Associations between depression risk, bullying and current smoking among Chinese adolescents: Modulated by gender

School Bullying Victimization and Depression Symptoms in Adolescents: The Mediating Role of Internet Addiction and Moderating Role of Living Areas

School bullying and depression are both serious social and public health problems among adolescents. Prior studies indicated a correlation between bullying and depression. However, the potential moderators remain largely unexplored. This study aimed to identify the mediating effect of Internet addiction and the moderating effect of living in urban or rural areas in the relationship between school bullying victimization and depression symptoms among Chinese adolescents. This cross-sectional study of adolescents was conducted using two-stage random cluster sampling of students in urban and rural public high schools in China. A moderated mediation model was constructed to uncover the underlying mechanism of school bullying victimization and depression symptoms. A total of 2,376 adolescents (52.65% females, mean age ± SD a 14.69 ± 1.76 years) were included in the study. The prevalence of clinical depression symptoms with a cut-off value of 16 on the Center for Epidemiological Studies Depression Scale (CES-D) was 21.76% (95% CI: 20.15, 23.46), and with a cut-off value of 20 on the CES-D was 13.85% (95% CI: 12.51, 15.30) for overall. Our findings indicated a significant positive association between school bullying victimization and depression symptoms (p < 0.01) and a significant mediating effect of Internet addiction in the association between school bullying victimization and depression symptoms (indirect effect = 1.143, 95% CI: 0.677, 1.609; percentage of mediation: 16.7%, 95% CI: 10.3, 23.1). This indirect relationship was partially moderated by the living in urban or rural areas in the mediation process. Specifically, the effect of school bullying victimization on Internet addiction was greater among urban adolescents (simple slope: 0.774, 95% CI: 0.524, 1.024, p < 0.01) than among rural adolescents (simple slope: 0.337, 95% CI: 0.132, 0.543, p < 0.01), but moderating effect of urban-rural areas was not significant on the relationship between Internet addiction and depression symptoms. These findings highlight the mediating role of Internet addiction and the moderating role of living areas in school bullying victimization and adolescents' depression symptoms, which provide evidence for social work, mental health services, and policy interventions for adolescents in China.

Bullying Victimization and Comorbid Patterns of PTSD and Depressive Symptoms in Adolescents: Random Intercept Latent Transition Analysis

Many studies have examined post-traumatic stress disorder (PTSD) or depressive symptoms in adolescents under the background of school bullying, but not their comorbidities and changes over time. This study used random intercept latent transition analysis (RI-LTA) to examine the transitions in comorbid patterns of PTSD and depressive symptoms among 815 adolescents (45.0% boys; Mage-baseline = 13.69, SD = 1.60), who reported their symptoms in a 3-year longitudinal study. Three comorbid patterns were found: low symptoms, predominantly PTSD symptoms, and symptoms of comorbidity. Among these patterns, five trends were found through 3 years: stable low symptoms, stable PTSD symptoms, improving symptoms, worsening symptoms, and an inverted-U pattern. Age, time that parents spend with their child, being an only child, family income and experiencing relational bullying were predictors of these transitions. These suggest that patterns of PTSD and depressive symptoms are heterogeneous and may change over time since trauma events. Developing targeted interventions based on underlying factors through distinct patterns and transitions may help us better optimize and utilize intervention resources to alleviate symptoms from bullying victims.

The Role of Coping Styles in Mediating the Dark Triad and Bullying: An Analysis of Gender Difference

Recently, the phenomenon of school bullying has gradually become a primary focus of social attention. To reduce the occurrence of bullying, it is important that we explore the psychological mechanisms of students with bullying tendencies. We conducted mediation models through a multi-group analysis to verify the mediating effect of coping styles on the relationship between dark personality traits and bullying, and further explored the differences in this mechanism between male and female groups. The participants were 772 high school students recruited from a middle school in Tianjin, China. They completed a set of self-reported measurements including the Dirty Dozen (DD), Simplified Coping Style Questionnaire (SCSQ), Buss-Perry Aggression Questionnaire (BPAQ), and Reactive-Proactive Aggression Questionnaire (RPQ). All the measurement instruments have acceptable reliability and validity. The results of the multi-group multiple models indicated that (1) there are significant gender differences in bullying behavior, with males scoring significantly higher than females. Moreover, the gender difference was only reflected in proactive aggression, in which males had higher scores than females; there was no significant gender difference in reactive aggression. (2) In the group of females, both negative and positive coping styles partially moderated the relationship between the Dark Triad and bullying. However, in the group of males, only negative coping styles partially mediated the relationship between the Dark Triad and bullying. (3) The above results also held for proactive aggression. In conclusion, our study highlights the gender differences in the mediating effect of coping styles on the relationship between the Dark Triad and bullying and proactive aggression. These findings contribute to better shared understanding of gender-related aspects in school bullying.

Prevalence of depression and anxiety, and associated factors, among Chinese primary and high school students: A cross-sectional, epidemiological study

INTRODUCTION

This study aimed to investigate the prevalence of depression and anxiety, and associated factors, among Chinese children and adolescents aged 8-18 years who attend primary or high school.

METHODS

A total of 23 005 primary and high school students were recruited from February to December, 2019 for this cross-sectional study. The questionnaire included demographic information, questions assessing suicidality, resilience, depression (Center for Epidemiological Studies Depression Scale for Children), and anxiety (Screen for Child Anxiety Related Disorders). Binary logistic regression was used to analyze the independent correlates of depression and anxiety.

RESULTS

Overall, 13.06% of participants experienced depressive symptoms, 22.34% experienced anxiety symptoms, 26.34% experienced transient suicidal ideation, 2.23% had serious suicidal ideation, and 1.46% had a history of suicide attempts. Anxiety (odds ratio [OR], 4.935; 95% confidence interval [CI][4.442-5.485]), suicidality (OR, 2.671; 95% CI[2.203-3.237]), skipping breakfast (OR, 1.920; 95% CI[1.348-2.736]), sleep duration (OR, 0.470; 95% CI[0.398-0.556]) and self-expectations (OR, 1.924; 95% CI[1.550-2.389]) were associated with depression (all p < .05). Depression (OR, 4.424; 95% CI[3.983-4.914]), female sex (OR, 1.903; 95% CI[1.759-2.060]), school-based traumatic experience(s) (OR, 1.905; 95% CI[1.747-2.077]), relationships with teachers (OR, 1.575; 95% CI[1.103-2.249]), and suicidality (OR, 1.467; 95% CI[1.218-1.766]) were associated with anxiety symptoms (all p < .05).

DISCUSSION

Depression and anxiety are common among school-age children and adolescents in China. Childhood school- and family-based traumatic experience(s), female sex, and lifestyle factors (eating breakfast, sleep duration, exercising, and Internet use) are significantly associated with mental health among children and adolescents. Developing interventions targeting these factors to protect students from depression and anxiety are needed.

Prevalence and associated factors of bullying victimization among Chinese high school students in Shandong, China

BACKGROUND

Bullying is a growing concern worldwide. However, there is insufficient research on the prevalence and factors associated with different forms of bullying in a large sample of Chinese adolescents. This study aims to investigate the prevalence and associated factors of bullying victimization among Chinese high school students.

METHODS

Data from the 2020-2021 cross-sectional survey of the DYH program were used. A total of 8203 high school students were randomly selected from all 17 cities in Shandong Province, China. Bullying victimization was measured using two separate questions and identified into three types: school bullying victims, cyberbullying victims, and combined bullying victims. The multinomial logit model was used to explore the factors related to bullying victimization.

RESULTS

The prevalence of bullying victimization was 11.59 %, with 4.04 % of school bullying, 3.37 % of cyberbullying, and 4.18 % of combined bullying. Smoking was negatively associated with bullying victimizations. Male, physical exercise, peer relationships, and obsessive-compulsive symptoms were significantly associated with school bullying victims and combined victims. Watching TV was an influencing factor for school bullying victims and cyberbullying victims. Single-child households, family economic status, drinking alcohol, parent-child relationships, and paranoia were correlated with different types of bullying victimization.

LIMITATIONS

The cross-sectional design limited the examination of causal inferences.

CONCLUSION

We should pay more attention to cyberbullying victimization, which has become as common as school bullying victimization among high school students. The associated factors explored in this study may contribute to understanding bullying victimizations and designing bullying intervention strategies among high school students in China.

Screening Depressive Symptoms and Incident Major Depressive Disorder Among Chinese Community Residents Using a Mobile App-Based Integrated Mental Health Care Model: Cohort Study

Background

Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely depressive disorder case identification and intervention may improve health outcomes and cost-effectiveness among affected individuals. China’s public and academic communities have reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression.

Objective

This study aims to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in the cohort study using a mobile app–based integrated mental health care model and investigate the 12-month incidence rate and related factors of major depressive disorder (MDD) among those with subthreshold depressive symptoms.

Methods

Data were drawn from the Depression Cohort in China (DCC) study. A total of 4243 community residents aged 18 to 64 years living in Nanshan district, Shenzhen city, in Guangdong province, China, were encouraged to participate in the DCC study when visiting the participating primary health care centers, and 4066 (95.83%) residents who met the DCC study criteria were screened for subthreshold depressive symptoms using the Patient Health Questionnaire-9 at baseline. Of the 4066 screened residents, 3168 (77.91%) with subthreshold depressive symptoms were referred to hospitals to receive a psychiatric diagnosis of MDD within 12 months. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were also investigated. The diagnosis of MDD was provided by trained psychiatrists using the Mini-International Neuropsychiatric Interview. Univariate and multivariate logistic regression models were performed to explore the potential factors related to subthreshold depressive symptoms at baseline, and Cox proportional hazards models were performed to explore the potential factors related to incident MDD.

Results

Anxiety symptoms (adjusted odds ratio [AOR] 1.63, 95% CI 1.42-1.87) and insomnia symptoms (AOR 1.13, 95% CI 1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms, whereas well-being (AOR 0.93, 95% CI 0.87-0.99) was negatively associated with depressive symptoms. During the follow-up period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 5.97% (189/3168). After incorporating all significant variables from the univariate analyses, the multivariate Cox proportional hazards model reported that a history of comorbidities (adjusted hazard ratio [AHR] 1.49, 95% CI 1.04-2.14) and anxiety symptoms (AHR 1.13, 95% CI 1.09-1.17) were independently associated with an increased risk of incident MDD. The 5-item World Health Organization Well-Being Index was associated with a decreased risk of incident MDD (AHR 0.90, 95% CI 0.86-0.94).

Conclusions

Elevated anxiety symptoms and unfavorable general well-being were significantly associated with subthreshold depressive symptoms and incident MDD among Chinese residents in Shenzhen. Early screening for subthreshold depressive symptoms and related factors may be helpful for identifying populations at high risk of incident MDD.

Relationship between school bullying and mental health status of adolescent students in China: A nationwide cross-sectional study

INTRODUCTION

School bullying, as a public health problem, has been linked to many emotional disorders. However, the overall status of school bullying among adolescent students in China is unknown. This nationwide study aimed to investigate school bullying in China and evaluate the relationships between school bullying and mental health status.

METHODS

A total of 15, 415 middle and high school students were enrolled in this study through multistage stratified cluster random sampling. Multinomial logistic regression models were used to examine the association between school bullying and mental health status and the analysis was stratified by gender.

RESULTS

Students were divided into four groups: 2.72%, bully/victims; 1.38%, bullies; 10.89%, victims; 85.01%, uninvolved. Compared with uninvolved students, students with anxiety symptoms, non-suicidal self-injury and suicide ideation had a higher risk of being involved in school bullying and were more likely to be bully/victims, bullies, and victims. Stratified analysis indicated that boys with anxiety symptoms and non-suicidal self-injury risks tended to be bullies, victims and bully/victims. However, for girls, bullying others or being bullied was related to anxiety symptoms and suicide ideation.

CONCLUSION

Our study indicated that school bullying is still a health problem in the adolescent students of China, and is related to many mental health problems. Intervention programs are in urgent need to help the students involved in school bullying, both in terms of their mental and physical health.

Unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents

BACKGROUND

It is well known that some lifestyle-related behaviors are related to depressive symptoms, but the unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents are still controversial.

AIMS

The aims of this study were to examine the unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents, and explored the potential influences of gender difference on these associations.

METHODS

We conducted a cross-sectional study among 3967 Chinese adolescents aged 11 to 19 from Jilin, China during September and October of 2018. Students reported their lifestyle factors including sleep duration, time spent on computer, time spent on television, time spent on homework, eating breakfast, smoking, drinking, physical activity, and outdoor activity. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

The prevalence of depressive symptoms was 28.2% among Chinese adolescents. Multivariate logistic regression analysis revealed that sleep duration <8 hour/day, time spent on homework ⩾3 hour/day, skipping breakfast, alcohol use, physical activity <3 days/week, and outdoor activity <2 hour/day were positively associated with depressive symptoms in both girls and boys. Time spent on computer ⩾2 hour/day was an independent risk predictor for depressive symptoms in males, while smoking only showed higher risk of depressive symptoms in females. There was an additive relationship between the lifestyle risk index scores and the risk of depressive symptoms for both genders, the relationship being strongest among females.

CONCLUSION

The important role of lifestyle factors should be taking into consideration when create intervention programs to prevent and reduce depressive symptoms among adolescents. In addition, preventive interventions may need to focus on gender-informed approaches when targeting multiple lifestyle factors.

School Bullying Among Vocational School Students in China: Prevalence and Associations With Personal, Relational, and School Factors

This study poses the following research questions: What is the prevalence of bullying in vocational schools in China? What are the differences between different genders and professions? How should individuals, families, and schools do to affect school bullying? What can we do to improve and to respond school bullying, to reduce its occurrence and consequences? This cross-sectional study was conducted in 2018 with 95,873 students from 85 vocational schools. The main outcome indicators were self-reported involvement in bullying (perpetrator, victim, perpetrator-victim, or uninvolved). Multinomial logistic regression analyses were conducted, with personal characteristics, relational characteristics, and school climate as predictors. A total of 30.4% of participants reported being bullied, 2.9% reported bullying others, and 21.7% reported being bullied and bullying others. Majors related to primary and secondary industries are more likely to involvement in bullying than majors related to tertiary industries. Boys were more involved in physical or verbal bullying, whereas girls were more involved in relational bullying and cyberbullying. Sex, history of fighting, and emotional/mental state were the strongest individual factors associated with bullying. Having friends was inversely associated with bullying involvement; moreover, a positive relationship with parents and a good parenting style (warmth, democracy, and mutual concern) protected students from bullying others as well as being bullied. School bullying programs, happiness at school, and insecurity at school were strong negative predictors of bullying. Bullying is prevalent among vocational school students in China. An appropriate response to school bullying requires strengthening student capacity to correctly understand and deal with bullying, identifying victims and vulnerable groups, developing school-based interventions, involving parents in prevention programs, and enhancing students' sense of responsibility in supervision, reporting, and creating a friendly environment.

Prevalence of depression, anxiety and associated factors among school going adolescents in Bangladesh: Findings from a cross-sectional study

BACKGROUND

Common mental disorders in early life represent a major concern as they become more complex and intense with transition into adolescence. Despite global recognition of the significance of adolescent mental health, it remains a neglected area in research and health policy in Bangladesh. This study aimed to investigate the prevalence and factors associated with depression and anxiety among school going adolescents in Bangladesh.

METHODS

A cross-sectional survey was conducted among 563 students aged 13-18 years at selected schools (secondary and higher secondary) in Dhaka City. After providing written informed consent, participants completed a survey examining socio-demographic variables, along with the PHQ-9 and GAD-7 scales. Logistic regression was used to examine associations between variables under examination.

RESULTS

The prevalence rates of moderate to severe levels of depression and anxiety were 26.5% and 18.1%, respectively. Based on multivariable analyses, unsatisfactory sleep (AOR = 3.17; 95% CI = 1.81-5.53, p < .001), cigarette smoking (AOR = 2.00; 95% CI = 1.01-3.97, p = .048), and anxiety (AOR = 10.47; 95% CI = 6.11-17.95, p < .001) were associated with depression. Anxiety was associated with being 15-16 years (AOR = 2.66; 95% CI = 1.18-6.00, p = .018), not having good perceived relationships with friends (AOR = 2.10; 95% CI = 1.24-3.56, p = .006) and depression (AOR = 10.22; 95% CI = 6.01-17.38, p < .001).

CONCLUSIONS

Depression and anxiety were prevalent among school going adolescents in Bangladesh. The findings suggest epidemiological data can direct policy-level decisions regarding evaluation, prevention, and intervention of mental health conditions among school going adolescents in Bangladesh.

Depressive Symptoms Among Children and Adolescents in China: A Systematic Review and Meta-Analysis

Background

Depressive symptoms are a pervasive mental health problem in Chinese adolescents. The aim of this article was to systematically assess the trend of depressive symptoms in China among adolescents (1988 to 2018).

Material/Methods

A systematic and comprehensive literature search was conducted in both English and Chinese databases, including PubMed, EMBASE, Cochrane CENTRAL, CNKI, and Wan Fang Database, to identify relevant studies published between 1988 and 2018. Batteries of analyses in this meta-analysis were undertaken using Stata version 12.0 statistical software.

Results

Sixty-two related reports involving 232 586 participants finally met our inclusion and exclusion criteria. The results suggest the prevalence of depressive symptoms has generally increased over time. The prevalence estimates before 2000 were 18.4% (95% CI, 14.5–22.3%), and were 26.3% (95% CI, 21.9–30.8%) after 2016. The pooled prevalence of depressive symptoms among children and adolescents was 22.2% (95% CI: 19.9–24.6%, I²=99.6%, p<0.001). More subgroup analyses classified by screening instrument, gender, and region were carried out in this meta-analysis.

Conclusions

Results of our meta-analysis suggest that depressive symptoms have become more prevalent among Chinese adolescents. This trend emphasizes the need for effective prevention strategies and greater availability of screening tools for this vulnerable population.

Associations of childhood maltreatment with subsequent illicit drug use among Chinese adolescents: The moderating role of the child's sex

Adolescence is a critical period for the onset of illicit drug use. This study aimed to estimate the prevalence of illicit drug use among Chinese adolescents, to assess the associations between different forms of childhood maltreatment and subsequent illicit drug use and to test whether the child's sex plays a moderating role in the associations. A secondary analysis was made of cross-sectional data collected from 10th to 12th graders from China who were sampled in the 2015 School-based Chinese Adolescents Health Survey. A total of 59,518 questionnaires were included in the final analysis. The prevalence estimates and logistic regression analyses were weighted to account for the complex survey design. If the interaction term (between childhood maltreatment and sex) was significantly associated with illicit drug use, we would perform stratification analyses across sex. Of the total sample, 45.2% were boys, and the mean (SD) age was 17.0 (0.9) years. The results of stratification analyses demonstrated that among boys, physical abuse and sexual abuse were independently associated with an increased risk of use during their lifetime of MDMA, methamphetamine, ketamine, and mephedrone; among girls, only emotional abuse and sexual abuse were associated with MDMA use, methamphetamine use, ketamine use, and mephedrone use.

Associations between History of Hospitalization for Violence Victimization and Substance-Use Patterns among Adolescents: A 2017 Korean National Representative Survey

Violence victimization can adversely affect adolescents' long-term health. Existing research has mainly focused on the link between victimization and substance use; however, the evidence obtained to date has been inconsistent. This study, using a Korean national representative sample, examined the association between violence victimization and substance-use patterns (including tobacco, alcohol, and drug use) in terms of sex and number of violence victimization experiences. We analyzed secondary data from the 2017 Korean Youth Risk Behavior Web-based Survey. Chi-squared test analyses and logistic regression analysis were used to examine substance use in terms of violence victimization; additionally, p-values for trends were calculated to reveal the dose-response relationship per number of violence victimization experiences. We consequently found that participants' rates of tobacco, alcohol, and drug use were higher among those who experienced violence victimization than among those who did not. For each substance-use-related variable, the greater the violence victimization experience, the higher the odds of substance use (p for trend < 0.001). Early intervention may help prevent the development of substance use, especially among adolescents who have experienced violence victimization. Prevention efforts regarding substance abuse and violence prevention should be included in school curricula to effectively prevent adverse health consequences among adolescents.

Associations of Childhood Maltreatment with Single and Multiple Suicide Attempts among Older Chinese Adolescents

OBJECTIVES

To test, among older Chinese adolescents, the associations of childhood maltreatment with single and multiple suicide attempts and whether these associations vary in relation to the presence of sleep disturbance.

STUDY DESIGN

We analyzed data collected from 10th to 12th graders from 7 randomly selected provinces of China in the 2015 School-based Chinese Adolescents Health Survey. There were 83 200 students who were invited to participate, and 75 715 students' questionnaires were completed and qualified for the survey. Adjusted multinomial logistic regression models were conducted to evaluate the associations of childhood maltreatment with suicide attempts.

RESULTS

Compared with no suicide attempts, each type of adjusted childhood maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect, or emotional neglect) was associated with an increased risk of single and multiple suicide attempts (P < .05). The magnitude of the aORs in multiple suicide attempters was greater than those in single suicide attempters. Moreover, the adjusted interaction effects for a single suicide attempt between each type of childhood maltreatment and sleep disturbance were all statistically significant in the multivariable multinomial logistic regression models (P < .001). However, the adjusted interaction effects for multiple suicide attempts were not significant (P > .05).

CONCLUSIONS

Maltreatment during one's childhood is associated with an increased risk of single and multiple suicide attempts among older Chinese adolescents. Sleep disturbances play a moderating role in these associations for a single suicide attempt.

The mediating effects of depressive symptoms on the association of childhood maltreatment with non-medical use of prescription drugs

BACKGROUND

Childhood maltreatment might increase the risk of subsequent drug use behavior, and depressive symptoms have been reported to be associated both childhood maltreatment and non-medical use of prescription drugs (NMUPD). This large-scale study aimed to test the mediating effects of depressive symptoms on the association of childhood maltreatment with NMUPD among Chinese adolescents.

METHODS

A secondary analysis of the cross-sectional data collected from 7th to 12th graders who were sampled using a multistage, stratified cluster, random sampling method in the 2015 School-based Chinese Adolescents Health Survey. There were 24,457 students who were invited to participate and 23,039 students' questionnaires were completed and qualified for our survey (response rate: 94.2%).

RESULTS

In the adjusted models without mediation, the results showed that students who reported that they had experienced emotional abuse were at a higher risk of past year use and past month use of opioids (past year: Adjusted OR [AOR] = 1.07, 95% CI = 1.05-1.10; past month: AOR = 1.08, 95% CI = 1.06-1.10) and sedatives (past year: AOR = 1.06, 95% CI = 1.03-1.08; past month: AOR = 1.15, 95% CI = 1.13-1.16). The results of mediation analyses demonstrated that there were significant standardized indirect effects of emotional abuse on opioids use and sedatives use through depressive symptoms, respectively (P < 0.001).

LIMITATIONS

Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design.

CONCLUSIONS

Depressive symptoms play a significant mediator role on the association of childhood maltreatment with NMUPD. Interventions targeted at adolescents who are involved in NMUPD should pay attention to their histories of childhood maltreatment.

Risk Factors for Depression in Patients with Chronic Obstructive Pulmonary Disease

Background

Depression is a major comorbidity in patients with chronic obstructive pulmonary disease (COPD). The aim of this prospective study was to investigate socio-demographic and clinical factors and serum markers of inflammation, including cytokines that, may be a cause or an association with COPD-related depression.

Material/Methods

This study enrolled 53 patients who were hospitalized in the Department of Respiratory Medicine of Hefei First People’s Hospital, China between October 2015 and October 2016. Patients were consecutively recruited who were diagnosed with COPD and without lower respiratory tract disease, psychiatric disorders, or a family history of cognitive disorders. All patients were investigated for symptoms of depression. Lung function testing included forced expiratory volume in 1 second (FEV₁). Serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) were measured.

Results

Of the 53 patients with COPD, 40 (75.47%) patients had symptoms of depression. Univariate analysis showed that gender, smoking, a high level of education, duration of a cough, FEV₁, and serum CRP level were associated with depression. A multivariate logistic regression model identified two risk factors for depression in patients with COPD: serum CRP level and FEV₁.

Conclusions

The findings of this study showed that the risk factors for COPD-related depression included male gender, heavy smoking, higher academic qualifications, and duration of cough, but the two strongest risk factors were a high serum CRP level and low FEV₁.

School-related factors affecting smoking intention among Korean middle school students

INTRODUCTION

This study examined school-related factors affecting smoking intention among Korean middle school students who were current non-smokers.

METHODS

We used a descriptive, cross-sectional design based on the model explaining smoking initiation among Asian adolescents, to analyze data from 561 adolescents aged 14-16years in middle school.

RESULTS

School-related cognitive and psychological engagement and close friends' smoking were significantly associated with smoking intention after controlling for covariates, such as personal and familial factors. Of the familial factors, mothers' previous or current smoking status were significantly associated with smoking intention. In addition, for personal factors, smoking experience was associated with smoking intention. The explanatory power of these variables in the predictive model was 36.0%.

CONCLUSION

Health care providers in schools and communities should develop smoking prevention strategies reflecting school-related factors associated with smoking intention such as improving school engagement and providing healthy alternative methods for social interaction with peers rather than smoking.

School Bullying in Urban China: Prevalence and Correlation with School Climate

School violence and bullying in China is under investigated, though it has become a national concern recently. Using updated national representative survey data collected in 2016 from seven provinces across China, covering students from all pre-college school types (primary, middle, high and vocational schools), this paper analyzes the prevalence of school bullying and the correlation with several school attributes. The incidences of reported bullying, bullying others and witnessing bullying are 26.10%, 9.03% and 28.90%, respectively. Primary school students are more likely to be involved in bullying behaviors. Students from elite schools (leading schools) are also more likely to be involved. Relation with teachers, relation with peers and perceived academic achievement are protective factors. Being a boy is the only significant predictor of school bullying among the family and demographic characteristics used. The results highlight the importance of school climate on preventing school violence and bullying, and a whole-school intervention approach is needed for future intervention.

Associations between childhood maltreatment and non-medical use of prescription drugs among Chinese adolescents

AIMS

To test, among Chinese adolescents: (1) whether childhood maltreatment is associated with non-medical use of prescription drugs (NMUPD) and (2) whether there are interaction effects of childhood maltreatment and depressive symptoms on NMUPD.

DESIGN

A secondary analysis of the cross-sectional data collected from 7th- and 12th-graders who were sampled using a multi-stage, stratified-cluster, random-sampling method in the 2015 School-based Chinese Adolescents Health Survey (SCAHS).

SETTING

Surveys conducted in high schools in six cities of China in 2015.

PARTICIPANTS

There were 24 457 students who were invited to participate and 23 039 students' questionnaires were completed and qualified for our survey.

MEASUREMENTS

The outcomes comprised self-report of NMUPD (prior 30 days); a history of childhood maltreatment was our main predictor. Other covariates included depressive symptoms, smoking, drinking and demographics. Data were analysed using multi-level regression modelling.

FINDINGS

Our final multivariable logistic regression models demonstrated that after adjusting for other variables, physical abuse was associated positively with non-medical use of opioids [adjusted odds ratio (AOR) = 1.13, 95% confidence interval (CI) = 1.10-1.22], sedatives (AOR = 1.11, 95% CI = 1.10-1.21) and any prescription drugs (AOR = 1.13, 95% CI = 1.09-1.20); emotional abuse, sexual abuse and emotional neglect were also associated with an increased risk of opioids, sedatives and any prescription drugs misuse; students who reported that they had experienced childhood physical neglect were more likely to be involved in the non-medical use of sedatives (AOR = 1.08, 95% CI = 1.04-1.12) and any prescription drugs (AOR = 1.06, 95% CI = 1.03-1.10). Additionally, there was no evidence of interaction effects on NMUPD between depressive symptoms and each of physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect, respectively.

CONCLUSIONS

Maltreatment while a child is associated with an increased risk of non-medical use of prescription drugs (NMUPD) among Chinese adolescents. The interactions of maltreatment while a child and depressive symptoms do not appear to be associated significantly with NMUPD among Chinese adolescents.

Association between sleep duration, suicidal ideation, and suicidal attempts among Chinese adolescents: The moderating role of depressive symptoms

BACKGROUND

Suicidal ideation and attempts are still currently serious problems among adolescents worldwide, and there is evidence that sleep problem may be associated with increased rates of mental disorder. This study aimed to examine the associations between sleep duration and suicidal ideation and attempts among adolescents and to test whether depressive symptoms have moderating effects on the associations.

METHODS

A 3-stage, stratified cluster, random sampling method was used to collect data from 20,130 high school students in southeast China.

RESULTS

The weighted prevalence of short sleep among Chinese adolescents was 5.6% (95% CI, 5.3-6.0%), and the weighted prevalence of long sleep was 2.7% (95% CI, 2.5-3.0%). The final results demonstrated that short sleep was positively associated with suicidal ideation (AOR=2.28, 95% CI=1.96-2.66) and suicidal attempts (AOR=3.20, 95% CI=2.46-4.16), and long sleep was only significantly associated with suicidal attempts (AOR=2.47, 95% CI=1.70-3.58). Stratification analyses conducted separately for students with and without depressive symptoms demonstrated that depressive symptoms may have moderating effects on the associations between sleep duration and suicidality.

LIMITATIONS

Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design.

CONCLUSIONS

Sleep duration was associated with suicidal ideation and attempts, and the association between sleep duration and suicidal attempts was U-shaped. These findings support that proper treatments services with the potential to restore adolescent normal sleep would be helpful in preventing suicidality among adolescents.

Psychosocial Factors Associated With Smoking Intention in Korean Male Middle School Students

This study examined psychosocial factors influencing smoking intention in Korean male middle school students. We used a descriptive cross-sectional design, based on the biopsychosocial model, to analyze data from 309 male adolescents aged 14–16 years in middle school. Of the psychological factors examined, stress and risk-taking tendency were significantly associated with smoking intention. Of the social factors examined, social normative beliefs, close friends’ and siblings’ smoking, and low socioeconomic status were significant factors in smoking intention. The explanatory power of these variables in the predictive model was 23.1%. In conclusion, the unique psychological and social characteristics of adolescents should be reflected in interventions for smoking prevention.