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The behaviors of children may be affected by sleep-disordered breathing (SDB). This study adopts a cross-sectional approach to investigate the relationship between the sleep apneas–hypopneas index during sleep and the behavioral and academic performance of schoolchildren in Taiwan. A total of 138 children (85 boys and 53 girls), ages 6–11, were recruited from two elementary schools to participate in this study. Overnight polysomnographic examinations in hospital were performed to assess sleep quality, including total sleep time, arousal index, apneas–hypopneas index, desaturation index, and lowest oxygen saturation, as well as the percentage of total sleep time spent in rapid eye movement, stage 1, stage 2, stage 3, and stage 4. The children’s parents and teachers were required to complete a Chinese version of the Child Behavior Checklist and Teacher’s Report Form to assess child behavior and academic achievement. Compared with children without SDB (apneas–hypopneas index ≤1), those with severe SDB (apneas–hypopneas index >15) exhibited more irregular behavioral performance in somatic complaints (odds ratio (OR) = 9.43; 95% confidence interval (CI) = 1.04–85.71) and attention (OR = 9.95; 95% CI = 1.02–97.00). However, different severities of SDB groups did not show significant associations in academic performance. Our study suggests that children with severe SDB may predispose to somatic complaints and attention problems so that sleep examination or medical intervention might be provided at an early age in these children.

BACKGROUND: Organophosphorus pesticides are widely used throughout the world. Because of their ease of availability, organophosphorus compounds are commonly used for self-poisoning in developing countries. The acute effects of exposure to organophosphorus pesticides are well known, but the chronic effects are unclear. Recent studies suggest that abnormalities of the central and peripheral nervous systems persisted for up to 5 years after acute poisoning due to a single large dose of organophosphates (OPs). However, the long-term effects on cardiovascular diseases are poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: An OPs-exposed cohort (N = 7,561) and an age- and gender-matched control cohort (N = 30,244), both identified from the National Health Insurance Research Database, were compared. We utilized the multivariable Cox proportional model to estimate the risks of developing arrhythmia, coronary artery disease (CAD) and congestive heart failure (CHF). The patients with acute poisoning from OPs had higher incidence rates of arrhythmia (5.89 vs. 3.61 per 1,000 person-years), CAD (9.10 vs. 6.88 per 1,000 person-years), and CHF (3.89 vs. 2.98 per 1,000 person-years) compared with that of the non-OPs poisoning cohort, with a crude subhazard ratio (SHR) of 1.40, 1.13, and 1.12, respectively. Additionally, a significantly higher risk of arrhythmia was observed in the OPs poisoning cohort (adjusted SHR = 1.25) compared with the non-OPs poisoning cohort, particularly in male patients (adjusted SHR = 1.33) and those under 49 years of age (adjusted SHR = 3.16). After accounting for the competing risks of death, there was a higher risk of arrhythmia and CAD during a three year follow-up period (adjusted SHR = 1.50 for arrhythmia; adjusted SHR = 1.10 for CAD). We also found an adjusted SHR of 1.36 associated with developing CHF after 6 years of follow-up for OPs poisoning cohort. CONCLUSIONS: Acute OPs poisoning may continuously impact human health through mechanisms that are unclear. Any supportive measurements that could contribute to a reduction in the risk of heart disease may be beneficial in cases of OPs poisoning survivors. Language: en

BackgroundThe purpose of this study was to develop a new visual grading system for the vascular ratio, to assess the correlation of the prognostic significance of the visual grading system, tumoral blood flow velocity and squamous cell carcinoma (SCC) antigen serum levels in invasive SCC of the cervix.Patients and MethodsA total of 117 patients with invasive cervical carcinoma were enrolled for the assessment of vascular grading and tumor flow using transvaginal ultrasound with power Doppler angiography (TV-PDA) before treatment. The modified visual grading system of the vascular ratio (grades 1 to 3) and six blood flow characteristics of tumor vessels (pulsatility index, resistance index, peak systolic velocity, end-diastolic velocity, time-averaged maximum velocity, vascular index) were measured by TV-PDA. In addition, serum levels of SCC antigen were randomly obtained in 74 patients with invasive cervical SCC (stages Ia to IIIb) before treatment.ResultsThe modified visual grading system of the vascular ratio significantly correlated with pretreatment SCC antigen serum levels (p < 0.05) and intratumoral resistance index values (p < 0.05, r2 = 0.49) from multiple regression analysis in 71 patients with invasive SCC of the cervix. Modified visual grading of the vascular ratio negatively correlated with intratumoral resistance index values (Pearson's correlation coefficient, r = −0.571, p = 0.001), but positively correlated with pretreatment serum levels of SCC antigen (r = 0.296, p = 0.012). In addition, this modified vascularity grading positively correlated with FIGO stage (r = 0.336, p = 0.004) by correlation analysis.ConclusionThe modified visual grading system of the vascular ratio is a valuable sonographic marker in assessing invasive cervical carcinoma. The three major advantages of this semi-quantitative analysis are ease of discrimination, immediate results, and avoiding wasting time. This semi-quantitative analysis with pretreatment SCC antigen serum levels are two effective markers for assessing invasive cervical carcinoma.

This work reports on a study to evaluate the relative contributions of genetic and environmental factors to both competence scales and behavioral/emotional syndromes as assessed by the Child Behavior Checklist (CBCL). A total of 279 pairs of twins and same-sex sib-pairs aged 12-16 years were recruited from 51 junior high schools in Taipei City, Taiwan. Twins' zygosity was determined by a combination of DNA typing and physical similarity. The Mx program was used to estimate parameters for a full model that contains effects from sex-specific additive genes, shared environment, and nonshared environment for the majority of the scales. The shared environment in the full model was replaced with nonadditive genetic factors for some scales when indicated. All girls' competence and behavioral/emotional syndromes exhibited a substantial heritability (h2 > 0.4), except for Social Competence and Withdrawn. For boys, though the heritability was also >0.4 for some scales (Social and School Competence, Thought Problems, Attention Problems, Delinquent Behavior, and Total Behavior Problems), environmental influences, especially shared environment, were predominant for most of the scales (10 out of 15 scales). Genetic factors are important for explaining adolescent behavioral problems, especially for girls, while shared environmental influences cannot be ignored for boys. Gender differences in heritability exist for various CBCL-based competence and behavioral/emotional problems.

Background: Despite that adolescent substance use is increasingly prevalent throughout the world and leads to increased risk of progression to illicit drug use, few studies have examined in detail individual features that are associated with such use. We aimed to examine personality traits, incompetence, and behavioral/emotional problems in relation to adolescent substance use and possible interactions between these factors. Methods: Junior high school adolescents (N=905) randomly selected from Taipei in 1996 completed a questionnaire consisting of substance use experience, the Junior Eysenck Personality Questionnaire (JEPQ), and the Tridimensional Personality Questionnaire (TPQ). Students’ parents (N=854) were asked to complete the Child Behavior Checklist. Logistic regression was used to assess the relationship between substance use and personality traits or behavioral problems. Results: The most commonly used substance was liquid substance (alcohol and refreshing beverage), followed by tobacco and betel nut with an age-related trend in boys. Associated factors of substance use included higher Extroversion and lower Lie Scale (as measured in the JEPQ), higher Novelty Seeking (as measured in the TPQ), poorer School Competence, and more Delinquent Behavior, Aggressive Behavior, and Somatic Complaints. The associations remained unchanged with potential confounders controlled for. Conclusions: Adolescents who use substance have specific individual features that are readily assessable by existing instruments. This bears important implications for the early intervention of substance abuse in adolescents.

Little is known about the interplay of cultural, parenting, and sociodemographic/socioeconomic factors on children’s behavioral problems, especially within culturally mixed families in Chinese society. This study compares the presence of behavioral problems between children from families with an immigrant mother and those from native-born families in a randomly selected sample of 957 children aged 6 to 12 years from three counties in central Taiwan. Behavioral problems were assessed using the Child Behavior Checklist completed by parents and the Teacher’s Report Form. Parenting styles were assessed using the Parental Bonding Instrument completed by children. Children of immigrant mothers had higher scores for all behavioral syndromes based on the parent’s report. However, in the teacher’s report a difference was only observed for withdrawn/depressed syndrome. Children of immigrant mothers were more likely, and children with high paternal care were less likely, to have internalizing and total problems in the parent’s report. For the teacher’s report, only high education in fathers was associated with decreased internalizing and total problems in children. These findings suggest that children growing up in a cross-cultural environment with an immigrant mother, as opposed to a native-born Taiwanese family environment, are more likely to have higher internalizing problems and total behavioral problem scores, due to a number of cultural, parenting, and sociodemographic factors. Children’s behaviors appear to be more influenced by fathers’ than mothers’ parenting styles, regardless of family type. The study findings imply that unequal health and social conditions exist between cross-cultural and native-born families.

Objective To evaluate the rates and patterns of comorbidity between behavioral syndromes in adolescents as reported by parents and teachers. Whether the patterns of comorbidity were “epiphenomenal” was also assessed. Method Parents of 854 randomly selected students (response rate = 88%) in Taipei in 1996 completed the Child Behavior Checklist; among them, 240 also were randomly selected to have the Teacher's Report Form completed by their teachers. In addition to bidirectional comorbidity rates, odds ratios with and without other comorbid pairs controlled for were estimated via multiple logistic regressions. Results High comorbidity rates between behavioral syndromes were found in adolescents as reported both by parents and teachers except for that of Somatic Complaints with other syndromes. When other comorbidity pairs were controlled for, the comorbidity rates between Anxious/Depressed with externalizing syndromes turned out to be epiphenomenal, whereas those between externalizing syndromes remained high for both informants’ reports. Attention Problems also remained significantly comorbid with other syndromes in the multiple logistic regressions except for that of Aggressive Behavior in the Teacher's Report Form sample. Conclusions High comorbidity rates between adolescent behavioral syndromes exist in both parents’ and teachers’ reports, and it is important to control for the epiphenomenal condition when assessing such comorbidity rates.

The present study investigated whether dual-task Timed UpGo tests (TUG) could identify prefrail individuals more sensitively than the single-task TUG (TUGsingle ) in community-dwelling middle-aged and older adults.This cross-sectional study recruited adults aged 50 years and older who actively participated in local community programs. Time taken to complete single-task TUG and dual-task TUG, carrying a cup of water (TUGmanual ) or carrying out serial-3 subtraction (TUGcognitive ) while executing TUG, was measured. Prefrailty status was defined based on Fried's phenotypic definition.Of the 65 participants (mean age 71.5±8.1 years), 33.3% of the 12 middle-aged (50-64 years) and 62.3% of the 53 older (≥65 years) adults were prefrail, mainly as a result of weak grip strength. The receiver operating characteristic curve analyses for differentiating prefrailty from non-frailty showed that the area under the curve (AUC) for TUGmanual (0.73, 95% CI 0.60-0.86) was better than that for TUGsingle (0.67, 95% CI 0.54-0.80), whereas the AUC value was not significant for TUGcognitive (0.60, 95% CI 0.46-0.74). The optimal cut-off points for detecting prefrailty using TUGsingle , TUGmanual and TUGcognitive were 7.7 s (sensitivity 68%), 8.2 s (sensitivity 83%), and 14.3 s (sensitivity 29%), respectively. After adjusting for age, logistic regression analyses showed that individuals with TUGmanual 8.2 s or slower were 7.2-fold more likely to have prefrailty than those with TUGmanual faster than 8.2 s.TUGmanual is more valid and sensitive than TUGsingle in identifying prefrail individuals. The TUGmanual thus could serve as a screening tool for early detection of individuals with prefrailty in community-dwelling middle-aged and older adults.

The relationships of Internet use, web communication, and sources of social support with adolescent self-injurious thoughts and behaviors (SITBs) in Taiwan were investigated. The study sample of 391 12 to 18-year-olds was selected from nine public high schools. Findings show that girls are more likely to have SITBs, except for suicide gestures. Web communication is a risk factor for SITBs in boys but not in girls. Family support is protective in both genders. Support from friends is protective and support from significant others was a risk factor for suicide plans in girls. Support from virtual social communities can have both positive and negative effects on adolescent SITBs, with different effects by gender.

To compare intensiveness of use of child preventive health services (CPHS) between cross-cultural immigrant families and native-born families in Taiwan and to explore factors associated with differences in intensiveness of CPHS use.Cross-cultural immigrant families were defined as families where the mother was an immigrant from another southeast Asian country. In native-born families, both parents were Taiwanese-born. Data were collected from 318 immigrant mothers and 340 native-born mothers of children aged 7 years or younger in a cross-sectional survey in central Taiwan. A social determinants framework of health inequities was constructed, and ordinal logistic regression models were used to examine the effect of four domains of intermediary determinants on the relationship between family type and underuse of CPHS: CPHS-related factors, medical-related factors, maternal acculturation factors, and sociodemographic/socioeconomic characteristics.Cross-cultural immigrant families were less likely to intensively use CPHS than native-born families. This difference appeared to be mediated by the greater likelihood of having an older child or a lower educated father in cross-cultural families.Findings of this study highlight the importance of promoting health behaviors and combating health inequities and social inequalities for cross-cultural immigrant families in Taiwan from a sociodemographic/socioeconomic and political context.

This study aimed to explore the role of perseveration in the relations between life events and depression in a 2-year prospective study of non-referred adolescents. Participants were 400 middle school students randomly selected in Taipei. Baseline perseveration was measured using Perseverative Errors on the Wisconsin Card Sorting Test and psychological distress was measured using Anxious/Depressed syndrome on the Child Behavior Checklist. These individuals also completed the Life Event Checklist and the Center for Epidemiologic Studies Depression Scales at follow-up. With adjustment for initial psychological distress and demographic features, the results of multiple regression analyses showed that more perseveration at baseline was associated with greater influence of negative life events on the subsequent depressive symptoms. Perseveration might act as a moderator on the relations of life events to depressive symptoms and lowering perseveration may be a plausible way to decrease the impact of negative life events on adolescent depressive symptoms.

Ten stations alongside major thoroughfares were selected as exposure sites, while a small village located about 3 kilometers away from a main traffic route was selected as the control site. The concentrations of particulate matters with aerodynamic less than 2.5 microm (PM(2.5)) and elemental carbon (EC) at exposure sites were both higher than those at the control site. Daytime mean concentrations of total polycyclic aromatic hydrocarbons (t-PAHs), carcinogenic PAHs (car-PAHs), and Benzo(a)pyrene-equivalent dose (BaP(eq)) at exposure sites were all about twice as high as those at the control site. A significant relationship between t-PAHs and EC was found, suggesting that most of the t-PAHs at exposure sites were contributed by diesel exhaust. Furthermore, the diagnostic ratios also show that diesel emissions were the dominant sources of PAHs at exposure sites. A multiple linear regression was applied to urinary 1-hydroxyprene (1-OHP) using four variables (exposure status, sex, smoker status, and incense burning) as independent variables. The results showed that the concentrations of 1-OHP in exposure groups were significantly (p0.001) higher than those in the control group. The explainable percentage for exposure status was 91.1%, indicating that the exposure factor, in comparison with other factors, has a dominant contribution to the concentration of 1-OHP. After subtracting the background levels of 1-OHP, the levels of urinary 1-OHP for residents exposed to the exhaust of 100 vehicles were about 0.062 microg/g creatinine.

We conducted a repeated-measures cohort study of coke oven workers to evaluate the relationships between the traditional exposure biomarker, urinary 1-hydroxypyrene (1-OHP), and a series of biomarkers, including urinary 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG), N7-methylguanine (N7-MeG), acute toxicity, and mutagenicity. A total of eight spot urine samples were collected from each high-exposed (at topside oven area) and low-exposed workers (at side oven area) during the whole working cycle, which consisted of 6 consecutive days of working followed by 2 days off. Our results showed that the high-exposed workers had significantly higher urinary levels of 1-OHP, 8-oxodG, and N7-MeG compared with the low-exposed workers. Acute toxicity and mutagenicity of urine were also found to be markedly increased in the high-exposed workers, as determined by Microtox assay and Ames test, respectively. Multivariate regressions analysis revealed that the urinary 8-oxodG, N7-MeG, or acute toxicity was significantly correlated with 1-OHP concentrations. Overall, the present study showed that exposure to coke oven emissions increased oxidatively damaged DNA products and mutagenicity of urine, and for the very first time, such exposure was also found to increase DNA methylation and urinary acute toxicity. The potential source of methylating agents in coke oven emissions warrants further investigation. Additionally, with repeated measurements, the pattern of time course for urinary 1-OHP was found to be different from those of 8-oxodG and N7-MeG, as well as acute toxicity and mutagenicity. This finding implies that the single measurement that was often conducted in occupational healthy investigations should be used with certain precautions, because single measurement may fail to provide the proper information of interest. (Cancer Epidemiol Biomarkers Prev 2008;17(12):3381–9)

One hundred fifty seven fifth-grade students (aged 10-12 years) from three elementary schools in three different towns in Taichung County, Taiwan were chosen as study subjects for the present arsenic and lead exposure study. The three towns--Longgang, Shalach, and Shuntain--are known to be highly, moderately, and lightly (control) polluted by As and Pb, respectively. Spot morning urine samples of students were collected and analyzed for arsenic and lead. The levels of As in the urine of Longgang schoolchildren showed the highest value among the three schools, while those of the control group (Shuntain) had the lowest values. In addition, the levels of Pb in the urine of the schoolchildren in Shuntain were significantly lower than those in Longgang and Shalach, while the levels of Pb in the urine of the schoolchildren in Longgang and Shalach showed no significant difference. Results of daily intake of metals from the different exposure pathways (i.e., ingestion from drinking water, household dust and food, and inhalation from airborne particles) showed that the Longgang area had the highest daily intake of As and Pb among the three areas, while the lowest daily intake of As and Pb occurred in the control area (Shuntain). A significant correlation between the doses of daily intake and urinary concentrations of As (p = 0.002) and Pb (p = 0.020) was observed. This correlation suggests that the increase of unit dose of the daily intake for As resulted in an increase of 0.953 microg g(-1) creatinine of As, whereas the increase of unit dose of the daily intake for Pb led to an increase of 0.053 microg g(-1) creatinine of Pb. These data indicate that the level of As in urine increased about 18 times higher than that of Pb for the same amount of increase in daily intake.

This study compared parents' ratings of behavioral and emotional problems on the Child Behavior Checklist (Achenbach, 1991;Achenbach & Rescorla, 2001) for general population samples of children ages 6 to 16 from 31 societies ( N = 55,508). Effect sizes for society ranged from .03 to .14. Effect sizes for gender were ≤ .01, with girls generally scoring higher on Internalizing problems and boys generally scoring higher on Externalizing problems. Effect sizes for age were ≤ .01 and varied across types of problems.Total Problems scores for 19 of 31 societies were within 1 SD of the overall mean of 22.5. Bisociety correlations for mean item scores averaged .74. The findings indicate that parents' reports of children's problems were similar in many ways across highly diverse societies. Nonetheless, effect sizes for society were larger than those for gender and age, indicating the need to take account of multicultural variations in parents' reports of children's problems.

This study examines the applicability for adolescents of the Tridimensional Personality Questionnaire (TPQ), which was originally designed for adults, as compared to the Junior Eysenck Personality Questionnaire (JEPQ). The study also evaluates their inter-relationship and associations with various behavioral problems as reported by parents using the Child Behavior Checklist (CBCL). In a representative community sample of 905 adolescents, the results of internal consistency, test-retest reliability, and factor analysis showed that both the Harm Avoidance (HA) and the Novelty Seeking (NS) scales of the TPQ have sound construct validity, although the Reward Dependence (RD) scale has less so. The intercorrelation and factor analysis of the two questionnaires showed that the TPQ and the JEPQ are not simply alternative descriptions of the same construct of personality. In their associations with various behavioral problems, the scales of the TPQ are relatively more specifically associated with behavioral problems than the scales of the JEPQ. Our results provide empirical support for the applicability of the NS and the HA scales of the TPQ in adolescents, particularly in relation to behavioral problems.

Background : Efficient screening is important in two-phase surveys. We examined whether the Center for Epidemiologic Studies Depression Scale (CES-D) is an appropriate instrument for screening depressive disorders among adolescents in Taipei, an ethnic group whose depression is little known of. Methods : Among the 2440 students of a school in Taipei, aged 12 to 16 years who completed the CES-D and eating attitude test (EAT; response rate=98.5%), 178 were randomly selected from four subgroups defined by the 90th percentile of the two screening tools for face-to-face interview, using the Schedule for Affective Disorders and Schizophrenia for Children (K-SADS). Discriminatory validities of instruments for depressive disorders were estimated, and then a stratum-specific likelihood ratio (SSLR) analysis was conducted for instruments with sufficient validity. Results : The prevalence estimates of depressive disorders varied with different levels of impairment, with a value of 2.4% for major depressive disorder and 0.3% for dysthymic disorder if at least two impairment items were endorsed. The areas under the receiver operative characteristic (ROC) curves were consistently high (0.88–0.90) for major depressive disorder with or without impairment requirement, but low (0.49) for dysthymic disorder without impairment requirement. Three strata of CES-D scores (0–28, 29–48, and ≥49) were derived for major depressive disorder with (SSLR=0.63, 3.00, and 11.75) and without (SSLR=0.61, 5.09, and 10.42) impairment requirement. Conclusions : The CES-D is useful in screening for major depressive disorder among nonreferred adolescents. Three strata are recommended for its practical application.

Objectives Cardiovascular disease (CVD) and depressive disorders are the most two harmful problems for human health in the 21st century. The relationships between the two diseases are complicated, yet the mechanisms are not clear so far. This study addressed this issue by clarifying shared and unique factors between metabolic syndrome (MS) and mild psychiatric disorder (MPD) using the 8-year follow-up Landseed cohort. Methods A total of 5712 community residents were followed-up and analyzed. The point prevalence rates of MS and MPD and their comorbidity rate were estimated by each wave. Three multiple logistic regression models, with each treating MS, MPD, and comorbid condition as dependent variable, were compared to identify the shared and unique factors. Variables specifically correlate with MS or MPD are defined as unique factors; whilst those correlated with both MS and MPD or with comorbid condition as shared factors. Results The point prevalence rates of MS ranged 13.83-14.26%, MPD ranged 17.17-19.60%, and comorbidity rates 2.75-3.07% in three waves. Educational level and weekly exercise frequency are shared factors of MS and MPD. Moderate personal income is a unique protective factor for MS; and male and abstaining from alcohol use are unique protective factors for MPD. Conclusions A balanced life style is beneficial for both physical and psychological health. Specifically, there are no dose-response effects between weekly exercise frequency and MS or MPD. It is important for clinicians and health educators to educate community people to engage in exercise in a proper way to improve public health.

Objective To investigate competence and behavioral/emotional problems among nonreferred adolescents in Taiwan, using a Chinese version of the Child Behavior Checklist (CBCL-C) and the Teacher's Report Form (TRF-C). The psychometric properties of these instruments and cross-cultural differences were also examined. Method Parents of 854 junior high school students aged 12 to 16 years in Taipei, Taiwan, were asked to complete the CBCL-C. Among these students, 162 had their teachers' ratings on the TRF-C. Results The internal consistency and 1-month test-retest reliability were satisfactory for both the CBCL-C and TRF-C, which were moderately correlated. Both exploratory and confirmatory factor analysis provided some support for the validity of Achenbach's cross-informant model. Parents' reports showed that compared with their American counterparts, Taiwanese adolescents tended to have lower scores on most competence scales, higher scores on scales that reflect covert behavior problems, and lower scores on scales that reflect more overt behavior problems. However, teachers' reports showed no significant differences on most competence and behavior problem scales. Conclusion The CBCL-C and TRF-C are useful tools for assessing the mental health status of Taiwanese adolescents. The cross-cultural differences in adolescent behavior problems are discussed.

The aims of this study were to assess developmental trends in performance on the Wisconsin Card Sorting Test (WCST) among 817 randomly selected adolescents aged 13-15 years, and to explore WCST performance factor structure and relationship to schizotypy. The results showed that of the nine WCST indexes, only the Categories Achieved and Failure to Maintain Set scores were associated with age, and only the Learning to Learn scores reached adult levels. Factor analysis of WCST performance scores yielded a three-factor structure. Psychometrically defined schizotypic subjects did not perform significantly worse than control subjects on any WCST indexes. These findings suggest that performance on various WCST indexes might indicate developmental changes at different ages, and deficits in WCST performance might not be sensitive indicators of vulnerability to schizophrenia in adolescence.

Background Mental health problems in young people are an important public health issue. Students leaving their hometown and family at a young age to pursue better educational opportunities overseas are confronted with life adjustment stress, which in turn affects their mental health and academic performance. This study aimed to examine the relationships among stress, coping strategies, and depressive symptoms using the stress coping framework in overseas Chinese university preparatory students in Taiwan. Methods A cross-sectional study was conducted at an overseas Chinese university preparatory institute in Taiwan. Of enrolled overseas Chinese university preparatory students at 2009, 756 completed a structured questionnaire measuring stress, strategies for coping with it, and the Center for Epidemiologic Studies Depression Scale. Results High levels of stress significantly predicted the adoption of active, problem-focused coping strategies (R 2 = 0.13, p < .01) and passive, emotion-focused coping strategies (R 2 = 0.24, p < .01). Acceptable CFI, SRMR, and RMSEA values from the structural equation modeling analysis demonstrated that the model satisfactorily fits the stress coping framework, after active coping strategies were eliminated from the model. Results from the Sobel test revealed that passive coping strategies mediated the relation between stress and depressive symptoms (z = 8.06, p < .001). Conclusion Our study results suggested that stress is associated with coping strategies and depressive symptoms and passive strategies mediate the relation between stress and depressive symptoms in overseas Chinese university preparatory students.