Ruminative and catastrophizing cognitive styles mediate the association between daily hassles and high anxiety in Hong Kong adolescents

The relationship between childhood maltreatment subtypes and adolescent internalizing problems: The mediating role of maladaptive cognitive emotion regulation strategies

BACKGROUND

While childhood maltreatment is understood to be a significant risk factor for adolescent internalizing problems (depression and anxiety), underlying mechanisms linking each type of maltreatment to internalizing problems in adolescents remain unclear. Moreover, the current state of knowledge regarding the associations between maladaptive cognitive emotion regulation strategies and each type of maltreatment, as well as their impact on adolescent internalizing problems, is limited. Additionally, it remains unclear whether these maladaptive strategies mediate this relationship.

OBJECTIVE

This study sought to investigate the effects of childhood maltreatment types on adolescent internalizing problems and to explore whether the overall and specific types of maladaptive strategies mediate these associations.

METHODS

Using a cross-sectional design, adolescents (N = 7071, Mage = 14.05 years, SDage = 1.54) completed online questionnaires assessing childhood maltreatment, maladaptive cognitive emotion regulation strategies (including rumination, catastrophizing, self-blame, and other-blame), anxiety, and depression. The hypothesized mediating effects were tested using the Lavaan package in R software (4.1.2).

RESULTS

Different maltreatment types had varying effects on adolescent internalizing problems. Emotional neglect, emotional abuse, and sexual abuse significantly affected anxiety and depression, whereas physical neglect and physical abuse did not. Other than physical neglect and physical abuse, overall maladaptive strategies mediated the relationship between the other three types of maltreatment (emotional abuse, emotional neglect, and sexual abuse) and internalizing problems (anxiety and depression). For specific maladaptive strategies, rumination mediated the effects of physical abuse, emotional abuse, emotional neglect, and sexual abuse on internalizing problems (anxiety and depression). In contrast, catastrophizing mediated the relationship between physical neglect, emotional abuse, emotional neglect, sexual abuse and internalizing problems (anxiety and depression).

CONCLUSIONS

These results suggest that the effects of maltreatment types on internalizing problems are different and that maladaptive strategies, particularly rumination and catastrophizing, are important mechanisms through which childhood maltreatment affects internalizing problems. This is a reminder that mental health workers need to consider the different effects of maltreatment types when intervening and recognize the importance of prioritizing interventions for rumination and catastrophizing.

Is it a vicious circle and for whom? The reciprocal association between rumination and somatic symptoms and moderation by stress: A daily diary study among Chinese college students

College students who experienced somatic symptoms during the COVID-19 pandemic may engage in rumination, but their bidirectional nature remains underexplored. Symptom perception theory suggests a reciprocal relationship between rumination and somatic symptoms, and the multiple-stressor perspective and the perseverative cognition hypothesis assume that the reciprocal association might be exacerbated by high stress. In this study, we examined temporal associations between rumination and somatic symptoms and variations by patterns of stress related to COVID-19 and daily hassles. A total of 582 Chinese college students provided daily reports on rumination, somatic symptoms, COVID-related stress, and daily hassles for seven consecutive days in November 2020. A cross-lagged panel model showed a positive reciprocal association between rumination and somatic symptoms. Greater rumination predicted more next-day somatic symptoms, and more somatic symptoms increased next-day rumination. Dual trajectory analysis identified four stress patterns of COVID-related stress and daily hassles (i.e. low-low, low-high, high-low, and high-high), and multi-group analysis found the reciprocal association only presented in the high-high group. Our findings indicate a vicious circle between rumination and somatic symptoms that is dependent on heterogeneous stress patterns. Attention should be paid to the high-risk group with both high levels of COVID-related stress and daily hassles.

Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review

Background: The prevalence and comorbidity of anxiety disorders are significantly different between women and men, with research showing a greater impact on women. The aim of this review was to identify the psychosocial and biological factors that have been considered to explain this gender and sex difference in prevalence and determine whether these factors are related to any anxiety comorbidity differences between men and women. Methods: Following the PRISMA guidelines, we carried out a systematic review of studies published between 2008 and 2021 in PsycINFO and PubMed databases. Empirical and review studies evaluating psychosocial and biological factors that could influence the difference in prevalence and comorbidity between men and women were included. A qualitative narrative synthesis was performed to describe the results. Results: From 1012 studies, 44 studies were included. Retrieved articles were categorized depending on their object of study: psychosocial factors (n = 21), biological factors (n = 16), or comorbidity (n = 7). Results showed that differences in anxiety between women and men have been analyzed by psychosocial and biological factors but rarely together. Among the psychosocial factors analyzed, masculinity may be a protective factor for anxiety development, while femininity can be a risk factor. In the studies that took biological factors into account, the potential influence of brain structures, genetic factors, and fluctuations in sexual hormones are pointed out as causes of greater anxiety in women. Concerning comorbidity, the results noted that women tend to develop other internalizing disorders (e.g. depression), while men tend to develop externalizing disorders (e.g. substance abuse). Conclusions: For an accurate understanding of differences between women and men in anxiety, both biological and psychosocial factors should be considered. This review highlights the need to apply the biopsychosocial model of health and the gender perspective to address differences in anxiety between sexes.

Daily Stress and Behavioral Problems in Chinese Children: The Moderating Roles of Family Functioning and the Classroom Environment

Grounded in the stress-coping model, our study examined family functioning and the classroom environment as protective factors in the relationship between daily stress and behavioral problems in Chinese children. The participants were 1,450 children (51.7% male, M age = 10.91 years, SD = 0.96) in the fourth, fifth, and sixth grades at five schools. The children completed the questionnaires measuring daily stress, family functioning, and the classroom environment. Additionally, their parents rated their behavioral problems. The latent moderated structural (LMS) equation approach was used to test moderator effects. After controlling for sex and grade, our results indicate that daily stress positively predicted the children's behavioral problems. Both family functioning and the classroom environment moderated the relationship between daily stress and behavioral problems. Further assessment of latent interaction effects indicate that buffering effects on behavioral problems were most prominent in conditions involving low stress. In sum, families and schools should not ignore children's minor stressors, as interventions involving family functioning and favorable classroom environments may help to reduce behavioral problems in children who report low levels of daily stress.

Association of health-risk behaviors and depressive symptoms and anxiety symptoms: a school-based sample of Chinese adolescents

Background Depressive symptoms and anxiety symptoms of adolescents not only affect youth but also have wide-ranging impacts on the health of adults. The study was carried out to determine the epidemiological characteristics of depressive symptoms and anxiety symptoms and the associations between the two and health-risk behaviors in Chinese adolescents. Methods Participants were recruited from the junior and senior high schools in China. Data were collected by self-designed questionnaires. The questionnaires included questions about demographic characteristics, depressive symptom scales, anxiety symptom scales and nine categories of health-risk behaviors. Descriptive analysis and binary logistic regression were performed by SPSS 21.0 software. Results There were 4.4% of the participants with depressive symptoms. Approximately 32.0% of the participants had anxiety symptoms. Girls and general senior school students were risk factors for depressive symptoms and anxiety symptoms. Multiple health-risk behaviors were associated with depressive symptoms and anxiety symptoms in Chinese adolescents. Conclusion Depressive symptoms and anxiety symptoms were prevalent in Chinese adolescents. Their distribution was affected by certain health-risk behaviors. Multiple health-risk behaviors were associated with depressive symptoms and anxiety symptoms in Chinese adolescents.

Social, Cognitive, and eHealth Mechanisms of COVID-19-Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study

BACKGROUND

Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak.

OBJECTIVE

This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China.

METHODS

An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020.

RESULTS

Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (χ214=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; β=.02, 95% CI 0.01-0.02; P=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; β=.03, 95% CI 0.02-0.03; P=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths.

CONCLUSIONS

Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women.

Effect of a peer-led intervention combining mental health promotion with coping-strategy-based workshops on mental health awareness, help-seeking behavior, and wellbeing among university students in Hong Kong

Background

The psychological well-being of university students is an important factor in successfully coping with the demands of academic life. This study aimed to assess the impact of a peer-led intervention of mental health promotion combined with coping-strategy-based group workshops on mental health awareness and help-seeking behavior among university students in Hong Kong.

Method

A mixed-method concurrent design was used for this study. Quantitative data, based on one-group pretest-posttest design, were collected using Mental Health Knowledge Schedule Questionnaire to assess mental health awareness, and Attitude Towards Seeking Professional Help Questionnaire-Short Form to examine help-seeking behavior of university students from The Hong Kong Polytechnic University. Qualitative data were collected from written post-activity reflections and focus group discussions which were thematically analyzed.

Results

A total of 62 university students (mean age: 23.2 ± 5.1 years) were included in this study. Mental health awareness was significantly improved (p = 0.015, 95% Confidence Interval of − 2.670, − 0.297) after program implementation. Help-seeking behavior mean score increased from pretest to posttest, however, no significant difference was observed (p = 0.188, 95% CI = − 1.775, 0.355). Qualitative analysis revealed that the program helped participants learn about coping strategies to help themselves and others with mental health challenges.

Conclusions

The peer-led intervention provided a positive impact through increased mental health awareness and knowledge of coping strategies on self-help and helping others among university students. Further study could focus on the impact of the program when applied regularly throughout the entire academic year.

Gray Matter Density of the Dorsomedial Prefrontal Cortex Mediates the Relationship Between Catastrophizing and Anxiety in Somatic Symptom Disorder

OBJECTIVE

Catastrophizing is commonly co-occurrence with anxiety in somatic symptom disorder (SSD). However, the quantitative relationship between catastrophizing and anxiety in SSD and its underlying neuropsychopathology remains unclear.

METHODS

To address the issue, twenty-eight SSD patients and twenty-nine healthy controls (HCs) completed the Hamilton anxiety scale and the catastrophizing subscale of the cognitive emotion regulation questionnaire. Then they underwent structural magnetic resonance imaging and voxel-based morphometry analysis was performed to obtain gray matter density (GMD) of the dorsomedial prefrontal cortex (dmPFC).

RESULTS

Independent samples t-tests showed no significance between SSD patients and HCs in the scores on the catastrophizing subscale and GMD of the dmPFC. However, correlation analysis found that catastrophizing was significantly positively associated with anxiety in SSD. Further, mediation analyses revealed that GMD of the dmPFC (bilateral medial Brodmann area 8) mediated the relationship between catastrophizing and anxiety in SSD.

CONCLUSION

These findings support Kirmayer's disease model of SSD that catastrophic interpretations of somatic symptoms resulted in increased anxiety and demonstrate that the dmPFC may be a potential neural site linking catastrophizing and anxiety in SSD.

Children and Young Anxiety ScaleCYAS: Scale Development and Psychometric Properties in Brazilian Sample

The aim of the study was to search for evidence of validity based on the relationship with external variables, and incrementally for the Child-Youth Anxiety Scale (CYAS). The convenience sample consists of 500 children and adolescents aged 10 to 18 years. The correlation between the scores of the CYAS factors and the scores of the instruments of the other constructs ADHD (MTA-SNAP-IV), anxiety (OQPS), rumination (QRR) and mood states (BRUMS) was initially performed, finding medium and strong correlations, which shows a satisfactory linear relation between the constructs to attest validity based on the relation with external variables. Structural Equation Modeling (SEM) was also performed with total MTA-SNAP-IV and its factors as criterion. In the modeling, it was possible to observe that, when introduced in the models, the CYAS becomes the latent variable with the greatest contribution, decreasing and canceling the OQPS contribution. These results affirm incremental validity for the CYAS.

The latent profile analysis of Chinese adolescents' anxiety: Examination and validation

The main purpose of current study was to investigate the characteristics of anxiety in Chinese adolescents using Latent Profile Analysis (LPA) with the Screen for Child Anxiety Related Emotional Disorders. LPA was conducted with a sample of 2158 participants aged 12-20 years from 3 urban schools in Beijing, China. Results suggested a best-fitting model with three profiles: Low Group with Diffuse Types of Anxiety, Moderate Group with Predominant Generalized and Social Anxiety and High Group with Predominant Somatization Anxiety. Additional analyses using Regression Mixture Modeling suggested that older adolescents and girls were significantly more likely to be classified into the High Group with Predominant Somatization Anxiety. Finally, in support of the construct validity of the anxiety profiles, differential negative cognitions, especially the subscales measuring cognitions about social threat and physical threat, predicted the anxiety profiles. The current study supports an intuitive model of adolescent anxiety in a large, non-Western population with clinical implications for anxious adolescents in China.

Factor Structure of the Screen for Child Anxiety-Related Emotional Disorders (SCARED) in a Community Sample of Hong Kong Chinese Adolescents

The current study tested the factor structure of the 41-item SCARED in assessing anxiety in a sample of Hong Kong adolescents. Data were collected from 5,226 youths (54.5 % boys) aged 12-18. Results showed that the scale and the five subscales had high internal consistency. However, confirmatory factor analyses showed that the original five-factor model did not fit the data collected in this sample. Instead, the results revealed a seven-factor model consisting of one second-order factor of anxiety and seven first-order factors: the four original factors of General Anxiety, Panic/Somatic Syndromes, Social Anxiety, and School Phobia and three new factors representing different aspects of Separation Anxiety. Group invariance in the Boys and Girls models was found. It is recommended that the three new factors (Fear of Loneliness, Separation Fear, Worry about Harm) be further developed by adding new items so as to enhance the content and construct validities of the SCARED when used with Hong Kong adolescents.