Gender differences in the relationship between forbearance and depression among college students — a cross-sectional study

Gender differences in the relationship between forbearance and depression among college students — a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gender differences in the relationship between forbearance and depression among college students — a cross-sectional study Wangrong Zhang, Xia Lv, Rong Xiao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4338140/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: College students are at a high risk of depression, and forbearance might be a critical resource to help college students alleviate depression. However, forbearance exhibits heterogeneity, with people displaying distinct styles of forbearance in coping with stress. Furthermore, gender differences in the relationship between forbearance and depression have not been investigated. Thus, the study aims to comprehensively explore gender differences in the relationship between forbearance and depression. Methods: Data were collected from 825 Chinese college students. We assessed their forbearance using the Forbearance Scale (FS) and evaluated their depression using the 9-item Patient Health Questionnaire (PHQ-9). A moderated model was used to explore the effect of gender in the relationship between forbearance and depression. Results: Active forbearance ( b = -0.22, t = -5.29, p ＜0.01) had a negative predictive effect on depression in college students, while repressive forbearance ( b = 0.10, t = 2.35, p ＜ 0.05) had a positive predictive effect on depression. The interaction term of active forbearance and gender was a significant predictor of depression ( b = 0.19, t = 2.71, p ＜0.01), and active forbearance negatively predicted depression in females at a significant level ( b = -0.22, t = -5.29, p ＜0.01), but not in males ( b = -0.03, t = -0.60, p = 0.55). The interaction term of repressive forbearance and gender was not a significant predictor of depression ( b = 0.04, t = 0.54, p = 0.59). Conclusions: The impact of active forbearance on depression was modulated by gender. When utilizing forbearance for psychological health interventions, relevant personnel should consider the heterogeneity of forbearance and potential gender differences to enhance the effectiveness of interventions. Forbearance Depression Gender differences College students Figures Figure 1 Figure 2 Figure 3 Introduction Depression is a common mental disorder in college students (Ibrahim et al., 2013 ). College students face multiple pressures, such as academic challenges, employment concerns, and interpersonal barriers, while also being in a phase of adolescence or early adulthood when psychological development is not yet mature, making them a population with a high incidence of depression (Gao et al., 2020 ; Liu et al., 2019 ). A study from China found that the incidence of depression among Chinese adolescents has reached 32.2% (Quan et al., 2023 ), and the global prevalence of depression among college students is roughly 33.6% (Li et al., 2022 ). College students with depression often experience issues such as sleep disorders (Shi et al., 2022 ) and cognitive deficits (Rock et al., 2014 ), leading to their academic failure and higher risk of suicide. Therefore, it is crucial to thoroughly investigate the factors and mechanisms influencing depression in college students to promote their healthy psychological and physical development. According to the diathesis-stress model, depression arises from the interaction between intrinsic personal traits and external environmental stressors (Li et al., 2022 ). Forbearance, as an inner personal quality, refers to the psychological trait that enables one to withstand temptations, cope with setbacks and stress, temporarily tolerate discomfort or humiliation for long-term benefits and objectives, avoid conflict and confrontation, and thereby regulate emotions, attitudes, and behavior (Yu, 2020 ). In traditional Chinese culture, forbearance has long been regarded as a valuable tool for resolving conflicts. Forbearance can help shift negative cognition and emotion, functioning as a positive psychological quality (Deng et al., 2020 ; Mehmood et al., 2021 ). In addition, forbearance also serves as a positive psychological resource that enables individuals to cope with potential conflicts and difficulties (Güss et al., 2018 ), which is critical for reducing the occurrence and relieving symptoms of depression (Aghababaei & Tabik, 2015 ). However, although forbearance has a positive effect on mental health, some studies believe that forbearance is repressive, and indiscriminate forbearance may exacerbate individual psychological stress and have adverse effects on the development of mental health (Mary Jo Coiro & Compas, 2017 ). Block ( 1996 ) also found people with an extremely strong ability to delay gratification may suffer some negative effects. Furthermore, forbearance may be accompanied by emotional avoidance and repression in certain situations, which may maintain distress and could have other adverse consequences (Richards & Gross, 1999 ). Early studies have explored gender differences in the incidence of depression, with some studies pointing to a trend where female college students exhibit higher levels of depression than their male counterparts (Edlund et al., 2022 ; Simegn et al., 2021 ), while others suggested the opposite (Xuan et al., 2023 ). Research on forbearance also revealed gender disparities (Deng & Xiao, 2022 ). Further studies found that women possess greater resilience when dealing with emotional pain and psychological stress (Xu et al., 2019 ), exhibiting more flexibility in emotion regulation and processing (Goubet & Chrysikou, 2019 ), which suggests their psychological forbearance may be more advantageous compared to men. Do these gender differences in the forbearance prevail universally? As an inner psychological quality, can forbearance influence the onset and manifestation of depression differently depending on gender? Addressing these questions is of vital importance for a more precise approach to the prevention and treatment of depression. Up to now, few studies have explored how gender influences the relationship between forbearance and depression. Therefore, the objective of this study was to explore the gender differences in the relationship between forbearance and depression among college students. Method Participants This study was conducted following the Declaration of Helsinki and was approved by the ethic committee of Southern Medical University. All participants got a detailed explanation before participating in the study. Informed consent was obtained from each participant. This study utilized a snowball sampling approach for convenience, utilizing the Questionnaire Star online platform to invite college students to participate. A total of 1079 questionnaires were collected. After review, questionnaires from those who appeared not to have answered seriously were excluded (including those with a completion time of less than 420 seconds, careless entries in personal information, characteristics not matching a typical college student such as an age entry of 50 years, etc.), resulting in 825 valid questionnaires. The validity rate of the returned questionnaires was 76.5%. Measures Forbearance Forbearance was measured by the Forbearance Scale (Yu, 2020 ). The scale came from a Chinese master's thesis and undergone rigorous validation with a good reliability (Cronbach’s alpha = 0.87, split-half reliability = 0.84, test-retest reliability = 0.80) and validity (χ 2 /df = 3.58, GFI = 0.98, CFI = 0.98, TLI = 0.96, RMSEA = 0.03). The 20-item tool measured five factors (repression, self-restraint, patience and calm, delaying gratification, and positive cognition) of forbearance on a 5-point Likert scale, where 1 = very uncharacteristic and 5 = very characteristic. All items were positively scored. The five factors were summarized into two dimensions: repressive forbearance (containing repression factor) and active forbearance (including self-restraint, patience and calm, delaying gratification, and positive cognition factors). Individuals' psychological forbearance was categorized into four types based on their scores across factors and dimensions: high forbearance type, tenacious forbearance type, rare forbearance type, and repressive forbearance type. For the high forbearance type, the average score of all five factors was ≥ 4; for the rare forbearance type, the patience and calm factor score was ≤ 3, and the average score of the other four factors was < 4. Excluding those classified as high or rare forbearance type, individuals with a higher average score in the dimension of repressive forbearance than in active forbearance were categorized as repressive forbearance type, while the rest were tenacious forbearance type. In this study, the scale's Cronbach's alpha was 0.93. Depression The 9-item Patient Health Questionnaire (PHQ-9) developed by Kroenke et al. ( 2001 ) was used to measure depression. The scale contained 9 items to measure depression in a 4-point Likert scale, with 0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day (over the last month). A score of 0–4 indicated no depression, 5–9 mild depression, 10–14 moderate depression, and a score of 15 or above severe depression. The scale's Cronbach's alpha in this study was 0.90. Statistical analysis In the study, IBM SPSS 26.0 was used to perform statistical analysis. First, a t-test and chi-square test were used to test gender differences in forbearance and depression. In addition, person correlation analysis was performed for all the study variables. Finally, the moderating role of gender in the relationship between forbearance and depression was performed via the PROCESS Macro (Model 1) based on the bias-corrected percentile bootstrap method (Bootstrap = 5000, 95% CI). Results Preliminary analyses The participants included 261 males (31.6%) and 564 females (68.4%) aged 16–24 years ( M = 19.54, SD = 1.15). Among them, freshmen accounted for 151 (18.3%) and there were 134 individuals lived in rural areas (16.2%). Other demographic variables of participants are shown in Table 1 . Table 1 Demographic characteristics of study participants ( N = 825) N/Mean %/(SD) Gender Male 261 31.6 Female 564 68.4 Age (years) 19.54 1.15 Grade Freshman 151 18.3 Sophomore 474 57.5 Junior 137 16.6 Senior 48 5.8 Fifth-year and others 15 1.8 Place of residence Rural areas 134 16.3 County towns 152 18.4 Small to mid-sized cities 275 33.3 Large cities 264 32.0 Severity of depression No depression 175 21.2 Mild depression 360 43.7 Moderate depression 180 21.8 Severe depression 110 13.3 Gender differences in college students' forbearance and depression As shown in Table 2 , female students show significantly higher depression scores than male students ( t = 4.81, p 0.05). Table 2 T-test for gender differences in forbearance and depression Males ( n = 261) Females ( n = 564) t p Repressive forbearance 3.41 ± 0.70 3.40 ± 0.67 -0.14 0.89 Active forbearance 14.00 ± 2.52 14.02 ± 2.27 0.14 0.89 Forbearance 69.62 ± 12.31 69.70 ± 10.96 0.09 0.93 Depression 7.31 ± 5.30 9.20 ± 5.22 4.81 0.00 Correlational analysis of forbearance and depression in male and female college students The correlations between all dimensions of forbearance as well as the total score and depression are shown in Table 3 . The results demonstrate that depression is positively correlated with repressive forbearance ( p < 0.01), and negatively correlated with both the total forbearance score and active forbearance ( p < 0.01). Among male students, depression is positively correlated with repressive forbearance ( p < 0.05), but there is no significant correlation with either the total forbearance score or active forbearance. Among female students, depression is positively correlated with repressive forbearance ( p < 0.05), and negatively correlated with both the total forbearance score and active forbearance ( p < 0.01). Table 3 Pearson correlation analysis PHQ-9 (Total) PHQ-9 (Males) PHQ-9 (Females) Repressive forbearance 0.11 ** 0.14 * 0.10 * Active forbearance -0.15 ** -0.04 -0.22 ** Forbearance -0.10 ** 0.003 -0.16 ** * p <0.05, ** p <0.01, *** p <0.001, the same below Differences in positive rates of depression among four types of forbearance in male and female college students As shown in Table 4 , there is a significant difference in the positive rate of depression among different types of forbearance in total. Specifically, rare forbearance persons show a higher positive rate of depression than tenacious forbearance persons, and repressive forbearance persons show a higher positive rate of depression than high forbearance persons and tenacious forbearance persons. Comparing different genders: among male students, rare forbearance persons have a higher positive rate of depression than rare forbearance and tenacious forbearance persons; and among female students, rare forbearance and repressive forbearance persons have a higher positive rate of depression than tenacious forbearance persons. Table 4 Chi-square test Rare forbearance type Repressive forbearance type High forbearance type Tenacious forbearance type χ² P n % n % n % n % Males Depression 14 22.6 32 45.1 3 16.7 27 24.5 12.50 0.01 No depression 48 77.4 39 54.9 15 83.3 83 75.5 Females Depression 68 49.3 79 48.5 14 33.3 53 24.0 33.87 0.00 No depression 70 50.7 84 51.5 28 66.7 168 76.0 Total Depression 82 41.0 111 47.4 17 28.3 80 24.2 37.23 0.00 No depression 118 59.0 123 52.6 43 71.7 251 75.8 Analysis of the moderating effect of gender Harman single factor test found 4 factors with eigenvalues more than 1, and the first factor explained 29.94% of the variance, suggesting that there was no serious common method bias problem in the present study. The PROCESS Macro (Model 1) was adopted to test the moderating effect of gender in the relationship between forbearance and depression. Since gender is a categorical variable, it was dummy coded (female = 0, male = 1), and all variables apart from the gender were standardized. As displayed in Table 5 , forbearance have a significant negative effect on depression ( β = -0.16, 95% CI = [-0.25, -0.08], t = -3.77, p < 0.01). And the interaction of forbearance and gender show a significant positive effect on depression ( β = 0.16, 95% CI = [0.03, 0.30], t = 2.32, p < 0.05). The simple slope analysis (Fig. 1 ) was executed to further examine the moderating effect of gender. While forbearance negatively predicted depression in females at a significant level ( β = -0.16, 95% CI = [-0.25, -0.08], t = -3.77, p < 0.01), forbearance had no effect on depression in males ( β = 0.003, 95% CI = [-0.11, 0.11], t = 0.05, p = 0.96). To further explore whether gender moderates the relationship between different dimensions of forbearance and depression, repressive and active forbearance were selected as dependent variables. The results (Table 5 ) indicate that repressive forbearance has a significant positive effect on depression ( β = 0.10, 95% CI = [0.02, 0.18], t = 2.35, p < 0.05), but the interaction between repressive forbearance and gender is not significant ( β = 0.04, 95% CI = [-0.10, 0.18], t = 0.54, p = 0.59). Active forbearance has a significant negative effect on depression ( β = -0.22, 95% CI = [-0.30, -0.14], t = -5.29, p < 0.01), and the interaction between active forbearance and gender has a significant positive effect on depression ( β = 0.19, 95% CI = [0.05, 0.33], t = 2.71, p < 0.01). The simple slope analysis (Fig. 3 ) was executed to further examine the moderating effect of gender. While active forbearance negatively predicted depression in females at a significant level ( β = -0.22, 95% CI = [-0.31, -0.14], t = -5.29, p <0.01), active forbearance had no effect on depression in males ( β = -0.03, 95% CI = [-0.14, 0.08], t = -0.60, p = 0.55). Table 5 The moderating role of gender in the relationship between forbearance and depression among college students Outcome Predictors β t 95%CI Depression Forbearance -0.16 -3.77 *** [-0.25, -0.08] Gender -0.36 -4.85 *** [-0.50, -0.21] Forbearance×Gender 0.16 2.32 * [0.03, 0.30] Depression Repressive forbearance 0.10 2.35 * [0.02, 0.18] Gender -0.36 -4.85 *** [-0.50, -0.21] Repressive forbearance×Gender 0.04 0.54 [-0.10, 0.18] Depression Active forbearance -0.22 -5.29 *** [-0.31, -0.14] Gender -0.36 -4.90 *** [-0.50, -0.21] Active forbearance×Gender 0.19 2.71 ** [0.05, 0.33] Discussion The study found no gender differences in the two dimensions of forbearance or the overall forbearance score. The reason may be that forbearance is a unique psychological trait for Chinese people, deeply in ingrained Chinese culture and widely recognized across society (Lee & Yau, 2020 ). Forbearance has a universal psychological value and transcends the differences brought by gender identity. Both boys and girls are educated from a young age that "A little impatience spoils great plans." Chinese culture educates across genders to inherit the value of forbearance. Therefore, there were no significant differences in forbearance between male and female students. At the same time, we found that female students' depression scores were significantly higher than male students, in line with previous empirical studies (Chen & Lucock, 2022 ; Kropp & Hodes, 2023 ). This could be because women have more complex neural connection patterns, higher emotional perception and response, and more activated brain areas such as the amygdala when facing negative events (Filkowski et al., 2017 ). Therefore, female college students may have more negative evaluations when facing negative events, resulting in higher depression scores than male college students. We found a significant correlation between repressive forbearance and depression in both men and women. Repressive forbearance is usually associated with negative emotion regulation strategies, such as suppressing emotional expression. However, emotional suppression is an inefficient and unhealthy regulation strategy (Brans et al., 2013 ), which hinders negative emotions from being effectively processed and released, resulting in heightened depression in male and female college students. Furthermore, active forbearance was positively correlated with depression in women, but not in men. Min et al. ( 2021 ) discovered that gender role stereotypes play a significant role in shaping the social and emotional behavior of different gender groups. Men are often expected to be strong and independent, and may be less skilled at expressing their emotions compared to women. As a result, they may be less encouraged to seek social and emotional support, which could reduce the impact of active forbearance on depression in males. Social culture often has a double standard when it comes to impulsivity. Male impulsiveness is often accepted and even seen as part of their identity, while women who exhibit impulsive behavior are often met with social pressure and negative feedback (Chapple & Johnson, 2007 ), which increases their psychological stress and negative emotions. In addition, emotion-related impulsivity can exacerbate depression when dealing with stress (Johnson et al., 2022 ), which is more prevalent among women (Clark, 2005 ). Therefore, among females, the positive rate of depression among rare forbearance persons was significantly higher than that among tenacious forbearance persons, but this phenomenon did not exist among males. When discussing the moderating role of gender on the relationship between forbearance and depression, we found that increased levels of forbearance could reduce the level of depression in female students but not in male students. Further analysis revealed this phenomenon exists in the relationship between active forbearance and depression, but not between repressive forbearance and depression. That is, there is a gender difference in the effect of active forbearance on depression, but no gender difference in the effect of repressive forbearance on depression. The reasons for this might be that women tend to have higher punishment sensitivity and negative affectivity susceptibility (Cross et al., 2011 ), and active forbearance can help them cope with and mitigate the adverse effects of negative events, thereby reducing depression levels. In addition, Graves et al. ( 2021 ) revealed females use more emotion-centered coping strategies. When facing troubles, females are more likely to confide to get support. By seeking help from others to solve the problems they face, which reduces the accumulation of negative emotions and stress. However, males are more likely to suppress their emotions when confronted with stress (Berke et al., 2017 ). They are not adept at using active forbearance strategies to deal with problems. Therefore, it seems more difficult for males to adjust their original attitudes and emotional responses. Furthermore, there may be differences in other factors between male and female students, leading to gender differences in the predictive effect of forbearance on depression. Wei et al. ( 2012 ) discovered that the relationship between forbearance and depression symptoms is not always consistent in exploring previous research. They thought that other underlying factors such as social support could moderate the relationship between forbearance and depression. Forbearance can be an effective coping strategy when people in an individual's support system realize they are under stress and need support. In contrast, males are able to get less social support from the outside world than females (Alsubaie et al., 2019 ; Li et al., 2022 ), so women are more likely to receive emotional and psychological relief when facing negative events, thereby reducing stress and relieving depression, making active forbearance more effective in them. In conclusion, psychological health interventions and depression treatment should consider possible gender differences. For instance, for female students, interventions aimed at increasing their active forbearance levels can be designed and implemented, and universities should highlight the training and cultivation of their active forbearance psychological qualities in the education process of female students' mental health. Male students may exhibit distinct psychological responses during depression intervention. Seeking other mental health intervention methods, such as encouraging males to express themselves and increasing communication with others to broaden their social support may be more meaningful. Our study has some limitations. Firstly, the study was s cross-section research, and we cannot infer the causality of the variables. Secondly, since the subjects selected in this study were mainly college students, it is not clear whether the results can be well generalized to other groups. Future research could design a longitudinal study, and investigate a wider range of subjects. Moreover, this study only focused on gender differences, and future research could further explore the mechanisms by which other factors play a role between forbearance and depression. Conclusions There were some differences in the positive rates of depression among male and female college students across four types of forbearance, which may be attributed to societal and cultural expectations. In addition, despite the lack of significant differences in the psychological performance of forbearance between male and female college students, the relationship between forbearance and depression was still moderated by gender, and women with higher levels of forbearance were more likely to alleviate their depression. Declarations Author Contribution Study conception and data analysis were performed by Wangrong Zhang. Validation was conducted by Xia Lv and Rong Xiao. Data collection and funding acquisition were performed by Rong Xiao. The first draft of the manuscript was written by Wangrong Zhang and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript. Acknowledgement We would like to thank all the individuals who participated in the study. Data Availability Data will be made available on reasonable request from the corresponding author. References Aghababaei, N., & Tabik, M. T. (2015). 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Depression, anxiety, stress and their associated factors among Ethiopian University students during an early stage of COVID-19 pandemic: An online-based cross-sectional survey. PLOS ONE , 16 (5), e0251670. https://doi.org/10.1371/journal.pone.0251670 Wei, M., Liao, K. Y.-H., Heppner, P. P., Chao, R. C.-L., & Ku, T.-Y. (2012). Forbearance coping, identification with heritage culture, acculturative stress, and psychological distress among Chinese international students. Journal of Counseling Psychology , 59 (1), 97–106. https://doi.org/10.1037/a0025473 Xu, W., Yang, G., Zhu, M., Chen, J., & Li, W. (2019). Effect of psychological resilience on creativity: The mediating of cognitive flexibility. China Journal of Health Psychology , 27 (12), 1885–1890. https://doi.org/10.13342/j.cnki.cjhp.2019.12.034 Xuan, L., Hua, S., Lin, L., & Jianli, Y. (2023). Gender differences in the predictive effect of depression and aggression on suicide risk among first-year college students. Journal of Affective Disorders , 327 , 1–6. https://doi.org/10.1016/j.jad.2023.01.123 Yu, X. (2020). The Development and Preliminary Application of the Patience Scale (in Chinese). Masters. Southern Medical University. https://kns.cnki.net/kcms2/article/abstract?v=S5uBaE2M3OdryoXSpoU8vntJdJjV12rgAflVCqQISKoK4etkYJTK9BLPYChwPPg1Xi4AJQGXJHTntXLs AyxFsLElLRMdUSmuzkA9DSWFv1w26MsB_M0hCQ==&uniplatform=NZKPT&language=gb Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4338140","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":296372262,"identity":"d9d729d0-da00-400e-8bf6-27ed6b8eed57","order_by":0,"name":"Wangrong Zhang","email":"","orcid":"","institution":"Southern Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wangrong","middleName":"","lastName":"Zhang","suffix":""},{"id":296372266,"identity":"4435e075-712d-40a5-9ebf-50d3fc722957","order_by":1,"name":"Xia Lv","email":"","orcid":"","institution":"Southern Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Lv","suffix":""},{"id":296372267,"identity":"5db92026-daa1-45b6-abbe-e98e1639687f","order_by":2,"name":"Rong Xiao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAnUlEQVRIiWNgGAWjYFAC5gMQ+gDxWtgSSNbCY0CiFoPbZz5/utnGIMd3I4HxcwExWiT7crdJ57YxGEveSGCWnkGMFn4e3m3MQC2JG24ksDHzEKOFjYfn8WeglnritfDz8DCAHJZgQLQWyR42M+mccxKGM888bJYmSovBGebHn3PKbOT5jicf/EyUFiiQAGLGBhI0jIJRMApGwSjACwDVtCpUgQukTwAAAABJRU5ErkJggg==","orcid":"","institution":"Southern Medical University","correspondingAuthor":true,"prefix":"","firstName":"Rong","middleName":"","lastName":"Xiao","suffix":""}],"badges":[],"createdAt":"2024-04-28 13:40:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4338140/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4338140/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56024653,"identity":"f90c8193-000b-42e2-a091-1f27f00f89f1","added_by":"auto","created_at":"2024-05-07 16:52:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47862,"visible":true,"origin":"","legend":"\u003cp\u003eInteraction of gender and forbearance on depression.\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4338140/v1/8aee34887185ed95d857c77e.jpg"},{"id":56023768,"identity":"4781c4d7-6873-4867-9144-6aefa2e9e1a2","added_by":"auto","created_at":"2024-05-07 16:44:37","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55071,"visible":true,"origin":"","legend":"\u003cp\u003eInteraction of gender and repressive forbearance on depression.\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4338140/v1/852b7202fa03b106af337865.jpg"},{"id":56023767,"identity":"fbccd288-46ee-4ccb-a460-b22fe7b2aeec","added_by":"auto","created_at":"2024-05-07 16:44:37","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52850,"visible":true,"origin":"","legend":"\u003cp\u003eInteraction of gender and active forbearance on depression.\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4338140/v1/41ca2fca25bc87e0b9f4c0ee.jpg"},{"id":66758233,"identity":"46454ba2-81e9-41ae-be9b-424f1105f0f3","added_by":"auto","created_at":"2024-10-16 08:32:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":809649,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4338140/v1/924d671b-a1d5-4056-88f7-572a90fdb65a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gender differences in the relationship between forbearance and depression among college students — a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDepression is a common mental disorder in college students (Ibrahim et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). College students face multiple pressures, such as academic challenges, employment concerns, and interpersonal barriers, while also being in a phase of adolescence or early adulthood when psychological development is not yet mature, making them a population with a high incidence of depression (Gao et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Liu et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). A study from China found that the incidence of depression among Chinese adolescents has reached 32.2% (Quan et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and the global prevalence of depression among college students is roughly 33.6% (Li et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). College students with depression often experience issues such as sleep disorders (Shi et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and cognitive deficits (Rock et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), leading to their academic failure and higher risk of suicide. Therefore, it is crucial to thoroughly investigate the factors and mechanisms influencing depression in college students to promote their healthy psychological and physical development.\u003c/p\u003e \u003cp\u003eAccording to the diathesis-stress model, depression arises from the interaction between intrinsic personal traits and external environmental stressors (Li et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Forbearance, as an inner personal quality, refers to the psychological trait that enables one to withstand temptations, cope with setbacks and stress, temporarily tolerate discomfort or humiliation for long-term benefits and objectives, avoid conflict and confrontation, and thereby regulate emotions, attitudes, and behavior (Yu, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In traditional Chinese culture, forbearance has long been regarded as a valuable tool for resolving conflicts. Forbearance can help shift negative cognition and emotion, functioning as a positive psychological quality (Deng et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Mehmood et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In addition, forbearance also serves as a positive psychological resource that enables individuals to cope with potential conflicts and difficulties (G\u0026uuml;ss et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), which is critical for reducing the occurrence and relieving symptoms of depression (Aghababaei \u0026amp; Tabik, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, although forbearance has a positive effect on mental health, some studies believe that forbearance is repressive, and indiscriminate forbearance may exacerbate individual psychological stress and have adverse effects on the development of mental health (Mary Jo Coiro \u0026amp; Compas, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Block (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1996\u003c/span\u003e) also found people with an extremely strong ability to delay gratification may suffer some negative effects. Furthermore, forbearance may be accompanied by emotional avoidance and repression in certain situations, which may maintain distress and could have other adverse consequences (Richards \u0026amp; Gross, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1999\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly studies have explored gender differences in the incidence of depression, with some studies pointing to a trend where female college students exhibit higher levels of depression than their male counterparts (Edlund et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Simegn et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), while others suggested the opposite (Xuan et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Research on forbearance also revealed gender disparities (Deng \u0026amp; Xiao, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Further studies found that women possess greater resilience when dealing with emotional pain and psychological stress (Xu et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), exhibiting more flexibility in emotion regulation and processing (Goubet \u0026amp; Chrysikou, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), which suggests their psychological forbearance may be more advantageous compared to men. Do these gender differences in the forbearance prevail universally? As an inner psychological quality, can forbearance influence the onset and manifestation of depression differently depending on gender? Addressing these questions is of vital importance for a more precise approach to the prevention and treatment of depression.\u003c/p\u003e \u003cp\u003eUp to now, few studies have explored how gender influences the relationship between forbearance and depression. Therefore, the objective of this study was to explore the gender differences in the relationship between forbearance and depression among college students.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e This study was conducted following the Declaration of Helsinki and was approved by the ethic committee of Southern Medical University. All participants got a detailed explanation before participating in the study. Informed consent was obtained from each participant. This study utilized a snowball sampling approach for convenience, utilizing the Questionnaire Star online platform to invite college students to participate. A total of 1079 questionnaires were collected. After review, questionnaires from those who appeared not to have answered seriously were excluded (including those with a completion time of less than 420 seconds, careless entries in personal information, characteristics not matching a typical college student such as an age entry of 50 years, etc.), resulting in 825 valid questionnaires. The validity rate of the returned questionnaires was 76.5%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eForbearance\u003c/h2\u003e \u003cp\u003eForbearance was measured by the Forbearance Scale (Yu, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The scale came from a Chinese master's thesis and undergone rigorous validation with a good reliability (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.87, split-half reliability\u0026thinsp;=\u0026thinsp;0.84, test-retest reliability\u0026thinsp;=\u0026thinsp;0.80) and validity (χ\u003csup\u003e2\u003c/sup\u003e/df\u0026thinsp;=\u0026thinsp;3.58, GFI\u0026thinsp;=\u0026thinsp;0.98, CFI\u0026thinsp;=\u0026thinsp;0.98, TLI\u0026thinsp;=\u0026thinsp;0.96, RMSEA\u0026thinsp;=\u0026thinsp;0.03). The 20-item tool measured five factors (repression, self-restraint, patience and calm, delaying gratification, and positive cognition) of forbearance on a 5-point Likert scale, where 1\u0026thinsp;=\u0026thinsp;very uncharacteristic and 5\u0026thinsp;=\u0026thinsp;very characteristic. All items were positively scored. The five factors were summarized into two dimensions: repressive forbearance (containing repression factor) and active forbearance (including self-restraint, patience and calm, delaying gratification, and positive cognition factors). Individuals' psychological forbearance was categorized into four types based on their scores across factors and dimensions: high forbearance type, tenacious forbearance type, rare forbearance type, and repressive forbearance type. For the high forbearance type, the average score of all five factors was \u0026ge;\u0026thinsp;4; for the rare forbearance type, the patience and calm factor score was \u0026le;\u0026thinsp;3, and the average score of the other four factors was \u0026lt;\u0026thinsp;4. Excluding those classified as high or rare forbearance type, individuals with a higher average score in the dimension of repressive forbearance than in active forbearance were categorized as repressive forbearance type, while the rest were tenacious forbearance type. In this study, the scale's Cronbach's alpha was 0.93.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eDepression\u003c/h2\u003e \u003cp\u003eThe 9-item Patient Health Questionnaire (PHQ-9) developed by Kroenke et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) was used to measure depression. The scale contained 9 items to measure depression in a 4-point Likert scale, with 0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;several days, 2\u0026thinsp;=\u0026thinsp;more than half the days, 3\u0026thinsp;=\u0026thinsp;nearly every day (over the last month). A score of 0\u0026ndash;4 indicated no depression, 5\u0026ndash;9 mild depression, 10\u0026ndash;14 moderate depression, and a score of 15 or above severe depression. The scale's Cronbach's alpha in this study was 0.90.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIn the study, IBM SPSS 26.0 was used to perform statistical analysis. First, a t-test and chi-square test were used to test gender differences in forbearance and depression. In addition, person correlation analysis was performed for all the study variables. Finally, the moderating role of gender in the relationship between forbearance and depression was performed via the PROCESS Macro (Model 1) based on the bias-corrected percentile bootstrap method (Bootstrap\u0026thinsp;=\u0026thinsp;5000, 95% CI).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePreliminary analyses\u003c/h2\u003e \u003cp\u003eThe participants included 261 males (31.6%) and 564 females (68.4%) aged 16\u0026ndash;24 years (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19.54, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.15). Among them, freshmen accounted for 151 (18.3%) and there were 134 individuals lived in rural areas (16.2%). Other demographic variables of participants are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of study participants (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;825)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eN/Mean\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e%/(SD)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFreshman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSophomore\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFifth-year and others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounty towns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall to mid-sized cities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarge cities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSeverity of depression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eGender differences in college students' forbearance and depression\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, female students show significantly higher depression scores than male students (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.81, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). But there is no significant difference between male and female students in the two dimensions of forbearance or the total forbearance score (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eT-test for gender differences in forbearance and depression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMales (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;261)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemales (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;564)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepressive forbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive forbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.62\u0026thinsp;\u0026plusmn;\u0026thinsp;12.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.70\u0026thinsp;\u0026plusmn;\u0026thinsp;10.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCorrelational analysis of forbearance and depression in male and female college students\u003c/h2\u003e \u003cp\u003eThe correlations between all dimensions of forbearance as well as the total score and depression are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The results demonstrate that depression is positively correlated with repressive forbearance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and negatively correlated with both the total forbearance score and active forbearance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Among male students, depression is positively correlated with repressive forbearance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but there is no significant correlation with either the total forbearance score or active forbearance. Among female students, depression is positively correlated with repressive forbearance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and negatively correlated with both the total forbearance score and active forbearance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePHQ-9 (Total)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePHQ-9 (Males)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9 (Females)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepressive forbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.11\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive forbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.15\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.22\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.10\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.16\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, \u003csup\u003e***\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, the same below\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDifferences in positive rates of depression among four types of forbearance in male and female college students\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, there is a significant difference in the positive rate of depression among different types of forbearance in total. Specifically, rare forbearance persons show a higher positive rate of depression than tenacious forbearance persons, and repressive forbearance persons show a higher positive rate of depression than high forbearance persons and tenacious forbearance persons. Comparing different genders: among male students, rare forbearance persons have a higher positive rate of depression than rare forbearance and tenacious forbearance persons; and among female students, rare forbearance and repressive forbearance persons have a higher positive rate of depression than tenacious forbearance persons.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-square test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRare forbearance type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eRepressive forbearance type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eHigh forbearance type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eTenacious forbearance type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eχ\u0026sup2;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e75.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e33.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e76.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e37.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e71.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e75.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of the moderating effect of gender\u003c/h2\u003e \u003cp\u003eHarman single factor test found 4 factors with eigenvalues more than 1, and the first factor explained 29.94% of the variance, suggesting that there was no serious common method bias problem in the present study. The PROCESS Macro (Model 1) was adopted to test the moderating effect of gender in the relationship between forbearance and depression. Since gender is a categorical variable, it was dummy coded (female\u0026thinsp;=\u0026thinsp;0, male\u0026thinsp;=\u0026thinsp;1), and all variables apart from the gender were standardized. As displayed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, forbearance have a significant negative effect on depression (\u003cem\u003eβ\u003c/em\u003e = -0.16, 95% CI = [-0.25, -0.08], \u003cem\u003et\u003c/em\u003e = -3.77, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). And the interaction of forbearance and gender show a significant positive effect on depression (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.16, 95% CI = [0.03, 0.30], \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.32, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The simple slope analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was executed to further examine the moderating effect of gender. While forbearance negatively predicted depression in females at a significant level (\u003cem\u003eβ\u003c/em\u003e = -0.16, 95% CI = [-0.25, -0.08], \u003cem\u003et\u003c/em\u003e = -3.77, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), forbearance had no effect on depression in males (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003, 95% CI = [-0.11, 0.11], \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.96).\u003c/p\u003e \u003cp\u003eTo further explore whether gender moderates the relationship between different dimensions of forbearance and depression, repressive and active forbearance were selected as dependent variables. The results (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) indicate that repressive forbearance has a significant positive effect on depression (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.10, 95% CI = [0.02, 0.18], \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.35, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but the interaction between repressive forbearance and gender is not significant (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04, 95% CI = [-0.10, 0.18], \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.54, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.59). Active forbearance has a significant negative effect on depression (\u003cem\u003eβ\u003c/em\u003e = -0.22, 95% CI = [-0.30, -0.14], \u003cem\u003et\u003c/em\u003e = -5.29, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and the interaction between active forbearance and gender has a significant positive effect on depression (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.19, 95% CI = [0.05, 0.33], \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.71, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The simple slope analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) was executed to further examine the moderating effect of gender. While active forbearance negatively predicted depression in females at a significant level (\u003cem\u003eβ\u003c/em\u003e = -0.22, 95% CI = [-0.31, -0.14], \u003cem\u003et\u003c/em\u003e = -5.29, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01), active forbearance had no effect on depression in males (\u003cem\u003eβ\u003c/em\u003e = -0.03, 95% CI = [-0.14, 0.08], \u003cem\u003et\u003c/em\u003e = -0.60, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.55).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe moderating role of gender in the relationship between forbearance and depression among college students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePredictors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.77\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[-0.25, -0.08]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.85\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[-0.50, -0.21]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForbearance\u0026times;Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.32\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[0.03, 0.30]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepressive forbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.35\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[0.02, 0.18]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.85\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[-0.50, -0.21]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepressive forbearance\u0026times;Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[-0.10, 0.18]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActive forbearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.29\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[-0.31, -0.14]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.90\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[-0.50, -0.21]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActive forbearance\u0026times;Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.71\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[0.05, 0.33]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study found no gender differences in the two dimensions of forbearance or the overall forbearance score. The reason may be that forbearance is a unique psychological trait for Chinese people, deeply in ingrained Chinese culture and widely recognized across society (Lee \u0026amp; Yau, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Forbearance has a universal psychological value and transcends the differences brought by gender identity. Both boys and girls are educated from a young age that \"A little impatience spoils great plans.\" Chinese culture educates across genders to inherit the value of forbearance. Therefore, there were no significant differences in forbearance between male and female students. At the same time, we found that female students' depression scores were significantly higher than male students, in line with previous empirical studies (Chen \u0026amp; Lucock, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Kropp \u0026amp; Hodes, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This could be because women have more complex neural connection patterns, higher emotional perception and response, and more activated brain areas such as the amygdala when facing negative events (Filkowski et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Therefore, female college students may have more negative evaluations when facing negative events, resulting in higher depression scores than male college students.\u003c/p\u003e \u003cp\u003eWe found a significant correlation between repressive forbearance and depression in both men and women. Repressive forbearance is usually associated with negative emotion regulation strategies, such as suppressing emotional expression. However, emotional suppression is an inefficient and unhealthy regulation strategy (Brans et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), which hinders negative emotions from being effectively processed and released, resulting in heightened depression in male and female college students. Furthermore, active forbearance was positively correlated with depression in women, but not in men. Min et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) discovered that gender role stereotypes play a significant role in shaping the social and emotional behavior of different gender groups. Men are often expected to be strong and independent, and may be less skilled at expressing their emotions compared to women. As a result, they may be less encouraged to seek social and emotional support, which could reduce the impact of active forbearance on depression in males.\u003c/p\u003e \u003cp\u003eSocial culture often has a double standard when it comes to impulsivity. Male impulsiveness is often accepted and even seen as part of their identity, while women who exhibit impulsive behavior are often met with social pressure and negative feedback (Chapple \u0026amp; Johnson, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), which increases their psychological stress and negative emotions. In addition, emotion-related impulsivity can exacerbate depression when dealing with stress (Johnson et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), which is more prevalent among women (Clark, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Therefore, among females, the positive rate of depression among rare forbearance persons was significantly higher than that among tenacious forbearance persons, but this phenomenon did not exist among males.\u003c/p\u003e \u003cp\u003eWhen discussing the moderating role of gender on the relationship between forbearance and depression, we found that increased levels of forbearance could reduce the level of depression in female students but not in male students. Further analysis revealed this phenomenon exists in the relationship between active forbearance and depression, but not between repressive forbearance and depression. That is, there is a gender difference in the effect of active forbearance on depression, but no gender difference in the effect of repressive forbearance on depression. The reasons for this might be that women tend to have higher punishment sensitivity and negative affectivity susceptibility (Cross et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), and active forbearance can help them cope with and mitigate the adverse effects of negative events, thereby reducing depression levels. In addition, Graves et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) revealed females use more emotion-centered coping strategies. When facing troubles, females are more likely to confide to get support. By seeking help from others to solve the problems they face, which reduces the accumulation of negative emotions and stress. However, males are more likely to suppress their emotions when confronted with stress (Berke et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). They are not adept at using active forbearance strategies to deal with problems. Therefore, it seems more difficult for males to adjust their original attitudes and emotional responses. Furthermore, there may be differences in other factors between male and female students, leading to gender differences in the predictive effect of forbearance on depression. Wei et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) discovered that the relationship between forbearance and depression symptoms is not always consistent in exploring previous research. They thought that other underlying factors such as social support could moderate the relationship between forbearance and depression. Forbearance can be an effective coping strategy when people in an individual's support system realize they are under stress and need support. In contrast, males are able to get less social support from the outside world than females (Alsubaie et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), so women are more likely to receive emotional and psychological relief when facing negative events, thereby reducing stress and relieving depression, making active forbearance more effective in them.\u003c/p\u003e \u003cp\u003eIn conclusion, psychological health interventions and depression treatment should consider possible gender differences. For instance, for female students, interventions aimed at increasing their active forbearance levels can be designed and implemented, and universities should highlight the training and cultivation of their active forbearance psychological qualities in the education process of female students' mental health. Male students may exhibit distinct psychological responses during depression intervention. Seeking other mental health intervention methods, such as encouraging males to express themselves and increasing communication with others to broaden their social support may be more meaningful.\u003c/p\u003e \u003cp\u003eOur study has some limitations. Firstly, the study was s cross-section research, and we cannot infer the causality of the variables. Secondly, since the subjects selected in this study were mainly college students, it is not clear whether the results can be well generalized to other groups. Future research could design a longitudinal study, and investigate a wider range of subjects. Moreover, this study only focused on gender differences, and future research could further explore the mechanisms by which other factors play a role between forbearance and depression.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThere were some differences in the positive rates of depression among male and female college students across four types of forbearance, which may be attributed to societal and cultural expectations. In addition, despite the lack of significant differences in the psychological performance of forbearance between male and female college students, the relationship between forbearance and depression was still moderated by gender, and women with higher levels of forbearance were more likely to alleviate their depression.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eStudy conception and data analysis were performed by Wangrong Zhang. Validation was conducted by Xia Lv and Rong Xiao. Data collection and funding acquisition were performed by Rong Xiao. The first draft of the manuscript was written by Wangrong Zhang and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank all the individuals who participated in the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData will be made available on reasonable request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAghababaei, N., \u0026amp; Tabik, M. T. (2015). Patience and Mental Health in Iranian Students. \u003cem\u003eIranian Journal of Psychiatry and Behavioral Sciences\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(3), e1252. https://doi.org/10.17795/ijpbs-1252\u003c/li\u003e\n \u003cli\u003eAlsubaie, M. M., Stain, H. 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College students coping with interpersonal stress: Examining a control-based model of coping. \u003cem\u003eJournal of American College Health\u003c/em\u003e, \u003cem\u003e65\u003c/em\u003e(3), 177\u0026ndash;186. https://doi.org/10.1080/07448481.2016.1266641\u003c/li\u003e\n \u003cli\u003eMehmood, A., Hanif, R., \u0026amp; Noureen, I. (2021). Influence of Trait-Patience in Goal Pursuit and Subjective Well-Being Among University Students. \u003cem\u003ePakistan Journal of Psychological Research\u003c/em\u003e, \u003cem\u003e35\u003c/em\u003e(4), 707\u0026ndash;723. https://doi.org/10.33824/PJPR.2020.35.4.38\u003c/li\u003e\n \u003cli\u003eMin, M. C., Islam, M. N., Wang, L., \u0026amp; Takai, J. (2021). Cross-cultural comparison of university students\u0026rsquo; emotional competence in Asia. \u003cem\u003eCurrent Psychology\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(1), 200\u0026ndash;212. https://doi.org/10.1007/s12144-018-9918-3\u003c/li\u003e\n \u003cli\u003eQuan, L., Lu, W., Zhen, R., \u0026amp; Zhou, X. (2023). Post-traumatic stress disorders, anxiety, and depression in college students during the COVID-19 pandemic: A cross-sectional study. \u003cem\u003eBMC Psychiatry\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1), 228. https://doi.org/10.1186/s12888-023-04660-9\u003c/li\u003e\n \u003cli\u003eRichards, J. M., \u0026amp; Gross, J. J. (1999). Composure at any cost? The cognitive consequences of emotion suppression. In \u003cem\u003ePersonality and Social Psychology Bulletin\u003c/em\u003e (Vol. 25, Issue 8, pp. 1033\u0026ndash;1044). https://doi.org/10.1177/01461672992511010\u003c/li\u003e\n \u003cli\u003eRock, P. L., Roiser, J. P., Riedel, W. J., \u0026amp; Blackwell, A. D. (2014). Cognitive impairment in depression: A systematic review and meta-analysis. \u003cem\u003ePsychological Medicine\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(10), 2029\u0026ndash;2040. https://doi.org/10.1017/S0033291713002535\u003c/li\u003e\n \u003cli\u003eShi, C., Wang, S., Tang, Q., Liu, X., \u0026amp; Li, Y. (2022). Cross-lagged relationship between anxiety, depression, and sleep disturbance among college students during and after collective isolation. \u003cem\u003eFrontiers in Public Health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e, 1038862. https://doi.org/10.3389/fpubh.2022.1038862\u003c/li\u003e\n \u003cli\u003eSimegn, W., Dagnew, B., Yeshaw, Y., Yitayih, S., Woldegerima, B., \u0026amp; Dagne, H. (2021). 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Effect of psychological resilience on creativity: The mediating of cognitive flexibility. \u003cem\u003eChina Journal of Health Psychology\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(12), 1885\u0026ndash;1890. https://doi.org/10.13342/j.cnki.cjhp.2019.12.034\u003c/li\u003e\n \u003cli\u003eXuan, L., Hua, S., Lin, L., \u0026amp; Jianli, Y. (2023). Gender differences in the predictive effect of depression and aggression on suicide risk among first-year college students. \u003cem\u003eJournal of Affective Disorders\u003c/em\u003e, \u003cem\u003e327\u003c/em\u003e, 1\u0026ndash;6. https://doi.org/10.1016/j.jad.2023.01.123\u003c/li\u003e\n \u003cli\u003eYu, X. (2020). The Development and Preliminary Application of the Patience Scale (in Chinese). Masters. Southern Medical University. https://kns.cnki.net/kcms2/article/abstract?v=S5uBaE2M3OdryoXSpoU8vntJdJjV12rgAflVCqQISKoK4etkYJTK9BLPYChwPPg1Xi4AJQGXJHTntXLs\u003cbr\u003eAyxFsLElLRMdUSmuzkA9DSWFv1w26MsB_M0hCQ==\u0026amp;uniplatform=NZKPT\u0026amp;language=gb\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Forbearance, Depression, Gender differences, College students","lastPublishedDoi":"10.21203/rs.3.rs-4338140/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4338140/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCollege students are at a high risk of depression, and forbearance might be a critical resource to help college students alleviate depression. However, forbearance exhibits heterogeneity, with people displaying distinct styles of forbearance in coping with stress. Furthermore, gender differences in the relationship between forbearance and depression have not been investigated. Thus, the study aims to comprehensively explore gender differences in the relationship between forbearance and depression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Data were collected from 825 Chinese college students. We assessed their forbearance using the Forbearance Scale (FS) and evaluated their depression using the 9-item Patient Health Questionnaire (PHQ-9). A moderated model was used to explore the effect of gender in the relationship between forbearance and depression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Active forbearance (\u003cem\u003eb\u003c/em\u003e = -0.22, \u003cem\u003et\u003c/em\u003e = -5.29, \u003cem\u003ep\u003c/em\u003e ＜0.01) had a negative predictive effect on depression in college students, while repressive forbearance (\u003cem\u003eb\u003c/em\u003e = 0.10, \u003cem\u003et \u003c/em\u003e= 2.35, \u003cem\u003ep\u003c/em\u003e ＜ 0.05) had a positive predictive effect on depression. The interaction term of active forbearance and gender was a significant predictor of depression (\u003cem\u003eb\u003c/em\u003e = 0.19, \u003cem\u003et \u003c/em\u003e= 2.71, \u003cem\u003ep \u003c/em\u003e＜0.01), and active forbearance negatively predicted depression in females at a significant level (\u003cem\u003eb \u003c/em\u003e= -0.22, \u003cem\u003et\u003c/em\u003e = -5.29, \u003cem\u003ep\u003c/em\u003e＜0.01), but not in males (\u003cem\u003eb \u003c/em\u003e= -0.03, \u003cem\u003et\u003c/em\u003e = -0.60, \u003cem\u003ep \u003c/em\u003e= 0.55). The interaction term of repressive forbearance and gender was not a significant predictor of depression (\u003cem\u003eb\u003c/em\u003e = 0.04, \u003cem\u003et \u003c/em\u003e= 0.54, \u003cem\u003ep\u003c/em\u003e = 0.59).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The impact of active forbearance on depression was modulated by gender. When utilizing forbearance for psychological health interventions, relevant personnel should consider the heterogeneity of forbearance and potential gender differences to enhance the effectiveness of interventions.\u003c/p\u003e","manuscriptTitle":"Gender differences in the relationship between forbearance and depression among college students — a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 16:44:32","doi":"10.21203/rs.3.rs-4338140/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"054f3b31-29fb-49b7-a121-facd74f5e70e","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-16T08:23:54+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-07 16:44:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4338140","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4338140","identity":"rs-4338140","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}