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e Perceived Mental Health Eects of China’s
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Avery Rasmussen
SIT Study Abroad
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THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
i
The Perceived Mental
Health Effects of China’s
One-Child Policy
Rasmussen, Avery
Academic Director: Lu, Yuan
Advisor: Zhao, Jie (Charles)
University of Vermont
Neuroscience
China, Yunnan, Kunming, Wuhua District
Submitted in partial fulfillment of the
requirements for China: Health, Environment and
Traditional Chinese Medicine, SIT Study Abroad,
Fall 2017
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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Abstract
This study looked at the perceived impacts of China’s 30 year One-Child Policy (OCP).
Previous studies suggested the OCP affected Chinese culture and society in a number of ways,
however no studies (to the knowledge of the principal investigator) had looked at perceptions of
the effects of the OCP on anxiety levels and other mental health issues of students in China. This
study sought to fill the aforementioned knowledge gap and aimed to determine perceptions about
the mental health effects of the OCP on students. Specifically, this study endeavored to gain a
better understanding of perceptions of the effects of the OCP on Chinese culture, the aging
population, and students’ mental health along with adults who are only children. This mixed-
methods study used two forms of data collection; in-person interviews and WeChat surveys. The
quantitative results of this study were analyzed using SPSS Statistical Analysis Software and
qualitative data was thematically analyzed to compliment the quantitative results. The results of
this study indicated that the primary effects of the OCP on Chinese culture were changes in the
values placed on different family roles and a decrease in the value placed on and prevalence of
traditional Chinese culture. The results also suggested egocentrism, selfishness and independent
awareness were perceived to be higher among OC, which could have been the result of changes
in the way OC were treated by their parents and therefore how they developed. Results also
indicate the perception that spoiling of OC by parents and grandparents resulted in the lowering
of OC’s tolerance to adversity and increased frustration when presented with challenges. Another
percieved implication of being an OC was less developed social skills, which could be due to the
lack of siblings. Based on the results of this study, it can be suggested that there are significant
perceived impacts of the OCP on the mental health of OC.
Key Words: Mental health, public health, health sciences
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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Table of Contents
ABSTRACT .................................................................................................................................. II
ACKNOWLEDGEMENTS ....................................................................................................... IV
LIST OF FIGURES .................................................................................................................... VI
INTRODUCTION......................................................................................................................... 1
MENTAL HEALTH IN CHINA ....................................................................................................................... 1
CHINA’S ONE-CHILD POLICY .................................................................................................................... 2
EFFECTS OF THE ONE-CHILD POLICY ........................................................................................................ 5
Chinese Culture..................................................................................................................................... 5
Women’s Rights..................................................................................................................................... 6
China’s Population ............................................................................................................................... 7
Economy ................................................................................................................................................ 8
Aging Population .................................................................................................................................. 9
Sex Ratio ............................................................................................................................................. 10
Misconceptions.................................................................................................................................... 11
Obesity and Diabetes .......................................................................................................................... 12
Little Emperors ................................................................................................................................... 12
Benefits ................................................................................................................................................ 13
Behavior .............................................................................................................................................. 14
Psychological ...................................................................................................................................... 15
STUDY AIMS ............................................................................................................................................ 16
METHODOLOGY ..................................................................................................................... 17
STUDY LOCATION AND RATIONALE ........................................................................................................ 17
PARTICIPANT RECRUITMENT AND RATIONALE ....................................................................................... 18
PARTICIPANT INFORMATION ................................................................................................................... 19
DATA COLLECTION.................................................................................................................................. 20
DATA PROCESSING AND ANALYSIS ......................................................................................................... 21
RESULTS .................................................................................................................................... 23
DISCUSSION .............................................................................................................................. 25
Chinese Culture and Society ............................................................................................................... 25
Child Behavior and Development ....................................................................................................... 28
Mental Health ..................................................................................................................................... 31
SHORTCOMINGS AND LIMITATIONS......................................................................................................... 21
CONCLUSIONS ......................................................................................................................... 35
RECOMMENDATIONS FOR FURTHER STUDY ............................................................... 37
REFERENCES ............................................................................................................................ 38
APPENDIX I: STUDY QUESTIONS ....................................................................................... 47
APPENDIX II: SAMPLE WECHAT SURVEY （STUDENTS） ........................................ 52
APPENDIX III: SYMPTOMS OF ANXIETY (STUDENTS) ................................................ 55
APPENDIX IV: FIELD STUDY HOURS BREAKDOWN .................................................... 56
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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Acknowledgements
This study would not have been possible without the support, guidance and resources
provided by SIT Kunming staff and affiliates. Thanks to Yunnan Nationalities University and the
review board of SIT affiliates for taking the time to review this study proposal and supporting it.
Thanks to Lu Yuan, the Academic Director of SIT Kunming, for allowing this study to take
place, helping in the development of the study concept, and her integral guidance on the design
of the study. Thanks to Zhao Jie, the Assistant Academic Director of SIT Kunming for being the
advisor for this study and for all of the effort and time he put into helping make this a successful
project. Zhao Jie not only secured the majority of in-person interviews, he also served as a
translator at these interviews. Without Zhao Jie’s extensive assistance, this study would not have
been possible. Zhou Yan, the Student Affairs Director for SIT Kunming should also be thanked
for the hours she spent reviewing and revising the study question translations and recruitment
materials. Furthermore, Zhou Yan, Luo Xiao Lei, Huang Su Ying and Zhang Xian (SIT language
teachers) assisted in the recruitment of parents for this study. Thanks to Huang Su Ying and Xiao
Hua Guo for their language instruction over the semester. Without the language skills learned in
Teacher Huang and Teacher Xiao’s classes, this study would have been more difficult to conduct
and far less fruitful. Another acknowledgement must be made to Dr. Zhao, an anthropologist at
Kunming University of Science and Technology. Dr. Zhao reviewed the proposal for this study
and provided thoughtful feedback that shaped the focus of this study. Moreover, Dr. Zhao
connected the principal investigator with his daughter (a college student in Beijing) who helped
secure 20 study participants. Thanks to Dr. Huang, an experienced Traditional Chinese Medicine
Doctor for helping the principal investigator secure an interview with a psychological counselor
and for taking the time on two separate occasions to meet and discuss this ISP. School
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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administrators and teachers at the Experimental Middle School Attached to Yunnan Normal
University should also be thanked for the time and effort they put into securing interviews for
this study. Additionally, acknowledgments should be made to the teachers and former students at
Kunming’s Number 16 Middle School for the time they took out of their days to participate in
this study. Last but not least, thanks to all of the participants for their candid responses to the
extensive and sometimes personal study questions; this study would not have yielded results if it
were not for these participants’ thorough and thoughtful responses.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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List of Figures
Figure 1: Participant Distribution by Group ................................................................................. 20
Figure 2: Geographical Distribution of Participants Across China .............................................. 23
Figure 3: Student Perceptions of the Most Prominent Causes of Anxiety among Students ......... 33
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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Introduction
Mental health in China
The ethics behind and efficacy of cross-cultural studies should be discussed whenever
such a study is considered. This is an especially important consideration when conducting
research on human subjects involving mental health. The World Health Organization defines
mental health as “a state of well-being in which every individual realizes his or her own
potential, can cope with the normal stresses of life, can work productively and fruitfully, and is
able to make a contribution to her or his community” (WHO, 2014). There are numerous
examples of cross-cultural mental health assumptions that turned out to be incorrect and
negatively affected the wellbeing of the international communities being served (Watters, 2010).
Because the sociocultural environments are different around the world, the same etiological
models for mental health problems (MHP) cannot be used internationally without prior
community-based research. Even though someone might have clinical depression according to
Western diagnostics, the community and/or individual might not view it as such (Fadiman,
1997). Moreover, in every culture, there are specific MHP only present in that community (or
group of communities) called culture-bound syndromes (Fadiman, 1997; Nichter, 2008).
Multiple studies have been published (both Chinese and Western) “supporting the cross-cultural
generalizability of etiological methods” of diagnosing depression and other MHP in adolescents
in China (Chen J., Li, Natsuaki, Leve, & Harold, 2014). According to studies conducted by
international organizations and the World Health Organization, “the entire range” of Western-
diagnosed MHP and their symptoms “have been observed in the Chinese” (Lin T., 1983). Every
type of mental disorder has been treated in Chinese communities using Western methods (Lin T.,
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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1983). The results of these studies suggest that conducting an ethical cross-cultural study related
to mental health in China is possible and can be done effectively.
As mental illness continues to become less stigmatized in China and more citizens are treated
for MHP, the prevalence of diagnosis and treatment will continue to rise (Zhong et al., 2013).The
current prevalence of MHP in China is comparable to the lower end of Western MHP prevalence
(when diagnosed using Western criteria), but clinical diagnosis and treatment have not kept up
with this rise (Bartlett, W., & Raikhel, 2014; Lin T., 1983). Chinese culture often considers what
Western criteria would diagnose as an MHP to be the manifestation of social pressures and not a
health problem. This view of mental health contributes to the lower treatment levels of MHP in
China. Moreover, family plays a much larger “role in coping and help-seeking” for people with
MHP in Chinese communities than in Western cultures (Lin T., 1983; Zhong et al., 2013). This
is because, in accordance with Chinese cultural norms, it makes more sense to talk to a trusted
family member than a complete stranger (mental health professional). Furthermore, it is
important to recognize the role of indigenous knowledge and health systems when analyzing
culture-specific mental health. According to an experienced Traditional Chinese Medicine
(TCM) doctor based in Kunming, TCM has not yet developed a comprehensive or effective
approach for treating MHP. As half of the medical care provided is in TCM settings, the
development of psychiatric infrastructure to treat MHP has been inhibited by TCM (Lin T.,
1983). All of these sociocultural factors contribute to the lower levels of diagnosis and treatment
of MHP in China.
China’s One-Child Policy
China’s One-Child Policy (OCP) has been widely recognized as the largest population
control measure of all time (Jiang, Li, & Feldman, 2013). The OCP was introduced as a short-
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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term, emergency population control measure (Hesketh, Lu, & Xing, 2005). When the People’s
Republic of China (PRC) was established in 1949, Mao Zedong proclaimed having a large
population was a point of national pride as it provided the country with labor and soldiers
(Clarke, 2015; Jiang et al., 2013; Tong, 2010). The Chinese government encouraged citizens to
reproduce and condemned the use of contraceptives (Jiang et al., 2013; White, 2006). As a result,
over the next few years, the Chinese population doubled (Clarke, 2015). From 1958 to 1961, “30
million starved to death from famine,” because there were not enough resources to support to
rapidly booming population (Clarke, 2015; Tong, 2010). In 1962, Chairman Mao “changed his
stance” and ensuing propaganda in an attempt to control the population size and introduced a
voluntary version of the OCP (Jiang et al., 2013; Tong, 2010; Yang, 2003). After the Cultural
Revolution, baby boomers were reaching reproductive age and the market had stagnated (Zhu,
2003). The OCP was needed for population growth (2%) to be slowed “to cooperate with
economic development and resources” and to improve living standards (Hesketh et al., 2005;
Tao, 1999; Tong, 2010; White, 2006; Zhu, 2003).
Despite its name, the OCP was not as simple as one child per family. The OCP set
restrictions on family size, late marriage and childbearing and the spacing of children (case
depending; only if a second child was allowed) (Hesketh et al., 2005). These restrictions were
enforced locally but regulated by the State Family Planning Bureau, which determined the
overall “targets and policy direction” of the OCP (Hesketh et al., 2005). Enforcement of the OCP
was very strict, especially for urban residents and government employees (Hesketh et al., 2005).
Exceptions were granted to families whose firstborn was disabled (Hesketh et al., 2005).
Furthermore, urban families in which both parents were from one-child families or in which both
parents worked in high-risk occupations were allowed to have more than one child (Hesketh et
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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al., 2005). Rural citizens (often whose firstborn was a girl) were also allowed to have a second
child after five years (Hesketh et al., 2005) and some ethnic minorities (and people in
underpopulated remote regions) were allowed to have three children (Hesketh et al., 2005). The
OCP was enforced by local officials using a combination of economic incentives for compliance
and penalties in the form of fines, confiscation and dismissal from work (Hesketh et al., 2005).
In addition to widespread family planning propaganda, access to contraceptives and abortions
was also improved to meet the goals of the OCP (Hatton, 2013; Hesketh et al., 2005).
The OCP was introduced as a short-term measure to limit population growth and as
population growth decreased, it became less and less necessary (Greenhalgh & Bongaarts, 1987;
Nardelli & Swann, 2015). Moreover, as living standards improved (especially in urban areas
where people were most affected by the OCP), an increasing number of citizen attained the level
of wealth necessary to pay the fines and support multiple children (Hesketh et al., 2005).
Furthermore, indicators showed that China had made the shift towards a small family culture
(Lin B., 2003). As illustrated by these figures, China outgrew the OCP. The Chinese government
updated its family planning regulations in 2013, at which time the OCP was enforced only for
“urban Han parents who were both the product of two-child homes” (Pasick, 2013). After
roughly 30 years of the OCP, it was replaced by a “universal two-child policy” (TCP) in the fall
of 2015 (Zeng & Hesketh, 2016). According to the literature, concerns over the wellbeing of the
aging population was cited as one of the primary reasons that the OCP was phased out (Barrows,
2016). It was estimated that this change will result in the additional birth of 10 million people
annually, a relatively small increase (Pasick, 2013; Zeng & Hesketh, 2016). Although the change
was small, it is expected to have a variety of impacts. More people means higher demand for
resources, and the government estimates that “demand for water might outstrip supply by 2030”
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
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(Pasick, 2013). Other effects of the new policy will not be realized for two or more decades, but
have already been predicted to be mostly beneficial (Zeng & Hesketh, 2016). It has been
predicted that the OCP ending will (over time) create a healthier housing market, because there
will be more demand (Pasick, 2013). Health outcomes, such as a reduction in the number of
abortions for unapproved pregnancies, a decrease in the number of unregistered children and a
normalization of the sex ratio have all been predicted outcomes of the transition to the TCP
(Zeng & Hesketh, 2016). The potential impacts of the TCP are relatively tame compared to the
effects of the OCP.
Effects of the One-Child Policy
Chinese Culture
The success of the OCP is still being measured and cannot yet be ascertained. Certain
outcomes, however, have already been determined. The OCP aimed at shifting China to a
“voluntary small family culture” (Hesketh et al., 2005). This was an ambitious goal given that
prior to the OCP, families in China had an average of four children and large families were more
valued (Hatton, 2013). The goal of the OCP was to keep the population size under 1.2 billion by
2000, however, the population in 2000 was estimated to be over 1.27 billion (Hesketh et al.,
2005). It is difficult to measure the extent to which the OCP influenced population growth. Other
factors, such as economic development, could have been responsible for a percentage of the
population decline following the start of the OCP (Tien, 1984).
The OCP was successful in reaching its fertility rate goal (Hesketh et al., 2005; Hesketh
& Xing, 2006; Wang J., 2003). The rate was decreased by almost half in urban areas, creating a
demographic divide between rural families (mostly two children) and urban families (mostly one
child) (Hesketh et al., 2005; Hesketh & Xing, 2006; Wang J., 2003). Currently, China has one of
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the lowest fertility rates in the world, which can (at least in part) be attributed to the OCP (Li,
2004; Tong, 2017) These findings illustrate that the OCP was an obvious family planning
success (Tao, 1999). Furthermore, the population growth rate decreased from 2.5% to 1.5% in
just 10 years (Tao, 1999). The Chinese government proudly announced that through the OCP
they were able to prevent 400 million births, “relieving pressures” on the environment and
resources (medical care, education, social services) (Jiang et al., 2013; Kane & Choi, 1999;
Tong, 2017). Maternal mortality decreased (50 fold from 1950 to 2005) and having fewer
children allowed women more independence, and enabled them to elevate their status in society
and the workplace (Harris et al., 2007; Hesketh & Zhu, 1997; Merli M.G. & Morgan, 2011). The
successes of the OCP, including improvements in women’s rights are only one side of the story.
The OCP has undeniably benefited China, however, “it has also had many side effects” (Wu,
Viisainen, & Hemminki, 2006).
Women’s Rights
The OCP was a double-edged sword; vast societal benefits and equally immense
consequences. For example, virtually universal access to contraception and abortions was
accompanied by minimal to no choice in the type of contraception (IUD, sterilization,
etc.)(Hesketh et al., 2005). Forced abortions, use of IUDs and sterilizations were among the
human-rights abuses that mostly ended with the transition to the TCP (Hesketh et al., 2005;
Pasick, 2013; Short, Linmao, & Wentao, 2000), however, the “vast social difficulties and human
suffering” caused by these forced family planning measures are still present (Greenhalgh &
Bongaarts, 1987). In line with the collectivist culture and government, the OCP put national
interests above those of families (Jiang et al., 2013). There was no consideration for the effects
the OCP could have on traditional Chinese culture and family and even when these effects were
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finally realized, the OCP was kept in place to maintain economic growth (Tong, 2010). The lack
of forethought on the possible effects of the OCP contributed to the immensity of these
consequences.
China’s Population
The OCP directly affected one-third of the Chinese population; Urban, Han Chinese
families in which at most one parent was an only child. However, the effects of the OCP have
permeated every corner of Chinese society and affected “nearly a quarter of the world’s
population for a quarter of a century” (Hesketh et al., 2005; Pasick, 2013). The OCP is
considered by many to have been “a 30-year-old social engineering experiment that changed the
face of China’s society” (Pasick, A. 2013). One of the primary objectives of the OCP was to shift
China to a small family culture (Lin B., 2003). During the 2013 policy relaxation, only twelve
percent of the twelve million couples who were eligible to “apply to have a second child”
expressed interest in doing so, exhibiting China’s successful cultural shift (Clarke, 2015). This
trend is projected to continue under the TCP. The fertility rate will remain below replacement
level but will now be the result of a desire for small families and not due to the government’s
family planning policy (Baochang, Feng, Zhigang, & Erli, 2007; Cai Y., 2010; Clarke, 2015).
The most likely cause of permanent change was the shift from a quantity-based to a quality-
based societal view of offspring and the rising costs of education and child-rearing (Li, 2004;
Merli M.G. & Morgan, 2011). Women in remote or more rural areas, however were less likely to
move as quickly to the small family culture, which could cause demographic disparities between
urban and rural areas (Merli M.G. & Morgan, 2011). Although these disparities exist, the
populations of 48 out of 55 minority ethnic groups declined due to the distorting of the sex ratio
(and urbanization) as a result of the OCP and economic development. The possible extinction of
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certain minority ethnic groups would reduce diversity in China’s gene pool and be disastrous for
Chinese cultural preservation, further illustrating the effects of the OCP on culture (Cao &
Wang, 2010; Harris et al., 2007).
Economy
China’s “emergence as an economic powerhouse” was fast-tracked by the OCP (Pasick,
2013). Having only one child allowed families to have disposable income to invest in education
or consumer expenses, one of the government’s primary economic objectives (Hatton, 2013;
Pasick, 2013). During the early stages, the low fertility rates resulting from the OCP played a
“positive role in economic growth” by improving the “quality of human capital” (Jiang et al.,
2013). The early economic effects of the OCP were positive, however, over time these benefits
will decrease as the detrimental economic effects are realized (Jiang et al., 2013). Many scholars
believe that the OCP deprived China of the young generation needed for China to flourish (Tong,
2010). Without enough young people “to work and pay taxes, care for the elderly and invent
things,” China’s new economic prosperity could fizzle out (McDonald, 2006; Tong, 2010). One
of the most detrimental effects of the OCP on China’s economy will be “serious future labor
shortages” as the working population shrinks at a rate of 10 million per year (McDonald, 2006;
Nardelli & Swann, 2015; Pasick, 2013). Ending the OCP was too little too late to replace the
workforce and even if all women in China gave birth to two children under the TCP (an
impossible scenario), the working population would not be replenished until the 2030s or 2040s
(Clarke, 2015; Pasick, 2013). Moreover, the smaller population sizes of the OCP generations
caused the Chinese housing market to stagnate (Pasick, 2013). The economic advancements
allowed by the introduction of the OCP were immense, however, the aforementioned long-term
economic consequences of the OCP could be irreversible.
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Aging Population
One of the principal reasons for ending the OCP was the impending effects on China’s
aging population. Aging populations are not a distinctly Chinese issue. As life expectancy and
healthcare quality increase, countries are experiencing the aging of their (mean) populations
(Clarke, 2015). The aging of a population results in an increase of the age dependency ratio,
meaning the number of elders who rely on social services compared to the number of young
people who are able to support those elders (Nardelli & Swann, 2015; Peng, 1998). The greatly
reduced birthrate coupled with improved living standards and life expectancy have exacerbated
the aging population issue in China, making it the fastest and largest aging population in the
world (Cai F., 2007; Peng, 1998). One of the foundational elements of Chinese culture, dictated
by Confucian doctrine, is filial piety or devotion to one’s family (especially to parents). It is
assumed (and required by law) that children show their devotion to their parents by taking care
of them as they age. This cultural norm is illustrated by the fact that at the start of the 21
st
century, 70% of elderly people in China financially depended on their offspring (Sun, 1998). The
family structure resulting from the OCP has been labeled the “4-2-1 phenomenon” and consists
of two parents who must take care of four grandparents and one child (Winker, 2002). This
structure puts “tremendous pressure” on the family. Urbanization (moving away from parents),
increasingly stressful working environments and attention to the child’s education were all
factors that exacerbated this familial pressure (Jiang et al., 2013; Rajan, 1994). China’s changing
social structures drastically impacted the population’s ability to care for their elderly family
members (Jiang et al., 2013). Because elders were historically cared for by younger family
members, public infrastructure for eldercare is virtually nonexistent in China (Jiang et al., 2013;
Rajan, 1994). This issue is of even greater concern when the fragility of one-child families is
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considered. Families with only one child are more susceptible to becoming childless (Jiang et al.,
2013; Pui Yan Flora, 2014). It is estimated that “one million families have lost their only child in
China” due to accidents and natural disasters such as the Sichuan earthquake of 2008 (Pui Yan
Flora, 2014; Song, 2014). Accompanying the immense psychological stress of losing an only
child came substantial economic burden (Jiang et al., 2013; Song, 2014). Without any
governmental eldercare infrastructure and no children to take care of them, these citizens’ most
prominent worry was how they would be able to survive old age (Song, 2014).
Sex Ratio
Potentially the only notion of traditional Chinese society that expanded as a result of the
OCP was gender preference (Li, 2004; Lipatov, Li, & Feldman, 2008). China has a “2,500-year-
old culture of son preference” (Lipatov et al., 2008). Historically, the sex ratio was slightly
skewed due to infanticide of females at birth, however, because of technological advancements
and the OCP, this disparity steadily intensified (Baochang et al., 2007; Davis, Gottlieb, &
Stampnitzky, 1998; Gu B. R., K., 1995; Kang, 2003; Li, 2004; Nardelli & Swann, 2015; Wu et
al., 2006). Although illegal in China, sex selection abortions (SSA) were still common practice in
the private sector and were almost always performed on female fetuses (Hesketh et al., 2005).
SSA and non-registration of female births contributed to China’s dangerously skewed sex ratio
(Merli M. G. & Raftery, 2000; Short & Fengying, 1998). The OCP has been referred to as the
“at-least-one-son” policy (Wu et al., 2006). This, along with the fact that the government allowed
rural citizens to have another child if their first was a girl (known as the “1.5-child policy”)
exacerbated the sex ratio by reinforcing the values of the son preference and access to methods
of achieving it (SSA, etc.) (Yi, 2007). According to a study conducted in China, this engrained
gender bias carried on to postnatal discrimination against females (Li, 2004).
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11
Many researchers have indicated that the so called “bare branches” (unmarried Chinese
men) could be susceptible to “socially disruptive” or even violent behavior as a result of being
socially outcast (Hudson & denBoer, 2004; Tuljapurkar, 2009). Coupled with the increase in the
trafficking of women for marriage and commercial sex work, this could pose an increased threat
to women’s safety (Tucker et al., 2005). The increase in commercial sex work (CSW) has also
increased the risk of commercial sex workers contracting and spreading HIV/AIDS (Tucker et
al., 2005). Furthermore, the prevalence of “severe depression and suicide ideation” among these
“bare branches” was a growing public health concern (Tuljapurkar, 2009; Zhou, Yan, &
Hesketh, 2013). The aforementioned results of the sex ratio gap not only affect the health and
wellbeing of Chinese men and women today, but could threaten the stability of China in the
future (Hudson & denBoer, 2004).
Misconceptions
More than 90% of urban and 60% of rural children do not have siblings (according to 2003
statistics)(Chen X. S., 2003). The effects of the OCP on the Chinese population and culture have
been evidenced, however the impacts on the only children (OC) themselves have not. Early
research suggested OC were at a disadvantage, but most current research illustrated no major
disadvantages of being an only child (Tao, 1999). There are many misconceptions and negative
perceptions about OC (Wang Y. & Fong). In the early 20
th
century, being an OC was so looked
down upon that it was believed to be a disease and parents would have a second child just to
avoid an OC (Thompson, 1974). The majority of recent studies, however, indicate no major
differences in the personalities of OC and children with siblings (CWS) (Falbo T., 1984; Falbo
T. & Poston, 1993; Hatton, 2013; Tao, 1999; Tseng et al., 1988). Perceptions of OC were forced
to change due to the OCP and have improved ever since its inception.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
12
Obesity and Diabetes
The 4-2-1 family structure caused by the OCP not only impacted Chinese culture and society,
but children’s physical and psychological health. Childhood obesity and diabetes rates rose
dramatically since the introduction of the OCP (and acceleration of the westernization of Chinese
culture), especially in only children in urban areas (He, James, Merli, & Zheng, 2013; Hesketh,
Qu, & Tomkins, 2003). More than 83% of recent studies conducted on this topic suggested
higher rates of obesity and type II diabetes in only children than in children with siblings (Cheng
T.O., 2005; Cheng T. O., 2013; Falbo T. & Poston, 1993; Fu et al., 2013; Hesketh et al., 2003;
Min, Xue, Wang, Li, & Wang, 2017; Wang D. et al., 2016). Studies contributed this rise to an
increase in availability of and “purchasing power for obesogenic goods” in urban areas and to the
OCP (He et al., 2013). The OCP was directly linked to this rise in two ways (Cheng T. O., 2013).
In OC families with great grandparents, this link was so apparent that Chinese idiom was created
for it; “‘er’(2 parents), ‘si’(4 grandparents), ‘ba’(8 great-grandparents), you get fat” (Cheng T.O.,
2005). With only one child and (typically) six parents and grandparents per family, the OCP
resulted in substantial and widespread overfeeding of only children by parents and grandparents
in China (Cheng T.O., 2005). The second direct impact was the lack of siblings to share food
with (French & Crabbe, 2010). This “six-pocket syndrome” occurred when one person ate all of
the food that would have been distributed among siblings (French & Crabbe, 2010). Given the
effects on obesity and diabetes, it can be concluded that the OCP had detrimental effects on the
physical health of only children.
Little Emperors
The underlying cultural phenomenon responsible for the rise in childhood obesity and
diabetes in China was also contributed to the presence of “little emperors” (Cheng T. O., 2013).
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
13
Research on the OC generations yielded much debate over this topic. Books were published
about the so-called “littler emperors,” while other research found little indication of increased
prevalence of egocentrism in OC (Cameron, Erkal, Gangadharan, & Meng, 2013; Cheng T. O.,
2013; Falbo T., 1982; Falbo T. & Poston, 1993; Falbo T. F. & Poston, 1995; Hatton, 2013; Wang
M., Chen, & Fu, 2007; Wang Y. & Fong). Although it is unclear if China truly had two
generations of “little emperors,” it is undeniable that the OC generations were given more
attention, comforts and opportunities than any preceding generation in China (Wang Y. & Fong).
Because of this, egocentrism and individualism were more prevalent in the OC generation than
any prior (Wang Y. & Fong). Studies indicated that OC more often required instant gratification,
showed “disrespect to elders,” and refused to eat food they did not enjoy than CWS. Moreover,
OC were determined to be “less conscientious individuals” who threw significantly more temper
tantrums as children (Cameron et al., 2013; Hesketh et al., 2003; Tao, 1999). These studies
suggested that there were certain marked differences in personalities of OC and CWS, most of
which were negative.
Benefits
The consequences of the OCP on health and wellbeing did not provide a comprehensive
look at the effects of the OCP. The health benefits of the policy also needed to be addressed. For
example, obesity and diabetes rates were higher in OC, but so were nutritional intake and height
for age (Li, 2004). Multiple Chinese studies indicated that OC typically had higher academic
performance and achieved higher levels of education than CWS (Beal-Hodges, Loh, &
Stranahan, 2011; Falbo T. & Poston, 1993; Falbo T. P., D. , 1986; Hatton, 2013). Moreover,
research suggested that OC had better leadership skills and showed “imagination to a greater
degree” (Falbo T. P., D. , 1986; Tao, 1999). CWS exhibited more aggression than OC and male
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
14
CWS were more hyperactive, according to a 10 year Chinese study (Tao, 1999). These figures
illustrated that being an OC was not, as it was described in the early 20
th
century, a disease. A
comprehensive look at the effects of the OCP determined that although benefits to being an OC
existed, there were also health consequences.
Behavior
There were few widespread personality differences between OC and CWS, however,
research suggested the presence of a significant divergence in behavioral patterns (Hatton, 2013;
Tao, 1999). It was difficult to judge the cause of behavioral differences in OC, because
behavioral development had so many influencing factors, including stage of development, living
environment and parenting methods (Cameron et al., 2013; Falbo T., 1982; Falbo T. & Poston,
1993; Falbo T. F. & Poston, 1995; Tao, 1999; Tseng et al., 1988; Wang M. et al., 2007).
Differences in behavioral patterns were identified primarily in male OC who were raised by
grandparents, exhibiting increased “anxious aggression” (Tao, 1999; Tseng et al., 1988). This
illustrated, as pointed out by the Deputy Director of the Chinese Children’s Center in Beijing,
that family greatly influenced child development and behavioral patterns (Chen X. S., 2003; Tao,
1999). According to the research, including a study of 21,013 urban primary school students in
22 provinces, there was no significant difference in prevalence of behavioral problems between
OC and CWS (Tao, 1999; Wang Y. E., Shen, & Guo, 1988). However, CWS exhibited more
“externalizing behavior problems” and OC had more “internalizing behavior problems” (Tao,
1999). Internalizing behavior problems were less noticeable than externalizing issues and include
withdrawal from social activities and a negative internalizing of criticism (Tao, 1999).
Furthermore, this internalizing of issues by OC made them less likely to admit to having mental
health issues than CWS (Hesketh et al., 2003; Wang W., Du, Liu, Liu, & Wang, 2002).
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
15
Psychological
In addition to internalizing behavior, female OC were significantly more insecure and
emotionally driven than their counterparts with siblings (Tao, 1999). Another difference in the
mindset of OC and CWS was perception of social support. Mental health strongly correlated to
the feeling of social support and OC perceived less social support than CWS, even when
receiving the same amount (Gu Y., Hu, Hu, & Wang, 2016). This could have indicated higher
levels of mental health issues in OC and explained certain social patterns of OC. According to
the research, lacking siblings influenced social development and made it hard for OC to build
close and long-term relationships (Falbo T. P., D. , 1986). This lack of social development
resulted in OC being “significantly less trusting” and more reliant on parents for social support
(Cameron et al., 2013; Feiring, 1984; Hesketh et al., 2003; Mercy, 1982). Without siblings to
learn from, OC also had inferior teamwork skills, which could have led to social isolation (Falbo
T. P., D. , 1986). Moreover, because they lacked siblings, OC were less competitive and more
risk-averse than CWS (Cameron et al., 2013; Tao, 1999). Because there was only one child per
family, studies suggested that only children had “less opportunity to experience rejection or
abandonment from their parents” (Chen Y., 2007). This, in turn, lowered their ability to handle
challenges because they rarely experienced adverse situations as children (Chen Y., 2007). OC’s
low tolerance to difficulties was exhibited by their self-reported significantly higher levels of
suffering, heightened level of pessimism, and increased likelihood of complaining (Cameron et
al., 2013; Tao, 1999; Wang D. et al., 2016). Only children’s less developed ability to handle
challenges coupled with their less developed social skills could have put these OC at serious risk
of developing mental health issues. The burgeoning of mental health problems in China could
have been partially due to the family pressures caused by the OCP. Parents of OC, often referred
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
16
to as “tiger parents,” “focus[ed] excessively” on their OC and had higher expectations for the
child’s academic and career success (Chen X. S., 2003; Chen Y., 2007; Hatton, 2013). Parents
often planned the lives of their OC and provided extended attachment, reducing the ability for
OC to become autonomous and independent (Chen Y., 2007; Hatton, 2013). The lack of
independence to pursue their dreams could have caused long-term mental health issues for OC
(Hatton, 2013).
Study Aims
This review of previous literature regarding the OCP and its effects was comprehensive if not
exhaustive. Due to restrictions on language capabilities, literature searches were only conducted
in international databases and only relevant English (or translatable) literature was read and
included. No uniquely Chinese databases were searched; however, Chinese sources were used
whenever possible. Previous research suggested the presence of differences between OC and
CWS, however, no studies (to the knowledge of the principal investigator) looked at the
perceived effects of the OCP. This study aimed to determine the mental health effects of the
OCP on OC. Moreover, it sought to gain a better understanding of perceptions of the effects of
the OCP on Chinese culture, the aging population, students’ mental health and OC as adults.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
17
Methodology
Study Location and Rationale
This study was conducted in Wuhua District, Kunming, Yunnan Province, China. All
interview participants (but not all WeChat survey respondents) lived in Kunming at the time of
the interviews. Because interviews were arranged to accommodate the interviewees, interviews
were conducted at multiple sites. One interview was conducted at OnePizzi Restaurant. One
interview was conducted at a Psychology Conference at Yunnan University’s Yunda Hotel.
Three interviews were conducted at the Experimental Middle School Attached to Yunnan
Normal University. Two informal interviews were conducted at Green Lake Park (English
Corner). Seven interviews were conducted at a sporting event for the Experimental Middle
School Attached to Yunnan Normal University Kunming Stadium. Three interviews were
conducted at the SIT language teacher’s workshop. Two interviews were conducted at a
restaurant near the Kunming Number 16 Middle School.
Kunming was chosen as the primary study site, because it was the most practical option.
Conducting this experiment in Kunming allowed access to more participant groups than would
have been accessible in a different location in Yunnan. Furthermore, it allowed for close
proximity to the study’s advisors, which was of undeniable benefit to the success of the study.
Because this study did not require respondents from specific ethnic populations in Yunnan,
conducting the study anywhere but Kunming would have reduced participant recruitment
opportunities. By returning to Kunming for this study, it was possible to recruit participants from
specific groups that are geographically restricted. For example, only a few schools in Yunnan are
privileged enough to have their own psychological counselors and those schools are mostly
concentrated in and around Kunming. Moreover, there was a significantly higher population of
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
18
the core focus of this study, only children, in Kunming than in rural areas of Yunnan (See
Introduction). For the aforementioned reasons, Kunming was chosen as the most practical study
location.
Participant Recruitment and Rationale
The following groups of people were recruited for participation in this study: mental health
professionals and other medical professionals, school counselors and administrators, teachers,
college students. Mental health professionals were interviewed in order to gain their perspective
on the mental health status of only children. Medical professionals were included for their
perspective on physical and behavioral differences between only children and children with
siblings. School counselors and teachers could offer unique perspectives on only children’s
mental health and behavior in an educational setting. College students were included to hear
about their experiences as a part of the One-Child Policy generation first-hand. Originally, the
study also aimed to recruit middle/high school student participants, however, after consideration
it was determined that this topic could be too triggering for those populations. So, in the interest
of protection of human subjects, this group was not recruited for this study. The selected
participant groups were recruited to help determine perceptions of the effects of the OCP.
Participants were recruited using a variety of methods through SIT affiliates and connections
in Kunming. Dr. Zhao connected the principal investigator with his daughter, who is a college
student in Beijing. Dr. Zhao’s daughter assisted in the recruitment of 20 college students for this
study. Other participants were recruited with the assistance of SIT Kunming staff. The Academic
Director, Lu Yuan, assisted in the recruitment of a Traditional Chinese Medicine pediatrician
who helped recruit an additional participant. Other connections were made through the Assistant
Academic Director and the Director of Student Affairs, Zhao Jie and Zhou Yan, respectively.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
19
The following SIT Kunming language teachers aided in the recruitment of parents: Zhou Yan,
Luo Xiao Lei, Huang Su Ying and Zhang Xian. Because all of the participant recruitment was
initiated through SIT Kunming staff or affiliates, this study does not represent random sampling
within participant groups. Moreover, although random sampling techniques were employed in
certain settings, those settings negate the randomness of the sampling. For example, random
parents were asked to participate in this study at the Experimental Middle School Attached to
Yunnan Normal University’s sporting event at the Kunming Stadium. All of these parents had
children who attend this privileged school and thus could not be classified as a random sample of
parents.
Participant Information
To protect the privacy of participants, no names were used in the data analysis or discussion
of the results of this study. The participants’ identities were coded based on date and time of
interview. The full list of interviewees with their codes was solely recorded in a password-
protected Excel Spreadsheet that only the principal investigator could access. The following
information was recorded in this spreadsheet: Participant name, date interviewed, interview
format, response status (for WeChat surveys), length of interview, participant group, location of
interview and coded participant ID.18 in-person interviews were conducted with 26 different
interviewees for this study. These interviews ranged from 30 minutes to 1.5 hours in length.
Zhao Jie was present as a translator at over half of the interviews conducted. The majority of
interviews were conducted one-on-one (not including Zhao Jie). In addition to the in-person
interviews, surveys were sent to 29 participants. 28 surveys were completed by 28 different
interviewees for this study, making the survey response rate 96.6% (28/29). These surveys
contained the same questions as the in-person interviews along with additional demographic
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
20
information. The total
number of unique
participants was 47; nine
teachers and school
administrations, 27
students, seven parents,
one TCM pediatrician,
three psychological
counselors (two school-based, one private practice-based) (See Figure 1). The gender
distribution of participants was 82.9% female (39 participants) and 17.1% male (8 participants).
Data Collection
Data was collected for this study between November 7
th
, 2017 and December 6
th
, 2017. Data
was collected using two methods; in-person interviews and WeChat surveys (See Appendices II
and III). Most in-person interviews were formal; however, interviews were more conversational
when appropriate. For the sake of uniformity, each participant was asked every question for their
respective participant group and except for certain demographic information, the questions were
the same for in-person interviews and WeChat surveys. In-person interviews were recorded in
two ways; iPhone audio recording and notetaking. Notes were taken at all interviews, but only
interviews in which permission was explicitly received were recorded. Surveys were sent to
participants via WeChat messaging. Surveys were in Microsoft Word .docx format (See
Appendix III). Once completed and returned to the investigator, the data from the surveys was
compiled in a Microsoft Excel spreadsheet using the coded participant IDs.
27
7
9
3
1
Students
Parents
Teachers and School
Administrators
Psychological Counselors
Other Medical
Professionals
Figure 1: Participant Distribution by Group
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21
Data Processing and Analysis
Because this was a mixed-methods study, both quantitative and qualitative data were
collected. The qualitative data came from in-person interviews and specific survey questions.
Quantitative data also came from in-person interviews, but was primarily collected via the
WeChat surveys. All data was compiled in a Microsoft Excel spreadsheet after being collected.
Any data in Mandarin was translated into English in a separate spreadsheet before the
translations were edited and verified by a classmate with more advanced language skills (Rachel
Bernstein). After the translations were verified, the data was cleaned in Excel and the variables
were coded in the quantitative data. The quantitative data was then analyzed by running it
through SPSS Statistical Analysis Software. The analytics for the quantitative study data were
then exported into a new Microsoft Excel spreadsheet and organized to complement the thematic
analysis of the qualitative data. The qualitative data was organized by corresponding question
and then analyzed thematically in English to complement the themes identified by the
quantitative data analysis.
Shortcomings and Limitations
The most obvious shortcoming of this study was the identity of the principal investigator.
The principal investigator of this study was a foreigner who was not fluent in the local language
nor an expert on Chinese culture. The inherent biases that accompanied cross-cultural inquiry
coupled with the short amount of time the principal investigator spent in China inevitably
skewed the focus and results of this study. Furthermore, the fact that the principal investigator
was a foreigner could have influenced participant responses and further reduced the validity of
the results. The acknowledgement of these biases cannot make up for this shortcoming, an
unavoidable limitation of performing cross-cultural studies.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
22
The reliance on personal connections to recruit participants was necessary to comply with
Chinese cultural norms, however, this could have greatly reduced the validity of this study. Not
being able to employ a valid sampling technique, such as random sampling, could have skewed
the data collected. This was because personal connections tended to be more similar
(socioeconomic status, demographic, values and beliefs) than a random sample. Moreover, the
reliance on the connections of others made it difficult to recruit large enough sample sizes for
each participant group. Part of the intrigue of researching the OCP was a lack of expertise on the
subject. This also proved to be a shortcoming of the study. Furthermore, the gender distribution
of participants (82.9% female) was significant enough to note as a possible source of erroneous
data. Another skewed demographic of this study was socioeconomic status. All participants were
of middle to high socioeconomic status and most had a high level of education, which could have
affected the data collected.
Issues related to the language barrier discussed in the proposal for this study were
realized during data collection and processing. Multiple interviews were conducted in English so
no language barrier was present. About half of the interviews (and all but one WeChat survey)
were conducted in Mandarin. Translations were verified by a proficient classmate; however, it is
still probable that a number of concepts were lost in translation. Another possible limitation of
this study was the use of Zhao Jie as a translator. Not having Zhao Jie present to translate in-
person interviews would have made them exponentially more difficult to conduct and ultimately
would have led to a reduction in the quantity and quality of data collected. However, having a
translator diluted the information from its original source more so than if the data would have
been collected in its original language. As the data had to be analyzed in English, however, this
translation dilution would have been unavoidable.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
23
Results
According to the results of this study, the OCP was believed to have affected the mental
health of OC. Moreover, the majority of participants believed that the OCP had an effect on
Chinese culture, the aging population,
and the wellbeing of OC. Of the 28
students who participated, 24 identified as
OC. As illustrated in Figure 2, 30
participants were living in Kunming, 13
living in Beijing and four living in other
regions of China at the time the study was
conducted. Also at the time the study was
conducted, teachers and medical
professionals had (on average) been practicing their professions for over 10 years (min: 2; max:
20). On average, each teacher who responded to the question reported being responsible for
around 400 students (mean of 900; min of 57; max of 4000). The average number of
schoolchildren that psychological counselors saw weekly was five and most were returning
clients. On average, 70% of students seen by the three counselors were OC. 91% (10/11) of
respondents stated that there were differences in the mental state and mental health issues of OC
and CWS and that the OCP had affected their work. 89% of teachers, administrators and health
care professionals responded that they thought the OCP had affected their students or patients.
Of the 12 participants asked about if they believed the OCP had affected anxiety levels and
behavior of schoolchildren, 91.6% said there was an effect. Moreover, this same set of
participants (100%) responded that they believed the OCP would have long-term effects on
Kunming (30), Beijing (13), Other regions (4)
Figure 2: Geographical Distribution of
Participants Across China
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
24
Chinese culture. 11/12 of participants asked believed that the OCP would have long-term effects
on the aging population. Furthermore, 100% of participants asked (11) believed the OCP would
have long-term effects on adults who were OC. When asked if they would tell the parents of a
student if they believed that student had a mental health problem, all teachers, administrators and
counselors said they would do so. However, not all participants thought this was the best first
option for helping a student with an MHP. Most of the teachers (5/6) interviewed said they
taught mostly only children. One teacher responded that her students were half OC and half
CWS, but this was the first year she had so many CWS in her class. 19 out of 27 students (70%)
believed anxiety to be prevalent at their schools; 89% believed anxiety to be prevalent among
schoolchildren in China. 67% of students reported that most, 22% reported that some, and 11%
reported that a little of their anxiety was school-related. In order to minimize egocentric data
analysis, students were asked what their anxiety felt like. Feeling anxious, nervous and
experiencing insomnia were the most commonly described symptoms of anxiety. See Appendix I
for the complete list of symptoms described by participants. 70% of students reported that they
or someone they knew had sought help for a mental health issue and 81.5% responded that they
felt they could talk about anxiety or other mental health issues they were having. 85.2% of
students felt that the OCP had affected the mental health of students and 64% of students felt the
OCP had affected students’ anxiety. 55.3% of students who identified as OC reported that being
an OC had an effect on their mental health. 75% of parents who were old enough to have gone
through school before the OCP felt that anxiety was more prevalent among students now than
before the policy. 100% of parents who responded to the question said their children felt
comfortable talking about mental health problems they were experiencing. Moreover, 100% of
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
25
parents who identified as OC responded that they believed being an OC had affected their
parenting and how they taught their children.
Discussion
Chinese Culture and Society
This study attempted to gauge perceptions regarding the effect of the OCP on Chinese
culture. Medical professionals (psychological counselors and doctors), teachers and school
administrators were asked about this and 100% responded that they believed the OCP would
have long-term effects on Chinese culture. These participants identified three primary areas of
Chinese culture and society that would be most affected; families, traditional culture and societal
structure. Five participants emphasized that the OCP had a huge impact on families. One of the
primary effects cited by participants was the impact on family structure. As evidenced in the
introduction, China transitioned to a small family culture (Hesketh et al., 2005). This notion was
supported by the results of this study. Four participants talked about the social burden and big
commitment of having two kids in modern China. According to one participant, urbanization led
to a decrease in the amount of childcare available to families from grandparents, which in turn
led to a decrease in plausibly having a second child for families. Based on the results of this
study, another way in which the OCP impacted Chinese families is that it changed the value of
specific family roles. As dictated by the foundational core of Confucianism, Chinese families
historically valued and respected elder members more than children (Hatton, 2013). This
fundamental pillar of Chinese society was challenged by the OCP, according to participants. The
results suggest that family culture shifted along with family structure. According to four
participants, children were valued over (and had less respect for) elders in Chinese families,
because of the 4-2-1 phenomenon and ensuing loss of filial piety. This notion was supported by
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
26
previous studies and some participants believed these changes in family structure and culture to
be irreversible (He et al., 2013; Hesketh et al., 2003). The results of this study indicated that
these changes to family structure and culture reduced the level of family education to a
detrimental degree. One participant discussed that there used to be more than 40 titles for various
family members to show respect, but most people were unfamiliar with these titles and
traditional family values in modern China. As evidenced in the introduction, family education
plays a crucial role in child development, so this reduction in traditional family education could
have severe effects (Chen X. S., 2003; Tao, 1999).
According to the majority of participants, many of the traditional family values (e.g. filial
piety) were lost in addition to other aspects of Chinese culture due to the OCP. Although the
perceived nature of the effects varied between participants, this study suggested that the OCP
“definitely had an obvious impact on traditional culture” (I6). According to multiple participants,
the OC generations valued Western culture more than those before them, which reduced the
prevalence of Chinese cultural traditions during these generations. The majority of participants
believed that these effects would prevail in China for generations to come and could even be
irreversible. According to multiple participants, reverting back to more traditional Chinese
culture would be inhibited by the OC generation’s lack of knowledge about these traditions.
According to I6, this lack of knowledge occurs “because the older generation didn't teach history
to the younger generation and the younger OC generations don't care” (direct quote from an
interview conducted in English). The perceived effects of the OCP on Chinese culture varied
between participants, however, the presence of effects was clearly evidenced by 100% of
participants. The primary effects of the OCP on Chinese culture (according to the data analysis)
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
27
were changes in the values placed on different family roles and a decrease in the value placed on
and prevalence of traditional Chinese culture.
Medical professionals (psychological counselors and doctors), teachers and school
administrators who participated in this study were asked if they believed the OCP would have
long-term effects on the aging population. Prior research on the subject suggested that there
would be effects and the results of this study reinforce this idea (Cai F., 2007; Clarke, 2015;
Nardelli & Swann, 2015; Peng, 1998). 91.6% (11/12) of participants felt the OCP would have
long-term effects on the aging population and two participants felt these effects would worsen
over the next few generations as the population growth continues to decrease. The one
participant that felt these effects would not be present cited a rise in economic conditions as the
reason there would be no impact. This participant believed that the aging population would have
enough economic resources to support themselves without assistance from their children.
Furthermore, one of the three primary reasons participants gave as to why they believed the OCP
would have long-term effects on OC as adults was the burden of caring for aging parents
(identified by nine participants). The presence of effects of the OCP on the aging population was
supported by this study. These effects not only pertained to the aging population themselves but
to the OC that would have to care for them. One participant’s notion that the aging population
would have enough economic resources to care for themselves said a lot about changing family
culture and the egocentrism of the OC generation. This idea that if parents could provide
financially for themselves, the OC did not need to support them was an entirely new and
distinctively not traditional Chinese mindset. This apparent shift away from traditional
Confucian family values could be a substantial impact of the OCP on Chinese culture.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
28
Child Behavior and Development
Previous studies came to different conclusions regarding the effects of being an OC on
personality development, but most found no significant personality differences between OC and
CWS (Hatton, 2013; Tao, 1999). Results from this study did not support this notion. 91% of the
participants asked suggested that there were personality differences between OC and CWS. The
major difference cited by participants was that OC tended to have more independent
personalities. This could be because they had no siblings to help shape and challenge the
development of their ideology. Additionally, while prior research suggested the presense of
behavioral differences between OC and CWS, the results of this study did not indicate a
significant difference (Hatton, 2013; Tao, 1999). The reasons for these discrepancies could be
due to differences in sample population. This study asked adults who worked with or were the
parents of OC about these differences, while previous studies measured discrepancies of OC and
CWS directly. This study was unique because it looked at perceptions of the effects rather than
the direct effects of the OCP on personality and behavior.
Another debated perception of OC was their classification as “little emperors” (Cameron
et al., 2013; Cheng T. O., 2013; Falbo T., 1982; Falbo T. & Poston, 1993; Falbo T. F. & Poston,
1995; Hatton, 2013; Wang M. et al., 2007; Wang Y. & Fong). Participants were not asked about
little emperors, but some broached the subject independently. Ten participants identified
egocentrism as a primary consequence of the OCP on OC. Furthermore, participants felt that OC
were more entitled than CWS. Participants had varied responses as to what type of entitelment,
but multiple brought up OC feelings of entitlement to parents’ resources. None of the
participants that felt OC were entitled were themselves OC. This was important to note, because
it illustrated the difference between previous studies conducted directly on OC and this study.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
29
Although previous studies indicated that OC are entitled, this study exhibited how different
groups who are close to OC percieve that they are entitled (Cameron et al., 2013; Cheng T. O.,
2013; Falbo T., 1982; Falbo T. & Poston, 1993; Falbo T. F. & Poston, 1995; Hatton, 2013; Wang
M. et al., 2007; Wang Y. & Fong). Moreover, ten participants noted selfishness as a key
characteristic of OC. This was significant because strong selfishness goes against collectivism,
the very foundation of Chinese culture.
The results of this study indicated the presence of the aforementioned personality
differences between OC and CWS. 91% of respondents stated that there were differences in the
mental state and mental health issues of OC and CWS. Increased egocentrism, selfishness and
entitlement in OC could have been the result of differences in how OC are treated in their
families. As previously mentioned, family education played a crucial role in child development,
so it made sense that changing how OC were raised would also alter how they developed. The
data analysis for this study suggested that both parents and grandparents paid more attention to
OC than to CWS. Participants suggested that parents and grandparents were more overprotective
of OC than of CWS, had a higher tolerance for mistakes made my OC, and tended to spoil their
OC. The tendency for parents to overprotect and spoil their OC could have been the reason that
the results of this study indicated a discrepancy in dependence on parents between OC and CWS.
Theme analysis of the data collected determined that all participant groups (including OC
students) felt that OC tended to stay in their comfort zones and were more dependent on their
parents for longer than CWS.
The most frequently identified difference between OC and CWS in every participant
group was tolerance to adversity. This exact sentiment was echoed in the majority of interviews
and was also the most frequently mentioned distinction between OC and CWS in the survey
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
30
responses. Lower tolerance to adversity was also suggested by previous OC studies (Cameron et
al., 2013; Chen Y., 2007; Tao, 1999; Wang D. et al., 2016). This study is significant, because as
previously suggested it distinctly looked at perceived effects rather than direct effects. This lower
tolerance to adversity could have been the result of how parents treated OC. By spoiling OC and
overprotecting them from challenges, OC did not learn how to overcome difficulties to the extent
that CWS were able to. Furthermore, a common theme identified by participants was that OC
had a hard time accepting criticism. This could have been due to the fact that OC parents gave
more positive affirmations, so the children had limited exposure to criticism. This was another
facet of changes in family education due to the OCP that (according to the results of this study)
negatively impacted OC. Another related theme identified by participants was that OC were
more easily frustrated. This made sense because with the reduction (or elimination) of
challenges, children would have fewer reasons to get frustrated and therefore not only have a
lower threshold for frustration but have a less developed capacity for dealing with feelings of
frustration. OC’s lower tolerance to adversity and tendency to get easily frustrated could have
impacted their mental health when coupled with an inability to communicate their frustrations.
The effect of being an OC on the development of social skills was another theme often
discussed by participants. 91.6% of participants believed OC to lack the same level of social
skills that CWS possess. Primarily, participants identified an inability to effectively
communicate (eight participants), an overal lack of sociability (eleven participants), and
difficulty handling conflict in relationships (four participants) as key characteristics of OC. One
participant pointed out a possible reason for this perceived discrepancy between OC and CWS.
OC “do not have the buffer of siblings” to learn how to interact socially and resolve confict, so
their development of these skills could be behind those of CWS (I3). A decreased ability to
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
31
effectively communicate among OC could have influenced OC mental health. Another effect of
less developed social skills among OC as adults was the effect on long-term relationships.
Furthermore, 100% of participants asked (11) believed the OCP would have long-term effects on
adults who are OC. One of the most commonly cited long-term issues facing OC as adults was a
high divorce rate. According to twelve participants (and supported by the literature), because
OC had less developed social skills and abilities to handle conflict resolution, they were more
likely to get divorced than CWS (Falbo T. P., D. , 1986). This could have been why the divorce
rate skyrocketed to 70% (the world’s highest) during the OC generations, according to a medical
professional interviewed.
Mental Health
According to the quantitative data analysis, 85.2% (23/27) of students felt that the OCP
had affected the mental health of students, describing the impact as “direct” and “influential”
(W22, I10). Furthermore, 55.3% (14/24) of students who identified as OC reported that being an
OC had an effect on their mental health. Data regarding the prevalence of mental health
problems (MHP) in general were not significant enough to be discussed as an outcome of this
study, however, themes regarding perceptions of the most prevalent MHP in China were
statistically significant (ten respondents). The main types of MHP discussed by participants were
stress-related (eight participants) and depression-related (nine participants).
Depression was cited as the most common MHP among students by both school
psychological counselors and eight additional participants. Two counselors and one medical
professional described over anxiety and loneliness as the primary causes of depression among
their patients. As the proportion of their patients who were OC was proportional to the general
population, it could not be determined that these were distinctive to OC.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
32
Seven participants (teachers, school administrators and psychological counselors)
believed the most prominent MHP among schoolchildren was overstress from grades.
Furthermore, 89% of students reported that some or most of their anxiety was school-related.
Students most commonly expressed that their biggest challenges in school were maintaining
good grades and handling relationships. One medical professional and two psychological
counselors suggested that OC felt more stress and had more MHP related to school than CWS.
Moreover, the private-practice psychological counselor stated that the primary reason parents
brought children to see a counselor was worries about their academic performance. These results
indicated that school was the primary cause of stress in schoolchildren. This could have been due
to the amount of school-related pressure put on students by parents.
According to participants, the primary causes of the most prevalent MHP in
schoolchildren (stress-related and depression-related) were school-related pressure and anxiety,
and loneliness. Differences in prevalence of these MHP in OC and CWS was not determined by
this study, however, thematic analysis regarding the OCP and anxiety levels proved statistically
significant. As anxiety was described as a primary cause of the main MHP in schoolchildren, a
difference in the prevalence of anxiety between OC and CWS could have also implicated
differences in the prevalence of related MHP between these two groups. 72% (28/39) of
participants who were asked if they believed the OCP had affected anxiety levels of
schoolchildren said there was an effect. The degree of statistical significance varied between
participant groups; 63% students (17/27) and 91.6% teachers, school administrators and
psychological counselors (11/12) felt the OCP had increased students’ anxiety levels. As
aforementioned, the majority of the 27 student participants believed anxiety to be prevalent
among their classmates (89%) and students in China (70%). This theme was also present among
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
33
parents who were old enough to have gone through school before the OCP (75%). These parents
expressed a belief that anxiety was more prevalent now than before the OCP when they were
students. However, student responses ranged in the degree to which they believed anxiety was
prevalent among their classmates. Roughly half of students believed anxiety was extremely
prevalent among their classmates. The other half generally felt that anxiety was present, but only
prevalent in certain (unspecified) groups of students.
When asked how the OCP had affected students’ anxiety levels, students cited increased
academic pressure (eight participants), decreased tolerance to anxiety (five participants) and a
lack of buffers for social anxiety (four participants) as the primary influencing factors (See
Figure 3). As
aforementioned, the
results of this study
suggested that these
factors were more
prevalent in OC than
CWS. The lack of buffers
for social anxiety could
have been due to the above-evidenced less developed social skills attributed to a lack of siblings.
Furthermore, 30 participants felt that pressure was a leading cause of anxiety and that the OCP
increased pressure. 16 participants attributed this rise in pressure to the parents of OC. This result
was supported by previous research (Quach, Epstein, Riley, Falconier, & Fang, 2015). With all
of the attention and expectations of the family placed entirely on one child, it made sense that
OC would have felt greater pressure from parents than CWS. Most participants felt parental
0
1
2
3
4
5
6
7
8
9
Academic pressure Tolerance to
anxiety
Social anxiety
Number of Participants
Figure 3: Student Perceptions of the Most Prominent Causes of Anxiety
among Students
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
34
pressure was the primary cause of anxiety in schoolchildren. Moreover, according to the results
of this study, anxiety was a leading cause of mental health problems in schoolchildren. Based on
this evidence it can be reasonably concluded that as OC received more parental pressure, they
were also more susceptible to developing pressure-related MHP.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
35
Conclusions
The goal of this study was to discover the perceived mental health effects of the OCP on
OC. The primary objectives of this study were to understand perceptions of the effects of the
OCP on Chinese culture, the aging population, students’ mental health and adults who were only
children. According to the data analysis, the primary effects of the OCP on Chinese culture were
changes in the values placed on different family roles and a decrease in the value placed on and
prevalence of traditional Chinese culture. Participants believed these cultural changes would be
difficult (if not impossible) to reverse. Furthermore, the results of this study indicated that there
would be long-term impacts on China’s aging population. These effects would be felt not only by
the elders within families, but also by the OC that would be responsible for their care. In contrast
to previous studies, these results suggested that there were personality differences but no
behavioral distinctions between OC and CWS. Although the notion that OC were little emperors
was not supported by the majority of participants, the results of this study suggested egocentrism
and selfishness were perceived to be higher among OC. Results also indicated the perception that
spoiling of OC by parents and grandparents resulted in the lowering of OC’s tolerance to
adversity and increased frustration when presented with challenges. Another percieved
implication of being an OC was less developed social skills, which could have been due to the
lack of siblings. Although the behavioral differences between OC and CWS were null,
perceptions of the presence of discrepancies between the mental health statuses of these two
groups was significant. The main types of MHP discussed by participants were stress-related
(eight participants) and depression-related (nine participants). Pressure and stress related to
school and parents were believed by participants to influence MHP, especially in OC.
Furthermore, participants often described loneliness resulting from being an OC, which could
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
36
impact MHP. It is important to note that this study did not attempt to discover MHP causation,
but to discover perceptions towards the effects of the OCP as they relate to mental health. Based
on the results of this study, it can be suggested that there were significant perceived impacts of
the OCP on the mental health of OC.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
37
Recommendations for Further Study
Because there are still knowledge gaps in the literature, this study encourages future SIT
Kunming students to pursue an ISP topic related to mental health and the OCP. Students
mentioned depression-related MHP as prevalent, but this could be further examined by looking
at the effects of the OCP on depression. This study could be conducted with participants ranging
from students to the elderly in order to gain a more comprehensive perspective on the topic.
Similarly, students could look at the effects of the OCP on the mental health of the aging
population. The age dependency ratio and childless elders (both exacerbated by the OCP) could
have effects on the mental health of the aging population.
THE PERCEIVED MENTAL HEALTH EFFECTS OF CHINA’S ONE-CHILD POLICY
38
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Appendix I: Study Questions
Demographic Questions
年龄（Age）
性别（Gender）
民族（Nationality）
出生地（Birthplace）
居住城市（Current city, province）
文化水平（Education level）
职业（Occupation）
你有几个兄弟姐妹？（Number of siblings）
• 你有几个孩子？（Number of children）
Psychological Counselor Interview Questions：
• 你做精神病医生多长时间？How long have you been practicing psychiatry?
• 你的 病人 里面有上学的孩子吗？Do you work with school children?
o 每星期你看几个孩子？How many per week?
o 你看的上学的孩子数量有变化吗？ Have you noticed any changes in the
number of school children you see?
▪ 如果对， 什么变化，为什么有这样的变化？If yes, what changes and
why?
o 他们怎么找到你的？Who recommends school children to see you? 学生的父
母？ Parents? 学校？Schools?
o 你看的孩子是什么样的家庭，有什么社会经济地位？What is the average
socioeconomic status of the parents whose children you see?
• 你看的孩子主要有什么心理问题？What are the main mental health issues children
have when they come for treatment?
• 你看的主要是 独生子女吗／ Do you treat more only children or children who have
siblings?
o 独生子女 和非独生子女 心理健康状态 有什么不同？ Are there any
differences between the mental health status of these two groups?
o 独生子女 和非独生子女 会有不同的心理问题吗？Are there any differences in
the mental health issues you treat with only children versus children with
siblings?
• 你觉得这些家庭为什么愿意带他们的孩子 来接受心理治疗？Why do you believe
families seek out mental health treatment?
• 你觉得独生子女政策 对你的工作有影响吗？Do you believe the one-child policy has
affected your work?
• 你觉独生子女政策得对你的病人有影响吗？Do you believe the one-child policy has
affected the children who you treat’s mental health?
o 你觉得 独生子女 对孩子的焦虑程度有什么影响？Effect on anxiety levels
among schoolchildren?
o 你觉得 OCP 对你的 独生子女成年病人 有什么长期的影响？Long-term
effects on adults who are only-children?
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o 你觉得 OCP 对中国文化 有什么长期的影响？Long-term effects on Chinese
culture?
School Counselor Interview Questions
• 你多少时间做 学校心里咨询师？How long have you been a counselor?
• 你觉得跟别的昆明的学校比起来这所学校有什么不同？How would you compare this
school to other middle schools/high schools in Kunming?
o 每星期你看几个学生的孩子？How many per week?
o 你看的上学的孩子数量有变化吗？ Have you noticed any changes in the
number of school children you see?
▪ 如果对， 什么变化，为什么有这样的变化？If yes, what changes and
why?
• 是老师让他们咨询你的还是你自己决定来的？ teachers refer children to see you or do
the children see you of their own accord?
• 你看的孩子主要有什么心理问题？What are the main mental health issues children
have when they come for treatment?
• 你看的主要是 独生子女吗／ Do you treat more only children or children who have
siblings?
o 独生子女 和非独生子女 心理健康状态 有什么不同？ Are there any
differences between the mental health status of these two groups?
o 独生子女 和非独生子女 会有不同的心理问题吗？Are there any differences in
the mental health issues you treat with only children versus children with
siblings?
• 你觉得独生子女政策 对你的工作有影响吗？Do you believe the one-child policy has
affected your work?
• 你觉独生子女政策得对你的病人有影响吗？Do you believe the one-child policy has
affected the children who you treat’s mental health?
o 你觉得 独生子女 对孩子的焦虑程度有什么影响？Effect on anxiety levels
among schoolchildren?
o 你觉得 独生子女对你的 独生子女成年病人 有什么长期的影响？Long-term
effects on adults who are only-children?
o 你觉得独生子女对中国文化 有什么长期的影响？Long-term effects on
Chinese culture?
o 你觉得独生子女政策对老龄化有什么长期的影响？Long-term effects on aging
population?
College Student Interview Questions
• 年龄（Age）
• 性别（Gender）
• 民族（Nationality）
• 出生地（Birthplace）
• 居住城市（Current city, province）
• 文化水平（Education level）
• 职业（Occupation）
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• 你有几个兄弟姐妹？（Number of siblings）
• 你怎么描述你的在大学的经历？你在高中的经历？你在初中的经历？How would
you characterize your college experience? High school? Middle school?
• 到目前为止，你觉得在学校的最大的挑战是什么？What have been your biggest
challenges in school up to this point?
• 你觉得 你的学校有很多焦虑的学生吗？Do you feel anxiety is prevalent among
students in your school?
o 如果有， 你觉得中国有很多焦虑的学生吗？
• 你觉得你的焦虑多少是来自学校的压力？How much anxiety do you feel because of
school?
• 你的焦虑主要是因为什么导致的？ What causes you the most anxiety？
o 你焦虑的时候 具体是什么感觉？What does your anxiety feel like?
• 你或者你认识的人曾因为焦虑或者别的心理问题寻求过帮助吗？Have you or
anyone you know ever sought help for anxiety or other mental health issues?
o 如果有， 向谁寻求帮助？ If so, from who?
• 你觉得你能跟别的人谈论 你的焦虑或者别的心理问题吗？Do you feel you can talk
about anxiety and other mental health issues you are having?
o 如果能， 你跟谁 谈论你的焦虑或者别的心理问题？If so, who do you talk to
about these issues?
• 你觉得 独生子女 政策 对学生的心理健康 有影响吗？ Do you feel the one-child
policy has affected the mental health of students?
o 你觉得独生子女 政策 对学生的焦虑程度 有影响吗？Do you feel the one-child
policy has affected students’ anxiety?
• 你觉得你的独生子女的身份对你的心理健康有影响吗？Do you feel being an only
child has affected your mental health? 如果有，有什么影响？ If so, how?
Parent/Family Interview Questions
• 年龄（Age）
• 性别（Gender）
• 民族（Nationality）
• 出生地（Birthplace）
• 县居住（Current city, province）
• 文化水儿（Education level）
• 职业（Occupation）
• 你有几个兄弟姐妹？（Number of siblings）
• 你有几个孩子？（Number of children）
• 你怎么描述你的在学校的经历？ How would you characterize your school
experience？
• 你怎么描述你的孩子在学校的经历？ How would you characterize your
child/children’s school experience?
• 你觉得在学校的最大的挑战是什么？What do you think were your biggest challenges
in school？
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• 你觉得你的孩子在学校的最大的挑战是什么？What do you think are your
child/children’s biggest challenges in school？
• 你觉得 中间 你的孩子的学校的学生焦虑是于今为然吗？Child school
o 你觉得 中间中国的学生焦虑是于今为然吗？Do you feel anxiety is prevalent
among students in China?
o 你觉得独生子女政策实施以后比实施以前有更多的学生有焦虑问题吗？ Do
you feel anxiety is more prevalent among students now than before the one child
policy when you were a student?
o 如果是， 为什么？If so, why?
• 你是学生的时候，觉得你的焦虑多少是来自学校的压力？How much anxiety did you
feel because of school when you were a student？
o 你焦虑的时候 具体是什么感觉？What did your anxiety feel like?
• 你觉得你能跟别的人谈论 你的焦虑或者别的心理问题吗？Do you feel you can talk
about anxiety and other mental health issues you are having？
o 如果对， 你跟谁的人你谈论得了你的焦虑或者别的心理保健疾？If so, who
do you talk to about these issues？
• 你感觉你的孩子方便 跟别人谈论他的焦虑问题或者别的心理问题吗？Do you think
that your child/children feel comfortable talking about anxiety and other mental health
issues they are having？
o 如果方便，跟谁谈论他的焦虑问题或者别的心理问题？ If so, who do they
feel comfortable talking to about these issues？
If they are an only child:
• 你觉得你的独生子女的身份对你的心理健康有什么影响？Do you feel being an only
child has affected your mental health?
• 你觉得你的独生子女的身份对你教育孩子的方法有什么影响？ Do you feel being an
only child has affected your parenting?
If they have one child:
• 你觉得 独生子女政策对你的孩子 的心理健康有什么影响？Do you feel the one-child
policy has affected the mental health of your child？
o 你觉得 独生子女政策对你的孩子 的焦虑程度有什么影响？Do you feel the
one-child policy has affected your child’s anxiety？
If they have multiple children but are an only child:
• 你觉得你能给你的两个孩子足够的注意力吗？Do you feel it is possible for you to
give both of your children enough attention?
o 如果不能， 为什么？ If not, why not?
Teacher Interview Questions
• 你多少时间是老师？How long have you been a teacher？
• 你觉得跟别的昆明的学校比起来这所学校是怎么样？How would you compare this
school to other middle schools/high schools in Kunming？
• 你教什么课？What subject do you teach？
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• 你有几个学生？
• 3 你对看学校辅导员举荐学生或者学生自己决定看学校辅导员？Do you refer
children to see school counselors or do the children seek help of their own accord?
o 在你推荐去看心理咨询师的学生中，有更多的独生子女还是更多的非独生子
女？ Do you refer more only children or children who have siblings to see a
counselor for a mental health issue？
• 你的学生中有更多的独生子女还是非独生子女？ Do you teach more only children or
children who have siblings？
o 心理保健的这两个组有没有差异？Do you think there are any differences
between the mental health status of these two groups？
• 你教的孩子中，主要有什么心理问题？ What do you think the main mental health
issues are that children in your class have？
• 你觉得 独生子女政策实施以前和以后 学生有什么明显的相同点和不同点吗？ What
do you think are the noticeable similarities and differences between students before the
one child policy and now?
• 你觉得独生子女政策对你的工作有什么影响？ Do you believe the one-child policy
has affected your work？
• 你觉得独生子女政策对你的学生的心理健康有什么影响？Do you feel the one-child
policy has affected the mental health of your students?
o 你觉得 独生子女 对孩子的焦虑程度有什么影响？Effect on anxiety levels
among students?
o 你觉得独生子女政策对学生的课堂表现 有什么影响？Effects on how students
behave in class?
o 你觉得 独生子女政策对你的 独生子女成年病人 有什么长期的影响？Long-
term effects on adults who are only-children?
o 你觉得独生子女政策对老龄化有什么长期的影响？Long-term effects on aging
population?
o 你觉得独生子女政策对中国文化 有什么长期的影响？Long-term effects on
Chinese culture?
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Appendix II: Sample WeChat Survey （Students）
感谢你对参与！ 这是一个匿名的学习， 所以你不需要给我你的名
字。你不需要回答你不愿意回答的问题。你可以请我如果你有问题！
年龄: ___________________________ 性别: 女 ／男 （选一个）
民族: ___________________________ 出生地: _____________________________
居住城市: _______________________ 文化水平: ___________________________
职业: ___________________________ 你有几个兄弟姐妹？: _________________
1. 你怎么描述你的在大学的经历？你在高中的经历？你在初中的经历？
2. 到目前为止，你觉得在学校的最大的挑战是什么？
3. 你觉得 你的学校有很多焦虑的学生吗？
a. 如果有， 你觉得中国有很多焦虑的学生吗？
联系人: Avery Rasmussen
微信证件: averyrasmussen
电话号: +86 18669004492
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4. 你觉得你的焦虑多少是来自学校的压力？
5. 你的焦虑主要是因为什么导致的？
6. 你焦虑的时候 具体是什么感觉？
7. 你或者你认识的人曾因为焦虑或者别的心理问题寻求过帮助吗？
a. 如果有， 向谁寻求帮助？
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8. 你觉得你能跟别的人谈论 你的焦虑或者别的心理问题吗？
a. 如果能， 你跟谁 谈论你的焦虑或者别的心理问题？
9. 你觉得 独生子女 政策 对学生的心理健康 有影响吗？
10. 你觉得独生子女 政策 对学生的焦虑程度 有影响吗？
11. 你觉得你的独生子女的身份对你的心理健康有影响吗？ 如果有，有什么影响？
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Appendix III: Symptoms of Anxiety (Students)
• W23: Irritability, do not want to live, want to fight something, want to cry
• W24: Irritability, confusion, listlessness
• W25: Hungry, want to binge
• W26: terribly upset
• W22: Anxiety, insomnia, fear, frustration.
• W1: scatterbrained/superficial/shallow, do not want to study, do not know what I should
do
• W10: stare blankly/ be in a daze
• W11: feel anxious
• W12: very panicked, at a loss/confused
• W13: comparatively exhausted and nervous/tense
• W16: Nervous, uncomfortable, worried, afraid
• W17: Insomnia, poor memory, in a bad state
• W18: Tense, there will be unstable emotions, and I'll even vent to friends around
• W2: Always let my imagination run away with me, there is no way to solve it
• W20: Need to calm down to work hard, irritability, mental rigidity, cannot turn up, feel
all kinds of bad, uncomfortable. . .
• W3: miss close relatives, perplexed about future
• W4: nervous/ fast heartbeat, cannot sleep, hair loss
• W5: One kind of tearing feeling, do not know if it is appropriate. Although I know I have
a lot of things to do, but I cannot put effort into work or study.
• W6: No matter what I do not want to play/ have fun
• W7: restless with anxiety mood, overactive/restless
• W8: feel very fidgety/agitated/irritable, moreover very easily reject myself. Compared
with the now popular saying, it is more "dispirited"
• W9: do not know what I should do, cannot do anything, bad mood
• W21: Insomnia, loss of appetite
• W14: Upset, irritable, unable to focus attention, cannot focus on one thing for a long
time, it is difficult to sleep.
• W15: Head pain, vomiting.
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Appendix IV: Field Study Hours Breakdown
Activity
Total Hours
Participant recruitment
20
Review of literature
40
ISP proposal (writing and revising)
8
In-person interviews
16
Data collection activities
15
Participant communication
4
Translating responses
8
Creating datasheets
3
Creating syntax for SPSS data analysis
6
Qualitative theme analysis
5
Writing and editing ISP Paper
50
Creating ISP presentation
10
Creating graphics and figures for ISP
results
5
Meals with participants/advisors
4
Total
194
