BackgroundCatastrophic health expenditure (CHE) reflects the financial protection level towards the universal health coverage target. Air pollution is a major contributor to the economic burden of diseases. However, the relationship between air pollution and CHE remains largely unexplored. This study aims to investigate the effect of air pollution on CHE among middle-aged and older adults in China, and whether this effect is ameliorated by social health insurance.MethodsUsing four waves of the China Health and Retirement Longitudinal Study data matched with PM2.5 and meteorological data, we included 24004 participants aged 45 and above in the analysis. CHE was defined as out-of-pocket health expenditure exceeding 40% of non-food expenditure. We employed a random effects logit model and instrumental variable estimation to examine the effect of annual average PM2.5 concentration on CHE, and analyzed mechanisms and subgroup heterogeneity. Besides, the interaction effects of social health insurance types and PM2.5 on CHE were tested.ResultsPM2.5 was significantly associated with an increased likelihood of CHE among middle-aged and older adults in China. Increased exposure to PM2.5 may exacerbate CHE by elevating the direct costs of diseases and diminishing labor supply. Heterogeneity analysis indicated that those living in urban areas, aged above 65 years, with low educational attainment, and chronic conditions are more susceptible to PM2.5 than their counterparts. Further analysis revealed that only enrollment in the Urban and Rural Residents Medical Insurance, a basic health insurance with low premiums, mitigated the effect of PM2.5 on CHE among social health insurance types.ConclusionsThis study provides novel evidence that improved air quality lowers the likelihood of CHE, potentially through reduced disease-related direct costs and increased labor supply. These findings underscore the necessity of air pollution regulations and offer valuable insights for developing effective strategies to prevent air pollution and illness-related poverty.

Current studies suggest the intergenerational transmission of educational advantages is bidirectional over the life course. However, results from causal analysis studies do not consistently support the beneficial effect of adult children's education on aging parents' health. The conflicting evidence indicates a complex relationship, which may be nonlinear or only prominent in certain settings or explained by specific pathways, but remains unexplored. Using the 2016 and 2018 China Family Panel Studies data and instrumental variable estimation, we examine the effect of adult children's education on parents' health and systematically explore its heterogeneity and underlying mechanisms. Our study finds that adult children's education significantly improves parents' health in middle and older ages using instrumental variables estimation with two-stage least squares (IV/2SLS), but the effect may be nonlinear. The beneficial intergenerational transfer of health may slightly weaken when adult children's educational attainment exceeds the middle school education level. The effect of adult children's education on parents' health may be more notable in less developed regions and among younger parents and parents living with or less educated than their adult children. The mechanism analyses results suggest that adult children's education may enhance parents' health through both stress-based pathways (i.e., family economic hardship) and resource-based pathways (i.e., emotional support from children, housework support from parents, and improving parents' access to the resources), but not via the analyzed health habits. Our findings suggest that promoting children's education may improve parents' health over the life course, especially at least graduating from middle school. Our findings imply that prioritizing basic education policy in less developed regions, and providing buffers for economic stressors or enhancing daily intergenerational interactions within families are important for healthy aging in developing societies.

This study explored the current status and influencing factors of HIV-related stigma among elderly men (≥50 years old) in rural Chengdu, China. A structured face-to-face interview survey was conducted among 286 elderly males from three towns in Chengdu using convenience sampling, 240 men (83.9%) who had heard of HIV/AIDS were included in the analysis. Hierarchical regression was used to examine the associated factors of HIV-related stigma, including demographic variables, HIV/AIDS knowledge level, receiving HIV/AIDS-related health education in the past year, depression, and anxiety, and to examine the moderating effect of educational level on HIV/AIDS knowledge and HIV-related stigma. Hierarchical regression analysis showed that men with lower HIV/AIDS knowledge scores, primary school or below educated, and depression had higher HIV-related stigma total score and social stigma dimensional scores than their counterparts. In addition, living alone was associated with higher HIV-related stigma, and elderly men with lower monthly income and those without HIV/AIDS-related health education in the past year had higher levels of social stigma. Higher HIV/AIDS knowledge score was significantly associated with lower HIV-related stigma level among those with middle school or above education level, but no such effect in those with primary school or below. In conclusion, the HIV-related stigma level among elderly men in rural Chengdu was high and positively associated with depression. HIV/AIDS education should target elderly men with low education, living alone, and low income, and interventions to promote mental health may work together to reduce HIV-related stigma in the rural elderly population.

Oil fume is always considered as a major source of indoor air pollution. This article aims to examine the effects of cooking oil fume as environmental pollution on the health of Chinese women by using the data obtained from China Labor force Dynamic Survey (CLDS). In order to estimate the effect of environmental pollution on the human health, we utilize probit model approach and baseline regression method. The results showed that oil fume has a significant negative impact on the health indicators of “physical pain, health impact on work and injury.” By conducting endogeneity analysis, our results show the robustness and indicate that oil fume has a robust effect on the women health. Heterogeneity analysis show that heavier oil fume has a negative impact on the subjective health of middle-aged and young women, while it has  a significant negative impact on the objective health of middle-aged women. Analysis of the impact mechanism reveal that heavier oil fumes will reduce women’s sleep quality and will lead to the poorer health. Based on our study findings, this study proposes policy recommendations from the perspectives of the use of smoke extraction equipment, cooking methods, and sleep quality to reduce the negative impact of cooking fumes on women’s health.

Background: ACEs hurt subsequent physical and mental health outcomes. However, still little has been known about the rate of ACEs among rural Chinese emerging adults and the different buffering effects of the three types of social support on different kinds of ACEs. This study described the rate of ACEs among Chinese rural emerging adults, examined the relationship between ACEs and deviant behaviors, and tested the moderating effect of three different sources of perceived social support on this relationship. We hope these results will be helpful in further interventions.Methods: We used the second wave of a longitudinal survey that included ACEs variables in 2018. A total of 1031 emerging adults aged 18 to 25 participated in the current study.Results: we found that (1) the rate of abuse, neglect, and household dysfunction was 10.0, 30.0, and 24.9%, respectively among Chinese rural emerging adults; (2) abuse and household dysfunction experience were significantly and positively associated with deviant behaviors; (3) friend support moderated the relationship between three types of ACEs and deviant behaviors. Other support moderated the relationship between abuse/household dysfunction and deviant behaviors.Conclusions: ACEs could increase the risk of deviant behaviors. Perceived friend support could reduce the negative effect of three types of ACEs. Other support could reduce the negative impact of abuse and household dysfunction. These results suggest that reducing ACEs to make children's family environments safer and enhancing social support for emerging adults from rural areas are beneficial, which could prevent or reduce their deviant behaviors.

Abstract Background China is facing big challenges to achieve the “90–90-90 targets”. The HIV prevalence of elderly (≥50 years) men have been steadily increasing in China, mainly through the sexual transmission route, but sexual behaviors of them are far from well-studied. In 2019, elderly men accounted for 59.2% of HIV/AIDS cases in Sichuan, China. Methods The research design is a cross-sectional study. Face-to-face interviews were conducted among 795 HIV negative elderly men from rural Chengdu, capital City of Sichuan. Bivariate and multivariate logistic regression models were applied to examine factors associated with commercial heterosexual behavior from a modified Knowledge-Attitude-Practice (KAP) perspective. Results 129 (16.23%) respondents admitted high-risk sexual behaviors, including 11.07% commercial heterosexual behavior, 6.16% extramarital, 2.89% casual and 0.25% homosexual behavior, and no one used condom consistently. 427(68.43%) had ever gotten HIV-related Health Education (HRHE), mainly through mass media (70.49%). The HIV-related knowledge awareness rate was only 31.41%. Migration history (AOR =2.46,95% CI = 1.02–5.91), age(≥60 vs. 50–59, OR = 0.41, 95% CI = 0.19–0.91), receiving HRHE from mass media (OR = 0.37, 95%CI = 0.16–0.85), marital status (married vs. never married, OR = 0.04, 95%CI = 0–0.52), and undecided (AOR =0.02, 95%CI = 0.01–0.09) and objection (AOR =0.04, 95%CI = 0.01–0.1) attitude toward commercial sex were related to lifetime commercial heterosexual behavior. Conclusions High-risk sexual behaviors are common among elderly men from rural areas in Chengdu. Receiving HRHE from mass media and undecided and objection attitude toward commercial sex prevent elderly from being involving in commercial heterosexual behavior. According to the results, health facilities should continue to conduct systematic interventions, paying more attention to 50–59 years old group. Sex and condom use need to be talked in public. Working with mass media, health facilities give elderly men education not only focusing on HIV/AIDS, but also on knowledge and skills of condom use.

With the COVID-19 vaccination widely implemented in most countries, propelled by the need to revive the tourism economy, there is a growing prospect for relieving the social distancing regulation and reopening borders in tourism-oriented countries and regions. This need incentivizes stakeholders to develop border control strategies that fully evaluate health risks if mandatory quarantines are lifted. In this study, we have employed a computational approach to investigate the contact tracing integrated policy in different border-reopening scenarios in Hong Kong, China. Explicitly, by reconstructing the COVID-19 transmission from historical data, specific scenarios with joint effects of digital contact tracing and other concurrent measures (i.e., controlling arrival population and community nonpharmacological interventions) are applied to forecast the future development of the pandemic. Built on a modified SEIR epidemic model with a 30% vaccination coverage, the results suggest that scenarios with digital contact tracing and quick isolation intervention can reduce the infectious population by 92.11% compared to those without contact tracing. By further restricting the inbound population with a 10,000 daily quota and applying moderate-to-strong community nonpharmacological interventions (NPIs), the average daily confirmed cases in the forecast period of 60 days can be well controlled at around 9 per day (95% CI: 7–12). Two main policy recommendations are drawn from the study. First, digital contact tracing would be an effective countermeasure for reducing local virus spread, especially when it is applied along with a moderate level of vaccination coverage. Second, implementing a daily quota on inbound travelers and restrictive community NPIs would further keep the local infection under control. This study offers scientific evidence and prospective guidance for developing and instituting plans to lift mandatory border control policies in preparing for the global economic recovery.

Reviewed by: The Race Card: From Gaming Technologies to Model Minorities by Tara Fickle Huan He (bio) The Race Card: From Gaming Technologies to Model Minorities, by Tara Fickle. New York: New York University Press, 2019. 272 pp. $89.00 hardcover, ISBN: 9781479868551; $30.00 paper. ISBN: 9781479805952. If prevailing theories of Asian American racialization have been defined by labor, then Tara Fickle's The Race Card: From Gaming Technologies to Model Minorities (2019) considers how racial meaning and ideas are constituted by games and play. Fickle persuasively shows that games are not merely artifacts of leisure or entertainment (as one might assume) but reflect and shape the imaginaries of modern US race relations. Drawing from a rich archive of Asian American culture, ranging from games, literature, sociology, journalism, and visual media, The Race Card demonstrates how Asian Americans have functioned as a racial avatar for neoliberalism by encapsulating game-based ideas of fairness and deservedness through their perceived "exceptional" history as model minorities. Fickle reinterprets histories familiar to Asian American studies—such as Asian exclusion, Japanese American internment, and the model minority myth—to suggest that the ludic played a key role in these moments of racial formation. The stakes associated with racial inclusion and assimilation depended upon perceptions of Asians being not only hard workers but also hardcore gamers, stereotypes that persist into the digital present. Fickle reveals how Asian American studies is uniquely positioned to demonstrate how racialization is constituted through the logic of gaming, the technologies that "transform an imagined fiction into a social reality" and explain how "arbitrary typologies of human difference are made to feel not only real but justified in the contemporary epoch" (9). In the introduction, The Race Card offers its central concept of "ludo-Orientalism, wherein the design, marketing, and rhetoric of games shape how Asians as well as East-West relations are imagined and where notions of foreignness and racial hierarchies get reinforced" (3). Uniting insights from critical game studies and Asian American studies, ludo-Orientalism allows the reader to understand how ludic processes constitute the contradictions most familiar to scholars of Asian American studies, such as the simultaneous embodiment of "yellow peril" and "model minority" ideas or the limits and possibilities of Asian American political identity. Racialization and identity formation are "played out both in and through games" (3), cohering the terms of agency, individualism, and representation under US liberal capitalism. Extending the work of feminist media studies scholars such as Lisa Nakamura, Wendy Hui Kyong Chun, and Tara McPherson, Fickle understands race not simply on the level of visual representation or content but as a phenomenon behind the screen, encoded within the formal logics and infrastructure of gaming itself. For this reason, the book's playful organization also embodies [End Page 515] a formal and structural experiment based on the logic of a six-sided die. An "oppositional yet complementary coherence" (22) links chapters one with six, two with five, and three with four, allowing the book to offer a historical chronology of ludo-Orientalism without fortifying any notion of racial or technological progress. These pairings structurally reveal the lasting effects of ludo-Orientalism and its role in nation-building of the United States and the "West" through the "abstract game ideals of fairness and freedom" (21), against racialized ideas of Asian difference and threat. Chapters one and six address the topic of Chinese laborers and how ludic pursuits were pathologized and/or venerated along racial lines. Chapter one examines the role of gambling in ushering in anti-Asian sentiment and laws in the nineteenth century, as depictions of Chinese gamblers were levied by exclusionists as an "affront to the 'fair play' on which U.S. democracy was ostensibly founded" (21). Challenging assumptions that notions of "inveterate gamblers" (34) only played a minor role in comparison to the rhetoric of racialized labor in exclusion debates, chapter one demonstrates that "gambling allowed both sides of the exclusion debate to discuss work and play … as two sides of the same racial character trait" (42). Fickle turns to historical and literary materials, most prominently Bret Harte's poem "The Heathen Chinee" (1870), in order to illustrate how Chinese labor was perceived...

在我国当前经济发展阶段下,人力资本的重要性日益凸显.本文采用2016年的中国劳动力动态调查(CLDS)数据,考察了互联网使用对居民健康的影响,并探讨了该影响在不同群体中可能存在的异质性及其影响机制.结果 发现,使用互联网对居民健康具有显著的正面影响.相比不使用互联网,使用互联网时,居民自评非常健康的可能性上升3.9％,没有身体疼痛的可能性上升2.7％,情绪改善约0.75,遭遇伤病和住院的可能性分别下降1.3％和1.1％.考虑到可能存在的内生性问题,本文通过选择合适的工具变量处理内生性之后,结果仍然稳健.对该影响在不同群体中可能存在的异质性进行分析,结果发现,相比经济条件较差、在城镇居住和青年群体,互联网使用对经济条件较好、在农村居住和中年群体的影响程度更大.进一步对影响机制分析发现,互联网使用能够通过提升居民收入水平和锻炼等可能性,进而促进他们的健康改善,即预算约束放松和健康生产效率提升是互联网使用改善居民健康的重要机制.在此基础上,本文建议从提高互联网普及率、提升互联网使用技能和正确引导互联网使用等方面努力,以互联网的健康促进效应推动中国经济健康发展.

BackgroundSchool bullying is a destructive behaviour common among adolescents that can sometimes escalate to criminal activity. This study aimed to examine the association between four types of school bullying (i.e., physical, verbal, relational, and cyber) and murderous ideation and behaviours (i.e., ideation, plans, preparation, and attempts) among adolescent students.MethodsData were collected from 5726 middle and high school students using self-administered questionnaires in December 2013. The participants were selected using a 3-stage random cluster-sampling strategy. The participants were asked about the frequency of their bullying experiences in the past two months and the frequencies of their murderous ideation and behaviours in the past six months. Multivariate logistic regressions were performed to explore the association between school bullying and murderous ideation and behaviours.ResultsEach type of school bullying perpetration was associated with murderous ideation and behaviours, as was each type of bullying victimization. Students who experienced more types of school bullying perpetration and victimization were more likely to report murderous ideation and behaviours. Moreover, the number of types of bullying perpetration and victimization had a dose-response association with murderous ideation and behaviours (aOR min=1.45, aOR max=2.72), as did the frequency of involvement in bullying perpetration and victimization (aOR min=1.33, aOR max=2.00). Being a bully-victim was a risk factor for murderous ideation and behaviours (aOR min=3.88, aOR max=7.24).ConclusionsEach type of school bullying was associated with an increased risk for murderous ideation and behaviours among adolescents. Dose-response relationships between the frequency of bullying and number of bullying types experienced and murderous ideation and behaviours were found in this study. Future studies are warranted to confirm our findings and explore the mechanisms underlying the relationship between school bullying and murderous ideation and behaviours.

Abstract The objective of this study was to examine the longitudinal health consequences of the Wenchuan earthquake. Based on descriptive analyses of national-level data and multivariate analyses on a six-wave repeated cross-sectional survey, the findings suggested that after 8 years health risks remained high among earthquake-affected survivors; however, a process of recovery existed. To conceptualize these findings, in this study, we proposed a three-stage recovery model in which the postdisaster health status was divided into three stages: acute, stagnant, and adaptive. At each stage, the health risk varied, and over time, associations between health outcomes and protective factors varied. The three-stage recovery model identified the trends of long-term health consequences among adult earthquake survivors and provided guidance for postdisaster reconstruction in China on the basis of protective factors analyses.

社会的不断发展给外语教学提出了新的要求,适应当今社会需求的外语人才必须是具有创新精神和自主学习能力的.为响应高校日语教学改革的需要,同时也为培养更高水平的日语人才,提升学生的自主学习能力成为了重要的课题.本文试从教学模式、教师角色定位和教学资源三个方面分析日语专业学生自主学习能力低下的原因并提出相应的培养策略,探索日语精读课堂提高教学效率的途径.

The objective of this study was to examine the longitudinal health consequences of the Wenchuan earthquake. Based on descriptive analyses of national-level data and multivariate analyses on a six-wave repeated cross-sectional survey, the findings suggested that after 8 years health risks remained high among earthquake-affected survivors; however, a process of recovery existed. To conceptualize these findings, in this study, we proposed a three-stage recovery model in which the postdisaster health status was divided into three stages: acute, stagnant, and adaptive. At each stage, the health risk varied, and over time, associations between health outcomes and protective factors varied. The three-stage recovery model identified the trends of long-term health consequences among adult earthquake survivors and provided guidance for postdisaster reconstruction in China on the basis of protective factors analyses.

本研究以广西壮族自治区桂林市全州县为例,运用二元logistics回归分析模型对影响农户参与土地承包经营权抵押贷款因素进行分析及预测,结果表明:农户参与意愿强烈,73.48％ 的农户有愿意参与;农户户主年龄、农户务农收入占比、贷款利率、农户家庭总收入以及农地总面积对参与意愿有显著影响,且农户户主年龄和务农收入占比越小、贷款利率越低,农户家庭总收入以及农地总面积越大,贷款意愿越强烈.论文针对调查结果提出对应策略以供参考.

Early distinguishing the cognitive impairment from healthy population is crucial to delay the progression of mild cognitive impairment (MCI) and Alzheimer disease (AD). Test Your Memory (TYM) has been proved to be a valid and reliable screening instrument for AD and MCI. This study aimed to develop a culturally appropriate and functional Standard Mandarin Chinese translation of the TYM, and to evaluate its reliability and validity in detecting AD and MCI in Chinese.

持续提升工业用地利用效率,保障工业用地最有效使用,是合理控制工业用地规模的关键.通过对研究区域实地调查,选取27家典型企业,利用固定效应模型测算企业用地边际效益,并探讨其与控制指标之间的关系,以提升企业用地利用效率,促进工业用地规模合理发展.研究结果表明:(1)企业用地边际效益集中在200-1000万元/hm2之间,提升空间较大.(2)容积率对企业用地边际效益的促进效用高于投资强度的促进效用.但随企业经营时间增长,投资强度的促进效应减弱,随企业规模的扩大,容积率的促进效应被削弱.

Introduction: The associations of maternal conditions, before or during pregnancy, with placental lesions have not been adequately studied in populations.Methods: In the Boston Birth Cohort, we evaluated associations between three maternal medical conditions (hypertensive disorders [HDs], gestational/pre-gestational diabetes and obesity), and placental histological findings, using a standardized classification system proposed by the Amsterdam Placental Workshop Group. Placental pathology diagnoses and clinical data from 3074 mothers with clinical indications who delivered singleton live births at the Boston Medical Center between October 1998 and November 2013 were evaluated. Associations between each maternal condition and maternal vascular malperfusion (MVM) of the placental bed and its standardized subgroups were examined using multivariate logistic and multinomial regressions.Results: Women with HDs (chronic hypertension, eclampsia, preeclampsia, HELLP syndrome) had significantly increased odds of MVM lesions when compared to women with no HD (aOR 2.08 95% CI 1.74-2.50), after adjusting for demographics, substance use, diabetes and body mass index. No significant differences in frequencies or aORs were seen in women with and without diabetes, or across body mass index categories. Co-morbid condition patterns that included HDs were more likely to be associated with MVM than those without.Discussion: Using a standardized classification system, we showed that MVM is strongly and specifically associated with maternal HDs, but not other maternal conditions. Additional studies are needed to confirm and validate our findings, and evaluate the role of maternal vascular lesions of the placental bed in relation to postnatal growth and development of the offspring and effect modifiers. (C) 2017 Elsevier Ltd. All rights reserved.

IntroductionLow- and middle-income countries (LMICs) have a disproportionately high burden of injuries. Most injury severity measures were developed in high-income settings and there have been limited studies on their application and validity in low-resource settings. In this study, we compared the performance of seven injury severity measures: estimated Injury Severity Score (eISS), Glasgow Coma Score (GCS), Mechanism, GCS, Age, Pressure score (MGAP), GCS, Age, Pressure score (GAP), Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS) and Kampala Trauma Score (KTS), in predicting in-hospital mortality in a multi-hospital cohort of adult patients in Kenya.MethodsThis study was performed using data from trauma registries implemented in four public hospitals in Kenya. Estimated ISS, MGAP, GAP, RTS, TRISS and KTS were computed according to algorithms described in the literature. All seven measures were compared for discrimination by computing area under curve (AUC) for the receiver operating characteristics (ROC), model fit information using Akaike information criterion (AIC), and model calibration curves. Sensitivity analysis was conducted to include all trauma patients during the study period who had missing information on any of the injury severity measure(s) through multiple imputations.ResultsA total of 16,548 patients were included in the study. Complete data analysis included 14,762 (90.2%) patients for the seven injury severity measures. TRISS (complete case AUC: 0.889, 95% CI: 0.866–0.907) and KTS (complete case AUC: 0.873, 95% CI: 0.852–0.892) demonstrated similarly better discrimination measured by AUC on in-hospital deaths overall in both complete case analysis and multiple imputations. Estimated ISS had lower AUC (0.764, 95% CI: 0.736–0.787) than some injury severity measures. Calibration plots showed eISS and RTS had lower calibration than models from other injury severity measures.ConclusionsThis multi-hospital study in Kenya found statistical significant higher performance of KTS and TRISS than other injury severity measures. The KTS, is however, an easier score to compute as compared to the TRISS and has stable good performance across several hospital settings and robust to missing values. It is therefore a practical and robust option for use in low-resource settings, and is applicable to settings similar to Kenya.

BACKGROUND:The Wenchuan earthquake was China's worst natural disaster of the past three decades. Although the psychological sequelae of disasters can last for many years, the long-term sequelae and their risk factors tend to receive little research attention.OBJECTIVES:The objectives of the present study were to estimate the prevalences of symptomalogical PTSD and depression among survivors 8 years after the Wenchuan earthquake, and to identify the shared and unshared risk factors associated with PTSD and depression, using data from a cross-sectional survey.METHODS:1369 participants were recruited from two different sites in the areas that were severely affected by the earthquake. Symptomalogical PTSD was assessed by the Impact of Event Scale-Revised (IES-R). The Chinese edition of the Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depression. Traumatic exposure to the Wenchuan earthquake was assessed using an exposure checklist designed by this study.RESULTS:Eight years after the Wenchuan earthquake, 11.8% of the respondents had symptomalogical PTSD, and 24.8% of respondents had probable depression. The results also indicated that female gender, low education, poor perceived health, and traumatic experiences after the earthquake were associated with higher odds of both PTSD and depression among survivors. Direct exposure to the earthquake was associated with comorbid symptomalogical PTSD and depression (OR=1.86; 95% CI=1.42, 2.44). Those having only depression were more likely to be unmarried/divorced/widowed, and to have experienced fear at the time of the earthquake (OR=1.34; 95% CI=1.04, 1.72), while those with only symptomalogical PTSD were likely to be from the township of Yongan as opposed to Guangji (OR=1.86; 95% CI=1.06, 3.31).LIMITATIONS:This is a cross-sectional study, and thus is insufficient for determining causal relationships with regard to chronic PTSD or depression.CONCLUSIONS:The results of this study indicate that symptomalogical PTSD and depression persist among many survivors of the Wenchuan earthquake, 8 eight years later. Objective earthquake exposure is associated with symptomalogical PTSD, while subjective exposure is associated with long-term depression.

It has been eight years since the Wenchuan earthquake. We don't know how the lives of those affected by the disaster may remain blighted by its effects, or how many remain thus affected. The aim of the present study was to examine the relationship of disaster exposure, PTSD, depression and suicidal behaviors, using data from a cross-sectional survey conducted in earthquake-affected areas of China. 1369 participants were recruited from two different sites that were severely affected by the Wenchuan earthquake. The survey assessed suicidality (suicidal ideation, plans and attempts) and other mental health issues. Probable PTSD was assessed using the Impact of Event Scale-Revised (IES-R). The Center for Epidemiologic Studies Depression Scale (CES-D) Chinese edition was used to assess depressive symptoms. The results showed that 11.2% of participants felt that their lives had not yet recovered from the effects of the Wenchuan earthquake, even after eight years. Suicidal ideation, plans, and attempts were reported by 9.1%, 2.9%, and 3.3%, respectively, of the respondents. PTSD, depression, and perceived non-recovery were highly associated with suicidality. These results indicate that suicidality can be a long-term mental health sequela of disaster. Targeted, long-term suicide prevention programs for adult survivors should be further developed.