Threat to democracy: Physical and mental health impact of democracy movement in Hong Kong


Background: This study examined the prevalence and critical predictors of anxiety and depressive symptoms and self-rated health, following the Umbrella Movement in Hong Kong. Methods: Random digit dialing recruited a population-representative sample of 1208 Chinese Hong Kong citizens (mean age¼46.89 years; 63% female) in the first two weeks of February 2015. Respondents gave their informed consent and reported personal, social, and economic resource loss since the Umbrella Movement (Conservation of Resources-Evaluation), current anxiety symptoms (State-Trait Anxiety Inventory) and depressive symptoms (Patient Health Questionnaire-9), and self-rated health (1¼very good, 4¼very bad).

Results: A total of 47.35% (95% CI¼44.55, 50.17) respondents reported moderate/severe anxiety symptoms and 14.4% (95% CI¼12.54, 16.50) reported oderate/severe depressive symptoms; 9.11% (95% CI¼7.61, 10.86) reported “poor” or “very poor” health. Multivariable regressions revealed that personal and social resource loss was associated with higher anxiety and depressive symptoms and greater odds of “very poor” health (adjusted odds ratios/incidence rate ratios¼5–102%), independent of lower education level and income and being unmarried.

Limitations: This study was cross-sectional in nature and thus could not determine causality from the associations between resource loss and outcome variables. Second, the telephone survey relied on selfreports; response bias and social desirability could influence respondents’ answers and discount data validity. Third, potential confounders such as preexisting mental and physical health issues and concurrent predictors like exposure to the Umbrella Movement were not assessed

Conclusions: This is one of the first studies following any recent political movement (e.g., The Arab Spring) to quantify distress and the associated correlates of distress among affected citizens. Perceived psychosocial resource losses were critical predictors of poor outcomes

Zohar Massey | Karen G. Chartier | Mary B. Stebbins | Daphna Canetti | Stevan E. Hobfoll | Brian J. Hall | Kerem Shuval


A pro-democracy movement, originally named “Occupy Central” and then the “Umbrella Movement/Revolution,” emerged in Hong Kong Special Administrative Region between September 28 and December 15, 2014 after the People’s Republic of China (PRC) government’s decision to reserve the right to pre-approve the candidates for Chief Executive Election in 2017. Citizens blocked traffic at three major business/administrative districts by building encampments that were occupied for nearly three months. An estimated 17% of the 7.2 million Hong Kong citizens joined the protests (The Chinese University of Hong Kong, 2014). The Umbrella Movement was probably the first large-scale pro-democracy movement among Chinese since the Tiananmen Square protests in 1989. The impact on mental and physical health and specific predictors of these outcomes following political movements are unknown for Chinese populations, or indeed following similar movements elsewhere in the world (e.g., the Arab Spring).

The conservation of resources (COR) theory suggests that resource loss is the central mechanism driving adaptation to stress. Resources broadly include those personal, social, and material resources that we centrally value and are often divided between internal and external resources (Hobfoll, 1998; Hou and Wan, 2012). Internal or personal resources consist of entities that are possessed by the self and can be mobilized on one’s own such as sense of self-worth, sense of control over one’s life, and optimism (Diener et al., 2003). External resources consist of entities that are embedded within the physical environment or interpersonal interactions, such as social relationships, money, and employment (House et al., 1988). A summary of media reports revealed that people supported the Movement because they foresaw threat of resource loss including abolishment of the rule of law and deprivation of freedom (e.g., speech and press) (Bertolini, 2015; Cheung, 2014). Use of tear gas and pepper spray, physical assaults to suppress the protestors, and cases of selective law enforcement (e.g., non-action to some violence against the protestors by anti-protestors) further heightened people’s perceived threat of potential political oppression if there was no universal suffrage in 2017. The Umbrella Movement could be understood as an investment of internal or external resources to create passageways for political resources, i.e., democracy and universal suffrage, among some Hong Kong citizens (Hobfoll, 2012). A recent study focusing on the Arab Spring in North Africa and the Middle East has shown that the timing of social protest is linked to a particular increase in food prices (Lagi et al., 2011). This suggests that the inability to provide for oneself and family, the lack of self-sufficiency, and the fear of economic loss and deprivation are also some of the prime drivers of social action. Perhaps the most potent example of the consequences of the depletion of internal and external resources was the actions of Mohammed Bouazizi, a street vendor, in Tunisia on December 17, 2010. He, after having had his wares confiscated by municipal workers, set fire to himself, thus setting in motion the events that led to the Arab Spring (Dupont and Passy, 2011).

Despite the possibility that social protests could create resource passageways, they also have the power of depleting internal and external resources, which has central impact on the citizens’ psychological and physical well-being. Preventing depletion of these resources is key for maintaining healthy functioning (Hobfoll, 1998; Hobfoll et al., 2009; Hou and Lam, 2014; Hou et al., 2010a, 2010b, 2015). In Cairo, Egypt, citizens who were injured in political demonstrations reported higher levels of psychiatric symptoms than patients who experienced physical trauma from other causes. In both groups (N¼120 each), similar levels of perceived external control over life (e.g., other important persons, fate, chance) were reported and predicted higher symptoms, suggesting the adverse impact of possible depletion of personal resources (Papanikolaou et al., 2013).

There is limited study of the psychological and health impact of political movements with reference to resource loss (de la Sablonnière et al., 2013). Prior studies reported the association between resource loss and psychological functioning during major social upheaval. Among 145 Russian women in the midst of Russian economic transition, loss of economic resources (e.g., housing, stable employment) predicted depressive symptoms both directly and indirectly through a reduction of a personal sense of mastery over their life situations (Shteyn et al., 2003). Among Israeli settlers (N¼190) who had faced terrorism and armed conflict and were subsequently evacuated by force from Gaza, a place that provided them with economic compensation and ideological and religious meaning, loss of economic resources (e.g., economic suffering, property damage) predicted clinically significant depressive symptoms, whereas loss of personal and social resources (e.g., confidence in coping with major crises, social intimacy) predicted both depressive and posttraumatic stress symptoms (Hall et al., 2008). A recent population-representative study conducted among 643 adults living in the Palestinian Authority found that the most salient predictor of new cases of posttraumatic stress disorder was social resource loss (Hall et al., 2015). A study among 4838 East and West Germans found that loss of social and economic resources (e.g., partner relationships, standard of living) between 1986 and 1996 after the fall of the Berlin Wall predicted lower life satisfaction and higher negative affect (Westerhof and Keyes, 2006).

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