Xiaozhao Yousef Yang, Patricia Morton, Fangying Yang & Boye Fang (2022) The Moderation Role of Neuroticism for Anxiety among Burdened Dementia Caregivers: A Study on Care Giver-Recipient Dyads, Journal of Gerontological Social Work, DOI: 10.1080/01634372.2021.2019164
Caregiving burden proves to be a risk factor of anxiety disorders and anxiety affection. The current study investigates how an endogenous personality dimension – neuroticism – moderates the association between caregiving burden and anxiety affection. Between 2015 and 2017, the study deployed a cross-sectional survey of 674 (response rate = 89%) older adults who were hospitalized for dementia at two hospitals. From all primary caregivers of these patients, 661 agreed to participate in the survey which yielded 661 matched dyads as the final sample. Caregiving burden, neuroticism, and anxiety affection were each measured by established assessment instruments. We employed multivariate OLS regression to test the moderator and regressor effects. We found that care burden is a significant risk factor of higher levels of anxiety affection (β = .17, p < .001), and accounts for 4.6% of the variance in anxiety. Neurotic personality is also significantly associated with a greater level of anxiety (β = .26, p < .001). Neurotic personality moderates the association between anxiety and care burden (β = .24, p < .001). Our findings suggest that social and healthcare workers should assess caregiver personality and burden as well as provide support, resources, and coping strategies to those with neurotic personality traits or high care burden in an effort to reduce anxiety among caregivers.
Editor's Choice
Xiaozhao Yousef Yang, Sihui Peng, Tingzhong Yang, Randall R Cottrell, Changing trends of mental and behavioral responses and associations during the COVID-19 epidemic in China: a panel study, Health Education Research, Volume 36, Issue 2, April 2021, Pages 151–158
This prospective observational study examined changing trends in mental and behavioral responses, and their association with perceived risk, severity, self-efficacy and isolation status during the Chinese COVID-19 epidemic. There were five waves of interviews. Descriptive statistics and non-parametric test methods were used for data analysis. Participants numbered 150 for the linkable baseline survey and 102 completed all 5 survey waves and were included in the analysis. Mental stress, emotional status and lifestyle manifested a statistically significant downwards trend across the total period of this panel study. The number of reported new confirmed patients perceived high risk and perceived severity were positively associated with mental stress, emotional status and lifestyle. Self-efficacy was negatively associated with each type of mental and behavioral response. The more time people were confined to their home, the more serious the emotional and lifestyle problems. Dose-response relationships were noted between the number of reported new confirmed patients and mental stress, emotional status and lifestyle during the five observation points. This study yielded new information about mental and behavioral responses among Chinese people during the COVID-19 epidemic. Policy changes and health education are essential for minimizing the adverse health effects of these responses.
D Wu, T Yang, XY Yang, CH. Hoe, S Peng & L Yu (2020) Behavioral and psychosocial correlates of road traffic injuries: evidence from a nationwide study on Chinese undergraduates, Traffic Injury Prevention, DOI: 10.1080/15389588.2020.1770236
Objective: The purpose of this study was to investigate the prevalence and behavioral and psychosocial correlates of road traffic injuries (RTIs) among Chinese university students.
Methods: A cross-sectional survey was conducted among fifty universities in China, using a multi-stage sampling methodology. The participants were asked to report their RTIs in the past year. The chi-square test and binary logistic regression analysis were utilized to identify factors associated with RTIs, including specific types of RTIs.
Results: Among the 11,770 participants, a total of 1,482 university students reported at least one RTI yielding an overall weighted injury prevalence of 12.96% over the past year. Estimated weighted prevalence by type was 6.10%, 5.94%, 5.12%, and 5.35% for automobile (car, truck, or bus), bicycle, motorcycle, and pedestrian injuries, respectively. Logistic regression analysis found that students who studied at low-level universities, smoked cigarettes, drank alcohol, slept less than 7 hours, went to bed after 12:00 am, or students with psychological distress were more likely to experience overall and four types of RTIs. Students who studied in the eastern universities had a higher likelihood of automobile injury, motorcycle injury and pedestrian injury than those who studied in western universities.
Conclusions: Several critical factors associated with RTIs were identified. These findings have implications for the design and implementation of RTI prevention and interventions programs targeted at university students.
Methods: A cross-sectional survey was conducted among fifty universities in China, using a multi-stage sampling methodology. The participants were asked to report their RTIs in the past year. The chi-square test and binary logistic regression analysis were utilized to identify factors associated with RTIs, including specific types of RTIs.
Results: Among the 11,770 participants, a total of 1,482 university students reported at least one RTI yielding an overall weighted injury prevalence of 12.96% over the past year. Estimated weighted prevalence by type was 6.10%, 5.94%, 5.12%, and 5.35% for automobile (car, truck, or bus), bicycle, motorcycle, and pedestrian injuries, respectively. Logistic regression analysis found that students who studied at low-level universities, smoked cigarettes, drank alcohol, slept less than 7 hours, went to bed after 12:00 am, or students with psychological distress were more likely to experience overall and four types of RTIs. Students who studied in the eastern universities had a higher likelihood of automobile injury, motorcycle injury and pedestrian injury than those who studied in western universities.
Conclusions: Several critical factors associated with RTIs were identified. These findings have implications for the design and implementation of RTI prevention and interventions programs targeted at university students.
Peng, S; Yang, XY; Rocket, IR (2019): A typology of social capital and its mixed blessing for suicidal ideation: A multilevel study of college students. Social Science & Medicine 243:112640
Rationale: Social capital is an important theoretical construct often used to explain positive behavioral outcomes. However, suicide research is often hampered by a limited definition of social capital, at the expense of its multidimensional nature, since suicide may occur when individuals are beset by overwhelming and conflicting relationships. We hypothesize not all dimensions of social capital protect individuals from suicidal ideation, and the beneficial return from some types also gradually diminishes.
Methods: We conducted a hierarchical ordinal regression analysis of combined samples of university students from 22 cities across all regions of China (n=5025, response rate 97%).
Results: 1) whereas social capital, measured as network connection, embedded-resource, and generalized trust, is negatively associated with self-reported suicidal ideation, controlling for mental stress and other covariates, when measured as social participation, shows a positive association; 2) the moderate curvilinear effects of embedded resource and network connection imply that the return from some dimensions of social capital gradually diminishes.
Conclusions: Weleveragedtheresultstodiscussthetheoreticalrelevanceofsocialcapitalinthesuicideliterature –particularly its dark side– and the need for more contextualized public health intervention programs for suicide prevention.
Methods: We conducted a hierarchical ordinal regression analysis of combined samples of university students from 22 cities across all regions of China (n=5025, response rate 97%).
Results: 1) whereas social capital, measured as network connection, embedded-resource, and generalized trust, is negatively associated with self-reported suicidal ideation, controlling for mental stress and other covariates, when measured as social participation, shows a positive association; 2) the moderate curvilinear effects of embedded resource and network connection imply that the return from some dimensions of social capital gradually diminishes.
Conclusions: Weleveragedtheresultstodiscussthetheoreticalrelevanceofsocialcapitalinthesuicideliterature –particularly its dark side– and the need for more contextualized public health intervention programs for suicide prevention.
Hu, Anning, Xiaozhao Yousef Yang and Weixiang Luo. 2017. "Christian Identification and Self-Reported Depression: Evidence from China." Journal for the Scientific Study of Religion 56(4):765-80.
The nexus between religion and mental health in the East has been understudied, where the coexistence of multiple religions calls for scholarly attention to religious identification. This article investigates the impact on self‐reported depression of an individual's identification with Christianity in a non‐Judeo‐Christian and religion‐regulating social setting. Taking advantage of the Chinese General Social Survey 2010, our empirical analyses suggest that people who explicitly identify with Christianity report a significantly higher level of depression compared with both religious nones and self‐claimed Buddhists. In contrast, there is no significant difference in self‐reported depression between religious nones and self‐identified Buddhists. This study supplements current literature on the connection between religious affiliation and mental health with a particular interest in East Asia, suggesting that the consequence on mental health of religious identification is contingent on a religion's social status, and a religion's marginal position may turn religious identification into a detrimental psychological burden.
Yang, T., Yang, X. Y., Yu, L., Cottrell, R. R., & Jiang, S. (2017). Individual and regional association between socioeconomic status and uncertainty stress, and life stress: a representative nationwide study of China. International Journal for Equity in Health, 16(1), 118.
Background Many studies have examined the association between socioeconomic status (SES) and mental stress. Uncertainty stress is a prominent aspect of mental stress. Yet no research has ever empirically analyzed the impact of SES on uncertainty stress.
Methods Students were identified through a multistage survey sampling process including 50 universities. Each student participant completed the Global Health Professions Student Survey (GHPSS) on Tobacco Control in China. Regional variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were considered in the analyses.
Results Among the 11,942 participants, severe uncertainty stress prevalence was 19.6%, while severe life stress prevalence was 8.6%. Multilevel logistic regression showed that most SES variables were associated with uncertainty stress. Students with “operation and commercial work” as mother’s occupation and “rural or township” as family location exhibited a higher prevalence of severe uncertainty stress. Lower family income and original region gross domestic products (GDP) were also associated with higher severe uncertainty stress prevalence. However, only father’s occupation was correlated with life stress.
Conclusions Based on the literature review, this is the first empirical study examining the impact of SES on uncertainty stress in China and elsewhere in the world. Our research underscores the importance of decreasing socioeconomic inequalities in controlling excessive uncertainty stress.
Methods Students were identified through a multistage survey sampling process including 50 universities. Each student participant completed the Global Health Professions Student Survey (GHPSS) on Tobacco Control in China. Regional variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were considered in the analyses.
Results Among the 11,942 participants, severe uncertainty stress prevalence was 19.6%, while severe life stress prevalence was 8.6%. Multilevel logistic regression showed that most SES variables were associated with uncertainty stress. Students with “operation and commercial work” as mother’s occupation and “rural or township” as family location exhibited a higher prevalence of severe uncertainty stress. Lower family income and original region gross domestic products (GDP) were also associated with higher severe uncertainty stress prevalence. However, only father’s occupation was correlated with life stress.
Conclusions Based on the literature review, this is the first empirical study examining the impact of SES on uncertainty stress in China and elsewhere in the world. Our research underscores the importance of decreasing socioeconomic inequalities in controlling excessive uncertainty stress.

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Wang, H., Yang, X. Y., Yang, T., Cottrell, R. R., Yu, L., Feng, X., & Jiang, S. (2015). Socioeconomic inequalities and mental stress in individual and regional level: a twenty one cities study in China. International Journal for Equity in Health, 14(1), 25. doi:10.1186/s12939-015-0152-4
Objectives This study will examine explanatory variables including socioeconomic inequalities related to mental stress at both the individual and regional level.
Methodology A cross-sectional multistage sampling process was used to obtain participants. Data on mental stress and individual socioeconomic status were gathered via face to face interview. Regional variables were retrieved from a national database. Multilevel logistic regression analysis was used to assess socioeconomic variances in mental stress.
Results Among the 16,866 participants, 27.2% reported severe levels of mental stress (95% CI: 19.4%-35.1%). Multilevel regression analysis indicated that lower individual educational attainment and income, and lower regional Per Capita GDP was associated with mental stress. The results also indicated that managers, clerks, and professional workers manifested higher stress levels than those in other occupations.
Conclusions Based on the results of this study individual and regional socioeconomic inequalities in China are associated with mental stress.
Methodology A cross-sectional multistage sampling process was used to obtain participants. Data on mental stress and individual socioeconomic status were gathered via face to face interview. Regional variables were retrieved from a national database. Multilevel logistic regression analysis was used to assess socioeconomic variances in mental stress.
Results Among the 16,866 participants, 27.2% reported severe levels of mental stress (95% CI: 19.4%-35.1%). Multilevel regression analysis indicated that lower individual educational attainment and income, and lower regional Per Capita GDP was associated with mental stress. The results also indicated that managers, clerks, and professional workers manifested higher stress levels than those in other occupations.
Conclusions Based on the results of this study individual and regional socioeconomic inequalities in China are associated with mental stress.

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Yang, T., Rockett, I.R., Yang, X., Xu, X 2009: Patterns and Correlates of Stress among Rural Chinese Males: A Four-region Study, Public Health; 123,10: 694-698
Objectives Prior research has revealed a high prevalence of stress among general urban populations in China. However, little is known about stress in rural Chinese counterparts. This research estimates the prevalence of severe stress among rural Chinese males and identifies sociodemographic and psychological correlates.
Study designThe study design was a cross-sectional survey with multistage sampling.
Methods Subjects were male residents aged ≥15 years from four geographic regions of China (N = 4414), namely Jinbei, Jinnan, Guidongbei and Subei. Information was collected on perceived stress and potential sociodemographic and behavioural correlates as well as on perceived health status. Data were assessed by means of χ2 tests and unconditional logistic regression analysis.
Results The mean score for the rural male resident sample on the Chinese Perceived Stress Scale (CPSS) was 24.8 (standard deviation = 7.7), and 44% of subjects reported severe stress. With Subei residents as the referent, respondents from Guidongbei region [adjusted odds ratio (OR) = 0.66; 95% confidence interval (CI) = 0.52–0.84] had a lower likelihood of reporting severe stress and those from Jinbei region (OR = 3.54; 95% CI = 2.85–4.39) and Jinnan region (OR = 2.73; 95% CI = 2.21–2.39) had higher likelihoods. Respondents aged 35–44 years (OR = 0.69; 95% CI = 0.55–0.85) and ≥45 years (OR = 0.67; 95% CI = 0.54–0.83) had a lower likelihood of reporting severe stress than those aged <25 years, and respondents in non-farming jobs (OR = 1.33; 95% CI = 1.09–1.62) had an excess likelihood relative to those in farming. An excess likelihood of reporting severe stress was manifest among the divorced and widowed relative to the unmarried, and a lower likelihood was observed among respondents with a higher education relative to the least educated. Hedonism seeking was positively associated with severe stress among rural Chinese males (OR = 2.43; 95% CI = 2.09–2.84) and social participation was negatively associated (OR = 0.62, 95% CI = 0.54–0.73).
Study designThe study design was a cross-sectional survey with multistage sampling.
Methods Subjects were male residents aged ≥15 years from four geographic regions of China (N = 4414), namely Jinbei, Jinnan, Guidongbei and Subei. Information was collected on perceived stress and potential sociodemographic and behavioural correlates as well as on perceived health status. Data were assessed by means of χ2 tests and unconditional logistic regression analysis.
Results The mean score for the rural male resident sample on the Chinese Perceived Stress Scale (CPSS) was 24.8 (standard deviation = 7.7), and 44% of subjects reported severe stress. With Subei residents as the referent, respondents from Guidongbei region [adjusted odds ratio (OR) = 0.66; 95% confidence interval (CI) = 0.52–0.84] had a lower likelihood of reporting severe stress and those from Jinbei region (OR = 3.54; 95% CI = 2.85–4.39) and Jinnan region (OR = 2.73; 95% CI = 2.21–2.39) had higher likelihoods. Respondents aged 35–44 years (OR = 0.69; 95% CI = 0.55–0.85) and ≥45 years (OR = 0.67; 95% CI = 0.54–0.83) had a lower likelihood of reporting severe stress than those aged <25 years, and respondents in non-farming jobs (OR = 1.33; 95% CI = 1.09–1.62) had an excess likelihood relative to those in farming. An excess likelihood of reporting severe stress was manifest among the divorced and widowed relative to the unmarried, and a lower likelihood was observed among respondents with a higher education relative to the least educated. Hedonism seeking was positively associated with severe stress among rural Chinese males (OR = 2.43; 95% CI = 2.09–2.84) and social participation was negatively associated (OR = 0.62, 95% CI = 0.54–0.73).

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