A latent class analysis of psychological symptoms and health risk behaviors among Chinese adolescents

Association of depressive symptoms with risk of incidence low back pain in middle-aged and older Chinese adults

BACKGROUND

Elevated Depressive symptoms (DS) and low back pain (LBP) pose significant and growing public health challenges, and China is no exception. This study innovatively examined the relationship between specific DS and distinct patterns of DS and incident LBP.

METHODS

This study extracted data from 4713 participants aged 45+ years from the China and Health Retirement Longitudinal Study (CHARLS), followed-up for incidence LBP (June 2011-September 2020). DS was assessed by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). The incident LBP was determined by self-reported. Latent class analysis (LCA) was employed to categorize patterns of DS. Cox proportional hazards regression models were used to examine the association between DS and incident LBP.

RESULTS

Over the 9.25-year follow-up period, 2234 incident LBP cases were identified. There was a significant independent association between positive DS and incident LBP with an HR of 1.73 (95 % CI = 1.55-1.94). Of the 10-item DS, difficulty concentrating (adjusted HR = 1.16, 95 % CI = 1.03-1.31), effortfulness (adjusted HR = 1.32, 95 % CI = 1.18-1.49), hopelessness (adjusted HR = 1.13, 95 % CI = 1.02-1.25), restless sleep (adjusted HR = 1.17, 95 % CI = 1.06-1.30), and loneliness (adjusted HR = 1.18, 95 % CI = 1.02-1.36), each independently associated with incident LBP. Regarding patterns of DS, compared to the "healthy" pattern of DS, four patterns showed significant association with incident LBP, especially the cumulative pattern of DS.

LIMITATIONS

DS and LBP were assessed based on self-reported.

CONCLUSIONS

In middle-aged and older Chinese adults, 5 specific DS (difficulty concentrating, effortfulness, hopelessness, restless sleep, and loneliness) and distinct patterns of DS indicate varied risks of developing LBP.

Patterns of unhealthy lifestyle and their associations with depressive and anxiety symptoms among Chinese young adults: A latent class analysis

BACKGROUND

There is little evidence on the association between patterns of unhealthy lifestyle and mental health among young adults.

METHOD

This study included a total of 28,978 young adults aged 18 to 44 years old in Guangdong province in south China, which was conducted from September to December in 2022. We used latent class analysis to classify the patterns of unhealthy lifestyle among young adults and used multiple logistic regression to explore their associations with depressive and anxiety symptoms.

RESULT

The weighted prevalence of depressive and anxiety symptoms were 28.0 % and 19.5 %, respectively. The cumulative effect of unhealthy lifestyles on depressive and anxiety symptoms was significant. Five patterns of unhealthy lifestyle were classified. Compared to the relatively healthy lifestyle class, the class with more unhealthy lifestyles (OR = 6.54, 95 % CI: 5.70-7.51) and insufficient sleep (OR = 6.16, 95 % CI: 4.92-7.70) had higher risk for depressive and anxiety symptoms. Meaningfully, having adequate mental health literacy could reduce the risk of depressive and anxiety symptoms from unhealthy lifestyle by half.

LIMITATIONS

The cross-section design study limited causal inferences, and the self-report information may lead to recall bias.

CONCLUSIONS

Unhealthy lifestyles have a negative impact on depressive and anxiety symptoms through independent, cumulative and combined effects, and they could be interrelated. Unhealthy lifestyle patterns differed in younger population by socio-demographic characteristics and mental health literacy. Health-care professionals and policymakers may provide programs to intervene multiple unhealthy lifestyles and improve mental health literacy by integrating healthy lifestyle education to promote youngers' mental health.

Associations between healthy lifestyle behavioral patterns and mental health problems: A latent class analysis of 161,744 Chinese young adults

BACKGROUND

Youth mental health problems are a public health priority. Multiple healthy lifestyle behaviors may cluster into healthy lifestyle behavioral patterns (HLBPs) that increase mental health risks in adolescents and older adults, but little is known regarding young adults. This study aimed to explore the associations between cluster HLBPs and mental health problems in young adults.

METHODS

We selected 161,744 young adults aged 20-39 as participants from the database of a Chinese general hospital health management center for the years 2015-2020. The latent class analysis was used to identify HLBPs.

RESULTS

A total of 15.0 % of young adults have at least one mental health problem. Five clusters of HLBPs were identified, characterized as low-risk class (1.6 %), moderate-risk class 1 (12.0 %), moderate-risk class 2 (2.1 %), moderate-risk class 3 (56.8 %), and high-risk class (27.4 %). The odds ratios (ORs) for young adults with two mental health problems increased with the risk grade of HLBPs, while the ORs for young adults with one or three mental health problems ranged from high to low according to the risk grade of HLBPs: high-risk class, moderate-risk class 2, moderate-risk class 3, moderate-risk class 1.

LIMITATIONS

Cross-sectional design and no causal conclusions could be drawn.

CONCLUSION

Young adults demonstrated a cluster phenomenon of healthy lifestyle behaviors and significant associations between HLBPs and mental health problems. Young adults with a higher risk grade for HLBPs were more likely to have mental health problems. Different HLBPs should be taken into account when implementing mental health interventions.

Effectiveness of a localised and systematically developed gatekeeper training program in preventing suicide among Chinese adolescents

To combat the pressing issue of contemporary suicide rates, an effective Life Gatekeeper training program was developed to educate school teachers in identifying and intervening with at-risk students. Two single-arm sequential studies evaluated the program's effectiveness, spanning implementation science stages from design to refinement. The initial study employed face-to-face training (FTF), followed by a standardized video-based 'Train-the-trainer' (TTT) approach. In Study 1, post-intervention and one-month follow-up results showed improved suicide literacy, reduced stigma, and increased willingness to intervene among gatekeepers. The revised TTT program (study 2) also yielded reduced stigmatization and improved intervention competence. In addition, six out of twenty teachers exhibited gatekeeper behaviors. In conclusion, both delivery methods proved effective, particularly the practical application of the TTT version, although further research is warranted to examine long-term effectiveness of the program.

Pattern of lifestyle behaviors and associated risk of being bullied at schools: A latent class analysis of 25,379 adolescents in Jiangsu Province of China

School bullying is a worldwide problem. Although previous studies examined the association between different lifestyle behaviors and bullying victimization, the complex co-occurrence of these behaviors was not identified, and their association with the risk of being bullied remains unclear. We aimed to identify the behavioral patterns of adolescents and to explore their association with bullying victimization. This cross-sectional study employed data from the "Surveillance for Common Diseases and Health Risk Factors among Students" project implemented in Jiangsu Province of China in 2019, and a total of 25,379 school-enrolled students were included. We used a latent class analysis to identify behavioral patterns and a regression mixture model to explore various demographic characteristics, such as age, sex, and family structure in relation to bullying victimization across different patterns. We considered respondents having targeted behaviors, including smoking, alcohol consumption, illicit drug use, sugar consumption, no fruit consumption, low physical activity, electronic media use, and insufficient sleep. Four behavioral patterns were identified, including the "adolescents without apparent targeted behaviors" (19.65%), "substance and electronic media users" (12.76%), "typical electronic media users" (54.49%), and "typical substance users" (8.10%). The risk of being bullied was the highest in the "substance and electronic media users" (probability: 0.33), tripled that in "adolescents without apparent targeted behaviors" (odds ratio: 3.60, 95% confidence interval: 3.01-4.30). Risk of being bullied was reduced for those "substance and electronic media users" living with a nuclear family. Behavioral patterns and their association with being bullied differ between groups of school-aged adolescents. To better inform decision-making based on the current real-world findings, the implementation of bullying prevention programs could target specific behavioral patterns.

Socio-Demographic Factors Associated with Rural Residents' Dietary Diversity and Dietary Pattern: A Cross-Sectional Study in Pingnan, China

There is limited evidence regarding the factors correlated with dietary diversity (DD) and dietary pattern (DP) in rural residents of China. This study aims to identify the DD and DP of rural residents and their association with socio-demographic factors. A cross-sectional survey was conducted in Pingnan, China. The Food Frequency Questionnaire (FFQ) was applied to evaluate dietary intake. Latent class analysis (LCA) was used to identify patterns of six food varieties, including vegetables-fruits, red meat, aquatic products, eggs, milk, and beans-nuts. Generalized linear models and multiple logistic regression models were used to determine factors associated with the DD and DP. Three DPs were detected by LCA, namely "healthy" DP (47.94%), "traditional" DP (33.94%), and "meat/animal protein" DP (18.11%). Females exhibited lower DD (β = -0.23, p = 0.003) and were more likely to adhere to "traditional" DP (OR = 1.46, p = 0.039) and "meat/animal protein" DP (OR = 2.02, p < 0.001). Higher educational levels and annual household income (AHI) were positively associated with higher DD (p < 0.05) and less likely to have "traditional" DP and "meat/animal protein" DP (p < 0.05). Non-obese people exhibited higher DD (β = 0.15, p = 0.020) and were less likely to have "meat/animal protein" DP (OR = 0.59, p = 0.001). Our study reveals that females, those with lower educational levels and AHI, and obese people are more likely to have a lower DD and are more likely to adhere to "traditional" DP and "meat/animal protein" DP. The local, regional, and even national performance of specific diet-related health promotion measures and interventions must target these vulnerable populations to improve a healthier DD and DP.

Exploring associations of adverse childhood experiences with patterns of 11 health risk behaviors in Chinese adolescents: focus on gender differences

PURPOSE

Adolescents exposed to adverse childhood experiences (ACEs) are at increased risk for health-compromising behaviors. However, few studies have investigated how ACEs correlate with patterns of health risk behaviors (HRBs) during adolescence, a crucial developmental period. The aim was to extend the current knowledge about the relationship between ACEs and HRB patterns among adolescents, and to explore gender differences.

METHODS

A multi-centered population-based survey was conducted in 24 middle schools in three provinces across China between 2020 and 2021. A total of 16,853 adolescents effectively completed anonymous questionnaires covering exposure to eight ACE categories and 11 HRBs. Clusters were identified using latent class analysis. Logistic regression models were utilized to test the association between them.

RESULTS

There were four classes of HRB patterns: "Low all" (58.35%), "Unhealthy lifestyle" (18.23%), "Self-harm" (18.42%), and "High all" (5.0%). There were significant differences between HRB patterns in terms of the different numbers and types of ACEs in three logistic regression models. Specifically, compared to "Low all," different types of ACEs were positively associated with the three other HRB patterns, and there were significant trends toward increase in the three latent classes of HRBs with higher ACEs. In general, females with ACEs had a higher risk of "High all" except sexual abuse than males.

CONCLUSION

Our study comprehensively considers the association between ACEs and aggregation categories of HRBs. The results support efforts to improve clinical healthcare, and future work may explore protective factors based on individual, family, and peer education to mitigate the negative trajectory of ACEs.

Cluster Analysis of Sleep Time and Adolescent Health Risk Behaviors

Adolescents are prone to multiple health risk behaviors. These might lead to insufficient sleep, which is inconducive to adolescent growth. Therefore, this study explored the impact of a cluster of adolescent health risk behaviors on sleep time, providing a reference for designing relevant intervention measures. From November to December 2019, a stratified cluster sampling method was used to sample middle and high schools in 4 functional districts of Chongqing, China. A total of 8546 participants were selected for a questionnaire survey. Two-step clustering helped identify the health risk behavior clusters. Multivariate logistic regression models helped examine the association between the different clusters and sleep time. The rate of insufficient sleep was 65.8%. Three types of clusters were identified, namely (1) high-risk (poor) cluster (17.3%), (2) low physical activity (medium) cluster (55.1%), and (3) low-risk (good) cluster (27.6%). The high-risk and low physical activity clusters showed that the adjusted OR values of 1.471 (1.266-1.710) and 1.174 (1.052-1.310) were significantly associated with insufficient sleep (P < .001). Adolescent health risk behaviors were clustered, and different clusters had different sleep time. Schools authorities and healthcare practitioners should formulate effective intervention measures according to the characteristics of different clusters to promote healthy growth among adolescents.

Longitudinal Trajectories of Depressive Symptoms Among Patients With Knee Osteoarthritis: The Role of Pain Intensity

BACKGROUND

Pain is the primary symptom of knee osteoarthritis (KOA), significantly associated with depressive symptoms. Whether the early pain intensity could distinguish different trajectories of depressive symptoms is not well understood among patients with KOA.

AIMS

To identify heterogeneous depressive symptoms trajectories among patients with KOA, and investigate the association between depressive symptoms subgroups and pain intensity.

DESIGN

Secondary analysis of a cohort sample.

SETTING

Three waves of data from the China Health and Retirement Longitudinal Study was collected in 28 provinces across China.

PARTICIPANTS

702 patients with KOA aged ≥ 45 years completed the Center for Epidemiologic Studies Depression Scale biennially from 2011 to 2015.

METHODS

Latent class growth analysis was performed to identify the optimal trajectory shape and number of classes. Multinomial logistic regression analysis was conducted to compare pain intensity across the trajectories.

RESULTS

Four distinct trajectories were identified as follows: no depressive symptoms, highly stable, decreasing, and increasing. In multivariate analysis, compared with the "no depressive symptoms" class, patients in the "highly stable" class and "increasing" class were more likely to report moderate pain (p < 0.05) and severe pain (p < 0.05). In addition, there was no significant difference in pain intensity between "no depressive symptoms" class and "decreasing" class (p > 0.05).

CONCLUSIONS

These results suggest important heterogeneity in depressive symptom trajectories among patients with KOA. Pain intensity could predict different depressive symptom trajectories in patients with KOA. Efforts to improve the depressive symptoms in patients with KOA must incorporate strategies to address pain.