The Association between Cumulative Distal and Proximal Adversity with Depression and Anxiety among Township Grassroots Civil Servants in China

Zhu Xiong¹Yawen Zheng²Mengting Wang³Jian Wenqian³Pan Hong³Chen Li³Liu Xiaoyue^3*

• ¹Department of Psychiatry, The Third People’s Hospital of Huzhou Municipal, The Affiliated Hospital of Huzhou University, huzhou, China
• ²Lishui Second Affiliated Hospital of Wenzhou Medical University, wenzhou, China
• ³School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang Province, China

Background: 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. Methods: 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. Results: 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. Conclusion: 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.