 years, and reported that they were married or in a relationship in the preceding year. A total of 670 participants completed the CRAT-V during the field survey. We utilized exploratory factor analysis to validate the fact structure of CRAT-V. The Cronbach's alpha of the CRAT-V was 0.90, indicating good reliability. The CRAT-V reported that 45.07% (302/670) of participants were in risk of IPV, and the risk was higher in women who were 16 to 29 years old, having 7 years and higher education, and living in stem families. The CRAT-V fit a 5-factor model including healthy relationship, jealous feeling, jealous reaction, stressful living condition, and sexual abuse. Our findings provided support for using the CRAT-V as a culturally sensitive measure to predict the risk of experiencing IPV in China, and lend insights into factors that may contribute to timely IPV prevention and intervention.

Objective Work-Related Factors, Job Satisfaction and Depression: An Empirical Study among Internal Migrants in China

This study examines the associations between objective work-related factors, job satisfaction and depression among migrants in China. Data from a representative sample of Chinese migrants named Management and Services of Migrants Study (MSMS) were used after excluding 1068 self-employed participants. We employed multivariate linear regression analysis. Depression was measured by the Centre for Epidemiologic Study Depression (C-ESD) scale. Objective work-related factors included firm size, job classification, mode of employment, working hours per week, union membership and working overtime compulsorily. Measurement of job satisfaction was derived from the Job Descriptive Index. We found that migrants in the sales/services sector and the clerical/technical/managerial sector had more depressive symptoms compared with those in the manufacturing/transportation sector. Working more than 55 h per week was associated with more depressive symptoms. Working overtime compulsorily and joining a labour union were all associated with more depressive symptoms. In addition, job satisfaction was negatively associated with depressive symptoms. The research findings on the relationship between work-related factors and depressive symptoms may serve as a guide for vocational rehabilitation counselling programs and for further research on depression in workplaces.

The impact of intimate partner violence on the trajectory of perinatal depression: a cohort study in a Chinese sample

Abstract.

AIMS

Intimate partner violence (IPV) is an important risk factor for perinatal depression (PND). But IPV's impact on the natural prognosis of PND symptoms is not well understood. We tested two hypotheses: (1) pregnant women with IPV experiences will exhibit more severe PND symptoms than women without IPV experience; (2) IPV experience will impede the recovery prognosis of PND. We also explored the contribution of IPV to PND comparing with other risk factors.

METHOD

The sample is comprised of 813 pregnant women followed through perinatal period in Hunan, China. We assessed IPV experience using items from the Short Form of the Revised Conflict Tactics Scale (CTS2S), and PND symptoms via the Edinburgh Postnatal Depression Scale (EPSD). We conducted Linear Mixed-effects Model to compare the trajectories of PND symptoms between victims and non-victims and a multistage Generalised Estimating Equations Model to explore salient factors on the trajectory of PND symptoms.

RESULTS

There were 90 participants (11.07%) who reported IPV experience in the past 12 months. With respect to physical, psychological and sexual violence, the prevalence was 4.55% (37/813), 9.23% (75/813) and 2.34% (19/813). Victims reported more severe PND symptoms (t = 5.30, p < 0.01) and slower decreasing slope of trajectories (t = 28.89, p < 0.01). The PND trajectory was associated with IPV experience (OR = 3.78; 95% CI 1.39-10.26), social support (OR = 0.93; 95% CI 0.88-0.97), positive coping strategies (OR = 0.85; 95% CI 0.80-0.91), negative coping strategies (OR = 1.25; 95% CI 1.14-1.37) and monthly income of $0.15-$298.36 (compared to no income, OR = 0.0075; 95% CI 0.00052-0.11).

CONCLUSIONS

The findings suggest the reported prevalence of IPV is lower in Hunan than most of the previous studies during perinatal period in other provinces of China, and IPV victimisation is associated with increased severity and slowed prognosis of PND symptoms. Future studies that screen for victimisation and establish its explicit mechanism to the poorer prognosis of PND symptoms would benefit the prevention and treatment of PND.

Prevalence and socio-demographic correlates of major depressive disorder in older adults in Hebei province, China

BACKGROUND

Major depressive disorder (MDD) is common among older adults. The epidemiology of MDD is greatly influenced by sociocultural and economic factors. This study examined the 1-month and lifetime prevalence of MDD and its socio-demographic correlates in older adults living in Hebei province, an agricultural area of China.

METHODS

Multistage, stratified, random sampling was administered between April and August 2016. The diagnosis of MDD was established with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) Axis I Disorders.

RESULTS

A total of 3911 participants were enrolled. The 1-month and lifetime prevalence of MDD in older adults was 2.0% (95%CI: 1.6-2.4%) and 3.4% (95%CI: 2.8-4.0%), respectively. Multivariable logistic regression analyses revealed that female gender [P < 0.001, adjusted odds ratio (aOR) = 2.6, 95%CI: 1.53-4.53], presence of comorbid major medical conditions (P < 0.001, aOR = 4.8, 95%CI: 2.17-10.39) and family history of psychiatric disorders (P = 0.013, aOR = 3.4, 95%CI: 1.30-8.96) were independently and significantly associated with higher odds of MDD.

CONCLUSION

The prevalence of MDD in older adults in Hebei province, China, was lower than most findings in China and other countries. Nevertheless, continued surveillance of elderly depression in China along with the development of primary, secondary and tertiary preventative interventions for the elderly with MDD is indicated.

The association between emotional and instrumental social support and risk of suicide death: A population-based cohort study

Suicide is an important public health issue and previous studies have suggested that social support can one preventive factor. However, the association between emotional and instrumental social support and suicide death has not been investigated in detail. The purpose of this study was to investigate the association between each type of social support and suicide death based on a population-based cohort study. We analyzed follow-up data for 47,223 subjects (aged ≥40 y) participating in a community-based, prospective cohort study. At the baseline, the subjects were asked five questions about social support. The end point of the study was suicide mortality, based on data from the National Vital Statistics. The Cox model was used to estimate the multivariate-adjusted hazard ratios of suicide death. In addition, stratified analysis was conducted to test the interaction of each type of social support with gender (male/female) and age (<65/≥65 y) separately. Among 320,880 person-years of follow-up, 90 cases of suicide death were documented. There were significant association between instrumental social support and lower risk of suicide death, and the hazard ratio was 0.60 (95% CI: 0.38-0.94). Emotional social support was also associated with a lower risk of suicide death, but not to a significant degree, and the hazard ratio was 0.70 (95% CI: 0.42-1.17). It is suggested that instrumental social support was significantly associated with a lower risk of suicide death, and emotional social support tended to be associated with a lower risk of suicide death.

Caregiver Depression and Early Child Development: A Mixed-Methods Study From Rural China

Half of rural toddlers aged 0-3 years in China's Qinling Mountainous region are cognitively delayed. While recent studies have linked poor child development measures to the absence of positive parenting behaviors, much less is known about the role that caregiver depression might play in shaping child development. In this paper, a mixed methods analysis is used to explore the prevalence of depression; measure the association between caregiver depression and children's developmental delays, correlates of depression, and the potential reasons for caregiver depression among women in rural China. The analysis brings together results from a large-scale survey of 1,787 caregivers across 118 villages in one northwestern province, as well as information from in-depth interviews with 55 female caregivers from these same study sites. Participants were asked to respond to the Depression, Anxiety and Stress Scale-21 (DASS-21) as well as a scale to measure children's social-emotional development, the Ages and Stages Questionnaire: Social-Emotional (ASQ-SE). We also administered a test of early childhood development, the Bayley Scales of Infant and Toddler Development (BSID-III), to all of the study household's infants and toddlers. The results show that the prevalence of depression may be as high as 23.5 percent among all female caregivers (defined as scoring in the mild or higher category of the DASS-21). Grandmothers have higher prevalence of depression than mother caregivers (p < 0.01). Caregiver depression also is significantly associated with a 0.53 SD worsening of children's social-emotional development (p < 0.01) and a 0.12 SD decrease in children's language development (p < 0.05). Our qualitative findings reveal six predominant reasons for caregiver depression: lack of social support from family and friends; the burden of caregiving; lack of control and agency within the household; within-family conflict; poverty; the perception of material wealth as a measure of self-worth. Our findings show a serious lack of understanding of mental health issues among rural women, and suggest that rural communities could benefit greatly from an educational program concerning mental health and its influence on child development. Our findings confirm the need for a comprehensive approach toward rural health, with particular attention paid to mental health awareness and support to elderly caregivers.

Factors associated with life satisfaction among married women in rural China: a cross-sectional study based on large-scale samples

Purpose

The living environment in rural China may predispose individuals there to low life satisfaction (LS). This study aims to evaluate factors that affect LS among married women in rural China.

Materials and methods

This cross-sectional study was conducted in rural Liaoning Province in China, in 2015. Out of 3,900 married women, 3,385 (86.8%) completed a questionnaire survey. LS was assessed using the Satisfaction with Life Scale (SWLS), with 35 as the maximal possible score. Stress (quantified by the Perceived Stress Scale [PSS]), resilience (assessed by the Ego-Resiliency Scale [ERS]), and demographic and living/health conditions factors were collected through self-reported questionnaires. Hierarchical multiple regression and structural equation modeling were used to explore the contributing and mediating factors related to LS.

Results

The overall LS score was 18.94±4.96. A younger age, lower monthly income, presence of chronic diseases, left-behind status, and sense of marriage insecurity were negatively associated with LS. Perceived stress was a strong predictor of LS, as it explained 19.7% of the variance. Higher levels of resilience were related to higher levels of LS, explaining 15.4% of the variance. Resilience partially mediated the relationship between stress and LS for rural residents in China.

Conclusion

Overall, married women living in rural China experienced a relatively low level of LS. The construction of additional recreational facilities, provision of convenient access to medical information, facilitation of communication between couples, reduction of stress, and development of resilience could all be beneficial intervention strategies to improve LS for these rural residents.

Prevalence of childhood trauma and correlations between childhood trauma, suicidal ideation, and social support in patients with depression, bipolar disorder, and schizophrenia in southern China

BACKGROUND

Childhood trauma has long-term adverse effects on physical and psychological health. Previous studies demonstrated that suicide and mental disorders were related to childhood trauma. In China, there is insufficient research available on childhood trauma in patients with mental disorders.

METHODS

Outpatients were recruited from a psychiatric hospital in southern China, and controls were recruited from local communities. The demographic questionnaire, the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and the Social Support Rating Scale (SSRS) were completed by all participants, and the Self-rating Idea of Suicide Scale (SIOSS) were completed only by patients. Prevalence rates of childhood trauma were calculated. Kruskal-Wallis test and Dunnett test were used to compare CTQ-SF and SSRS scores between groups. Logistic regression was used to control demographic characteristics and examine relationships between diagnosis and CTQ-SF and SSRS scores. Spearman's rank correlation test was conducted to analyze relationships between suicidal ideation and childhood trauma and suicidal ideation and social support.

RESULTS

The final sample comprised 229 patients with depression, 102 patients with bipolar, 216 patient with schizophrenia, and 132 healthy controls. In our sample, 55.5% of the patients with depression, 61.8% of the patients with bipolar disorder, 47.2% of the patients with schizophrenia, and 20.5% of the healthy people reported at least one type of trauma. In patient groups, physical neglect (PN) and emotional neglect (EN) were most reported, and sexual abuse (SA) and physical abuse (PA) were least reported. CTQ-SF and SSRS total scores, and most of their subscale scores in patient groups were significantly different from the control group. After controlling demographic characteristics, mental disorders were associated with higher CTQ-SF scores and lower SSRS scores. CTQ-SF scores and number of trauma types were positively correlated with the SIOSS score. Negative correlations existed between SSRS scores and the SIOSS score.

LIMITATIONS

Our sample may not be sufficiently representative. Some results might have been interfered by demographic characteristics. The SIOSS was not completed by controls. Data from self-report scales were not sufficiently objective.

CONCLUSIONS

In southern China, childhood trauma is more severe and more prevalent in patients with mental disorders (depression, bipolar disorder and schizophrenia) than healthy people. Among patients with mental disorders in southern China, suicidal ideation is associated with childhood trauma and poor social support.

Using confirmatory factor analysis to explore associated factors of intimate partner violence in a sample of Chinese rural women: a cross-sectional study

OBJECTIVES

To estimate the prevalence of intimate partner violence (IPV) among a sample of rural Chinese women and to explore associated factors.

DESIGN

Cross-sectional study.

SETTING

Rural areas of Guangyuan City, Sichuan, China.

PARTICIPANTS

We recruited 1501 women, aged 16 years and older, who had been living locally for at least 2 years and reported being married or in a relationship during the past 12 months. They were among a sample of 1898 potential participants from our larger parent study on the prevalence of depressive-distress symptoms.

METHODS

Participants completed demographic and social economic measures, the Short Form of the Revised Conflict Tactics Scale and the Duke Social Support Index. We applied χ² test, analysis of variance and confirmatory factor analysis for analysis.

RESULTS

The overall prevalence of IPV in the past 12 months was 29.05%; the prevalence of physical, psychological and sexual violence was 7.66%, 26.58% and 3.20%, respectively. The overall prevalence was highest among women aged 16-29 years, and was more common among those without a high school diploma and who saw their family's financial status as very poor or stagnant. Women who were not victims of IPV had higher levels of social support. Confirmatory factor analysis showed that the total effects of social support on physical, psychological and sexual violence were -0.12, -0.35 and -0.12, respectively. The indirect effects of objective economic status on physical, psychological and sexual violence were -0.047, -0.014 and -0.047, respectively, but the total effect was not significant. The indirect effect of education on psychological violence was -0.056.

CONCLUSION

IPV is common in rural Guangyuan. Our data are comparable with the findings from north-west of China. Social support is an important protective factor. Future work is needed to develop, test and later disseminate potential IPV interventions, with a focus on building actual and perceived supportive social networks.

Depression as seen through the eyes of rural Chinese women: Implications for help-seeking and the future of mental health care in China

BACKGROUND

As part of a larger epidemiological study of depression among rural Chinese women, we sought to understand their explanatory models of depression. We explored how participants describe depression, to what cause they attribute depression, and what sources of treatment they would recommend.

METHODS

Participants first were assessed with the Center for Epidemiological-Depression scale (CES-D), with a cut-point of 16 or greater indicative of depression. The Short Explanatory Model Interview (SEMI), a semi-structured questionnaire, was our primary tool for exploring participants' explanatory models relating to a vignette describing a rural Chinese woman with depression.

RESULTS

Among the 416 women who consented and completed the SEMI, 277(66.6%) reported that the woman in the vignette had something wrong with her health. Among these, only 8(2.9%) women provided a specific psychiatric name for the condition, while 150(54.2%) provided non-specific psychiatric disease names or affective symptoms, and 78(28.2%)of the sample provided physical disease names. Participants attributed causes largely to internal factors (41.5%) or external factors (36.8%). In terms of help-seeking, 101(36.4%) said the woman in the vignette should see a doctor, 70(25.3%) indicated that she should solve the problem herself, and 42(15.2%) recommended seeking support from family members and friends. We did not find any differences in recognition, causal attribution, and help-seeking suggestions between women with a CES-D ≥ 16 and those with CES-D < 16.

LIMITATIONS

The use of a vignette to prompt discussion was not the same as talking about real-life personal situations.

CONCLUSION

Our results point to potential challenges and opportunities that lay ahead as China develops mental health services in its vast rural areas among women who may be at risk for developing depression. We found that our participants often attributed their symptoms to internal or external social causes, and preferred not speaking with family members and friends. Our findings suggest that rural Chinese women may be reticent to recognize or describe categorical concepts such as "depression" as a health problem, and they invite further consideration about how best to develop new health services in China's rural regions.

Caregiving burden and depression in paid caregivers of hospitalized patients: a pilot study in China

Background

Caregiving burden and depression in family caregivers have been investigated, but little is known about how they affect paid caregivers. The aim of this study was to investigate caregiving burden and depression in paid caregivers of hospitalized patients.

Methods

A cross-sectional survey study was conducted in a tertiary referral hospital (Chengdu, China) that enrolled 108 paid caregivers who worked in the inpatient department. The Caregiver Burden Inventory (CBI) and the Center for Epidemiologic Studies Depression (CES-D) scale were incorporated into a self-developed questionnaire to gather demographic information on the following four aspects: general, work, income, and family.

Results

The mean total CBI score was 29.7 ± 12.5. The time-dependence burden had the highest score of 15.3 ± 4.0, which was followed by the physical burden score of 6.5 ± 4.6, developmental burden score of 3.7 ± 4.0, social burden score of 3.2 ± 4.0, and emotional burden score of 2.4 ± 3.1. Multiple linear regression analysis showed that a higher CBI was associated with a longer time as a paid caregiver [β=7.041, 95% Confidence Interval (CI):1.935 to 12.974, p = 0.009], lower income satisfaction (β= − 6.573, 95% CI: -11.248 to −3.020, p = 0.001), and higher frequency of meeting with their relatives (β=7.125, 95% CI: 2.019 to 12.456, p = 0.006). The mean CES-D score was 11.9 ± 8.7, and significant depression was found in 28 (25.9%) paid caregivers according to the CES-D score ≥ 16 cut-off. There was a moderate positive correlation between the CBI and CES-D scores (Pearson’s r = 0.452, p < 0.001).

Conclusions

A high caregiving burden was commonly observed in paid caregivers of hospitalized patients in China, as was a high prevalence of depression symptoms. Several associated factors were identified that could be areas for future interventions.

Gender Differences in Depressive Symptoms Among HIV-Positive Concordant and Discordant Heterosexual Couples in China

HIV seropositive individuals and their heterosexual partners/spouses, either seropositive or seronegative, are facing several mental health challenges. The objective of this study was to examine gender differences in depressive symptoms among HIV-positive concordant and HIV-discordant couples. We identified heterosexual couples from participants of a randomized controlled trial conducted in Anhui province, China. A total of 265 couples, comprising 129 HIV+ male/HIV- female couples, 98 HIV- male/HIV+ female couples, and 38 HIV-positive concordant couples, were included in the analyses. We collected data using the computer-assisted personal interview method. We used a linear mixed-effects regression model to assess whether gender differences in depressive symptoms varied across couple types. HIV-positive women reported a significantly higher level of depressive symptoms than their partners/spouses. HIV-positive women with HIV-positive partners had higher depressive symptoms than those with HIV-negative partners, whereas HIV-positive men reported similar levels of depressive symptoms regardless of their partners' serostatus. Among the concordant couples, those with the highest annual family income showed the greatest gender differences in depressive symptoms. We suggest that family interventions should be gender- and couple-type specific and that mental health counseling is warranted not only for HIV-positive women but also for HIV-negative women in an HIV-affected relationship.

Depressive symptoms and positive affect in Chinese and United States breast cancer survivors: a cross-cultural comparison

PURPOSE

Research in the area of cultural response pattern on questionnaires in the oncological setting and direct cross-cultural comparisons are lacking. This study examined response pattern in the reporting of depressive symptoms in Chinese and US women with breast cancer. We hypothesized that Chinese women are less likely to endorse positive affect items compared to their US counterparts. Additionally, we explored cultural differences in the association between positive affect and QOL.

METHODS

Secondary analyses of baseline assessments of two mind-body intervention studies for women with breast cancer undergoing radiotherapy in the USA (N = 62) and China (N = 97) are presented. All participants completed measures of depressive symptoms (CES-D) and cancer-specific QOL (FACT-B). We examined cultural differences on positive and negative affect items on the CES-D.

RESULTS

Controlling for demographic factors, ANCOVA revealed a significant cultural difference in positive (F = 7.99, p = 0.005) but not negative affect (p = 0.82) with Chinese women reporting lower positive affect compared to US women (Chinese = 6.97 vs. US = 8.31). There was also a significant cultural difference (F = 3.94, p = 0.03) in the association between positive affect and QOL so that lower positive affect was more strongly associated with worse emotional well-being in Chinese (beta = 0.57, p < 0.0001) than US women (beta = 0.35, p < 0.01).

CONCLUSIONS

Chinese women reported lower positive affect compared to US women and lower levels of positive affect were more strongly associated with worse QOL. Special attention is needed when examining mental health in different cultures to ascertain effective delivery of clinical services to those in need.

Experiences of Depression in Low Income Elderly Women

PURPOSE

The purpose of this qualitative research was to understand the meaning of the depression in low income elderly women.

METHODS

Participants were 15 elderly women, aged between 60 and 80 who were registered in two senior welfare centers in Seoul. Data were collected from June to December, 2012 after having obtained consent from participants. In-depth interviews were done with open-ended questions about their depression experiences, which were audio-taped and transcribed with verbatim. Data were analyzed using qualitative content analysis to discover the categories considering their relationships and abstractness.

RESULTS

Depressions of aged women were a part of the their life throughout their long lived hardship and was implied unhealed wounds within the relationship. Participants did not know how to manage with depression symptoms that they tried to overcome individually but due to decreased activities and interpersonal relationships, their depressions were tended to continue. They have tried to get out from depressive symptoms, but it still remains unseen shadow of mind.

CONCLUSION

This results suppose that social support and aged welfare policy included reliving the economical difficulty and improving relationships will be provided to manage the depression for low income elderly women.

Parental social networks during childhood and offspring depression in early adulthood: a lifecourse approach

BACKGROUND

Little is known on how parental social relationships may affect their children's mental health. We sought to examine the relation between parental social relationship characteristics and subsequent offspring depression in young adulthood.

METHODS

We used 2009 Trajectoires Épidémiologiques en Population (TEMPO) study data from 1087 French young adults ages 22 to 35 and parental data from the corresponding Gaz et Eléctricité (GAZEL) study in 1991. Multivariable logistic regression was used to examine parental social networks, quality of parental relationships, and reciprocity of parental social support measured in 1991 in relation to offspring depression in young adulthood measured using the Adult Self Report in 2009. Analyses were stratified by participant sex.

RESULTS

In adjusted models, daughters of parents who reported giving more support to others than they received had 1.72 higher odds (95% CI, 1.09-2.70) of depression in young adulthood. Daughters of parents who were unsatisfied with their social relationships had 2.14 (95% CI, 1.22-3.76) higher odds of depression. Among male participants, there was no statistically significant association between parental relationship satisfaction, reciprocity of parental exchanges, and depression.

CONCLUSIONS

Parental relationships during mid-childhood have long-term associations with offspring depression. Results suggest that enhancing social support for parents may have positive implications for their children's mental health.

Type D personality, illness perception, social support and quality of life in continuous ambulatory peritoneal dialysis patients

The previous studies reported Type D was associated with poor quality of life (QoL), increased psychological distress, and impaired health status in cardiac patients. The aim of this study is to assess the relationships among Type D personality, illness perception, social support, and investigate the impact of Type D personality on QoL in continuous ambulatory peritoneal dialysis (CAPD) patients. Type D personality was assessed by the Chinese 14-item Type D Personality Scale (DS14). Illness perceptions were assessed using the Chinese version of the Brief Illness Perception Questionnaire (B-IPQ). Social support status was assessed by the well-validated social support rating scale (SSRS). Patients' QoL was assessed by using Medical Outcomes Short Form 36 (SF-36), respectively. The Type Ds had significantly lower objective support score (8.18 ± 2.56 vs. 9.67 ± 3.28, p = 0.0001), subjective support score (6.71 ± 2.0 vs. 7.62 ± 1.93, p = 0.0001) and utilization of social support score (6.76 ± 2.0 vs. 7.61 ± 1.94, p = 0.0001) than that of the non-type Ds. Type Ds believed their illness had much more serious consequences (7.67 ± 2.64 vs. 6.27 ± 3.45, p < 0.001), and experience much more symptoms that they attributed to their illness (6.65 ± 2.54 vs. 7.31 ± 2.36, p = 0.023). Significant differences were found between Type Ds and non-Type Ds in PCS (40.53 ± 6.42 vs. 48.54 ± 6.21 p < 0.001) and MCS (41.7 1 ± 10.20 vs. 46.35 ± 9.31, p = 0.012). The correlation analysis demonstrated that Type D was negatively associated with physical component score (PCS) (r = -0.29, p < 0.01), mental component score (MCS) (r = -0.31, p < 0.01), and social support (r = -0.24, p < 0.001). Using multiple linear regression analysis, we found that Type D personality was independently associated with PCS (β = -0.32, p < 0.001) and MCS (β = -0.24, p < 0.001). Type D personality was a predictor of poor QoL in CAPD patients. The current study is the first to identify a strong association among Type D, illness perceptions, social support and QoL in CAPD patients. The worse illness perceptions and lower social support level therefore represent possible mechanisms to explain the link between Type D and poor QoL in CAPD patients.