The influence of social support, lifestyle and functional disability on psychological distress in rural China: Structural equation modelling

Objective To describe the prevalence of psychological distress in rural China and examine the associated influence of social support, lifestyle and functional disability. Design Cross-sectional survey with two-stage stratified random sampling. Setting Twenty-seven villages in Dongying City of Shandong Province. Participants A total of 2541 rural residents aged 1591 years. Main outcome measures Psychological distress was assessed by the Kessler 10, social support was assessed by the Social Support Rating Scale and lifestyle and functional disability was assessed with self-developed questionnaires. Results Of the rural residents assessed, 32.9% had K10 scores of 16 or greater. Women scored significantly higher than men did on the K10 (t (2539)=7.23, P<0.001). Functional disability was found to have a direct positive effect on psychological distress. Lifestyle had a direct negative effect on psychological distress and an indirect negative effect on psychological distress by reducing functional disability. Social support had an indirect negative effect on psychological distress by reducing functional disability and enhancing healthy lifestyles. Conclusions A third of the rural population in China reported psychological distress, with the highest prevalence observed in women. Functional disability had a significant direct effect, social support had significant indirect effects and lifestyle had both significant direct and indirect effects on psychological distress.