Adaptation of the two-item generalized anxiety disorder scale (GAD-2) to Chinese rural population: A validation study and meta-analysis

Evaluating the reliability and validity of the Questionnaire on Well-Being: a validation study for a clinically informed measurement of subjective well-being

Researchers and clinicians are becoming increasingly aware of the importance of assessing positive functioning to inform clinical outcomes. This paper evaluates the Questionnaire on Well-Being (QWB, available for free https://doi.org/10.17605/OSF.IO/GSC3R), a clinically informed instrument that assesses subjective well-being, across two studies. Study One, consisting of treatment-seeking individuals in an assertiveness training sample (n = 495), explored the factorial structure of the QWB, assessed the four-week test-retest reliability, criterion-related validity, and identified a preliminary cutoff point for the QWB with clinical significance. Study Two, including participants from the general public (n = 1561), confirmed the factorial structure of the QWB and further evaluated criterion-related validity. The results provided support for a unidimensional structure for the QWB. Furthermore, the QWB exhibited excellent internal reliability (Cronbach's alpha = 0.93 and 0.94 in Study One and Two, respectively), high test-retest reliability (ICC3 = .50 at a four-week follow-up in Study One), and appropriate criterion-related validity demonstrating positive correlations with positive affect and negative correlations with psychopathology. Finally, a cutoff point on the QWB below 50 was associated with marked psychopathology. These findings provide preliminary support for the usage of the QWB in clinical and non-clinical settings, establishing the QWB as a reliable indicator of subjective well-being.

Supporting Older Adults' Mental Health Against Suspected Mental Health Problems: The Moderating Role of an Age-Friendly Neighborhood

This study examined how compensatory and enabling domains of an Age-Friendly City (AFC) moderate the relationship between suspected mental health problems and depressive and anxiety symptoms among older adults. Four thousand six hundred and twenty-five Hong Kong Chinese aged ≥60 years completed a telephone survey between April and July 2022, including PHQ-2 and GAD-2. AFC indices sourced from prior territory-wide study. Linear mixed models showed that enabling AFC domains, namely, social participation, respect and social inclusion, and civic participation and employment, alleviated the effects of suspected mental health problems on respondents' depressive and anxiety symptoms (b = -0.40 to -0.56). Three-way interaction models revealed that the protective effects of all compensatory and enabling AFCC domains (b = -1.23 to -6.18), except civic participation and employment, were stronger in old-old (70-79 years) and oldest-old (≥80 years) than young-old (60-69 years). AFCC-based interventions should focus on compensatory and enabling domains to support older adults' mental health.

[Analysis of the Occurrence and Influencing Factors of Oral Frailty in Elderly Residents of Elderly Care Facilities]

Objective

To investigate the occurrence and influencing factors of oral frailty in elderly residents of elderly care facilities and to provide a basis for the development of effective intervention programs for oral frailty in this population.

Methods

A combination of subjective and objective measurements of oral frailty, a general information questionnaire, a leisure activity questionnaire, the Dietary Variety Score (DVS), the Short Nutritional Assessment Questionnaire (SNAQ), the Short-Form Mini Nutritional Assessment (MNA-SF), Barthel Index (BI), the Mini-Mental State Examination (MMSE), 15-Item Geriatric Depression Scale (GDS-15), and the Generalized Anxiety Disorder Scale-2 (GAD-2) were used to survey 348 elderly residents in three elderly care facilities in Chengdu and to analyze the factors related to oral frailty.

Results

The prevalence of oral frailty in elderly residents of elderly care facilities was 31.0% (108/348). Multivariate logistic regression analysis revealed that advanced age (odds ratio [OR]=1.347, 95% confidence interval [CI]: 1.237-1.496, P<0.001), cognitive impairment (OR=6.769, 95% CI: 2.628-18.916, P<0.001), and depression (OR=8.632, 95% CI: 1.931-44.387, P=0.007) were risk factors for oral frailty in elderly residents of elderly care facilities. High scores in leisure activities (OR=0.883, 95% CI: 0.786-0.986, P=0.030), and dietary diversity (OR=0.199, 95% CI: 0.069-0.530, P=0.002) were protective factors against oral frailty.

Conclusion

The prevalence of oral frailty is relatively high among elderly residents of elderly care facilities. Risk factors for oral frailty include advanced age, cognitive impairment, and depression, while increased levels of leisure activities and dietary diversity can help prevent the occurrence of oral frailty in elderly individuals.

Association between fluoride exposure and psychiatric disorders in adults

To explore the association between fluoride exposure and depression / anxiety in adults, the 1,169 participants were recruited. The demographic information of participants was obtained through questionnaire survey and physical measurements. Morning urine samples were collected, and urinary fluoride (UF) level was determined. Changes in depression and anxiety levels were evaluated using the Patient Health Questionnaire-2 and General Anxiety Disorder-2 scales. The association between psychiatric disorders and UF levels was analyzed. In the total population, the prevalence of depression and anxiety were 3.17% and 4.19%, respectively. These results showed no significant association between depression / anxiety scale scores and UF levels. Logistic regression suggested no significant association between depression / anxiety levels, and UF levels, but there was an interaction between UF and income on depression. Our findings highlighted the interaction between fluoride exposure and monthly income, which may affect depression in adults.

Multi-level factors associated with psychological resilience in the face of adverse childhood experiences among Chinese early adolescents

BACKGROUND

Adverse childhood experiences (ACEs) are pervasive and exert enduring negative effects on health throughout one's life. A better understanding of resilience among adolescents with ACEs exposure is crucial to enhance their mental health; however, comprehensive and multifaceted analyses of its associated factors are limited.

OBJECTIVE

This study aimed to investigate multi-level correlates of psychological resilience in Chinese early adolescents exposed to ACEs.

PARTICIPANTS AND SETTING

In a sample of 5724 middle school students, 65.5 % (n = 3749; 49.1 % females; Mage = 13.57, SD = 0.96) reported ACEs during their primary school period and were finally included in this study.

METHOD

Both linear regression and network models were conducted to explore correlates of capacity- and outcome-oriented resilience at the individual (i.e., five personality traits, emotional release, and loneliness), family (i.e., family support and relationships with the mother and father), and school levels (i.e., peer support, teacher support, and relationships with classmates and teachers).

RESULTS

Linear regression analysis revealed that all correlates were associated with capacity- (β ranged from -0.271 to 0.503, PFDR < 0.001 for all) and outcome-oriented resilience (β ranged from -0.516 to 0.229, PFDR < 0.001 for all). Similarly, network analysis revealed that neuroticism, conscientiousness, loneliness, emotional release, extraversion, and the relationship with the mother were directly associated with both capacity- (weights ranged from 0.029 to 0.179) and outcome-oriented resilience (weights ranged from 0.024 to 0.396). However, openness, peer and family support, and relationships with classmates and teachers were directly associated with capacity-oriented resilience (weights ranged from 0.020 to 0.201).

CONCLUSIONS

This study identified the shared and unique associated factors for capacity- and outcome-oriented resilience in the face of ACEs and demonstrated the complex interactions between these factors, which can guide tailored interventions to enhance resilience among Chinese early adolescents with ACEs exposure. Further longitudinal studies may endeavor to confirm our results.

Influence of Nurses' Perceptions of Government Policies and COVID-19 Risks on Their Mental Health Status: A Web-Based Cross-Sectional Study

This study aimed to understand nurses' perceptions of COVID-19-related policies and risks during the outbreak of COVID-19 in Hong Kong and to determine how their perceptions influenced their mental health status. A web-based online survey among Hong Kong nurses was conducted. The questionnaire included a self-designed 5-point Likert scale with 17 items to assess the nurses' perceptions of COVID-19-related policies and risks, as well as the Davidson Trauma Scale (DTS), the Perceived Stress Scale (PSS), the Patient Health Questionnaire-2 (PHQ-2) and the Generalised Anxiety Disorder scale (GAD) for measurement of posttraumatic stress disorder (PTSD), stress, depression and anxiety, respectively. Of 592 nurses enrolled, 30.6% had PTSD (DTS total score ≥40), and 80.4%, 19.9% and 16.4% had moderate-to-high levels of stress (PSS-10 score ≥14), depression (PHQ-2 score ≥3) and anxiety (GAD score ≥3), respectively. The top three concerned aspects were 'worried about themselves and friends to suffer this disease' (84.5%), 'insufficient number of isolation wards' (81.8%) and 'insufficient number of personal protective equipment' (74.3%). Logistic regression analyses showed that more negative perception on 'personal protective equipment in the healthcare institutions', 'the confidence in HK's control of COVID-19', 'worried about themselves and friends to suffer this disease' and 'self-perceived risk of infection' indicated higher severity of the four mental health problems (all p < 0.01). The perception on 'public gathering ban', 'the number of isolation wards' and 'expected time to control COVID-19' were significantly associated with PTSD and stress (all p < 0.05). Nurses' perception on government policies and COVID-19 risks played an important role in predicting their mental health status. Policy makers should be aware of nurses' psychological responses and provide timely and targeted emotional support to nurses amid and after the COVID-19 pandemic.

Diagnostic accuracy and clinical utility of the PHQ-2 and GAD-2: a comparison with long-format measures for depression and anxiety

Background

Anxiety and depression are highly prevalent and often comorbid mental disorders that are encompassed within the broad category of emotional disorders. The frequent comorbidity of anxiety and depression can pose challenges for accurate diagnosis and treatment which, in turn, highlights the need for reliable measurements that are simultaneously responsive to change and prevent non-response bias. Brief measures of anxiety and depression can potentially increase response rates due to their brevity and ease of administration. This study evaluates the psychometric characteristics, discriminative accuracy, and sensitivity to change of the Generalized Anxiety Disorder 2-item scale (GAD-2) and the Patient Health Questionnaire 2-item scale (PHQ-2) within a clinical population.

Method

The sample comprised treatment-seeking participants (n = 3,411), screened (n = 2,477) to receive an internet-based psychotherapeutic intervention (cognitive-behavioral, psychodynamic, or waitlist).

Results

Brief measures can effectively detect individuals who may be eligible for a diagnosis of depression and anxiety, not only prior to but also during and following the completion of psychological treatment. The discriminative ability of the GAD-2 was significantly greater during active treatment and at post-assessment compared with pre-treatment screening, although no such differences were found for the PHQ-2. Finally, endorsing the most severe response option on the GAD-2 and PHQ-2 was associated with a high probability of presenting with clinically relevant anxiety and depressive symptoms.

Conclusion

Brief measures of anxiety and depression are viable instruments to screen for and monitor anxiety and depressive symptoms.

Clinical trial registration

ClinicalTrials.gov, identifier NCT05016843.

Discrimination is associated with depression, anxiety, and loneliness symptoms among Asian and Pacific Islander adults during COVID-19 Pandemic

In the United States, Asian and Pacific Islander (A/PI) communities have faced significant discrimination and stigma during the COVID-19 pandemic. We assessed the association between discrimination and depression, anxiety, and loneliness symptoms among Asian or Pacific Islander adults (n = 543) using data from a 116-item nationally distributed online survey of adults (≥ 18 years old) in the United States conducted between 5/2021-1/2022. Discrimination was assessed using the 5-item Everyday Discrimination Scale. Anxiety, depression, and loneliness symptoms were assessed using the 2-item Generalized Anxiety Disorder, 2-item Patient Health Questionnaire, and UCLA Loneliness Scale-Short form, respectively. We used multivariable logistic regression to estimate the association between discrimination and mental health. Overall, 42.7% of participants reported experiencing discrimination once a month or more. Compared with no discrimination, experiencing discrimination once a month was associated with increased odds of anxiety (Adjusted Odds Ratio [aOR] = 2.60, 95% CI = 1.38-4.77), depression (aOR = 2.58, 95% CI = 1.46-4.56), and loneliness (aOR = 2.86, 95% CI = 1.75-4.67). Experiencing discrimination once a week or more was associated with even higher odds of anxiety (aOR = 6.90, 95% CI = 3.71-12.83), depression, (aOR = 6.96, 95% CI = 3.80-12.74), and loneliness (aOR = 6.91, 95% CI = 3.38-13.00). Discrimination is detrimental to mental health, even at relatively low frequencies; however, more frequent discrimination was associated with worse mental health symptoms. Public health interventions and programs targeting anti-A/PI hate and reducing A/PI mental health burden are urgently needed.

Development of an optimal short form of the GAD-7 scale with cross-cultural generalizability based on Riskslim

Despite the relatively small number of items in the GAD-7, fewer items are increasingly sought to shorten testing time in large-scale mental health screenings. As a result, short forms based on the GAD-7, the GAD-2, and GAD-mini, have become popular. However, the GAD-2 and GAD-mini have reported lower diagnostic accuracy in some cultural contexts, implying that a validated short-form version of the GAD-7 may be lacking in large-scale cross-cultural anxiety screening. Based on this, to develop an optimal short form of the GAD-7 with cross-cultural stability, we utilized seven GAD-7 datasets from six different countries, totaling 47,484 participants. Five 2 to 6 item short forms of the GAD were constructed using the Riskslim machine learning algorithm. We evaluated the diagnostic accuracy of the GAD-7 short forms in the training and test sets based on the coefficient of determination(R2) and area under the curve(AUC) metrics, and the results showed that GAD-R2 performed poorly in some cultures, and all of the 3 to 6 item short forms of the GAD performed good in cross-cultural diagnostic rates, with the GAD-R6 showing the highest diagnostic accuracy in all cultures; GAD-R3 outperformed GAD-R2, GAD-2, and GAD-mini in all cultures; GAD-R3 had higher generalizability across cultures and special populations; Given that the GAD-R3 was shorter and nearly as accurate as the GAD-R6, we recommend the use of the GAD-R3 in clinical studies and epidemiologic investigations. And we recommend the optimal actual cutoff value of 15 for GAD-R3. Overall, we recommend GAD-R3 as the short-form version of GAD-7 in cross-cultural studies. However, the 2-item GAD scale is also optimal for the short-form version in clinical practice.

Uncertainty Breeds Anxiety and Depression: The Impact of the Russian Invasion in Ukraine on a Swedish Clinical Population Receiving Internet-Based Psychotherapy

Background

Recent global crises, such as the COVID-19 pandemic and the 2022 Russian invasion of Ukraine, have contributed to a rise in the global prevalence of anxiety and depressive disorders. This study examines the indirect impact of the Ukraine war on emotional disorders within a Swedish clinical population.

Method

The sample comprised participants (n = 1,222) actively engaged in an internet-based psychotherapeutic intervention (cognitive-behavioral, psychodynamic, and waitlist) when the war broke out. The Patient Health Questionnaire-9 scale and the Generalized Anxiety Disorder-7 scale were used to measure depression and anxiety.

Results

Anxiety and depressive symptom severity increased following the war's onset, with an average weekly increase of 0.77-points for anxiety (p = .001, Cohen's d = 0.08) and 0.09-points for depression (p = .70, Cohen's d = 0.01); however, the increase was negligible for depression. Furthermore, higher socioeconomic status (SES) predicted declines in depression and anxiety during the study period, with a 0.69-point average weekly decrease in anxiety (p < .001, Cohen's d = 0.32) and a 1.09-point decrease in depression (p < .001, Cohen's d = 0.48) per one unit increase in SES, suggesting that SES may serve as a protective factor that buffers against psychopathological development during crises.

Conclusions

These findings have implications for mitigating the development of psychopathology during crises and interpreting treatment efficacy estimates during such events. Our findings also emphasize the potential of internet-based psychotherapy in addressing emotional disorders during crises. This study presents up-to-date information about the reaction of treatment-seeking individuals to abrupt uncertainty.

Internalized Homonegativity and Psychological Distress Among Chinese Gay Men: The Mediating Role of Loneliness and the Moderating Role of Authoritarian Filial Piety

Purpose: Previous research has consistently found that internalized homonegativity is a salient predictor of psychological distress, but how and when this relationship occurs is unclear, especially among Chinese sexual minority individuals, who are less frequently studied in the literature. This study explored whether the cultural norm of filial piety moderates the indirect association between internalized homonegativity and psychological problems (i.e., symptoms of anxiety and depression) through a sense of loneliness. Methods: To study this question, data were collected from 426 self-identified gay men in China, from February to July 2021, using an online platform. Demographic data, loneliness, authoritarian filial piety (AFP), and internalized homonegativity were measured in this cross-sectional study. Results: In the direct and mediation models, internalized homonegativity had a significant association with psychological distress. In the moderated mediation model, AFP strengthened the effect of internalized homonegativity on loneliness. The indirect positive effect of internalized homonegativity on psychological distress through loneliness was stronger for participants with higher AFP. Conclusions: Loneliness appears to play a role in the relationship between internalized homonegativity and psychological distress. Intervention programs for reducing psychological distress among sexual minority individuals should especially target gay men who endorse high levels of AFP because as a group, their internalized homonegativity is more likely to have a stronger impact on psychological health through loneliness compared with those with low levels of AFP.

Soreness Reminds Me of Grief: Patients With Chronic Pain Show Less Differentiated Representations of Emotional Feelings and Bodily States

People experience similarities between emotional feelings and bodily states on a daily basis, but both the magnitude and pervasiveness of this experiential similarity vary across individuals. Inspired by previous findings that chronic pain (CP) is characterized by strengthened pain-affect coupling and reduced interoceptive accuracy, we conducted 2 cross-sectional studies to examine whether patients with CP would exhibit less differentiated perception and mental representation of emotional feelings and bodily states. In study 1 (N = 500), patients with CP and healthy controls (HCs) completed a self-report questionnaire that asked explicitly about the perceived similarity between 5 basic emotion categories and a series of bodily states. In study 2 (N = 73), a specially designed false memory test was administered to examine whether patients with CP would have reduced differentiation of concepts of negative emotion and somatic distress. We found that patients with CP perceived greater and more pervasive similarities between emotional feelings and bodily states, as indicated by higher questionnaire scores and denser, less specialized bipartite emotion-body networks, both associated with lower subjective interoceptive accuracy. Furthermore, patients with CP formed false memories of negative emotion words (eg, grief) more readily than HCs after memorizing somatic distress words (eg, soreness), as if they represented negative emotion and somatic distress as a single, enmeshed semantic category. Our findings extend previous literature by demonstrating reduced discrimination between emotional and bodily experiences in CP that is not restricted to pain-related emotional and sensory experiences and may be related to a fundamentally less differentiated interoception. PERSPECTIVES: This study shows that patients with chronic pain have a profoundly less differentiated perception and implicit conceptualization of emotional feelings and bodily states, which appears to be associated with altered interoception. These findings may provide new perspectives on why they often experience a stronger pain-affect coupling.

Validation of the Chinese version of the Sleep Regularity Questionnaire (SRQ) and analysis of influencing factors

BACKGROUND

Currently, there is no instrument to measure sleep regularity in China. In this study, the Sleep Regularity Questionnaire（SRQ） was translated into Chinese, tested for reliability and validity, and analyzed for factors affecting sleep regularity.

METHODS

The English version of the SRQ was translated into Chinese, and a total of 3642 individuals were included in this research. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the underlying factor structure of the Chinese version of the SRQ and to measure its reliability and validity. In addition, the correlations between sleep regularity and general information, personal habits, self-control, stress, anxiety, and depression were explored.

RESULTS

The Cronbach's α of the Chinese SRQ was 0.858, supporting the two-factor structure. Sleep regularity was statistically different between gender and ethnicity (p < 0.05), and personal habits (exercise, continued eating after dinner, smoking and drinking) had an effect on sleep regularity. Sleep regularity was positively associated with individual self-control and negatively associated with stress, anxiety, and depression.

CONCLUSIONS

The Chinese version of the SRQ has excellent reliability and validity. There are two dimensions, namely circadian regularity and sleep continuity regularity, which can be used to assess the sleep regularity of Chinese adults. The results of this study showed that males and Han Chinese having better sleep regularity. And people with good lifestyle habits and greater self-control sleep more regularly, while stress, anxiety and depression can affect individuals' sleep regularity.

Association between Shift Work and Health Outcomes in the General Population in China: A Cross-Sectional Study

Shift work may adversely affect individuals' health, thus, the current study aimed to investigate the association between shift work and health outcomes in the general population. A total of 41,061 participants were included in this online cross-sectional survey, among which 9612 (23.4%) individuals engaged in shift work and 31,449 (76.6%) individuals engaged in non-shift work. Multiple logistic regression analyses were conducted to explore the association between shift work and health outcomes (psychiatric disorders, mental health symptoms, and physical disorders). In addition, associations between the duration (≤1 year, 1-3 years, 3-5 years, 5-10 years, ≥10 years) and frequency of shift work (<1 or ≥1 night/week) and health outcomes were also explored. The results showed that compared to non-shift workers, shift workers had a higher likelihood of any psychiatric disorders (odds ratios [OR] = 1.80, 95% CI = 1.56-2.09, p < 0.001), mental health symptoms (OR = 1.76, 95% CI = 1.68-1.85, p < 0.001), and physical disorders (OR = 1.48, 95% CI = 1.39-1.57, p < 0.001). In addition, inverted U-shaped associations were observed between the duration of shift work and health outcomes. These results indicated that shift work was closely related to potential links with poor health outcomes. The findings highlighted the importance of paying attention to the health conditions of shift workers and the necessity of implementing comprehensive protective measures for shift workers to reduce the impact of shift work.

Utilization and engagement with an employer-provided digital mental health platform: An international perspective

Objective

This retrospective study (2020-2022) compared the usage patterns across international regions of an employer-provided digital mental health platform, which is available in native languages and offers both self-guided digital activities and one-on-one sessions.

Methods

Routine data from the platform were analyzed by describing the demographic profile of 178,119 users from different geographical regions, their baseline mental health status and burnout levels, as well as patterns of engagement. Statistical analyses were conducted using logistic and ordered logit models to examine the association between cumulative engagement with the platform over time and baseline characteristics.

Results

The platform had high engagement and satisfaction levels across regions and age groups. Female users were more engaged than males in both self-guided digital activities and one-on-one sessions. Older users and those from non-US regions were more engaged in self-guided digital activities, while younger users and those from the US were more engaged in one-on-one sessions. Symptoms of anxiety were also associated with engagement with one-on-one sessions.

Conclusions

The study's findings provide valuable insights into the benefits of digital platforms in addressing mental health needs of employers from different regions. Future research should focus on exploring the specific factors that influence engagement with digital mental health platforms and how these platforms can be optimized and tailored to better serve diverse populations.

Sleep Duration and Insomnia with Comorbid Depression and Anxiety Symptoms in Chinese Adults: A Cross-Sectional Study

Purpose

Depression and anxiety are two highly prevalent mental disorders that commonly coexist. However, little is known about the association between sleep and comorbid depressive and anxiety symptoms (CDAS). Therefore, this study aims to explore the relationship between sleep duration, insomnia and CDAS.

Methods

This is a cross-sectional study of 22,004 community adults who participated in the China Multi-Ethnic Cohort (CMEC) study. Chinese version of Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen CDAS in community adults. A positive score on each scale was considered indicative of CDAS. All participants received face-to-face interviews, medical examinations, and biochemical examinations to assess sleep duration and insomnia and collect covariates. The self-reported sleep duration was divided into three groups: <7 hr, 7-9 hr and >9 hr groups. Logistic regression was used to analyze the association between sleep duration, insomnia and CDAS. A restricted cubic spline (RCS) was used to explore the dose-response relationship between sleep duration and CDAS. Stratified analysis based on gender and age was conducted.

Results

Overall, 2.8% (95% CI 2.6%~3.0%) of participants reported having CDAS. After adjusting the potential covariates, sleep duration <7 hr (OR=1.635, 95% CI=1.335~2.004) was significantly associated with CDAS, compared with sleep 7-9 hr. After RCS analysis, there was a nonlinear relationship between sleep duration and CDAS. The increase in the number of types of insomnia, the greater the likelihood of CDAS (p for trend<0.05). In sensitivity analysis, it was found that the results were consistent with those of the main analysis. After stratification by gender and age, the association between sleep duration and CDAS was only observed in female and young and middle-aged adults, not in men and older adults.

Conclusion

Both insufficient sleep duration and insomnia are associated with a higher prevalence of CDAS in Chinese adults.

Changes in sleep disturbance among Chinese adolescents: A population-based online survey

OBJECTIVE

Sleep disturbance is prevalent among adolescents but little is known about the short-term changes among Chinese adolescents. The study aimed to explore the prevalence and change patterns of sleep disturbance and identify its risk and protective factors.

METHODS

Data were collected online from April 21st to May 12th, 2021 (Time 1, T1) and December 17th to 26th, 2021 (Time 2, T2). The final sample comprised 34,260 adolescents. Self-administrated questionnaires were used to assess socio-demographic variables, sleep disturbance, depression, anxiety, life events, family function, and resilience.

RESULTS

The prevalence of sleep disturbance was 12.0% at T1 and 11.8% at T2, with higher rates in females than males. Four groups of sleep disturbance change patterns were identified: non-sleep disturbance group (80.4%), persistent group (4.2%), new-onset group (7.6%), and remission group (7.8%). Risk factors for new-onset sleep disturbance included being in junior high school (AOR = 1.26, 95%CI = 1.15-1.38), family history of mental disorders (AOR = 1.49, 95%CI = 1.03-2.15), and moderate (AOR = 1.24, 95%CI = 1.13-1.36) and severe (AOR = 1.48, 95%CI = 1.27-1.72) family dysfunction. Risk factors for persistent sleep disturbance included being in junior (AOR = 1.25, 95%CI = 1.08-1.45) and senior (AOR = 1.53, 95%CI = 1.15-2.03) high school, parental currently unmarried status (AOR = 1.34, 95%CI = 1.05-1.73), moderate (AOR = 1.19, 95%CI = 1.02-1.39) and severe (AOR = 1.28, 95%CI = 1.06-1.55) family dysfunction. Medium (AOR = 0.48, 95%CI = 0.43-0.53) and high (AOR = 0.34, 95%CI = 0.29-0.40) levels of resilience were protective factors against new-onset sleep disturbance, as well as against persistent sleep disturbance (medium level: AOR = 0.51, 95%CI = 0.43-0.60; high level: AOR = 0.32, 95%CI = 0.25-0.43).

CONCLUSIONS

Interventions aimed at promoting family functions and enhancing resilience may improve sleep disturbance among adolescents.

Longitudinal correlates of bullying victimization among Chinese early adolescents: A cross-lagged panel network analysis

BACKGROUND

Bullying victimization is a major public health issue often faced by adolescents. This highlights the need to identify the relevant risk factors to inform intervention. Based on the ecological systems theory and applied cross-lagged panel network analysis, this study explored the longitudinal correlates of bullying victimization among Chinese early adolescents.

METHODS

A total of 1686 early adolescents (60.4 % were boys) from the Chinese Early Adolescent Cohort study were included in this study. Bullying victimization and its associated factors were assessed using the self-report questionnaires, which was administered from 2019 (T1), 2021 (T2), and 2022 (T3). The longitudinal relationships between bullying victimization and its correlates were examined using a cross-lagged panel network analysis.

RESULTS

27.0 %, 14.9 %, and 13.2 % of the participants reported being bullied by peers at T1, T2, and T3, respectively. The temporal network suggested that individual-level (sex, depression, and anxiety), family-level (child abuse), school-level (satisfaction with classmates), and social-level (satisfaction with society) factors were associated with bullying victimization. The node with the greatest centrality strength was anxiety. Notably, relationship with teachers and classmates were the unique nodes in the T2 → T3 replication network.

LIMITATIONS

The sample is unrepresentative, as it is from only one middle school.

CONCLUSIONS

The findings provide important insights into bullying victimization prevention and intervention among Chinese early adolescents: 1) highlighting the importance of joint interventions across multiple departments; 2) focusing on the most central factors of bullying victimization; and 3) considering the effect of time when exploring the correlates of bullying victimization.

The role of bidirectional associations between depression, anxiety, and emotional exhaustion on turnover intention among nurses: a multicenter cross-sectional study in China

BACKGROUND

A high turnover rate in nursing has become a global concern. Mental health issues may increase the turnover intention of nurses and lead to turnover behaviors. However, very little is known about the role of bidirectional associations between emotional exhaustion and depression/anxiety on turnover intention. This study aimed to examine the associations among depression, anxiety, emotional exhaustion and turnover intention, and to test the role of bidirectional associations between depression, anxiety, and emotional exhaustion on turnover intention among nurses.

METHODS

An online multicenter cross-sectional study was conducted in Hunan Province, China, from December 2021 to February 2022. The questionnaire collected data from the Turnover Intention Scale, the Emotional Exhaustion Scale, the Patient Health Questionnaire-2, and the Generalized Anxiety Disorder Scale-2, as well as sociodemographic information. Data analysis was performed by univariate analysis, Pearson correlation analysis, multiple linear regression analysis, and structural equation modeling.

RESULTS

The average turnover intention score among Chinese nurses was 14.34 ± 3.75. The prevalence of depression and anxiety was 25.9% and 22.3%, respectively. Depression (r = 0.378, P < 0.001), anxiety (r = 0.391, P < 0.001), and emotional exhaustion (r = 0.532, P < 0.001) were positively associated with turnover intention. Emotional exhaustion partially mediated the associations between depression/anxiety and turnover intention, with both mediating effects accounting for 60.7%. The mediating ratios of depression/anxiety on the associations between emotional exhaustion and turnover intentions were 17.6% and 16.5%, respectively.

CONCLUSIONS

Depression, anxiety, and emotional exhaustion showed significant positive effects on turnover intention among nurses. Emotional exhaustion played a partial mediation role between depression/anxiety and turnover intention, while depression/anxiety played no significant mediation role between emotional exhaustion and turnover intention.

Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population

OBJECTIVES

The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population.

DESIGN

Our study has a cross-sectional design.

SETTING

Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1).

PARTICIPANTS

The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety.

RESULTS

The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability.

CONCLUSIONS

The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.

The prevalence and factors associated with posttraumatic growth after 3-years outbreak of COVID-19 among resident physicians in China: a cross-sectional study

Introduction

The Coronavirus disease 2019 (COVID-19) pandemic is a global traumatic event that has profoundly struck individuals' mental health. However, this might potentially promote positive transformation such as posttraumatic growth (PTG). Studies have indicated that the COVID-19 pandemic negatively affected the well-being of resident physicians, but little is known about PTG among this vulnerable population in China. Therefore, this study investigated the prevalence and associated factors of PTG among Chinese resident physicians after 3-years outbreak of COVID-19.

Methods

An online survey was conducted from 9 March to 20 March in 2023. PTG was assessed using the 10-item Posttraumatic Growth Inventory-Short Form (PTGI-SF). Scores ≥30 implied moderate-to-high PTG. We also collected possible associated factors for PTG, including socio-demographic and psychological variables. Data was analyzed by applying descriptive statistics, univariable and multivariable logistic regression models.

Results

In total, 2267 Chinese resident physicians provided validated data. 38.7% of them reported moderate-to-high PTG. In the multivariable logistic regression models, age (odds ratio, OR = 1.039; 95% confidence interval, 95%CI = 1.008-1.070), female (OR = 1.383, 95%CI = 1.151-1.662), satisfied or neutral with annual income (OR = 2.078, 95%CI = 1.524-2.832; OR = 1.416, 95%CI = 1.157-1.732), sufficient support at work (OR = 1.432, 95%CI = 1.171-1.751) and resilience (OR = 1.171, 95%CI = 1.096-1.252) were significantly positively associated with moderate-to-high PTG. On the contrary, burnout (OR = 0.653, 95%CI = 0.525-0.812), depression symptoms (OR = 0.700, 95%CI = 0.552-0.889), and stress (OR = 0.757, 95%CI = 0.604-0.949) were significantly negatively associated with moderate-to-high PTG.

Discussion

Overall, resident physicians in China experienced relatively high prevalence of PTG that could be associated with several psychosocial factors. Findings may provide evidence to develop interventions for resident physicians to systematically and constructively process traumatic events related to the pandemic and foster their PTG.

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.

The Relationship Between eHealth Literacy and Mental Health of Adult Workers: A Cross-Sectional Study

The current cross-sectional study aimed to investigate eHealth literacy among adult workers in China and explore the relationship between eHealth literacy and mental health in this population. Convenience sampling was used to conduct a survey among adult workers aged 18 to 60 years. Potential participants were chosen from those who completed physical examinations at the Health Management Center of one hospital in China. Participants' eHealth literacy and mental health were assessed using the eHealth Literacy Scale, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Perceived Stress Scale. Mean scores for eHealth literacy and perceived stress were 28.39 (SD = 5.78) and 5.49 (SD = 2.61), respectively. Depression and anxiety were found in 8.2% and 10.1% of participants, respectively. Multivariate logistic regression analysis showed that a 1-point increase in eHealth literacy score was associated with a 7% decrease in depressive symptoms (odds ratio [OR] = 0.93, 95% confidence interval [CI] [0.88, 0.99]) and a 6% decrease in anxiety symptoms (OR = 0.94, 95% CI [0.89, 0.99]). Furthermore, multiple linear regression analysis showed that perceived stress decreased 0.08 points (B = -0.08, 95% CI [-0.13, -0.04]) with every 1-point increase in eHealth literacy score. Thus, eHealth literacy has the potential to reduce risk of depression, anxiety, and perceived stress, and to promote the mental health of adult workers. [Journal of Psychosocial Nursing and Mental Health Services, 61(9), 40-46.].

Limitations on participation and global quality of life among CRC survivors with permanent stomas: moderated mediation analysis of psychological distress and family functioning

PURPOSE

Although a cancer diagnosis and stoma creation leave colorectal cancer (CRC) survivors with significant limitations on participation in life activities that would impair their global quality of life (QoL), the underlying psychological mechanisms are understudied. The aim of this cross-section study was to examine whether psychological distress mediates the association of limitations on participation in life activity with global QoL, and whether family functioning moderated the indirect effects of limitations on participation in life activities on global QoL through psychological distress.

METHODS

CRC survivors with permanent stomas (n = 282) completed questionnaires assessing socio-demographic and clinical characteristics, limitations on participation in life activities, psychological distress, family functioning, and global QoL. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS.

RESULTS

Mediation analysis showed that the association of limitations on participation in life activities with global QoL was partially mediated by psychological distress (indirect effect = -0.087, 95% CI = -0.135 to -0.041). Moderated mediation analysis indicated that the indirect effects of limitations on participation in life activities on global QoL through psychological distress were significantly moderated by family functioning. Specifically, the indirect effects decreased were significant as family functioning levels increased.

CONCLUSION

CRC survivors with permanent stomas experienced poor global QoL. The moderated mediation model provides a better understanding of how limitations on participation in life activities, psychological distress, and family functioning work together to affect global QoL. Interventions aiming to improve QoL among CRC survivors with permanent stomas should consider targeting these aspects.

Determinants of depression and anxiety in homeless people: A population survey of homeless people in Hong Kong

BACKGROUND

There are growing concerns about the homeless and mental health issues globally. This study aims to examine the mental health situation of homelessness and the determinants of anxiety and depression of them in Hong Kong.

METHOD

The data from the largest territory-wide study of the homeless population in 2021 was analyzed. Descriptive statistics and logistic regressions were used to investigate the association between mental health and socioeconomic variables, including demographic background, economic indicators, COVID-19 worries, government measures, and respect by others. The symptoms of depression and anxiety were assessed using Patient Health Questionnaire (PHQ) and General Anxiety Disorder (GAD).

RESULTS

The results showed that being female, food insecurity, and chronic diseases were the risk factors for anxiety and depression. A high level of respect by others was the protective factor for depression (adjusted OR 0.37, 95% CI [0.23, 0.61]) and anxiety (adjusted OR 0.40, 95% CI [0.24, 0.68]), compared to a low level of respect in the multivariate model.

CONCLUSIONS

Providing medical outreach services, additional resources for social services, implementation of homeless-friendly policies, and a progressive supply of public and transitional housing would help enhance the well-being of the homeless population.

Influence of Subclinical Anxiety and Depression on Quality of Life and Perception of Facial Paralysis

Introduction: Patients with facial paralysis have increased psychosocial distress, which affects overall quality of life (QOL). Objective: To evaluate the relationship between QOL and paralysis severity among patients with subclinical anxiety and/or depression. Methods: Patients with facial paralysis were screened for anxiety and depression using the Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 surveys. QOL scores (Facial Clinimetric Evaluation) and paralysis severity scores (House-Brackmann [HB] and Sunnybrook [SB]) were collected. Patients with a mental health diagnosis or treatment were excluded. Univariate and multivariate analyses and Pearson's correlations were performed after stratifying by anxiety and/or depression screenings. Results: Positive anxiety and depression screening rates were 25.78% and 22.66%, respectively. Patients screening positive had significantly worse QOL scores despite no difference in paralysis severity. QOL scores did not correlate with SB scores among patients who screened positive for depression. Conclusion: Patients screening positive for anxiety and/or depression demonstrated worse QOL, which did not correlate with paralysis severity suggesting that health care professionals should remain alert to mental health symptoms when QOL impairment is out of proportion with the severity of paralysis.

Family context as a double-edged sword for psychological distress amid the COVID-19 pandemic with the mediating effect of individual fear and the moderating effect of household income

Background

The COVID-19 pandemic drives psychological distress. Previous studies have mostly focused on individual determinants but overlooked family factors. The present study aimed to examine the associations of individual and family factors with psychological distress, and the mediating effect of individual fear and the moderating role of household income on the above associations.

Methods

We conducted a population-based cross-sectional survey on Chinese adults in Hong Kong from February to March 2021 (N = 2,251) to measure the independent variables of anti-epidemic fatigue, anti-epidemic confidence, individual and family members' fear of COVID-19, and family well-being (range 0-10), and the dependent variable of psychological distress (through four-item Patient Health Questionnaire, range 0-4).

Results

Hierarchical regression showed that anti-epidemic fatigue was positively (β = 0.23, 95% CI [0.18, 0.28]) while anti-epidemic confidence was negatively (β = -0.29, 95% CI [-0.36, -0.22]) associated with psychological distress. Family members' fear of COVID-19 was positively (β = 0.11, 95% CI [0.05, 0.16]) while family well-being was negatively (β = -0.57, 95% CI [-0.63, -0.51]) associated with psychological distress. Structural equation model showed that individual fear mediated the above associations except for family well-being. Multi-group analyses showed a non-significant direct effect of anti-epidemic confidence and a slightly stronger direct effect of family well-being on psychological distress among participants with lower incomes, compared to those with higher incomes.

Conclusion

We have first reported the double-edged effect of family context on psychological distress, with the positive association between family members' fear of COVID-19 and psychological distress fully mediated by individual fear and the negative association between family well-being and psychological distress moderated by income level. Future studies are warranted to investigate how the contagion of fear develops in the family and how the inequality of family resources impacts family members' mental health amid the pandemic.

Does awareness of diabetic status increase risk of depressive or anxious symptoms? Findings from the China Multi-Ethnic cohort (CMEC) study

INTRODUCTION

People with diabetes mellitus (DM) have increased risk of depressive symptoms (DS) or anxious symptoms (AS). This study explores whether awareness of DM will contribute to prevalence of DS or AS.

METHODS

The baseline data including 81,717 adults from Southwest China was analyzed. DS and AS were assessed using PHQ-2 and GAD-2. Exposures were defined as 1) having self-reported physician diagnosis of diabetes (self-reported DM), 2) no prior diagnosis of diabetes but meeting diagnostic criteria (newly diagnosed DM), 3) having self-reported physician diagnosis or meeting criteria of non-diabetic diseases (non-diabetic patients), 4) healthy participants. Generalized linear mixed models were used to assess impact of presence and awareness of DM on DS or AS, adjusting for regional and individual related factors.

RESULTS

The prevalence of DS in self-reported DM, newly diagnosed DM, non-diabetic patient and healthy participants was 7.08 %, 4.30 %, 5.37 % and 3.17 %. The prevalence of AS was 7.80 %, 5.77 %, 6.37 % and 3.91 %. After adjusting for related factors, compared with healthy participants, self-reported DM and non-diabetic patients were associated with DS [AOR_{DS, self-reported} = 1.443(1.218,1.710), AOR_{DS, nondiabetic patients} = 1.265(1.143,1.400)], while the association between newly diagnosed DM and DS was not statistically significant. The associations between self-reported DM, newly diagnosed DM, non-diabetic patients and AS were all statistically significant.

LIMITATIONS

DS and AS were assessed through self-report and may suffer recall or information bias.

CONCLUSIONS

The association between awareness of diabetes and DS/AS suggests to pay attention to distinguish between self-reported and newly diagnosed DM and screening for DS and AS in diabetic population.

Multidimensional evaluation of healthy life expectancy indicators based on mental health among the rural older population: A large-scale cross-sectional study

BACKGROUND

This study aimed to estimate healthy life expectancy (HLE) regarding anxiety, depression and their comorbidity among rural older adults.

METHODS

A total of 12,851 subjects (5790 men and 7061 women) enrolled from the Henan Rural Cohort Study were used to evaluate healthy status expectancy (HSE), and 10,096 (4475 men and 5621 women) of them were used to estimate health-adjusted life expectancy (HALE). The life expectancy was calculated using period life table, and HSE and HALE indicators were calculated via the Sullivan method.

RESULTS

For participants aged 60, the depression-free life expectancy (DFLE), anxiety-free life expectancy (AFLE), and depression- and anxiety-free life expectancy (DAFLE) were 23.0993, 23.3314, and 22.7206 years, respectively. The quality-adjusted life expectancy (QALE) of those with neither anxiety nor depression, with anxiety, with depression, and with comorbidity was 22.0727, 20.8751, 18.1484, and 17.0823 years, respectively. The ratio of DFLE (AFLE) to LE increased with age among both genders, while the DAFLE/LE showed a decreasing trend. Regardless of HSE or HALE indicators, women tended to have higher HLE, while HLE/LE was lower than men. Furthermore, all HLE indicators associated with anxiety were the largest in both genders compared to indicators regarding depression.

LIMITATIONS

The HLE may be overestimated ignoring institutional population in the study.

CONCLUSION

Anxiety and depression played essential roles in the quality of life among rural older adults, especially depression. Comorbidity would intensify the adverse effect in rural areas, especially for older men. More attention should be paid to the psychological problems among rural older population.

Cross-lagged relationship between anxiety, depression, and sleep disturbance among college students during and after collective isolation

Object

Repeated quarantine policies over the past 3 years have led to poor psychological consequences for the public. Previous studies have proved that the quarantine policy leaves individuals vulnerable to anxiety, depression, and insomnia, especially among college students. This study aims to explore whether psychological problems during isolation continue with the release of isolation.

Methods

Overall, 2,787 college students both answered a web-based survey during and after the closure management was lifted. The Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Youth Self-rating Insomnia Scale were measured. The cross-lagged path model was used to explore the influence of psychological impact during isolation on the individual after the release.

Results

We found that anxiety and sleep disturbance levels alleviated significantly after quarantine, except for depression. As expected, a bidirectional relationship exists between anxiety, depression, and sleep disturbance. Moreover, depression and sleep disturbance can predict post quarantine depression, sleep disturbance, and anxiety, yet anxiety cannot predict sleep disturbance afterward.

Conclusion

Timely and effective intervention for anxiety, depression, and insomnia during isolation is essential for individuals to repair themselves quickly after the release.

Depressive Symptoms and Ageism among Nursing Home Residents: The Role of Social Support

(1) Background: Ageism refers to the stereotyping, prejudice, and discrimination against older individuals or groups based on their age. This study investigates the modifying role of social support in the relationship between depressive symptoms and ageism in China; (2) Methods: A cross-sectional study was performed in 21 nursing homes in Jinan from March to June in 2019. The data were analyzed through a multilevel mixed-effects generalized linear model; (3) The analysis showed that older adults in nursing homes experienced moderate levels of ageism. There were significant interaction effects between depressive symptoms and social support on overall ageism and objective ageism after controlling for covariates (p < 0.05). As the level of social support increased, the predicted ageism greatly reduced among older adults without depressive symptoms when compared to those with depressive symptoms; (4) Conclusions: This study highlights the importance of identifying strategies to enhance social support and reduce depressive symptoms for nursing home residents. Having positive attitudes toward aging and overcoming negative age-related stereotypes may benefit older adults' physical and mental health, well-being, and help to promote an age-friendly society.

Mapping network connection among symptoms of anxiety, depression, and sleep disturbance in Chinese high school students

Background

Due to tremendous academic pressure, Chinese high school students suffer from severe depression, anxiety, and sleep disturbances. Moreover, senior high school students commonly face more serious mental health problems than junior high school students. However, the co-occurrence and internal relationships of depression, anxiety, and sleep disturbances clusters are scarcely examined among high students. Therefore, the current study inspected relationships between depression, anxiety, and sleep disturbance symptoms through network analysis and identified key symptoms bolstering the correlation and intensifying the syndromes.

Methods

A total of 13,999 junior high school students (M _age = 13.42 years, SD _age = 1.35, 50% females) and 12,550 senior high school students (M _age = 16.93 years, SD _age = 1.67, 47% females) were recruited in Harbin. We constructed networks for all students, junior high group, and senior high group, including data from the Youth Self-rating Insomnia Scale-3 (YSIS-3), the Generalized Anxiety Disorder-2 (GAD-2), and the Patient Health Questionnaire-2 (PHQ-2). The indices of "strength" was used to identify symptoms' centrality, and "bridge strength" was used to find specific nodes that could bridge anxiety, depression, and sleep disturbance.

Results

The networks of all students, junior high and senior high students, were stable and accurate. Among all networks, "Nervousness" (GAD1) had the highest strength, and "Nervousness"-"Excessive worry" (GAD1-GAD2) had the strongest correlation. "Nervousness" (GAD1) also functioned as the bridge symptom among junior high students, while "Sad mood" (PHQ2) among senior high students. Senior high students scored higher than junior high students on all items and had a tighter network structure.

Conclusions

In networks consisting of anxiety, depression, and sleep disturbance, anxiety plays a conspicuous role in comorbidity among junior high school students, which transforms into depression among senior high school students. Treatments or interventions should be focused on these critical symptoms.

Symptoms of anxiety and depression predicting fall-related outcomes among older Americans: a longitudinal study

Background

Anxiety and depressive symptoms are associated with fear of falling and fear of falling-related activity restrictions. However, it remains unknown whether anxiety or depressive symptoms alone could predict fear of falling and activity restrictions in older adults. We sought to determine if anxiety and depressive symptoms alone could be an independent predictor of fear of falling and activity restrictions in community-dwelling older adults.

Methods

This longitudinal analysis used waves 5 (time 1, [T1]) and 6 (time 2, [T2], 1 year from T1) data (N = 6376) from the National Health and Aging Trends Study. The Generalized Anxiety Disorder Scale 2 and Patient Health Questionnaire 2 were used to assess anxiety and depressive symptoms, respectively. Interview questions included demographics, health-related data, and fall worry levels (no fear of falling, fear of falling but no activity restrictions, and activity restrictions). Using multinomial logistic regression models, we examined whether anxiety and depressive symptoms (T1) predicted fear of falling and activity restrictions (T2).

Results

In wave 5 (T1, mean age: 78 years, 58.1% female), 10 and 13% of participants reported anxiety and depressive symptoms. About 19% of participants experienced fear of falling but not activity restrictions, and 10% of participants developed activity restrictions in wave 6 (T2), respectively. Participants with anxiety symptoms at T1 had a 1.33 times higher risk of fear of falling (95% CI = 1.02–1.72) and 1.41 times higher risk of activity restrictions (95% CI = 1.04–1.90) at T2. However, having depressive symptoms did not show any significance after adjusting for anxiety symptoms.

Conclusions

Anxiety symptoms seemed to be an independent risk factor for future fear of falling and activity restrictions, while depressive symptoms were not. To prevent future fear of falling and activity restrictions, we should pay special attention to older individuals with anxiety symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03406-8.

Preliminary evaluation of the Chinese version of the patient-reported outcomes measurement information system 29-item profile in patients with aortic dissection

BACKGROUND

The Patient-Reported Outcomes Measurement Information System 29-item Profile (PROMIS-29) has been widely used to measure health outcomes from the patient's perspective. It has not been validated in adults with aortic disease. The aim of this study was to explore the reliability and validity of the Chinese PROMIS-29 among patients undergoing surgery for aortic dissection (AD).

METHODS

A cross-sectional design was applied. Eligible patients completed a questionnaire that contained the PROMIS-29 and legacy measures, including the Short Form-12 Health Survey (SF-12), 8-item Somatic Symptom Scale (SSS-8), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-2 (PHQ-2). The structural validity of the PROMIS-29 was evaluated using confirmatory factor analysis (CFA). Reliability was evaluated with Cronbach's α. Construct validity was assessed by calculating Spearman's rank correlations and comparing known-group differences.

RESULTS

In total, a sample of 327 AD patients was included in the final analysis. Most of them were male (89%) with a mean age of 52.7 (± 10.3). CFA revealed good model fit of the seven-factor structure within PROMIS-29, as well as most domains in single-factor analysis. Reliability was confirmed with Cronbach's α > 0.90. Correlations between comparable domains of the PROMIS-29 and those of legacy questionnaires and most know-group comparisons were observed as hypothesized.

CONCLUSIONS

This study found evidence for acceptable structural validity, construct validity and internal consistency of the PROMIS-29 in a sample of AD patients. It can be applied to AD survivors by researchers or clinicians, measuring outcomes after surgery and identifying those with worse health status.

Associations between Chinese college students’ anxiety and depression: A chain mediation analysis

Objective

Anxiety and depression are great public health concerns among college students. The purpose of this study was to explore whether sleep quality and quality of life (QoL) play mediating roles in anxiety and depression among Chinese college students.

Method

A total of 2757 college students (mean age = 19.07; SD = 1.14) completed the questionnaires, including a brief demographic survey. The 2-item General Anxiety Disorder (GAD-2) and the 2-item Patient Health Questionnaire (PHQ-2) were used to assess the symptoms of anxiety and depression, respectively. And the Pittsburgh Sleep Quality Index (PSQI) and the Short-Form 36 Health Survey (SF-36) were used to evaluate college students’ sleep quality and QoL, respectively. Mediation analyses were conducted by using PROCESS macro in the SPSS software.

Result

Anxiety had both direct and indirect effects on depression. Sleep quality and QoL were not only independent mediators in the relationship between anxiety and depression but also chain mediators.

Conclusion

The results of the current study highlight the crucial role of early intervention for depression with a focus on college students with anxiety, more especially, on those with poorer sleep quality and lower QoL.

Effect modification of kitchen ventilation on the associations of solid fuel use and long-duration cooking with the increased prevalence of depressive and anxiety symptoms: The Henan Rural Cohort Study

Although solid fuel use for cooking is linked to an increased risk for depression, there is limited evidence on the effects of cooking duration and kitchen ventilation on these associations in rural areas. Among 29 903 participants from the Henan Rural Cohort, the independent and combined associations of cooking fuel type, cooking duration, and kitchen ventilation with depressive and anxiety symptoms were examined by logistic regression models and restricted cubic spline. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of solid fuel use for depressive and anxiety symptoms were 1.237 (1.041, 1.469) and 1.384 (1.153, 1.662), respectively. Increased cooking duration was associated with an increased prevalence of depressive symptoms (aOR: 1.098, 95% CI: 1.033, 1.166) and anxiety symptoms (aOR: 1.074, 95% CI: 1.009, 1.144). Solid fuel use and long-duration cooking associated with increased prevalence of depressive and anxiety symptoms were only observed in individuals without kitchen ventilation. Kitchen ventilation may attenuate the positive associations of solid fuel use and long-duration cooking with the prevalence of depressive and anxiety symptoms, which suggested popularizing clean fuel and promoting kitchen ventilation may be effective strategies to improve mental health related to household air pollution sourced from solid fuel use and long-duration cooking.

The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey

Background

Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an “infodemic” of overabundant and questionable information that has affected older adults’ mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization’s Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults.

Objective

This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media.

Methods

Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district–based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions.

Results

Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=–0.39, P=.002) and AFC-Communication Technology (b=–1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=–0.03, P=.002) and AFC-Communication Technology (b=–0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=–0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=–0.65, P<.001; AFC-Information × social media use b=–2.18, P<.001; 3-way interaction b=0.40, P=.003).

Conclusions

Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults.

Comorbid Depressive and Anxiety Symptoms and Their Correlates Among 93,078 Multiethnic Adults in Southwest China

Background: Depressive symptoms and anxiety symptoms commonly coexist and severely increases the disease burden worldwide. Little is known about the patterns and correlates of comorbid depressive and anxiety symptoms among the multiethnic populations of China.

Methods: This population-based study investigated the comprehensive associations of comorbid depressive and anxiety symptoms with lifestyles, stressful life events, chronic diseases, and physical and mental well-being among 93,078 participants (37,193 men, 55,885 women) aged 30–79 years across seven ethnic groups in Southwest China. Multivariable logistic regression models were used to estimate associations.

Results: Overall, 2.9% (2.1% in men and 3.5% in women) participants had comorbid depressive and anxiety symptoms; there was considerable heterogeneity among multiethnic populations. Participants with chronic diseases were more likely to have comorbidity than those without them; people with rheumatic heart disease reported the highest risk, with an odds ratio (OR) of 6.25 and 95% confidence interval (CI) of 4.06–9.62. Having experienced 3 or more stressful life events (OR, 8.43, 95% CI: 7.27–9.77), very poor self-rated health status (OR, 33.60, 95%CI: 25.16–44.87), and very unsatisfied life (OR, 33.30, 95% CI: 23.73–46.74) had strong positive associations with comorbid depressive symptoms and anxiety symptoms, with a dose-response relationship (P < 0.05). High frequency of physical activity had negative associations. All the associations were stronger than depressive symptoms alone or anxiety symptoms alone.

Conclusions: Our findings emphasize the need to focus on the vulnerable ethnic groups with comorbid depressive and anxiety symptoms, ultimate for help early prevention and improvement of health equity in the underdevelopment and high urbanization areas.

Seeking bridge symptoms of anxiety, depression, and sleep disturbance among the elderly during the lockdown of the COVID-19 pandemic-A network approach

BACKGROUND

Besides physical changes, elderly adults are prone to have mental disorders such as anxiety, depression, and sleep disturbance, and the pandemic of COVID-19 worsened the situation. However, internal relationships and co-occurrence of psychopathologies were scarcely examined. Therefore, in the current study, through network analysis, we inspected relationships among symptoms of depression, anxiety, and sleep disturbance and identified key symptoms that espoused the disease.

METHODS

We asked 1,302 elderly adults to fill in Patient Health Questionnaire-2 (depressive symptoms), the Generalized Anxiety Disorder-2 (anxiety symptoms), and the Youth Self-rating Insomnia Scale (sleep disturbance) and then constructed three networks for elderly adults, male elderly, and female elderly. Via network analysis, we accomplished four goals. First, we identified symptom with the highest centrality (i.e., strength) index for each network; then, we found the strongest correlation (i.e., edges) in each network; thirdly, we confirmed specific nodes that could bridge anxiety, depression, and sleep disturbance; the last was to compare networks based on genders. Network stability and accuracy tests were performed.

RESULTS

Networks of elderly adults, male elderly, and female elderly were stable, accurate, and intelligible. Among all networks, "Nervousness"- "Excessive worry" (GAD-1- GAD-2) had the strongest correlation, and "Nervousness" (GAD-1) had the highest strength and bridge strength value. When we made a comparison between female elderly's and male elderly's networks, except for the significant difference in the mean value of "Difficulty initiating sleep" (YSIS-3), the findings showed that the two networks were similar. Network stability and accuracy proved to be reliable.

CONCLUSIONS

In networks of anxiety, depression, and sleep disturbance, anxiety played a conspicuous role in comorbidity, which could be a target for practical intervention and prevention.

Associations between depressive symptoms, anxiety symptoms, their comorbidity and health-related quality of life: a large-scale cross-sectional study

Background

There were few studies exploring the associations between depressive symptoms, anxiety symptoms and health-related quality of life (HRQoL) in the general population, especially in resource limited area. The aims of this study were to assess the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL in rural area.

Methods

A total of 23,496 eligible participants from Henan rural cohort were included. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were employed to assess depressive and anxiety symptoms, respectively. HRQoL was measured via European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). Tobit regression and generalized linear model were utilized to explore the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL.

Results

A total of 1320 individuals were identified as depressive symptoms with a prevalence rate of 5.62%, while 1198 participants were classified as anxiety symptoms with a prevalence rate of 5.10%. After multiple adjustment, the regression coefficients (β) and 95% confidence interval (CI) of utility index for depressive and anxiety symptoms were − 0.166 (− 0.182, − 0.149) and − 0.132 (− 0.149, − 0.114), respectively. The β and 95% CI of VAS score for depressive and anxiety symptoms were − 7.65 (− 8.60, − 6.70) and − 5.79 (− 6.78, − 4.80), respectively. Additionally, the comorbidity was strongly associated with low utility index and VAS score. These findings were observed robustly in men and women.

Conclusion

Depressive symptoms, anxiety symptoms and their comorbidity were associated with low HRQoL in rural population, which needed further efforts on preventive and treatment interventions.

Clinical trial registration

The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11969-1.

Associations of COVID-19 online information sources and information overload with psychological distress symptoms: a population-based study

Using information communication technologies as information sources of COVID-19 was associated with psychological problems, but mechanisms remain uncertain. We examined associations of COVID-19 information sources and information overload with psychological distress symptoms and explored the mediating effect of information overload in Hong Kong. A random sample of Chinese adults (N = 1501; 52.6% females; 55.0% aged 30-59) from dual landline and online surveys in April 2020 reported frequency of using traditional media, internet websites, social networking sites, instant messaging, and online discussion forums as COVID-19 information sources. Psychological distress symptoms were measured using the Patient Health Questionnaire 4-item ([PHQ-4]; 0-12). Information overload defined as a perception of being overwhelmed was measured (1-6). Linear regressions were performed to analyze the associations, and the mediating effect of information overload was examined. Greater PHQ-4 score was observed for frequent use of internet websites (adjusted b = 0.58, 95% CI 0.29, 0.87, adjusted β = 0.12) and online discussion forums (adjusted b = 0.39, 95% CI 0.08, 0.70, adjusted β = 0.08) and information overload (adjusted b = 0.54, 95% CI 0.44, 0.63, adjusted β = 0.28). Information overload mediated 44.9% and 36.9% of associations of frequent use of internet websites and online discussion forums with PHQ-4 score, respectively. Frequent use of social networking sites was associated with lower PHQ-4 score (adjusted b = -0.37, 95% CI -0.69, -0.04, adjusted β = -0.07) partially through lower information overload (37.5%). Psychological distress symptoms were associated with frequent use of internet websites and online discussion forums as COVID-19 information sources, which were mediated through information overload.

Health-related quality of life among rural adults with type 2 diabetes mellitus: a cross-sectional study

BACKGROUND

Previous reports about health-related quality of life (HRQoL) of type 2 diabetes mellitus (T2DM) concentrated on general patients rather than patients in rural areas with poor infrastructure and limited resources. Thus, the aims of this study were to evaluate the HRQoL of diabetics in the countryside and explore its influencing factors.

METHODS

A total of 23 053 participants aged from 18 to 79 years were drawn from the Henan Rural Cohort Study for this cross-sectional study. The HRQoL of participants were assessed by utility index and VAS-score of European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) instrument. Binary logistic regression, generalized linear and tobit regression models were used to estimate the potential influencing factors on HRQoL.

RESULTS

This study (23 053 participants) included 2231 T2DM patients with a crude prevalence of 9.68%. The utility index and VAS-score in health group were 0.96 ± 0.10 and 78.85 ± 14.53, while in T2DM group were 0.93 ± 0.15 and 74.09 ± 16.09, respectively. In total, most diabetics reported problem about pain/discomfort dimension. Being old, poverty, low physical activity, and with comorbidities was negatively related to HRQoL of diabetics, while high educational level was positively related to HRQoL.

CONCLUSION

HRQoL of rural T2DM patients depended on several sociodemographic factors. More attention should be paid to diabetics with poor socioeconomic status in rural areas.

CLINICAL TRIAL REGISTRATION

The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375.

The Relationship between Restrained Eating, Body Image, and Dietary Intake among University Students in China: A Cross-Sectional Study

This study aims to explore the association between restrained eating, body image, and dietary intake among Chinese college students. This cross-sectional study included 1301 college students at two universities in Hunan Province. Electronic questionnaires were used to collect information including students’ demographic characteristics, restrained eating, perception of body weight, body satisfaction, and dietary intake. Anthropometric measurements were collected to calculate body mass index (BMI). The prevalence of high restrained eating was 52.8%. Students who were dissatisfied with their bodies or overestimated their body weight showed a higher tendency toward high restrained eating (p < 0.05). Students with high restrained eating tended to eat fruits and eggs more frequently, while the frequency of eating domestic animals and poultry, sugar-sweetened beverages, and fast food were the opposite. Moreover, high restrained eating was a risk factor for low dietary diversity (odds ratio (OR) = 1.384, 95% confidence interval: 1.002~1.912). The high incidence of restrained eating among Chinese college students and its energy-restricted diets that may lead to possible health implications require attention. Further studies are needed to investigate the characteristics of college students’ restrained eating to tailor appropriate interventions for forming positive body images and promoting healthy eating behaviors, thus, improving dietary quality.

Long-term exposure to ambient PM1 strengthened the association of depression/anxiety symptoms with poor sleep quality: The Henan Rural Cohort study

Evidence from numerous epidemiological studies for the relationship between mental disorder and sleep quality was inconclusive and few studies assessed the modification effect of exposure to ambient air PM₁ (particulate matter with an aerodynamic diameter ≤ 1.0 µm) on this association. In this study, 27,572 participants aged 18-79 years from The Henan Rural Cohort study were included in the final analyses. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) scales were used to estimate the frequency of depression and anxiety symptoms of all participants, respectively. The Pittsburgh Sleep Quality Index (PSQI) scale was used to assess night sleep quality and PSQI global score (GSC) ≥ 6 was classified as poor sleep quality. The three-year average exposure concentration of PM₁ before the baseline survey was determined as long-term exposure concentration of ambient PM₁. Logistic regression model was conducted to estimate the independent or joint effect of depression/anxiety symptoms and ambient PM₁ exposure on poor sleep quality. In the adjusted models, the odds ratios (ORs) and 95% confidence intervals (95% CIs) of poor sleep quality associated with depression and anxiety symptoms were 3.75 (3.37, 4.17) and 3.42 (3.06, 3.81), respectively, and that associated with long-term exposure to PM₁ was 1.06 (1.03, 1.09). An interaction effect was observed between anxiety symptoms score and PM₁ concentration on poor sleep quality. With the increment of PM₁ concentration, the association was strengthened between depression/anxiety symptoms and poor sleep quality. Besides, compared with the reference group, the ORs (95% CIs) of poor sleep quality in those with comorbidity of depression and anxiety symptoms were 4.98 (3.95, 6.29), 5.23 (3.98, 6.87), 5.76 (4.42, 7.49), and 5.58 (3.83, 8.14), respectively, from the first to the fourth quartile level of the PM₁ concentration. These findings suggested that long-term exposure to PM₁ strengthened the association of depression/anxiety symptoms with poor sleep quality in rural China.

GAD-7, GAD-2, and GAD-mini: Psychometric properties and norms of university students in the United States

OBJECTIVE

The Generalized Anxiety Disorder (GAD-7 & GAD-2) scales are reliable and valid instruments for assessing generalized anxiety symptoms in the general and clinical populations. However, little attention has been given to the psychometric qualities of GAD-7 and reduced length versions in a diverse sample of young adult college students stratified by sex. Thus, the aims for this study are to test psychometric properties and normative values of GAD-7, GAD-2, and GAD-Mini scales.

METHOD

U.S university students (N = 4128; females n = 2527, males n = 1601) ages 18-26 years completed an online survey composed of the GAD-7, Patient Health Questionnaire (PHQ-2), and demographic questions.

RESULTS

Exploratory principal components analysis yielded a one factor solution for GAD-7 across sexes. In reducing scale length, iterative confirmatory principal components analyses stratified by sex revealed a two-item scale (GAD-Mini) with high factor loading items, internal consistency (α ≥ 0.85), and construct validity with PHQ-2 (r ≥ 0.55). Normative data indicate that regardless of whether GAD-7, GAD-2, or GAD-Mini scores were considered, about three-quarters of men and two-thirds of women scored below the reasonable cut-points in screening for GAD.

CONCLUSION

Findings from this study may help health care providers and researchers better understand the interpretation of these scales among university students when screening for GAD.

Consuming Information Related to COVID-19 on Social Media Among Older Adults and Its Association With Anxiety, Social Trust in Information, and COVID-Safe Behaviors: Cross-sectional Telephone Survey

Background

COVID-19-related information on social media is overabundant and sometimes questionable, resulting in an “infodemic” during the pandemic. While previous studies suggest social media usage increases the risk of developing anxiety symptoms, how induced anxiety affects attitudes and behaviors is less discussed, let alone during a global pandemic. Little is known about the relationship between older adults using social media during a pandemic and their anxiety, their attitudes toward social trust in information, and behaviors to avoid contracting COVID-19.

Objective

The goal of this study was to investigate the associations between using social media for COVID-19-related information and anxiety symptoms as well as the mediation effect of anxiety symptoms on social trust in information and COVID-safe behaviors among older adults.

Methods

A cross-sectional telephone survey was conducted in Hong Kong between May and August 2020. A rapid warm-call protocol was developed to train social workers and volunteers from participant nongovernmental organizations to conduct the telephone surveys. Questions related to COVID-safe behaviors, social trust in information, social media use, anxiety and depressive symptoms, and sociodemographic information were asked. The number of confirmed COVID-19 cases at the community level was used to account for the risk of contracting COVID-19. Ordinary least squares regressions examined the associations between social media use and anxiety symptoms, and how they were associated with social trust in information and COVID-safe behaviors. Structural equation modeling further mapped out these relationships to identify the mediation effects of anxiety symptoms.

Results

This study collected information regarding 3421 adults aged 60 years and older. Use of social media for COVID-19-related information was associated with more anxiety symptoms and lower social trust in information but had no significant relationship with COVID-safe behaviors. Anxiety symptoms predicted lower social trust in information and higher COVID-safe behaviors. Lower social trust in information was predicted by using social media for COVID-19 information, mediated by anxiety symptoms, while no mediation effect was found for COVID-safe behaviors.

Conclusions

Older adults who rely on social media for COVID-19-related information exhibited more anxiety symptoms, while showing mixed effects on attitudes and behaviors. Social trust in information may be challenged by unverified and contradictory information online. The negligible impact on COVID-safe behaviors suggested that social media may have caused more confusion than consolidating a consistent effort against the pandemic. Media literacy education is recommended to promote critical evaluation of COVID-19-related information and responsible sharing among older adults.

Job Dissatisfaction Mediated the Associations Between Work Stress and Mental Health Problems

Objective: This study aimed to explore the relationships and the underlying mechanisms between work stress and mental health problems, and potential mediation effects through job dissatisfaction in a working population. Methods: A large population-based study among workers in China was conducted. The self-reported scales of assessing job dissatisfaction and work stress were included in the questionnaire. Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 were used for assessment of mental health. Univariate logistic regression was conducted to test the associations between work stress and mental health. Path analysis was conducted to test the proposed mediation model. Results: Of the 6,190 included employees, 27.72% reported that they perceived work stress, 14.84% of them reported that they were not satisfied with their work, 5.01% of the employees reported depressive symptoms, and 3.75% of the employees reported anxiety symptoms. The results of univariate logistic regression showed that employees who perceived work stress were more likely to report anxiety symptoms (adjusted odds ratio (AOR) = 2.78; 95% CI: 2.03-3.79) or depressive symptoms (AOR = 1.61; 95% CI: 1.22-2.12). The path analysis showed that work stress was positively associated with job dissatisfaction. Job dissatisfaction mediated the relationship between work stress and mental health problems among Chinese working adults. Conclusion: This study suggests the importance of psychosocial work environment for mental health among Chinese working adults. Work dissatisfaction is a stressor that may induce negative consequences on the mental health among Chinese workers. Interventions to help workers with stress management may be beneficial for their mental health.

Associations of Residential Greenness with Depression and Anxiety in Rural Chinese Adults

Background

Depression and anxiety are top contributors to non-fatal health loss globally. Several studies have indicated the association between residential greenness and mental health.

Method

The participants (n = 27,366) were recruited from four counties in Henan Province, China during 2015–2017. Symptoms of depression and anxiety were evaluated using the Patient Health Questionnaire-2 (PHQ-2) and the Generalized Anxiety Disorder-2 (GAD-2) in the baseline survey. The level of residential greenness during the 3-year period before the baseline survey was assessed using the Moderate Resolution Imaging Spectroradiometer (MODIS) Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI). The mixed-effect linear regression model was applied to examine the associations of residential greenness with depression and anxiety.

Results

The results of adjusted models showed that the score of PHQ-2 (Δscore and 95% confidence interval [CI]) decreased by −0.024 (−0.041, −0.006) and −0.022 (−0.038, −0.004) with an interquartile range (IQR) increase in NDVI and EVI within a 1,000-m buffer radius, respectively. The score of GAD-2 (Δscore and 95% CI) decreased by −0.024 (−0.040, −0.006) and −0.028 (−0.044, −0.011), in relation to an IQR increase in NDVI and EVI within a 1,000-m buffer radius, respectively.

Conclusions

A higher level of residential greenness was significantly associated with lower risk of depression and anxiety in rural areas of Henan Province. Improving residential greenness accessibility may help to promote the mental health of rural populations.

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Mental disorders, particularly depression and anxiety, have become one of the most serious public health issues globally.

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Symptoms of depression and anxiety and level of residential greenness were investigated for 27,366 participants from the Henan Rural Cohort.

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The mixed effect linear regression model was used to examine the associations between level of residential greenness and depression and anxiety in rural areas of Henan Province, China.

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Higher residential greenness was significantly associated with lower risks of depression and anxiety.

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Stronger effects of residential greenness were observed in males and in those with higher income and education level.