The 6-item Kessler psychological distress scale to survey serious mental illness among Chinese undergraduates: Psychometric properties and prevalence estimate

A national survey of pandemic fear and cyberchondria after ending zero-COVID policy: The chain mediating role of alexithymia and psychological distress

BACKGROUND

More than half the domestic population in China were infected with COVID-19 in two months after ending "zero-infection policy", which severely overwhelmed frontline healthcare providers with stress and fear. However, there is no study to date investigating the associations between nurses' fear of pandemic and cyberchondria. This study aimed to 1) investigate the correlations between fear pandemic and cyberchondria among frontline nurses, and 2) discover its potential mechanism.

METHODS

A cross-sectional sample of frontline nurses (N = 8161) was recruited from 98 hospitals across China in February 2023. Participants were invited to complete an online, self-rated standardized questionnaire focused on pandemic fear, alexithymia, psychological distress, and cyberchondria. Environmental, clinical and socioeconomic information were collected for adjustment while conducting chain mediation analysis.

RESULTS

When other covariates were controlled, it was found that fear of the pandemic significantly contributed to cyberchondria (b = 0.58, 95%CI [0.56, 0.60], p < .001). The chain mediation model suggested that both alexithymia and psychological distress were mediating factors between pandemic fear and cyberchondria.

CONCLUSIONS

The higher the perceived fear, the greater the cyberchondria, which suggests that reducing fear about the pandemic and providing adequate support could reduce the incidence of cyberchondria. As alexithymia and psychological distress may be transdiagnostic mechanisms between fear and cyberchondria, targeted interventions focused on expression dysregulation and emotional identification could be useful.

Financial Literacy and Mental Health: Empirical Evidence from China

BACKGROUND AND OBJECTIVE

While financial literacy is a plausible determinant of mental health, there are relatively few studies exploring the relationship between financial literacy and mental health, and the existing literature focuses on a single construct of financial literacy in high-income settings. Our study addresses this by investigating whether there is an association between financial knowledge, attitudes, and behaviours and mental health in Chinese adults.

METHODS

We use data from the China Family Panel Studies, a nationally representative longitudinal survey. Mental health is measured using the Kessler Psychological Distress Scale (K6) and financial literacy is assessed using a unique module on financial literacy covering financial knowledge, financial attitudes and financial behaviours.

RESULTS

We found that overall financial literacy and two of its dimensions (financial attitudes and financial behaviours) are always positively associated with mental health. A positive association between basic financial knowledge and mental health is also apparent but is mediated by households' finances. Our results are robust to using different outcome variables and estimation methods. Finally, we found that compared with their counterparts without debt, indebted respondents show a stronger sensitivity of mental health to basic financial knowledge, as well as a significant association between advanced financial knowledge and mental health, which persist when we control for households' finances.

CONCLUSIONS

Our findings suggest that investments in financial education might significantly benefit mental health in Chinese adults. This is especially the case among indebted adults.

Prevalence of smartphone addiction and its relation with psychological distress and internet gaming disorder among medical college students

Background

The incidence of smartphone addiction has been widely studied, but the research on the relationship between smartphone addiction and psychological distress and internet gaming disorder is limited. This study investigated the characteristics and prevalence of smartphone addiction and its relation with psychological distress and internet gaming disorder. Furthermore, it provides the scientific basis for intervention measures in schools, families, and society.

Methods

A random cluster sampling method was applied to investigate 656 medical students from grades 1 to 4 at Wannan Medical College in Anhui province, People's Republic of China. The questionnaire consisted of general information, a smartphone addiction scale, an Internet gaming disorder scale, and a Kessler 6-item psychological distress test. The obtained results were first summarized using descriptive statistics. The Chi-square test was used to compare the status of smartphone addiction. Binary logistic regression was used to analyze the relationship between smartphone addiction and various variables.

Results

Our results showed that the prevalence of smartphone addiction in medical students was 49.5% (325/656). Psychological distress (p < 0.001), internet gaming disorder (p < 0.001), and childhood trauma (p = 0.001) were highly correlated with smartphone addiction in medical students. Psychological distress, and internet gaming disorder were positively associated with smartphone addiction (p < 0.000).

Conclusion

The prevalence of smartphone addiction is high among medical students in Chinese. Smartphone addiction is highly related to related to internet gaming disorder and psychological distress.

Self-objectification in Chinese pregnant women: The mixed role of functionality appreciation

Extensions of objectification theory to pregnant women are few and continued research is needed to better understand the psychological consequences of significant changes to physical appearance during pregnancy. Specific interests in this area include functionality appreciation which may be particularly relevant to pregnancy. Research in this area is also lacking representation of non-Western cultural contexts. To this end, we employed an online survey to assess objectification theory and functionality appreciation in Chinese pregnant women (N = 345). Correlations showed that higher body surveillance and body shame were associated with higher disordered eating and psychological distress, and higher functionality appreciation was associated with lower body surveillance, body shame, and disordered eating. Mediation analyses suggested that higher body surveillance was associated with higher body shame which, in turn, was associated with higher disordered eating and psychological distress. Main effects suggested a negative association between functionality appreciation and body shame, but moderation analyses suggested that higher functionality appreciation strengthened the positive association between body surveillance and body shame. Findings underscore objectification theory as a useful framework to understand eating and body image disturbances and psychological distress in Chinese pregnant women and outline future directions to clarify the temporal nature of these associations and the precise role of functionality appreciation.

The effect of physical fitness on psychological health: evidence from Chinese university students

BACKGROUND

Despite frequent discussions on the link between physical and mental health, the specific impact of physical fitness on mental well-being is yet to be fully established.

METHOD

This study, carried out between January 2022 and August 2023, involved 4,484 Chinese University students from eight universities located in various regions of China. It aimed to examine the association between physical fitness on psychological well-being. Descriptive statistics, t-tests, and logistic regression were used to analyze the association between physical fitness indicators (e.g., Body Mass Index (BMI), vital capacity, and endurance running) and mental health, assessed using Symptom Checklist-90 (SCL-90). All procedures were ethically approved, and participants consented to take part in.

RESULTS

Our analysis revealed that BMI, vital capacity, and endurance running scores significantly influence mental health indicators. Specifically, a 1-point increase in BMI increases the likelihood of an abnormal psychological state by 10.9%, while a similar increase in vital capacity and endurance running decreases the risk by 2.1% and 4.1%, respectively. In contrast, reaction time, lower limb explosiveness, flexibility, and muscle strength showed no significant effects on psychological states (p > 0.05).

CONCLUSION

Improvements in BMI, vital capacity, and endurance running capabilities are associated with better mental health outcomes, highlighting their potential importance in enhancing overall well-being.

The performance of K6 as a screening tool for mood disorders: A population-based study of the São Paulo metropolitan area

AIM

The use of screening instruments allows the detection of psychological and behavioural manifestations there are often not identified in users of health services. We evaluated the performance of the Kessler Psychological Distress Scale (K6) in identifying mood disorders (MD), using the Composite International Diagnostic Interview (CIDI) as gold-standard, in a population-based sample (n = 5037) of adult residents of metropolitan São Paulo.

METHODS

Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated to assess the performance of K6 in detecting 30-day CIDI MD. All cut-points for each disorder were analysed using the Youden index and the area under the receiver operating characteristic curve (AUC), and the best cut-points were identified. Cronbach's alpha was calculated to assess internal consistency.

RESULTS

In total, 5.5% respondents screened positive for any MD (95% IC 4.84-6.14). A good detection performance was observed for all MD, with AUC values for any MD of 0.91 (95% IC 0.89-0.92), ranging from 0.80 (95% CI 0.71-0.98) for minor depression to 0.93 (95% CI 0.87-0.98) for bipolar I disorder. Best cut-points for each MD were identified, with overall sensitivity and specificity of 88.8% and 80.2%, respectively. Cronbach's alpha was 0.83.

CONCLUSIONS

K6 is a good screening tool for MD in the Brazilian population. It is a brief and easy to use instrument that can promote the early identification and treatment of MD, reducing the burden of mental illness.

Exploring the relationship between adverse working environments and poor psychological states of Chinese workers: A comprehensive study

BACKGROUND

Employee mental health is linked with job satisfaction and productivity. However, there is a notable lack of empirical evidence regarding the adverse effects of Hazardous Work Environments (HWE) on employee mental health, indicating a significant gap in occupational health research.

METHODS

Data from the China Family Panel Studies involving 9972 participants were utilized. Mental health was assessed using the Kessler 6 Psychological Distress Scale at baseline and the 8-item Center for Epidemiologic Studies Depression scale at follow-up. Associations between HWE exposure and mental health were explored cross-sectionally at baseline plus mediation analyses for the influence of sleep duration. Cox proportional hazards regression was used to assess the longitudinal implications of HWE exposure.

FINDINGS

Participants exposed to HWE showed a higher risk of having serious psychological distress (OR (95%CI): 1.47 (1.29-1.69)) cross-sectionally at baseline, and this risk rose with increased number of HWE elements (1.30 (1.11-1.52) and 2.18 (1.75-2.72) for 1-2 and ≥ 3 elements, respectively). Longitudinally, HWE exposure was associated with an increased risk of depression (HR (95%CI): 1.10 (1.07-1.14)). Similarly, this risk risen with increased number of HWE elements (1.08 (1.06-1.09) and 1.20 (1.05-1.38) for 1-2 and ≥ 3 elements, respectively) and longer duration of exposure (1.01 (1.00-1.01)). Short sleep duration emerged as a significant mediator between HWE exposure and psychological distress.

INTERPRETATION

This study illuminates a robust association between HWE exposure and psychological distress, especially under prolonged and multiple exposures. We advocate for rigorous mental health monitoring and interventions for workers in adverse working environments.

FUNDING

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Effects of physical fitness on mental health of Chinese college students: across-sectional study

BACKGROUND

The physical and mental health of college students is often mentioned, but there is limited research on a direct relationship between the mental health status of college students and their physical fitness level. This study mainly proves the relationship between Chinese college students' mental health and physical fitness indicators.

METHOD

This study collected SCL-90 Scale test results from 5262 students (4012 boys and 1250 girls) through a questionnaire survey and conducted a Sport Quality Test on these students. Statistical software SPSS was applied for differential analysis and logistic regression analysis. Specifically, the differences in sport quality indicators between normal and abnormal mean total scores of psychological tests were analyzed first. Then, the binary logistic regression model was used to explore the impacts of sports quality indicator scores on students' psychological fitness.

RESULTS

There are differences in the results of physical fitness tests between students with abnormal psychology and students with normal psychology. The four indexes of students' vital capacity, speed, explosive power of lower limbs, and endurance running are effective in improving students' psychologically abnormal state, and endurance running and improving vital capacity are the most effective methods to improve students' psychologically abnormal state. In the physical tests of Chinese college students, the risk of psychological abnormalities was reduced by 9% for every one-point increase in lung capacity and 10.4% for every one-point increase in endurance running performance.

CONCLUSIONS

Chinese college students' physical fitness and mental health are related. The best methods for treating psychological disorders are lung capacity improvement and endurance running. According to the physical test results of Chinese college students, for every 1-point increase in lung capacity and endurance running, the risk of psychological abnormalities decreased by 9% and 10.4%, respectively.

Evaluation of a Low-Intensity Online Intervention (LiON) for Reducing Distress and Mental Health Symptoms in Young People

PURPOSE

Enhancing young people's mental health is crucial given that most adult mental disorders develop before age 24 years. However, it is unclear whether low-intensity interventions delivered online can be effective. This study aimed to provide preliminary evidence on whether a low-intensity online intervention (LiON) can effectively lower young people's distress levels and mental health symptoms.

METHODS

We compared the preintervention and postintervention changes in distress level and severity of depression and anxiety symptoms in 137 young people aged 15-24 years who used the LiON service with the three-month changes in a 1:1 propensity score-matched control group of community young people who did not use the service. They participated in one of the following modules for the first time: (1) sleep and relaxation, (2) stress-coping, and (3) problem-solving.

RESULTS

Participants who received LiON intervention (mean age 22.88 [standard deviation 3.67] years, 65.7% female) showed significantly greater reductions in distress level (Cohen's f2: 0.079), as well as the severity of depressive symptoms (Cohen's f2: 0.056) and anxiety symptoms (Cohen's f2: 0.044) compared to the control group.

DISCUSSION

The findings suggest that the LiON intervention has the potential to effectively reduce distress and mental health symptoms in young people. Future research should aim to confirm these findings through randomized controlled trials and explore the cost-effectiveness of the intervention.

Loot boxes, gambling-related risk factors, and mental health in Mainland China: A large-scale survey

Loot boxes can be bought with real-world money to obtain random content inside video games. Loot boxes are viewed by many as gambling-like and are prevalently implemented globally. Previous Western and international studies have consistently found loot box spending to be positively correlated with problem gambling. Previous Western studies presented mixed results as to the correlations between loot box purchasing and gambling-related risk factors, mental wellbeing, and psychological distress. A large-scale survey of adult video game players from the People's Republic of China (PRC) (N = 2601) was conducted through Tencent Survey. The positive correlations between loot box spending and problem gambling, and between loot box spending and problem videogaming, were successfully replicated. However, other potential risk factors (i.e., impulsivity/impulsiveness; binary past-year gambling participation status; and sensation-seeking tendencies) either did not positively correlate with loot box spending or only did so weakly. Contrary to expectations, high impulsivity was negatively associated with loot box engagement. The Risky Loot Box Index (RLI) most strongly positively correlated with, and was the best predictor in multiple linear regression models for, loot box spending. The RLI may be effective at measuring loot box harms cross-culturally. A surprising weak positive correlation was found between loot box engagement and PRC players' mental wellbeing, and high psychological distress unexpectedly negatively predicted loot box purchasing. Although gambling-like, the risk and protective factors of loot boxes are seemingly different, meaning they should rightfully be treated as novel products. Cross-cultural research can contribute to a better understanding of loot box harms.

A cross-disasters comparison of psychological distress: Symptoms network analysis

Large-scale traumatic events have the potential to trigger psychological distress, particularly among those in the affected areas. However, the manifestation of psychological distress may vary across different types of disasters. This study thus aimed to compare the symptoms network structure of psychological distress as assessed by the Kessler Psychological Distress Scale across three types of disasters: Terror (n = 5842), COVID-19 (n = 2428), and a nature-related disaster (n = 1001). Across disasters, two communities representing depression and anxiety symptoms were revealed. However, while after a nature-related disaster and the COVID-19 pandemic depression and anxiety items were interconnected via hopelessness, a terror attack resulted in more separated manifestations of anxiety and depression. Examination of symptom centrality showed that while in the Terror and the COVID-19 networks "depressed/no cheering up" was most connected to other symptoms, for the nature-related disaster network, two items were most central: "depressed/no cheering up" and "restless or fidgety". The results may point to different mechanisms of psychological distress structures after different disasters. Depending on the type of disaster, trauma-focused interventions may require targeted support and treatment.

Family characteristics in adolescents with overweight or obesity: a network analysis

Background

Rates of overweight and obesity continue to grow in adolescents. Overweight and obesity in adolescence are associated with numerous immediate and long-term adverse health conditions. Throughout adolescence, parents and the family have an important and central influence on adolescents' health and lifestyle. The home environment may be a major factor in shaping children's weight. However, our current understanding of the interplay between family-related variables in adolescents with overweight or obesity is limited and fragmented. This study aimed to assess the relationship between family-related variables in adolescents who are overweight or obese using network analysis and inform future health promotion for family-based intervention.

Methods

Participants (n = 488) were recruited from middle schools in Nanjing from October 2022 to March 2023. Participants, together with their parents, completed a questionnaire at school about the family food environment, family size, family APGAR index, family physical activity facilities, parental mental health, rearing behavior, parental weight status, drinking history, marital satisfaction, and sociodemographic characteristics.

Results

The network split into three distinct communities of items. Network analysis showed that parental mental health and paternal rearing styles-rejection were the most central nodes in the network. In contrast, maternal weight status was the most peripheral and least connected nodes.

Conclusion

Family-related variables constituted a connected network in adolescents with overweight or obesity. The pattern of network node connections supports that interventions could prioritize targeting changing parental mental health and paternal rearing styles in adolescents with overweight or obesity.

A network analysis of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults

OBJECTIVE

Previous studies have revealed associations between disordered eating symptoms, big-five personality traits, and psychological distress. However, limited research has explored these relationships as a network, including their interconnections, and even less has done so in non-Western populations. We employed network analysis to investigate the co-occurrence of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults.

METHOD

A sample of 500 Chinese adults (256 men) completed measures assessing big-five personality traits, psychological distress, and disordered eating symptoms. The network of personality traits, psychological distress, and disordered eating symptoms was estimated, including its central and bridge nodes.

RESULTS

The central nodes in the network were the facets of openness (like adventure), extraversion (like going to social and recreational parties), and disordered eating symptoms (dissatisfaction with body weight or shape). Moreover, certain facets of neuroticism (always worrying something bad will happen), psychological distress (feeling worthless), and an inverse facet of extraversion (bored by parties with lots of people) were identified as essential bridge nodes in maintaining the structure of the network.

CONCLUSION

Our findings suggest that personality traits (e.g., openness and extraversion) and body dissatisfaction are important in maintaining the network in a community sample of Chinese adults. While future replication is needed, findings from this study suggest that individuals with negative self-thinking, predisposed neuroticism, and extraversion may be at risk of developing disordered eating symptoms.

PUBLIC SIGNIFICANCE

The present study contributes to existing knowledge by employing a network perspective to examine the associations between disordered eating symptoms, big-five personality traits, and psychological distress in a Chinese adult community sample. The identified facets of neuroticism and extraversion and symptoms of psychological distress may be worthy of targeting in the prevention and treatment of disordered eating in the Chinese context.

Assessment of psychometric properties of the Huaxi Emotional-distress Index questionnaire (HEI)in a large sample of general hospital inpatients

OBJECTIVES

Huaxi Emotional-distress Index questionnaire (HEI) is a 9-item questionnaire designed to measure psychological distress. The present study aimed to validate the factor structure of the HEI and its reliability and validity using a large sample from inpatients of West China Hospital.

METHODS

HEI data were collected from inpatients of various departments at West China Hospital in 2019 through the hospital's data management platform (total sample, N = 55,396). The internal consistency reliability of the HEI was examined. Exploratory factor analysis (N = 27,696) and confirmatory factor analysis(N = 27,700) were conducted to validate the construct validity.

RESULTS

Three factors, namely depression (DEP), anxiety (ANX), and suicidal risk (SR), were extracted through exploratory factor analysis, which accounted for 79.55% of the total variance.The results of confirmatory factor analysis supported the fit for the three-component model oblique model as the best-fitting model compared with one-component model and two-component model. The internal consistency of the HEI was α =0.918. The internal consistencyα of ANX, DEP and SR is 0.87,0.814,0.843 respectively.

CONCLUSIONS

HEI is a validated and concise tool that serves a dual purpose of screening for mood disorders and assessing depressive and anxiety symptoms as well as suicidal risk among inpatients in Chinese general hospitals.

Picky eating is associated with lower life satisfaction and elevated psychological distress and psychosocial impairment in Chinese pregnant women

OBJECTIVE

This study assessed picky eating in pregnant women by exploring whether picky eating is associated with pregnant women's well-being, including life satisfaction, psychological distress, and psychosocial impairment.

METHOD

Data collected were from 345 Chinese pregnant women (M age = 29.95 years, SD = 5.58). Pearson correlation analyses were conducted to examine zero-order correlations between picky eating and well-being variables (i.e., life satisfaction, psychological distress, and psychosocial impairment). Hierarchical multiple regressions were conducted to examine the unique associations of picky eating with well-being variables, adjusting for demographic and pregnancy-related characteristics and thinness-oriented disordered eating.

RESULTS

Picky eating was significantly and negatively correlated with life satisfaction (r = -.24, p < .001) and positively correlated with psychological distress (r = .37, p < .001) and psychosocial impairment (r = .50, p < .001). When adjusting for covariates and thinness-oriented disordered eating, picky eating was still significantly associated with lower life satisfaction, higher psychological distress, and higher psychosocial impairment.

DISCUSSION

The findings suggest that picky eating may be a significant correlate of pregnant women's poorer well-being. Future research with longitudinal designs is warranted to further examine the temporal associations between picky eating and pregnant women's well-being.

PUBLIC SIGNIFICANCE

Picky eating behaviors are poorly understood in pregnant women. Our results revealed that higher picky eating behaviors were associated with lower life satisfaction and higher psychological distress and psychosocial impairment in Chinese pregnant women. Researchers and clinicians may consider picky eating in the assessment and treatment of mental health and disordered eating in pregnant women.

Assessing the Smallest Detectable Change of the Kessler Psychological Distress Scale Score in an Adult Population in Japan

Background

Psychological distress is prevalent worldwide and can lead to the development of mental conditions such as major depression and anxiety disorders. It is essential to assess the severity of patient-reported outcomes to provide effective treatment for psychological distress. The Kessler Psychological Distress Scale (K6) is one of the most widely used psychological distress scales. However, the smallest detectable change (SDC) of the K6 score has not been elucidated. Therefore, the current study aimed to determine the SDC of the K6 score in a Japanese adult population.

Methods

Participants aged 20-59 years who are native Japanese speakers were recruited from the panel list of a web research firm. The K6 score was assessed at baseline (T1) and at 2-week follow-up (T2). SDCs were calculated at the individual (SDC_ind) and group (SDC_group) levels. Intraclass correlation coefficient agreement (ICC_agreement) was calculated to assess test-retest reliability and Cronbach's alpha to evaluate internal consistency.

Results

A total of 3254 (1627 [50%] female) responded at T1 and T2. The mean (standard deviation) K6 scores were 5.71 (5.84) at T1 and 5.65 (5.83) at T2. The SDC_ind and SDC_group of the K6 score were 8.47 (35.31%) and 0.15 (0.63%), respectively. The ICC_agreement was 0.73, and the Cronbach's alpha was 0.94.

Conclusion

Our study provided evidence on the reliability and interpretation of the K6 score. Calculating the SDC of the K6 score can help identify the significance of changes in psychological distress over time and can determine the efficacy of interventions for psychological distress.

The Chinese version of the Functionality Appreciation Scale: Psychometric properties and measurement invariance across gender and age

BACKGROUND

Functionality appreciation, as an important aspect of positive image, is associated with fewer body image disturbances, fewer disordered eating behaviors, and improved psychological well-being. However, it has been under-researched in Asian countries. The current work aimed to examine the psychometric properties of the Functionality Appreciation Scale (FAS) among four Chinese samples of different ages, and further examine measurement invariance and differences of the FAS across gender and age groups.

METHODS

Exploratory and confirmatory factor analyses (EFA and CFA) were conducted to examine the factorial structure of the FAS among four Chinese samples of different ages, including middle school adolescents (n = 894, M_age = 12.17 years), high school adolescents (n = 1347, M_age = 15.07 years), young adults (n = 473, M_age = 21.95 years), and older adults (n = 313, M_age = 67.90 years). The measurement invariance of the FAS across gender and age was examined. Internal consistency reliability and construct validity were evaluated.

RESULTS

The FAS had a unidimensional structure and was invariant across gender and age groups. The FAS presented sound psychometric properties in all age groups by gender, with good internal consistency reliability [e.g., high Cronbach's α values (.91 ~ .97)] and good construct validity (e.g., significant associations with body appreciation, body dissatisfaction, and disordered eating). Moreover, group comparisons showed minimal gender differences in functionality appreciation. However, significant age differences were found in functionality appreciation, with older ages generally associated with higher functionality appreciation.

CONCLUSION

Overall, findings suggest that the FAS is a sound instrument to be used in the Chinese context. Furthermore, functionality appreciation was found to be higher in older adults than adolescents or young adults, suggesting the potential important role of aging in functionality appreciation.

The impact of immigration detention on the mental health of refugees and asylum seekers

Studies consistently report that asylum seekers held in immigration detention have relatively high rates of mental distress, yet evidence of the long-term impact of immigration detention is limited. Using propensity score-based methods, we estimated the impact of immigration detention on the prevalence of nonspecific psychological distress, using the Kessler-6, and probable posttraumatic stress disorder (PTSD), using the PTSD-8, among participants in a national sample of asylum seekers in the 5 years following their resettlement in Australia (N = 334). At Wave 1, the prevalence of nonspecific psychological distress was high among all participants regardless of detainment status, OR = 0.28, 95% CI [0.04, 2.06], and did not change over time for either detainees (n = 222), OR = 1.01, 95% CI [0.46, 2.18], or nondetainees (n = 103), OR = 0.81, 95% CI [0.39, 1.67]. In contrast, the odds of probable PTSD were significantly higher for former detainees, OR = 8.20; 95% CI [2.61, 26.73], than nondetainees at Wave 1; although they declined among former detainees, OR = 0.56, 95% CI [0.38, 0.82]), and increased among nondetainees, OR = 1.57, 95% CI [1.11, 2.23], in the years following resettlement. These results imply the use of immigration detention to manage unauthorized migration increases the prevalence of probable PTSD in the short term among former detainees who have resettled in Australia.

Stressors in health care and their association to symptoms experienced by gender diverse people

OBJECTIVES

Many individuals whose gender does not align with the sex they were assigned at birth (gender diverse [GD] people) report stressful health care encounters. We examined the relationship of these stressors to symptoms of emotional distress and impaired physical functioning among GD people.

STUDY DESIGN

This study was conducted using a cross-sectional design with data from the 2015 United States Transgender Survey.

METHODS

Composite metrics of health care stressors and physical impairments were developed, and the Kessler Psychological Distress Scale (K-6) provided a measure of emotional distress. Linear and logistic regression were used to analyze the aims.

RESULTS

A total of 22,705 participants from diverse gender identity subgroups were included. Participants who experienced at least one stressor in health care during the past 12 months had more symptoms of emotional distress (β = 0.14, P < .001) and 85% greater odds of having a physical impairment (odds ratio = 1.85, P < .001). Transgender men exposed to stressors were more likely than transgender women to experience emotional distress and have a physical impairment, with other gender identity subgroups reporting less distress. Black participants exposed to stressful encounters reported more symptoms of emotional distress than White participants.

CONCLUSIONS

The results suggest that stressful encounters in health care are associated with symptoms of emotional distress and greater odds of physical impairment for GD people, with transgender men and Black individuals being at greatest risk of emotional distress. The findings indicate the need for assessment of factors that contribute to discriminatory or biased health care for GD people, education of health care workers, and support for GD people to reduce their risk of stressor-related symptoms.

Impact of Sertraline, Fluoxetine, and Escitalopram on Psychological Distress among United States Adult Outpatients with a Major Depressive Disorder

How impactful is the use of Sertraline, Fluoxetine, and Escitalopram monotherapy on psychological distress among adults with depression in the real world? Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. Medical Expenditure Panel Survey (MEPS) longitudinal data files from 1 January 2012 to 31 December 2019 (panel 17-23) were used to assess the effects of Sertraline, Fluoxetine and Escitalopram on psychological distress among adult outpatients diagnosed with a major depressive disorder. Participants aged 20-80 years without comorbidities, who initiated antidepressants only at rounds 2 and 3 of each panel, were included. The impact of the medicines on psychological distress was assessed using changes in Kessler Index (K6) scores, which were measured only in rounds 2 and 4 of each panel. Multinomial logistic regression was conducted using the changes in the K6 scores as a dependent variable. A total of 589 participants were included in the study. Overall, 90.79% of the study participants on monotherapy antidepressants reported improved levels of psychological distress. Fluoxetine had the highest improvement rate of 91.87%, followed by Escitalopram (90.38%) and Sertraline (90.27%). The findings on the comparative effectiveness of the three medications were statistically insignificant. Sertraline, Fluoxetine, and Escitalopram were shown to be effective among adult patients suffering from major depressive disorders without comorbid conditions.

Association between mental health and academic performance among university undergraduates: The interacting role of lifestyle behaviors

OBJECTIVES

Impaired mental health status tends to be associated with poor academic performance, but few prospective studies have examined the association between mental health and academic performance among undergraduates while considering the interacting roles of multiple lifestyle behaviors.

PARTICIPANTS AND METHODS

A total of 1823 Japanese undergraduate students (67% men) were followed up for 4 years. Their mental health status was measured by the six-item Kessler Psychological Distress Scale (K6). We defined poor academic performance as a grade point average (GPA) <2.0. Cox proportional hazards models were used to determine the relationship between the students' mental health status and the incident risk of poor academic performance.

RESULTS

Our analyses revealed that impaired mental health status in the first semester of university study significantly predicted an increased incident risk of poor academic performance during the overall undergraduate period. This association remained significant when the health lifestyle behaviors were adjusted, and the hazard ratio (95% confidence interval) for poor academic performance was 1.62 (1.18-2.23). This significant association disappeared in the low-lifestyle-behavior-risk group.

CONCLUSION

Impaired mental health status in the first semester significantly predicts an increased incident risk of poor academic performance during the undergraduate period.

Relationships between weight bias internalization and biopsychosocial health outcomes: A prospective study in Chinese adolescents

OBJECTIVE

An extensive literature has documented the deleterious effects of weight bias internalization (WBI) on biopsychosocial health outcomes. Still, this research is largely confined to the Western context. Furthermore, few studies have explored associations between WBI and biopsychosocial health outcomes, including in non-Western adolescent populations.

METHOD

The present study explored the longitudinal relationships between WBI and body dissatisfaction, disordered eating, psychosocial impairment related to eating disorder features, and psychological and physical well-being in a sample (N = 1549; aged 11-18 years at baseline) of Chinese adolescents. Relationships between study variables were examined between two waves of data measurement (Time 1, baseline, and Time 2, 6-month). Cross-lagged and multivariate models were used to explore prospective relationships between WBI and biopsychosocial correlates.

RESULTS

Bidirectional relationships were observed between WBI and biopsychosocial correlates in Chinese adolescents. Adjusting for covariates and other predictor variables, higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 1 predicted higher WBI at Time 2. Furthermore, higher WBI at Time 1 predicted higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 2.

DISCUSSION

Weight bias internalization and psychosocial correlates were interrelated across time in Chinese adolescents. Improving WBI might be promising in the prevention of eating and body image disturbances and diminished psychosocial well-being. Similarly, reducing eating and body image disturbances and improving psychosocial well-being might be useful prevention targets in reducing WBI in Chinese adolescents.

PUBLIC SIGNIFICANCE

The present study represents an initial effort to explore bidirectional relationships between WBI and biopsychosocial health outcomes in Chinese adolescents. Findings suggest bidirectional relationships between WBI and psychosocial variables, highlighting the potential utility of incorporating WBI interventions into eating pathology and poor psychosocial well-being prevention designs for Chinese adolescents.

Self-Compassion and Physical Activity: The Underpinning Role of Psychological Distress and Barrier Self-Efficacy

Unlike other personality traits or dispositions, self-compassion can be nurtured and is likely a driving source for physical activity. Emerging research has started to examine self-compassion in physical activity contexts; however, most existing studies were underpowered and overlooked the psycho-behavioural factors underlying the link between self-compassion and physical activity. In a sample of 569 UK adults (mean age = 41.92 years, SD = 13.70; 47.8% female), we examined the hypothesis that self-compassion's positive influence on physical activity operates through reduced psychological distress and subsequently increased barrier self-efficacy. Results supported the prediction, with the positive influences of self-compassion being more prominent in more vigorous physical activity. The findings suggest that self-compassion is a good source of emotional resources (i.e., attenuated psychological distress) and confidence to overcome challenges and obstacles (i.e., increased barrier self-efficacy) in the context of physical activity. Future interventions and programs could consider incorporating self-compassion for physical activity adoption and maintenance.

Mental health symptoms and coping strategies among Ukrainians during the Russia-Ukraine war in March 2022

CONTEXT

The Russian attack on Ukraine has been ongoing since February 24, 2022. Nevertheless, no research has documented the mental health of Ukrainians during the biggest land war in Europe after the Second World War, or how Ukrainians cope with the impact of the war.

OBJECTIVES

To provide the prevalence rates of symptoms of psychological distress, anxiety, depression, and insomnia; and to link them with Ukrainians' productive coping strategies during the war.

DESIGN, SETTING, AND PARTICIPANTS

Online survey conducted in Ukraine during the initial period of the Russian invasion (March 19-31, 2022), using a quota sampling method, of 1,400 Ukrainians aged 18 years or older, with a total of 801 valid responses for a response rate of 57.2%.

MAIN OUTCOME MEASURES

Psychological distress assessed by the Kessler Psychological Distress scale (K6); anxiety assessed by Generalized Anxiety Disorder-2 (GAD-2) scale; depression assessed by Patient Health Questionnaire-2 (PHQ-2); insomnia assessed by Insomnia Severity Index-4 (ISI-4); modes of coping assessed by Brief COPE.

RESULTS

Of 801 Ukrainian adults, 52.7% had symptoms of psychological distress (mean = 13.3 [SD = 4.9]); 54.1% of them reported symptoms of anxiety (mean = 2.9 [SD = 1.7]); 46.8% reported symptoms of depression (mean = 2.6 [SD = 1.6]). Symptom criteria for insomnia were met by 97 respondents (12.1%) (mean = 10.4 [SD = 4.2]). Demographic variables (including gender, living in an urban area, having children or elderly persons in the household, living in an area occupied by Russian forces) were associated with symptoms of distress, anxiety, depression, and insomnia. The productive coping strategies of using instrumental support, behavioral disengagement, self-distraction, and planning were significantly associated with mental health symptoms.

CONCLUSIONS

Prevalence rates of symptoms of psychological distress, anxiety, depression, and insomnia were high. These findings underscore the need for healthcare and productive coping strategies for Ukrainians during the war.

Superwoman Schema and John Henryism among African American women: An intersectional perspective on coping with racism

RATIONALE

John Henryism and Superwoman Schema (SWS) are dispositional characteristics adopted to overcome the challenges of chronic psychosocial stress, and have particular salience for African American women. Both show protective and harmful effects on health and share conceptual similarities and distinctions, yet there is no empirical evidence of the potential overlap resulting in uncertainty about the unique roles they may each play concerning the health of African American women.

OBJECTIVE

We examined: 1) whether and to what extent John Henryism and SWS represent similar or distinct constructs relevant to the unique sociohistorical and sociopolitical position of African American women, and 2) whether the two differentially predict health outcomes.

METHODS

Data are from a purposive and socioeconomically diverse sample of 208 African American women in the San Francisco Bay Area. First, we conducted a progressive series of tests to systematically examine the conceptual and empirical overlap between John Henryism and SWS: correlation analysis, exploratory factor analysis (EFA), principal component analysis and k-modes cluster analysis. Next, we used multivariable regression to examine associations with psychological distress and hypertension.

RESULTS

John Henryism and SWS were moderately correlated with one another (rs = 0.30-0.48). In both EFA and cluster analyses, John Henryism items were distinct from SWS subscale items. For SWS, feeling an obligation to present an image of strength and an obligation to help others predicted higher odds of hypertension (p < 0.05); having an intense motivation to succeed predicted lower odds (p = 0.048). John Henryism did not predict hypertension. Feeling an obligation to help others and an obligation to suppress emotions predicted lower levels of psychological distress (p < 0.05) whereas John Henryism predicted higher distress (p = 0.002).

CONCLUSIONS

We discuss the implications of these findings for the measurement of culturally specific phenomena and their role in contributing to the unequal burden of ill health among African American women.

Prevalence of internet addiction and its impact on selected psychological parameters among UG nursing students

BACKGROUND

Currently, the use of the internet is one of the most important tools, which may lead to negative or positive impact on college or school students. The excessive use of electronic media may lead to change in the mood, an inability to resist internet usage, a diminishing social life, withdrawal symptoms while unengaged, affecting self-esteem, and adverse work or academic consequences. The main objective of this study is to explore Internet use and its impact on selected psychological parameters such as depression and insomnia among undergraduate (UG) nursing students.

MATERIALS AND METHODS

A total of 385 college students selected by purposive sampling technique were included in the study. Young's Internet Addiction Test (YIAT20) for Internet addiction (IA) assessment, and Beck's depression inventory Scale to assess level of depression, and insomnia severity index (ISI) scale to measure insomnia were used.

RESULTS

Among 385 participants, 175 and 210 were male and female, respectively. Demographic variables such as pursuing course, study year, use of Internet/day; and the purpose of Internet use such as social networking, games, entertainment, pornography, and news were significantly associated with IA. Depression and insomnia were found to be correlated with IA.

CONCLUSION

Internet usage more than the normal limit has a profound effect on college or school students, in particular, depression and insomnia. At times, it ends up in problems in their social and family relationship.

Factor structure and longitudinal measurement invariance of the K6 among a national representative elder sample of China

Background

As the number of older people is rapidly growing, prevention, screening, and treatment of mental health problems (including anxiety and depression) in this population increasingly become a heavy burden to individuals, families, and even the whole society. The Kessler-6 screening measure (K6) is an efficient and effective instrument for general mental health problems. However, few studies have examined its measurement invariance across time, which is particularly important in longitudinal studies, such as exploring developmental trajectories of non-specific psychological distress and evaluating the effects of certain interventions.

Methods

The current study investigated the factor structure and the longitudinal measurement invariance of the K6 among a national representative elder sample of China. Longitudinal data in two survey waves (the year 2010, and the year 2014) from the China Family Panel Studies were drawn for secondary data analysis. A total of 3845 participants aged 60 years old and above (52.2% male, mean age = 66.99 years, SD = 5.93 years) responded to both waves of the survey.

Results

A comparison of four existing models with confirmatory factor analysis supported a two-factor solution of the K6. A series of multi-group confirmatory factor analyses further indicated that the K6 held strict longitudinal measurement invariance across time. Additionally, the internal consistency indices across time and the stability coefficients over time were acceptable.

Conclusions

The findings further confirmed the psychometric defensibility of the K6 when used in the old Chinese population. The longitudinal measurement invariance justified comparisons of psychological distress scores among different measurement time points.

Subjective wellbeing and psychological symptoms of university students during the COVID-19 pandemic: Results of a structured telephone interview in a large sample of university students

University students are at elevated risk for psychological distress, especially during the COVID-19 pandemic. The aim of this study was to warmly contact our students and investigate the psychological impact of the COVID-19 pandemic on the subjective wellbeing (SWB) and levels of psychological symptoms (such as depressive and anxious feelings) of university students in Belgium. All bachelor and master students of the Vrije Universiteit Brussels (N = 15,475) were invited for a brief structured telephone interview in March, 2021. In total, 7,154 students were assessed by a structured interview, based on the Kessler Psychological Distress Scale (K6) and the Anamnestic Comparative Self-Assessment (ACSA). Compared to a representative sample, students considered their life during the pandemic as less satisfying compared to their life before the pandemic. Overall, all students have suffered from COVID-19 and the measures taken to contain the pandemic. Twenty percent of our sample of 7,154 VUB students scored above the K6 cutoff, indicating a heightened risk for having a diagnosable mental illness severe enough to cause functional limitations and to require treatment. This study highlights the need for psychological support for all students, during the COVID-19 pandemic.

Chronic Conditions and Psychological Distress in Older Asian Americans: The Mediating Role of Subjective Health Perception

Given the importance of understanding the connection between physical and mental health in old age, the study examined the mediating role of subjective health perception in the relationship between chronic conditions and psychological distress among older Asian Americans. Using data from 533 Asian Americans aged 60 and over in the 2016 Asian American Quality of Life Study, the direct and indirect effect models were tested with multivariate linear regressions and the PROCESS macro. Results show that chronic conditions pose significant risks to psychological distress and that subjective health perception mediates their association. The observed role of subjective health perception as an intervening step between physical and mental health offers implications for gerontological social work research and practice by highlighting the importance of positive self-appraisals for the health and well-being in later years of life.

Do Specific Craniomaxillofacial Features Correlate with Psychological Distress in Adult Pretreatment Orthodontic Patients? A Cephalometric Study

Purpose

To explore the relationship between craniomaxillofacial features and psychological distress among adult pretreatment orthodontic patients.

Methods

A group of 190 patients (95 males and 95 females) was included. Questionnaires including the Kessler psychological distress scale (K10) were sent to patients, and cephalograms were collected. Patients were divided into two groups according to K10 score: psychological distress group (score ≥ 20) and no psychological distress group (score < 20). Nineteen hard tissue and thirteen soft tissue parameters were traced on cephalograms to characterize the craniomaxillofacial features.

Results

There was no significant difference in gender or age distribution between the two groups. Male patients with psychological distress showed statistically significantly larger anterior facial height (AFH) (126.62 mm vs. 120.97 mm), upper lip length (25.11 mm vs. 23.26 mm), and smaller overbite (1.21 mm vs. 2.75 mm) than patients without psychological distress. Male patients with hyperdivergent pattern and open bite were more likely to have psychological distress. None of the parameters showed statistical differences across groups in females. Frankfort-mandibular plane angle (r = 0.235), Bjork's sum (r = 0.311), AFH (r = 0.322), overbite (r = −0.238), AFH/posterior facial height (r = 0.251), and upper anterior facial height (UAFH)/lower anterior facial height (LAFH) (r = −0.230) were correlated with K10 score in males. After adjusting gender and age, the AFH (B = 0.147) and UAFH/LAFH (B = −14.923) were significantly related with the K10 score.

Conclusion

Psychological distress was mainly correlated with hyperdivergent pattern, open bite, and larger lower anterior facial height proportion in pretreatment orthodontic patients. Orthodontists should be aware of the possible underlying psychological distress in patients with specific craniomaxillofacial features. Clinical assessment of psychological distress may need to take into account gender differences in patients.

Chinese translation of the Clinical Impairment Assessment (CIA 3.0): Psychometric properties and measurement invariance across sex and age in adolescents, young adults, and adult men

The Clinical Impairment Assessment (CIA) is the most widely used instrument for assessing psychosocial impairment related to eating disorders (EDs). The CIA was translated into Chinese based on standard procedures. The psychometric properties of the Chinese CIA (C-CIA) were assessed among four adolescent and adult samples [i.e., 792 junior high school students (47.0% boys; M_age = 13.09 years), 1324 senior high school students (44.2% boys; M_age = 16.06 years), 812 undergraduate students (36.3% boys; M_age = 18.88 years), and 406 male adults from a general population (M_age = 28.53 years)]. The three-factor structure of the CIA was replicated. Excellent internal consistencies of the C-CIA were revealed, α = 0.93-0.98. The C-CIA showed moderate and good test-retest reliability in a six-month interval for junior high school students (ICC = 0.69) and senior high school students (ICC = 0.76), respectively. The C-CIA had good test-retest reliability in a two-week interval for undergraduate students (ICC = 0.78) and general adult men (ICC = 0.81). Our results supported good construct validity, known-group validity of the C-CIA, and measurement invariance across sex and age. These findings suggest that the C-CIA can be a useful tool assessing psychosocial impairment related to EDs for Chinese adolescents, young adults, and adult men.

Using machine learning to explore core risk factors associated with the risk of eating disorders among non-clinical young women in China: A decision-tree classification analysis

BACKGROUND

Many previous studies have investigated the risk factors associated with eating disorders (EDs) from the perspective of emotion regulation (ER). However, limited research has investigated interactions between co-existing risk factors for EDs, especially in China where research in EDs is underrepresented.

METHODS

This study examined core risk factors related to maladaptive eating behaviors and ER, and how their interactions affect the detection of EDs. Using machine learning, a decision tree model was constructed on a data set of 830 non-clinical Chinese young women with an average age of 18.91 years (SD = 0.95). The total data set was split into training and testing data sets with a ratio of 70 to 30%.

RESULTS

Body image inflexibility was identified as the major classifier for women at high risk of EDs. Furthermore, interactions between body image inflexibility, psychological distress, and body dissatisfaction were important in detecting women at high risk of EDs. Overall, the model classifying women at high-risk for EDs had a sensitivity of 0.88 and a specificity of 0.85 when applied to the testing data set.

CONCLUSIONS

Body image inflexibility, psychological distress, and body dissatisfaction were identified as the major classifiers for young women in China at high risk of EDs. Researchers and practitioners may consider these findings in the screening, prevention, and treatment of EDs among young women in China.

Association between migration paths and mental health of new-generation migrants in China: The mediating effect of social integration

BACKGROUND

The new-generation migrants born in 1980 and later are large and vulnerable internal migrants in China. Migration paths and social integration are important factors to explain for their mental health. However, they faced difficulties in social integration varying from migration paths. We aimed to explore the mediating role of social integration between migration paths and the mental health of new-generation migrants.

METHODS

The migration paths included urban-to-urban, urban-to-rural, rural-to-urban and rural-to-rural. Mental health was assessed by the Kessler Screening Scale for Psychological Distress (K6) and the Perceived Stress Scales (PSS-4). Social integration was measured by economic integration, life integration, maintenance of the local culture, acceptance of the host culture and psychological integration. Multiple linear regressions with bootstrapping were used to examine the mediating effect.

RESULTS

A total of 9,830 new-generation migrants were included in this study. The mean age was 26.92 (SD = 4.47) years and the proportion of rural-to-urban migrants was 63.7%. Compared with the new generation of rural-to-rural migrants, rural-to-urban migrants had higher psychological distress (β = 0.305, 95% CI: 0.152-0.458) and perceived stress (β = 0.328, 95% CI: 0.199-0.456). The bootstrapping test found that two dimensions ("life integration" and "acceptance of the host culture") of social integration as a mediator weakened the negative effect of the rural-to-urban migration path on the mental health of new-generation migrants.

CONCLUSION

Rural-to-urban migrants had poorer mental health, and the association was mediated by their poorer social integration. The migration policies developed to enhance social integration could effectively improve the mental health of new-generation migrants.

Sustained effects of left-behind experience during childhood on mental health in Chinese university undergraduates

Rapid industrialization and urbanization in China have resulted in labor migrants leaving children behind. For left-behind children (LBC), disrupted parental attachment may increase the risk of psychiatric morbidity in adulthood. To investigate psychopathological consequences for university students who were LBC and to estimate the effects of one or both parents being migrants, the duration of left-behind experience, and parental absence during critical periods of growth on psychiatric morbidity. We conducted an annual survey of all freshmen at a Chinese university from 2014 to 2018. The questionnaire collected information on left-behind experiences and psychiatric morbidity using standardized self-report instruments. Regression coefficients derived from logistic regression were used to measure the associations among total time left behind, absence of one parent or both parents, age when left behind and psychopathological consequences. A total of 42,505 students were included. Students who were LBC had more psychopathology, including depression, anxiety, somatoform disorder, obsessive-compulsive disorder, self-reported suicide attempts and deliberate self-harm, than those who were not. Students for whom one or both parents were migrants showed a greater risk of psychiatric morbidity. The risk of psychiatric morbidity increased with the length of parental absence. Left-behind experience during childhood represents sustained impacts for university students into early adulthood. The higher prevalence of psychiatric morbidity in young adults who experienced the absence of one or both of their parents, especially in their early childhood, suggests that other factors besides attachment, such as protection from other risks, are important and that further research is necessary.

The Muscularity-Oriented Eating Test, Drive for Muscularity Scale, and Muscle Dysmorphic Disorder Inventory among Chinese Men: Confirmatory Factor Analyses

Research on eating disorders (EDs) and body image disturbances has focused mostly on females from Western countries, and little is known about EDs in male populations in China, which is partially due to the lack of validated assessment measures. The current work aims to translate the Muscularity-Oriented Eating Test (MOET), Drive for Muscularity Scale (DMS) and Muscle Dysmorphic Disorder Inventory (MDDI) into Chinese and examine their psychometric properties. The factor structures, reliability and validity of the translated scales were examined with two samples: male university students (n = 295, M_age = 18.92 years) and general adult men (n = 406, M_age = 28.53 years). With confirmatory factor analyses, the original factor structures are replicated for the MOET, DMS and MDDI. The results also support the adequate internal consistency for both samples. Strong evidence of convergent and incremental validity for the three measures is also found in both samples. Overall, the three measures prove to be good instruments for use among Chinese male university students and general adult men.

Telemedicine Assessment for the Mental Health of Rural Residents Based on the Safety Degree of Housing in Seismically Active Regions

Earthquakes inevitably affect the mental health of local residents. In seismically active regions of Southwest China, local rural residents' dilapidated housing with poor seismic performance aggravates the impacts of earthquakes on their mental health. These residents' mental health is difficult to recognize because of the lack of appropriate assessment methods. In addition, rural residents in the area have a low socioeconomic status and cannot access adequate mental treatment. Thus, telemedicine could be an effective approach to assist mental health practice in such areas. However, the lack of telemedicine assessment factors in these areas makes it difficult to complete the correct triage and prioritization of rural residents' mental health quickly and effectively. To provide a foundation for applying telemedicine to assess the risk of mental health problems that rural residents in seismically active regions experience, this paper studied whether the degree of safety of housing can affect mental health. In this study, nine villages near the epicenter of the 2019 6.0-magnitude earthquake in Changning County, China were randomly selected, and 162 valid questionnaires were completed. SPSS statistical software was used to analyze the collected data. First, the satisfaction of rural residents with the degree of safety of housing significantly affected the K6 score and whether they suffered from mental problems. Second, the mental health of rural residents living in reinforced concrete frame structure housing was obviously superior to that of those living in other types of housing. Next, the most significant factor affecting mental health was the degree of wall cracks. Finally, a new approach was developed to assess and prioritize the mental health of rural residents by using degrees of housing safety and smart technology in seismically active regions. The telemedicine assessment approach is expected to be used in the future for mental health evaluation and the large-scale data scoring of rural residents.

The impact of COVID-19 pandemic on headache symptoms and drug withdrawal among patients with medication overuse headache: a cross-sectional study

Background

Coronavirus disease 2019 (COVID-19) bring about a range of psychological distress and symptom deterioration to headache patients especially to some migraineurs. Compared to migraineurs or normal control, medication overuse headache (MOH) patients are more likely to experience a worse psychological distress and poorer outcome in non-COVID-19 time. However, in COVID-19 pandemic, whether MOH patients would have greater physical and mental symptom deterioration or worse relief of headache symptoms and medications overuse remained unclear. We aim to investigate the impact of COVID-19 on MOH patients to guide for a better management in this study.

Methods

We enrolled MOH patients who were diagnosed and treated at headache clinic of West China Hospital. Information of the pre-pandemic 3 months period and COVID-19 pandemic period was collected. Univariate and multivariate logistic regression were performed to identify independent factors associated with changes in headache symptoms and drug withdrawal.

Results

Seventy-eight MOH patients were enrolled into the study ultimately. In comparison to pre-pandemic period, fewer MOH patients reported decreased headache days, intensity and days with acute medications per month during the pandemic. Available access to regular prophylactic medications was significantly associated with a reduction of at least 50% in headache days and decrease in headache intensity per month with respective odds ratios of 39.19 (95% CI 3.75–409.15, P = 0.002) and 10.13 (95% CI 2.33–44.12, P = 0.002). Following abrupt withdrawal and high educational level were both significant factors in decreasing headache intensity. Male sex was significantly associated with decrease in days with acute medication per month during the pandemic (odds ratios 4.78, 95%CI 1.44–15.87, P = 0.011).

Conclusions

Our findings reflect that MOH patients experienced a worse relief of headache symptoms and drug withdrawal during the pandemic. Available access to regular prophylactic medications was the significant independent factor for improvement of headache symptoms. Male sex was significantly associated with decreased days with acute medications per month.

Association between the serum insulin-like growth factor-1 concentration in the first trimester of pregnancy and postpartum depression

AIM

Patients with major depression present with an increased serum insulin-like growth factor-1 (IGF-1) concentration. However, the longitudinal relationship between serum IGF-1 levels and depression development remains unclear. This study aimed to investigate the longitudinal association between the serum IGF-1 concentration in the first trimester of pregnancy and postpartum depression development using data obtained from the Japan Environment and Children's Study (JECS).

METHODS

The JECS included 97 415 pregnant women; among them, 8791 were enrolled in this study. Data regarding depression in the first trimester, postpartum depression development at 1 month after childbirth, and other covariates were collected using a self-administered questionnaire. Serum IGF-1 levels were measured in the first trimester of pregnancy. The participants were divided into four groups according to the serum IGF-1 level.

RESULTS

In the first trimester, serum IGF-1 levels were not significantly associated with psychological distress in pregnant women. In the longitudinal analyses, however, postpartum depression development in mothers within the highest quartile for serum IGF-1 concentration in the first trimester was significantly less common than in those within the lowest quartile (odds ratio 0.48, 95% confidence interval 0.30-0.79).

CONCLUSION

Pregnant women with a high serum IGF-1 concentration in the first trimester were less likely to develop postpartum depression than those with a low concentration. A high serum IGF-1 concentration during pregnancy may help to protect against postpartum depression development.

Examining the associations between self-care practices and psychological distress among nursing students during the COVID-19 pandemic

There is limited research regarding the impact of self-care practices on psychological distress, specifically on nursing students during a pandemic, such as COVID-19 (Corona Virus Disease- 2019). A 10-minute electronic survey was sent to nursing students at a large academic-medical center, and data from 285 student respondents were analyzed to assess psychological status, attitudes and behaviors in regards to the COVID-19 pandemic. Significant differences were found when comparing self-care practice scores by school grade for total scores (F = 4.48 [df = 4,250], p = .002), emotional subscale (F = 4.78 [df = 4,250], p = .001), and relationship subscale (F = 3.44 [df = 4,250], p = .009). While there were no significant differences in psychological distress by school grade, graduate students had the lowest self-care practice score compared to all the other grades. Finally, the subscale and total self-care practice scores were significantly and negatively associated with psychological distress. These findings suggest that utilization of self-care practices is associated with lower psychological distress, and should therefore be promoted among nursing student populations and integrated into curricula. Future studies should assess specific needs geared towards populations that may have poor self-care practices, such as graduate students, and understand ways to improve sleep quality to mitigate rates of psychological distress during a pandemic.

Serious psychological distress: A national study of Middle Eastern immigrants

WHAT IS KNOWN ON THE SUBJECT?: There is very limited literature on the health of Middle Eastern immigrants in the United States, and the available studies were mostly conducted on small convenient samples in local communities. There is also a need to understand changes in the rates of serious psychological distress (SPD) during the 15 years after 2001, as there were negative effects on Arabs' health since the September 2001 aftermath. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: The study examined the rates of SPD, the risk of SPD and its associated factors in a national sample of Middle Eastern immigrants in the United States from 2001 to 2015. The study found that serious psychological distress rate was high among Middle Eastern immigrants. Being a female and having obesity were associated with a higher risk of reporting serious psychological distress among this population. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These outcomes necessitate mental health nursing interventions that provide culturally sensitive mental health care to immigrants For example, developing community-based prevention programmes is required to address risk factors of psychological distress and to increase awareness about psychological distress among Middle Eastern immigrants. ABSTRACT: Introduction While Middle Eastern immigrants are a fast-growing population in the United States, there is very limited literature on their mental health. Most of the available studies were conducted on small convenient samples in local communities. Aims To examine rates of serious psychological distress (SPD) and its associated factors among Middle Eastern immigrants in the United States, compared with US-born, non-Hispanic Whites. Methods Data from the National Health Interview Survey (NHIS) from 2001 to 2015 were analysed. The survey included 1,246 Middle Eastern immigrants and 232,392 US-born, non-Hispanic Whites. SPD was measured by the Kessler-6 psychological distress scale. Survey analysis procedures, sampling weights and variance estimates were conducted. Descriptive statistics and regression analyses were employed to examine differences and factors associated with SPD. Results SPD rate was the highest among Middle Eastern immigrants (5.99%) between 2006 and 2010. Among Middle Eastern immigrants, being female and obese were significantly associated with a higher risk of SPD. Discussion Middle Eastern immigrants in the United States suffered high rates of SPD. Gender and obesity were factors associated with SPD risk. Implications These outcomes indicate the need for mental health nursing interventions that provide culturally sensitive mental health care to immigrants, such as developing community-based prevention programmes.

Orthorexia nervosa is associated with positive body image and life satisfaction in Chinese elderly: Evidence for a positive psychology perspective

OBJECTIVE

Obsessive attention to healthy eating might paradoxically lead to physical and psychosocial impairments, a potential eating disorder termed orthorexia nervosa (ON). An ongoing debate concerns whether ON should be categorized as an eating disorder, an obsessive-compulsive disorder, or a mental disorder at all. A missing voice in this debate is ON in the elderly, which remains unknown, despite health being a more central issue in everyday life during old age. Similarly missing is ON in East Asia, which remains largely unexplored.

METHOD

The current study investigated ON in 313 Chinese elderly (M = 67.90, SD = 7.94) using the Chinese version of the Düsseldorf Orthorexia Scale (C-DOS). Questionnaires were used to measure traditional eating disorder symptomatology, body image (body dissatisfaction, body appreciation, and functionality appreciation), lifestyle behaviors (fruit and vegetable consumption and time spent on physical activity), and indexes of well-being (psychological distress, food-related quality of life, and life satisfaction).

RESULTS

ON symptoms were positively related to physical activity, fruit and vegetable (F&V) consumption, body appreciation, functionality appreciation, and life satisfaction, but negatively related to body dissatisfaction. Compared with those without ON, the elderly with ON scored higher on positive psychological/lifestyle measures but lower on negative psychological measures.

DISCUSSION

Contrary to the dominant characterization of ON as a variant of disordered eating, in Chinese elderly ON was associated with several positive lifestyle and psychological measures. Thus, ON in the elderly might not be viewed as a form of disordered eating but can be protective and beneficial.

Psychological Distress, Social Support, Coping Style, and Perceived Stress Among Medical Staff and Medical Students in the Early Stages of the COVID-19 Epidemic in China

Background: The COVID-19 pandemic has had impact that may contribute to a rise in mental health problems. The present study was aimed to better understand psychological status among medical staff and medical students during the early epidemic and to explore the influence factors of psychological distress. Methods: A cross-sectional survey was conducted online from February 2-14, 2020. We collected general information related to the COVID-19 outbreak. Respondents were assessed using the Kessler-6 Psychological Distress Scale (K6), Social Support Rating Scale (SSRS), Perceived Stress Scale (PSS) and Simplified Coping Style Questionnaire (SCSQ). Stepwise multiple linear regression was performed to identify factors influencing psychological distress. Results: Five hundred and twenty-eight respondents returned valid questionnaires. Medical staff and Medical students scored averages of 6.77 ± 5.04, 15.48 ± 8.66 on the K6, 37.22 ± 11.39, 22.62 ± 11.25 on the SSRS and 18.52 ± 7.54, 28.49 ± 11.17 on the PSS, respectively. Most medical staff (279, 91.77%) and 148 medical students (66.07%) showed a positive coping style. Social support, perceived stress, hours spent watching epidemic-related information per day and frequency of epidemic-related dreams were identified as factors influencing psychological distress among medical staff and medical students. Coping style emerged as a determinant of psychological distress among medical staff. Conclusions: In the early stages of the COVID-19 epidemic in China, medical staff and medical students were at moderate to high risk of psychological distress. Our results suggest that psychological interventions designed to strengthen social support, reduce perceived stress and adopt a positive coping style may be effective at improving the mental health of medical staff and medical students.

Racial/ethnic differences in correlates of psychological distress among five Asian-American subgroups and non-Hispanic Whites

Objective: Despite their vastly different historical backgrounds, unique languages and variable pre- and post-immigration experiences, Asian-Americans are considered to share stressors surrounding immigration, but there is a gap in describing manifestations of possible mental distress. Thus, the purpose of this study was to explore and compare differences in factors associated with psychological distress among Asian subgroups including Chinese, Filipino, Vietnamese, Korean, Japanese, and non-Hispanic Whites. Design: Using a cross-sectional study design, California Health Interview Survey (CHIS) 2011/2012 data were analyzed. The sample consisted of 29,142 participants: 25,645 non-Hispanic Whites, 3497 non-Hispanic Asian-Americans, 1156 Chinese, 471 Filipinos, 864 Vietnamese, 704 Koreans, and 302 Japanese. Sociodemographic characteristics included gender, age group, marital status, education, poverty level, working status, health insurance, level of acculturation, social cohesion, neighborhood safety, and civic engagement. Physical health status included disability and chronic illness. Psychological distress was evaluated using the Kessler 6 (K6) scale. Results: Results showed that psychological distress levels ranged between 1.96 and 4.52 (p < .05) out of 24 and associated factors were significantly different among the five Asian subgroups and non-Hispanic Whites. Conclusions: The current study highlights the differences in characteristics of psychological distress among Asian subgroups. It underscores the significance of understanding individualized cultural and historical background in each Asian subgroup and subsequently developing and applying appropriate interventions for those groups. In addition, different influencing factors should be applied to assess and prioritize the needs of Asian subgroups to improve psychological distress. The study also warrants further investigation and careful description of each Asian subgroups.

COVID-19 outbreak-related psychological distress among healthcare trainees: a cross-sectional study in China

OBJECTIVES

The COVID-19 outbreak has caused enormous strain on healthcare systems, and healthcare trainees, which comprise the future healthcare workforce, may be a vulnerable group. It is essential to assess the psychological distress experienced by healthcare trainees during the COVID-19 outbreak.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study with 4184 healthcare trainees at Sichuan University in China was implemented during 7-13 February 2020. Participants were grouped by training programmes (medicine, medical technology and nursing) and training stages (undergraduate, postgraduate and residency).

MAIN OUTCOMES

COVID-19-related psychological distress and acute stress reaction (ASR) were assessed using the Kessler 6-item Psychological Distress Scale and the Impact of Event Scale-Revised, respectively. We estimated the ORs of distress by comparing trainees across programmes and training stages using multivariable logistic regression.

RESULTS

Significant psychological distress was found in 1150 (30.90%) participants and probable ASR in 403 (10.74%). Compared with the nursing trainees, the medical trainees (OR 1.54, 95% CI 1.22 to 1.95) reported a higher burden of psychological distress during the outbreak, while the medical technology trainees (OR 1.25, 95% CI 0.97 to 1.62) reported similar symptom scores. Postgraduates (OR 1.55, 95% CI 1.16 to 2.08) in medicine had higher levels of distress than their undergraduate counterparts did, whereas the nursing residents (OR 0.38, 95% CI 0.20 to 0.71) reported a lower burden than did nursing undergraduates. A positive association was found between having active clinical duties during the outbreak and distress (OR 1.17, 95% CI 0.98 to 1.39), particularly among the medical trainees (OR 1.85, 95% CI 1.47 to 2.33) and undergraduates (OR 4.20, 95% CI 1.61 to 11.70). No clear risk patterns of ASR symptoms were observed.

CONCLUSIONS

Medical trainees, particularly postgraduates and those with active clinical duties, were at risk for psychological distress during the COVID-19 outbreak. Stress management may be considered for high-risk healthcare trainees.

Performance of an Abbreviated Lubben Social Network Scale (LSNS-6) among Three Ethnic Groups of Older Asian Americans

BACKGROUND AND OBJECTIVES

The present study examined the measurement quality and performance of an abbreviated Lubben Social Network Scale (LSNS-6) in three ethnic groups (Chinese, Koreans, Vietnamese) of older Asian Americans, addressing both within- and cross-group validations.

RESEARCH DESIGN AND METHODS

We selected 605 participants aged 50 or above (242 Chinese, 150 Koreans, 213 Vietnamese) from the 2015 Asian American Quality of Life (AAQoL) survey, conducted with self-identified Asian Americans aged 18 or above living in central Texas. We analyzed LSNS-6 data on measurement qualities (internal consistency and corrected item-total correlation), dimensionality (exploratory and confirmatory factor analyses), and correlations with other indicators.

RESULTS

LSNS-6 showed very good internal consistency in each ethnic group, and the two-factor structure of family and friends were invariant across the groups. The items on friends demonstrated greater homogeneity than those on family and emerged as a first factor. Both subscale and total scores of LSNS-6 were associated in expected directions with the social and health indicators considered.

DISCUSSION AND IMPLICATIONS

The findings confirm the measurement qualities of LSNS-6 within each group and provide support for measurement invariance across the groups. While the observed difference in family and friend networks warrants further investigation, LSNS-6 serves as a viable option for the assessment of social networks. When using LSNS-6 with older Asian Americans, it is highly recommended to use the family/friend subscales in consideration of cultural and immigration contexts.

The mental state and risk factors of Chinese medical staff and medical students in early stages of the COVID-19 epidemic

OBJECTIVE

This study aimed to investigate the mental state of medical staff and medical students in the early stages of the SARS-CoV-2 outbreak, as well as analyze the risk factors of serious mental illness (SMI), so as to provide a scientific basis for further psychological intervention and management.

METHOD

A cross-sectional survey was conducted from February 2-7, 2020. The Kessler 6 Psychological Distress Scale and a general information questionnaire were administered on-line to a convenience sample of 548 medical staff and medical students in China. Multivariate binary logistic regression analysis was used to screen the risk factors of SMI in medical staff and medical students.

RESULTS

Of the 505 respondents in the final analysis, 188 (37.23%) were at high risk of SMI. Respondents were at significantly higher risk of SMI if they had been suspected of being infected with the SARS-CoV-2 (OR = 7.00, 95% CI: 1.19-41.14), had relatives suspected of being infected with the SARS-CoV-2 (OR = 23.60, 95% CI: 1.11-501.30), felt concerned towards media coverage of outbreak-related information (OR = 11.95, 95% CI: 3.07-46.57), recently dreamed related to SARS-CoV-2 (OR = 4.21, 95% CI: 2.22-8.01), experienced difficulty in controlling emotions during SARS-CoV-2 epidemic (OR = 3.25, 95% CI: 1.66-6.37), or spent hours watching outbreaks per day (OR = 1.29, 95% CI: 1.13-1.46).

CONCLUSION

Our findings highlight that medical staff and medical students were vulnerable to SMI during the early stages of the SARS-CoV-2 outbreak and identify the factors associated with SMI which can be used to formulate psychological interventions to improve the mental health. The independent risk factors for SMI among them are suspicion that they or relatives were infected with the SARS-CoV-2, greater interest in media reports about the epidemic, frequency of recent dreams related to SARS-CoV-2, difficulty in controlling emotions during the epidemic, and hours spent watching outbreaks per day.

A Mokken scale analysis of the Kessler-6 screening measure among Chinese older population: findings from a national survey

BACKGROUND

The aging population increases rapidly across the world. Timely and effective screening of their mental-health problems is important to individuals, families, and the whole society. The Kessler-6 screening measure (K6) is a very popular instrument for non-specific psychological distress. However, few studies have focused on the psychometric properties of this instrument in the older population.

METHODS

The present study employed Mokken scale analysis to evaluate its dimensionality and structure. This study also used differential item functioning (DIF) to examine whether the same structure existed across sex in a national representative sample of old Chinese people. Data were drawn from a public data set, the 2010 China Family Panel Studies (CFPS2010), and responses from a total of 6450 participants aged 60 years old and above (3136 males and 3314 females) were included in the final analysis.

RESULTS

Mokken scale analysis supported the unidimensional structure of the K6. Differential item functioning (DIF) analysis revealed that two of the six items ("Hopeless" and "Everything was an effort") were marked for DIF based on the Chi-square. However, their impacts were negligible in terms of McFadden's pseudo R2.

CONCLUSIONS

The K6 demonstrates adequate psychometric properties in the old Chinese population. The sum of all six items can be used as an indicator of non-specific psychological distress. Differences in the indicator across sex should be considered as a real difference in psychological distress between the female and the male.

Applying the WHO ICF Framework to the Outcome Measures Used in the Evaluation of Long-Term Clinical Outcomes in Coronavirus Outbreaks

(1) Objective: The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) classification is a unified framework for the description of health and health-related states. This study aimed to use the ICF framework to classify outcome measures used in follow-up studies of coronavirus outbreaks and make recommendations for future studies. (2) Methods: EMBASE, MEDLINE, CINAHL and PsycINFO were systematically searched for original studies assessing clinical outcomes in adult survivors of severe acute respiratory distress syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease-19 (COVID-19) after hospital discharge. Individual items of the identified outcome measures were linked to ICF second-level and third-level categories using ICF linking rules and categorized according to an ICF component. (3) Results: In total, 33 outcome measures were identified from 36 studies. Commonly used (a) ICF body function measures were Pulmonary Function Tests (PFT), Impact of event scale (IES-R) and Hospital Anxiety and Depression Scale (HADS); (b) ICF activity was 6-Minute Walking Distance (6MWD); (c) ICF participation measures included Short Form-36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ). ICF environmental factors and personal factors were rarely measured. (4) Conclusions: We recommend future COVID-19 follow-up studies to use the ICF framework to select a combination of outcome measures that capture all the components for a better understanding of the impact on survivors and planning interventions to maximize functional return.