The error-related negativity (ERN) moderates the association between interpersonal stress and anxiety symptoms six months later

The burden of brooding on neural error processing: The role of repetitive negative thinking in major depressive disorder with and without comorbid anxiety disorders

BACKGROUND

Repetitive negative thinking (RNT), particularly its brooding aspect, is a prominent feature in Major Depressive Disorder (MDD) with and without comorbid anxiety. Error processing, an adaptive cognitive operation, seems to be impaired in individuals with exaggerated RNT. This study measured a post-error neural response, error-related negativity (ERN), during an inhibitory task to examine the mechanism underlying the relationship between RNT and faulty error processing.

METHODS

We examined current MDD patients with (n = 61) and without comorbid anxiety disorders (COM; n = 38), propensity-matched into High- or Low-RNT groups according to Ruminative Response Scale Brooding subscale scores. Using 32-channel electroencephalography (EEG) during a stop-signal task, we measured baseline-corrected ERN amplitude at FCz 0-100 ms after an incorrect response. A between-subjects ANOVA was conducted with group (High RNT, Low RNT) and comorbidity (MDD, COM) as factors.

RESULTS

A significant group-by-comorbidity interaction (η2 = 0.07) was found, with MDD participants exhibiting high RNT revealing smaller (more positive) ERN amplitudes compared to their COM counterparts with high RNT (d = 0.77) and MDD participants with low RNT (d = 0.92).

CONCLUSIONS

Non-anxious individuals with MDD and high RNT showed blunted post-error neural responses, potentially indicating a diminished adaptive neural mechanism for recognizing and correcting errors. However, the presence of comorbid anxiety disorders in individuals with high RNT appears to counteract this reduction, potentially through an enhanced neural response to errors, thereby maintaining a higher level of error-processing activity. Further understanding of these relationships is essential for developing targeted interventions for MDD, with particular focus on the detrimental impact of brooding RNT.

The associations among sleep-related difficulties, anxiety, and error-related brain activity in youth

Given the high prevalence of anxiety disorders and their associated impairment, elucidating neural mechanisms related to these disorders has been increasingly prioritized. The error-related negativity (ERN) has been identified as a neural marker that indexes risk for anxiety across development. The ERN seems to confer risk for developing anxiety, especially in the context of stressful life events. The present study sought to examine sleep-related difficulties as another stressful factor that might impact the ERN. In a sample of 221 girls, aged 8 to 15 years old, we first examined the relationship between longer-term (i.e., over the past month) and shorter-term (i.e., over the past week) sleep difficulties and the ERN. We then investigated whether specific sleep difficulties uniquely predict the ERN. In exploratory analyses, we assessed whether sleep difficulties moderate the relationship between the ERN and anxiety. Results indicated that youth who report longer-term lower sleep duration, longer-term worse sleep, and shorter-term lower sleep duration on school days over the past week have a larger (i.e., more negative) ERN. Additionally, only shorter-term sleep duration on school days over the past week uniquely predicted the ERN. Finally, an elevated ERN predicted greater clinical anxiety in the context of longer-term sleep difficulties. Future studies should clarify the direction of these associations via longitudinal designs.

Cognitive inflexibility and heightened error monitoring are related to lower sexual functioning

Sexual functioning is an important predictor of well-being and relationship satisfaction. Previous research indicates that several aspects of cognitive function are related to sex-related behaviors and functioning among individuals with sex-related disorders, neurological disorders, and in older adults; however, this has been relatively underexamined in younger populations. To examine this, the present study assessed whether behavioral and/or neurophysiological measures of cognitive function are associated with sexual functioning in a community sample of young 489 adults (64 % female) ages 18-30. Cognitive flexibility (n = 460) and inhibition (n = 466) were measured using neuropsychological assessment (D-KEFS), and conflict monitoring and error monitoring were measured by event-related potentials (conflict N2: n = 394; error-related negativity: n = 389). After separately testing relations between the different measures of cognitive function and sexual functioning, we assessed whether results (1) remained after covarying for externalizing and internalizing dimensions (PID-5; n = 489) or (2) varied by gender. Finally, we tested whether any aspects of cognitive function were unique predictors of sexual functioning. Cognitive flexibility and error monitoring (i.e., error-related negativity) were both significantly related to sexual functioning among males and females, such that poorer cognitive flexibility and heightened error monitoring were related to lower sexual functioning. No significant effects emerged for inhibition or conflict monitoring. In a multiple regression model, cognitive flexibility and error monitoring each accounted for a unique portion of variance in sexual functioning beyond other aspects of cognitive function and psychopathology-related traits. Results suggest that cognitive function is a meaningful correlate of sexual functioning in young adulthood, which should be considered further in future research.

The impacts of latent profiles and transitions of stresses on adolescent mental health: A person-centred analysis

Research has demonstrated robust links between adolescent stress and serious psychological problems. The current study aimed to identify latent stress profiles of 1510 adolescents (59.7% females; Mage  = 16.77 years, SD = 0.86) based on five stresses (parental stresses, family environment stresses, academic stresses, teacher stresses, and peer stresses) at three time points (T1/2/3). Moreover, this study would investigate the transition patterns of these profiles over time and examine the associations between the profiles and adverse psychological symptoms (e.g., anxiety, depression, nonsuicidal self-injury [NSSI], and suicidal ideation). Three latent stress profiles were identified, including High-stress profile, Medium-stress profile, and Low-stress profile. The three profiles were significantly different on the levels of T1/2/3 anxiety, depression, NSSI, and suicidal ideation. The profile memberships remained relatively stable across three time points. Notably, the present study found gender differences, with boys were more likely to be in the High-stress profile and to transition from the Medium- to the High-stress profile, compared to girls. Furthermore, left-behind adolescents were more likely to be in the High-stress profile than non-left-behind adolescents. The findings highlight the importance of adopting 'this-approach-fits-this-profile' interventions for adolescents. Parents and teachers are advised to adopt different strategies for girls and boys.

Psychological grit moderates the relation between lifetime stressor exposure and functional outcomes among HIV-seropositive and HIV-seronegative adults

The ability to maintain functional independence throughout the lifespan may be diminished among medically compromised and chronically stressed populations. People living with HIV are more likely to demonstrate functional impairment and report greater exposure to lifetime and chronic stressors than their seronegative counterparts. It is well-known that exposure to stressors and adversity is associated with functional impairment outcomes. However, to our knowledge, no studies have examined how protective factors such as psychological grit mitigate the negative effects of lifetime and chronic stressor exposure on functional impairment, and how this association differs by HIV-status. To address this issue, we studied associations between lifetime and chronic stressor exposure, grit, and functional impairment in 176 African American and non-Hispanic White HIV-seropositive (n = 100) and HIV-seronegative (n = 76) adults, aged 24-85 (M = 57.28, SD = 9.02). As hypothesised, HIV-seropositive status and lower grit, but not lifetime stressor exposure, were independently associated with more functional impairment. Moreover, there was a significant three-way interaction between HIV-status, grit, and lifetime stressor exposure, b = 0.07, p = 0.025, 95% CI [0.009, 0.135]. Specifically, lifetime stressor exposure was related to more functional impairment for HIV-seronegative-but not HIV-seropositive-adults who reported low levels of grit. These findings suggest that the protective effects of grit may differ across populations at risk for functional impairment.

Effects of the COVID-19 Pandemic on Neural Responses to Reward: A Quasi-experiment

BACKGROUND

The COVID-19 pandemic has been a prolonged period of stress due to social isolation, illness, death, and other major life disruptions. Neural reward sensitivity, essential for healthy functioning, may become reduced under major naturalistic stressors, though few studies have examined this. The present study sought to test whether neural responses to rewards were significantly blunted by the stress of the pandemic.

METHODS

We compared 2 groups of young adult participants, who completed a monetary reward task while an electroencephalogram was recorded, at 2 time points, 1 to 3 years apart. Our measure of reward sensitivity was the reward positivity (RewP), a neural marker enhanced to gain relative to loss feedback. The magnitude of the RewP is sensitive to stress exposure and can prospectively predict depression. The pre-pandemic group (n = 41) completed both time points before the pandemic, while the pandemic group (n = 39) completed the baseline visit before the pandemic and the follow-up visit during its second year.

RESULTS

The pandemic group reported having experienced significant stressors over the course of the pandemic. We did not observe a significant decrease in the RewP from baseline to follow-up in the pre-pandemic group. In contrast, in the pandemic group, the RewP was significantly blunted at the follow-up visit to the extent that it no longer distinguished gain from loss feedback.

CONCLUSIONS

These results suggest that prolonged naturalistic stressors can result in adaptations in neural responses to rewards. Our findings also highlight a possible mechanism linking stress to the development of depression.

Cumulative lifetime acute stressor exposure interacts with reward responsiveness to predict longitudinal increases in depression severity in adolescence

BACKGROUND

Life stress and blunted reward processing each have been associated with the onset and maintenance of major depressive disorder. However, much of this work has been cross-sectional, conducted in separate lines of inquiry, and focused on recent life stressor exposure, despite the fact that theories of depression posit that stressors can have cumulative effects over the lifespan. To address these limitations, we investigated whether acute and chronic stressors occurring over the lifespan interacted with blunted reward processing to predict increases in depression over time in healthy youth.

METHOD

Participants were 245 adolescent girls aged 8-14 years old (Mage = 12.4, s.d. = 1.8) who were evaluated at baseline and two years later. The reward positivity (RewP), an event-related potential measure of reward responsiveness, was assessed at baseline using the doors task. Cumulative lifetime exposure to acute and chronic stressors was assessed two years later using the Stress and Adversity Inventory for Adolescents (Adolescent STRAIN). Finally, depressive symptoms were assessed at both baseline and follow-up using the Children's Depression Inventory.

RESULTS

As hypothesized, greater lifetime acute stressor exposure predicted increases in depressive symptoms over two years, but only for youth exhibiting a blunted RewP. This interaction, however, was not found for chronic stressors.

CONCLUSIONS

Lifetime acute stressor exposure may be particularly depressogenic for youth exhibiting a blunted RewP. Conversely, a robust RewP may be protective in the presence of greater acute lifetime stressor exposure.

Relational victimization prospectively predicts increases in error-related brain activity and social anxiety in children and adolescents across two years

Recent research has focused on identifying neural markers associated with risk for anxiety, including the error-related negativity (ERN). An elevated ERN amplitude has been observed in anxious individuals from middle childhood onward and has been shown to predict risk for future increases in anxiety development. The ERN is sensitive to environmental influences during development, including interpersonal stressors. Of note, one particular type of interpersonal stressor, relational victimization, has been related to increases in anxiety in adolescents. We tested whether relational victimization predicts increases in the ERN and social anxiety symptoms across two years in a sample of 152 child and adolescent females (ages 8 - 15). Results indicated that children and adolescents' baseline ERN was positively related to the ERN two years later. Furthermore, greater relational victimization at baseline predicted greater increases in the ERN two years later, controlling for baseline ERN. Moreover, relational victimization at baseline predicted increases in social anxiety, and this relationship was mediated by increases in the ERN. These results suggest that relational victimization impacts the developmental trajectory of the neural response to errors and thereby impacts increases in social anxiety among children and adolescents.

Neural response to social but not monetary reward predicts increases in depressive symptoms during the COVID-19 pandemic

The prevalence of depressive symptoms has increased during the COVID-19 pandemic, especially among those with greater pandemic-related stress exposure; however, not all individuals exposed to pandemic stress will develop depression. Determining which individuals are vulnerable to depressive symptoms as a result of this stress could lead to an improved understanding of the etiology of depression. This study sought to determine whether neural sensitivity to monetary and/or social reward prospectively predicts depressive symptoms during periods of high stress. 121 participants attended pre-pandemic laboratory visits where they completed monetary and social reward tasks while electroencephalogram was recorded. Subsequently, from March to August 2020, we sent eight questionnaires probing depressive symptoms and exposure to pandemic-related stressors. Using repeated-measures multilevel models, we evaluated whether neural response to social or monetary reward predicted increases in depressive symptoms across the early course of the pandemic. Furthermore, we examined whether neural response to social or monetary reward moderated the association between pandemic-related episodic stressors and depressive symptoms. Pandemic-related stress exposure was strongly associated with depressive symptoms. Additionally, we found that blunted neural response to social but not monetary reward predicted increased depressive symptoms during the pandemic. However, neither neural response to social nor monetary reward moderated the association between episodic stress exposure and depressive symptoms. Our findings indicate that neural response to social reward may be a useful predictor of depressive symptomatology under times of chronic stress, particularly stress with a social dimension.

Performance monitoring moderates the relationship between stress and negative affect in response to an exam stressor

The present longitudinal study examined the role of performance monitoring in the relationships between stress (both stress change and chronic stress) and negative affect to a real-life stressor-final exam among 60 undergraduates. Participants firstly completed a Go/No-Go task in the laboratory with electroencephalogram recordings. At T1 (31 days before the final exam), participants reported their chronic perceived stress. Then, with the daily dairy method, their daily stress level and negative affect were collected for three consecutive days. At T2 (three days before the final exam), the 3-day daily dairy was repeated. Results showed that performance monitoring, as measured by behavioral adjustments and electrophysiological correlates, moderated the effects of stress change as well as chronic perceived stress on the negative emotional response to the final exam. More specifically, as the stress change from baseline to exam increases, individuals with shorter PES, lower PEAD or larger Pe amplitudes experienced less negative affect increases in response to exam. Additionally, individuals with shorter PES or larger Pe amplitudes showed no significant relationship between chronic stress and negative affect, whereas individuals with longer PES or smaller Pe amplitudes showed significant positive relationship between chronic stress and negative affect increases in response to exam. The results demonstrated that efficient performance monitoring is a protective factor for stress.

Why is subjective stress severity a stronger predictor of health than stressor exposure? A preregistered two-study test of two hypotheses

Subjective stress severity appraisals have consistently emerged as better predictors of poor health than stressor exposure, but the reason for this is unclear. Subjective stress may better predict poor health for one of at least two reasons. First, because stressor exposure measures consider all stressors as equal, stress severity measures-which "weight" stressors by self-reported severity-might better predict poor health simply by not treating all stressors as being equally impactful. Second, subjective stress appraisals may index important individual differences in stress vulnerability. We tested these two possibilities in this preregistered, two-study manuscript. Across these two different studies, subjective stress severity was a better predictor of poor health than independently weighted stress severity or stressor exposure. These results demonstrate that, beyond weighting of stressful experiences, subjective stress severity indexes health-relevant individual differences. Moreover, the results suggest that subjective stress severity may be the preferred stress summary metric even when derived from imprecise stress assessment instruments.

The impact of punishment on error-related brain activity in children

The error-related negativity (ERN) is sensitive to individual differences relating to anxiety and is modulated by manipulations that increase the threat-value of committing errors. In adults, the ERN magnitude is enhanced when errors are followed by punishment, especially among anxious individuals. Punitive parenting is related to an elevated ERN in children; however, the effects of task-based punishment on the ERN in children have yet to be understood. Furthermore, there is a need to assess developmental periods wherein the ERN might be especially prone to modulation by punishment. We examined the impact of punishment on the ERN in a sample of children and assessed whether the impact of punishment on the ERN was moderated by age and anxiety. Punishment potentiated the ERN in children, especially among higher trait-anxious individuals; the punishment potentiation of the ERN was also associated with older age. The interaction between child age and anxiety symptoms did not significantly predict the punishment potentiation of the ERN; however, both child age and anxiety symptoms uniquely predicted the punishment potentiation of the ∆ERN. Anxious children may be especially prone to punishment-related alterations in error monitoring, and the impact of punishment on the ERN may become more pronounced as children age.

Unraveling the effect of ambivalence over emotional expression on subjective wellbeing in Chinese college students in romantic relationships: A multiple mediation model

The sudden and unpredictable outbreak of the COVID-19 pandemic has severely threatened young adults' physical and mental health and damaged the quality of relationships. As a critical stage of development, their well-being is more vulnerable to adverse environments which may lead to profound negative long-life mental health status. The current study aimed to investigate the mediation effects of fear of intimacy and attachment avoidance in the association between ambivalence over emotional expression and subjective wellbeing. A sample of 555 Chinese college students who are currently involved in romantic relationships (Mean age = 19.69, SD age = 1.36, 52% females) completed anonymous questionnaires regarding ambivalence over emotional expression, fear of intimacy, attachment avoidance, and subjective wellbeing. The findings revealed that ambivalence over emotional expression can predict negative subjective wellbeing of college students in romantic relationships significantly, and fear of intimacy and attachment avoidance played a sequentially mediating role in the association between ambivalence over emotional expression and subjective wellbeing. Surprisingly, when considering attachment avoidance independently, we found it had an inhibitory action on the link between ambivalence over emotional expression and subjective wellbeing. The present study contributes to a better understanding of how ambivalence over emotional expression can decrease subjective wellbeing, and also has implications for the intervention of students' subjective wellbeing and closeness during the period of COVID-19.

Associations between lifetime stress exposure and the error-related negativity (ERN) differ based on stressor characteristics and exposure timing in young adults

Life stress increases risk for multiple forms of psychopathology, in part by altering neural processes involved in performance monitoring. However, the ways in which these stress-cognition effects are influenced by the specific timing and types of life stressors experienced remains poorly understood. To address this gap, we examined how different social-psychological characteristics and developmental timing of stressors are related to the error-related negativity (ERN), a negative-going deflection in the event-related potential (ERP) waveform that is observed from 0 to 100 ms following error commission. A sample of 203 emerging adults performed an ERN-eliciting arrow flanker task and completed an interview-based measure of lifetime stress exposure. Adjusting for stress severity during other developmental periods, there was a small-to-medium effect of stress on performance monitoring, such that more severe total stress exposure, as well as more severe social-evaluative stress in particular, experienced during early adolescence significantly predicted an enhanced ERN. These results suggest that early adolescence may be a sensitive developmental period during which stress exposure may result in lasting adaptations to neural networks implicated in performance monitoring.

The relationship between stressful life events and the error-related negativity in children and adolescents

The error-related negativity (ERN) has been cited as a neural marker that indexes risk for anxiety in children and across development. Environmental factors, such as punishment in the lab and parenting styles, have been shown to impact the ERN. However, little is known about how other environmental factors may shape this neural risk marker. The current study examines how the environmental factor of stressful life events may relate to the ERN in children and adolescents. In a sample of 176 females, ages 8–15 years, we examined associations between the frequency of recent stressful life events and the ERN. We also investigated whether interpersonal dependent life events or non-interpersonal life events uniquely relate to the ERN. Finally, we explored whether recent stressors differentially relate to the ERN based on age. Results suggest that youth who have experienced more frequent stressful life events have an increased (i.e., more negative) ERN. Moreover, more frequent interpersonal dependent stressors uniquely predicted the magnitude of the ERN. Lastly, results supported a moderation model wherein the relationship between the frequency of interpersonal dependent stressors and the ERN was moderated by age, such that the relationship between stressors and the ERN was significant only for younger children.

Cumulative lifetime stressor exposure assessed by the STRAIN predicts economic ambiguity aversion

Uncertainty is inherent in most decisions humans make. Economists distinguish between two types of decision-making under non-certain conditions: those involving risk (i.e., known outcome probabilities) and those that involve ambiguity (i.e., unknown outcome probabilities). Prior research has identified individual differences that explain risk preferences, but little is known about factors associated with ambiguity aversion. Here, we hypothesized that cumulative exposure to major psychosocial stressors over the lifespan might be one factor that predicts individuals’ ambiguity aversion. Across two studies (Study 1: n = 58, M_age = 25.7; Study 2: n = 188, M_age = 39.81), we used a comprehensive lifetime stressor exposure inventory (i.e., the Stress and Adversity Inventory for Adults, or STRAIN) and a standard economic approach to quantify risk and ambiguity preferences. Greater lifetime stressor exposure as measured by the STRAIN, particularly in early life, was associated with higher aversion to ambiguity but not risk preferences.

Uncertainty is a factor in most decisions. Here the authors quantify tolerance for two forms of economic uncertainty—risk and ambiguity—and show that greater lifetime stressor exposure (as assessed by a comprehensive lifetime stressor exposure inventory) was associated with higher aversion to decisions involving ambiguity, but not risk.

On the relationship between the error-related negativity and anxiety in children and adolescents: From a neural marker to a novel target for intervention

The current review focuses on our work on the relationship between the error-related negativity (i.e., ERN) and anxiety in children and adolescents. The ERN is an event-related potential (ERP) that appears as a negative deflection in the ERP waveform when individuals make errors and has been found to be increased in anxious individuals. We, and others, have extended this work into developmental populations, finding that the ERN can be measured reliably in children and that the ERN is increased among clinically anxious youth. Furthermore, we have found that the ERN predicts risk for increases in anxiety across development, among healthy and clinically anxious children. We have done work to elucidate what psychological phenomena the increased ERN among anxious children may reflect by creating a self-report measure of error sensitivity (i.e., the Child Error Sensitivity Index) that relates to the ERN. Moreover, we review our work on parenting and the ERN, which suggests that harsh or critical parenting styles may potentiate the ERN in offspring. And, building on these findings, we discuss our recent work to develop novel, computerized intervention strategies to reduce the ERN and thereby risk for anxiety.

Understanding Trajectories to Anxiety and Depression: Neural Responses to Errors and Rewards as Indices of Susceptibility to Stressful Life Events

Between-individuals variation in neural responses to errors and rewards is associated with the degree of risk for developing depression and anxiety, but not all individuals with perturbations in systems that generate these responses go on to develop symptoms. We propose that exposure to stressful life events may determine when these individual differences in neural responses to errors and rewards result in anxiety or depression. In this article, we review key findings and discuss limitations and questions in research on how stressors interact with reward and error processing to predict the development of symptoms. We conclude by outlining future research directions.

Neurocognitive Profiles in Adolescence Predict Subsequent Anxiety Trajectories During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has created increased stress and anxiety for many; however, some individuals are particularly prone to heightened anxiety. It is unclear if and how prestress neurocognitive factors moderate risk for anxiety during high-stress situations. Enhanced error monitoring and a cognitive control strategy of more instantaneous (reactive) control have both been independently related to anxiety. We examined if a specific neurocognitive profile characterized by heightened error monitoring and a more reactive cognitive control strategy in adolescence predicts young adults' anxiety trajectories across 3 early months of the COVID-19 pandemic.

METHODS

As part of a longitudinal study (N = 291), data were acquired in adolescence (13 years) on error monitoring (n = 124) and cognitive control strategy (n = 119). In young adulthood (18 years), anxiety was assessed three times during the COVID-19 pandemic (n = 162).

RESULTS

On average, participants experienced greater anxiety in the first COVID-19 pandemic assessment, then anxiety decreased in the following months. Error monitoring and cognitive control strategy interacted to predict anxiety trajectories, such that among adolescents with an increased reliance on reactive control, error monitoring predicted greater anxiety in the first assessment but greater decreases the following months as stay-at-home orders were lifted and families adapted to the restrictions.

CONCLUSIONS

Results suggest that neurocognitive profiles in adolescence predict young adults' anxiety responses during a highly stressful period, such as the initial months of the COVID-19 pandemic. Our findings have implications for the early identification of individuals at greater risk for anxiety.

In the Face of Potential Harm: The Predictive Validity of Neural Correlates of Performance Monitoring for Perceived Risk, Stress, and Internalizing Psychopathology During the COVID-19 Pandemic

Background

The COVID-19 pandemic is a major life stressor posing serious threats not only to physical but also to mental health. To better understand mechanisms of vulnerability and identify individuals at risk for psychopathological symptoms in response to stressors is critical for prevention and intervention. The error-related negativity (ERN) has been discussed as a neural risk marker for psychopathology, and this study examined its predictive validity for perceived risk, stress, and psychopathological symptoms during the COVID-19 pandemic.

Methods

A total of 113 individuals who had participated as healthy control participants in previous electroencephalography studies (2014–2019) completed a follow-up online survey during the first COVID-19 wave in Germany. Associations of pre-pandemic ERN and correct-response negativity (CRN) with perceived risk regarding COVID-19 infection, stress, and internalizing symptoms during the pandemic were examined using mediation models.

Results

Pre-pandemic ERN and CRN were associated with increased perceived risk regarding a COVID-19 infection. Via this perceived risk, the ERN and CRN were associated with increased stress during the pandemic. Furthermore, risk perception and stress mediated indirect effects of ERN and CRN on internalizing psychopathology, including anxiety, depression, and obsessive-compulsive symptoms, while controlling for the effects of pre-pandemic symptom levels.

Conclusions

In summary, heightened pre-pandemic performance monitoring showed indirect associations with increases in psychopathological symptoms during the first COVID-19 wave via effects on perceived COVID-19 risk and stress. These results further strengthen the notion of performance monitoring event-related potentials as transdiagnostic neural risk markers and highlight the relevance of stress as a catalyst for symptom development.

How stress, discrimination, acculturation and the gut microbiome affect depression, anxiety and sleep among Chinese and Korean immigrants in the USA: a cross-sectional pilot study protocol

INTRODUCTION

Although a considerable proportion of Asians in the USA experience depression, anxiety and poor sleep, these health issues have been underestimated due to the model minority myth about Asians, the stigma associated with mental illness, lower rates of treatment seeking and a shortage of culturally tailored mental health services. Indeed, despite emerging evidence of links between psychosocial risk factors, the gut microbiome and depression, anxiety and sleep quality, very few studies have examined how these factors are related in Chinese and Korean immigrants in the USA. The purpose of this pilot study was to address this issue by (a) testing the usability and feasibility of the study's multilingual survey measures and biospecimen collection procedure among Chinese and Korean immigrants in the USA and (b) examining how stress, discrimination, acculturation and the gut microbiome are associated with depression, anxiety and sleep quality in this population.

METHOD AND ANALYSIS

This is a cross-sectional pilot study among first and second generations of adult Chinese and Korean immigrants in the greater Atlanta area (Georgia, USA). We collected (a) gut microbiome samples and (b) data on psychosocial risk factors, depression, anxiety and sleep disturbance using validated, online surveys in English, Chinese and Korean. We aim to recruit 60 participants (30 Chinese, 30 Korean). We will profile participants' gut microbiome using 16S rRNA V3-V4 sequencing data, which will be analysed by QIIME 2. Associations of the gut microbiome and psychosocial factors with depression, anxiety and sleep disturbance will be analysed using descriptive and inferential statistics, including linear regression.

ETHICS AND DISSEMINATION

This study has been approved by the Institutional Review Board at Emory University (IRB ID: STUDY00000935). Results will be made available to Chinese and Korean community members, the funder and other researchers and the broader scientific community.

The Impact of Chinese College Students' Perceived Stress on Anxiety During the COVID-19 Epidemic: The Mediating Role of Irrational Beliefs

Objective: To explore the underlying mechanism of the impact of perceived stress on anxiety of the Chinese college students during the COVID-19 epidemic. Methods: The Perceived Stress Scale, Irrational Belief Scale, and General Anxiety Scale were adopted in the current study. College students were randomly selected for online questionnaire survey. There were 1,598 valid questionnaires, and the proportion of women was 47.81%. Results: The perceived stress and anxiety, as well as the three dimensions of irrational beliefs (catastrophizing, low frustration tolerance, and depreciation) were significantly positively correlated; demandingness was not significantly correlated with anxiety. Further analysis found that the perceived stress had a significant positive predictive effect on the anxiety of college students. Catastrophizing, low frustration tolerance, and depreciation played part of the mediating role, and there was no significant difference in the strength of these mediating roles. Conclusion: The perceived stress of the COVID-19 epidemic had a positive effect on the anxiety of Chinese college students, this was partly mediated by irrational beliefs.

Associations between lifetime stress exposure, race, and first-birth intendedness in the United States

This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants' stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States.