Internal migration, mental health, and suicidal behaviors in young rural Chinese

Childhood maltreatment associated suicidal risk in Chinese children and adolescents: a mediation of resilience

BACKGROUND

Existing evidence suggests that children and adolescents who had experienced childhood maltreatment (CM) are at higher suicidal risk. However, the mediation role of resilience in this association remains unclear. We aim to investigate the mediation via resilience in the associations between CM and three suicidal risk indicators (suicidal ideation, SI; suicidal plan, SP; suicidal attempt, SA) among a large sample of Chinese children and adolescents.

METHODS

A population-based cross-sectional survey was conducted in southwestern China Yunnan province. A total of 9723 children and adolescents were included and analyzed by using a multi-stage stratified cluster sampling design. Univariate and multivariate logistic regression models were fitted to explore the associations between CM, resilience, and the three suicidal risk indicators, dose-response trends further elucidated by using the restricted cubic splines. Path models were adopted to estimate the mediation of resilience.

RESULTS

The estimated prevalence rates for one-year SI, SP and SA were 32.86% (95% CI: 31.93-33.80%), 19.36% (95% CI: 18.57-20.16%) and 9.07% (95% CI: 8.51-9.66%). After adjustment, CM significantly associated with all 3 suicidal risk indicators, and the odds ratios (ORs) were 2.13 (95% CI: 1.91-2.37), 2.45 (95% CI: 2.13-2.81), and 3.61 (95% CI: 2.90-4.52) for one-year SI, SP, and SA, respectively. Path models revealed that resilience significantly mediated the associations between CM and the three suicidal risk indicators, and among all dimensions of resilience, family support presented the strongest mediation consistently.

CONCLUSIONS

Our study results suggest that intervention measures which focusing on improving psychological resilience might be effective in reducing suicidal risk for children and adolescents who had experienced maltreatment. Prospective studies should be done to corroborate our findings.

The Impact of Stressors on Depressive Symptoms Among Youth Myanmar Migrant Workers in Thailand: A Cross-Sectional Study

Background

Many youths suffer from depressive symptoms globally, especially youth migrant workers who are more vulnerable to depressive symptoms than non-migrant youths. Given the extensive literature reviewed, little is known about the impact of stressors on depressive symptoms among young migrant populations. Therefore, this study aimed to investigate the impact of stressors on depressive symptoms among young Myanmar migrants in Thailand.

Methods

This cross-sectional analytical study was conducted between August and December 2023, using self-administered questionnaires. The sample size was 165 young migrant workers in Myanmar by simple random sampling. The exclusion criteria were participants who had serious physical illness or acute mental illness, and unwillingness to participate in the study. Sociodemographic characteristics, Rosenberg Self-Esteem Scale, and CESD (The Center for Epidemiological Studies-Depressive symptoms) were included in the questionnaires. Chi-square and Fisher exact tests were used for descriptive statistics. Hierarchical linear regression analysis was used to examine the association between stressors, self-esteem, coping behavior, and depressive symptoms.

Results

It was found that 47.9% of young Myanmar migrant workers had experienced depressive symptoms. Depressive symptoms was associated with four variables: workplace stressors (β = 0.525, p <0.001), security stressors (β = 0.181, p <0.01), living stressors (β = 0.126, p <0.05), and self-esteem (β = -0.135, p <0.05).

Conclusion

According to hierarchical linear regression analysis, workplace, security, and living stressors significantly increased depressive symptoms scores, whereas self-esteem decreased depressive symptoms scores among young 165 Myanmar migrant workers. Therefore, policymakers should be encouraged to establish preventive measures against specific stressors. In addition, many young migrant workers have been found to experience depressive symptoms. Mental health care should be prioritized and made accessible to this vulnerable and risky group.

Factors associated with mental health of internal migrants (Kayayei) in Agbogbloshie-Ghana

BACKGROUND

The United Nations (UN) Sustainable Development Goal (SDG) Eight (8) advocates for decent work and improved economic outcomes for all. However, internal migrant workers in Ghana, especially female head porters, commonly known as "Kayayei", work in exploitative and hazardous conditions exposing them to physical and mental health risks. Yet, mental health among this vulnerable group of migrants has not been given the needed attention it deserves in the country. We, therefore, examined the factors associated with mental health challenges among internal migrants (Kayayei) in Ghana.

METHODS

A cross-sectional study among a systematic random sample of 352 Kayayei was conducted in Agbogbloshie-Accra, Ghana. An interviewer-administered questionnaire was used to collect data on the factors impacting the mental health of Kayayei. The study used binary logistic regression in predicting factors impacting mental health distress at a 0.05 level of significance and 95% confidence interval.

RESULTS

The prevalence of depression, anxiety, and stress were, 305 (86.6%), 332 (94.4), and 149 (42.4), respectively, with 147(41.1%) of respondents having all three mental health issues. The difficult nature of work significantly predicted depression, anxiety, and stress. Respondents who perceived their work as very difficult were 4.3 times, (aOR = 4.36, 95% CI = 2.17, 8.76, p =  < 0.001), 3.66 times (aOR = 3.66, 95% CI = 1.37, 9.76, p = 0.009), and 1.73 times (aOR, = 1.73, 95% CI = 1.04, 2.85, p =  < 0.009) more likely to be depressed, anxious, and stressed respectfully as compared to those who rate their work as just difficult.

CONCLUSION

The majority of the Kayayei suffered from mental health distress (depression, anxiety, and Stress) due to their work circumstances. This study suggests that the Ghana Labour Commission must extend the Labour Act 2003(Act 651) to cover the informal sector and create awareness among the Kayayei community to know their rights and report any abuse to law enforcement agencies. It is also suggested that the government, NGOs, and other benevolent organisations train the Kayayei to attain alternative and sustained livelihoods that will not negatively impact their mental health as has been found in the current study. Finally, the government should fully implement the 2012 Mental Health Act to increase awareness and access to quality mental health care.

Suicidality and Its Association with Stigma in Clinically Stable Patients with Schizophrenia in Rural China

Purpose

Patients with schizophrenia not only experience more stigma than those with other mental illnesses, but they also have a higher risk of committing suicide. There are, however, few research on the connection between rural individuals with clinically stable schizophrenia and suicidality when they feel stigmatized. Therefore, the purpose of this study was to look at the suicidality in clinically stable patients with schizophrenia in rural China, including the prevalence, clinical correlates, and its relationships with stigma.

Patients and Methods

From September 2022 to October 2022, we conducted a multicenter, cross-sectional study in rural Chaohu, Anhui Province, China, and A total of 821 patients with schizophrenia completed the assessment. Three standardized questions were used to assess suicidality (including suicidal ideation, suicide plan, and suicide attempt), Patient Health Questionnaire with 9 items (PHQ-9) for determining depressive state, the first two items of the World Health Organization Quality of Life Questionnaire-Brief Version (QOL), which measures quality of life, the Social Impact Scale (SIS) to assess stigma, and some other important variables (eg employment, psychiatric medication, etc.) were measured using a homemade scale.

Results

Of the 821 participants who completed the questionnaire, 19.2% of the patients were found to have suicidality, of which 19.2% (158/821) were suicidal ideation, 5.6% (46/821) were suicide plans and 4.5% (37/821) were suicide attempts. Binary logistic regression analysis showed that job status (OR=0.520, p=0.047), psychiatric medication (OR=2.353, p=0.020), number of hospitalizations (OR=1.047, p=0.042), quality of life (OR=0.829, p=0.027), PHQ-9 (OR=0.209, p<0.001) stigma (OR=1.060, p<0.001) and social isolation in stigma (OR=1.134, p=0.001) were associated independently with suicidality.

Conclusion

Among clinically stable schizophrenia patients in rural China, suicidality is frequent and associated with stigma. Since stigma and some risk factors have a negative impact on suicidality, we should conduct routine screening and take suicide prevention measures to clinically stable schizophrenia patients in rural areas of China.

Social support and quality of life in migrant workers: Focusing on the mediating effect of healthy lifestyle

Objective

To investigate the relationship between social support and quality of life of Chinese migrant workers and to explore the mediating role of healthy lifestyles in social support and quality of life.

Methods

Using a stratified multi-stage sampling method, 1, 298 migrant workers and 983 urban workers across 110 neighborhood committees in five economic development zones in eastern China were surveyed. The social support level of participants was quantified using the Social Support Rating Scale, and quality of life was evaluated using the SF-8. Healthy lifestyle was evaluated based on a combination of sleep, smoking, alcohol consumption, and exercise. Multiple linear regression analysis was used to assess the relationship between quality of life and social support. Stepwise regression was used to analyze the mediating effect of healthy lifestyle, social support, and quality of life among migrant workers.

Results

Total SSRS and total SF-8 scores of migrant workers were significantly higher than those of urban workers (P < 0.001). After controlling for confounders, social support showed an independent positive association with quality of life for both migrant (β = 0.50, P < 0.05) and urban workers (β = 0.62, P < 0.05). Mediation effect analysis revealed that healthy lifestyle partially mediated the relation between social support and quality of life of migrant workers with a mediation effect of 0.07, accounting for 11.70% of the total effect.

Conclusions

This study showed a significant correlation between social support and quality of life of Chinese migrant workers, with healthy lifestyle playing a mediating role. Improving the social support and health literacy of migrant workers and developing a healthy lifestyle are key to improving their quality of life.

Anxiety symptoms in older Chinese adults in primary care settings: Prevalence and correlates

Background

Integrating mental health services into primary care is a potentially cost-effective way to decrease the treatment gap for anxiety in older adults but data on the epidemiology of anxiety symptoms in older Chinese adults in primary care settings have been very limited. This study investigated the prevalence and correlates of anxiety symptoms in Chinese older primary care patients.

Methods

A total of 753 older primary care patients (≥65 years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the short form of the Geriatric Anxiety Inventory (GAI-SF).

Results

The prevalence of anxiety symptoms (GAI-SF ≥ 3) in older primary care patients was 21.1%. Statistically significant correlates of anxiety symptoms were female sex (vs. male, OR = 1.85, P = 0.002), poor economic status (vs. good, OR = 2.31, P = 0.013), fair and poor family relationship (vs. good, OR = 1.85, P = 0.006), hypertension (OR = 2.01, P < 0.001), chronic gastric ulcer (OR = 6.82, P < 0.001), and Parkinson's disease (OR = 7.83, P = 0.031).

Conclusions

Anxiety symptoms are prevalent among older adults attending primary care clinics. Efforts for preventing or reducing anxiety symptoms in older primary care patients may be more useful to target those who are women, have poor financial status, don't have a good family relationship, suffer from hypertension, have chronic gastric ulcer, and suffer from Parkinson's disease.

Prevalence and correlates of suicidal ideation among older adults attending primary care clinics in Wuhan, China: A multicenter cross-sectional study

Background

Primary care represents an ideal setting for screening for and managing suicidal older adults but the clinical epidemiology of suicidal ideation in Chinese older primary care patients remains unclear. This study investigated the prevalence and correlates of suicidal ideation in older Chinese adults receiving primary care.

Methods

This multicenter cross-sectional survey included a total of 769 older adults (≥65 years) from seven urban and six rural primary care clinics in Wuhan, China. The presence of depressive symptoms and suicidal ideation was assessed with the Geriatric Depression Scale and a single-item question "In the past 12 months, did you think about ending your life?," respectively.

Results

The 12-month prevalence of suicidal ideation in older primary care patients was 16.6%. Significant correlates of suicidal ideation were poor economic status (vs. good, OR = 2.80, P = 0.008), heart disease (OR = 2.48, P = 0.005), chronic gastric ulcer (OR = 3.55, P = 0.012), arthritis (OR = 2.10, P = 0.042), and depressive symptoms (OR = 11.29, P < 0.001).

Conclusions

Suicidal ideation is common among older adults attending Chinese primary care clinics. It is necessary to integrate psychological crisis intervention into primary care to prevent late-life suicide.

Suicidal Ideation and Mental Health Help-Seeking Behaviors Among Older Chinese Adults During the COVID-19 Pandemic

OBJECTIVE

To examine prevalence and correlates of suicidal ideation in older Chinese adults (OCAs) during the COVID-19 pandemic, as well as mental health help-seeking behaviors of suicidal OCAs.

BACKGROUND

Few data on suicidal behaviors of older adults during the pandemic are available.

METHODS

In this cross-sectional survey, 1159 OCAs completed an online self-administered questionnaire between 23 February and 25 March 2020. A standardized single question and the 12-item General Health Questionnaire were used to assess the presence of suicidal ideation and common mental health problems (CMHPs), respectively. Suicidal ideators were further asked about their perceived need for mental health care and help-seeking from mental health workers.

RESULTS

4.1% of the OCAs experienced suicidal ideation during the past 2 weeks. Among the suicidal OCAs, 31.9% perceived a need for mental health care but only 10.6% had sought help from mental health workers. Factors significantly associated with suicidal ideation were a marital status of "others" (OR=2.39, P = .021), disagreement regarding the successful containment of the pandemic (OR=2.43, P = .022), physical health problems (OR=2.23, P = .012), and CMHPs (OR=4.99, P < .001).

CONCLUSIONS

During the COVID-19 pandemic, OCAs constitute a subpopulation that needs mental health services for suicidal problems but tends not to seek mental health help. Mental health services for OCAs may include mental health education, periodic evaluation of risk of suicide, expanded psychosocial support, and, when necessary, psychological crisis intervention and psychiatric treatment.

Negative coping style mediates the relationship between negative mental and suicide risk among migrant workers in China

Suicide is increasingly recognized as a major public health concern among migrant workers in China. Despite negative mental and negative coping styles being core themes found in suicide notes, there is scarce research addressing the theoretical framework of underlying mechanisms between these variables. The study was designed to examine the relationships of negative mental, negative coping styles, and suicide risk among migrant workers. It hypothesized that negative mental would exert a positive effect on suicide risk via increased negative coping. Using a cross-sectional design, the study was conducted using a sample of 3095 migrant workers from Shenzhen, China. Self-made Suicide Risk Scale (SRS), Short-form of the ULCA Loneliness Scale (USL-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7), Simplified Coping Style Questionnaire (SCSQ) were used to collect data. Structural equation modeling (SEM) was performed to quantitatively explore the path effects between negative mental, negative coping styles and suicide risk. Results showed that negative coping style had a positive association with suicide risk (β = 0.029, P < 0.001). Negative mental had both direct and indirect positive effects on suicide risk through negative coping styles (β = 0.109, β = 0.013, P < 0.001). Therefore, to prevent suicidal behaviors among migrant workers, targeted interventions focusing on improving their mental health and coping strategies are needed.

The association between entrapment and depression among migrant workers in China: a social rank theory based study

BACKGROUND

Migrant workers are a group susceptible for depression evolution due to occupational maladaptive triggers. The social rank theory illustrates the pathology process from defensive adaptation to depression, pointing out the early prevention of depression by discovering entrapment. This study aims to reveal the relationship between migrant workers' entrapment and depressive symptoms.

METHODS

A total of 1805 migrant workers in Shenzhen were recruited by stratified multi-stage sampling. Sample's demographic, behavioral and psychosocial characteristics were described and analyzed to reveal the relationship between entrapment and depressive symptoms. The Receiver Operator Characteristic was performed to find the optimal cut-off point of Entrapment Scale for predicting depressive symptoms.

RESULTS

In the binary logistic regression of sociodemographic variables, migrant workers who were married (univariate odds ratio (ORu) = 0.69, 95% Confidence Interval (CI) = 0.56-0.84), owned 1 or 2 children (ORu = 0.71, 95% CI = 0.58-0.86), had been working over 10 years (ORu = 0.71, 95% CI = 0.54-0.95), earned > 4999 yuan per month (ORu = 0.68, 95% CI = 0.47-0.99; multivariate odds ratio (ORm) = 0.57, 95% CI = 0.38-0.87) or with low risks of alcohol use disorders (ORu = 0.51, 95% CI = 0.34-0.75) had lower risks of depressive symptoms. After adjusted the aforementioned significant sociodemographic variables, migrant workers with severer entrapment were more likely to have depressive symptoms (adjusted odds ratio (ORa) = 1.13, 95% CI = 1.12-1.15). Besides, the study proved the reliability and validity of the Chinese version Entrapment Scale, preferring a two-dimensional structure, and 11 was the optimal cut-off value of this scale for predicting depressive symptoms among migrant workers.

CONCLUSIONS

This result indicates the potential value of entrapment according to the social rank theory on facilitating early prevention of migrant works' depression and the application value of Entrapment Scale for effectively measuring mental status among migrant workers.

Relationship Among Social Capital, Employment Uncertainty, Anxiety, and Suicidal Behaviors: A Chained Multi-mediator Mediation Modeling Analysis

OBJECTIVE

Social capital is a significant predictor of suicidal behaviors among Chinese rural migrants. However, the mechanism, including the impact of employment and mental health, has not been fully understood. This study aims to examine the complex relationships linking social capital to suicidal behaviors.

METHOD

Data were collected from a probability sample (n = 1,245) of rural migrants in Wuhan, China. Social capital was used to predict suicidal behaviors, with employment uncertainty as step 1 mediator and anxiety as step 2 mediator. Suicidal ideation and attempt were analyzed separately using a chained moderated mediation model. Years of migration was included as moderator in all models to control its confounding effect.

RESULTS

Of the total sample, 50.9% were male with mean age of 32.0 (SD = 7.8) years. The association between social capital and suicidal ideation was significantly mediated by employment uncertainty (indirect effect [95% CI] = -0.14 [-0.24, -0.04]), but not for suicidal attempt (-0.02 [-0.20, 0.15]). Anxiety significantly mediated the same association for both suicidal ideation (-0.19 [-0.37, -0.01]) and attempt (-0.20 [-0.40, -0.01]). The chained relationship from social capital to employment uncertainty, anxiety, and suicidal behaviors was also significant with indirect effect of -0.05 [-0.09, -0.01] for both suicidal ideation and attempt. Similar results were observed for bonding and bridging capital.

CONCLUSIONS

Social capital may exert an effect on suicidal behaviors through employment and mental health among rural migrants in China. Social capital-based suicide prevention must consider both employment and mental health problems to obtain better effects.HighlightsEmployment and anxiety mediate social capital-suicidal behavior relation.Bonding capital affects anxiety and bridging capital affects employment.There is a chained relation among social capital, employment, anxiety, and suicidal behaviors.

Frequency of basic public health services utilization by married female migrants in China: associations of social support, discrimination and sociodemographic factors

Background

Utilization of basic public health services (BPHS) allows for disease prevention and management and is an essential component for protecting health. Disparities in utilization exist between rural-to-urban migrants and their local counterparts in China. This study sought to determine the frequency of BPHS utilization and whether social support, discrimination, and sociodemographic features were risk factors for low BPHS utilization by Chinese female migrants.

Methods

Data were derived from a survey of female rural-to-urban migrants at nine work sites in Changsha, China. The association between social support, discrimination, sociodemographic factors and BPHS utilization was obtained using Chi-square and logistic regression analysis.

Results

Between December 2017 and April 2018, 307 female participants completed the survey. A total of 24.7% reported having had health education, 26.1% had breast and cervical cancer screening, 27.2% had established a health care record, and 40.9% had received basic contraceptive services. Two factors were associated with the reduced likelihood of BPHS utilization: Length of migration and health record establishment (OR = 0.53; 95% CI = 0.31, 0.92) and years of education and basic contraceptive service use (OR = 0.36; 95% CI = 0.20, 0.67). The remaining six factors were associated with an increased likelihood of BPHS utilization: Living circumstances and health record establishment (OR = 2.11; 95% CI = 1.17, 3.80), health education (OR = 2.71; 95% CI = 1.51, 4.87) and cancer screening (OR = 2.38; 95% CI = 1.30, 4.36). Utilization of social support was associated with health record establishment (OR = 1.24; 95% CI = 1.06, 1.44), basic contraceptive service use (OR = 1.21; 95% CI = 1.04, 1.42) and cancer screening (OR = 1.29; 95% CI = 1.10, 1.51). Objective social support was associated with health education utilization (OR = 1.15; 95% CI = 1.04, 1.26), while subjective social support was associated with basic contraceptive service use (OR = 1.11; 95% CI = 1.05, 1.18) and cancer screening (OR = 1.10; 95% CI = 1.02, 1.17). Family location was associated with basic contraceptive service use (OR = 1.96; 95% CI = 1.12, 3.44) and migration time in Changsha was associated with basic contraceptive service use (OR = 2.24; 95% CI = 1.18, 4.27).

Conclusions

Overall, there was low utilization rate for four BPHS by Chinese female migrants, and social support appears to be an important factor in this setting. Government, community, and workplace education efforts for enhancing BPHS utilization among female rural-to-urban migrants are recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01482-3.

Influence of Subjective/Objective Status and Possible Pathways of Young Migrants' Life Satisfaction and Psychological Distress in China

Young migrants have been the major migrant labor force in urban China. But they may be more vulnerable in quality of life and mental health than other groups, due to their personal characteristic and some social/community policies or management measures. It highlights the need to focus on psychological wellbeing and probe driving and reinforcing factors that influence their mental health. This study aimed to investigate the influence of subjective/objective status and possible pathways of young migrants' life satisfaction and psychological distress. Data on 9838 young migrants in the China Migrants Dynamic Survey were analyzed by LISREL 8.8. A total of 94.03% migrated for jobs or business. Subjective status, including subjective socioeconomic status, social adaptation, and psychological integration, had positive effects on life satisfaction, whereas social adaptation and psychological integration negatively affected psychological distress. Objective status, including objective socioeconomic status and health insurance, had adverse effects on life satisfaction, whereas they positively affected psychological distress. Social participation and city belonging had only significant positive mediating roles on life satisfaction. It is essential to increase social adaptation and decrease integration stress according to younger internal migrants' practical needs. It is also necessary to enhance community/social resources and activities in the context of developing sustainability in the community to assist in mental health promotion.

The Interactive Effect of Social Capital and Duration of Migration on Suicidal Behaviors Among Rural-to-Urban Migrants in China: Evidence from a GIS/GPS-Assisted Probability Sample

Suicide for rural-to-urban migrants in China presents a challenge. Social capital as a modifiable factor is associated with suicidal behaviors at different levels for different populations. This study focuses on the social capital-suicidal behavior relationship among rural migrants with detailed social capital measures and their interaction with migration duration. Data were collected from a rural migrant sample in Wuhan, China. Outcome variable was reported suicidal ideation and attempts in the past 12 months. Social capital was measured using the Personal Social Capital Scale. Year of migration was measured as the number of years a subject migrated to the city. Multivariate logistic regression (coefficients [95%CIs]) was used for data analysis. Time of crossover for interaction was estimated as the year when the effect of social capital on a suicidal behavior revered from negative to positive. Study findings show a negative association between social capital and suicidal ideation (-1.48 [-2.86, -0.10]), but the association was not significant for suicidal attempts (-1.30 [-2.68, 0.08]) after considering the positive interaction between social capital and year of migration (0.11 [0.03, 0.19] for ideation and 0.11 [0.02, 0.19] for attempts). Similar effects were found for detailed social capital measures. The estimated time of crossover ranged from 7.0 to 14.8 years for different social capital measures. The findings of this study confirm the protective relationship between social capital and suicidal behaviors in the early years of migration among rural migrants. These findings inform suicide prevention among rural migrants by considering social capital during the first 7 to 15 years of migration.

The mental health and depression of rural-to-urban migrant workers compared to non-migrant workers in Shanghai: a cross-sectional study

BACKGROUND

Migrant workers worldwide commonly are susceptible to mental disorders. Since the 1980s, there has been a large-scale increase in the number of migrant workers in China; this development parallels the acceleration of socio-economic transformation. Studies addressing this population rarely focus on workers' mental health or psychological well-being, yet it is imperative to understand the mental health status of rural-to-urban migrant workers and study the relationship between migration and mental health.

METHODS

A cross-sectional survey of 3286 participants (response rate 85.4%) was conducted among different work units in Shanghai. All of the variables of this survey were assessed by a self-administered questionnaire, with depression measured by the Patient Health Questionnaire-9 (PHQ-9) scale and poor mental health (PMH) measured by the World Health Organization 5-Item Well-Being Index (WHO-5) scale. Pearson's χ2 test and logistic regression were used to compare migrants with urbanites, and to identify factors related to mental health outcomes.

RESULTS

Migrant workers (15.3%) had a slightly higher prevalence of depression than non-migrant (12.0%) workers, with notable PMH (26.9%) among participants >45 y of age. In the logistic regression models, those who reported low job satisfaction, unhealthy organizations, poor physical health (self-rated) and long working hours were 2.86 (95% CI 2.14 to 3.84), 1.42 (95% CI 1.06 to 1.91), 1.89 (95% CI 1.41 to 2.55) and 1.48 (95% CI 1.08 to 2.03) times more likely to have depression, respectively. Similarly, workers >45 y of age were 2.92 (95% CI 1.65 to 5.16) and 1.80 (95% CI 1.01 to 3.21) times more likely to have PMH for low job satisfaction and unhealthy organizations, respectively.

CONCLUSIONS

There are numerous potential causes affecting the mental health of Chinese internal migrant workers. Strengthening the construction of healthy organizations and enhancing workers' job satisfaction may improve the mental health status or psychological well-being of this group.

Has Rural-Urban Migration Promoted the Health of Chinese Migrant Workers？

The relationship between health and migration has always been an important theme in immigration research. This research develops a new approach to test the healthy migrant hypothesis and the salmon bias hypothesis in China by examining an interaction term combining agricultural hukou and migrant status, non-agricultural employment history, and subsequent area of residence. Based on two Chinese micro-databases, CGSS 2015 and Harmonized CHARLS, we conducted an empirical test on the relationship between migration and health. Our empirical evidence suggests that the initial health advantage among Chinese rural migrant workers was largely due to self-selection rather than migration effects. After controlling for demographic and socioeconomic characteristics, this advantage disappeared. After their health deteriorated, migrant workers returned to their original location. This could exacerbate the contradiction between the allocation of medical resources and the demand in rural and urban China, further intensifying the already widening health status gap between rural and urban residents.

Experiences of stigma and suicidal behaviors among rural-to-urban migrants: the mechanistic roles of depression and substance use

This study aims to examine the mechanisms of how experiences of stigma affect suicidal behaviors through depression and substance use among migrant workers in China. A sample of 641 young rural-to-urban migrants was recruited in Beijing, China. Participants were assessed on their sociodemographic characteristics, suicidal behaviors, experiences of stigma, depression, and substance use. Path analysis was used to examine the relationship between experiences of stigma and suicidal behaviors as well as the mechanistic roles of depression and substance use. The path model showed a good model fit. While the direct path from experiences of stigma to suicidal behaviors was not significant, the indirect paths between these two concepts were significant. Experiences of stigma were positively associated with both depression and substance use, which in turn were positively related to suicidal behaviors. The chain effect from experiences of stigma, depression, substance use to suicidal behaviors was also significant. To prevent and reduce suicidal behaviors among migrant workers, targeted interventions focusing on reducing experiences of stigma and improving mental and behavioral health are needed.

Nonfatal Suicidal Behaviors of Chinese Rural-to-Urban Migrant Workers: Attitude Toward Suicide Matters

OBJECTIVE

To examine the attitude toward suicide (ATS) and its influence on nonfatal suicidal behaviors of Chinese rural-to-urban migrant workers (MWs).

METHOD

Altogether, 3031 MWs completed the positive ATS Scale and structured questions regarding lifetime suicide ideation, plan, and attempt. Mental health help-seeking behaviors of MWs were also investigated.

RESULTS

Overall, MWs held a more negative ATS than the Chinese general population. The lifetime prevalence of suicide ideation, plan, and attempt was 5.5%, 1.3%, and 1.1%, respectively. After controlling for lifetime depressive disorders and other covariates, a negative ATS was still significantly associated with lower risk of lifetime suicide ideation (OR = 0.32), plan (OR = 0.22), and attempt (OR = 0.26). MWs with a negative ATS were more likely to talk to others and seek help by online/telephone consultation for their mental health and suicidal problems (p < .05). A more positive ATS was significantly associated with male gender, low education level, ethnic minority of Miao, low monthly income, and originating from western China.

CONCLUSIONS

The majority of MWs hold a negative ATS, which significantly contributes to their relatively low risk of nonfatal suicidal behaviors. The more help-seeking from others and online/telephone consultation in MWs with a negative ATS may lower their risk of nonfatal suicidal behaviors.

Depressive symptoms in Chinese assembly-line migrant workers: A case study in the shoe-making industry

INTRODUCTION

Assembly-line migrant workers (AMWs), as a major workforce in China, may be at particularly high risk of depression due to their relative low social economic status and particular job characteristics. However, little is known about the frequency and characteristics of depression among Chinese AMWs. This study investigated the prevalence and correlates of depressive symptoms in Chinese AMWs.

METHODS

In this cross-sectional survey, 915 Chinese AMWs from two shoe-making factories completed a standardized questionnaire to report their socio-demographics, physical health, migration, and work. They also reported their depressive symptoms by completing the Beck Depression Inventory-Short Form (BDI-SF). We conducted multiple logistic regression analysis to identify factors related to depression.

RESULTS

We found that 31.7% of AMWs were clinically depressed (BDI-SF ≥ 8). The multiple regression model included age, self-rated physical health, pain, family relationships, having no good friends at the same factory, and working under high pressure.

DISCUSSION

Our findings suggest that depression is common among Chinese AMWs. We argue that there is an urgent need for health care providers and factory managers to work on the early identification of AMWs, who are at high risk for depression. Psychological and psychiatric treatments are necessary in the Chinese labor-intensive industries.

Health Selectivity and Rural-Urban Migration in China: A Nationwide Multiple Cross-Sectional Study in 2012, 2014, 2016

Background: China is undergoing an unprecedented rural-urban migration, which may deeply influence the health of internal migrants. Previous studies suggested that migrants are a selectively healthier population. This paper examines the evidence for and the changes of health selectivity among Chinese internal migrants. Methods: We use data from the China Labor-force Dynamics Survey (CLDS), a nationally representative survey conducted in 2012, 2014, and 2016, respectively. The health statuses of four groups of research subjects (out-migrants, returned migrants, rural residents, and urban residents) are measured by general health, physical health, and emotional health. Results: By comparing the health status of migrants with that of rural residents, we find supportive evidence for the Healthy Migrant Hypothesis that migrants exhibit better health than rural residents in their hometown. We also add strength to the Salmon Bias Hypothesis that migrants returning to their hometowns are less healthy than those still being outside. However, migrants present worse emotional health in both comparisons. The general and physical health gaps between migrants, rural residents, and returnees widened in all three rounds of the survey, which implies a possibly increasing trend of health selectivity. This study also suggests that bringing family to the destination requires better general and physical health, but not emotional health. Conclusions: Migrants are positively selected on general and physical health. The health selectivity in 2012–2016 is highly likely to increase, which means that there are increasing number of obstacles for migrants to overcome. Family migration’s high requirement for health might also contribute to it. It is urgent to establish and improve primary health care service systems in rural areas in current circumstances.

Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview

Recent studies have demonstrated that immigrants and ethnic minorities may be at higher risk of suicidal behaviour as compared to the general population. We conducted a literature search to identify studies in English from 1980 to 2017 related to suicide risk among immigrants and ethnic minorities. Six hundred and seventy-eight reports were screened, and 43 articles were included in the qualitative synthesis of the review. Some studies reported lower rates of suicide attempts, while other findings suggested higher rates of suicidal behaviour and deaths among immigrants as compared to the native population. Also, a positive correlation was found between suicidal behaviour and specific countries of origin. Non-European immigrant women were at the highest risk for suicide attempts, a group which included young women of South Asian and black African origin. Risk factors among migrants and ethnic minorities were found to be: language barriers, worrying about family back home, and separation from family. The lack of information on health care system, loss of status, loss of social network, and acculturation were identified as possible triggers for suicidal behaviour. Overall, results suggest that specific migrant populations and ethnic minorities present a higher risk of suicidal behaviour than native populations, as well as a higher risk of death by suicide.

Common mental health problems in rural-to-urban migrant workers in Shenzhen, China: prevalence and risk factors

AIMS

Rural-to-urban migrant workers are a large marginalised population in urban China. Prevalence estimates of common mental health problems (CMHPs) in previous studies varied widely and very few studies have investigated migration-related factors of CMHPs in migrant workers. The objective of this study was to determine the prevalence and risk factors of CMHPs among Chinese migrant workers.

METHODS

A random sample of 3031 migrant workers of ten manufacturing factories in Shenzhen, China, completed a standardised questionnaire containing socio-demographic and migration-related variables and the Chinese 12-item General Health Questionnaire (GHQ-12). A GHQ-12 score of three or higher was used to denote the presence of CMHPs.

RESULTS

The prevalence of CMHPs was 34.4% in Chinese migrant workers. In multiple logistic regression, risk factors for CMHPs included being 16-25 years old (odd ratio [OR] 1.65, 95% confidence interval [CI] 1.28, 2.12), being 26-35 years old (OR 1.36, 95% CI: 1.05, 1.75), low monthly income (OR 1.42, 95% CI 1.04, 1.92), poor living condition (OR: 1.76, 95% CI: 1.22, 2.54), physical illness in the past 2 weeks (OR 1.72, 95% CI 1.43, 2.05), having worked in many cities (OR 1.34, 95% CI 1.03, 1.74), infrequently visiting hometown (OR 1.56, 95% CI 1.22, 1.99), poor Mandarin proficiency (OR 1.51, 95%CI 1.13, 2.01), a low level of perceived benefits of migration (OR 1.33, 95% CI 1.14, 1.55) and working more than 8 h/day (OR 1.39, 95% CI 1.14, 1.70).

CONCLUSIONS

CMHPs are very prevalent among Chinese migrant workers. Given the large number of Chinese migrant workers, there is an urgent need to address the mental health burden of China's migrant worker population.

Association between induced abortion and suicidal ideation among unmarried female migrant workers in three metropolitan cities in China: a cross-sectional study

Background

Despite reports of mental health issues, suicidality has not been closely examined among the migrant population. The association between induced abortion and suicidal ideation is unknown among unmarried female migrant workers of reproductive age in China. This study aims to examine induced abortion and suicidality among the Chinese migrant population.

Methods

We recruited 5115 unmarried female migrant workers during 2015 to 2016 from Shanghai, Beijing and Guangzhou, and collected demographic, psychosocial, reproductive and mental health information using structured questionnaires. We used logistic regression models to examine the association between lifetime induced abortion and suicidal ideation during the past year among the subjects.

Results

Overall, 8.2% of the subjects had suicidal ideation during the past year, and 15.5% of the subjects experienced induced abortion. Induced abortion was associated with nearly twice the odds of having past-year suicidal ideation (Odds ratio, OR = 1.89; 95% confidence interval, CI: 1.46, 2.44) after adjusting for age, education, years in the working place, tobacco use, alcohol consumption, daily internet use, attitude towards premarital pregnancy, multiple induced abortion, self-esteem, loneliness, depression, and anxiety disorders. The association was stronger in those aged > 25 (OR = 3.37, 95% CI = 2.16, 5.28), with > 5 years of stay in the working place (OR = 2.98, 95% CI = 2.02, 4.39), the non-anxiety group (OR = 2.28, 95% CI = 1.74, 3.00), and the non-depression group (OR = 2.94, 95% CI = 2.08, 4.15).

Conclusions

Induced abortion was associated with increased odds for suicidal ideation among the unmarried female migrant workers in urban cities in China. More attention should be paid to the mental health of the population.

Suicidal ideation among Chinese cancer inpatients of general hospitals: prevalence and correlates

Cancer patients are at high risk for suicide, particularly when they are informed about the cancer diagnosis or hospitalized for cancer treatment. Therefore, oncology healthcare settings such as large general hospitals in China, may represent an ideal setting to identify and treat suicidality in cancer patients. However, the clinical epidemiology of suicidality of Chinese cancer patients remains largely unknown. This study examined the prevalence and correlates of suicidal ideation among Chinese cancer inpatients of large general hospitals. A total of 517 cancer inpatients were consecutively recruited from two tertiary general hospitals of a metropolitan city in northern China, and administered with standardized questionnaires to collect data on sociodemographics, mental health, and cancer-related clinical characteristics. Suicidal ideation and mental health were measured with a single self-report question “In the past month, did you think about ending your life?” and Hospital Anxiety and Depression Scale, respectively. The one-month prevalence of suicidal ideation was 15.3% in Chinese cancer inpatients. In multivariable Logistic regression, depression, anxiety, moderate-to-severe pain, metastatic cancer, poor performance status, surgery, and palliative care were significantly associated with suicidal ideation. Cancer inpatients of large Chinese general hospitals have high prevalence of suicidal ideation and therefore potentially at high risk for suicide. Suicide prevention efforts for cancer inpatients should include periodic evaluation of suicidality, effective pain management, psychooncological supports, and, when necessary, psychiatric treatment and crisis intervention.

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.

Mental health of the old- and new-generation migrant workers in China: who are at greater risk for psychological distress?

Rural-to-urban migrant workers (MWs) are a large vulnerable population in China and, recently, the new-generation MWs (those born in 1980 or later) have become the majority of this population. Examining difference in the epidemiology of poor mental health between the new- and old-generation (those born before 1980) MWs would facilitate mental health promotion efforts. However, very few related studies are available and they produced conflicting findings. This study investigated intergenerational difference in prevalence and correlates of psychological distress (PD) in MWs. A total of 3031 MWs (691 old- and 2340 new-generation MWs) completed a standardized questionnaire containing socio-demographic, migration-related, and work-related variables and the Chinese 12-item General Health Questionnaire (GHQ-12). A GHQ-12 score of 3 or higher was used to denote PD. PD was more prevalent in the new- than old-generation MWs (36.2% versus 28.2%, P < 0.001). The elevated risk of PD in the new- versus old-generation remained significant after controlling for potential confounders (OR=1.51, P < 0.001). For the new-generation, correlates for PD included low monthly income, recent two-week physical morbidity, migrating alone, poor Mandarin proficiency and long working hours; while for the old-generation, correlates for PD included low education, recent two-week physical morbidity, and having worked in many cities. The new-generation MWs are at higher risk for PD than the old-generation MWs. Mental health services for addressing the generation-specific needs may be an effective way to prevent or reduce PD of MWs.

The effect of socioeconomic status and social inclusion on the mental health of Chinese migrants: A comparison between interprovincial and intra-provincial migrants

This article sought to explore the impacts of socioeconomic status and social inclusion on intra-provincial and interprovincial migrants' mental health by constructing the Bayesian structural equation model. A total of 14,584 migrants aged 15-59 years living in eight cities of China were selected. It was found that the impacts of socioeconomic status and social inclusion on mental health were converse for these two groups. And the manifest variables coefficients of socioeconomic status and social inclusion were also converse. Therefore, governments should make some policies to further improve the mental health of migrants, including strengthening the community cohesion, social atmosphere, and governmental support.

Development and validation of brief scales to measure emotional and behavioural problems among Chinese adolescents

OBJECTIVES

To develop and validate brief scales to measure common emotional and behavioural problems among adolescents in the examination-oriented education system and collectivistic culture of China.

SETTING

Middle schools in Hunan province.

PARTICIPANTS

5442 middle school students aged 11-19 years were sampled. 4727 valid questionnaires were collected and used for validation of the scales. The final sample included 2408 boys and 2319 girls.

PRIMARY AND SECONDARY OUTCOME MEASURES

The tools were assessed by the item response theory, classical test theory (reliability and construct validity) and differential item functioning.

RESULTS

Four scales to measure anxiety, depression, study problem and sociality problem were established. Exploratory factor analysis showed that each scale had two solutions. Confirmatory factor analysis showed acceptable to good model fit for each scale. Internal consistency and test-retest reliability of all scales were above 0.7. Item response theory showed that all items had acceptable discrimination parameters and most items had appropriate difficulty parameters. 10 items demonstrated differential item functioning with respect to gender.

CONCLUSIONS

Four brief scales were developed and validated among adolescents in middle schools of China. The scales have good psychometric properties with minor differential item functioning. They can be used in middle school settings, and will help school officials to assess the students' emotional/behavioural problems.

Sociodemographic Antecedent Validators of Suicidal Behavior: A Review of Recent Literature

Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known impact of age and gender, sociodemographic variables such as marital and parental status, education, occupation, income, employment status, religion, migration or minority status, and sexual orientation are repeatedly reported to play an important role in suicidal behavior. This narrative review aimed to summarize recent research on sociodemographic risk factors for suicidal behavior and to elicit possible implications for suicide prevention.

The Association Between Social Resources and Depressive Symptoms Among Chinese Migrants and Non-Migrants Living in Guangzhou, China

Background: Depression is a commonly studied mental disorder affecting Chinese internal (i.e., rural-to-urban) migrants. Social resources effectively reduce depression for many communities experiencing adversities. This study evaluated social-level risk factors for depression between internal migrant and non-migrant Chinese living in mainland China. Method: We conducted a random population-level survey among migrants and local residents living in Guangzhou, China. Data were collected using face-to-face interviews. We used items from the Social Support Rating Scale to measure social resource dimensions, including social network size, emotional support, structural social capital, and one (self-developed) item that measured belonging (an element of social cohesion). The Patient Health Questionnaire-9 measured depression. Correlation and regression analyses of the partial sample ( n = 678) were conducted to estimate the association between social resources and depression for migrants ( n = 383) and non-migrants ( n = 295). Results: Stratified regression analysis demonstrated that for migrants, greater belonging was associated with less depression, while age and larger friendship social network size was related to less depression among non-migrants. Conclusion: Differences emerged in our sample with regard to the types of social resources that are protective against depression between migrants and non-migrants. Interventions that provide opportunities for migrants to better integrate and feel welcomed into their new communities may reduce their depression symptoms.

Prevalence and correlates of major depressive disorder among rural-to-urban migrant workers in Shenzhen, China

BACKGROUND

In China, rural-to-urban migrant workers (MWs) are a large and vulnerable population that may be at high risk for depression, but previous studies focused on depressive symptoms of MWs and no study has investigated the epidemiology of major depressive disorder (MDD). The objective of this study was to determine the prevalence and correlates of one-month and lifetime MDD among MWs in Shenzhen, China, and mental health services utilization of MWs with lifetime MDD.

METHODS

A total of 3031 MWs were recruited from 10 manufacturing factories and interviewed with the Chinese version of the Mini International Neuropsychiatric Interview.

RESULTS

The one-month and lifetime prevalence rates of MDD were 1.39% (95% CI: 0.97%, 1.80%) and 5.08% (95% CI: 4.30%, 5.86%), respectively. No significant gender and age-group differences were found in these rates. The risk factors for lifetime MDD included lower education, worse living condition, poorer self-perceived physical health, migration before adulthood, infrequently calling family members, and having done lots of jobs. Only 3.25% of the respondents with lifetime MDD had sought professional help prior to the interview.

LIMITATIONS

The MW sample was selected from manufacturing factories, we should be cautious in generalizing our findings to MWs of other industries.

CONCLUSIONS

Compared with the Chinese general population, MWs may have a similar prevalence of MDD, but the rate of lifetime mental health services use of MWs with lifetime MDD is extremely low. MDD is a major public health concern for this population. There is an urgent need to improve mental health services for MWs.