Experiences of Stigma and Health Service Utilization among Young Rural-to-urban Migrants in China: The Mediation Role of Social Capital

Perceived Stress Predicts Drug Use in Transgender Women: The Mediating Role of Loneliness

Purpose

Drug use is quite common in transgender women, but the mechanisms of the drug use remain unclear. The purpose of this study was to investigate the mediating role of loneliness in perceived stress and the drug use among transgender women.

Methods

A cross-sectional survey was conducted from April to September 2018 in Shenyang and Kunming, China, among 247 transgender women. Chinese Perceived Stress Scale, the Chinese version of 8-item UCLA Loneliness Scale, a drug use questionnaire, and a demographic characteristic questionnaire were included in the survey. Descriptive analysis, logistic regression, and mediation analysis were done using SPSS Statistics version 26.0 and Mplus version 8.3.

Results

The mean age of transgender women in the study was 33.04 years (standard deviation=8.14). Around 33.20% (n=82) of transgender women reported ever using one kind of drugs, the most commonly used drugs were rush (79.20%), ice (8.50%), and 5-MeO-DIPT (8.50%). Univariate logistic regression showed that perceived stress (odds ratio [OR]=1.73, 95% bootstrap confidence intervals [CI]=1.27-2.36) and loneliness (OR=1.62, 95% CI=1.23-2.13) had a significant association with drug use, all p [ps] <0.01. The effect of perceived stress on drug use was partially mediated by feeling of loneliness (estimate=0.09, standard error=0.04, p<0.05), the mediating effect (0.09) accounted for 27.27% of the total effect (0.33).

Conclusion

Perceived stress can positively predict drug use. Loneliness plays an important role in drug use among transgender women.

Latent Profile Analysis of Self-Stigma Among Individuals With Schizophrenia and Its Relationship With Illness Perception

PURPOSE

To investigate self-stigma among individuals with schizophrenia, identify potential categories of self-stigma, and analyze the association between self-stigma categories and dimensions of disease perception.

METHOD

Convenience sampling was used to select individuals with schizophrenia (N = 216) in psychiatric hospitals. A General Demographic Information Questionnaire, the Internalized Stigma of Mental Illness Inventory, and Brief Illness Perception Questionnaire were used for data collection. A latent profile analysis was performed on self-stigma characteristics of participants, and potential categories of influencing factors and their relationship with illness perception were examined.

RESULTS

Participants were classified into three potential categories: low self-stigma-low resistance (19.4%), medium self-stigma (55.6%), and high self-stigma-high discrimination (25%). Compared with the low self-stigma-low resistance group, those with higher illness representation and illness understanding scores were more likely to be classified as medium self-stigma, and emotional representation was the strongest predictor for high self-stigma-high discrimination.

CONCLUSION

Self-stigma among participants was mostly medium to high. Self-stigma of individuals with schizophrenia demonstrates group heterogeneity; therefore, nurses should formulate targeted interventions based on the characteristics of each category to achieve precise interventions and reduce self-stigma. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Social Integration and Health Among Young Migrants in China: Mediated by Social Mentality and Moderated by Gender

Population mobility has been one of the most basic social characteristics of China’s reform and opening up for more than 40 years. As the main labor force in Chinese cities, young migrants have made major contributions toward China’s economic miracle as the country has experienced rapid industrialization and urbanization. However, frequent mobility has caused an imbalanced social mentality in young migrants and often leads to issues with social integration, which has made this group more vulnerable with respect to their health. This study used the 2013 and 2015 Chinese General Social Survey (CGSS) data of 1,007 young migrants to investigate social mentality mediating the linkage between social integration and health among young migrants. Additionally, to probe the moderating role of gender, multi-group structural equation modeling was applied to test if the pathways in the mediation model differed between young male and female migrants in a significant way. The results suggested that after controlling for the influence of age, marital status, education, and personal annual income, social integration positively impacted the health of young migrants in a significant way; social mentality mediated the action of social integration on this group’s health; and with respect to gender difference, on the three paths of social integration affecting health, social integration affecting social mentality, and social mentality affecting health, young male migrants were more affected than young female migrants. The findings of this study could help improve gender-specific policies on the health of the floating population and offer important theoretical reference and practical suggestions for future research.

The Mediating Effect of Depression on the Relation Between Interpersonal Needs and Suicidal Ideation Among Chinese Transgender Women

BACKGROUND

Transgender women are at high risk of depression and suicidal ideation. The interpersonal theory of suicide proposes that suicidal ideation could be a consequence of high interpersonal needs (thwarted belongingness and perceived burdensomeness). The current study tests this theory and investigates whether depression could mediate the relationship between interpersonal needs and suicidal ideation among transgender women in Shenyang, China.

METHODS

A total of 198 transgender women were recruited by snowball sampling. A cross-sectional study was conducted through a structured questionnaire. Suicidal ideation, depression, and interpersonal needs were assessed. Path analysis was used to carry out the research goals and the mediating effect of depression was tested.

RESULTS

There were nearly 37% of the participants reported lifetime suicidal ideation. Suicidal ideation was positively correlated with thwarted belongingness (t = -5.53, p < 0.01) and perceived burdensomeness (t = -5.02, p < 0.01). The direct effect from thwarted belongingness to suicidal ideation via depression was statistically significant (Std. β = 0.232, p < 0.01). Depression could also mediate the indirect path from perceived burdensomeness to suicidal ideation through depression (Std. β = 0.222, p < 0.01) although the direct path between them was not significant (Std. β = 0.046, p = 0.693).

CONCLUSIONS

Depression fully mediated the relationship between perceived burdensomeness and suicidal ideation, and partially mediate the relationship between thwarted belongingness and suicidal ideation. To reduce the risk of suicidal ideation among transgender women, interventions targeting thwarted belongingness, perceived burdensomeness, and depression are needed.

Association of Health Insurance and Documentation with Stigma and Social Support Among Myanmar Migrants with Tuberculosis Before and During Thailand's Policy on Border Closure Due to COVID-19: a Cross-Sectional Study

OBJECTIVE

The objective of this study was to assess the effect of health insurance and documentation status on tuberculosis (TB)-related stigma and social support before and during Thailand's policy on border closure.

METHODS

A cross-sectional study was conducted in two TB clinics in Mae Sot district, a border area of Thailand. Myanmar migrants with new TB were interviewed before (between September 2019 and March 2020) and during Thailand's policy (between April 2020 and January 2021). We used multiple linear regression models to assess the association of health insurance and documentation status with stigma and social support before and during the policy on border closure.

RESULTS

Of 229 migrants diagnosed new TB recruited, 117 and 112 were interviewed before and during Thailand's policy on border closure. The relationship of stigma with health insurance and documentation status was modified by the policy. Migrants with health insurance reported significantly lower stigma during the policy compared to those without health insurance, whereas documented migrants had lower stigma before the policy compared to undocumented migrants. No significant association of health insurance and documentation status with social support was observed. Ethnicity, perceived TB severity and education level were also independently associated with TB-related stigma.

CONCLUSION

The relationships between health insurance, documentation status and TB-related stigma were modified by Thailand's policy on border closure among Myanmar migrants with TB in a border area of Myanmar and Thailand. Promotion of health insurance and well-planned documentation for migrants should be more discussed and strengthened among stakeholders and policymakers.

COVID-19-related stigma and its influencing factors: a nationwide cross-sectional study during the early stage of the pandemic in China

OBJECTIVES

To describe the situation of COVID-19-related stigma towards patients with COVID-19 and people from the city of Wuhan in China and to assess the associations between COVID-19-related stigma, health literacy and sociodemographic characteristics during March 2020, the early stage of the pandemic.

DESIGN

A cross-sectional online survey.

SETTING

The study surveyed 31 provinces in China.

PARTICIPANTS

This study surveyed 5039 respondents in China.

OUTCOME MEASURES

Public stigma towards both patients with COVID-19 and Wuhan residents was measured. Binary logistic regression was used to identify the factors associated with public COVID-19-related stigma.

RESULTS

Among the participants, 122 (2.4%) reported themselves and 254 (5.0%) reported the communities they lived in as holding a stigmatising attitude towards patients with COVID-19, respectively. Additionally, 114 (2.5%) and 475 (10.3%) reported that themselves and the communities they lived in, respectively, held a stigma against people from Wuhan, which was the most severely affected area in China. People aged over 40, lived in areas with severe epidemics (adjusted OR (aOR)=2.03, 95% CI (1.05 to 3.92)) and who felt it difficult to find and understand information about COVID-19 (aOR=1.91, 95% CI (1.08 to 3.37); aOR=1.88, 95% CI (1.08 to 3.29)) were more likely to stigmatise patients with COVID-19. People who were male, aged 41-50 and had difficulty understanding information (aOR=2.08, 95% CI (1.17 to 3.69)) were more likely to stigmatise people from Wuhan.

CONCLUSIONS

Patients with COVID-19 and Wuhan residents suffered stigma at both the individual and the community levels. Those who had low health literacy, who lived in areas with a large number of COVID-19 cases and who were of ethnic minorities were more likely to stigmatise others. Tailored interventions are encouraged to improve health literacy and consequently to reduce public COVID-19-related stigma.

Impact of social capital, sex and education on the utilization of public health services: a cross sectional study based on the China migrant dynamic survey

Background

China is making efforts to promote the equalization of National Essential Public Health Services (NEPHS) for internal migrants. Studies have demonstrated that the impacts of social capital on health services are different among subgroups of people. Clarifying these differences will help China accurately promote the equalization of NEPHS for the internal migrants and provide reference for other countries.

Methods

Data from the China Migrant Dynamic Survey of 2017, involving 130,642 migrants in 31 provinces were used to clarify the complex relationship between social capital and the utilization of NEPHS. Social capital was divided into regional cognitive social capital (RCSC), regional structural social capital (RSSC), individual cognitive social capital (ICSC), and individual structural social capital (ISSC). Then, multi-level logistic regression was conducted to analyze their impacts on the utilization of NEPHS of the migrants, and whether such impacts are moderated by sex and education.

Results

(1) There are significant differences in the levels of CSC, SSC, and NEPHS utilization between different sexs and educational subgroups of the migrants, among which the educational difference is more prominent. (2) An interaction exists between the levels and dimensions of social capital and NEPHS projects. Also, the impact of SSC on NEPHS is always greater than that of CSC at the same level. (3) The effects of RCSC, RSSC, ICSC, and ISSC on NEPHS utilization by migrants are not moderated by sex. However, a high education could weaken the relationship between RCSC and health education, ISSC and health education, and RSSC and health records but strengthen the correlation between RSSC and health education.

Conclusion

Social capital plays an important role in the access of migrants to NEPHS. Governments should vigorously promote the construction of regional social capital, encourage migrants to actively participate in community activities, especially pay attention to the enhancement of the migrants with low SES to the destination identity.

Barriers to medication adherence for rural patients with mental disorders in eastern China: a qualitative study

BACKGROUND

Mental disorders are destructive and usually require long-term medication, but non-adherence of medication is highly prevalent in patients with mental disorders. Previous studies relating to medication non-adherence were mainly quantitative. Meanwhile, there have been even fewer studies conducted in rural areas in China that focused on patients' medication non-adherence. This study aims to explore the barriers to medication adherence for rural patients with mental disorders in China from the perspectives of patients, patients' family members and healthcare providers.

METHODS

A qualitative study was carried out in the rural areas of four towns within Shandong Province in eastern China. The study adheres to COREQ guidelines. Semi-structured in-depth interviews were conducted with 11 patients, 21 family members and 8 primary mental health service providers.

RESULTS

Thematic analysis generated five major themes: (1) lack of self-insight, (2) inadequate family support, (3) long treatment duration and side effects of drugs, (4) poor economic conditions, and (5) the perceived stigma of illness.

CONCLUSION

These findings may be useful for policymakers and planners to improve medication adherence and decrease the recurrence rate of mental disorders in China.