title: Threat to democracy: Physical and mental health impact of democracy movement in Hong Kong.
abstract: BACKGROUND
  This study examined the prevalence and critical predictors of anxiety and depressive symptoms and self-rated health, following the Umbrella Movement in Hong Kong.
  
  
  METHODS
  Random digit dialing recruited a population-representative sample of 1208 Chinese Hong Kong citizens (mean age=46.89 years; 63% female) in the first two weeks of February 2015. Respondents gave their informed consent and reported personal, social, and economic resource loss since the Umbrella Movement (Conservation of Resources-Evaluation), current anxiety symptoms (State-Trait Anxiety Inventory) and depressive symptoms (Patient Health Questionnaire-9), and self-rated health (1=very good, 4=very bad).
  
  
  RESULTS
  A total of 47.35% (95% CI=44.55, 50.17) respondents reported moderate/severe anxiety symptoms and 14.4% (95% CI=12.54, 16.50) reported moderate/severe depressive symptoms; 9.11% (95% CI=7.61, 10.86) reported "poor" or "very poor" health. Multivariable regressions revealed that personal and social resource loss was associated with higher anxiety and depressive symptoms and greater odds of "very poor" health (adjusted odds ratios/incidence rate ratios=5-102%), independent of lower education level and income and being unmarried.
  
  
  CONCLUSIONS
  This study was cross-sectional in nature and thus could not determine causality from the associations between resource loss and outcome variables. Second, the telephone survey relied on self-reports; response bias and social desirability could influence respondents' answers and discount data validity. Third, potential confounders such as preexisting mental and physical health issues and concurrent predictors like exposure to the Umbrella Movement were not assessed.
  
  
  CONCLUSIONS
  This is one of the first studies following any recent political movement (e.g., The Arab Spring) to quantify distress and the associated correlates of distress among affected citizens. Perceived psychosocial resource losses were critical predictors of poor outcomes.
authors.affiliation: Department of Psychological Studies, The Hong Kong Institute of Education, Hong Kong (SAR), People's Republic of China; Laboratory of Psychobiology of Emotion and Stress (LoPES), The Hong Kong Institute of Education, Hong Kong (SAR), People's Republic of China; Centre for Psychosocial Health, The Hong Kong Institute of Education, Hong Kong (SAR), People's Republic of China. Electronic address: wkhou@ied.edu.hk.
authors.forename: Wai Kai
authors.initials: WK
authors.lastname: Hou
authors.affiliation: Department of Psychology, Faculty of Social Sciences, University of Macau, Macau (SAR), People's Republic of China; Global and Community Mental Health Research Group, University of Macau, Macau (SAR), People's Republic of China; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hall
authors.affiliation: School of Political Science, University of Haifa, Haifa, Israel.
authors.forename: Daphna
authors.initials: D
authors.lastname: Canetti
authors.affiliation: Department of Psychological Studies, The Hong Kong Institute of Education, Hong Kong (SAR), People's Republic of China; Laboratory of Psychobiology of Emotion and Stress (LoPES), The Hong Kong Institute of Education, Hong Kong (SAR), People's Republic of China.
authors.forename: Kam Man
authors.initials: KM
authors.lastname: Lau
authors.affiliation: Department of Psychological Studies, The Hong Kong Institute of Education, Hong Kong (SAR), People's Republic of China; Laboratory of Psychobiology of Emotion and Stress (LoPES), The Hong Kong Institute of Education, Hong Kong (SAR), People's Republic of China.
authors.forename: Sin Man
authors.initials: SM
authors.lastname: Ng
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Stevan E
authors.initials: SE
authors.lastname: Hobfoll
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003709:Democracy; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence
keywords: Conservation of resources theory; Hong Kong; Political movements; Prevalence of psychiatric symptoms; Self-rated health