Prenatal anxiety and the associated factors among Chinese pregnant women during the COVID-19 pandemic--a smartphone questionnaire survey study.

BACKGROUNDS: The uncertainty of the pandemic of Coronavirus Disease 2019 (COVID-19) brought about tremendous psychological harm for pregnant women, causing their high rates of prenatal anxiety. The impacts of COVID-19 pandemic and symptoms of pregnant status are highly linked with prenatal anxiety. Whereas, self-efficacy and support from family and friends could attenuate the development of prenatal anxiety. Thus, the purpose of the study is to evaluate the prevalence of prenatal anxiety and its influence factors among pregnant women during the pandemic of COVID-19 in Shenyang, China. METHODS: A cross-sectional study with face-to-face interview between April 24, 2020 and May 3, 2020 during the COVID-19 pandemic was applied among pregnant women in Shenyang Women's and Children's Hospital. Chi-square tests were calculated to determine the differences in prenatal anxiety among categorical variables. Multivariable logistic regression was employed to investigate the risk factors of prenatal anxiety. RESULTS: The percentage of prenatal anxiety (GAD-7 score ≥ 7) among pregnant women during the pandemic of COVID-19 was 34/304 (11.18%). Logistic regression indicated that vomiting (OR 4.454, 95% CI 1.113-17.821) and feeling susceptible to SARS-CoV-2 infection (OR 2.966, 95% CI 1.151-7.642) increased the odds of prenatal anxiety. Satisfaction with medical care (OR 0.303, 95% CI 0.113-0.813) and self-efficacy (OR 0.253, 95% CI 0.100-0.639) decreased the odds of prenatal anxiety. High monthly income (OR 0.246, 95% CI 0.078 ~ 0.780) reduced the chances of suffering from prenatal anxiety. CONCLUSION: The pregnant women in China exerted a higher prevalence of prenatal anxiety during the COVID-19 pandemic than that without COVID-19 pandemic. Effective management on symptoms of pregnant status should be delivered to relieve prenatal anxiety for the pregnant women. Furthermore, interventions on self-efficacy enhancement and high-quality medical prenatal care should be provided to prevent from the susceptibility of SARS-CoV-2 infection and reduce prenatal anxiety.

Resilience mediates the effect of self-efficacy on symptoms of prenatal anxiety among pregnant women: a nationwide smartphone cross-sectional study in China.

BACKGROUND: Prenatal anxiety is one of the most prevalent mental disorders during pregnancy. This study assessed the prevalence of prenatal anxiety and examined whether resilience could play the mediating role in the association between self-efficacy and symptoms of prenatal anxiety among pregnant women in China. METHODS: A nationwide smartphone cross-sectional study was carried out in three cities (Shenyang of Liaoning Province, Zhengzhou of Henan Province and Chongqing Municipality) in China from July 2018 to July 2019. The questionnaire consisted of questions on demographic characteristics, the Generalized Anxiety Disorder Scale (GAD-7), the Chinese version of General Self-efficacy Scale (GSES), and the 14-item Wagnild and Young Resilience Scale (RS-14). A total of 665 pregnant women were recruited in this study. A hierarchical multiple regression model was employed to explore the associate factors and mediators of symptoms of prenatal anxiety. A structural equation model was employed to test the hypothesis that resilience mediates the association between self-efficacy and symptoms of prenatal anxiety. RESULTS: The prevalence of symptoms of prenatal anxiety was 36.4% in this study. Self-efficacy was negatively correlated with symptoms of prenatal anxiety (r = -0.366, P < 0.01). Resilience had a significant positive correlation with self-efficacy (r = 0.612, P < 0.01) and had a negative correlation with symptoms of prenatal anxiety (r = -0.427, P < 0.01). The hierarchical multiple regression model indicated that self-efficacy and resilience were the main factors associated with symptoms of prenatal anxiety and contributed to 11.9% and 6.3% to the variance of symptoms of prenatal anxiety, respectively. Resilience served as a mediator between self-efficacy and symptoms of prenatal anxiety (a*b = -0.198, Bias-corrected and accelerated bootstrap 95% Confidence interval: -0.270, -0.126). CONCLUSIONS: Self-efficacy was a negative predictor of symptoms of prenatal anxiety among pregnant women. Moreover, resilience mediated the relation between self-efficacy and symptoms of prenatal anxiety among pregnant women in China. It was observed in this study that psychological interventions might be beneficial for pregnant women to relieve symptoms of prenatal anxiety through improved self-efficacy and resilience.

Recovery experiences mediate the effect of burnout on life satisfaction among Chinese physicians: a structural equation modeling analysis.

PURPOSE: Recovery experiences not only make it possible for individuals to restore their energy resources and return to pre-stressor levels but also contribute to the formation of their subjective well-being. This paper investigates the effect of burnout on life satisfaction among Chinese physicians who are frequently confronted with a considerable number of work-related stressors and examines the mediating role of recovery experiences in the relationship between burnout and life satisfaction. METHODS: A total of 642 physicians working in five public tertiary hospitals in China responded to a self-administered questionnaire including demographic information, the Satisfaction with Life Scale, the Maslach Burnout Inventory-General Scale, and the Recovery Experience Questionnaire. Hierarchical multiple regression analysis was conducted to test the incremental variance of any given set of independent variables. Structural equation modeling was employed to test the presumed relationships between variables involved. Asymptotic and resampling strategies were used to examine the mediating effects of recovery experiences in the relationship between burnout and life satisfaction. RESULTS: Burnout and recovery experiences were important predictors of life satisfaction and the direct effect of burnout on life satisfaction was statistically significant and negative and the path coefficients of burnout with life satisfaction were significantly decreased when recovery experiences were modeled as mediators. CONCLUSION: Findings of the study highlight the importance of promoting recovery experiences to reduce burnout and improve life satisfaction among physicians rather than focusing on the less easily modifiable work-related stressors.

Coping Styles for Mediating the Effect of Resilience on Depression Among Medical Students in Web-Based Classes During the COVID-19 Pandemic: Cross-sectional Questionnaire Study.

BACKGROUND: Due to strict, nationwide, comprehensive COVID-19 protective measures, including home quarantine, all Chinese medical students began taking web-based classes beginning in the spring semester of 2020. Home quarantine, web-based classes, and the stress surrounding the COVID-19 pandemic may have triggered an increased incidence of mental health problems among medical students. Although there have been increasing amounts of literature on depression among medical students, studies focusing on positive psychological resources, such as resilience during the COVID-19 pandemic, still need to be expanded. OBJECTIVE: This study aims to assess depression among medical students who are taking web-based classes during the COVID-19 pandemic and to investigate the role of coping styles as mediators between resilience and depression. METHODS: A cross-sectional study of 666 medical students involving stratified sampling in Shenyang, Liaoning Province, China, was completed between March 20 and April 10, 2020. The participants responded to a self-administered, smartphone-based questionnaire, which included the Patient Health Questionnaire-9, Simplified Coping Style Questionnaire, and Ego Resilience 89 Scale. Hierarchical linear regression and structural equation modeling were used in this study. RESULTS: The prevalence of depression among the participants was 9.6% (64/666) in this study. The regression analysis revealed that grade (the year in which the medical student was in training) (P=.013), how well students adapted to web-based classes (P<.001), their levels of resilience (P=.04), and their coping styles were independent predictors for depression (P<.001). Resilience and positive coping styles were negatively related to depression (resilience: P=.04; positive coping styles: P<.001), and negative coping styles were positively related to depression (P<.001). The structural equation modeling analysis showed that the effect of resilience on depression was partially mediated by coping styles (P=.007). CONCLUSIONS: In this study, it was found that the prevalence of depression was slightly low and coping styles mediated the association between resilience and depression among medical students during the COVID-19 pandemic. These findings have significant implications for future studies. Future studies and interventions should aim to improve resilience and promote positive coping styles.

Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study.

BACKGROUND: The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic. OBJECTIVE: This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic. METHODS: From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants' levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety. RESULTS: This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety. CONCLUSIONS: This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety.

Positive effects of resilience and self-efficacy on World Health Organization Quality of Life Instrument score among caregivers of stroke inpatients in China.

AIM: Stroke is one of the major health challenges affecting life expectancy and quality of life around the world. However, there is limited reporting on the status of some caregivers, including Chinese caregivers of stroke inpatients. Limited information is available on evaluations using the World Health Organization Quality of Life Instrument (WHOQOL) and the effects of resilience and self-efficacy on WHOQOL score. Therefore, we conducted research to assess the role of resilience on the WHOQOL and to investigate the role of self-efficacy as a mediator between resilience and WHOQOL score among Chinese caregivers of stroke inpatients. METHODS: This cross-sectional study to gather data from north-east and south-east China was conducted from June 2019 to October 2019. Over 380 caregivers of stroke inpatients at two general public hospitals were interviewed face-to-face. About 305 caregivers (80.26%) completed the questionnaire, which included the Ego Resilience Scale, the General Self-Efficacy Scale, and the brief version of the WHOQOL and asked about demographic characteristics. This study also examined factors associated with WHOQOL score and used linear regression analysis and structure equation modelling to construct direct and indirect models, respectively. RESULTS: After adjustment for demographic characteristics, both resilience and self-efficacy were positively associated with all WHOQOL domains. Structure equation modelling revealed that self-efficacy mediated the relationship between resilience and WHOQOL score among caregivers of stroke inpatients. CONCLUSION: Chinese caregivers of stroke inpatients exhibited good social health but poor physical, psychological, and environmental health. It is necessary for promoting resilience and improving WHOQOL score through the mediating effect of self-efficacy. These results suggest that interventions in health care focused on both enhancing resilience and providing self-efficacy training could effectively improve WHOQOL score.

Optimizing quality of life among Chinese physicians: the positive effects of resilience and recovery experience.

BACKGROUND: The physicians in Chinese public tertiary hospitals are exposed to considerable work-related stress because of the imperfections in hierarchical diagnosis and treatment systems, such as the imperfections in referral system and low quality in diagnosis and treatment outcomes in community hospitals, for which most patients visit tertiary hospitals firstly in order to access a higher quality health care service. As a consequence, the health-related quality of life (HRQOL) for Chinese physicians is compromised. However, there is a paucity of research exploring physicians' physical and mental health and positive psychological resource factors such as resilience and recovery experience (RE) which can help maintain well-being. Thus, this study aims to assess HRQOL of Chinese physicians and explore the relationship between HRQOL, resilience, and RE. METHODS: A cross-sectional study with proportional sampling was conducted in Shenyang, China from February to October 2018. A total of 642 physicians in five public tertiary hospitals were enrolled in this study. They completed the smartphone questionnaire including the 36-item Short-Form Health Survey (SF-36), the EGO Resilience Scale, and Recovery Experience Questionnaire (REQ). Linear regression analysis was conducted to explore the factors associated with HRQOL. Structural equation modeling (SEM) was used to evaluate the mediating effect of RE on the relationship between resilience and HRQOL. RESULTS: Regression analysis indicated that resilience and RE were the most important contributors to both physical and mental component summary scores. SEM showed that RE partially mediated the relationship between resilience and HRQOL in these physicians. CONCLUSION: Chinese physicians exhibited good physical health, but poor mental health. Resilience could help maintain and improve HRQOL through the partial mediating effect of RE. Resilience and RE enhancement should be provided to effectively manage work-related stress and improve both physical and mental health for the long-term well-being of physicians.

Psychological Impact of Health Risk Communication and Social Media on College Students During the COVID-19 Pandemic: Cross-Sectional Study.

BACKGROUND: The outbreak of COVID-19 began in 2019 and is expected to impact the psychological health of college students. Few studies have investigated the associations among health risk communication, social media, and psychological symptoms during a major pandemic. OBJECTIVE: The aim of this research was to assess the prevalence of psychological symptoms among college students and explore their associations with health risk communication and social media. METHODS: A web-based survey was distributed through the Wenjuanxing platform among Chinese college students from March 3-15, 2020. In addition to demographics, information on health risk communication and social media was collected, and the Symptom Checklist 90 Phobia and Health Anxiety Inventory subscale was used to assess psychological symptoms among 1676 college students in China. Multivariable logistic regression was performed to examine these independent risk factors. RESULTS: The prevalence of panic and health anxiety was 17.2% (288/1676) and 24.3% (408/1676), respectively. Regarding risk communication, understanding the risk of COVID-19 (odds ratio [OR] 0.480, 95% CI 0.367-0.627) was a protective factor against panic. Knowledge of prognosis (OR 0.708, 95% CI 0.551-0.910), preventive measures (OR 0.380, 95% CI 0.195-0.742), and wearing face masks (OR 0.445, 95% CI 0.230-0.862) were shown to be protective factors in predicting health anxiety. Perceived lethality (OR 1.860, 95% CI 1.408-2.459), being affected by the global spread (OR 1.936, 95% CI 1.405-2.669), and impact on social contacts (OR 1.420, 95% CI 1.118-1.802) were identified as significant risk factors associated with health anxiety. In terms of social media, trust in mainstream media (OR 0.613, 95% CI 0.461-0.816) was considered to be a protective factor against health anxiety. CONCLUSIONS: There was a high prevalence of psychological symptoms among college students. Health risk communication and social media use were important in predicting psychological symptoms, especially health anxiety. Scientific and evidence-based information should be reported by social media platforms. Web-based consultation and intervention measures should be the focus of future studies.

Depression and Psychological-Behavioral Responses Among the General Public in China During the Early Stages of the COVID-19 Pandemic: Survey Study.

BACKGROUND: The COVID-19 pandemic has recently spread dramatically worldwide, raising considerable concerns and resulting in detrimental effects on the psychological health of people who are vulnerable to the disease. Therefore, assessment of depression in members of the general public and their psychological and behavioral responses is essential for the maintenance of health. OBJECTIVE: This study aimed to assess the prevalence of depression and the associated factors among the general public during the early stages of the COVID-19 pandemic in China. METHODS: A cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression.aA cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression. RESULTS: The prevalence of depression (PHQ-9 score ≥10) among the general public during the COVID-19 pandemic was 182/1342 (13.6%). Regression analysis indicated that feeling stressed, feeling helpless, persistently being worried even with support, never feeling clean after disinfecting, scrubbing hands and items repeatedly, hoarding food, medicine, or daily supplies, and being distracted from work or study were positively associated with depression, while social support and being calm were negatively associated with depression. CONCLUSIONS: The general public suffered from high levels of depression during the early stages of the COVID-19 pandemic. Thus, COVID-19-related mood management and social support should be provided to attenuate depression in the general public.

Perceived stress and social support influence anxiety symptoms of Chinese family caregivers of community-dwelling older adults: a cross-sectional study.

AIM: Chinese family members always take care of older adults because of obligations stemming from the culture of filial piety and the paucity of a long-term care system. These caregivers usually perceive high levels of stress that could compromise their psychological health and consequently result in anxiety impairments. This study aimed to assess the anxiety symptoms of Chinese family caregivers of older adults, explore factors associated with these symptoms, and provide theoretical evidence on improving their mental health. METHODS: A questionnaire survey was conducted face-to-face with caregivers of community-dwelling older adults. The survey asked about the demographic characteristics of the caregivers and older adults, objective caregiving loads, and social support and included the Zung Self-Rating Anxiety Scale and the Perceived Stress Scale. RESULTS: Anxiety symptoms were present in 43.1% of caregivers. The R2 changes indicated that the incremental variance explained by each block of variables was 9.8%, 5.0%, 0.7%, 17.6%, and 2.1% for demographic characteristics of caregivers, demographic characteristics of older adults, objective caregiving loads, perceived stress, and social support, respectively. Perceived stress was the strongest predictor of anxiety symptoms, and social support was positively associated with anxiety symptoms. Factors associated with caregivers' anxiety symptoms were having a chronic disease and living with older adults, as well as older adults' weight, hours of sleep, and education level. CONCLUSION: Chinese family caregivers of older adults experienced higher levels of anxiety symptoms. Perceived stress could aggravate these symptoms, but social support might assist in alleviating anxiety symptoms from the stress of caregiving.

Cost analysis of a store-and-forward teledermatology consult system in Philadelphia.

BACKGROUND: Store-and-forward (SAF) teledermatology (TD) has the potential to increase access to timely, high-quality care for underserved populations. However, the cost-effectiveness of TD for underserved populations is uncertain. OBJECTIVE: This study evaluates the potential cost savings associated with an SAF TD program implemented for an underserved population in the city health clinics of urban Philadelphia. METHODS: We performed a retrospective analysis of SAF TD consultations for 700 outpatients managed in 12 Philadelphia primary care clinics. Primary care providers were asked to specify a treatment plan, as well as the type of care for the patient, in the absence of the TD service. Analysis compared the cost of each patient case with use of the TD consult model versus with conventional care. RESULTS: In all, 27% of in-person dermatology clinic visits (189 of 700) and 3.29% of emergency room visits (23 of 700) were avoided by using TD. Compared with conventional care, TD had a mean expected cost savings of $10.00 to $52.65 per TD consult. In sensitivity analyses, these estimated savings remained positive across a range of parameters. LIMITATIONS: The cost analysis relies on several assumptions regarding the cost of care, and indirect costs were not included. CONCLUSION: TD can be a cost-saving model while increasing access to dermatologic care.

Prevalence and related factors of depressive symptoms in hemodialysis patients in northern China.

BACKGROUND: To determine the prevalence of depressive symptoms and to explore related factors of depressive symptoms in hemodialysis (HD) patients in northern China. METHODS: We used a cross-sectional research design to recruit 227 chronic kidney disease (CKD) patients who were undergoing HD treatment in northern China during December, 2012 to March, 2013. The Chinese edition of the Center for Epidemiologic Studies Depression (CES-D) was used to measure depressive symptoms. Information on quality of life (QOL), activities of daily living (ADL), social support status, coping style, self-efficacy, ego resiliency and demographic characteristics was all collected by face to face interview. Multivariate logistic regression analysis was used to explore related factors of depressive symptoms. RESULTS: The prevalence of depressive symptoms among HD patients was 29.1%. Patients with a lower mood have worse ADL and QOL than patients with better mood. Patients with a lower mood have got less social support than patients with better mood, including both family support and outside family support. For coping style, patients with a lower mood were more inclined to choose "acceptance-resignation" coping style than patients with better mood, while the result is opposite in "avoidance" coping style. And patients with a better mood have better self-efficacy and ego resiliency than patients with lower mood. Multivariate logistic regression analyses revealed that ADL (OR = 1.124, p = 0.002), family support (OR = 0.867, p = 0.021), "acceptance-resignation" coping style (OR = 1.228, p = 0.022), and ego resiliency (OR = 0.944, p = 0.021) were associated with low mood independently. CONCLUSIONS: The prevalence of depressive symptoms is high in CKD patients on HD in northern China. activities of daily living, family support, "acceptance-resignation" coping style and ego resiliency were independently associated with depressive symptoms.

Quality of Life of Transgender Women From China and Associated Factors: A Cross-Sectional Study.

INTRODUCTION: Transgender women are exposed to stressful situations such as gender transition and transition-related discrimination because of their limited acceptance by the general population and inadequate government-supplied resources, which can compromise their quality of life (QOL). However, there is a paucity of research on the QOL of transgender women from China. AIMS: To assess the QOL of transgender women from China and explore its associated factors. METHODS: A cross-sectional study was performed by convenience sampling in Shenyang, China from January 2014 to July 2014. This sample consisted of 209 transgender women. The women were interviewed face-to-face to assess their QOL and related factors using the 36-item Short-Form Health Survey, the Adult Dispositional (Trait) Hope Scale, and the EGO Resilience Scale. MAIN OUTCOME MEASURES: Response scores were calculated based on a questionnaire design. Hierarchical multiple regression analysis was performed to explore factors associated with QOL. RESULTS: Transgender women who used hormone therapy reported significantly lower levels of the physical component summary (PCS) and the mental component summary (MCS) compared with those who did not (P < .05). Hierarchical multiple regression analysis showed that of the 23 independent variables, 8 were significantly associated with the PCS and 9 were significantly associated with the MCS. The PCS was significantly and negatively associated with age and being chased or insulted by law enforcement officials. The PCS was positively associated with not using hormone therapy, having no casual partners, less discrimination from friends, knowledge of HIV prevention, hope, and resilience. Educational level and being chased or insulted by law enforcement officials were negatively associated with the MCS, whereas not using hormone therapy, having no regular partners or casual partners, less discrimination from friends, less social discrimination, knowledge of HIV prevention, and hope were positively associated with the MCS. CONCLUSION: Chinese transgender women reported high levels of physical QOL but low levels of mental QOL. Their mental QOL was more pronounced than their physical QOL. Transition status and sexual partnership played the most important roles in physical and mental health. Furthermore, mental QOL was best predicted by assessing positive capabilities, such as levels of hope. Future interventions should focus on recognizing transition status and identifying risky sexual partnerships, especially for the casual partners involved in these partnerships. In addition, positive capabilities are needed to ameliorate the negative impact of transition on QOL in Chinese transgender women.

Relationship between occupational stress and burnout among Chinese teachers: a cross-sectional survey in Liaoning, China.

OBJECTIVES: Teaching has been reported to be one of the most stressful occupations in the world. Few studies have been conducted to explore the effects of occupational stress on burnout among teachers in developing countries. This study aimed to explore the relationship between occupational stress and burnout among teachers in primary and secondary schools in the Liaoning Province of China. METHODS: A questionnaire that assessed occupational stress comprised of Karasek's job content questionnaire (JCQ), Siegrist's effort-reward imbalance questionnaire (ERI), and burnout assessed by the Maslach Burnout Inventory-General Survey was distributed to 681 teachers in primary and secondary schools. A total of 559 effective respondents became our final study subjects. Hierarchical linear regression and logistic regression analyses were performed through the use of SPSS 17.0 to explore the association between occupational stress and burnout. RESULTS: A high level of emotional exhaustion was significantly associated with high extrinsic effort, high overcommitment, low skill discretion, and high job demand. A high level of cynicism was associated with low reward, low skill discretion, high overcommitment, and low supervisor support. The low level of professional efficacy was associated with low coworker support, low reward, low skill discretion, and high job demand. Compared to the JCQ, the ERI was more likely to explain the burnout of teachers in our study. CONCLUSIONS: Occupational stress proved to be associated with dimensions of burnout among Chinese teachers. It is important for administrators of primary and middle schools to note that strategies to decrease teachers' occupational stress seem to be crucial to enhance physical and mental health of teachers in China.

Agreement between parents and adolescents on emotional and behavioral problems and its associated factors among Chinese school adolescents: a cross-sectional study.

BACKGROUND: Most studies about informant agreements on adolescents' emotional and behavioral problems have been conducted in Western countries, but this subject has not been well researched in China. The aim of this study was to evaluate the pattern of parent-adolescent agreement on adolescents' problems and its associated factors among school-age adolescents in China. METHODS: This cross-sectional study was conducted in November and December of 2010. A questionnaire including the Child Behavior Checklist (CBCL), the Youth Self-Report (YSR), the Family Environment Scale (FES) and the characteristics of the child (age and gender), parents (parent-adolescent relationship and parental expectations) and family (family structure, negative life events) was distributed to our study population. A total of 2,199 Chinese adolescents (aged 11-18) from 15 public schools in Liaoning Province, who completed the questionnaire, became our final participants. Pearson's correlation coefficient was used to assess parent-adolescent agreement, and linear regression analysis was used to explore the associated factors of parent-adolescent discrepancies on emotional and behavioral problems. RESULTS: The parent-adolescent agreement on emotional and behavioral problems was high (mean r = 0.6). The scores of YSR were higher than those of CBCL. Factors that increased informant discrepancies on emotional and behavioral problems were boys, older age, the experience of negative life events, low levels of cohesion and organization, and high levels of conflict in the family. CONCLUSIONS: A high level of parent-adolescent agreement on emotional and behavioral problems was found. Adolescents reported more problems than their parents did. Family environment is an important factor to be considered when interpreting informant discrepancies on the mental health of Chinese adolescents.

The mediating role of self-efficacy in the relationship between Big five personality and depressive symptoms among Chinese unemployed population: a cross-sectional study.

BACKGROUND: Besides the rapid growth of economy, unemployment becomes a severe socio-economic problem in China. The huge population base in China makes the unemployed population a tremendously huge number. However, health status of unemployed population was ignored and few studies were conducted to describe the depressive symptoms of unemployed individuals in China. This study aims to examine the relationship between Big five personality and depressive symptoms and the mediating role of self-efficacy in this relationship. METHODS: This cross-sectional study was performed during the period of July to September 2011. Questionnaires consisting of the Center for Epidemiologic Studies Depression Scale (CES-D), the Big Five Inventory (BFI) and the General Self-efficacy Scale (GSE), as well as demographic factors, were used to collect information of unemployed population. A total of 1,832 individuals (effective response rate: 73.28%) became our subjects. Hierarchical linear regression analyses were performed to explore the mediating role of self-efficacy. RESULTS: The prevalence of depressive symptoms was 67.7% among Chinese unemployed individuals. After adjusting for demographic characteristics, extraversion, agreeableness and conscientiousness were all negatively associated with depressive symptoms whereas neuroticism was positively associated with depressive symptoms. The proportion of mediating effect of self-efficacy in the relationship between extraversion/agreeableness/conscientiousness/neuroticism and depressive symptoms was 25.42%, 10.91%, 32.21% and 36.44%, respectively. Self-efficacy is a mediator in the relationship between extraversion/agreeableness/conscientiousness/neuroticism and depressive symptoms. CONCLUSION: Self-efficacy partially mediated the relationship between Big five personality and depressive symptoms among Chinese unemployed individuals. Interventions that focus on both individuals' personality and self-efficacy may be most successful to reduce depressive symptoms of unemployed individuals.

Prevalence and associated factors of depressive symptoms among Chinese male correctional officers.

OBJECTIVES: Chinese correctional officers (COs) consist of frontline COs in direct contact with the prisoners and non-frontline COs (including administrative staff and professionals). Male COs compose the majority of Chinese COs, especially for frontline COs. Although they are quite susceptible to depressive symptoms due to highly risky and stressful working environment, few studies focus on this issue. This study aimed to evaluate the prevalence of depressive symptoms and to explore its associated factors among Chinese male frontline and non-frontline COs. METHODS: This cross-sectional study was performed during the period of March/April 2011. The study population comprised of 1,900 male COs in four male prisons in a province of northeast China. A questionnaire including the Center for Epidemiological Studies Depression Scale, demographic factors, work conditions, effort-reward imbalance questionnaire was distributed to these COs. A total of 1,494 effective respondents became our subjects (981 frontline COs and 513 non-frontline COs). Frontline and non-frontline COs were analyzed separately. RESULTS: Approximately 61.4% of Chinese male COs had depressive symptoms (63.5% in frontline COs and 57.3% in non-frontline COs). Multivariate logistic analyses showed that effort-reward ratio, overcommitment, chronic disease, and threat perception were associated with depressive symptoms in frontline and non-frontline COs, whereas weekly work time had an effect only in frontline COs. CONCLUSIONS: Chinese male COs, especially frontline COs, might have high-level prevalence of depressive symptoms. Moreover, this study had identified important risk factors that might be important in planning strategies for prevention and intervention of depressive symptoms for Chinese male COs.

Outpatient depression current care expenditure changes in Liaoning Province from 2015 to 2020: a study based on the "system of health accounts 2011".

Introduction: Depression is the leading cause of disability worldwide and has become a health issue of global concern. Based on the "System of Health Accounts 2011" (SHA 2011) for patients with depression, this paper studies the changes in the current curative expenditure (CCE) of outpatient depression in Liaoning Province, China, and provides policy recommendations. Method: A stratified multistage random sample of 56,994 patients with depression included from 1,227 healthcare facilities in Liaoning Province were included. The significance of differences in variables within groups was analyzed by univariate analysis (including descriptive statistics analysis, Mann-Whitney U test and Kruskal-Wallis H test), and factors influencing depression outpatient CCE were analyzed by multiple linear regression analysis and constructing structural equation models (SEM). Results: The CCE of outpatient depression was ranging from CNY 75.57 million to CNY 100.53 million in 2015-2020, with the highest of CNY 100.53 million in 2018, CNY 103.28 million in 2019. Medical expenditures are mainly concentrated in general hospitals and provincial healthcare institutions, accounting for about 90% of all provincial scope expenditures. The multiple regression results show that provincial healthcare institutions, purchase of drug, select medical treatment for depression, general hospitals and urban employees' health insurance are the main influencing factors for depression outpatient CCE. The results of SEM show that insurance status negative impact outpatient expenditure. Conclusion: Health insurance is an important factor in equitable access to healthcare resources for patients, and medication expenditure is the influential factor affecting the high expenditure of outpatient clinics. It is of great importance to reduce the medical burden of patients by increasing the coverage of medical insurance, increasing the proportion of bills that are eligible for reimbursement, and improving the system by guaranteeing the supply of psychotropic medication.

The prevalence of depression and anxiety among Chinese adults with cancer: a systematic review and meta-analysis.

BACKGROUND: A lot of empirical studies have been conducted to evaluate the prevalence of depression and anxiety among Chinese adults with cancer. We aimed to conduct a meta-analysis in order to evaluate the prevalence and odds ratios of depression and anxiety in Chinese adults with cancer compared with those without. METHODS: The three most comprehensive computerized Chinese academic databases-CNKI, Wangfang and Vip databases-were systematically screened through September 2012. PubMed and Web of Science (SCIE) were also searched from their inception until September 2012 without language restrictions, and an internet search was also used. Case-control studies assessing the prevalence of depression and anxiety among Chinese adults with cancer were analyzed. Study selection and appraisal were conducted independently by three authors. The non-weighted prevalence, pooled random-effects estimates of odds ratio (OR) and 95% confidence intervals (CI) were all calculated. RESULTS: Seventeen eligible studies with a total of 3497 subjects were included. The prevalence of depression and anxiety were significantly higher in adults with cancer compared with those without (Depression: 54.90% vs. 17.50%, OR = 7.85, 95% CI = 5.56-11.07, P = 0.000; Anxiety: 49.69% vs. 18.37%, OR = 6.46, 95% CI = 4.36-9.55, P = 0.000), the same situation was also observed in subgroup of control groups, assessment methods and cancer types. Although no difference of depression was observed in studies utilizing clinical diagnosis compared with self-report, the OR of anxiety in adults with cancer compared with those without was higher in studies utilizing clinical diagnosis (OR = 8.42, 95% CI = 4.83-14.70) than self-reports (OR = 5.83, 95% CI = 3.64-9.34). The ORs of depression and anxiety in cancer patients compared with disease group (Depression: OR = 6.03, 95% CI = 4.23-8.61; Anxiety: OR = 4.40, 95% CI = 3.05-6.36) were lower than in those compared with normal group (Depression: OR = 13.58, 95% CI = 6.26-29.46; Anxiety: OR = 15.47, 95% CI = 10.00-23.95). CONCLUSIONS: We identified high prevalence rates of depression and anxiety among Chinese adults with cancer. The findings support that the prevalence of depression and anxiety among adults with cancer should receive more attention in Chinese medical settings.