[Analysis of the Status of Depression and the Influencing Factors in Middle-Aged and Older Adults in China].

OBJECTIVE: To understand the status of depression and its influencing factors in the middle-aged and older adult populations aged 45 and above in China on the basis of data from the 2018 China Family Panel Studies (CFPS), and to provide empirical evidence for the improvement of the mental health of the middle-aged and older adults and the alleviation of their depressive symptoms. METHODS: The source of the research data was the 2018 CFPS. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the prevalence of depression. A two-level two-category unconditional logistics regression method was used to analyze the influencing factors of the prevalence of depressive symptoms. RESULTS: The 80th percentile interval score of depression score was used as the critical value, and the detection rate of depressive symptoms was 23.61%. It was more likely for women to suffer from depressive symptoms than it was for men. Widowed individuals were at an even higher risk for having depression. The more education one had, the lower the possibility of developing depression. Middle-aged and older adults in rural areas were more likely to suffer from depression. Middle-aged and older adults with chronic diseases and self-rated poor health were at higher risk of depression. Sleep time is a protective factor that suppressed symptoms. After controlling the above-mentioned individual-level factors, middle-aged and older adults in coastal and economically developed areas were less likely to suffer from depression than those from inland and economically underdeveloped areas did. CONCLUSION: The health departments concerned should focus on the depressive symptoms of women, widowed individuals, and middle-aged and older adults with chronic diseases. In rural areas and underdeveloped inland regions, the state should invest more health resources in the prevention and improvement of depression among middle-aged and older adults.

[Influence of Social Capital on the Life Quality of Patients with Chronic Diseases-A Study Based on EQ-5D-5L Scale].

OBJECTIVE: To explore the influence of social capital on the quality of life of patients with chronic non-communicable diseases. METHODS: A multi-phase stratified cluster sampling method was adopted to select the survey respondents. Professionally trained surveyors made home visits in order to conduct face-to-face questionnaire surveys in person. European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) and a self-developed social capital scale were used to investigate the quality of life and social capital of the respondents. Factor analysis and Cronbach's α coefficient test were done to verify the reliability and validity of the self-developed social capital scale. The χ 2 test and robust Tobit regression model were used to analyze the impact of social capital on the quality of life of patients with chronic non-communicable diseases. RESULTS: The self-developed social capital scale showed excellent performance. The Cronbach's α coefficient was 0.728, the KMO value was 0.716, and the result of Bartlett's test of sphericity was statistically significant ( P<0.001), indicating that the data were well suited for factor analysis. The four common factors cumulatively explained 68.27% of the total variation. The health utility value of the survey respondents was 0.869±0.181. Those who could walk around, shower and dress themselves, and perform usual activities without any problem accounted for 75.70%, 80.10%, and 74.1% of the respondents, respectively. Those who had pain or discomfort and anxiety or depression, with no self-perceived problem were 43.40% and 58.90%, respectively. In the EQ-5D-5L scale, the self-rated health influencing factors of the physical health dimension were community safety and interpersonal network relationships. The influencing factors of social function health was community safety and mental health was affected by community safety, community trust and interpersonal network relationships. When community safety improved by one level, the health utility value of patients with chronic non-communicable diseases increased by 0.046, and when interpersonal network relationships improved by an additional level, their health utility value increased by 0.037. CONCLUSION: The main problem of the quality of life of patients with chronic non-communicable diseases was found in the mental health dimension. In the process of treating chronic non-communicable diseases, attention should also be given to psychological counseling. Community safety and interpersonal network relationships are the protective factors for self-rated health status. Providing a safe community environment and expanding interpersonal networks help improve the health of patients.

[Evaluation of Reliability and Validity of EQ-5D-5L Based on Residents in Southwest China].

OBJECTIVE: To explore the reliability and validity of the EQ-5D-5L scale in the population of southwest China. METHODS: The internal consistency reliability is measured by Cronbach's α coefficient and the structural validity is measured by factor analysis. The difference in health utility value of different characteristic populations is compared by t test and analysis of variance. RESULTS: Cronbach's α coefficient was 0.857. Exploratory factor analysis extracts two common factors whose cumulative contribution rate is 77.311%. The first common factor represents mobility, self-care and uaual activities. The second common factor represents pain/discomfort and anxiety/depression. The results of confirmatory factor analysis showed that the correlation of the two common factors was 0.659, the average variance of the first common factor was 0.862 and the combination reliability was 0.949, and the average variance extracted of the second common factor was 0.587 and the composite reliability was 0.739. The factor loadings for mobility, self-care and uaual activities on the first common factor were 0.871, 0.945 and 0.967, respectively. The loadings for pain/discomfort and anxiety/depression on the second common factor were 0.708 and 0.820, respectively. CONCLUSION: EQ-5D-5L has good reliability and validity when it is applied to the measurement of healthy life quality of residents in Southwest China.

[The Study of the Relationship Between Community Social Capital and Quality of Life among the Middle-aged and Elderly Rural-to-Urban Residents].

OBJECTIVE: To analyze the relationship between community social capital and quality of life among the middle-aged and elderly rural-to-urban residents, and to provide the policy reference for improving the health status. METHODS: A multi-stage random sampling method was used to select the research objects. Univariate analysis and logistic regression model were used to explore the effect of social capital on quality of life among the middle-aged and elderly rural-to-urban urbanized residents. RESULTS: The scores of self-rated physical health and mental health in the rural-to-urban residents were lower than those of urban residents ( P<0.05). The total score of community social capital, community participation and community cohesion in the rural-to-urban residents were lower than those of urban residents ( P<0.05). The result of multivariate analysis showed that community attachment and community cohesion were the protective factors of physical health ( P<0.05), and community cohesion was the protective factor of mental health ( P<0.05). CONCLUSION: There is a correlation between community belonging, community cohesion and quality of life among the elderly rural-to-urban residents. Attention should be paid to the promotion of community social capital so as to improve the health status of middle-aged and elderly rural-to-urban residents.

[The Effects of Social Capital on Depressive Symptoms of Elderly Patients with Chronic Diseases in Urbanized Communities].

OBJECTIVE: To understand the effects of social capital on depressive symptoms of elderly patients with chronic diseases in urbanized communities, and to explore preventive measures to promote their mental health. METHODS: A multi-stage stratified cluster sampling method was used to extract 740 elderly patients with chronic diseases in the urbanized communities in Chengdu and Kunming. The questionnaire survey was conducted by using the center of depression rating scale (CES-D) and the self-made social capital scale. Multivariate unconditional logistic regression was used to analyze the impact of urbanized residents' social capital on depressive symptoms. RESULTS: The self-made social capital scale has good reliability and validity. The incidence of depressive symptoms in this study was 24.9%. The incidence of depressive symptoms in elderly females with chronic diseases was higher (P < 0.05); the residents with high "sense of social trust and security" had lower risk of incidence of depressive symptoms 〔odds ratio (OR)=0.489〕; the residents with higher "community belonging" had a lower risk of incidence of depressive symptoms (OR=0.570), and the residents with higher "social support" scores had a lower risk of incidence of depressive symptoms (OR=0.233). CONCLUSION: Targeted measures should be taken to intervene in the social capital factors affecting the depressive symptoms of elderly patients with chronic diseases in urbanized communities to improve their mental health.

[Multilevel Modelling on the Prevalence and Determinants of Depressive Symptoms in Middle and Old-aged Rural-to-urban Immigrants in Chengdu].

OBJECTIVE: To determine the prevalence and determinants of depressive symptoms in middle and old-aged rural-to-urban immigrants in Chengdu. METHODS: A total of 1 645 middle and old-aged rural-to-urban immigrants aged over 45 yr. were selected to participate in a questionnaire survey through a multi-stage random sampling method in Chengdu. Multilevel (households and individuals) models were established to identify predictors of depressive symptoms. RESULTS: About 14.5% of respondents reported depressive symptoms. The multilevel model indicated that family clustering of depressive symptoms existed. Household income and length of urban life at the household level, and age, chronic diseases, smoking, and social support at the individual level were significant predictors of depressive symptoms. CONCLUSION: The prevalence of depressive symptoms in middle and old-aged rural-to-urban immigrants deserves increasing policy attention for the purpose of promoting mental health in the population.

Study on the equity of medical services utilization for elderly enrolled in different basic social medical insurance systems in an underdeveloped city of Southwest China.

BACKGROUND: The equity of medical services utilization for elderly individuals enrolled in different basic social medical insurance systems holds significant meaning for social harmony against a background of demographic aging and a growing wealth gap in China. This study is to explore the equity of the three medical insurance systems in southwest China with the aim of providing recommendations for relevant policy. METHODS: A total of 9600 elderly people insured through basic social medical insurance were selected and interviewed with a questionnaire. This study used a binary logistic regression model to investigate the effect of household income for medical services utilization and adopted a concentration index to measure the inequity of medical services utilization among elderly participants enrolled in different medical insurance categories. RESULTS: Outpatient services utilization was almost identical in the different insurance systems (78.5%, 77.7% and 78.6%). There were no statistically significant differences according to income level in the Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) programs, but in the New Cooperative Medical Scheme (NCMS), higher-income groups tended to utilize more services. The corresponding concentration index (CI) values were 0.0162, 0.0173 and 0.0179 respectively. The NCMS showed a lower hospitalization rate than UEBMI and URBMI (17.7% vs 24.2% and 24.9%). The higher income group utilized hospitalization more, regardless of the insurance system. The corresponding CI values were 0.0817, 0.0605 and 0.0319 respectively. CONCLUSION: The equity of medical services utilization for elderly exist in all three health insurance systems, in particular, the inequities in utilization of hospitalization were more severe than outpatient services. UEBMI and URBMI were better than NCMS in the equity of outpatient services. Although NCMS was more equitable than URBMI and UEBMI in terms of hospitalization, this was based on "overall low utilization of hospitalization regardless of income levels" in NCMS compared with URBMI and UEBMI. The disparities of the three basic social medical insurance systems should be eliminated. For low-income residents, specific insurance policies including reducing deductible, covering more medical service and increasing reimbursement ratio could be considered.

[Prevalence and Determinants of Depressive Symptoms in Middle and Senior Aged Populations with Visual Impairment].

OBJECTIVE: To determine the prevalence and determinants of depressive symptoms in visually impaired mid- and old-aged populations. METHODS: Data were extracted from the 2013 China Health and Retirement Longitudinal Study database. A total of 1 462 mid- and old-aged respondents reported visual problems. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression (CES-D) scale. Chi-square tests and binary logistic regression analyses were performed to identify factors associated with the prevalence of depressive symptoms. RESULTS: The study participants had an average age of (65±10) years. About 45.6% reported depression symptoms,with an average CES-D score of 10±7. The respondents aged between 55 and 64 years [odds ratio (OR)=1.679)],women (OR=1.310),and those who had shorter sleeping (OR=1.570) were more likely to have depressive symptoms than others ( P<0.05). Lower prevalence of depressive symptoms ( P<0.05) was found in the respondents who resided in urban areas (OR=0.480),had no chronic disease (OR=0.534),had no other disabilities (OR=0.570),perceived better general health (OR=0.324),reported better memory (OR=0.380),and expressed better life satisfaction (OR=0.126). CONCLUSION: Visually impaired mid- and old-aged people have high prevalence of depressive symptoms. Age,gender,residency,chronic conditions,self-rated general health,other disabilities,sleeping deprivation,memory,and life satisfaction are determinants of the prevalence of depressive symptoms.

[Equivalence of SF-12v2 and SF-36v2 in Assessing Health Related Quality of Life in a General Population in Chengdu].

OBJECTIVE: To determine the equivalence of SF-12v2 and SF-36v2 for assessing health related quality of life in a general population in Chengdu. METHODS: The equivalence between SF-12v2 and SF-36v2 was assessed using reliability,validity and responsiveness. RESULTS: The eight sub-scales of SF-36v2 had a score ranging from 64.13 to 89.15,compared with a range between 47.45 and 87.92 for SF-12v2. The SF-12v2 had larger standard deviations than the SF-36v2. No floor effects were detected; but ceiling effects were significant in the subscales of physical functioning (PF) ,role-physical (RP),bodily pain (BP),social functioning (SF) and role emotion (RE). The SF-12v2 had higher ceiling effects (56.66%-68.32%) than the SF-36v2 (50.14%-63.87%). The exploratory factor analyses extracted two factors in both cases,representing physical (PCS) and mental health (MCS),respectively. The total variances explained by the common factors reached 64.05% for the SF-36v2 and 55.79% for the SF-12v2. The SF-12v2 PCS and MCS scores explained 91.0% and 80.3% of the total variances of those of the SF-36v2,respectively. The effect size of PCSs ranges from 0.78 to 2.77 in the subpopulations with different health conditions,compared with 0.00-0.57 for MSCs. The relative validity (RV) of PCS-12 to PCS-36 ranged from 0.89 to 0.94,compared with a MCS-12 to MCS-36 range of 0.60-0.75. CONCLUSION: SF-12v2 is reliable and valid as a brief substitute version of SF-36v2 with acceptable responsiveness and equitable structure for assessing health related quality of life in the general population of Chengdu. But sub-scale scores were not recommended when using the SF-12v2 due to reduced precision.

[Health Determinants of Rural Elderly Populations with Different Living Arrangements: a Multilevel Model].

OBJECTIVE: To determine the health and its determinants of rural elderly populations in a city in Sichuan province. METHODS: Data were extracted from a 2015 household survey, containing 7 280 rural participants aged over 60 years. The prevalence of two-week morbidity and chronic conditions were compared among those with different living arrangements. Multilevel models were established to determine the family and individual factors associated with the health status of the respondents. RESULTS: Most respondents (57.0%) lived with a spouse, compared with 15.4% who lived alone. Those who lived alone had higher prevalence of two-week morbidity (48.0%) and chronic conditions (70.0%). The multilevel model indicated a familial clustering effect. Living arrangements and household income were associated with the prevalence of two-week morbidity and chronic conditions, after controlling for variations in age, depression, smoking, drinking, and exercise at the individual level. CONCLUSIONS: The rural elderly people who live alone have poor health status. Household income, age, depression, smoking, drinking and physical exercise are associated with two-week morbidity and chronic conditions.

[Overweight and Obesity among New Urban Migrants in Chengdu and Kunming].

OBJECTIVE: To determine the prevalence of overweight and obesity in new urban migrants. METHODS: A questionnaire survey was conducted on 21 651 urban residents in the downtown and surrounding urban areas of Kunming and Chengdu selected through a multi-stage stratified cluster sampling method. Factors associated with overweight and obesity were identified using Chi-square tests and multivariate logistic regression models. RESULTS: 11 626 people were enrolled. The new urban migrants (n=7 555) had 31.2% overweight and 6.7% obesity, compared with 24.9% and 4.3%, respectively, in the urban residents(n=4 071). Gender, age, educational, marital status and alcohol consumption were associated with overweight and obesity in the new urban migrants. Gender, age, education and alcohol consumption were predictors of overweight and obesity of the urban residents. CONCLUSIONS: Urban new immigrants are more likely to be overweight and obese than urban residents, although predictors for overweight and obesity remain similar.

Correlates of unequal access to preventive care in China: a multilevel analysis of national data from the 2011 China Health and Nutrition Survey.

BACKGROUND: Preventive care has an essential role in reducing income-related health inequalities. Despite a general consensus of the need of shifting focus from disease treatment to wellness and prevention, little is known about inequalities in access to preventive care in China. Our study aimed to explore the inequalities in preventive care usage and factors that were associated with such inequalities among Chinese adults. METHODS: Multilevel logistic regression analyses were performed using national data from the 2011 Chinese Health and Nutrition Survey. The study sample comprised 13,483 adults who were covered by Basic Social Medical Insurance (BSMI). We analyzed individual socioeconomic status (marital status, education attainment, annual household income per capita, and medical insurance) and contextual factors for their influence on preventive care usage (region of residence and type of community) after controlling for health needs (age, sex, and health condition). RESULTS: Out of the participants, 6.9 % received preventive care services over the past four weeks and 3.9 % went for a general physical examination prior to the survey. We noted regional disparities in the overall use of preventive care and specific use of general physical examination, with residents from central and northeastern regions less likely to use preventive care including general physical examination than in the more affluent eastern region. Lower levels of education and income were associated with reduced use of preventive care. Subscriptions to less generous social medical insurance programs such as Urban Resident-based Medical Insurance Scheme or New Rural Cooperative Medical Scheme were associated with decreased specific use of general physical examinations, but not overall use of preventive care. CONCLUSIONS: Inequalities in preventive care usage were evident in China, and were associated with health needs and socioeconomic characteristics. Current health insurance arrangements may fail to reduce inequalities relating to preventive care. A fair and more coherent policy across all BSMI schemes is needed.

[Impact of urbanization on the residents' health service needs and utilization based on the urban and rural integration development].

OBJECTIVE: To explore the impact of urbanization on the residents' health service needs and utilization for the purpose of providing references for health making-decision by analyzing the difference of health service needs and utilization in semi-urban residents, urban residents and rural residents. METHODS: The residents in the three economic zones of Chengdu were selected by stratified ration sampling and interviewed with the questionnaire. RESULTS: The two-week morbidity rate, hospitalization rate, and non clinical visit rate of semi-urban residents were higher than those of other people, and the chronic disease prevalence rate of urban residents was higher. Age, employment status, and the urban-rural identification were the main influential factors of two-week morbidity rate and chronic illness prevalence. After the related factors were controlled, the urban-rural identification was not the impact factor of the health service utilization. CONCLUSION: The urban-rural integration development has promoted the health service accessibility and narrowed the disparity of health to some extent between urban and rural residents. However, the semi-urban residents should be caught a great deal of attention as a special group, and given more employment assistance.

[Culture and quality of life assessment in Chinese populations].

OBJECTIVE: To investigate the impact of cultural factors on quality of life (QOL) and to identify appropriate ways of dividing sub-populations for population norm-based quality of life assessment. METHODS: The WHOQOL-BREF was used as a QOL instrument. Another questionnaire was developed to assess cultural values. A cross-sectional survey was undertaken in 1090 Guangzhou residents, which included 635 respondents from communities and 455 patients who visited outpatient departments of hospitals. Cronbach's a coefficients and item-domain correlation coefficients were calculated to test the reliability and validity of the WHOQOL-BREF, respectively. Student t test, ANOVA and stepwise multiple linear regression analysis were performed to identify the variables that might have an impact on the QOL. Two regression models with and without including cultural variables were constructed, and the extent of impact exerted by the cultural factors was assessed through a comparison of the change of adjusted R square values. RESULTS: A total of 1052 (96%) valid questionnaire were returned. The Cronbach's alpha coefficients of the WHOQOL-BREF ranged from 0.67 to 0.78. Age, education, occupation and family income were correlated with all of the domains of the WHOQOL-BREF. Chronic condition was correlated with physical, psychological, and social relationship domains of the WHOQOL-BREF. Gender was correlated with physical and psychological domains of the WHOQOL-BREF. The multiple regression analysis showed that social and demographic factors contributed to 6.3%, 13.6%, 10.4% and 8.7% of the predicted variances for the physical, psychological, social relationship, and environment domains, respectively. Social support, horizontal collectivism, vertical individualism, escape acceptance, fear of death, health value, supernatural belief had a significant impact on QOL. However, social support was the only one factor that had an impact on all of the four QOL domains. CONCLUSION: It is necessary to divide sub-cultural populations for population norm-based QOL assessment. Further research is needed to develop a practical approach to the sub-cultural population division.

Associations between poor health and school-related behavior problems at the child and family levels: a cross-sectional study of migrant children and adolescents in southwest urban China.

BACKGROUND: Due to urbanization in China, the numbers of migrant children and adolescents in urban environments have increased. Previous studies have indicated that children and adolescents are more likely to suffer from health problems and poor school achievement. The present study identified associations between poor health and school-related behavior problems (ie, learning attitudes and learning disabilities [LL], antisocial behavior and risk behavior [AR], and social adaptation and role function [SR]) at the child and family levels. METHODS: A cross-sectional design was used. Seven hundred and eighty-one participants were recruited in inclusive settings. Correlational analysis was conducted to assess the associations between demographic variables and the primary study variables. Logistic regression analysis was used to determine which study factors were the strongest predictors of general health problems. RESULTS: School-aged migrants who had poorer health tended to be more likely to suffer from school-related behavior problems. Poor health was also found to hinder scholastic achievement in migrant children and adolescents through a higher prevalence of school-related behavior problems, including negative learning attitudes and learning disabilities, antisocial behavior and risk behavior, and social maladjustment. Health risk factors included inappropriate parental education methods, fewer classmates, and less social support. CONCLUSIONS: Health and individual risk factors should be explored further to determine their causal role in migrant children and adolescents with school-related behavior problems. These results have implications for future school health education for these students.

[Assessing quality of life in an urban population in Chengdu using the SF-12].

OBJECTIVE: To assess the health-related quality of life in an urban population in Chengdu China using the SF-12. METHODS: A random sampling strategy stratified by age and sex was adopted to select the participants in Chengdu. A total of 1365 respondents with an age of older than 18 years completed the interviewer-administered SF-12 survey. The physical (PCS) and mental (MCS) component summary measures of the SF-12 were calculated using the standard US scoring method and compared to the urban population norms of Hong Kong and Australia. RESULTS: Similar PCS and MCS scores were obtained for the urban Chengdu population compared to the Hong Kong and Australian population norms, albeit a closer similarity between the Chengdu and Hong Kong populations. The PCS and MCS scores of the SF-12 changed with sex and age. CONCLUSION: The age- and sex-adjusted PCS and MCS scores of the SF-12 in the urban Chengdu population can serve as a reference for future studies using the SF-12 in China.

[An eight-year study on maternal and child health service utility in Sichuan province].

OBJECTIVE: To evaluate the effect of intervention on factors influencing the health service utility regarding Maternal and Child Health (MCH) under the 'Qinba Health Project' in Sichuan province. METHODS: 15 towns in 5 programmed counties were selected, using the method of 'random layer sampling' to be the trial group. With similar MCH status and comparable to the trial group, another 9 towns in 3 non-programmed counties were chosen as the control group, using the same sampling method. Indicators on MCH service utility were compared with that in the control group, and the influencing factors of MCH service utility analyzed by logistic model. RESULTS: The main characteristics of the two groups were quite similar at the baseline study, with the average annual family incomes and MCH service per 1000 people. Annual input on MCH services from the government had an distinct increase. The average annual rates of increase regarding the indicators as clean delivery, hospitalized delivery, systematic care on maternal and children, maternal and infant mortality rates were: 1.95%, 9.34%, 4.82%, 3.04%, -2.67%, -13.84% (P < 0.02) through chi2 trend tests. In the trial group, the changes seen in the 6 indicators were better in the control group than in the control group (P < 0.05). Data from the logistic regression model showed that the major influencing factors on the use of hospitalized delivery service were: age of the pregnant woman, average annual income of the family, health insurance status, number of pre-delivery visits, whether on poverty alleviate program, and on knowledge of MCH. CONCLUSION: The intervention project in this programmed area seemed effective and better than the non-programmed area, through an eight-year observation.

[Historical succour of poverty and medical assistance in rural China.].

There was considerable attention paid to the succour of poverty with widespread practice in China's history. Succour of poverty and medical assistance in rural areas were closely connected with famine relief carried out by the rulers. The mutual assistance of emotional and moral support long-term in rural communities is the most important form of medical assistance. A succour of poverty and medical assistance system in the modern sense should inherit and learn from the past consideration of poverty assistance and bring in the fine tradition of multiple forces to participate, in order to establish a succour of poverty and medical assistance system compatible with economic and social development. This is not only an important component of anti-poverty strategy in rural areas but also an inevitable requirement of historical development.

[Developing an evaluative indicator system for the institutional development of community health services in Sichuan].

OBJECTIVE: To develop an evaluative index system for the institutional development of community health services in Sichuan. METHODS: An index system was developed through literature review, followed by focus group discussions and Delphi consultation. The weights of the indicators were established by analytical hierarchy process (AHP). RESULTS: The activity coefficients were 100% and 96.43% for the two rounds of expert consultation, respectively. The concordance coefficients were 0.714 and 0.888 for the two rounds of expert consultation, respectively. The Cronbach's alpha were 0.9812 and 0.8873 for the two rounds of expert consultation, respectively. The authority coefficient reached 0.9093. The final indicators comprised 3 primary index, 12 secondary index and 29 tertiary index. CONCLUSION: The expert consultation has achieved reliable results. The established index system can serve as an instrument for the standardized development of community health services institutions.

Quality of life and hostile mentality trend of patients with HIV/AIDS in China.

OBJECTIVE: To assess the quality of life (QOL) and hostile mentality trend (HMT) of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in China, and to identify their major concerns. STUDY DESIGN AND METHODS: Short Form-36 (SF-36) was used to assess QOL, and seven items were developed to assess the HMT. In-depth interviews were conducted with patients and health workers. RESULTS: SF-36 had moderate reliability, with Cronbach's alpha coefficients ranging from 0.75 to 0.90 and test-retest correlation coefficients ranging from 0.54 to 0.80 for the eight domains. The item-subscale correlation coefficients ranged from 0.46 to 0.97. The QOL of patients with HIV/AIDS was significantly lower than the average QOL of the general population (P<0.01). Hostile mentality of patients was significant (mean scores of the seven items ranged from 2.87 to 4.32, and the mean sum of scores was 3.45 from a range of 1-5). Cronbach's alpha coefficient of HMT items was 0.75 and the test-retest correlation coefficient was 0.80. The major concerns of patients with HIV/AIDS were financial insecurity and family responsibilities, followed by the fear of death and no cure for HIV/AIDS. CONCLUSION: SF-36 is a reliable instrument for the assessment of QOL of patients with HIV/AIDS. The QOL of patients with HIV/AIDS in China is poor. The HMT is a valuable indicator to monitor the outcomes of care for patients with HIV/AIDS.