# The association between cumulative distal and proximal adversity with depression and anxiety among township grassroots civil servants in China

## TL;DR

This study finds high rates of depression and anxiety among Chinese township civil servants, linked to both past and current stressors.

## Contribution

The study identifies how cumulative distal and proximal adversities interact to affect mental health in a specific Chinese population.

## Key findings

- Depression and anxiety prevalence was 36.7% and 29.6% among township civil servants.
- Cumulative adversity showed a strong linear association with mental health outcomes.
- Proximal stressors like work stress and economic poverty mediated the impact of distal adversities.

## Abstract

Depression and anxiety are significant public health concerns among township grassroots civil servants, the largest segment of China’s civil service. This study aims to investigate the prevalence of depression and anxiety within this population, identify key distal and proximal adversity factors using the Developmental Adaptation Model, explore the association between cumulative adversity and mental health outcomes, and analyze the underlying pathways of association.

A cross-sectional study of 1,275 township grassroots civil servants collected data on demographics, distal adversities (e.g., left-behind experiences, emotional abuse), proximal adversities (e.g., parent-child conflict, divorce intentions, work stress), depression and anxiety using self-report questionnaires. Logistic regression was used to identify predictors, while ANOVA and hierarchical regression were used to examine the functional form of the relationship between cumulative adversity and mental health. Finally, mediation analysis was conducted to explore the role of proximal adversity in linking distal adversity to mental health outcomes.

The prevalence of depression and anxiety among township grassroots civil servants was high, at 36.7% and 29.6%, respectively. Multiple distal and proximal factors were significantly associated with both outcomes. Among distal adversities, domestic violence (aOR = 3.42) and emotional abuse (aOR = 2.89) were the strongest correlates of depression; among proximal adversities, work stress (aOR = 5.02) and economic poverty (aOR = 4.92) had the most substantial associations. Cumulative adversity was significantly and positively associated with both depression and anxiety (p < 0.001), showing a clear linear pattern. Mediation analysis revealed that the effect of cumulative distal adversity on both depression and anxiety was fully mediated by cumulative proximal adversity.

This study highlights an alarming prevalence of depression and anxiety among township grassroots civil servants. The findings underscore that while early life adversity creates a foundation of risk, current (proximal) stressors are the primary mechanism through which this risk translates into psychological distress. These insights can help government agencies develop more effective, targeted interventions by focusing on mitigating current work and life pressures.