Analysis of Mental Health Status and Inuencing Factors of Overseas Chinese in Laos

Background: To provide a reference for foreign aid workers by identifying the mental health status of Overseas Chinese resident in Laos and the inuencing factors. Methods :Convenience sampling method was used to select the 414 Overseas Chinese in Laos from April 10 to May 10 in 2020. The mental health status was assessed by using PHQ-9 and GAD-7 scales, and the inuencing factors were analyzed. Results :The prevalence of anxiety and depression among overseas Chinese in Laos was 28.5% and 36.2%. Factors inuencing anxiety and depression included family members' attitudes towards their departure abroad, nancial aid subsidies, living standards in Laos, and Laotian food. Conclusion :Degrees of anxiety and depressive were varying among Overseas Chinese in Laos. Depression was highly correlated with anxiety, and the inuencing factors of anxiety and depression were different. Foreign aid workers should pay attention to the mental health of the Overseas Chinese in Laos and the inuencing factors.


Background
The "One Belt and One Road" is the main framework for mutually bene cial cooperation between China and southeast Asian countries, as well as an important guarantee for the economic and social development of China and countries along the belt and road. In order to better implement the "One Belt And One Road" measures, in recent years, China has sent more and more citizens to Laos for construction assistance in the political, economic, military, cultural, health and other elds. Chinese citizens have been living in Laos which is quite different from Chinese culture and which has a relatively backward economic conditions for a long time.
They need to face multiple challenges in life and work, and are prone to CROSS-culture stress, which often leads to physical, psychological, behavioral and other health problems [1],In order to expand the scope of medical and health services, we should not only pay attention to the mental health of foreign medical personnel [2][3][4][5][6][7], but also should pay more attention to mental health status and in uencing factors of overseas Chinese in order to provide reference basis for later foreign aid work, so this cross-sectional survey is carried out.

Study Subjects
The convenience sampling method was adopted to investigate overseas Chinese over 18 years old who were studying and working in Laos on April 10 to May 10, 2020. All the respondents volunteered to participate in the survey.

Survey tool and scoring method
Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) [8] . Evaluation criteria[9-10]: 0 (not at all) ~ 3 (almost every day); GAD-7 rating criteria: a score of 0-4 for no anxiety, a score of 5-9 for mild anxiety, a score of 10-14 for moderate anxiety, and over 15 for severe anxiety. PHQ-9 rating criteria: 0-4 points for no depression, 5-9 points for mild depression, 10-14 points for moderate depression, 15-19 points for moderate and severe depression, and 20-27 points for severe depression. The total score ranges from 0 to 27 points. A higher score indicates more severe symptoms of anxiety and depression.
Data processing and analysis SPSS 18.0 software was used to sort out and analyze the survey data.

Baseline characteristics
Based on the sample estimation methods that the number of observations at least 10 times the number of variables in the multivariate analysis 11 , there are 35 independent variables in the study. Considering the 10% invalid questionnaire rate, no less than 385 samples should be required. In fact, 433 questionnaires were collected, and 19 people (under 18 years old and the subjects were not in Laos) were excluded according to the inclusion criteria. There were 414 valid questionnaires with an effective rate of 95.6%. Demographic characteristics show that the majority were young men under the age of 30, generally higher level of education, and their occupations are mainly administrative personnel, professional technical personnel and workers, etc. Their occupations are relatively dispersed, without concentration or deviation from a certain occupation.

Relevant situation in Laos
The time of visits to Laos: 130 (31.4%) went on the rst visit, 48 (11.6%) went on the second visit and 236 (57.0%) went on the third visit; Time in Laos: 189 (45.7%) were less than 3 months, 74 (17.9%) were between 3 and 6 months, 56 (13.5%) were between 6 and 12 months and 95 (22.9%) were greater than 12 months; Satisfaction degree of foreign nancial aid: 182 (44.0%) were satis ed, 74 (17.9%) were dissatis ed and 158 (38.2%) were not clear. The material living standards and daily needs in Laos: 98 were very satis ed (23.7%), of their families support them going to Laos and 38.2% of them are not aware of the foreign nancial aid.
Mental Health Status (Table 1) 5 points were selected as the cutoff point of total GAD-7 and PHQ-9 scores, and the incidence of anxiety was 28.5%, among which the incidence of mild, moderate and severe anxiety was 20.5%, 3.9% and 4.1% respectively. The incidence of depression was 36.2%, which was 23.9%, 6.3%, 3.4% and 2.7% respectively, in mild, moderate, moderate-to-severe and severe cases. After the measurement data were tested by normality test, Spearman rank correlation analysis was used to nd that the correlation coe cient between GAD 7 anxiety score and PHQ-9 depression score was 0.754 (P<0.001), indicating that there was a high positive correlation between depression and anxiety in Overseas Chinese in Laos.
In uencing factors of mental health status ( Table 2, 3,4) In uence factors analysis of anxiety and depression make anxiety (0 = no, 1 = yes) and depression (0 = no, 1 = yes) as the dependent variable, the possible in uence factors as independent variables. Nonconditional binary logistic regression method was used for single factor analysis one by one and independent variable with statistical signi cance (p<0.05) will make further multivariate analysis. Nonconditioned binary classi cation logistic regression was used for multivariate analysis and Omnibus method was used to test the overall effectiveness of logistic regression tting model. When regress tting equation, the forward stepwise LR regression in the stepwise method (= 0.05 as the inclusion criterion and = 0.10 as the exclusion criterion) was used for analysis.
The single factor analysis results showed that the factors affecting the anxiety and depression of overseas Chinese included gender, family's attitude towards going abroad, foreign nancial subsidies, local material living standard and diet in Laos.
The multivariate analysis results showed that the satisfaction with foreign nancial subsidies (Wald =12.359, p=0.002) and the satisfaction with diet (Wald =14.217, p=0.001) were the main factors for the incidence of depression among overseas Chinese in Laos. The differences between the comparison groups were statistically signi cant. The material living standard (Wald =47.546, P<0.01) and family support for going to Laos (Wald =10.321, P=0.006) were the main factors affecting the anxiety of overseas Chinese. There were signi cant differences between the two comparison groups.

Discussion
In order to make foreign aid work more detailed, better and more standardized, combined with the in uence factors of mental health, the author suggested that (1) Information disclosure: dispatched units should inform relevant self-protection knowledge and economic subsidy policies of foreign aid to foreign Chinese timely and in public, make them know fairly well and avoid the depression and anxiety due to entertain foolish ideas. (2) Economic support: in order to solve the problems of overseas Chinese, the dispatched units should in accordance with the relevant provisions of the documents or the contract and provide living allowances timely.
If conditions permit, raise the standard of overseas allowances. (3) Emotional support: dispatched units or foreign authorities should pay more attention to the mental health status of overseas Chinese and attach great importance to the in uence factors of overseas Chinese. For overseas Chinese dispatched to carry out missions, they mostly worry about their family. Dispatched units should dispatch staff to solve family di culties, eliminating the worries of the overseas Chinese. At the same time, we suggest the dispatched units conduct mental health investigation on the dispatched personnel, someone who has a serious psychological problem such as anxiety and depression should not be sent abroad. (4) Strengthen the establishment of psychological monitoring system. Add the psychological status of overseas Chinese into the system, establish a scienti c long-term mechanism of psychological crisis and organize a professional psychological intervention team. For the overseas Chinese who have psychological problems, we should take different intervention content and methods to help them make psychological adjustment timely.

Conclusion
Gad-7 and PHQ-9 have simple contents and strong operability. They have been veri ed by domestic and foreign studies with good reliability and validity [12][13][14][15][16][17][18], and widely used in a variety of research. In the next step, the author will continue to study the de ciencies in this survey, analyze and summarize the problems and experiences in the process of foreign aid. To provide reference for dispatched units to understand the mental health of foreign aid personnel, attach importance to relevant in uencing factors, and formulate targeted foreign aid management measures and humanistic care measures.

Funding
This study receives no funding or nancial support.

Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate
This study was approved by the Ethics Committee of Xijing Hospital.All the written consents were signed voluntarily and obtained online by all adult subjects.

Consent for publication
Not applicable

Competing interests
The authors declare that they have no competing interests.