Distinct roles of specific metacognitive beliefs in adolescent problematic mobile phone use: A Cross-Lagged panel network analysis

Problematic mobile phone use (PMPU) among adolescents is increasingly recognized as a significant behavioral health concern. Previous studies have found general metacognitive beliefs can positively predict PMPU. However, the longitudinal relationship between specific metacognitive beliefs and addictive behaviors has not been fully explored. This study aimed to explore the longitudinal relationship between metacognitions about mobile phone use, metacognitions about desire thinking, and PMPU among adolescents using cross-lagged panel network analysis. A sample of 993 adolescents were surveyed at two points over six months. Findings indicated that negative metacognitions about mobile phone use and positive metacognitions about desire thinking emerged as two prominent bridge nodes. Negative metacognitions about mobile phone use were strongly associated with withdrawal and relapse symptoms, while positive metacognitions about desire thinking correlated with tolerance and relapse. These results suggest that interventions aimed at addressing PMPU should consider the distinct impacts of different metacognitive beliefs and tailor their approaches accordingly.

Evaluating Problematic Smartphone Use Among Chinese Primary School Students Using SABAS: An IRT and Network Analysis

OBJECTIVES

This study assessed the psychometric properties of the Smartphone Application-Based Addiction Scale (SABAS) among Chinese primary school students, focusing on validity, reliability, and factor structure using Item Response Theory (IRT) and Network Analysis (NA).

METHODS

Data were collected from 1108 primary school students in China (52.98% female; ages 7-14 years; M = 10.58, SD = 0.99). SABAS was assessed using Item Response Theory (IRT) for factor structure, item parameters, cut-off scores, and reliability, while Differential Item Functioning (DIF) detected gender biases. Network Analysis (NA) examined the interrelationships among SABAS items.

RESULTS

Confirmatory factor analysis supported SABAS's unidimensional structure (RMSEA = 0.055, CFI = 0.984, TLI = 0.973, SRMR = 0.025). IRT indicated high item discrimination (α = 1.47-2.47) and identified a cut-off score of 27, classifying 1.7% of students as high-risk for problematic smartphone use. Gender DIF was noted in item 6, with boys showing higher relapse tendencies (p < 0.05). NA highlighted the centrality of tolerance and withdrawal items.

CONCLUSIONS

SABAS is a reliable tool for assessing problematic smartphone use in Chinese primary school students, particularly those at moderate to high risk.

Toward the classification of social media use disorder: Clinical characterization and proposed diagnostic criteria

Empirical studies and theoretical models highlight that problematic use of social media can lead to significant functional impairments in several domains, such as social, relational, occupational, and psychological functioning, as well as physical health. However, social media use disorder is not currently recognized as an official disorder in major diagnostic systems, limiting comparability among studies, precise prevalence estimation, and ad-hoc preventive and treatment program development. The present work aims to classify social media use disorder as a pathological condition sharing main mechanisms and maladaptive patterns with addictive behaviors. We discuss diagnostic criteria for social media use disorder by integrating peculiar features of this maladaptive behavior with criteria for substance use disorders and behavioral addictions from major diagnostic systems (i.e., DSM-5 and ICD-11). Moreover, we address some controversies related to the classification of social media use disorder as a behavioral addiction and highlight literature findings indicating social media use disorder shares main alterations in mechanisms and processes characterizing addiction (i.e., maladaptive activation of reward systems and impairment of inhibitory control mechanisms). Despite the lack of studies including clinical populations and the need for future research to validate the proposed criteria and refine knowledge of the mechanisms underlying this condition, our work provides a structured framework for classifying and identifying social media use disorder.

The temporal stability of problematic gaming and gaming disorder: A systematic review and meta-analysis

Classifying problematic gaming/gaming disorder as a formal psychiatric diagnosis requires data on its level of temporal stability: are the dysfunctional symptoms transient or can they persist in the absence of treatment? To evaluate this question, we conducted a literature review and meta-analysis to investigate temporal stability in problematic gaming/gaming disorder. We identified 50 relevant longitudinal studies on PubMed, PsycINFO, and SCOPUS. Our review and meta-analysis engaged on two types of temporal stability: categorical stability and dimensional stability. We used MetaXL to run the meta-analysis for categorical stability. Our meta-analysis revealed that overall, the categorical stability rate was approximately 34-38% for the 2-year follow-up studies and approximately 43-45% for the 1-year follow-up studies. This indicates that between 1/3 and 1/2 of the gamers who initially met the threshold for problematic gaming/gaming disorder continued to meet such a threshold at follow-ups. Our meta-analysis included predominantly adolescent groups, which should be noted when generalizing the obtained categorical stability rates. Our review results also showed that overall, the dimensional stability was positive and statistically significant, indicating moderate or high correlations between symptom severity at baseline and at follow-ups. Temporal stability can be a complex concept. Our results suggest that although the categorical stability of problematic gaming/gaming disorder is not as strong as some major psychiatric disorders such as schizophrenia and bipolar disorder, it is similar to personality disorder and gambling disorder. Many complex factors may affect the temporal stability of problematic gaming/gaming disorder, possibly including severity of the disorder, whether the data is from clinical or nonclinical populations, and an individual's age group or developmental stage. More methodologically rigorous longitudinal studies that address these issues are needed.

Determining the effects of nomophobia on nurses and midwives in a maternity and child health hospital: A cross-sectional study

AIM

This study aims to assess the levels of nomophobia among nurses and midwives employed at a gynecology and children's hospital and to explore its impact on their lives.

METHODS

This descriptive cross-sectional study was conducted in a gynecology and pediatrics hospital situated in the western region of Turkey. The research sample comprised 112 nurses and midwives. Data collection was facilitated through an "Introductory Information Form" and the "Nomophobia Scale," with adherence to the STROBE checklist for reporting this cross-sectional study.

RESULTS

The mean age of the participants was 34.50 ± 9.98 years. The average total score on the nomophobia scale was 68.45 ± 24.62, with 54.5% of participants classified as having moderate levels of nomophobia. Factors such as age, years of experience in nursing or midwifery, work patterns, and the habit of checking their phones immediately upon waking and before sleeping were found to influence their levels of nomophobia.

CONCLUSION

The study observed that mobile phone usage among nurses and midwives in a gynecology and pediatrics setting negatively affects their mental and physical health, with a moderate level of nomophobia being prevalent. Notably, older age and increased work experience were associated with lower nomophobia scores.

IMPLICATIONS FOR NURSING PRACTICE

Initiatives aimed at preventing the onset of nomophobia are recommended, especially targeting younger nurses and midwives who play a crucial role in health service delivery.

The causal inference between bullying victimization and mental well-being: The mediating role of social withdrawal and the moderating role of coping

BACKGROUND

Research has extensively explored the direct and indirect relationship between bullying victimization and the mental well-being of children with underlying mechanisms through cross-sectional data. However, limited knowledge exists regarding the causal inference and potential underlying mechanisms in this context.

OBJECTIVE

This study delves into these effects among Chinese children, investigating the mediating roles of social withdrawal and the moderating role of approach coping strategies using a two-wave longitudinal design.

PARTICIPANTS AND SETTING

This study collected two-wave data with a six-month interval from a cohort of 863 Chinese children. 49.7 % were identified as female and 50.3 % of samples were males, with an average age of 14.01 at Wave 1. Following the acquisition of informed consent from their legal guardians, all students voluntarily completed the self-report questionnaires.

METHODS

The study utilized R software to conduct data analysis. Half-longitudinal mediation and moderation models were adopted to examine the effects on mental well-being. Multi-group path analysis was used to examine the group differences in left-behind status.

RESULTS

The research results indicated that bullying victimization exhibited both direct (β = -0.085, p < 0.01) and indirect (β = -0.017, p < 0.05, 95 % CI: [-0.030, -0.002]) effects on diminished mental well-being, mediated by social withdrawal. In addition, higher levels of approach coping strategies act as a buffer in the adverse effect of bullying victimization on children's mental well-being (β = -0.054, p < 0.05). Furthermore, the study highlighted that the left-behind status significantly moderated the relationship between peer victimization and social withdrawal. Interestingly, this relationship was notably significant in non-left-behind children rather than their left-behind counterparts (βnon-left-behind = 0.121, p < 0.01; βleft-behind = 0.006, p = 0.926).

CONCLUSION

These findings enhance our comprehension of the intricate interplay between victimization and well-being, offering crucial insights for policymakers and social workers to craft targeted interventions. By developing a deeper understanding of how victimization influences psychological well-being, tailored strategies can be formulated to effectively support children impacted by such experiences.

Predicting Factors of Protective Behaviors Against COVID-19 Based on Protection Motivation Theory: A Cross-Sectional Study

Today, COVID-19 has become a global pandemic. Prevention has been described as the best way to break the transmission chain. The present study aimed to determine the predictors of protective behaviors against COVID-19 based on the protection motivation theory. The participants in the present cross-sectional study were 662 Sabzevar city (Iran) residents. Data was collected through a virtual questionnaire distributed through virtual media in non-probable methods (non-probability and snowball). The questionnaire used in this study was researcher-made that covered demographic questions and protection motivation theory variables. The validity and reliability of the questionnaire were assessed. Independent t-test, analysis of variance, Pearson, and linear regression were used for data analysis by SPSS23. In this study, the mean age of the participants was 40 years, 59% men and 76% married. The results showed that response efficacy, perceived rewards, and self-efficacy variables predicted at least 25% of protection motivation variability. Among these variables, self-efficiency had a more critical role than other variables (Standardized β = 0.276). Based on the findings of this study, protection motivation theory has an essential role in predicting the factors affecting the motivation to protect from Covid-19. Therefore, it is suggested that this theory be applied in educational planning to prevent Covid-19 and transmission chain disruption.

The evaluation of depression, anxiety, and stress among undergraduate dental students in graduation year in Mainland China: a cross-sectional study

BACKGROUND

Mental health issue in dental students has emerged as a worldwide concern. This study aims evaluate the mental health status among undergraduate dental students in their final year in mainland China, and to investigate the association factors behind it, aiming for better understanding of current situation of dental education and provide some perspectives.

METHODS

An analytical cross-sectional study was conducted using an Internet-based survey platform to collect data from undergraduate dental students in their final year in mainland China. The DASS-21 instrument was used to evaluate mental health outcomes, while a supplementary questionnaire was designed to gather information on their university experience and satisfaction across various aspects. The relationship between socio-educational characteristics and mental health was then analyzed.

RESULTS

Varying levels of depression, anxiety, and stress were found among investigated participants. The mental problem was found related to gender (p < 0.01), school levels (p < 0.001), and regions (p = 0.001). Regression analysis identified several factors correlating with DASS-21 scores, with concerns about physical appearance being particularly prominent among students.

CONCLUSION

Undergraduate dental students in final year in mainland China experience significant mental health challenges, including depression, anxiety, and stress. Factors including gender, school levels, and regions all showed significant difference in stress, depression, and anxiety. Besides, various academic and social reasons would contribute to that. Social support should pay more attention to mental health in dental students.

The central mediating effect of inhibitory control and negative emotion on the relationship between bullying victimization and social network site addiction in adolescents

BACKGROUND AND OBJECTIVES

Bullying victimization is strongly associated with social network site addiction among adolescents. However, the underlying mechanisms between these variables remain unclear. This study aims to explore the psychological mechanisms linking bullying victimization to social network site addiction by examining the mediating roles of depression, anxiety, stress, and inhibitory control.

METHODS

A self-report survey was conducted among a sample of 1,005 adolescents in China. The survey included measures of bullying victimization, social network site addiction, depression, anxiety, stress, and inhibitory control. Descriptive and correlational analyses were performed, followed by the construction of a chain mediation model.

RESULTS

Bullying victimization was significantly positively associated with social network site addiction. However, this relationship became non-significant when negative emotional states (depression, anxiety, stress) and inhibitory control were introduced as mediating variables. Specifically, bullying victimization significantly predicted negative emotional states and was negatively associated with inhibitory control. Negative emotional states were also negatively related to inhibitory control, while inhibitory control was negatively associated with social network site addiction. Among the negative emotional states, stress and anxiety showed a significant negative correlation with social network site addiction.

CONCLUSION

This study sheds further light on the psychological mechanisms linking bullying victimization and social network site addiction among adolescents. Depression, anxiety, stress, and inhibitory control act as mediating factors in this relationship. These findings highlight the importance of targeting these variables in understanding and developing interventions for social network site addiction among adolescents.

Long-Term Effects of the COVID-19 Open Strategy on the Mental Health of Chinese University Students: A Prospective Cohort Study

Background

In December 2022, the Chinese government shifted its COVID-19 prevention and control policy to full openness, leading to a widespread pandemic within a short period. This study aimed to examine the trajectories of stress, anxiety, and depressive symptoms among Chinese university students within 1 year after the implementation of the open policy. Additionally, it investigated the influence of sleep quality, psychological resilience, and medical specialization on these psychological trajectories.

Methods

A cohort study was conducted among Chinese university students using stratified sampling. Follow-up assessments were conducted at three time points: T1 (December 2022-January 2023), T2 (May-June 2023), and T3 (December 2023-January 2024). Generalized Estimating Equations were used to estimate mean differences in symptom levels over time and to examine the influence of sleep quality, psychological resilience, and medical specialization on these changes.

Results

At T1, a total of 2,062 university students were recruited. By T3, the follow-up rate was 63.43%, resulting in a final analytical cohort of 1,308 participants. Among them, 769 (58.8%) were female, and 539 (41.2%) were male. The majority (54.7%, n = 716) were between 19 and 22 years old. Stress, anxiety, and depression levels were highest among Chinese university students at the beginning of the open policy and gradually decreased over the following year. Students with poor sleep quality and poor psychological resilience exhibited worsening psychological trajectories, which showed more severe and persistent symptoms. Medical and Nonmedical students consistently exhibited similar psychological trajectories.

Conclusions

Collectively, the present study indicated that the change of COVID-19 prevention and control policy had more serious negative impacts on the mental health of Chinese university students than the epidemic itself. Thus, strengthening psychological treatments and psychosocial interventions for university students would be crucial in the context of a protracted infectious disease epidemic.

Mental health knowledge and service utilization among black adults: Moderation by mental illness stigma

Black adults delay treatment seeking and use mental health services at significantly lower rates than white adults, often resulting in more severe and chronic mental illness. Understanding the complex relationship between mental health knowledge, stigma, and service utilization is critical. This study examines how general and specific mental health knowledge are associated with willingness to engage in help-seeking behaviors and the moderating role of stigma. A cross-sectional survey of Black adults across the United States (N = 1117) assessed mental health knowledge, health service utilization, and the effects of mental illness stigma using tailored instruments. Gender differences emerged, with black females showing significantly higher specific mental health knowledge of depression, bipolar disorder, and drug addiction, while Black males had greater knowledge about stress (ps < 0.01). Gamma regression analyses revealed that participants with greater mental health knowledge about depression, schizophrenia, bipolar disorder, and drug addiction were more likely to report willingness to seek help from a mental health professional for personal/emotional problems and suicidal thoughts, controlling for demographic factors. Furthermore, future intended stigma behavior significantly moderated the association between specific knowledge (i.e., depression, bipolar disorder) and help seeking behavior (RRs: 0.94 to 0.97, ps < 0.05). Culturally tailored education programs and community-based outreach initiatives may aim to enhance Black men's knowledge of specific conditions like depression, bipolar disorder, and drug addiction. Additionally, future interventions should focus on improving both general and specific mental health knowledge while mitigating the negative effects of stigma on help-seeking behavior for Black adults.

A meta-analysis assessing reliability of the Yale Food Addiction Scale: Implications for compulsive eating and obesity

Food addiction (FA) is linked to eating disorders and obesity. The Yale Food Addiction Scale (YFAS), which has various versions in different languages, is widely used to assess FA worldwide. This meta-analysis aimed to assess the YFAS through reliability generalization meta-analysis (REGEMA). From their inception until April 2024, a comprehensive systematic review across more than 30 databases was conducted to identify studies reporting reliability measures (e.g., Cronbach's alpha and McDonald's omega) of the YFAS. Sixty-five studies were included in this meta-analysis, with a median sample size of 451 participants. The results of the random-effects meta-analysis showed a high pooled reliability coefficient (α = 0.85, 95% CI: 0.83 to 0.86 p < 0.001). Test-retest reliability was also estimated using a random-effects meta-analysis of 10 studies, resulting in a pooled test-retest correlation coefficient of intraclass coefficients of (ICC = 0.77, 95% CI: 0.70 to 0.84, p < 0.001). These findings highlight the consistency and robustness of the YFAS in detecting FA across studies, suggesting its reliability for screening for FA-related disordered eating.

The relationships between positive/negative metacognitions and Internet gaming disorder among Chinese adult gamers: Cross-sectional and longitudinal evidence

Previous research investigating Internet gaming disorder (IGD) in China involved mainly youth samples despite the large population of adult gamers. Drawing on the self-regulatory executive function model, this study aimed to demonstrate the psychometric robustness of negative and positive gaming-specific metacognitions assessed by the short-form Metacognitions about Online Gaming Scale (MOGS; Study 1). Then, Study 2 aimed to explore bidirectional associations between these two factors of the MOGS and IGD among a broad age spectrum of Chinese adult gamers. Through online surveys, we obtained data from Chinese community adults: Study 1 surveyed 409 past-month gamers (Mage = 42.45, SD = 11.66; 53.8 % female) and Study 2 surveyed 266 past-month gamers (Mage = 34.76, SD = 11.78; 65.8 % female). Results of Study 1 supported the robustness of the two-factor structure, demonstrated the short-form MOGS' satisfactory convergent validity and reliability, and displayed its scalar invariance between community adults and university students. Study 2 found bidirectional associations between negative metacognitions only and IGD, in which baseline negative metacognitions were associated with higher levels of individuals' follow-up vulnerability to developing IGD. In contrast, IGD had a prospective effect on negative metacognitions 6 months later. IGD also showed a significant prospective effect on positive metacognitions. These findings demonstrate that the short-form MOGS is a cost-effective tool for measuring gaming-specific metacognitions in Chinese adults, highlighting the prominent role of negative metacognitions in the vicious circle of maladaptive metacognitions and IGD, which has implications for IGD preventions.

Digital Media Usage Trends Among Children Aged 8-11 Years Before and After the COVID-19

OBJECTIVE

The coronavirus disease-2019 (COVID-19) pandemic has significantly altered daily life, potentially impacting children's digital media usage. This study investigates changes in smart device usage among children in South Korea, considering the pandemic's effects.

METHODS

A longitudinal analysis was conducted on a cohort of 313 children aged 8-11 years from 2018 to 2021. The study measured weekly usage of personal computers (PCs), tablet PCs, and smartphones, comparing pre-pandemic (up to 2020) and post-pandemic periods. Partial correlation analysis was employed to assess the impact of COVID-19, controlling for covariates such as age, household income, and parental education.

RESULTS

The analysis revealed a significant increase in smart device usage time following the onset of the pandemic. This increase remained statistically significant even after accounting for covariates. Notably, both age and maternal education level were significant factors influencing device usage.

CONCLUSION

This study demonstrates a significant shift in the digital behavior of children aged 8-11 in the context of the COVID-19 pandemic. The increase in smart device usage underscores the pandemic's far-reaching impact on children's daily routines and suggests a need for further research into its long-term effects. The findings highlight the importance of considering external societal changes when analyzing trends in digital media usage among children.

Stigma in substance-based and behavioural addictions: A systematic review

Background and Aims

The study of stigma contributes greatly to our understanding of individuals' experiences of mental disorders. Addictive disorders are often associated with public misconceptions of the disorder, which can contribute to shame, discrimination, and reticence to seek help. This review aimed to: (1) evaluate the nature, frequency, and prevalence of addiction stigma; (2) identify the correlates of addiction stigma; and (3) examine the psychometric qualities of addiction stigma measures.

Methods

A search of Web of Science, PubMed, Scopus, PsycINFO, and PsycNet, had 5,515 results which were screened for eligibility using Covidence. Eligible papers were quantitative, peer-reviewed studies, which reported an outcome variable of stigma related to an addiction.

Results

A total of 99 studies were included in the review, including 70 studies of substance-based addictions, 19 studies of behavioral addictions, and 10 studies which examined both. Thirteen of the 20 studies examining the impact of familiarity with addiction reported that greater familiarity was associated with lower public stigma. Studies comparing substance and behavioral addictions (n = 5) typically reported greater public stigma towards vignettes depicting substance-based addictions than for behavioral addictions. Between 22% and 40% of individuals with an addictive disorder identified stigma as a significant barrier to seeking help; however, the relative importance of stigma among other barriers was unclear.

Discussion and Conclusions

Evidence for countermeasures to prevent and/or reduce stigma is currently limited. Further research on the nature and prevalence of addiction stigma is needed to inform the development of effective clinical and public health countermeasures.

New Perspective on Digital Well-Being by Distinguishing Digital Competency From Dependency: Network Approach

BACKGROUND

In the digital age, there is an emerging area of research focusing on digital well-being (DWB), yet conceptual frameworks of this novel construct are lacking. The current conceptualization either approaches the concept as the absence of digital ill-being, running the risk of pathologizing individual digital use, or follows the general subjective well-being framework, failing to highlight the complex digital nature at play.

OBJECTIVE

This preregistered study aimed to address this gap by using a network analysis, which examined the strength of the relationships among affective (digital stress and web-based hedonic well-being), cognitive (online intrinsic needs satisfaction), and social (online social connectedness and state empathy) dimensions of DWB and their associations with some major DWB protective and risk factors (ie, emotional regulation, nomophobia, digital literacy, self-control, problematic internet use, coping styles, and online risk exposure).

METHODS

The participants were 578 adults (mean age 38.7, SD 13.14 y; 277/578, 47.9% women) recruited from the United Kingdom and the United States who completed an online survey. Two network models were estimated. The first one assessed the relationships among multiple dimensions of DWB, and the second examined the relationships between DWB dimensions and related protective and risk factors.

RESULTS

The 2 resulting network structures demonstrated high stability, with the correlation stability coefficients being 0.67 for the first and 0.75 for the second regularized Gaussian graphical network models. The first network indicated that all DWB variables were positively related, except for digital stress, which was negatively correlated with the most central node-online intrinsic needs satisfaction. The second network revealed 2 distinct communities: digital competency and digital dependency. Emotional regulation emerged as the most central node with the highest bridge expected influence, positively associated with emotion-focused coping in the digital competency cluster and negatively associated with avoidant coping in the digital dependency cluster. In addition, some demographic differences were observed. Women scored higher on nomophobia (χ24=10.7; P=.03) and emotion-focused coping (χ24=14.9; P=.01), while men scored higher on digital literacy (χ24=15.2; P=.01). Compared with their older counterparts, younger individuals scored lower on both emotional regulation (Spearman ρ=0.27; P<.001) and digital self-control (Spearman ρ=0.35; P<.001) and higher on both digital stress (Spearman ρ=-0.14; P<.001) and problematic internet use (Spearman ρ=-0.25; P<.001).

CONCLUSIONS

The network analysis revealed how different aspects of DWB were interconnected, with the cognitive component being the most influential. Emotional regulation and adaptive coping strategies were pivotal in distinguishing digital competency from dependency.

Internet gaming disorder in children and adolescents: A systematic review of familial protective and risk factors

Empirical research investigated psycho-social factors associated with the development and maintenance of Internet Gaming Disorder (IGD) in children and adolescents, but their potential role has not been highlighted in systematic reviews. The aims of the current systematic review were to (1) summarize and synthesize findings from empirical research on family factors related to children and adolescents' IGD; (2) identify familial protective and risk factors that are related to the development and maintenance of IGD in children and adolescents, and (3) provide suggestions for future research. A number of 64 studies fulfilled the inclusion criteria in the review from the following databases: Web of Science, Science Direct, Scopus, PubMed, ProQuest, Google Academic, and APA PsycNet. Family variables have been significantly connected to gaming addiction levels in children and adolescents. Results were divided into five main themes: parental mediation, positive parenting, poor parenting, familial disharmony, and familial socioeconomic status. Protective factors included parental knowledge and positive parenting, while poor parenting, familial disharmony and familial socioeconomic status with all their sub-themes represented risk factors. Restrictive mediation and affected parenting provided inconclusive results that deserve further research. Familial connection is imperative for gaming addiction prevention. A stressful familial environment (e.g., parental conflicts) could increase gaming addiction coping behavior. Longitudinal and cross-sectional results provided inconsistent results regarding the role of parental depression and parental mediation in children's gaming addiction development. Cross-cultural studies are needed on familial factors related to children's gaming addiction. Further longitudinal studies could provide answers for conflicting or underexplored areas.

Psychometric evaluation of the Chinese version of Risky Loot Box Index (RLI) and cross-sectional investigation among gamers of China

Nowadays, many of the top-selling video games include options to purchase loot boxes as paid virtual items. As research progressed, loot boxes have been found to have similar characteristics to gambling, and there has been an ongoing debate as to whether loot boxes can be defined as gambling. In order to better study loot boxes, psychometrically meaningful scales are necessary. The Risky Loot Box Index (RLI) was developed by Brooks and Clark, which is the most commonly used tool to assess the use of loot boxes. This study aimed to translate the original RLI into Chinese and evaluate its psychometric properties. Two samples were recruited through online gaming forums (n = 143) and offline internet cafes (n = 236). An exploratory factor analysis of the online sample yielded a one-dimensional nine-item model, with the factor focused on risky behaviors associated with loot boxes. The confirmatory factor analysis carried out on the offline sample corroborated the results obtained from the exploratory factor analysis, and the Chinese version of the RLI displays satisfactory psychometric properties. Furthermore, the Problem Gambling Severity Index (r = 0.57, P < 0.001) and the Internet Gaming Disorder Scale-Short Form (r = 0.67, P < 0.001) were found to be significantly associated with the RLI. We also found that players with high RLI scores may have higher levels of anxiety and depression, and they were more willing to spend money on loot boxes, with some spending nearly all their earnings. Interestingly, no significant correlations between age, gender, education, or income level, and the RLI were found.

Explanation of intention toward influenza vaccination among cardiovascular disease patients: An application of the extended protection motivation theory

OBJECTIVE

Patients with cardiovascular disease (CVD) are susceptible to influenza virus infection, and influenza vaccination is effective in preventing influenza, but its uptake remains low. This study will investigate the influencing factors affecting patients' intention to receive influenza vaccination based on the extended protection motivation theory (PMT) and explore whether there are differences in this psychological pathway among patients with different levels of illness perception.

STUDY DESIGN

Cross-sectional study.

METHODS

In this study, the extended PMT model was used, which consists of the original construct (threat and coping assessment) and the extended construct (social norms and trust). Based on this, the model used to explain influenza vaccination intentions in CVD patients was constructed. Structural equation modelling was then used to test the extended theory from the overall population, the high-illness-perception and low-illness-perception populations, respectively.

RESULTS

Intention toward influenza vaccination was positively correlated with severity (β = .211), vulnerability (β = .154), response efficacy (β = .243), self-efficacy (β = .154), and social norms (β = .179), while being negatively associated with response costs (β = -.244). Social norms influenced intention by mediating response efficacy and self-efficacy, while trust in information sources was mediated by self-efficacy. Extended PMT had higher interpretative efficacy in patients with high illness perception than in patients with low illness perception (75.1 % vs 35.2 %).

CONCLUSIONS

The study found that the extended PMT is appropriate for explaining the intention toward influenza vaccination of patients with CVD. Patients with different illness perception levels have differences in the paths. It is suggested that patients with different levels of illness perception be subdivided, and intervention strategies should be developed by considering the theoretical models of each subgroup.

The Self-Control Bridge: Connecting Social Media Use to Academic Procrastination

Problematic social media use can be characterized as compulsive or excessive engagement with social media applications that have addictive qualities. Research has highlighted a strong link between self-control and academic procrastination. Therefore, the primary aim of this study is to explore the connection between problematic social media use and academic procrastination, with self-control acting as a mediator. This study is cross-sectional and aims to describe and analyze simple and multiple-variable relationships within the framework of structural equation modeling. The participants of this study comprised 665 students (female 50.8% M-age 21.72). The survey was conducted online, and the respondents consented to participate in the study. Hierarchical regression revealed that problematic social media use (β = .238, p < .001) and self-control (β = -.691, p < .001) were independent factors of academic procrastination; the SEM results demonstrated that self-control fully mediated the relationship between problematic social media use and academic procrastination; the bootstrap method revealed that the bounds of the CI did not contain 0, confirming the significance of this mediating effect. Problematic social media use can positively predict academic procrastination, and this relationship is fully mediated by self-control.

Connecting self-esteem to problematic AI chatbot use: the multiple mediating roles of positive and negative psychological states

The emergence of AI chatbot products has ushered in a new era of human-AI interaction, yet scholars and practitioners have expressed concerns about their use due to potential addictive and adverse effects. Currently, the understanding of problematic AI chatbot use (PACU) remains incomplete and inconclusive. Despite previous findings that indicate negative outcomes associated with the use of AI products, limited studies have explored the underlying factors that drive the complex process leading to the formation of PACU. Furthermore, while existing literature highlights how personal traits influences problematic IT use via evoked psychological states, it largely overlooks that the positive psychological experience may also have a potential influence on problematic outcomes. Incorporating flow experience into the compensatory internet use theory, this study presents a multiple mediation model to investigate how social anxiety, escapism, and AI chatbot flow influence the relationship between self-esteem and PACU. We examine the model using Partial Least Squares Structural Equation Modeling (PLS-SEM) with cross-sectional data collected from 563 online users who have engaged with AI chatbots. Our findings indicate that users with low self-esteem are more likely to conduct problematic behavior when using AI chatbots. This relationship can be mediated by social anxiety, escapism and AI chatbot flow. This study sheds light on how self-esteem negatively affects PACU, unraveling the underlying psychological processes experienced by users with low self-esteem in their interactions with AI chatbots. Also, we provide practical insights for online users and practitioners to mitigate the potential negative impacts of AI product usage.

Impaired sleep quality mediates the relationship between internet gaming disorder and conduct problems among adolescents: a three-wave longitudinal study

BACKGROUND

Research increasingly demonstrates a positive association between Internet Gaming Disorder (IGD) and conduct problems among adolescents. However, longitudinal data are limited, and the mediating mechanisms remain unclear. This study aimed to examine the predictive effect of IGD on conduct problems and explore the mediating role of impaired sleep quality.

METHOD

A cohort of 20,137 Chinese seventh- and tenth-grade students was recruited and assessed at three time points: November 2020 (T1), 2021 (T2), and 2022 (T3). IGD, conduct problems, and impaired sleep quality were measured using the Internet Gaming Disorder Scale Short Form, the Strengths and Difficulties Questionnaire, and the Pittsburgh Sleep Quality Index, respectively. Mediation analyses were conducted to evaluate the direct and indirect effect of IGD on conduct problems, with subgroup analyses based on sex and developmental stage.

RESULTS

IGD was found to be an independent risk factor for conduct problems both cross-sectionally and longitudinally. Impaired sleep quality partially mediated the relationship between IGD and conduct problems, accounting for approximately 17.3% of the total effect. Subgroup analyses revealed that the mediation effect of impaired sleep quality was more pronounced in early adolescents and varied by sex, with a stronger total and direct effect in boys.

CONCLUSIONS

These findings highlight the need for comprehensive interventions targeting both IGD and impaired sleep quality, tailored to specific sexes and developmental stages, to effectively reduce conduct problems.

Prevalence and influencing factors of anxiety, depression, and burnout among teachers in China: a cross-sectional study

Background

Teachers are more likely to experience mental health issues than the general population, yet few studies focus on Chinese teachers. After the "Double Reduction" policy, teacher workload and stress have risen significantly. In Dongguan, a city actively implementing educational reforms, teacher mental health may be particularly concerning. Anxiety, depression, and burnout are prevalent mental health issues. This study examined the prevalence and factors linked to anxiety, depression, and burnout among Dongguan teachers.

Methods

A cross-sectional survey evaluated the mental health of primary and secondary school teachers in Dongguan, China, using two-stage random sampling. Eleven schools were randomly selected, with 30 teachers chosen from each of 330 invited participants, 313 completed the survey (94.8% response rate), and 259 valid responses were retained after excluding incomplete or inconsistent answers. The study used the Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), and Maslach Burnout Inventory-Educators Survey (MBI-ES). Wilcoxon rank-sum and Kruskal-Wallis tests identified factors linked to anxiety, depression, and burnout. Variables with p ≤ 0.10 in univariate analysis were included in multivariate logistic regression, with cut-offs of 50 for SAS, 53 for SDS, 27 for Emotional Exhaustion (EE), 13 for Depersonalization (DP), and 31 for Personal Accomplishment (PA). A p ≤ 0.10 threshold was used to avoid omitting potential predictors.

Results

The study found anxiety, depression, and burnout prevalence rates of 19.3%, 34.7%, and 74.5%, respectively (95% CI: 14.5-24.1; 28.9-40.6; 69.2-79.9). Junior high school teachers (OR = 0.47) and those with higher education (OR = 0.39) had a lower depression risk. Female teachers (OR = 1.96) had a higher risk of emotional exhaustion (EE), while older teachers (OR = 0.923) had a lower risk of reduced personal accomplishment (PA). Anxiety and depersonalization (DP) showed no significant associations.

Conclusion

The study found high rates of depression and burnout among teachers, influenced by educational level, school type, sex, and age. Authorities should address these issues by clarifying teacher responsibilities, providing mental health training, and establishing monitoring systems. As a cross-sectional study, it cannot determine causality, and further longitudinal research is needed to confirm these findings.

Applying the health belief model (HBM) to understand COVID-19 vaccine uptake among youth and young adults: Findings from a 6-month follow-up study in the United States

BACKGROUND

Vaccination is one of the most effective strategies for COVID-19 prevention. Monitoring and increasing vaccine uptake among youth and young adults (YYA) not only prevents the spread of the disease but also protects their health and well-being from serious COVID-19 illness. This study applied the health belief model (HBM) to understand the predictors of COVID-19 vaccine uptake among YYA in the United States.

METHODS

In early 2021, we conducted a national, online survey among diverse YYA aged 14 to 24 years in the United States. Between July 2021 and September 2022, this study followed participants who were not vaccinated for six months to learn about their vaccine status and prevention behaviors (N = 245). We explored the prevalence of COVID-19 vaccination among YYA by age, race/ethnicity, and sexual and gender identities. Multivariable logistic regression models were performed to estimate associations between HBM constructs and COVID-19 vaccination.

RESULTS

The majority of participants had received a vaccine. (80.8 %). We observed significant differences in COVID-19 vaccination uptake by age; those aged 18 to 21 years were over 3 times as likely to report receiving a vaccine. Regarding the HBM constructs, we found that health motivation, perceived benefits, and protection self-efficacy were significantly associated with vaccine uptake among YYA.

CONCLUSION

This study highlights the effectiveness of HBM in understanding COVID-19 vaccine uptake among YYA in the United States. The findings suggest that health motivation, perceived benefits of vaccination, and protection self-efficacy are key factors driving vaccine uptake in this demographic. Significant age differences in vaccination rates indicate that targeted interventions for younger age groups, particularly those aged 14 to 17 years, may be necessary to increase vaccination coverage. These insights can inform future public health strategies to improve vaccine acceptance and uptake, ensuring better health outcomes and protection against future public health crises in YYA populations.

Effects of Lacticaseibacillus paracasei K56 on perceived stress among pregraduate students: a double-blind, randomized, placebo-controlled trial

Background

Globally, master's and doctoral students, especially pregraduate students, are under great pressure. Probiotics are emerging as a promising intervention to improve mental health via gut-brain axis.

Objective

The aim of this study was to explore the impact of Lacticaseibacillus paracasei K56 supplementation on perceived stress among pregraduate students.

Methods

We conducted a double-blind, randomized, placebo-controlled trial in 120 healthy master's and doctoral students who faced graduation. Participants were randomly assigned to either probiotics (containing Lacticaseibacillus paracasei K56 6 × 1010 CFU / d) or placebo group for 2 weeks intervention. The main outcome was perceived stress assessed using Cohen's Perceived Stress Scale-10 (PSS-10). The secondary outcomes were stress, depression, and anxiety assessed by Depression, Anxiety and Stress Scales (DASS), gastrointestinal symptoms, and sleep evaluated by corresponding scales. These outcomes were assessed at baseline, 1, and 2 weeks. Pre- and post-treatment serum biomarkers, gut microbiota composition and metabolites were also detected.

Results

There was no difference in changes of PSS-10 scores from baseline to 2 weeks between the K56 groups and the placebo [mean (standard error): -1.68 (0.48) vs. -0.39 (0.46), p = 0.055]. Furthermore, the K56 group exhibited superior reductions in both stress [-2.15 (0.38) vs. -0.96 (0.49), p = 0.035] and anxiety symptoms [-1.54 (0.32) vs. 0.53 (0.43), p = 0.003] via DASS compared with the placebo group. Additionally, those receiving K56 also experienced improved sleep quality (p = 0.010) and elevated levels of serotonin (5-HT) (p = 0.038) compare to placebo group. Moreover, taking probiotics K56 could modulate the pressure-induced changes in gut microbiota composition, particularly by increasing the beneficial bacteria (Lacticaseibacillus and Lacticaseibacillus paracasei), while suppressing suspected pathogenic bacteria (Shieglla and Escherichia_coli). Metabolomic analysis revealed an increased in metabolites, especially butyric acid in the K56 group (p = 0.035). Notably, there was a significant negative correlation between relative abundance of lactobacillus and stress-related symptoms, whereas butyric acid showed a significant positive correlation with lactobacillus abundance level.

Conclusion

This study suggested the potential benefits of K56 supplementation in alleviating stress and significant effect in reducing anxiety and insomnia among master's and doctoral students, which may be attributed to K56-induced changes in microbial composition and butanoate metabolism.

Clinical trial registration

Chictr.org.cn, identifier ChiCTR2300078447.

The association between unintended pregnancy and maternal mental health in rural China

Background

Unintended pregnancies are common in rural China. However, the association between unintended pregnancy and maternal mental health remains poorly understood. This study aimed to assess the prevalence of unintended pregnancies, their association with mental health concerns, and the contributing factors in rural China.

Methods

A cross-sectional design was used in this study. We included 473 pregnant women (age ranging from 18 to 45 years; local residency for at least 1 year; current pregnancy) from 10 counties in rural areas of Shaanxi Province, which is highly representative of rural northwest China in terms of economic status, geographical characteristics, and traditional culture. Mental health was assessed using the Depression, Anxiety, and Stress Scales-21 (DASS-21), widely recognized for its reliability, validity, and applicability in the Chinese context. Descriptive statistics and logistic regression analyses were employed to elucidate the prevalence of unintended pregnancy issues and explored their association with maternal mental health.

Results

The prevalence rates of depression, anxiety, and stress in the full sample were 19.24, 23.68, and 10.99%, respectively. The proportion of unintended pregnancies was 41.44%, with significantly higher rates of depression, anxiety, and stress tendencies compared to intended pregnancy. Logistic regression analysis revealed a significant association between unintended pregnancy and an increased risk of anxiety tendency (OR = 1.96, 95% CI = 1.25-3.08, p = 0.004) as well as stress tendency (OR = 2.15, 95% CI = 1.15-4.02, p = 0.017). Furthermore, among women with unintended pregnancy, anxiety tendency was more pronounced among unemployed women (OR = 2.05, 95% CI = 1.25-3.35, p = 0.004), and co-residing with their mother-in-law (OR = 2.47, 95% CI = 1.40-4.38, p = 0.002). Similarly, stress tendency was more pronounced among unemployed women (OR = 2.20, 95% CI = 1.11-4.34, p = 0.023), and co-residing with their mother-in-law (OR = 2.60, 95% CI = 1.17-5.74, p = 0.018).

Conclusion

The positive correlation exists between unintended pregnancy and maternal mental health risks. The high prevalence of unintended pregnancies underscores the need for policies aimed at reducing their occurrence, as well as interventions targeting mental health support to pregnant women.

Cyberbullying Perpetration and Socio-Behavioral Correlates in Italian and Spanish Preadolescents: A Cross-National Study and Serial Mediation Analysis

The spread of information and communication technologies (ICTs) has brought advantages and disadvantages, particularly impacting youth, who use the Internet and social media applications daily. In preadolescents' social development, problematic social media use (PSMU) and cyberbullying (CB) are potential risk factors across several countries. PSMU is defined as the lack of regulation of social media platforms that is associated with negative outcomes in everyday life, while CB refers to using digital technology to harass, threaten, or embarrass another person. Among preadolescents, CB perpetration is frequently associated with cybervictimization (CV) experiences. The underlying mechanisms that drive this relationship have received limited attention. The aim of the cross-national comparative study, rooted in the general aggression model, is to investigate the direct and indirect effects between cyberbullying perpetration and cybervictimization, testing a model involving PSMU and moral disengagement (MD) as serial mediators in this association. A total of 895 Italian and Spanish preadolescents (Mage = 11.23, SDage = 1.064) completed a self-report survey during school hours. Descriptive statistics were computed, and a serial mediation model was run. The results show that CV is positively associated with CB, and that PSMU and MD positively serially mediate the CV-CB link. This study's insights suggest the need for tailored educational interventions targeting European youth, to promote more positive online social interactions and a safer digital environment.

The relationship between specific problematic internet use and hope: academic exhaustion as mediator and mattering as moderator among Chinese university students

Problematic social media use (PSMU) and problematic gaming (PG) among university students as specific types of problematic internet use (PIU) have become a growing concern. PSMU and PG may lead to negative outcomes such as academic exhaustion and diminished hope. However, previous studies have not simultaneously considered the associations among these variables from the perspective of Stressor-Strain-Outcome model. Furthermore, the concept of 'mattering'-the feeling of being valued and important to others and 'fear of not mattering' in this dynamic is notably under-investigated. The present study aimed to examine the associations among these variables and evaluated whether mattering profiles moderated the associations involving PIU among university students.A survey was conducted among 3,035 university students in China, with an average age of 19.24 years (SD = 1.83). The sample included 52% males and 48% females from 19 different universities. The Bergen Social Media Addiction Scale, the Internet Gaming Disorder Scale-Short Form, the General Mattering Scale, the Fear of Not Mattering Inventory, the Maslach Burnout Inventory-Student Survey, and the Dispositional Hope Scale were utilized to evaluate PSMU, PG, general mattering, fear of not mattering, academic exhaustion, and hope, respectively. Furthermore, latent profile analysis was used to categorize students into distinct mattering profiles based on measures of general mattering and fear of not mattering to others.Correlational analyses indicated that PSMU and PG were associated with greater academic exhaustion, reduced hope, and higher levels of fear of not mattering. Mediation analysis identified academic exhaustion as a mediator in the relationships between PSMU and hope, as well as between PG and hope. Profile analyses identified a group of students distinguished by exceptionally low levels of general mattering. Mattering profiles acted as moderators of the associations between PG and academic exhaustion, and between academic exhaustion and hope.PG negatively affected students' hope through academic exhaustion, while different mattering profiles had diverse associations. Customized intervention strategies focused on boosting hope and feelings of mattering, and reducing fears of not mattering are needed to reduce vulnerability to PG and PSMU.

Internet gaming disorder and suicidal behaviors mediated by sleep disturbance: a large-scale school-based study in 135,174 Chinese middle school students

Emerging research suggests a positive association between Internet gaming disorder (IGD) and suicidal behaviors. However, existing studies predominantly focus on suicidal ideation rather than suicide attempts and often do not adequately control for potential psychological confounders. The mechanism linking IGD to suicidality remains unclear. This study aims to assess the independent association between IGD and suicidal behaviors and to examine the mediating role of sleep disturbance among Chinese adolescents. We recruited 135,174 middle school students from Zigong City using cluster sampling. Data on demographics, suicidal ideation, and suicidal attempts were collected. IGD was assessed using the Internet Gaming Disorder Scale-Short Form. Mental distress, including depression, anxiety, hyperactivity/inattention, conduct problems, sleep problems, and psychotic experiences, was evaluated using standardized questionnaires. Multiple logistic regression models and mediation analysis were conducted. The prevalence rates of IGD, suicidal behaviors, suicidal ideation, and suicide attempts were 1.6%, 16.7%, 11.9%, and 9.8%, respectively. Adolescents with IGD showed a significantly higher risk for suicidality: nearly 60% reported suicidal behaviors, 50% reported suicidal ideation, and 40% reported suicide attempts. Both IGD and gaming usage were independently linked to suicidal behaviors. Sleep disturbance partially mediated the relationship between IGD and suicidal behaviors, accounting for 47.0% of the total effect. Our studies call for timely and regular assessments for suicidality and sleep disturbance in IGD. Targeted interventions addressing sleep disturbance might reduce suicidal risk among adolescents with IGD.

Psychological Balances in the Digital World: Dynamic Relationships Among Social Media Addiction, Depression, Anxiety, Academic Self-Efficacy, General Belongingness, and Life Satisfaction

In the present era, the rapidly growing social media trends of the digital age have the potential to affect the psychological well-being of individuals. In this context, understanding how Social Media Addiction (SMA) interacts with various factors is important to understanding its potential impact on individuals' psychosocial health. In particular, the prevalence of SMA and its strong relationship with important variables such as anxiety, depression, stress, academic self-efficacy, general belongingness, and life satisfaction have received considerable attention from researchers and the society. This research aims to address the relationship between SMA and these variables in a holistic manner. The research further explored the relationship between life satisfaction and depression, anxiety, academic self-efficacy, and general belongingness. The research is based on a study conducted with 616 students (388 female and 228 male; 17-32 age range) at a state university in the Southeast of Turkey. Personal information form, Smartphone Addiction Scale, Depression Anxiety Stress Scale, Academic Self-Efficacy Scale, General Belongingness Scale, and Life Satisfaction Scale were used as data collection tools. Using a structural equation modeling approach, the research not only examined the significant relationships but also examined the mediating and moderating effects in more detail. According to the research results, SMA significantly affects academic self-efficacy, general belongingness, depression, stress and anxiety. Academic self-efficacy and general belongingness both impact life satisfaction. However, SMA does not have a significant effect on life satisfaction. Moreover, it is revealed general belongingness play effective roles in the relationship between SMA and life satisfaction. As a result of the research, it was revealed that gender plays a moderating role in the relationship between SMA and life satisfaction. It has been observed that gender has a moderating role in the relationships between academic self-efficacy, general belongingness, depression, anxiety and stress and life satisfaction. Conversely, there is no moderating influence of gender on the impact of SMA on academic self-efficacy, general belongingness, depression, anxiety, or stress. Consequently, the relationships between SMA and other variables play an important role in understanding their effects on individuals' mental health.

A cross-country network analysis of disease infodemics: Looking through the lens of the COVID-19 pandemic

Infodemics surrounding pandemics and epidemics have persisted for centuries and continue to impede efforts to promote high vaccination coverage. We explored the complex interplay between COVID-19 vaccination attitudes and COVID-19-related infodemics across Germany, Ghana, India, and New Zealand using the novel network analysis. We conducted an online cross-sectional survey and recruited 1822 participants from the general populations of India (n = 411), New Zealand (n = 413), Ghana (n = 523), and Germany (n = 413) to complete COVID-19 infodemic measures and demographics questions. Predictors of less favourable COVID-19 vaccination attitudes included the apocalypse-related infodemic in India, compared to all countries, as well as the not harmful belief of COVID-19 in New Zealand, compared to India and Germany, and in Ghana compared to India. COVID-19 origin-related infodemics were found to positively impact COVID-19 vaccination attitudes in Ghana and New Zealand only. The most influential infodemics in each of the countries studied-Ghana, New Zealand, Germany, and India-were the beliefs in bioweapons, 5G technology, apocalypse, and bat consumption, respectively. Across all countries, there were consistent strong positive connections between the infodemics. Our results suggest that country-specific infodemics significantly impact COVID-19 vaccination attitudes, with variations observed between nations. While the infodemics can reinforce each other and complicate public health efforts during pandemics, understanding the interactions between the central infodemic in each country and others can aid in developing more effective strategies to counter their influences. This highlights the importance of targeted public health interventions that address the unique dynamics of local infodemics during pandemics, epidemics, and Pathogen X outbreaks.

Internet gaming disorder and depression mediated by impaired resilience and sleep distress: a three-wave longitudinal study among Chinese adolescents

AIMS

While the cross-sectional relationship between internet gaming disorder (IGD) and depression is well-established, whether IGD predicts future depression remains debated, and the underlying mechanisms are not fully understood. This large-scale, three-wave longitudinal study aimed to clarify the predictive role of IGD in depression and explore the mediating effects of resilience and sleep distress.

METHODS

A cohort of 41,215 middle school students from Zigong City was assessed at three time points: November 2021 (T1), November 2022 (T2) and November 2023 (T3). IGD, depression, sleep distress and resilience were measured using standardized questionnaires. Multiple logistic regression was used to examine the associations between baseline IGD and both concurrent and subsequent depression. Mediation analyses were conducted with T1 IGD as the predictor, T2 sleep distress and resilience as serial mediators and T3 depression as the outcome. To test the robustness of the findings, a series of sensitivity analyses were performed. Additionally, sex differences in the mediation pathways were explored.

RESULTS

(1) IGD was independently associated with depression at baseline (T1: adjusted odds ratio [AOR] = 4.76, 95% confidence interval [CI]: 3.79-5.98, p < 0.001), 1 year later (T2: AOR = 1.42, 95% CI: 1.16-1.74, p < 0.001) and 2 years later (T3: AOR = 1.24, 95% CI: 1.01-1.53, p = 0.042); (2) A serial multiple mediation effect of sleep distress and resilience was identified in the relationship between IGD and depression. The mediation ratio was 60.7% in the unadjusted model and 33.3% in the fully adjusted model, accounting for baseline depression, sleep distress, resilience and other covariates. The robustness of our findings was supported by various sensitivity analyses; and (3) Sex differences were observed in the mediating roles of sleep distress and resilience, with the mediation ratio being higher in boys compared to girls.

CONCLUSIONS

IGD is a significant predictor of depression in adolescents, with resilience and sleep distress serving as key mediators. Early identification and targeted interventions for IGD may help prevent depression. Intervention strategies should prioritize enhancing resilience and improving sleep quality, particularly among boys at risk.

Problematic Online Video Watching, Boredom Proneness and Loneliness Among First-Year Chinese Undergraduates: A Two-Wave Longitudinal Study

Purpose

While previous cross-sectional studies have investigated the relationship between problematic online video watching and mental health issues, longitudinal studies exploring their bidirectional relationship remain relatively scarce. This study aimed to fill this gap by conducting a two-wave longitudinal design.

Participants and Methods

Six hundred and ninety-nine first-year undergraduates voluntarily completed two rounds of questionnaire surveys assessing problematic online video watching, boredom proneness and loneliness with an interval of 4 months. To test the research hypotheses, cross-lagged panel models were performed using AMOS 24.0.

Results

Our results revealed the that (1) Boredom proneness and problematic online video watching were mutually influenced. (2) Loneliness at T1 positively predicted the level of problematic online video watching at T2 but not vice versa. (3) Boredom proneness mediated the link between loneliness and problematic online video watching. (4) Chinese first-year undergraduates' levels of problematic online video watching and boredom proneness significantly increased during their educational transition period from high school to university.

Conclusion

The present study enhances our understanding of the dynamic relationships between problematic online video watching, boredom proneness and loneliness, highlighting the targeted prevention and interventions for first-year undergraduates.

Digital traps: How technology fuels nomophobia and insomnia in Taiwanese college students

This study investigates the relationship between maladaptive digital technology use, which arises from nomophobia, and insomnia among young adults. It specifically focuses on problematic gaming (PG), problematic social media use (PSMU), and problematic YouTube use (PYTU) as significant forms of digital behavior contributing to this contemporary health concern. Adolescents and young adults, being the first generation raised in a highly digitized environment, encounter unique challenges, including the emergence of behavioral addictions. Our findings indicate a strong association between nomophobia and problematic digital behaviors, with PSMU identified as the most prevalent form of maladaptive use. Additionally, PG and PSMU are recognized as substantial contributors to the development of nomophobia. The interaction of cognitive overstimulation, emotional dysregulation, blue light exposure, time displacement, and reward-driven dependency on these digital platforms promotes compulsive behaviors, which subsequently lead to the onset of insomnia. Utilizing Structural Equation Modeling (SEM), the study illustrates that nomophobia precipitates problematic digital behavior, which in turn results in sleep disturbances, thereby elucidating a clear pathway from digital dependency to insomnia. The limitations of this study include its cross-sectional design and reliance on self-reported data, which may introduce potential biases. Despite these limitations, our findings underscore the critical role of nomophobia in triggering insomnia through various maladaptive digital behaviors. This highlights the urgent need for targeted prevention and intervention strategies aimed at fostering healthier digital habits and alleviating the adverse health effects of excessive technology use, ultimately enhancing well-being in an increasingly interconnected society.

Longitudinal Associations Between Sleep Disturbance Trajectories and Internet Gaming Disorder Mediated by Self-Control: A Six-Wave Longitudinal Investigation

Objective

The present study aims to analyze the heterogeneous trajectories of sleep disturbance (SD) among college students and to examine whether self-control mediates the association between sleep disturbance trajectories and Internet gaming disorder (IGD).

Methods

A total of 4352 students were initially invited to participate, and 4191 (M age = 19.12, SD = 0.98; 46.9% females) students were included as valid respondents at the first time-point. This study spanned six waves (from 2019 to 2022) with a six-month interval between each wave. Sleep disturbance was measured from Time 1 to Time 4, self-control was measured at Time 5, and Internet gaming disorder was measured at Time 6. Growth mixture modeling (GMM) was applied to identify latent classes of sleep disturbance over the four waves. Mediation analysis was conducted to examine the mediating role of self-control between sleep disturbance trajectories and IGD.

Results

The results of growth mixture modelling yielded a four-class solution for sleep disturbance: a stable-low group, an increasing group, a decreasing group, and a stable-high group. Additionally, the results of mediation models showed that increased sleep disturbance is associated with a higher likelihood of individuals becoming more addicted to Internet games due to decreased self-control. Conversely, improved sleep quality may decrease the likelihood of engaging in Internet games via by promoting higher levels of self-control.

Conclusion

Future prevention and intervention programs targeted at improving self-control may decrease the possibility of developing IGD.

Associations of food addiction symptomatology with bariatric surgical attrition: a cross-sectional analysis

BACKGROUND

Despite the effectiveness of bariatric surgery, there remains a high rate of attrition from surgical programs, highlighting the need to understand factors that influence presurgical attrition rates.

OBJECTIVES

To investigate the association between food addiction (FA) symptomatology and attrition from bariatric surgery.

SETTING

Surgical weight-loss program at a single academic medical center.

METHODS

Data for this analysis were collected from August 2020 until August 2022. Measures included sociodemographic variables, mental health, eating assessments, and FA symptomatology. Data were analyzed using a combination of descriptive statistics, univariable logistic regressions, and a multivariable stepwise logistic regression model.

RESULTS

A total of 505 adult patients were included (76.98% female, mean age 42.61 years, 263 [52.08%] undergoing surgery). FA scores were significantly and positively correlated with surgical attrition, current food insecurity, anxiety and depression symptoms, internalized weight bias, lower dietary quality, and distress and impairment due to FA. In the multivariable model, only current food insecurity, depressive symptoms, internalized weight bias, and impairment caused by FA were significant predictors of surgical attrition.

CONCLUSIONS

Although the number of FA symptoms was not associated in the multivariable model, impairment attributable to FA remained a significant predictor of surgical attrition. This trend suggests that an evaluation of FA may reflect a complex network of factors. Further, FA may not be a predictor of surgical attrition in the absence of perceived clinically significant impairment. Additional research should explore the relationship between impairment attributable to FA and surgical attrition to test the generalizability of these findings.

The Influence of Depression, Anxiety, and Stress on Ageism Among Undergraduates: Mediating Roles of Life Satisfaction, Gratitude, and Prosociality

Background

The rapid growth of the global aging population highlights the need to address ageism and promote social inclusiveness. While considerable research has explored the impact of perceived ageism on older adults' mental health, limited attention has been given to how negative mental health factors-such as depression, anxiety, and stress (DAS)-influence ageist attitudes among younger populations, along with the psychological mechanisms underlying this relationship.

Purpose

This study first investigates the prevalence of ageism among undergraduates and its variation across certain socio-demographic factors at the research site. It then examines the predictive effects of depression, anxiety, and stress (DAS) on ageism, accounting for these socio-demographic factors. Finally, the study explores how DAS influences ageism both directly and indirectly through life satisfaction, gratitude, and prosociality.

Design and Settings

A cross-sectional study conducted at 11 higher education institutions in Jiangxi, China.

Participants

A total of 1,213 undergraduates participated in the study between July and August 2024. Following data cleaning, 1174 responses were included for analysis.

Methods

Data were collected using online questionnaires. T-tests and ANOVA assessed socio-demographic differences in ageism, and regression analysis examined DAS's predictive effects. Structural Equation Modeling (SEM) explored the pathways linking DAS to ageism via mediators.

Results

A moderate level of ageism was observed, with significant variations across socio-demographic factors like academic year, physical health, and contact with older adults. Depression and stress directly predicted ageism, while anxiety had indirect effects via depression and stress. DAS-as a composite construct-indirectly affected ageism via life satisfaction, gratitude, and prosociality.

Conclusion

Educational interventions should not only target the reduction of ageist attitudes but also address the underlying mental health conditions that fuel these biases. Promoting life satisfaction, gratitude, and prosociality, along with fostering meaningful intergenerational interactions, will be crucial for developing more effective strategies to combat ageism.

Knowledge, attitudes, and practices of vocational college teachers towards occupational burnout

Objective

This study aimed to investigate the knowledge, attitudes, and practices (KAP) of vocational college teachers regarding occupational burnout.

Methods

A cross-sectional study was conducted among teachers from 15 vocational colleges between 20 April 2024 and 20 June 2024. Basic demographic information and KAP scores were collected through a self-developed questionnaire. The Maslach Burnout Inventory-Educators Survey (MBI-ES) was used to assess levels of occupational burnout.

Results

A total of 462 valid questionnaires were analysed, of which 264 (57.14%) respondents were female. The mean knowledge, attitude, and practice scores were 10.04 ± 4.61 (possible range: 0-18), 28.24 ± 3.77 (possible range: 7-35), and 16.68 ± 4.01 (possible range: 6-30), respectively. Multivariate linear regression analysis indicated that knowledge score (β = -0.137, 95% CI: -0.251 to -0.024, p = 0.018), attitude score (β = -0.284, 95% CI: -0.424 to -0.145, p < 0.001), practice score (β = 0.320, 95% CI: 0.193 to 0.446, p < 0.001), and sleep disorders (β = -1.915, 95% CI: -3.345 to -0.486, p = 0.009) were independently associated with MBI-ES scores. Structural equation modeling revealed that knowledge directly influenced attitude (β = 0.410, p < 0.001) and practice (β = 0.312, p = 0.001). Knowledge (β = -0.92, p = 0.024), attitude (β = -2.850, p < 0.001), and practice (β = 1.525, p < 0.001) directly affected burnout.

Conclusion

Although vocational college teachers demonstrate positive attitudes towards addressing occupational burnout, they exhibit insufficient knowledge and passive practices, leading to an increased risk of burnout. Targeted educational interventions are necessary to enhance vocational college teachers' knowledge and skills in managing occupational burnout.

Body satisfaction, problematic smartphone use, sleep deprivation, and psychological well-being in adolescents: A half-longitudinal serial mediation study

The relationships between body satisfaction, problematic smartphone use, sleep deprivation and psychological well-being have been examined with cross-sectional methods. However, the lack of any longitudinal study in which these variables were examined together made it necessary to conduct this study. In this study, we tested whether problematic smartphone use and sleep deprivation serially mediate the relationship between body satisfaction and psychological well-being. After matching the data obtained from the first (T1) and second waves (T2) of the study, the final sample consisted of 222 Turkish adolescents (M = 14.08 years, SD = 0.70). For this purpose, a study was conducted in two separate time waves and structural equation modeling was used to test longitudinal serial mediation between variables. According to the results, problematic smartphone use and sleep deprivation play a serial mediating role in the longitudinal relationship between body satisfaction and psychological well-being.

Network modeling of problematic social media use components in college student social media users

Background

While the constitutive features of problematic social media use (PSMU) have been formulated, there has been a lack of studies in the field examining the structure of relationships among PSMU components.

Method

This study employed network analytic methods to investigate the connectivity among PSMU components in a large sample of 1,136 college student social media users (M age = 19.69, SD = 1.60). Components of PSMU were assessed by the Bergen Social Media Addiction Scale (BSMAS) derived from a components model of addiction. We computed two types of network models, Gaussian graphical models (GGMs) to examine network structure and influential nodes and directed acyclic graphs (DAGs) to identify the probabilistic dependencies among components.

Result

Relapse component consistently emerged as a central node in the GGMs and as a parent node of other components in the DAGs. Relapse and tolerance components exhibited strong mutual connections and were linked to the most vital edges within the networks. Additionally, conflict and mood modification nodes occupied more central positions within the PSMU network for the low-BSMAS-score subgroup compared with the high-BSMAS-score subgroup.

Conclusion

Our findings shed new light on the complex architecture of PSMU and its potential implications for tailored interventions to relieve PSMU.

Necessary Conditions in Social Media Addiction: Identifying Key Antecedents

This study aims to address the fragmented understanding of the antecedents of social media addiction (SMA) by examining key factors and their roles as necessary and sufficient conditions. By integrating key variables from previous research, including the Dark Triad traits, self-regulation, social anxiety, and Fear of Missing Out (FoMO), the study investigates their relationships with SMA. Data were collected through 369 questionnaires and analyzed using regression analysis and Necessary Condition Analysis (NCA). The findings reveal that Machiavellianism, narcissism, and FoMO are significantly associated with SMA, while only Machiavellianism and FoMO are identified as necessary conditions. These results contribute to the theoretical understanding of SMA by identifying critical antecedents and offer practical insights for designing targeted interventions to mitigate its impact.

Longitudinal Interactions between Problematic Internet Gaming and Symptoms of Depression Among University Students: Differentiating Anhedonia and Depressed Mood

BACKGROUND/OBJECTIVE

This study examines the interplay between problematic internet gaming (PIG) and depressive symptoms among university students, specifically anhedonia and depressed mood. Prior studies lacked distinction between these symptoms and had limited follow-ups.

METHOD

The three-wave longitudinal study analyzed data from 1,720 university students (with an average age of 20 years and 49 % being female) using a random intercept cross-lagged panel model, which distinguished between-person and within-person effects.

RESULTS

At the between-person level, PIG was positively associated with two depressive symptoms. At the within-person level, PIG positively predicted future anhedonia. Besides, depressed mood positively predicted future PIG.

CONCLUSIONS

Our results have identified PIG as a risk factor for anhedonia and depressed mood as a risk factor for PIG among university students.

The Impact of Traditional Children's Games on Internet Use, Social Skills, and Stress Level: A Cross-Sectional Design

INTRODUCTION

Traditional games are essential for children's social inclusion due to cultural values and beliefs. This study was conducted to measure the impact of traditional children's games on internet use, social skills, and stress levels.

METHODS

A cross-sectional design was carried out. Children who had parental approval and agreed to participate were included in the study (n = 314). The data were collected using a questionnaire, the Perceived Stress Questionnaire (8-11 years), and the Social Skills Assessment Scale. Linear regression and multinomial logistic regression were performed to analyze the data. Mantel-Haenszel chi-square test was performed to assess the confounding factors for playing traditional games.

RESULTS

The children's mean age was 11.58 (SD = 0.49), and 56.1% were girls. Children who did not play traditional games were more likely to use the internet than those who played traditional games (odds ratio [OR] = 2.16, p = .014). The social skills were significantly associated with daily internet use time (β = 0.164, p = .003), playing traditional games (β = 0.155, p = .008), and frequency of gaming per week (β = 0.123, p = .035). The stress levels were associated with gender (β = 0.120, p = .033) and academic level (β = 0.111, p = .048).

DISCUSSION

Traditional game playing reduced the duration of one sitting and daily internet use. Moreover, outdoor gaming, frequency of playing games, and daily internet use duration were predictors of social skills, whereas being a girl and sixth-grade student were predisposing factors of stress level. Nurses could benefit from traditional games in reducing internet use and stress and improving social skills in children.

The longitudinal relationships between problematic smartphone use and anxiety symptoms among Chinese college students: A cross-lagged panel network analysis

Anxiety and problematic smartphone use (PSPU) are prevalent issues among college students, and traditional research has tended to focus on cross-sectional data and grounded only in overall levels, thereby ignoring the complex interactions between the two over time. The development of network analysis methods has provided a new perspective for in-depth exploration of the relationship. This study aimed to explore the complex longitudinal interactions and specific pathways between problematic smartphone use and anxiety among Chinese college students from an internal specific symptom perspective. This study constructed a cross-lagged network model using longitudinal data on problematic smartphone use and anxiety symptoms in two waves of college students collected from 2022 to 2023 (N=741, Mage = 18.49, SD=0.81, 45.6 % male). The study found that anxiety symptoms and problematic smartphone use interacted with each other and had a vicious cycle of symptoms over time, with the effects of anxiety symptoms being more pronounced. "Feeling afraid" and "Uncontrollable worrying" had the most significant effects on the other symptoms, with "Impatient without the phone" and "Can't stand not having a phone" were more likely to be influenced by other symptoms. "Feeling afraid" may be a bridge symptom in the network to connect the anxiety and problematic smartphone use communities. The findings suggest that accurately intervening in the intrinsic link between problematic smartphone use and anxiety symptoms can combat the exacerbation of both problems simultaneously, resulting in more effective and comprehensive treatment.

Psychometric properties of the Motors of Mpox Vaccination Acceptance Scale among men who have sex with men

An outbreak of monkeypox (Mpox) appeared suddenly and rapidly spread worldwide during 2022. Men who have sex with men (MSM) are at a high risk of contracting Mpox compared to other cohorts. The present study examined the psychometric properties of a newly developed scale among MSM: the Motors of Mpox Vaccination Acceptance Scale (MoMVA) assessing cognitive components of the motivation to receive an Mpox vaccination. In total, 389 MSM participated in an online survey study. The factor structures of the MoMVA were first examined using exploratory factor analysis. After determining the factor structures, the MoMVA was further examined for: (i) internal consistency using Cronbach's α; (ii) concurrent validity using correlations with risk perception of contracting Mpox and intention to receive an Mpox vaccination; and (iii) known-group validity by comparing the scores of the MoMVA between MSM who vaccinated and those who did not. The results indicated that the MoMVA had a two-factor structure (positive and negative motors). The MoMVA had acceptable internal consistency (α = 0.793 to 0.914), concurrent validity (associated with intention to receive an Mpox vaccination), and known-group validity (participants who vaccinated had higher MoMVA scores than those who did not). The results of the present study indicated that the psychometric properties of the MoMVA were good and that they can be used for assessing cognitive components of the motivation to receive an Mpox vaccination among MSM.

Change in intention and hesitancy regarding COVID-19 vaccines in a cohort of adults in Quebec during the pandemic

Although COVID-19 vaccine uptake was high in Quebec for the primary series, vaccine acceptance decreased for the subsequent booster doses. This article presents the evolution of vaccine intention, self-reported vaccination behaviors, and vaccine hesitancy over 2 years. A series of cross-sectional surveys were conducted in Quebec between March 2020 and March 2023, with a representative sample of 3,330 adults recruited biweekly via a Web panel. Panelists could have answered multiple times over the course of the project. A cohort of respondents was created to assess how attitudes and behaviors about COVID-19 vaccines evolved. Descriptive statistics and multivariate logistic regressions were performed. Among the 1,914 individuals with no or low intention of getting vaccinated in Fall 2021 (Period 1), 1,476 (77%) reported having received at least two doses in the Winter 2023 (Period 2). Not believing in conspiracy theory (OR = 2.08, 95% CI: 1.65-2.64), being worried about catching COVID-19 (OR = 2.12, 95% CI: 1.65-2.73) and not living in a rural area (ORs of other areas are 2.27, 95% CI: 1.58-3.28; 1.66, 95% CI: 1.23-2.26; 1.82 95% CI: 1.23-2.73) were the three main factors associated with being vaccinated at Period 2. Among the 11,117 individuals not hesitant at Period 1, 1,335 (12%) became hesitant at Period 2. The three main factors significantly associated with becoming vaccine hesitant were the adherence to conspiracy theories (OR = 2.28, 95% CI: 1.95-2.66), being a female (OR = 1.67, 95% CI: 1.48-1.90) and being younger than 65 years old (the ORs for 18-34, 35-49, and 50-64 compared with 65 and over are 2.82, 95% CI: 2.32-3.44; 2.39, 95% CI: 2.00-2.86 and 1.82, 95% CI: 1.55-2.15 respectively). As the pandemic is over, monitoring the evolution of vaccine attitudes and uptake will be important.

COVID-19 vaccine hesitancy among the Chinese elderly: A multi-stakeholder qualitative study

The United Nations reported that the mortality risk of Corona Virus Disease 2019 (COVID-19) is five times higher in the elderly than the global average. Although the COVID-19 vaccine effectively prevents infections and reduce mortality among the elderly, vaccine hesitancy among the Chinese elderly poses a significant threat. This study, utilizing the "Confidence, Convenience and Complacency (3 Cs)" vaccine hesitancy model, aimed to explore factors contributing to vaccine hesitancy among the Chinese elderly and assess national countermeasures and potential improvement approaches. Thirteen elderly with vaccine hesitancy and eleven vaccine-related staff participated in semi-structured interviews. Thematic analysis revealed three key determinants of vaccine hesitancy among the elderly: perceived low threat of COVID-19, lack of confidence in COVID-19 vaccine, and poor accessibility to vaccination. China has implemented strategies, including advocacy through diverse channels, joint multi-sectoral promotion vaccination, and enhancing ongoing vaccination services. Recommendations from the vaccine-related staff emphasize improving vaccine awareness among the elderly, and prioritizing the vaccination environment and process. The study underscores the importance of targeted vaccination promotion programs addressing hesitation reasons to improve vaccination rates. Furthermore, existing countermeasures can serve as a foundation for enhancing vaccination strategies, including improved publicity, administration, and management approaches.

Parental intention on getting children COVID-19 vaccinations: Invariance evaluation across parenting roles and COVID-19-like symptoms experiences among Iranians during the pandemic period

Countries worldwide are facing challenges with increasing the COVID-19 vaccination rates for children. This study examined associations between perceived knowledge, coping appraisal, threat appraisal, adaptive response, maladaptive response, and intention, and possible variance across parents (mother or father) and COVID-19-like symptoms experiences regarding parental intentions to vaccinate their children. A total of 836 Iranian parents with children between the ages of 6 and 12 y completed measures assessing perceived knowledge, coping appraisals, threat appraisals, intentions, adaptive responses, and maladaptive responses. Multigroup structural equation modeling revealed that perceived knowledge was positively associated with both coping and threat appraisals, coping appraisals positively associated with adaptive responses, maladaptive responses, and intentions to vaccinate, threat appraisals positively associated with adaptive and maladaptive responses, and adaptive responses positively associated with intentions to vaccinate. The invariance evaluation revealed no differences across parents or COVID-19-like symptoms experiences in parental intentions to get their children vaccinated. The findings suggest that cogent information regarding childhood COVID-19 vaccination may boost parents' knowledge influencing their appraisals, adaptive responses and intentions to vaccinate their children. Specifically, coping appraisals and adaptive responses appeared to be important mediators between knowledge and intentions to vaccinate. Furthermore, intentions to vaccinate children may not be strongly influenced by parental roles or COVID-19-like symptoms experiences. These findings may help multiple stakeholders promote COVID-19 vaccination rates among children, and countries should further examine ways of increasing rates based on their specific needs.