| BACKGROUND AND OBJECTIVESCompared with the residents in city, those residing in rural areas may encounter more mental health problems in China, because all of their economic status, lifestyle, and accessibilities to health services are inferior to the residents in city. However, their mental health has been neglected for a long time both by the academia and policy makers. In addition, because of the limitation of education level, the residents in rural areas have difficulty in discovering their potential risks of getting mental health problems and seeking for medical or psychological helping in case of need. So it is very important for us to explore the status quo of mental health of residents in rural areas and its correlates and mechanism. It will be of great benefit both for improving the quality of mental health service of local medical institution and enhancing mental health of rural residents.In sum, the current study was to investigate the characteristics of mental health of rural residents, and the related factors and mechanisms influencing the mental health of rural residents. The concrete objectives were as follows. Firstly, this study examined the status quo of mental health of rural residents. Secondly, the characteristics of lifestyle, social support and psychical health of rural residents were explored, and their relations with rural residents'mental and physical health were revealed, including the unique effect of each correlates and their combined effects.This study would give a more insight into the status quo of mental health among rural residents, and mechanism of related factors influencing mental health of rural residents, which would provide theoretical basis for our strategy to improve the rural resident's mental health.METHODSThe sample was obtained from Kenli County, Guangrao County and Lijin County in Dongying City by the multiple-staged stratified random sampling. Firstly, all the towns of each county were sorted into 3 grades according to the social and economic development, respectively named well-developed town, moderate-developed town and less-developed town. One town of each grade was selected randomly from the 3 counties, which resulted in 9 towns in sum. Employing the same procedure in selecting towns,3 villages were selected from one town and at the end 27 villages were sampled from the 9 towns. All of the residents aged 15 and above in the sampled villages were investigated, and 2541 valid questionnaires were obtained.A battery of questionnaires was employed to the participants. The 10-item Kessler Psychological Distress Scale (K10) and Social Support Rating Scale (SRRS) were used to measure mental health, and social support respectively, Information on demographic characteristics, economic status, health resources, physical health, and lifestyle (smoking, drinking, etc.) were collected. All of the measures were self-reported.Descriptive statistics (means and standard deviation), one-sample t test, multivariate analysis of variance (MANOVA), multiple regression, Pearson product-moment correlation, and Chi-square test were performed by SPSS 17.0 to reveal the characteristics of rural residents' mental health and related correlates and their relationships. Structural Equation Model (SEM) was performed by Amos 17.0 to explore the combined relationships among economic status, health resources, lifestyle, social support, physical health and mental health. Compared with the traditional statistics, SEM could produced more accurate estimation of the correlation and path coefficients among variables because of its ability to estimate latent variables, and moreover, SEM not only estimates the direct effect but also the indirect effect from one variable to the other one(s). Given the priorities of SEM mentioned above, it was employed to explore the relations among variables in this study. The fundamental qualification of SEM, big sample, is also met in this study (n=2541).RESULTSThe mean K10 score of rural residents in Dongying City was 14.86±6.25. 67.1 percent were in the lowest range (10?15),18.2 percent were in the lower range (16?21),10.1 percent were in the middle range (22?29),4.6 percent were in the upper range.The mean Body Mass Index (BMI) of rural residents in Dongying City was 24.46±4.43.5.8 percent had the lower weight (<18.5),54.5 percent had normal weight (18.5?23.9),31.1 percent had heavy weight (24?27.9),8.6 percent had heaviest weight (?28).2.7 percent of rural residents in Dongying City had got a fever during past two weeks and 2.8 percent had got a cough during past half a year.19.3 percent of rural residents in Dongying City had a chronic disease,5.2 percent had two chronic diseases,1.4 percent had three chronic diseases,0.2 percent had four chronic diseases and only 0.1 percent had five chronic diseases. The mean scores of disability of rural residents in Dongying City was 6.04±2.32?The mean scores of subjective social support, objective social support, utility of social support, and overall social support of rural residents in Dongying City were 3.30±0.56,3.05±0.79,2.46±0.82 and 2.94±0.56 respectively.Rural residents in Dongying City had averagely got 11.02±1.15 scores on eating habits questionnaire whose score ranging from 6 to 14, indicating they adopted a healthy eating habits.13.7 percent drank more than 5 times one week, 1.4 percent drank ranging from 3 to 4 times one week,8.3 percent drank ranging from 1 to 2 times one week,76.6 percent had never drunk or had quit drinking already. Among the residents who drank more than 3 times one week (n=385), 21.6 percent did not show alcohol dependence,22.3 percent showed some kind of alcohol dependence, and 56.1 percent showed severe alcohol dependence.23.4 percent were smoking,6.3 percent had quit smoking already and 70.4 percent had never smoked. Among the smokers (n=594),19 percent exhibited some nicotine dependence,40.4 percent exhibited moderate nicotine dependence and 40.6 percent exhibited severe nicotine dependence.78.1 percent had never exercised,8.8 percent exercised occasionally and 13.1 percent exercised regularly. Those residents who exercised regularly (n=333) exercised averagely 6.38±2.02 times in a week and had kept this habit for 7.79±8.23 years on average. It took them 52.35±31.85 minutes on average to exercise at one time.79.3 percent of rural residents in Dongying City reported their sleeping quality as good,13.3 percent normal, and 7.4 percent bad.As high as 53.2 percent had never paid attention to the propaganda and education of healthcare knowledge,27.3 percent had paid attention to this information sometimes, and only 19.6 percent had paid attention frequently. During the past two years only 23.9 percent had undergone medical examination. Only 6.5 percent had got on the internet, which took them 11.32±10.09 hours on average weekly.On the one hand, lifestyle had direct effects on mental health. On the other hand, lifestyle had indirect effects on mental health both by influencing physical health and by influencing social support. The size of direct effects lifestyle had on mental health was less than that of indirect effects. Although social support had no significant direct effects on mental health, it had some indirect effects on mental health. Compared with the effects of physical health had on mental health, mental health had lower effects on physical health. Although no significant effects of social support on mental health was found overall, social support had significant effects on mental health among rural residents with under primary school education and those with above senior high school education, which indicated the mediating effect of education on the relation between social support and mental health. In sum, physical health had the maximum effects on mental health, lifestyle had the moderate one and social support had the minimum one.Demographic characteristics had comprehensive effects on mental health through three pathways. Firstly, they had direct effects on mental health. Secondly, they had indirect effects on mental health by influencing lifestyle, physical health and social support. Finally, they had indirect effects on mental health by influencing economic status of rural residents. The direct effects demographic characteristics had on mental health, lifestyle, physical health and social support were as follows. Female rural residents reported unhealthier lifestyle, worse physical health, and worse metal health, but slightly higher social support than male rural residents. With the rural residents aging, their lifestyle, social support and physical health underwent significant positive change, but no significant change in mental health occurred. The lifestyle and physical health of the unmarried rural residents were the best, that of the married rural residents the moderate and that of the resident bereft of one's spouse the worst. The married rural residents reported the highest social support and best mental health, the resident bereft of one's spouse the lowest social support, and the unmarried rural residents the worst mental health. On one hand, the residents with higher education level reported healthier lifestyle and better physical health. On the other hand, the residents with lowest and highest education level had lowest social support and worst mental health. The residents with middle education level (junior high school education) had the highest social support and best mental health.Accessibilities to health resources not only had significant direct effects on mental health but also had significant indirect effects on mental health by influencing lifestyle of rural residents. But neither direct effects nor indirect effects were big.The direct effects of economic status had on mental health were enormous. Additionally, it had indirect effects on mental health by influencing lifestyle, social support and physical health.Based the result above, an integrative model reflecting the comprehensive mechanism of related factors influencing mental health of rural residents was proposed and examined.CONCLUSIONSIn general, rural residents in Dongying City showed good mental health. Demographic characteristics, economic status, lifestyle, social support and physical health had important effects on rural residents'mental health by comprehensive mechanism. POLICY ADVICES1. Increasing the rural residents'income is the foundation for enhancing their mental health.2. Increasing the accessibilities to health resources is the basis of enhancing mental health of rural residents in Dongying City.3. Changing lifestyle is crucial for enhancing mental health of rural residents in Dongying City.4. Improving social support is very important for enhancing mental health of rural residents in Dongying City.5. Enhancing mental health of disadvantaged minorities is the keystone and major difficulty of enhancing mental health of rural residents in Dongying City. |
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