DATA AND METHODOLOGY: Data were obtained by a questionnaire survey in a large public hospital in a big metropolitan city of China. The final sample consisted of 1012 respondents with 237 (23.4%) being male and 775 (76.6%) being female. The respondents were of three groups: (1) Believers (n = 34; 3.5%); (2) Non-Believers or Atheists (n = 547; 55.8%); and (3) Agnostics or Fence-Sitters (n = 400; 40.8%). Suicidality was measured by the NCS-Suicidality Scale, and standard measures were employed for other major variables.

FINDINGS: In line with other recent studies in China, the religion rate among the urban adults remained low (3.5%). However, about 40.8% of the respondents chose "don't know" and could be fence-sitters on the issue of religious belief. Many of them are involved in various folk beliefs which may not be considered as religious. The religious believers were at higher risk of suicidality and depression than the atheists and the fence-sitters. However, the fence-sitters were higher than the believers and atheists on psychological strains, and they were higher on depression compared to the atheists.

OBJECTIVES: The purpose of this study was to systematically review published evidence on the effectiveness of CAL in disseminating oral health care information to patients and caregivers.

MATERIALS AND METHODS: A structured comprehensive search was undertaken among 7 electronic databases (PUBMED, CINAHL Plus, EMBASE, SCOPUS, WEB of SCIENCE, the Cochrane Library, and PsycINFO) to identify relevant studies. Randomized controlled trials (RCTs) and observational studies were included in this review. Papers were screened by 2 independent reviewers, and studies that met the inclusion criteria were selected for further assessment.

METHODS: Data came from a large sample of 11,412 Chinese undergraduate students. A bifactor-IRT model, specifying one general strain factor and four specific strains factors, was examined for fit to the sample data. A detailed item analysis, with analysis of the differential item functioning (DIF) of the items across gender, was undertaken to evaluate the dimensionality of the PSS. The associations among the PSS scale scores with scores on the concurrent measures, assessing psychache and suicidal behaviors, were examined.

RESULTS: IRT-derived specific bifactor indices showed that the PSS was unidimensional, and thus the PSS total scores should be reported. Unidimensional subset of 5 items identified (Item 9, Item 12, Item 14, Item 16, and Item 20), using bifactor-IRT modeling and incremental validation, were selected to construct a potential short form of the PSS (PSS-SF). The PSS-SF scale scores demonstrated strong psychometric properties and associations with scores on the concurrent measures assessing relevant constructs.

LIMITATIONS: This study used cross-sectional data from a non-clinical sample of Chinese undergraduate students.

METHODS: 6,305 college students (39.3% men; 60.7% women) from six Chinese provincial-level jurisdictions completed a paper-and-pencil survey with Psychological Strain Scales (PSS-40) and Depression, Anxiety, and Stress Scales-21 (DASS-21), both validated in Chinese populations.

RESULTS: Both PSS-40 and DASS-21 have high internal consistency reliabilities, and are highly correlated with each other. Hence, Chinese college students with greater psychological strains (value, aspiration, deprivation, or coping) have greater depression, anxiety, and stress. These results still held after controlling for relevant socio-demographic variables in the multiple regression models.

LIMITATIONS: This was a cross-sectional study, and the sample only included several provinces in mainland China, not a representative sample of all of them.