Background: The intersection of aging and disability is an important social issue. The rehabilitation system of older adults with disabilities is a complex social system including various social units. This study aims to investigate the impact of the “inclusion of rehabilitation services in basic medical insurance” (IRSMI) policy on the utilization of rehabilitation services and annual household healthcare expenditure among older adults with disabilities. Methods: Using the data of China Disabled Persons’ Condition Monitoring Survey (2009–2012), this study employed the difference-in-differences method to analyze the impact of IRSMI on rehabilitation services utilization and household healthcare expenditure, and further examined the differential effects of the policy on service utilization across subpopulations with different demographic characteristics, including gender, age, and disability severity. The Heckman two-stage model corrects for sample selection bias caused by the share of households with zero health expenditures. Event-study specification was applied to assess the validity of the parallel trends assumption in the DID framework. Baron & Kenny’s three-step method was used to explore the potential mediating mechanism. Results: (1) IRSMI significantly increased the likelihood of utilizing rehabilitation services among older adults with disabilities (OR = 1.349), but this kind of promotive effect mainly focus on males (OR = 1.530), middle-aged and older disabled individuals (OR = 1.423), and those with mild disabilities (OR = 1.444). (2) The implementation of IRSMI contributed to an approximately 20.3% increase in annual healthcare expenditures for households with older adults with disabilities ($\beta$ = 0.185). (3) IRSMI significantly promoted the increase in household healthcare expenditures for high-income older adults with disabilities ($\beta$ = 0.181), but had limited impact on low- and middle-income groups. (4) Rehabilitation services utilization played a mediating role in the relationship between IRSMI and household healthcare expenditure, with about 19.0% of the increase in annual household healthcare expenditures attributable to the enhanced utilization of rehabilitation services. Conclusions: In the complex social system of rehabilitation for older adults with disabilities, the IRSMI policy significantly increases the likelihood of rehabilitation services utilization and substantially raises annual household healthcare expenditures. However, the heterogeneous effects across gender, age, disability severity, and income levels reflect structural inequities embedded in the rehabilitation system, underscoring the need for adaptive and equity-oriented interventions.

Improving the health-related quality of life of individuals with chronic diseases is a key goal in chronic disease management. However, limited research has examined how personality traits influence health-related quality of life in this population. This study aimed to develop a unified model to investigate the mediating roles of self-efficacy and medication adherence in the relationship between personality traits and health-related quality of life among middle-aged and older adults with chronic diseases. Data were obtained from the 2021 Psychology and Behavior Investigation of Chinese Residents (PBICR), a multi-center, cross-sectional survey conducted in 120 cities across 22 provinces in China. The final analytic sample included 1,037 patients aged 45 and older who had been diagnosed with chronic diseases and were on medication. Standardized instruments were used to measure Big Five personality traits (10-item Big Five Inventory, BFI-10), self-efficacy (General Self-Efficacy Scale, GSES), medication adherence (Medication Adherence Report Scale, MARS), and health-related quality of life (EuroQol 5-Dimension 5-Level questionnaire, EQ-5D-5 L). Structural equation modeling (SEM) was used to test the serial mediating roles of self-efficacy and medication adherence in the association between personality traits and health-related quality of life. The findings indicated that several personality traits, particularly Conscientiousness, Extraversion, and Neuroticism, were significantly associated with health-related quality of life. Self-efficacy and medication adherence sequentially mediated the relationship between personality traits and health-related quality of life. The proposed structural equation modeling showed good model fit (CFI = 0.996; RMSEA = 0.002), and the indirect effects were statistically significant based on bootstrapping results. This study advances understanding of the associations between personality traits and health-related quality of life in chronically ill middle-aged and older adults. By identifying self-efficacy and medication adherence as sequential mediators, the findings offer theoretical and practical insights for designing personalized behavioral interventions to improve health-related quality of life in this population.

As the social environment evolves, adolescents face increasing exposure to violence and psychological stress. Adolescent violence is a global public health issue that not only severely impacts their mental health but also profoundly affects their long-term well-being. Fewer studies have explored the mediating role of health-risk behaviors in the association between violence and depressive symptoms among adolescents, particularly the moderating effect of family health. Using cross-sectional data from the 2021 Psychological and Behavioral Investigation of Chinese Residents (PBICR) involving 1065 adolescents aged 12-18, results showed: Violence exposure significantly predicted elevated depressive symptoms, with 42.9% of this association mediated by health-risk behaviors. Family health moderated these relationships, significantly attenuating the impacts of violence on both health-risk behaviors and depressive symptoms. Higher family health levels correlated with reduced engagement in maladaptive coping strategies and lower depression severity. The study emphasized family health's dual role in buffering psychological trauma and reducing risk behaviors, proposing practical pathways to alleviate depression associated with violence exposure through interventions targeting health-risk behaviors and strengthening family support systems. Policy recommendations included advancing family mental health service systems under the Healthy China 2030 initiative.