Sex Differences and Psychological Stress: Responses to the COVID-19 Pandemic in China

BACKGROUND: About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals\u27 normal daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored - in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. METHODS: In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic snowball or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) - along with residential living arrangements and conditions - were measured along with psychological stress and emotional responses to the COVID-19 pandemic. RESULTS: Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (\u3c 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). Protective factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services. CONCLUSIONS: The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress

Study of surveillance data for class B notifiable disease in China from 2005 to 2014

Background: The surveillance of infection is very important for public health management and disease control. It has been 10 years since China implemented its new web-based infection surveillance system, which covers the largest population in the world. Methods: In this study, time series data were collected for 28 infectious diseases reported from 2005 to 2014 . Seasonality and long-term trends were explored using decomposition methods. Seasonality was expressed by calculating the seasonal indices. Long-term trends in the diseases were assessed using a linear regression model on the deseasonalized series. Results: During the 10-year period, 38 982 567 cases and 126 372 deaths were reported in the system. The proportion of deaths caused by AIDS increased from 12% in 2005 to 78% in 2014. There were six diseases for which the seasonal index range was greater than 2: dengue fever, Japanese encephalitis, leptospirosis, anthrax, cerebrospinal meningitis, and measles . Among the 28 diseases, the incidence of syphilis increased fastest, with an average increase of 0.018626/100 000 every month after adjustment for seasonality. Conclusions: Effective surveillance is helpful in gaining a better understanding of the infection behaviour of infectious diseases; this will greatly facilitate disease control and management

Gender disparities in depressive and anxiety symptoms among internal migrant workers in Shenzhen: a cross-sectional study

Objectives To investigate the gender disparities in the prevalence and severity of depressive and anxiety symptoms and associated factors among internal migrant workers in Shenzhen.Design Cross-sectional study.Setting Labour intensive factories in Shenzhen, Guangdong, China.Participants We recruited 3200 internal migrant workers who aged over 18 years old and above and did not register in Shenzhen’s household registration system. There were 3095 participants eligible for this study.Methods Participants completed sociodemographic questionnaire, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the UCLA Loneliness Scale, the Barratt Impulsiveness Scale, the Social Support Rating Scale, the Simplified Coping Style Questionnaire and Meaning in Life Questionnaire. We applied χ2 test, analysis of variance, Wilcoxon rank test, Fisher’s exact test and univariate and multivariate multilevel linear regression analysis.Results The overall prevalence of depressive and anxiety symptoms was 27.85% and 19.26% among internal migrant workers. We reported gender disparities of depressive and anxiety symptoms among participants that the prevalence of depressive and anxiety symptoms was higher in women (30.57% vs 26.43% and 22.67% vs 17.47%), and the symptoms were more severe among women. Female migrant workers were more likely to be singled, have lower prevalence of smoking and drinking, receive less education and monthly income, have higher level of impulsiveness and social support and lower level of meaning in life. We found age, marriage, income, adaption to living in Shenzhen, being discriminated, drinking, loneliness, impulsiveness, social support, coping strategies and meaning of life were associated with the severity of depressive and anxiety symptoms among internal migrant workers in Shenzhen.Conclusion Gender inequality may be the institutional factor leading to disparities in depressive and anxiety symptoms among internal migrant workers. Interventions should be embedded with strategies improving gender equality

Emergency Department Visits by Patients with Substance Use Disorder in the United States

Introduction: We aimed to characterize emergency department (ED) utilization and clinical characteristics of patients with substance use disorder (SUD) seeking emergency care for all reasons. Methods: Using 2016–2017 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, and clinical characteristics of patients with SUD vs those without SUD.  Results: Of all adult ED visits (N = 27,609) in the US in 2016–2017, 11.1% of patients had SUD. Among ED patients with SUD, they were mostly non-Hispanic White (62.5%) and were more likely to be male (adjusted odds ratio [aOR] 1.80 confidence interval [CI], 1.66-1.95). Emergency department patients with SUD were also more likely to return to the ED within 72 hours (aOR 1.32, CI, 1.09-1.61) and more likely to be admitted to the hospital (aOR 1.28, CI, 1.14-1.43) and intensive care unit (aOR 1.40, CI, 1.05-1.85). Conclusion: Patients with SUD have specific demographic, socioeconomic, and clinical characteristics associated with their ED visits. These findings highlight the importance of recognizing co-existing SUD as risk factors for increasing morbidity in acutely ill and injured patients, and the potential role of the ED as a site for interventions aimed at reducing harm from SUD

The role of illness‐related cognition in the relationships between resilience and depression/anxiety in nasopharyngeal cancer patients

Abstract Objective Resilience has been reported as an important predictor of better mental health and prognoses in cancer patients, while its mechanisms were not clearly elucidated. In this study, we surveyed a large sample of nasopharyngeal carcinoma patients to investigate the mediating role of illness‐related cognition (illness perception, stigma and meaning in life) on the associations between resilience and symptoms of anxiety and depression. Methods This cross‐sectional study involved 773 participants diagnosed with nasopharyngeal carcinoma. Participants completed a self‐reported structured questionnaire to assess their illness perception, stigma and meaning in life, resilience and symptoms of anxiety and depression. Structural equation models (SEM) were employed to explore the relationship between resilience and symptoms of anxiety and depression in the entire sample, as well as in two subgroups: Subgroup I (0–1 year since diagnosis), and Subgroup II (over 1 year since diagnosis). Results In the entire sample, after adjusting for potential confounders, illness perception, stigma and meaning in life were found to mediate the protective effect of resilience on symptoms of depression (mediating effect proportion: 65.25%) and anxiety (mediating effect proportion: 67.63%). In Subgroup I, direct effects were dominant in the associations between resilience and symptoms of anxiety (mediating effect proportion: 37.95%) and depression (mediating effect proportion: 29.13%). However, in Subgroup II, the associations between resilience and symptoms of anxiety (mediating effect proportion: 98.92%) and depression (mediating effect proportion: 81.04%) were completely mediated. Conclusions Our study suggests that direct and indirect effects of resilience on depression and anxiety dominate in early periods (0–1 year) and long‐term periods (over 1 year) following the cancer diagnosis, respectively. The findings indicate that comprehensive intervention considering both the direct effect of resilience in early stages (e.g., health education prescription and social support groups) and the indirect effects of illness cognition in long‐term periods (e.g., cognitive behavioral therapies) are likely to yield the most favorable outcomes for cancer patients

The Prevalence of Distress and Depression among Women in Rural Sichuan Province

<div><p>Background</p><p>In this paper, we report findings regarding the prevalence of expressed distress and depressive conditions among women living in a rural region of Sichuan Province. As well, we know of no data among women in rural China that examine whether “depression,” as categorically defined in classifications such as the DSM, adequately captures the expressed distress and symptomatic complaints of women in rural China.</p><p>Methods</p><p>A multistage sampling method was employed to recruit the target population. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure distress symptoms, and MINI International Neuropsychiatric Interview (MINI) was employed to determine the prevalence of diagnosable depression and other disorders.</p><p>Results</p><p>Among 1898 rural women, 12.4% (236) scored ≥16 on the CES-D, indicative of distress, and a subset of 7.7% (146) had scores ≥21, highly suggestive of a clinically significant disorder. We found that 49.8% women with ≥16 CES-D score were identified as showing features consistent with a current major depressive episode (MDE) vs. 1.9% in a sample of randomly selected women with <16 CES-D score. Among respondents, 30 of 84 (35.7%) scoring 16–20 and 83 of 143 (58.0%) scoring ≥21 reported symptoms consistent with MDE. 25.1% of women with a positive CES-D score did not describe symptoms consistent with any DSM-IV disorder.</p><p>Conclusions</p><p>We found a higher portion of women reporting significant distress than previously described. Among them, there was a clear gradient, such that 41.7% of women with moderate distress did not have a psychiatric diagnosis, and even among those with more severe symptoms, 15.4% did not manifest a DSM-specific psychiatric condition.</p></div

Sociodemographics Characteristics of Women.

<p>Sociodemographics Characteristics of Women.</p

Recruitment of subjects.

<p>Recruitment of subjects.</p

MINI Diagnosed Conditions among Participants with Distress.

<p>MINI Diagnosed Conditions among Participants with Distress.</p

Preliminary Validation of the Revised Illness Perception Questionnaire for Patients with Nasopharyngeal Carcinoma in China

Nasopharyngeal carcinoma is a common and highly malignant cancer in southern China. It is important to accurately assess the illness perception of nasopharyngeal carcinoma according to the common-sense model of self-regulation. The purpose was to validate the Chinese version of the Revised Illness Perception Questionnaire for patients with Nasopharyngeal carcinoma. A cross-sectional survey of 631 patients with Nasopharyngeal carcinoma was conducted in Guangzhou, China. The reliability of the scale was evaluated using Cronbach’s alpha. The factor structure was assessed using exploratory factor analysis (EFA) of each dimension. The EFA revealed that the 29-item self-rated scale has a seven-factor structure consistent with the original scale and explained 67.3% of the variance after extraction and rotation. The scale showed satisfactory reliability. The item–total correlations ranged from −0.16 to 0.64 (p p p r = 0.224, r = 0.166), consequences (r = 0.415, r = 0.338), timeline cyclical (r = 0.366, r = 0.284), emotional representations (r = 0.497, r = 0.465), personal control (r = −0.122, r = −0.134), treatment control (r = −0.135, r = −0.148), and illness coherence (r = −0.261, r = −0.213) subscales, and depression, anxiety (p < 0.05). The scale revealed acceptable reliability, factorial validity, and construct validity. It could be used to assess the illness representations of Chinese patients with nasopharyngeal carcinoma