Factor Structure of the CES-D and Measurement Invariance Across Gender in Mainland Chinese Adolescents

Gender, age, and longitudinal measurement invariance of child and adolescent depression scales: A systematic review

Understanding developmental trajectories and gender differences in depressive symptoms is clinically relevant. Discerning true differences across gender, age groups, and time is based on the often-neglected premise of measurement invariance (MI) of child and adolescent depression scales. In this systematic review, we assessed available evidence for MI across gender, age groups, and time for depression scales validated in children and adolescents, in studies with at least one assessment under age 18. A literature search using Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases identified 42 studies that examined MI. MI of eleven scales was tested in 1-9 studies per scale. Conclusions are hampered by different factor solutions tested within some scales. All included questionnaires showed preliminary evidence for MI across gender. Across some studies, crying had higher factor loadings in females compared to males, indicating that crying may be differently related to depression across gender. MI evidence was preliminary in just four scales across time, mostly confined to ages 13-17. One study showed developmental conclusions differed when non-invariance is not accounted for in observed scores. Overall, evidence for MI in child and adolescent depression scales is currently limited.

School Bullying Victimization and Depression Symptoms in Adolescents: The Mediating Role of Internet Addiction and Moderating Role of Living Areas

School bullying and depression are both serious social and public health problems among adolescents. Prior studies indicated a correlation between bullying and depression. However, the potential moderators remain largely unexplored. This study aimed to identify the mediating effect of Internet addiction and the moderating effect of living in urban or rural areas in the relationship between school bullying victimization and depression symptoms among Chinese adolescents. This cross-sectional study of adolescents was conducted using two-stage random cluster sampling of students in urban and rural public high schools in China. A moderated mediation model was constructed to uncover the underlying mechanism of school bullying victimization and depression symptoms. A total of 2,376 adolescents (52.65% females, mean age ± SD a 14.69 ± 1.76 years) were included in the study. The prevalence of clinical depression symptoms with a cut-off value of 16 on the Center for Epidemiological Studies Depression Scale (CES-D) was 21.76% (95% CI: 20.15, 23.46), and with a cut-off value of 20 on the CES-D was 13.85% (95% CI: 12.51, 15.30) for overall. Our findings indicated a significant positive association between school bullying victimization and depression symptoms (p < 0.01) and a significant mediating effect of Internet addiction in the association between school bullying victimization and depression symptoms (indirect effect = 1.143, 95% CI: 0.677, 1.609; percentage of mediation: 16.7%, 95% CI: 10.3, 23.1). This indirect relationship was partially moderated by the living in urban or rural areas in the mediation process. Specifically, the effect of school bullying victimization on Internet addiction was greater among urban adolescents (simple slope: 0.774, 95% CI: 0.524, 1.024, p < 0.01) than among rural adolescents (simple slope: 0.337, 95% CI: 0.132, 0.543, p < 0.01), but moderating effect of urban-rural areas was not significant on the relationship between Internet addiction and depression symptoms. These findings highlight the mediating role of Internet addiction and the moderating role of living areas in school bullying victimization and adolescents' depression symptoms, which provide evidence for social work, mental health services, and policy interventions for adolescents in China.

Childhood emotional abuse and depression symptoms among Chinese adolescents: The sequential masking effect of ruminative thinking and deliberate rumination

BACKGROUND

This study delves into the relationship between childhood trauma and adolescent depression symptoms, specifically examining the distinct roles of ruminative thinking and deliberate rumination in mediating this connection. The focus is on exploring whether these cognitive processes, namely ruminative thinking and deliberate rumination, operate differently and sequentially in mediating the impact of childhood emotional abuse (CEA) on the development of depression symptoms among Chinese adolescents.

METHODS

The study involved gathering data from 489 adolescents, with a relatively balanced gender distribution (44.79 % males and 55.21 % females). The average age of the participants was 16.92 years, with a standard deviation of 0.67. Data collection took place in two Chinese high schools, and participants were tasked with completing assessments related to CEA, ruminative thinking, deliberate rumination, and depression symptoms. The interplay among these variables was then examined using a serial mediation model.

RESULTS

The findings of the study indicate that CEA not only exhibited a direct association with adolescent depression symptoms but also exerted indirect effects through distinct mediating mechanisms involving ruminative thinking and deliberate rumination. Specifically, ruminative thinking was identified as a mediator, whereas deliberate rumination emerged as a buffer in the relationship between CEA and depression. Additionally, ruminative thinking and deliberate rumination partially masked the effect of CEA on adolescent depression symptoms in a sequential pattern.

CONCLUSIONS

Regarding the link from CEA to adolescent depression symptoms, ruminative thinking is an adverse mediator while deliberate rumination appears to play a benign role. Consequently, the promotion of a shift from ruminative thinking to deliberate rumination is proposed as a promising strategy for alleviating the detrimental effects of CEA on adolescent depression.

Explaining child maltreatment and aggression among Chinese drug user: The mediating and moderating roles of drug craving and impulsivity

BACKGROUND

The cycle of violence highlights a strong correlation between child maltreatment and aggression. However, there remains a significant gap in the pathway models of the cycle of violence. Given the exceptionally high rates of child maltreatment and violent crime among Chinese drug users, it is essential to examine the mechanisms of the cycle of violence within this group.

OBJECTIVE

The current study incorporates drug craving and impulsivity into the child maltreatment-aggression mechanism. We explore the potential mediating and moderating roles of these variables and further examine the heterogeneity.

PARTICIPANTS AND SETTING

A total of 894 participants (Meanage = 38.30, SDage = 8.38) were recruited as the final sample.

METHODS

We employed moderated mediation and serial mediation models to explore the roles of drug craving and impulsivity. The Johnson-Neyman method was utilized to investigate moderating effects. Rich demographic variables and depression were controlled.

RESULTS

There was no direct relationship between child maltreatment and aggression. The moderated mediation model indicated that drug craving played a mediating role, and there was a substitutive relationship between impulsivity and drug craving. The serial mediation model showed that child maltreatment could only affect drug craving (not impulsivity) and could ultimately influence aggression through a chain relationship. Heterogeneity tests revealed that the mechanisms might differ among various types of maltreatment.

CONCLUSION

Drug craving holds a significant position in the cycle of violence. Compared to impulsivity, it is a more proximal factor to child mistreatment. Future research should also focus on the heterogeneity of child maltreatment for targeted interventions.

Executive function performance in children and adolescent patients with narcolepsy type 1

OBJECTIVE

The executive function profile in patients with narcolepsy type 1 (NT1) has been mentioned; however, limited research exists on children and adolescent patients with NT1.This study aims to assess executive function in children and adolescent patients with NT1 in China, examine potential influencing factors and evaluate the short-term treatment effect on executive function.

METHODS

53 NT1 patients (36 males, age 12.2 ± 3.4 years) and 37 healthy controls (23 males, age 12.2 ± 2.5 years) underwent self-reported measures assessing subjective sleepiness, depression, anxiety and sleep quality. A comprehensive neuropsychological test was administered to assess executive function domains, including processing speed, inhibitory control, cognitive flexibility and working memory. These assessments were repeated in NT1 patients after three-day regular drug treatment.

RESULTS

NT1 patients exhibited higher levels of excessive daytime sleepiness, depression, anxiety, and poor sleep quality compared to healthy controls. Patients showed impaired processing speed, inhibitory control and cognitive flexibility (p < 0.05), whereas working memory was unaffected (p > 0.05). Regression analysis revealed that parameters from sleep monitoring, such as sleep efficiency and sleep latency, were correlated with executive function performance after controlling for age, gender, and education years. The short-term treatment led to improvements in inhibitory control, cognitive flexibility, and working memory.

CONCLUSION

The findings showed that executive function was impaired among children and adolescent patients with NT1, which was associated with objective sleep parameters. Furthermore, this study emphasizes the necessity of neuropsychological assessments and early interventions among children and adolescent NT1 patients.

Factor structure and longitudinal invariance for the Chinese Mainland version of the Edinburgh postnatal depression scale during pregnancy

BACKGROUND

There are inconsistent results on the Edinburgh Postnatal Depression Scale's (EPDS) factor structure and longitudinal invariance among different cultures. Furthermore, limited relevant studies in Chinese pregnant women exist.

PURPOSE

To test the factor structure of the Chinese Mainland EPDS during pregnancy and conduct longitudinal invariance analyses.

METHODS

A national multi-centre cohort study was conducted among 1207 pregnant women selected consecutively by convenience sampling from five hospitals in Zhuhai, Taiyuan, Haidian, Changchun, and Shenzhen in China between August 2015 and October 2016. Depression was measured by the EPDS during gestational weeks 10-13, 15-18, 23-25, 30-32 and 36-37, respectively.s RESULTS: Three factors with eigenvalues nearly larger than 1.0 were optimal for the Chinese Mainland EPDS, labelled "anxiety," "anhedonia," and "depression," and contained items 3-5, 1-2, and 6-10, respectively. The confirmatory factor analysis results of standardized root mean square residual (SRMR) = 0.034, root mean square error of approximation (RMSEA) = 0.049, comparative fit index (CFI) = 0.968, Tucker-Lewis index (TLI) = 0.954, and χ2, p < 0.05 indicated good fit. For the longitudinal invariance tests, the configural invariance was met, with the CFI and TLI both higher than 0.90 and the RMSEA lower than 0.08 (CFI = 0.919, TLI = 0.908, and RMSEA = 0.034). The metric-, scalar-, and strict invariances were met.

CONCLUSIONS

The three-factor model of the Chinese Mainland EPDS is invariant in pregnancy, suggesting stability and comparability in identifying the women screened positive at different points during pregnancy and making the scale feasible to screen prenatal depression and anxiety simultaneously.

A Chinese adaptation of the Patient Health Questionnaire for Adolescents (PHQ-A): factor structure and psychometric properties

BACKGROUND

To examine the factor structure and psychometric properties of the Patient Health Questionnaire for Adolescents (PHQ-A) in Chinese children and adolescents with major depressive disorder (MDD).

METHODS

A total of 248 MDD patients aged between 12 and 18 years were recruited and evaluated by the Patient Health Questionnaire for Adolescents (PHQ-A), the Center for Epidemiological Survey Depression Scale (CES-D), the Mood and Feelings Questionnaire (MFQ), and the improved Clinical Global Impression Scale, Severity item (iCGI-S). Thirty-one patients were selected randomly to complete the PHQ-A again one week later. Confirmatory factor analysis (CFA) was used to test the construct validity of the scale. Reliability was evaluated by Macdonald Omega coefficient. Pearson correlation coefficient was used to assess the item-total correlation and the correlation of PHQ-A with CES-D and MFQ respectively. Spearman correlation coefficient was used to assess test-retest reliability. The optimal cut-off value, sensitivity, and specificity of the PHQ-A were achieved by estimating the Receiver Operating Characteristics (ROC) curve.

RESULTS

CFA reported adequate loadings for all items, except for item 3. Macdonald Omega coefficient of the PHQ-A was 0.87. The Spearman correlation coefficient of the test-retest reliability was 0.70. The Pearson correlation coefficients of the PHQ-A with CES-D and MFQ were 0.87 and 0.85, respectively (p < 0.01). By taking the iCGI-S as the remission criteria for MDD, the optimal cut-off value, sensitivity and specificity of the PHQ-A were 7, 98.7%, 94.7% respectively.

CONCLUSION

The PHQ-A presented as a unidimensional construct and demonstrated satisfactory reliability and validity among the Chinese children and adolescents with MDD. A cut-off value of 7 was suggested for remission.

How Coparenting Is Linked to Depression among Chinese Young Girls and Boys: Evidence from a Network Analysis

This study aimed to explore the relationship between parental coparenting and depression among Chinese young adolescents and potential gender differences via network analysis. Thus, 793 fourth-grade students (girls: 281 (35.40%), Mage = 9.99 years, SD = 0.59 years) were recruited from three primary schools in Northern China. The young adolescents rated their depression and perceived paternal and maternal coparenting. Network analysis was used to detect the central nodes and bridge mechanisms among coparenting and depressive components. The results indicated that paternal and maternal consistency as well as maternal conflict were the most central components in the coparenting-depression network. Paternal consistency, maternal conflict and paternal disparagement in coparenting, as well as somatic complaints and positive affect in adolescents' depression, exhibited high bridge strengths, suggesting those constructs served as vital bridges to connect the two subnetworks. Moreover, paternal consistency showed a higher bridge strength in the boys' network than the girls' one, whereas the edge linking adolescents' positive affect to paternal disparagement and integrity was stronger in the girls' network. This study contributes to the understanding of associations between parental coparenting and young adolescents' depression and offered insights into targeted interventions for early adolescent depression by enhancing parental coparenting.

A bifactor representation of the Center for Epidemiological Studies Depression Scale for children: gender and age invariance and implications for adolescents' social and academic adjustment

BACKGROUND

The Center for Epidemiological Studies Depression Scale for Children (CES-DC) is a widely used scale for screening depressive symptoms in children and adolescents. This study aims to uncover the optimal factor structure of the DES-DC and presents an alternate conceptualization of adolescent depression by estimating bifactor models and several competing models using a sample of Chinese adolescents.

METHODS

The participants were 533 adolescents (49.7% boys, 49.7% girls, 3 participants did not report) between 12 and 18 years of age attending public secondary schools in the middle part of mainland China. Data were collected in classrooms using a questionnaire survey. A structural equation modeling approach was used to estimate and compare a series of competing models for the DES-DC.

RESULTS

A Bifactor exploratory structural equation model (Bi-ESEM) with the best model fit was retained for representing the current data. Tests of measurement invariance demonstrated strict measurement equivalence across gender and age. No gender and age differences have been found in the general depression factor. Findings provided evidence for the composite reliability and construct validity of DES-DC. Depressive symptoms positively related to the Big Five trait neuroticism, negative emotions, loneliness, social anxious behaviors, and disruptive behaviors during school and negatively related to agreeableness, conscientiousness, extraversion, physical health status, school connectedness, and academic self-efficacy.

CONCLUSIONS

This study provides support for the one general factor construct of the CES-DC and the continuum concept structure of adolescent depression. Moreover, this research offers empirical evidence for comparing depression symptoms among adolescent populations with diverse genders and age groups. Additionally, the findings replicate and expand upon the implications of depressive symptoms on adolescents' traits, well-being, social-relational adjustment, and academic adaptation.

Altered intrinsic functional network connectivity is associated with impulsivity and emotion dysregulation in drug-naïve young patients with borderline personality disorder

BACKGROUND

Despite impulse control and emotion regulation being altered in borderline personality disorder (BPD), the specific mechanism of these clinical features remains unclear. This study investigated the functional connectivity (FC) abnormalities within- and between- default mode network (DMN), salience network (SN), and central executive network (CEN) in BPD, and examined the association between aberrant FC and clinical features. We aimed to explore whether the abnormal large-scale networks underlie the pathophysiology of impulsivity and emotion dysregulation in BPD.

METHODS

Forty-one young, drug-naïve patients with BPD (24.98 ± 3.12 years, 20 males) and 42 healthy controls (HCs; 24.74 ± 1.29 years, 17 males) were included in resting-state functional magnetic resonance imaging analyses. Independent component analysis was performed to extract subnetworks of the DMN, CEN, and SN. Additionally, partial correlation was performed to explore the association between brain imaging variables and clinical features in BPD.

RESULTS

Compared with HCs, BPD showed significant decreased intra-network FC of right medial prefrontal cortex in the anterior DMN and of right angular gyrus in the right CEN. Intra-network FC of right angular gyrus in the anterior DMN was significantly negatively correlated with attention impulsivity in BPD. The patients also showed decreased inter-network FC between the posterior DMN and left CEN, which was significantly negatively correlated with emotion dysregulation.

CONCLUSION

These findings suggest that impaired intra-network FC may underlie the neurophysiological mechanism of impulsivity, and abnormal inter-network FC may elucidate the neurophysiological mechanism of emotion dysregulation in BPD.

Parental Phubbing and Adolescent Depressive Symptoms during COVID-19: A Serial Meditating Model

BACKGROUND

During the COVID-19 pandemic, depressive symptoms, a common emotional problem among adolescents, have become more prominent. Regarding the influencing factors of adolescent depressive symptoms, it is widely accepted that parents' problematic cellphone use around the family (specifically parental phubbing) is a strong predictive factor for the development of depressive symptoms among adolescents. Notably, the COVID-19 pandemic caused a sharp increase in the number of individuals with depressive symptoms, and the negative consequences of parental phubbing and depressive symptoms might have been exacerbated. Accordingly, this study aimed to examine the association between parental phubbing and adolescent depressive symptoms as well as their underlying mechanism.

METHOD

To test our hypotheses, we conducted an offline/online survey with 614 adolescents in Central China from May to June 2022, which corresponded to a period of strict lockdowns in some areas due to the outbreak of the Omicron variant. The participants completed a set of measures, including a technology interference questionnaire, a parent-child relationship scale, a self-concept clarity scale, and the depressive symptoms scale.

RESULTS

Parental phubbing was positively associated with adolescent depressive symptoms; the parent-child relationship and self-concept clarity could independently mediate this relationship; and the parent-child relationship and self-concept clarity were also serial mediators in this association. These findings extend previous research by highlighting the impact of parental technology use on their children and the underlying mechanism explaining adolescent depressive symptoms. They provide practical recommendations for parents to prioritize fostering a positive family environment and minimizing phubbing behaviors to enhance adolescent development, particularly in the context of the COVID-19 pandemic.

The reciprocal relations among self-compassion, and depression among adolescents after the Jiuzhaigou earthquake: A three-wave cross-lagged study

BACKGROUND

Previous cross-sectional studies have examined the relationship between self-compassion and depression. Although it is often implicitly assumed that self-compassion may increase the vulnerability of an individual to depression, only a few studies have assessed whether self-compassion is a cause or a consequence of depression or both.

METHOD

To examine such reciprocal effects, we assessed self-compassion and depression via self-report measures. At the baseline assessment (Time 1, T1), 450 students (M = 13.72, SD = 0.83, 54.2% females) participated 10 months after the Jiuzhaigou earthquake. We reassessed the T1 sample after 6- and 12-month intervals. At Time 2 (T2) assessment, 398 (56.0% female participants) of the Wave 1 participants were retained, and at Time 3 (T3) assessment, 235 (52.5% female participants) of the T1 and T2 participants were retained.

RESULTS

Cross-lagged analyses indicated that positive self-compassion could significantly reduce subsequent depression. However, depression did not significantly predict later positive self-compassion. Negative self-compassion at T1 increased depression at T2, but negative self-compassion at T2 did not significantly predict depression at T3. In addition, positive self-compassion significantly reduced subsequent negative self-compassion.

CONCLUSIONS

Positive self-compassion appears to protect adolescents against depression and maintain this protection over time, whereas negative self-compassion may worsen depression in adolescents during the initial stages of traumatic events. Additionally, positive self-compassion may decrease the level of negative self-compassion.

Association between bullying victimization, coping style, and mental health problems among Chinese adolescents

BACKGROUND

This study aimed to examine the association of bullying victimization with anxiety and depressive symptoms among Chinese adolescents and explored the role of coping styles in the foregoing associations.

METHOD

Data were drawn from the 2019 School-based Chinses Adolescents Health Survey (n = 19,809). Information about bullying victimization, coping styles, anxiety symptoms, and depressive symptoms were measured. Linear mixed-effects models were performed.

RESULTS

After adjusting for covariates, verbal victimization (β = 1.94 for anxiety symptoms; β = 4.62 for depressive symptoms), relational victimization (β = 3.40 for anxiety symptoms; β = 8.37 for depressive symptoms), physical victimization (β = 2.63 for anxiety symptoms; β = 6.07 for depressive symptoms) and cyber victimization (β = 4.68 for anxiety symptoms; β = 10.72 for depressive symptoms) were associated with anxiety and depressive symptoms. Moreover, the severity of anxiety and depressive symptoms tended to increase with the number of victimization types. The interaction effects between bullying victimization and coping style on anxiety and depressive symptoms were significant. Further stratified analyses by coping styles indicated that the association of relational and cyber victimization on anxiety and depressive symptoms were significantly stronger in adolescents with negative coping style than in those with positive coping style.

LIMITATIONS

Causal inference is limited due to the cross-sectional design.

CONCLUSION

Bullying victimization is associated with anxiety and depressive symptoms, and coping styles may play a moderate role in these associations. Interventions to promote mental health could focus on developing positive coping styles, particularly among adolescents with bullying victimization.

Psychological maltreatment and depression symptoms among Chinese adolescents: A multiple mediation model

BACKGROUND

Adolescents are at risk of depression, and recent studies also found a high prevalence of depression among Chinese adolescents. Therefore, it is necessary to explore the risk and protective factors of depression among Chinese adolescents.

OBJECTIVE

This study examined the direct effect of psychological maltreatment on depression symptoms in adolescents and the mediating roles of emotion regulation and social support in their relationship.

METHOD

Data were collected from Chinese senior high school students (N = 687, 36.5 % males and 63.5 % females, M_age = 16.44 years, SD = 0.78) who completed the measures of psychological maltreatment, depression symptoms, perceived social support, and emotion regulation strategies, including cognitive reappraisal and expressive suppression.

RESULTS

The results indicated that: (a) psychological maltreatment was positively correlated with depression symptoms; (b) the two emotion regulation strategies and perceived social support partially mediated the link between psychological maltreatment and depression symptoms separately; (c) the two emotion regulation strategies and perceived social support partially mediated the link between psychological maltreatment and depression symptoms in a sequential pattern.

CONCLUSION

Psychological maltreatment was positively associated with depression symptoms in adolescents. Emotion regulation and perceived social support both significantly mediated the relationship between psychological maltreatment and depression symptoms.

Direct and Indirect Effects of Strength-Based Parenting on Depression in Chinese High School Students: Mediation by Cognitive Reappraisal and Expression Suppression

PURPOSE

A growing amount of research has been dedicated to the protective role of strength-based parenting in psychological distress. Strength-based parenting is a style of parenting in which parents are conscious of their children's strengths, and encourage them to develop and make use of those strengths. However, the mechanisms linking strength-based parenting to depression are not well known. Drawing on the social-emotional learning model, this study examined the association between strength-based parenting and depression and the indirect role of emotion regulation (ie, cognitive reappraisal and expression suppression).

MATERIALS AND METHODS

A total of 750 Chinese middle school students from two middle schools completed questionnaires comprising the Strength-based Parenting Scale, the Emotion Regulation Scale, the Center for Epidemiologic Studies Depressive Scale, and sociodemographic characteristics. A total of 695 students provided accurate responses to the two validity check questions, and were thus retained in the final study sample. Of the final sample, 348 (50.1%) were girls, and the respondents overall had an average age of 16.22 years. The direct and indirect paths from strength-based parenting to depression were analyzed using structural equation modeling.

RESULTS

The results showed that strength-based parenting negatively predicted depression and cognitive reappraisal, while strength-based parenting positively predicted depression. Strength-based parenting indirectly predicted depression through cognitive reappraisal and expression suppression.

CONCLUSION

These findings suggest an underlying process by which high strength-based parenting resists depression by increasing cognitive reappraisal and decreasing expression suppression. It is necessary to implement a comprehensive intervention strategy that focuses on strength-based parenting and emotion regulation (eg, cognitive reappraisal).

Social Exclusion and Depression among undergraduate students: the mediating roles of rejection sensitivity and social self-efficacy

Nowadays, depression has been a prominent mental health problem throughout the world. A common but negative social experience, social exclusion (also known as ostracism) is a great risk factor for individuals' health and adaptation. Undergraduate students are in a development period of challenges and transitions, so they are vulnerable to suffering from depression and negative social experiences. Against this background, the present study aimed to examine the association between social exclusion and undergraduate students' depression as well as the underlying mechanism - the mediating roles of rejection sensitivity and social self-efficacy. Seven hundred sixty-two undergraduate students were recruited to participate in this study, who were asked to complete a set of questionnaires measuring social exclusion, depression, rejection sensitivity, and social self-efficacy. After controlling for gender, social exclusion was positively associated with undergraduate students' depression. And rejection sensitivity and social self-efficacy could significantly mediate this relation through three mediating paths - the separate mediating effects of rejection sensitivity and social self-efficacy, as well as the serial mediating effect of rejection sensitivity and social self-efficacy. These results could not only deepen our understanding of this theme, but also have several practical implications for the intervention of depression, for example, relevant social skill training and cognitive therapy could be adopted to intervene the rejection sensitivity and social self-efficacy.

Why is my world so dark? Effects of child physical and emotional abuse on child depression: The mediating role of self-compassion and negative automatic thoughts

BACKGROUND

The adverse effects of childhood maltreatment on the mental health of individuals have received increasing attention. However, it is unclear whether the effects of invisible emotional abuse and visible physical abuse differ on child depression and the mediating processes under this relationship.

OBJECTIVE

This study aimed to investigate whether self-compassion and negative automatic thoughts mediated the effects of physical abuse and emotional abuse on child depression and the underlying mechanistic differences.

PARTICIPANTS AND SETTING

Using a two-wave longitudinal design, a total of 946 elementary school students completed the self-report questionnaires at two-time points, including child abuse, self-compassion, negative automatic thoughts, and depression.

METHODS

This study constructed structural equation models (SEM) to examine the mediating role of self-compassion and negative automatic thoughts between emotional/physical abuse and child depression.

RESULTS

After controlling for demographic covariates, structural equation modeling (SEM) showed that only physical abuse significantly and positively predicted child depression directly (β = 0.16, p < 0.01). Emotional abuse was positively associated with child depression through self-compassion (β = 0.02, p < 0.05) and negative automatic thoughts (β = 0.02, p < 0.05), while physical abuse influenced child depression only via negative automatic thoughts (β = 0.07, p < 0.001).

CONCLUSIONS

The findings showed a strong association between emotional/physical abuse and child depression, but there were mechanistic differences under these relationships. Therefore, we also need to pay equal attention to the adverse effects of emotional abuse on children.

Associations of intensity and emotional connection related to online social networking use on the risk of incident depression among Chinese adolescents: A prospective cohort study

OBJECTIVE

To investigate the longitudinal prediction of intensity and emotional connection (EC) related to online social networking use at baseline on the risk of incident depression at nine-month follow-up among adolescents.

METHODS

A total of 3196 secondary school students, who were online social networking users and free of depression at baseline, were included in this study. Multilevel logistic regression models were applied to investigate the longitudinal prediction of two dimensions of online social networking use intensity (social function use intensity (SFUI), entertainment function use intensity (EFUI)) and EC scores at baseline on incident depression at follow-up.

RESULTS

The incidence of depression was 23.37 per 100-person-years during a nine-month follow-up period. Baseline SFUI and EFUI scores were significantly associated with higher level of incident depression (adjusted OR = 1.017, 95% CI: 1.004-1.029 for SFUI, p = 0.010; adjusted OR = 1.046, 95% CI: 1.012-1.080 for EFUI, p = 0.007), after adjustment of significant background factors and baseline depressive symptom score. The associations of EC at baseline and its interaction with SFUI and EFUI on incident depression were statistically non-significant.

CONCLUSION

Online social networking use seems be a risk factor of depression among adolescents, regardless of its specific functions. Early intervention is recommended to reduce the level of online social networking use intensity as a means of preventing depression among adolescents.

Differential Effects of Optimism and Pessimism on Adolescents' Subjective Well-Being: Mediating Roles of Reappraisal and Acceptance

Prior research has found the differential strength of optimism and pessimism in predicting physical health. However, whether similar findings would be obtained in predicting subjective well-being and the possible underlying mechanisms are still unclear. This study examined the relative strength of optimism and pessimism in predicting adolescent life satisfaction and depression, and further explored the possible mediating mechanisms from the perspective of emotion regulation. A sample of 2672 adolescents (M_age = 13.54 years, SD = 1.04; 55.60% boys) completed a survey assessing optimism and pessimism, the habitual use of reappraisal and acceptance strategies, life satisfaction, and depression. The results from dominance analysis revealed that the presence of optimism was more powerful than the absence of pessimism in predicting adolescent life satisfaction, while the absence of pessimism was more powerful than the presence of optimism in predicting adolescent depression. Moreover, mediation models showed that reappraisal and acceptance mediated both the link between optimism and life satisfaction and the link between pessimism and depression. These findings suggest possible avenues for intervening in different aspects of adolescent subjective well-being.

Psychometric Properties and Measurement Invariance of the Childhood Trauma Questionnaire (Short Form) Across Genders, Time Points and Presence of Major Depressive Disorder Among Chinese Adolescents

Purpose

The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a widely used self-report tool designed to assess juveniles' experiences of abuse and neglect. The current study examined the psychometric properties, particularly measurement invariance of the CTQ-SF in Chinese non-clinical adolescents and adolescents with major depressive disorder (MDD).

Methods

Participants included 1,507 high school students (non-clinical sample) from Hunan Province and 281 adolescent patients with major depressive disorder (MDD sample) from The Second Xiangya Hospital. We examined the reliability and validity of CTQ-SF, confirm the five-factor model of the CTQ-SF. Multiple-group confirmatory factor analysis (CFA) was used to examine the measurement invariance across genders, presence of depression, and over time.

Results

The CTQ-SF had good internal consistency in a non-clinical sample (Cronbach's α = 0.85) and MDD sample (Cronbach's α = 0.86). Good test-retest reliability (ICC = 0.72) and Adequate validity were also observed. Good fit of the five-factor CTQ-SF model was confirmed in both samples. Multiple-group CFA confirmed that the CTQ-SF had the scalar invariance across genders and the presence of MDD, as well as over time.

Conclusion

The CTQ-SF is an effective and reliable tool for assessing child maltreatment in Chinese adolescents (non-clinical sample and MDD sample). The results suggest that the horizontal and longitudinal invariance of CTQ-SF are strongly established, which means CTQ-SF can be meaningfully used to compare outcomes among Chinese adolescents (non-clinical sample and MDD sample). The experience of child maltreatment, especially neglect (emotional and physical), was found to be common in Chinese adolescents.

Depressive Symptoms and Mortality Among Middle-Aged and Older Adults in South Korea

OBJECTIVE

This study's aim is to verify the longitudinal effect of depressive symptoms on all-cause mortality depending on the age group.

METHODS

The Korean Longitudinal Study of Aging's data from 2006 to 2016 were assessed using longitudinal data analysis, and 10,145 participants (age [mean±standard deviation], 61.7±11.1 years; males, 4,426 [43.6%]; females, 5,719 [56.4%]; middle-aged adults, 6,036 [59.5%]; older adults, 4,109 [40.5%]) were included at baseline. The chi-square test, log-rank test, factor analysis, and Cox proportional hazards models were used to investigate the association between depressive symptoms and mortality. To verify that which feelings and behaviors are associated with mortality, factor analysis was used to Center for Epidemiologic Studies Depression (CES-D) scale and it was divided into two factors: negative and positive affects.

RESULTS

The hazard ratio (HR) of all-cause mortality for the Q1 (high) of the negative affect factor was higher than the Q3 (low) of this factor (HR, 1.489; 95% confidence interval, 1.284-1.728). Additionally, the association between negative affect and all-cause mortality was stronger in middle-aged adults than older adults.

CONCLUSION

The study provided evidence of the longitudinal effect of depressive symptoms on all-cause mortality regardless of age. However, middle-aged adults could be more sensitive to negative feelings and behaviors than older adults.

Long-term effects of a social media-based intervention, Run4Love, on depressive symptoms of people living with HIV: Three-year follow-up of a randomized controlled trial (Preprint)

Background

Emerging studies have shown the effectiveness of mobile health (mHealth) interventions in reducing depressive symptoms among people living with HIV. Most of these studies included only short-term follow-up, with limited data on long-term effects.

Objective

The purpose of this study is to assess the long-term effects of a randomized controlled trial called Run4Love on depressive symptoms among people living with HIV at 1-year and 3-year follow-ups.

Methods

A total of 300 people living with HIV with depressive symptoms were recruited and randomized to an intervention or a control group in Guangzhou, China, from September 2017 to January 2018. The intervention group received a 3-month Run4Love program, including adapted evidence-based cognitive behavioral stress management courses and exercise promotion via WeChat (Tencent), a popular social media app. The control group received usual care and a brochure on nutrition. The primary outcome was reduction in depressive symptoms, measured using the Center for Epidemiological Studies–Depression (CES-D) scale. Data used in this study were collected at baseline and at the 1-year and 3-year follow-ups. Generalized estimating equations were used to examine the group differences at 1-year and 3-year follow-ups.

Results

Approximately half of the participants completed the assessment at 1-year (149/300, 49.7%) and 3-year (177/300, 59%) follow-ups. At 1-year follow-up, participants in the intervention group reported significant reduction in depressive symptoms compared with the control group (CES-D: from 23.9 to 18.1 in the intervention group vs from 24.3 to 23.3 in the control group; mean −4.79, SD 13.56; 95% CI −7.78 to −1.81; P=.002). At 3-year follow-up, between-group difference in CES-D remained statistically significant (from 23.9 to 20.5 in the intervention group vs from 24.3 to 24.4 in the control group; mean −3.63, SD 13.35; 95% CI −6.71 to −0.54; P=.02). No adverse events were reported during the 3-year follow-up period.

Conclusions

The mHealth intervention, Run4Love, significantly reduced depressive symptoms among people living with HIV, and the intervention effects were sustained at 1-year and 3-year follow-ups. Further research is needed to explore the mechanisms of the long-term effects of mHealth interventions such as Run4Love and to implement these effective interventions among people living with HIV.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR-IPR-17012606

International Registered Report Identifier (IRRID)

RR2-10.2196/10274

Validation and Psychometric Testing of the Chinese Version of the Mental Health Literacy Scale Among Nurses

The Mental Health Literacy Scale (MHLS) is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale (MHLS-C) and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin's translation model and tested with a sample of 872 clinical registered nurses. The Jefferson Scale of Empathy-Health Professionals (JSE-HP), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder-2 (GAD-2) were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named "knowledge of mental disorder," "ability to seek information and help," "recognition of mental disorder," and "acceptance of patients with mental illness," with factor 1-3 were summarized into MHLS-Core (Core literacy subscale) and factor 4 as MHLS-SA (Social acceptance subscale). The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 (-0.111, -0.081) and highly positively correlated with JSE-HP (0.492). The Cronbach's α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients (ICCs) of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50 th percentile for the MHLS-C was 99, with 50 th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended.

Longitudinal associations between problematic Internet use, self-esteem, and depressive symptoms among Chinese adolescents

Problematic Internet use (PIU) has a negative impact on self-esteem among adolescents, thereby making them be vulnerable to developing depressive symptoms. However, there is a lack of longitudinal studies focusing on the process. This study aimed to explore the longitudinal associations between PIU, self-esteem, and depressive symptoms. A total of 1,736 adolescents completed this longitudinal study. The baseline survey was conducted in 2019, and the follow-up surveys were performed at 1-year and 2-year later. PIU, self-esteem, and depressive symptoms were measured. A cascade model was used to examine the longitudinal associations between PIU, self-esteem, and depressive symptoms. The mean age of participants was 13.6 (1.5) years at baseline. The final results observed significant within-time associations between PIU, self-esteem, and depressive symptoms at each time point. PIU and low level of self-esteem could predict subsequent depressive symptoms among adolescents, and depressive symptoms were also associated with subsequent PIU and self-esteem. Both PIU and self-esteem show bidirectional predictions with depressive symptoms among Chinese adolescents. Schools and parents should give more attention to adolescents prone to developing depressive symptoms and more social support to reduce their negative emotions. Health-related professionals should incorporate practical knowledge and skills into the education of adolescents to help them better control Internet use, attenuating the risk of future depressive symptoms.

Dose-Response Effects of Patient Engagement on Health Outcomes in an mHealth Intervention: Secondary Analysis of a Randomized Controlled Trial

Background

The dose–response relationship between patient engagement and long-term intervention effects in mobile health (mHealth) interventions are understudied. Studies exploring long-term and potentially changing relationships between patient engagement and health outcomes in mHealth interventions are needed.

Objective

This study aims to examine dose–response relationships between patient engagement and 3 psychosocial outcomes in an mHealth intervention, Run4Love, using repeated measurements of outcomes at baseline and 3, 6, and 9 months.

Methods

This study is a secondary analysis using longitudinal data from the Run4Love trial, a randomized controlled trial with 300 people living with HIV and elevated depressive symptoms to examine the effects of a 3-month mHealth intervention on reducing depressive symptoms and improving quality of life (QOL). We examined the relationships between patient engagement and depressive symptoms, QOL, and perceived stress in the intervention group (N=150) using 4–time-point outcome measurements. Patient engagement was assessed using the completion rate of course assignments and frequency of items completed. Cluster analysis was used to categorize patients into high- and low-engagement groups. Generalized linear mixed effects models were conducted to investigate the dose–response relationships between patient engagement and outcomes.

Results

The cluster analysis identified 2 clusters that were distinctively different from each other. The first cluster comprised 72 participants with good compliance to the intervention, completing an average of 74% (53/72) of intervention items (IQR 0.22). The second cluster comprised 78 participants with low compliance to the intervention, completing an average of 15% (11/72) of intervention items (IQR 0.23). Results of the generalized linear mixed effects models showed that, compared with the low-engagement group, the high-engagement group had a significant reduction in more depressive symptoms (β=−1.93; P=.008) and perceived stress (β=−1.72; P<.001) and an improved QOL (β=2.41; P=.01) over 9 months. From baseline to 3, 6, and 9 months, the differences in depressive symptoms between the 2 engagement groups were 0.8, 1.6, 2.3, and 3.7 points, respectively, indicating widening between-group differences over time. Similarly, between-group differences in QOL and perceived stress increased over time (group differences in QOL: 0.9, 1.9, 4.7, and 5.1 points, respectively; group differences in the Perceived Stress Scale: 0.9, 1.4, 2.3, and 3.0 points, respectively).

Conclusions

This study revealed a positive long-term dose–response relationship between patient engagement and 3 psychosocial outcomes among people living with HIV and elevated depressive symptoms in an mHealth intervention over 9 months using 4 time-point repeat measurement data. The high- and low-engagement groups showed significant and widening differences in depressive symptoms, QOL, and perceived stress at the 3-, 6-, and 9-month follow-ups. Future mHealth interventions should improve patient engagement to achieve long-term and sustained intervention effects.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019

Psychometric Properties of the Persian Version of the Center for Epidemiological Studies Depression Scale Among the Iranian Public People During COVID-19 Pandemic

Background: Several studies indicate a high prevalence of depression around the world during the period of the COVID-19 pandemic. Using a valid instrument to capture the depression of an individual in this situation is both important and timely. The present study aims to evaluate the psychometric properties of the Persian version of the Center for Epidemiological Studies Depression Scale (CES-D) among the public during the COVID-19 pandemic in Iran.

Method: This is a cross-sectional study that was conducted in the Iranian population (n = 600) from April to July 2020. A two-part online form was used: sociodemographic characteristics and depression items (CES-D). The construct validity and internal consistency reliability of the scale were evaluated.

Result: The results of the exploratory factor analysis illustrated two factors with 43.35% of the total variance of the depression were explained. Confirmatory factor analysis indicated that this model fits well. Internal consistency reliability was evaluated, and it was acceptable.

Conclusion: The findings demonstrated that, in the Iranian sample, this depression scale yielded two factors (somatic and positive affects) solutions with suitable psychometric properties.

The Association Between Morningness-Eveningness Preference, Depression, Anxiety and Insomnia Among Chinese Textile Workers With or Without Shift Work

OBJECTIVE

Circadian preference and mental health disorders are closely related to insomnia. This study aimed to evaluate insomnia symptoms in textile factory workers with different work schedules, and to investigate the association between insomnia, morningness-eveningness preference, anxiety, and depression.

METHODS

A total of 3,883 textile workers were assessed using the 3-items of Pittsburg Sleep Quality Index, Composite Scale of Morningness, Beck Anxiety Inventory, Center for Epidemiologic Studies-Depression Scale, and socio-demographic questionnaires.

RESULTS

The prevalence rate of insomnia in textile workers was 16.7% (N = 646), with 49.8% (N = 322) were shift workers. Among shift workers (N = 1,833), 9.5% had difficulty initiating sleep, and almost 9.0% suffered from early morning awakening, a rate significantly higher than among daytime workers. Logistics regressions revealed that work schedule was insignificantly associated with insomnia. Depression (OR = 1.034, 95% CI = 1.022-1.046) and anxiety (OR = 1.031, 95% CI = 1.018-1.043) positively predicted insomnia, whereas morningness preference (OR = 0.977, 95% CI = 0.960-0.995) decreased the likelihood of insomnia. Furthermore, mediation analysis showed that both anxiety and depression independently mediated the association between circadian preferences and insomnia in textile workers with or without shift work.

CONCLUSION

This study highlighted the insomnia, depression, and anxiety of textile factory workers in a Chinese textile factory. To improve insomnia symptoms, interventions to promote morningness circadian preference and reduce depressive and anxious symptoms among workers are encouraged.

Factor structure of the Chinese CES-D and invariance analyses across gender and over time among Chinese adolescents

BACKGROUND

Research findings on the factor structure and invariance of the Center for the Epidemiological Studies Depression Scale (CES-D) are inconclusive. Besides, very few studies have examined factorial invariance of the scale over time. Related studies based on Chinese adolescents are also sparse. This study attempted to examine the factor structure of the CES-D and its invariance across gender and time over a one-year period among adolescents in mainland China.

METHOD

A total of 3,010 adolescents (mean age = 13.16 years, 1,730 boys) completed a questionnaire including the CES-D at Wave 1 and 2,648 of them completed the same survey one year later. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure of the CES-D. Factorial invariance of the resultant factor structure was tested using cross-sectional multi-group CFA (girls vs. boys) at Wave 1 and Wave 2 and longitudinal CFA (Wave 1 vs. Wave 2).

RESULTS

EFA and CFA revealed a three-factor model of the CES-D, including "somatic complaints," "depressed affect," and "positive affect." Additionally, findings supported the factorial invariance across gender and over time for the three-factor model.

LIMITATIONS

Limitations of the present study included a lack of adolescents from different areas in mainland China (particularly rural areas) and only a one-year follow-up.

CONCLUSIONS

This pioneering study suggests that there are three stable dimensions of the CES-D in Chinese adolescents in mainland China which are invariant across gender and over time.

Dimensionality of the Chinese CES-D: Is It Stable across Gender, Time, and Samples?

Depression is a common mental illness among Chinese adolescents. Although the Epidemiological Studies Depression Scale (CES-D) has been widely used in diverse populations, the reported factor structures are inconsistent, and its longitudinal invariance is under-researched. This study examined the psychometric properties and factorial invariance across gender and time of the CES-D among Chinese adolescents. Adolescents aged above 11 years from five schools in Chengdu responded to a questionnaire at Wave 1 (n = 5690). Among them, 4981 participants completed the same questionnaire after six months (Wave 2). The matched sample was composed of 4922 students (51.5% were girls; mean age = 13.15 years) at Wave 1. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine the factor structure and performed multi-group CFA to test the factorial invariance across gender and time. A three-factor solution was identified, including "positive affect", "somatic complaints", and "depressed affect". Results of multi-group CFA comparisons supported the factorial invariance of the resultant three-factor solution. Using a new sample of Chinese adolescents in Southwestern China, the present study reproduced earlier findings on adolescents in other areas in China. This study has implications for depression assessment and research in Chinese adolescents.

Mediating Effects of Stigma and Depressive Symptoms in a Social Media-Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions.

OBJECTIVE

This study aims to explore the intervention mechanisms of a social media-based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period.

METHODS

We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants' QOL.

RESULTS

About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported.

CONCLUSIONS

These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media-based interventions that can address HIV-related stigma and alleviate depressive symptoms.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019.

Increased functional interaction within frontoparietal network during working memory task in major depressive disorder

Abnormal fronto-parietal activation has been suggested as a neural underpinning of the working memory (WM) deficits in major depressive disorder (MDD). However, the potential interaction within the frontoparietal network during WM processing in MDD remains unclear. This study aimed to examine the role of abnormal functional interactions within frontoparietal network in the neuropathological mechanisms of WM deficits in MDD. A total of 40 MDD patients and 47 demographic matched healthy controls (HCs) were included. Functional magnetic resonance imaging and behavioral data were collected during numeric n-back tasks. The psychophysiological interaction and dynamic causal modelling methods were applied to investigate the connectivity within the frontoparietal network in MDD during n-back tasks. The psychophysiological interaction analysis revealed that MDD patients showed increased functional connectivity between the right inferior parietal lobule (IPL) and the right dorsolateral prefrontal cortex (dlPFC) compared with HCs during the 2-back task. The dynamic causal modelling analysis revealed that MDD patients had significantly increased forward modulation connectivity from the right IPL to the right dlPFC than HCs during the 2-back task. Partial correlation was used to calculate the relationship between connective parameters and psychological variables in the MDD group, which showed that the effective connectivity from right IPL to right dlPFC was correlated negatively with the sensitivity index d' of WM performances and positively with the depressive severity in MDD group. In conclusion, the abnormal functional and effective connectivity between frontal and parietal regions might contribute to explain the neuropathological mechanism of working memory deficits in major depressive disorder.

Factor structure and measurement invariance of the Chinese version of the Center for Epidemiological Studies Depression (CES-D) scale among undergraduates and clinical patients

BACKGROUND

The Center for Epidemiologic Studies Depression scale (CESD) was widely used for screening of depressive symptoms. The purpose of the current study was to investigate the factor structure and measurement invariance of the CESD across genders and groups in a sample of Chinese undergraduates and clinical patients.

METHODS

Participants included 3093 undergraduates from the Hunan province and 336 patients from psychological clinics. The structure of the CESD scale was analyzed by confirmatory factor analysis (CFA). Multiple sets of CFAs were used to test measurement invariance across genders among undergraduates and clinical patients. Internal consistency reliability was also evaluated.

RESULTS

The five-factor model achieved satisfactory fit (in the undergraduate sample: WLSMVχ² = 1662.385, df = 160, CFI = 0.973, TLI = 0.968, RMSEA = 0.055; in the clinical patients: WLSMVχ² = 502.089, df = 160, CFI = 0.962, TLI = 0.955, RMSEA = 0.072). The measurement invariance of the five-factor model across genders was supported fully assuming different degrees of invariance. The CESD also showed acceptable internal consistency.

CONCLUSION

Due to its sound structure and measurement invariance, the five-factor model of the CESD is best suited for testing in Chinese mainland college students and clinical patients.

Roles of Psychosocial Factors on the Association Between Online Social Networking Use Intensity and Depressive Symptoms Among Adolescents: Prospective Cohort Study

BACKGROUND

The potential mechanisms underlying the association between online social networking use intensity and depressive symptoms are unclear and underresearched.

OBJECTIVE

We aimed to investigate the potential roles of interpersonal psychosocial factors on the association between online social networking use intensity and depressive symptoms among early adolescents.

METHODS

A total of 4237 adolescents from a 9-month longitudinal study were included. Score changes (indicated as △) for the social function use intensity (SFUI) and entertainment function use intensity (EFUI) subscales of the Online Social Networking Activity Intensity Scale and for friendship quality, perceived family support, perceived friend support, parent-adolescent conflict, social nonconfidence, and depressive symptoms were analyzed. The potential mediation effects of unfavorable psychosocial factors and suppression effects of favorable psychosocial factors on the association of △SFUI with △CES-D and the association of △EFUI with △CES-D were tested using hierarchical regression models.

RESULTS

The association between △SFUI and △CES-D was partially mediated by △mother-adolescent conflict (mediation effect size 5.11%, P=.02) and △social nonconfidence (mediation effect size 20.97%, P<.001) but partially suppressed by △friendship quality, △perceived family support, and △perceived friend support, with suppression effects of -0.011 (P=.003), -0.009 (P=.003), and -0.022 (P<.001), respectively. The association between △EFUI and △CES-D was partially mediated by △social nonconfidence (mediation effect size 30.65%, P<.001) but partially suppressed by △perceived family support and △perceived friend support, with suppression effects of -0.036 (P<.001) and -0.039 (P<.001), respectively.

CONCLUSIONS

The association between online social networking use intensity and depressive symptoms was partially mediated through the indirect increase in social nonconfidence and mother-adolescent conflict; however, better perceived social support and friendship quality would partially compensate for the harmful impact of online social networking use intensity on depressive symptoms among early adolescents.

Association among emotional and behavioural problems, sexual minority status and suicidal behaviours in adolescents: a cross-sectional study from Guangdong Province in China

OBJECTIVES

This study was conducted to estimate whether emotional and behavioural problems mediate the association between sexual minority status and suicidal behaviour among Chinese adolescents. We also tested whether such mediation is moderated by the sex assigned at birth.

DESIGN

Cross-sectional observational study.

SETTING

A secondary analysis of the cross-sectional data collected from 7th-grade to 12th-grade students in junior high schools (n=36), senior high schools (n=24) and vocational high schools (n=12) in six cities of Guangdong Province, China. A multistage, stratified cluster, random sampling method was used in the 2019 School-based Chinese Adolescents Health Survey.

PARTICIPANTS

A total of 16 663 students aged 11-20 years.

OUTCOME MEASURES

Two main psychological and mental health outcomes: (1) self-reported version of the Strengths and Difficulties Questionnaire to measure emotional and behavioural problems; and (2) presence of suicidal ideation and suicide attempts in the past 12 months.

RESULTS

Emotional and behavioural problems (peer problems, emotional problems, conduct problems and hyperactivity) partially mediated the effects of sexual minority status on suicidal ideation (indirect effect=0.020, 95% CI 0.015 to 0.025) and suicide attempts (indirect effect=0.012, 95% CI 0.009 to 0.016), accounting for 18.18% and 14.46% of the total effect, respectively. Further moderated mediation analyses revealed a greater risk of suicidality among sexual minority girls.

CONCLUSIONS

Emotional and behavioural problems partially explained the increased risk of suicidality among sexual minority adolescents, and appreciably higher among sexual minority girls than boys. To prevent subsequent suicidality, the risks of emotional and behavioural problems in sexual minority adolescents should be identified at an early stage and reduced by means of preventive measures.

Impaired impulse inhibition of emotional stimuli in patients with borderline personality disorder

This study was aimed to investigate whether BPD patients showed impaired impulse inhibition of emotional and non-emotional stimuli and to explore relevant neuroelectrophysiological mechanisms. A total of 32 BPD patients and 32 matched healthy controls were recruited. Self-reported scales were used to measure psychiatric symptoms. The event-related potentials (ERPs) were recorded when subjects were performing neutral and emotional Stop Signal Task (SST). Group differences in self-reported scores, behavioral variables and ERPs were compared. The BPD group scored significantly higher on impulsivity, severity of BPD symptoms, levels of depression and anxiety than the control group. In neutral SST, no significant group differences were detected in the amplitude and latency of ERPs components induced. In emotional SST, the P2 amplitude of negative emotion was significantly larger than that of neutral emotion in Go trials. In Stop trials, the P2 amplitude of BPD group was significantly smaller than that of control group, and the N2 amplitude of BPD group was significantly greater than that of control group. BPD patients showed impaired inhibition of emotional stimuli rather than non-emotional stimuli. The deficits of emotional impulse control mainly exhibit at the early attention, stimulus evaluation and conflict detection stages.

Cross-network interaction for diagnosis of major depressive disorder based on resting state functional connectivity

Previous studies have suggested that resting-state functional connectivity plays a central role in the physiopathology of major depressive disorder (MDD). However, the individualized diagnosis of MDD based on resting-state functional connectivity is still unclear, especially in first episode drug-naive patients with MDD. Resting state functional magnetic resonance imaging was enrolled from 30 first episode drug-naive patients with MDD and age- and gender-matched 31 healthy controls. Whole brain functional connectivity was computed and viewed as classification features. Multivariate pattern analysis (MVPA) was performed to discriminate patients with MDD from controls. The experimental results exhibited a correct classification rate of 82.25% (p < 0.001) with sensitivity of 83.87% and specificity of 80.64%. Almost all of the consensus connections (125/128) were cross-network interaction among default mode network (DMN), salience network (SN), central executive network (CEN), visual cortex network (VN), Cerebellum and Other. Moreover, the supramarginal gyrus exhibited high discriminative power in classification. Our findings suggested cross-network interaction can be used as an effective biomarker for MDD clinical diagnosis, which may reveal the potential pathological mechanism for major depression. The current study further confirmed reliable application of MVPA in discriminating MDD patients from healthy controls.

Gender differences in the relationships between different types of childhood trauma and resilience on depressive symptoms among Chinese adolescents

Growing studies have paid attention to the relationships between childhood trauma, resilience and depressive symptoms. Depression is more common in girls, while gender differences in these associations have been rarely studied. Yet the study will be beneficial for prevention and intervention of depression in adolescents. The aim of this study is to examine gender differences in the effects of different types of childhood trauma and resilience on depressive symptoms. Data was collected from 6510 students (3408 males, aged 10-17 years) in Wuhan, Hubei, China from 2015 to 2016. Participants completed a self-report questionnaire assessing childhood trauma, resilience, and depressive symptoms. Multiple regression analysis was used to determine gender differences in the relationships between childhood trauma, resilience and depressive symptoms. We found that childhood trauma was positively related to depressive symptoms for both genders, but the relationship in females was stronger than in males. No significant gender difference was found in the independent effect of resilience to depressive symptoms. Resilience moderated the effects of emotional abuse, physical abuse and sexual abuse on depressive symptoms in both males and females. However, the interaction effect of resilience with emotional abuse on depressive symptoms was stronger in females compared to males. Our findings revealed gender differences in the links between childhood trauma and depressive symptoms among adolescents, and the interaction effect of resilience and childhood emotional abuse on depressive symptoms was gender-specific. These provide the basis for gender-special prevention and intervention measures for depressive symptoms in adolescents.

Shift work disorder and related influential factors among shift workers in China

BACKGROUND

Shift work may cause insomnia and sleepiness in individuals. The present study aimed to exam shift work disorder (SWD), and to investigate their associations with individual characteristics.

METHODS

A total of 1833 shift workers were assessed using the Pittsburg Sleep Quality Index, Epworth Sleepiness Scale (ESS), Composite Scale of Morningness (CSM), Circadian Type Inventory (CTI), Center for Epidemiologic Studies-Depression Scale (CES-D), Beck Anxiety Inventory (BAI) and other self-compiled socio-demographic questionnaires.

RESULTS

In the current sample, 17.1% shift workers have experienced insomnia symptoms, 20.9% were tested for daytime sleepiness, and 19.9% were categorized as having SWD. Logistics regressions revealed that history of mental disorders (OR = 2.04, 95% CI = 1.30-3.21), chronic physical illness (OR = 1.53, 95% CI = 1.17-1.99), CES-D scores (OR = 1.03, 95% CI = 1.02-1.05), BAI scores (OR = 1.04, 95% CI = 1.03-1.06), languid/vigorous tendencies (OR = 1.06, 95% CI = 1.03-1.10) were positively associated with the onset of SWD, while morningness (OR = 0.97, 95% CI = 0.94-0.99) decreased the odds of SWD onset.

CONCLUSIONS

These findings suggested that attention should be drawn to individuals with mental and chronic diseases in when scheduling work shifts. While SWD and its associates should be considered when providing psychological services to shift workers.

Effects of polygenic risk score, childhood trauma and resilience on depressive symptoms in Chinese adolescents in a three-year cohort study

BACKGROUND

Polygenic risk score (PRS) is a method of revealing multiple genes effect. The study of PRS and childhood trauma (CT) and resilience on adolescent depressive symptoms are fewer reported, especially the functional mechanism of resilience among them.

METHODS

718 Chinese adolescents aged 10-14 years were surveyed including CT, resilience, depressive symptoms, and phenotype data in three years of the cohort study. PRS was calculated by the weighted accumulation effects of alleles on depressive symptoms. Their relationships were analyzed by the mediation and moderation models.

RESULTS

PRS and CT were risk factors for depressive symptoms. Interaction (PRS × CT) on depressive symptoms had no statistical significance. Resilience acted as the protective mediator from CT (emotional abuse, emotional neglect, physical neglect) to depressive symptoms and moderator from CT (emotional abuse) to depressive symptoms.

LIMITATIONS

The sample size was a little small so that the inference were drawn prudently. Except gene data, other were collected by self-reported questionnaire instruments which inevitably brought recall bias.

CONCLUSIONS

PRS and CT could have adverse impact on depressive symptoms, resilience could alleviate these risk effects as a moderator and a mediator. The findings have important implications for prevention and intervention in adolescent depressive symptoms.

Personality inventory for DSM-5 brief form(PID-5-BF) in Chinese students and patients: evaluating the five-factor model and a culturally informed six-factor model

BACKGROUND

The Personality Inventory for DSM-5 Brief Form (PID-5-BF) is a 25-item measuring tool evaluating maladaptive personality traits for the diagnosis of personality disorders(PDs). As a promising scale, its impressive psychometric properties have been verified in some countries, however, there have been no studies about the utility of the PID-5-BF in Chinese settings. The current study aimed to explore the maladaptive personality factor model which was culturally adapted to China and to examine psychometric properties of the PID-5-BF among Chinese undergraduate students and clinical patients.

METHODS

Seven thousand one hundred fifty-five undergraduate students and 451 clinical patients completed the Chinese version of the PID-5-BF. Two hundered twenty-eight students were chosen randomly for test-retest reliability at a 4-week interval. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to discover the most suitable factor structure in China, measurement invariance(MI), internal consistency, and external validity were also calculated.

RESULTS

The theoretical five-factor model was acceptable, but the exploratory six-factor model was more applicable in both samples (Undergraduate sample: CFI = 0.905, TLI = 0.888, RMSEA = 0.044, SRMR = 0.039; Clinical sample: CFI = 0.904, TLI = 0.886, RMSEA = 0.047, SRMR = 0.060). In the Chinese six-factor model, the Negative Affect domain was divided into two factors and the new factor was named "Interpersonal Relationships", which was in line with the Big-Six Personality model in Chinese. Measurement invariance across non-clinical and clinical sample was established (configural, weak, strong MI, and partial strict MI). Aside from acceptable internal consistency (Undergraduate sample: alpha = 0.84, MIC = 0.21; Clinical sample: alpha = 0.86, MIC = 0.19) and test-retest reliability(0.73), the correlation between the 25-item PID-5-BF and the 220-item PID-5 was significant(p < 0.01). The six PDs measured by Personality diagnostic questionnaire-4+ (PDQ-4+) were associated with and predicted by expected domains of PID-5-BF.

CONCLUSIONS

Both the theoretical five-factor model and the exploratory six-factor model of the PID-5-BF were acceptable to the Chinese population. The five-factor model could allow for comparison and integration with other work on the original theoretical model. However, the Chinese six-factor structure may be more culturally informed in East Asian settings. In sum, the PID-5-BF is a convenient and useful screening tool for personality disorders.

The factor structure of the Center for Epidemiological Study - Depression Scale in people with multiple sclerosis

Background: Depression is common in multiple sclerosis (MS); however, its assessment is complicated by biological processes. In this context it is important to consider the performance of depression screening measures including that their factor structure is consistent with expectation.  This study sought to identify the factor structure of the Center for Epidemiological Study - Depression Scale (CES-D) in people with MS (PwMS).

Methods: Participants (N = 493) were those who had consented to take part in a large three-phase longitudinal study of depression in PwMS. CES-D questionnaires completed at phase 1 of the study were utilised. An error in the questionnaire meant it was most appropriate to consider data for 19 of the 20 CES-D questionnaire items. The data was split into two samples by a random selection process to create an exploratory, model development sample and a validation sample. The first sample was subject to confirmatory factor analysis. Following examination of model fit and specification errors, the original model was modified. The revised model was tested in the confirmation sample to assess reproducibility.

Results: The analysis results supported the original four factor solution for the CES-D, that is: Depressed Affect, Positive Affect, Somatic Complaints/Activity Inhibition, and Interpersonal Difficulties.

Conclusions: The CES-D appears to have a coherent structure with which to examine depression in PwMS.

Revisiting the relationship between body dissatisfaction and eating disorder symptoms in Chinese adolescents: the mediating roles of regulatory emotional self-efficacy and depression symptoms

PURPOSE

Even though many studies have investigated the relationship between body dissatisfaction and eating disorder symptoms, the relationship is still far from being clear, especially about what factors that could potentially mediate such relationship. This study aimed to examine the direct pathway in the relationship between body dissatisfaction and eating disorder symptoms, and possible mediation pathways between the two via regulatory emotional self-efficacy and depression symptoms.

METHODS

A sample of 654 adolescents from central China completed questionnaires for a set of study variables. Modeling analysis was conducted that examined the direct pathway between body dissatisfaction and eating disorder symptoms, and the mediating roles of regulatory emotional self-efficacy and depression symptoms between these two constructs. Multi-group modeling analysis was conducted to assess model invariance across gender and age groups.

RESULTS

The results showed that, in addition to the direct pathway between body dissatisfaction and eating disturbances, regulatory emotional self-efficacy and depression symptoms partially mediated the relationship between these two constructs. Results of multi-group invariance analysis showed that the mediation model was consistent across gender and age groups.

DISCUSSION

These results indicated that management of regulatory emotional self-efficacy and appropriate intervention for depression could potentially buffer against the negative impact of body dissatisfaction on eating disorder symptoms. Finally, some potential clinical implications are discussed, and possible preventions for eating disorder symptoms are suggested.

LEVEL OF EVIDENCE

V, Cross-sectional descriptive study.

Impaired set-shifting in drug-naïve patients with borderline personality disorder: an event-related potentials study

BACKGROUND

Neurocognitive impairments might play a key role in the development of Borderline Personality Disorder (BPD), however, the pathophysiological mechanism underlying cognitive impairment of BPD is largely unknown. This study was aimed to examine the electrophysiological mechanism of deficits in set-shifting processing in patients with BPD.

METHODS

Twenty-seven drug-naïve patients with BPD and twenty-four healthy controls were recruited. Demographic variables and clinical characteristics of all subjects were collected. Behavioral data and event-related potentials (ERPs) were recorded when subjects were performing the task-switching paradigm, which was applied to investigate the set-shifting function. The P2, N2 and P3 components in the task-switching paradigm would be analyzed.

RESULTS

Patients with BPD had significantly higher level of impulsivity, depression and anxiety than healthy controls. When performing the switching task, the BPD group had lower P2 amplitude and higher N2 amplitude than the control group. In the BPD group, the P2 latency at Fz electrode in repeat task was correlated positively with the level of depression, and P2 latency at Pz electrode in repeat task and switch task both had significantly negative relationships with the the level of anxiety.

LIMITATIONS

This cross-sectional designed study did not clarify the causal relationship of the electrophysiological characteristics and the development of BPD.

CONCLUSIONS

Patients with BPD might have abnormal brain activities when overcoming the inhibition of current task and inhibiting the effects of prior task, and their top-down control function might be impaired. These findings provide some useful clues for the underlying pathophysiological mechanism of BPD.

Psychometric Properties and Measurement Invariance of the Cognitive Emotion Regulation Questionnaire in Chinese Adolescents With and Without Major Depressive Disorder: A Horizontal and Longitudinal Perspective

Objective: The purpose of this study was to examine the psychometric properties and posited nine-factor structure of the Chinese version of the Cognitive Emotion Regulation Questionnaire (CERQ-C) in high school students and adolescents with major depressive disorder (MDD), including assessment of measurement invariance of CERQ-C and its subscales across gender, time, and presence of depression. Methods: Chinese high school students from Hunan Province (N = 1,253) and adolescents with major depressive disorder (MDD) from the Medical Psychological Institute outpatient clinic at The Second Xiangya Hospital (N = 205) were enrolled. We examined the reliability, and model fit of the CERQ-C. Multigroup confirmatory factor analysis (CFA) was used to test measurement invariance of the subscales across gender, time, and presence of depression. Results: The CERQ-C subscales showed good internal consistency and moderate test-retest reliability in high school students and excellent internal consistency in adolescents with MDD group. The nine-factor model yielded adequate fit indices in different samples. Multigroup CFA confirmed that CERQ-C is strongly equivalent across gender, time, and presence of depression. Conclusions: The CERQ-C is a valid, reliable, and stable instrument for the evaluation of the cognitive emotion regulation (ER) strategies for different samples, including high school students and adolescents with MDD. The horizontal and longitudinal equivalences are strongly established.

Resilience as a mediator of interpersonal relationships and depressive symptoms amongst 10th to 12th grade students

BACKGROUND

The aim of this study was to explore the associations among interpersonal relationships, resilience and depressive symptoms, and to examine if resilience is a mediator between interpersonal relationships and depressive symptoms in senior high school students.

METHODS

Of 463 randomly selected participants from among 3,900 high school students, 450 (97.19%) consented to and completed a structured 4-part questionnaire consisting of demographic items, Inventory of Adolescent Resilience, Taiwan Relationship Inventory for Children and Adolescents, and Center for Epidemiologic Studies Depression Scale for Children. The associations between interpersonal relations and resilience and their associations with depressive symptoms were analyzed using MPlus 8.0 software for structural equation modeling.

RESULTS

Results from structural equation modeling indicate that resilience and interpersonal relationships were negatively associated with students' depressive symptoms, and resilience partially mediated the associations between interpersonal relationships and depressive symptoms after controlling for demographics.

CONCLUSION

Findings support that resilience and better interpersonal relationships are protective factors against depressive symptoms in adolescents. The positive association between the two protectors implies that interpersonal relationships might increase resilience and then alleviate depression amongst adolescents.

Association of Internet Addiction with Family Functionality, Depression, Self-Efficacy and Self-Esteem among Early Adolescents

Early adolescents usually have worse self-control and poor time management abilities. They are a higher-risk group for Internet addiction than older adolescents or adults. This study aims to explore the prevalence of Internet addiction and associated factors in early adolescents. Participants included 451 fifth and sixth-grade students in Central Taiwan. This study adopted a cross-sectional design and a structured questionnaire that consisted of demographics, Young's Internet Addiction Test, the Centre for Epidemiological Studies-Depression scale, the General Self-Efficacy Scale and the Rosenberg Self-Esteem Scale. The participants were 50.8% male, and the mean age was 11.35, with a range of 10.33-12.92 years. A total of 33.7% of all participants were prone to Internet addiction. The results showed that participants who were male and had high money allowance, poor family atmosphere, parents who did not limit Internet usage time, high depression, low self-efficacy and low self-esteem were more prone to Internet addiction. A multiple logistic regression analysis revealed that being male, having parents who did not limit Internet usage time and higher degrees of depression were the associated factors of Internet addiction in early adolescents. The phenomenon of Internet addiction among early adolescents seems to be increasing. Improving family functionality and individual mental health may be effective ways to reduce Internet addiction.

Emotion Regulation Questionnaire for Cross-Gender Measurement Invariance in Chinese University Students

OBJECTIVES

Emotion regulation has been extensively studied in various areas of psychology. The Emotion Regulation Questionnaire (ERQ) was developed to assess two specific constructs associated with emotion control-cognitive reappraisal and expression suppression (Gross and John, 2003). The instrument displayed sound psychometric properties; however, to date, inquiry regarding the measure's characteristics has been limited. This study aims to measure cross-gender invariance [measurement invariance (MI)] in Chinese undergraduates using the ERQ.

METHODS

This study measured the psychometric properties of the ERQ in a sample of 847 Mainland China undergraduates (401 males and 446 females) through confirmatory factor analysis. The tests of MI were used to examine potential structural differences based on gender.

RESULTS

The findings supported the measure's original structure with all demographic groups and demonstrated exceptional fit. Additional normative data for gender and ethnic groups are included as well. The results also supported the use of the instrument in future research.

CONCLUSION

The two-factor structure in the ERQ establishes a cross-gender equivalence between males and females in Chinese college students. This study supports the use of the instrument in future research.

Factor structure of the University Personality Inventory in Japanese medical students

Background

The age of onset for most mental disorders is typically young adulthood, and the university setting is an important one for addressing mental health. The University Personality Inventory (UPI), which was developed to detect mental health problems in university students, is widely used for screening in Japan. However, there have been limited reports on the factor structure of the UPI based on a statistical test for binary indicators. The objective of this study was to assess the factor structure of the UPI in Japanese medical students.

Methods

This study examined the factor structure of the UPI in a sample of 1185 Japanese medical students at the time of university admission. The students were divided into subgroup A (n = 589) and subgroup B (n = 596) according to their year of university admission. Based on tetrachoric correlation coefficients, exploratory factor analysis (EFA) with promax rotation was applied to explore the dimensions of the inventory in subgroup A. Confirmatory factor analysis (CFA) was then conducted to verify the dimensions in subgroup B.

Results

The EFA with categorical variables yielded four factors in subgroup A. These factors, accounting for 48.9% of the variance, were labeled “Depression and Irritability”, “Anxiety and Persecutory Belief”, “Physical Symptoms”, and “Dependence”. The new four-factor structure showed good fit, and traditional factor structures previously reported were replicated via CFA. The internal consistency reliability was good for the overall UPI scale (alpha = 0.97) and for its four new factors (alpha = 0.83–0.91).

Conclusions

The UPI is a valid and reliable measure that can be used to assess symptoms across four dimensions of mental health in university settings. These findings offer a starting point for the detection of individuals with mental health problems.

The Psychometric Properties of the Chinese Version of the Beck Depression Inventory-II With Middle School Teachers

As previous researchers have found, like other parts of the world, depression is prevalent among middle school teachers in China. The Beck Depression Inventory-II (BDI-II) has been widely used to detect depression among workers in different careers all over the world and has shown good scale properties but inconsistent factor structures. To examine the psychometric properties of the BDI-II among middle school teachers, a nationally representative sample of 4,672 valid cases from 688 middle schools were included. We first generated a new bifactor model based on exploratory factor analysis and agglomerate cluster analysis of the residual item correlations and then validated the modes and examined measurement invariance across gender and school location with multiple-group confirmatory factor analysis (CFA). Results indicated that (1) a new bifactor model with a general factor and two group factors (cognitive-affective group factor and somatic group factor) fitted well to the data [WLSMV χ² = 745.651, df = 173, P < 0.001, CFI = 0.983, TLI = 0.979, RMSEA = 0.037; 90% CI (0.035, 0.040)]; Omega values for the three factors varied from 0.88 to 0.92; (2) measurement invariance tests indicated that the BDI-II could equally measure depression of middle school teachers across gender and school location groups. All the findings suggest that the BDI-II is a self-report inventory with good psychometric properties for measuring depression among middle school teachers in China.