Prevalence of depression among Chinese university students: a systematic review and meta-analysis

The Mediating Role of Interoceptive Sensitivity in the Relationship between Physical Activity and Depression Symptoms in College Students

A substantial body of evidence indicates that neurological, psychological, and behavioral health issues are profoundly linked to interoceptive sensitivity. The present study aimed to identify the effects of interoceptive sensitivity on the relationship between physical activity and symptoms of depression in Chinese college students. This study employed a cross-sectional design using convenience sampling. An online self-reported survey was distributed to college students in China. The participants' interoceptive sensitivity, physical activity levels, and depressive symptoms were measured using the MAIA-2, IPAQ-SF, and PHQ-9, respectively. The mediating effect was tested via regression analysis and a parallel mediation model, with bootstrap confidence intervals for indirect effects. The results showed a significant negative correlation between physical activity and depression. A significant positive correlation was observed between physical activity and seven dimensions of interoceptive sensitivity. Conversely, interoceptive sensitivity exhibited a negative correlation with depression. The bootstrap mediation analysis showed that the "not distracting" and "trusting" dimensions of interoceptive sensitivity had significant indirect effects on the relationship between physical activity and depression, suggesting that physical activity might reduce depressive symptoms via these two interoceptive sensitivity dimensions. The findings suggest that interoceptive sensitivity should be integrated into therapeutic interventions, such as physical activity interventions, in the treatment of mental illnesses, particularly depression. Increasing physical activity levels, with a specific focus on enhancing interoceptive modulation, appears to be a promising approach for addressing depression in college students.

Enhancing psychological well-being in college students: the mediating role of perceived social support and resilience in coping styles

BACKGROUND

The prevalence of depression among college students is higher than that of the general population. Although a growing body of research suggests that depression in college students and their potential risk factors, few studies have focused on the correlation between depression and risk factors. This study aims to explore the mediating role of perceived social support and resilience in the relationship between trait coping styles and depression among college students.

METHODS

A total of 1262 college students completed questionnaires including the Trait Coping Styles Questionnaire (TCSQ), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Social Support Scale (PSSS), and the Resilience Scale-14 (RS-14). Common method bias tests and spearman were conducted, then regressions and bootstrap tests were used to examine the mediating effects.

RESULTS

In college students, there was a negative correlation between perceived control PC and depression, with a significant direct predictive effect on depression (β = -0.067, P < 0.01); in contrast, negative control NC showed the opposite relationship (β = 0.057, P < 0.01). PC significantly positively predicted perceived social support (β = 0.575, P < 0.01) and psychological resilience (β = 1.363, P < 0.01); conversely, NC exerted a significant negative impact. Perceived social support could positively predict psychological resilience (β = 0.303, P < 0.01), and both factors had a significant negative predictive effect on depression. Additionally, Perceived social support and resilience played a significant mediating role in the relationship between trait coping styles and depression among college students, with three mediating paths: PC/NC → perceived social support → depression among college students (-0.049/0.033), PC/NC→ resilience → depression among college students (-0.122/-0.021), and PC/NC → perceived social support → resilience → depression among college students (-0.016/0.026).

CONCLUSION

The results indicate that trait coping styles among college students not only directly predict lower depression but also indirectly influence them through perceived social support and resilience. This suggests that guiding students to confront and solve problems can alleviate their depression.

College students with depression symptom are more sensitive to task difficulty in reinforcement learning

BACKGROUND

Depression is usually characterized by impairments in reward function, and shows altered motivation to reward in reinforcement learning. This study further explored whether task difficulty affects reinforcement learning in college students with and without depression symptom.

METHODS

The depression symptom group (20) and the no depression symptom group (26) completed a probabilistic reward learning task with low, medium, and high difficulty levels, in which task the response bias to reward and the discriminability of reward were analyzed. Additionally, electrophysiological responses to reward and loss feedback were recorded and analyzed while they performed a simple gambling task.

RESULTS

The depression symptom group showed more response bias to reward than the no depression symptom group when the task was easy and then exhibited more quickly decrease in response bias to reward as task difficulty increased. The no depression symptom group showed a decrease in response bias only in the high-difficulty condition. Further regression analyses showed that, the Feedback-related negativity (FRN) and theta oscillation could predict response bias change in the low-difficulty condition, the FRN and oscillations of theta and delta could predict response bias change in the medium and high-difficulty conditions.

LIMITATIONS

The electrophysiological responses to loss and reward were not recorded in the same task as the reinforcement learning behaviors.

CONCLUSIONS

College students with depression symptom are more sensitive to task difficulty during reinforcement learning. The FRN, and oscillations of theta and delta could predict reward leaning behavior.

The Interpersonal Psychological Theory of Suicide in Italian University Students: Validation of the INQ-15 and the ACSS-FAD

In the frame of the interpersonal psychological theory of suicide (IPTS), Interpersonal Needs Questionnaire (INQ-15) assesses thwarted belongingness (TB) and perceived burdensomeness (PB), related to suicidal ideation (SI); Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD) measures this component which contributes to lethal self-harm. The objective was to evaluate the psychometric properties of INQ-15 and ACSS-FAD in a population of Italian university students. Since the Italian INQ-15 was already validated, we translated ACSS-FAD through a multistage procedure and administered both to 1,665 Italian university students. Factor analysis confirmed a two-factor-related model of INQ-15, one factor of ACSS-FAD, and good reliability for both. We proved the association between INQ-15 and current SI and between ACSS-FAD and lifetime suicidal planning and/or suicide attempt. The convergent and discriminant validities were in line with those of previous studies. Both tools are valid and reliable to assess the constructs associated with suicide outcomes according to IPTS.

Prevalence and Associations of Depression among Saudi College Nursing Students: A Cross-Sectional Study

Depression affects approximately 350 million individuals globally and is the leading cause of disability. Depression among nursing students is an ongoing issue, yet little is known about the relationship between depression and its risk factors among nursing students in Saudi Arabia. The purpose of this study was to determine the prevalence of depression among a cohort of Saudi nursing students and to explore the risk factors associated with depression in this group. A cross-sectional design was employed for this study, which was conducted by the nursing faculty at King Saud University in Riyadh, Saudi Arabia. The researcher sampled 330 nursing students, with 252 students (a 76.3% response rate) randomly selected by the academic advising unit in the nursing college between January and February 2023. The participants completed an online survey based on the Arabic version of the Center for Epidemiologic Studies Depression Scale. The data were analyzed using univariate analysis and backward multi-variable logistic regression. The findings revealed that 65.1% of the participants scored 16 or above on the depression scale, indicating high levels of depressive symptoms. Univariate analysis identified several significant risk factors for depression, including sex (OR, 0.29; 95% CI, 0.16-0.51; p < 0.001), academic pressure (OR, 5.87; 95% CI, 2.04-16.84; p < 0.001), interpersonal relationships (evaluated by balance and harmony in thoughts, emotions, behavior, and interactions with others; categorized as good/fair or poor), and the relationship with the father, which were strongly associated with the presence of depression symptoms. Backward multi-variable logistic regression analysis further revealed that being male, experiencing reduced academic pressure, having stronger father-son relationships, and maintaining positive interpersonal relationships were significantly associated with decreased levels of depression (ORs ranged from 0.25 to 3.94). These findings highlight the need for family and school-based prevention interventions to help nursing students in college avoid depression.

Effects of physical activity on depression, anxiety, and stress in college students: the chain-based mediating role of psychological resilience and coping styles

Background

Physical activity can alleviate negative emotions in college students by enhancing mood and cognitive functions. Yet, the mechanisms underlying these benefits remain unclear.

Purpose

This study examines the association between physical activity and negative emotions-specifically, depression, anxiety, and stress-in college students. Additionally, we explore the mediating effects of psychological resilience and coping styles to offer theoretical and practical insights for mitigating students' negative emotions.

Methods

Using a stratified random sampling approach, a total of 1,380 college students, from five universities in Hangzhou, Nanjing, and Wenzhou, were included in the analysis. The survey instruments included the Physical Activity Rating Scale, Connor-Davidson Resilience Scale, Simple Coping Style Scale, and Depression-Anxiety Stress Scale. The data were statistically analyzed using multivariate methods with IBM SPSS 25.0 and the PROCESS V3.3 plug-in.

Results

(1) College students engage in a low level of physical activity, with male students participating significantly more than female students (p < 0.001). (2) Physical activity was significantly positively correlated with psychological resilience and positive coping styles (t = 9.126, p < 0.001; t = 23.087, p < 0.001) and overall negative correlated with negative emotions in college students (t = -3.601, p < 0.001). (3) Psychological resilience and positive coping styles were found to play a chain mediating role between physical activity and negative emotions. The mediation effect consists of two paths: physical activity → psychological resilience → negative emotions (effect value: -0.0324), and physical activity → psychological resilience → positive coping → negative emotions (effect value: -0.0099). (4) Female students demonstrated higher levels of positive coping (p < 0.001), while male students exhibited more negative emotions (p < 0.001).

Conclusion

Our study identifies a significant indirect link, mediated by psychological resilience and positive coping styles, between physical activity and the reduction of negative emotions. Targeted interventions addressing gender differences, such as offering special courses and providing specialized exercise programs and emotional management strategies, can enhance psychological resilience and positive coping mechanisms. Consequently, these measures can alleviate the adverse effects of negative emotions. Our findings have broader implications for both research and practical interventions in promoting mental health among college students.

Chinese university students' help-seeking behaviors when faced with mental health challenges

BACKGROUND

Mental illnesses and mental health challenges have become increasingly pervasive among Chinese university students. However, the utilization rate of mental health services is low among students.

AIMS

We aimed to explore Chinese university students' help-seeking behaviors to understand how they deal with mental health challenges and use the results to inform the development of effective mental health promotion initiatives.

METHODS

In this study, we conducted 13 focus group interviews with students in six universities in Jinan, China, including 91 (62%) female students and 56 (38%) male students. We drew on the Theory of Planned Behaviors to guide our thematic analysis to gain a contextual understanding of participants' accounts on help-seeking.

RESULTS

Our results have depicted the help-seeking patterns of Chinese university students and show that there are four major behaviors which are self-reliance, seeking support from peers and families, seeking professional support, and accessing virtual mental health care.

CONCLUSION

Results from this study can be used to inform the development of mental health literacy programming for students in universities that share similar contexts, and the study has also opened up a new space for using qualitative approaches to study mental health needs and access to care in diverse populations.

The relationship between childhood psychological abuse and depression in college students: a moderated mediation model

BACKGROUND

Childhood psychological abuse (CPA) are highly correlated with depression among college students, but the underlying mechanisms between variables need further exploration. This study aims to investigate internet addiction as a mediating factor and alexithymia as a moderating factor, in order to further elucidate the potential risk factors between CPA and depression among college students.

METHODS

A self-report survey was conducted among 1196 college students from four universities in three provinces in China. The survey included measures of CPA, internet addiction, alexithymia, and depression. Descriptive and correlational analyses were performed on these variables, and a moderated mediation model was constructed.

RESULTS

CPA was positively correlated with depression among college students, as well as internet addiction with alexithymia. Internet addiction partially mediated the relationship between CPA and depression among college students, while alexithymia strengthened the relationships among the paths in the moderated mediation model.

CONCLUSION

This study provides further insights into the psychological mechanisms underlying the relationship between CPA and depression among college students. Internet addiction serves as a mediating factor in this relationship, while alexithymia may enhance the strength of the relationships among the three variables.

Depression, Anxiety and Poor Sleep Quality are Associated with Chronotype and Financial Wellness in University Students

Background: Evidence suggests the importance of a person's chronotype in predicting various aspects of an individual's physical and mental health. While the effect of depression on sleep is well established, the impact of a person's specific sleep timing and chronotype on the prevalence of both depression and anxiety has yet to be fully understood, especially among university students, vulnerable to mental health problems. In addition, other factors also seem to influence the occurrence of depression and anxiety among students as well as their quality of sleep, one of which being the students' financial wellness. The objective was to evaluate the association between chronotype and the severity and prevalence of depression among Lebanese university students, while also taking into account the possible connection between chronotype and financial wellness and both anxiety and sleep quality. Methods: This cross-sectional study was conducted between December 2021 and February 2022; 330 Lebanese university students was included (mean age 21.75 ± 2.43; 67.3% females). Results: The majority of the Lebanese university students in our sample were found to have an intermediate typology (63.0%), followed by the evening typology, which appeared to constitute 28.2% of the sample, while only 8.8% possessed a morning typology. In this study, having an intermediate or evening typology compared to a morning one was significantly associated with higher depression and worse sleep quality. In addition, having an evening chronotype compared to a morningness propensity was significantly associated with more anxiety. Conclusion: This study found a positive association between an evening typology (chronotype) and higher depression and anxiety and poorer quality of sleep. Although preliminary and based on cross-sectional data, this research could help provide a better understanding of the different chronotypes among university students, and of the possible increased susceptibility of some of these typologies (i.e., evening-type) to mental health problems.

Associations of chronotype with anxiety, depression and insomnia among general adult population: A cross-sectional study in Hubei, China

BACKGROUND

The relationship between chronotype and anxiety, depression, and insomnia was inconsistent. We aimed to assess the association between chronotype and mental health and the potential moderating effect of age and socioeconomic status (SES).

METHODS

A multi-stage sampling cross-sectional study with 12,544 adults was conducted. Chronotype, anxiety, depression, and insomnia were investigated by 5-item Morning and Evening, 7-item Generalized Anxiety Disorder, 9-item Patient Health, and the 7-item Insomnia Severity Index Questionnaires. Logistic regression was conducted.

RESULTS

The predominant chronotype was morning chronotype (69.2 %), followed by 27.6 % intermediate and 3.2 % evening chronotype. The prevalence of anxiety, depression, and insomnia was 0.7 %, 1.9 %, and 9.6 %, respectively. Compared with intermediate chronotype, morning chronotype participants had a lower risk of anxiety (OR = 0.28,95%CI:0.18-0.44), depression (OR = 0.54,95%CI:0.41-0.72) and insomnia (OR = 0.67,95%CI:0.58-0.77), while evening chronotype participants had a higher risk of depression (OR = 1.98,95%CI:1.06-3.71) but not anxiety or insomnia. Interactions between chronotype with age and SES on insomnia (Pinteraction < 0.05) were found. A more profound association between morning chronotype and insomnia was observed in <65 years participants (OR = 0.59,95%CI:0.50-0.71) and those with monthly household income ≥10,000yuan (OR = 0.21,95%CI:0.12-0.35), compared with their counterparts.

LIMITATIONS

The cross-sectional design limited causal conclusions. Only adults were included; the findings could not be generalized to children.

CONCLUSIONS

The morning chronotype might be protective for anxiety, depression, and insomnia, while the evening chronotype might be a risk factor for depression. Future studies are needed to assess the efficacy of chronotype-focused intervention for mental health. Insomnia prevention efforts should pay more attention to the elderly and those with lower incomes.

Childhood Trauma and Depressive Level Among Chinese College Students in Guangzhou: The Roles of Rumination and Perceived Stress

OBJECTIVE

Although previous studies have validated the effect of childhood trauma on depressive level, few studies have utilized the diathesis-stress theory to investigate the specific roles of perceived stress and rumination in the pathway between childhood trauma and depression in Chinese college students. This study aims to demonstrate the mediation effect of perceived stress and the moderation effect of rumination in the pathway between childhood trauma and depressive level in Chinese college students.

METHODS

A total of 995 Chinese college students in Guangzhou were included in this study by recruitment advertisement from October to December 2021. And they were asked to finish four self-report questionnaires, including Childhood Trauma Questionnaire-Short Form, Perceived Stress Scale, the 22-item Ruminative Response Scale, and Beck Depression Scale-II. Then the data were analyzed with Mplus 8.3.

RESULTS

Results revealed significant correlations among childhood trauma, perceived stress, rumination and depressive level. Further analyses revealed that perceived stress played a mediation role between childhood trauma and depressive level (estimate=0.09, standard error [SE]=0.02, t=5.93, 95% confidence interval [CI]=0.06-0.12), and rumination played a moderation role between childhood trauma and perceived stress (estimate=-0.17, SE=0.06, t=-2.86, 95% CI=-0.28- -0.05]) as well as between childhood trauma and depressive level (estimate=0.10, SE=0.04, t=2.74, 95% CI=0.03-0.16).

CONCLUSION

These results revealed the mediation effect of perceived stress and the moderation effect of rumination in the pathway between childhood trauma and depressive level in Chinese college students, which helped us to understand how the childhood trauma influenced the depressive level and gave us multi-dimensional indications for reducing the effect of childhood trauma on depressive level.

Assessing mental health among students in the UAE: A cross-sectional study utilizing the DASS-21 scale

Background

The escalating worldwide concerns for mental health, significantly amplified by the COVID-19 pandemic, necessitates understanding the impact on vulnerable populations, such as university students. This study aims to investigate the prevalence and implications of depression, anxiety, and stress among university students in the United Arab Emirates (UAE) using the Depression, Anxiety, and Stress Scale-21 Items (DASS-21).

Methods

This study utilized convenience sampling to investigate the mental health of undergraduates in UAE universities using a bilingual DASS-21 questionnaire via Google Forms. Analysis was conducted using SPSS version 29.0, employing descriptive statistics, Chi-squared tests, Mann-Whitney tests, Kruskal-Wallis tests, and Multinomial Logistic Regression to analyze relationships between sociodemographic variables and mental health scores.

Results

The study examined 332 students, with most female participants (81 %, n = 269) and individuals aged 18-20 (89.8 %, n = 298). It revealed higher mean DASS scores among females: Depression (M = 15.80, p = 0.030), Anxiety (M = 17.63, p < 0.001), and Stress (M = 22.61, p < 0.001). Fourth-year students exhibited the highest DASS scores for depression (M = 30.33, p = 0.002), anxiety (M = 21.33, p = 0.002), and stress (M = 27.00, p = 0.005). Younger participants aged 18-20 had an odds ratio (OR) of 4.925 for depression, indicating they were approximately five times more likely to experience depression.

Conclusions

This study reveals gender, age, and academic-year variations in depression, anxiety, and stress among UAE university students. Specifically, our findings indicate higher levels of anxiety and stress among females and reveal academic-year and age-related patterns in mental health conditions. University support services in the UAE should better address student needs, including counseling focused on high school to university transition challenges.

Understanding university students' attitudes and preferences for internet-based mental health interventions

Internet-based interventions are recognised as a practical approach to address mental health issues. The acceptance and utilisation of such interventions are closely linked to user attitudes and preferences. This study aims to examine the predictors of university students' attitudes towards internet-based interventions. Additionally, it seeks to elucidate students' preferences regarding crucial features of these interventions, such as the format, delivery mode, content type, and structural components, to understand better what makes these interventions appealing and practical for university students. A total of 273 university students (comprising 68 % females and 32 % males) participated in the study. The data collection instruments employed were the Personal Information Form, Internet-Based Intervention Preference Survey, E-therapy Attitude Measure (ETAM), Digital Literacy Scale, Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 (GAD-7). The data were analysed utilising descriptive statistics, Pearson correlation analysis, and multiple linear regression analysis. The multiple regression analysis revealed digital literacy as a predictive factor for attitudes towards internet-based interventions. Demographic variables, such as age and gender, and psychological variables, such as depression and anxiety levels, were found not to be associated with attitudes towards these interventions. While students are actively seeking mental health information online, a significant majority remain unaware of internet-based interventions. They show a preference for interventions offering greater human interaction, including face-to-face guidance and video content featuring people. Participants favour completing one or two sessions of the intervention weekly. Desired features of internet-based interventions include self-assessment scales, relatable characters, voice relaxation exercises, practical daily life activity tasks, and weekly reminders throughout the process. In conclusion, initiatives aimed at enhancing digital literacy levels could foster more positive attitudes towards internet-based interventions among students. Developers creating Internet-Based Interventions (IBI) for university students should consider these preferences.

A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial

Common mental disorders among young people are rising globally. Current university-based interventions are inadequate to address the need for evidence-based interventions. We investigated the effectiveness and implementation of Step-by-Step (SbS), a WHO digital intervention to address depression, among Chinese university students with depressive symptoms. In this paper, we report a type 1 hybrid effectiveness-implementation randomized controlled trial conducted between September 2021 and September 2022. The control condition was enhanced treatment as usual (ETAU, psychoeducation). The primary outcome was improvement in depression symptoms. Secondary outcomes were improvements in psychological well-being, anxiety symptoms, and self-identified psychosocial problems. Effectiveness of the intervention was evaluated using generalized linear mixed models. Implementation outcomes were evaluated by thematic analysis of participant interviews. A total of 371 participants were enrolled to two treatment conditions in a 1:1 ratio. SbS resulted in a greater reduction in depressive symptoms at posttreatment (p = 0.004, Hedges' g = 0.35), but no significant difference between SbS and ETAU was observed at three-month follow-up (p = 0.179, Hedges' g = 0.16). The treatment effect was larger among those who adhered to the treatment (Hedges' gs = 0.59 and 0.30). Subjective well-being also improved for SbS at both time points (Hedges' gs = 0.31 and 0.30). In addition, SbS resulted in more improvement in anxiety symptoms at posttreatment (p = 0.029, Hedges' g = 0.26), but not at three-month follow-up (p = 0.265, Hedges' g = 0.13). The qualitative results demonstrated that the intervention was well-implemented as a self-help mental health service, with minimal support from peer supporters. In conclusion, Step-by-Step, a digital intervention developed by WHO, was effective in reducing depressive symptoms in the short term and improving psychological well-being in a longer term. The sustained effect on depression needs further investigation. Improving uptake and engagement in the program is needed for its scale-up implementation as a university-based mental health service for Chinese young adults. Trial registration: ChiCTR2100050214.

Prevalence of depressive tendencies among college students and the influence of attributional styles on depressive tendencies in the post-pandemic era

Introduction

Depression symptoms are prevalent globally, including China, with a notable impact on college students. This study aims to not only estimate the prevalence of depressive tendencies and attributional styles among college students in the post-pandemic era but also explore the relationship between the two factors. The findings of this study can provide new insights into early intervention and support services for individuals exhibiting tendencies toward depression.

Methods

The survey was administered to college students from various academic backgrounds at a specific university in southern Jiangxi Province by employing two scales to investigate depressive tendencies and attributional styles. Depressive tendency was evaluated using the Patient Health Questionnaire-9 (PHQ-9), while the attributional styles were assessed using the Multidimensional-Multiattributional Causality Scale (MMCS). Univariate analysis and multiple logistic regressions were conducted to identify the related factors of depressive tendency.

Results

A relatively high (48.9%) prevalence of depression among college students was found in this study. College students with higher grades (OR = 1.574, 95%CI: 1.369-1.810), profession of medicine and allied health sciences (OR = 1.779, 95%CI: 1.203-2.629), experiencing higher study stress (OR = 2.006, 95%CI: 1.601-2.514), and having poor physical condition (OR = 1.527, 95%CI: 1.247-1.869) were identified as risk factors for depressive tendency. The correlation between higher grades and increased learning pressure, coupled with poorer physical condition, heightens the vulnerability of college students to depression. Moreover, the more they attribute these experiences to achievement effort (OR = 0.897, 95%CI: 0.828-0.972), achievement ability (OR = 0.903, 95%CI: 0.838-0.972), and affiliation context (OR = 0.919, 95%CI: 0.860-0.982), the less likely they are to develop depression.

Conclusion

In the group of college students, especially those in higher grades, profession of medicine and allied health sciences or experiencing high learning pressure and poor physical condition, emphasizing the significance of their mental well-being becomes crucial. Offering suitable support and assistance is essential. Additionally, fostering the cultivation of positive attributional and coping strategies by attributing difficulties to controllable factors and instilling a belief in their ability to overcome challenges can help reduce the risk of depression.

How loneliness linked to anxiety and depression: a network analysis based on Chinese university students

BACKGROUND

There is conclusive evidence of a multifaceted and bidirectional relationship between loneliness and depression and anxiety. Nonetheless, more extensive research is needed to examine their relationships at a more granular level. This study employed a network analysis approach to identify the pathological mechanisms underpinning those relationships and to identify important bridge nodes as potential targets for intervention.

METHODS

941 University students were included in this study. The ULS-6 (the short-form UCLA Loneliness Scale) was used to assess loneliness, the PHQ-9 (Patient Health questionnaire-9) and GAD-7 (Generalized anxiety disorder 7-item) scales were used to assess the symptoms of depression and anxiety. We constructed two network structures of loneliness-anxiety and loneliness-depression and computed bridge expected influence for each symptom. In addition, we showed a flow network of "Suicide" containing symptoms of depression and loneliness.

RESULTS

All edges were positive in both networks constructed and the strongest edges were present within disorder communities. The overall connection between loneliness and depression was stronger compared to anxiety. The results demonstrated that the loneliness item "People are around me but not with me" was identified as bridge symptom in both networks. Furthermore, "Suicide" was directly connected to five symptoms of depression and four items of loneliness, with the strongest connections being between it and "Feeling of worthlessness" and "Psychomotor agitation/retardation".

CONCLUSIONS

Our findings provide a more nuanced explanation of the link between loneliness and depression and anxiety. The results identified the bridge symptom "People are around me but not with me", which had the strongest effect on enhancing symptoms of depression and anxiety. Clinical improvements based on the findings of this study and the impact of the intervention are discussed.

Preparing future general practitioners: the effects of individual, familial, and institutional characteristics

BACKGROUND

There is a substantially increasing need for general practitioners (GPs) for future unpredictable pandemic crises, especially at the community-based health services (CBHS) level to protect the vast and varied grassroot-level population in China. Thus, it is crucial to understand the factors that affect Chinese medical students' GP career choices and commitments to CBHS.

METHODS

Leveraging the self-administered data collected across the country, this study conducted logistic regressions with 3,438 medical students. First, descriptive statistics of outcome variables and independent variables were provided. Then, stepwise logistic regression models were built, starting from adding individual characteristics, and then familial and institutional characteristics. Last, post-estimation was conducted to further assess whether there were significant marginal effects.

RESULTS

Results showed that women students were 24% less likely to choose GP careers but were 1.25 times more likely to commit to CBHS than their men peers, holding other individual, familial, and institutional characteristics constant. In addition, students who major in GP-orientated were more likely to choose GP careers and commit to CBHS, respectively, than those who major in clinical medicine. Furthermore, familial characteristics like annual income and mother's educational level only significantly predicted commitments to CBHS. Notably, sex-related differences in GP career choices and commitments to CBHS - by different regions - were observed.

CONCLUSIONS

Understanding the factors that affect medical students' GP career choices sheds light on how medical education stakeholders can make informed decisions on attracting more medical students to GP-orientated majors, which in turn cultivates more GP professionals to meet the nation's demand for GPs. In addition, by understanding the factors that influence medical students' commitment to CBHS, policymakers could make beneficial policies to increase medical students' motivations to the grassroot-level health institutions, and devote to CBHS as gatekeepers for a large population of residents' health.

How does change in leisure-time physical activity influence the growth trajectory of depressive symptoms in college students?

Objectives: This longitudinal study was designed to examine the growth trajectory of depressive symptoms among early-stage college students and how the development of vigorous, moderate, and light leisure-time physical activity (LTPA) was related to the growth trajectory. Participants: Four hundred and eighty-eight first- and second-year undergraduate students completed measures of depressive symptoms and LTPA at the beginning, middle, and end of a semester. Methods: Latent growth mixture modeling (LGMM) was conducted. Results: On average, students reported mild levels of depressive symptoms with significant variability at the semester start, but the symptoms elevated over time. LGMM identified two trajectories: low/gradual (75.8%) and high/increasing (24.2%). For both groups, neither vigorous nor moderate LTPA development predicted the growth trajectory of depressive symptoms. However, the change of light LTPA was negatively and significantly associated with the growth trajectory. Even when controlling for covariances, increased light LTPA still had a unique effect on buffering depressive symptoms. Conclusion: There is great potential in targeting comprehensive LTPA strategies to improve college students' mental health and promote an active lifestyle.

The associations between academic stress and depression among college students: A moderated chain mediation model of negative affect, sleep quality, and social support

BACKGROUND

Growing competition in tight job market and academic excellence as a social norm in Asian culture have made Chinese college students burdened with immense academic stress.

OBJECTIVES

This study aimed to explore the associations between academic stress and depression, and the mediating roles of negative affect and sleep quality, as well as the moderating role of social support in the relationship between negative affect and sleep quality.

METHODOLOGY

A convenience sample of 221 male and 479 female college students aged between 17 and 25 completed questionnaires on academic stress, depression, negative affect, sleep quality and social support.

RESULTS

Results indicated that academic stress could not only directly affect depression (b = 0.31, p < 001), but also affect depression through the mediation role of negative affect and sleep quality. The chain mediating effects includes three paths, namely, the mediating role of negative affect (indirect effect = 0.21, percentage of total effect = 69.58 %), the mediating role of sleep quality (indirect effect = 0.06, percentage of total effect = 21.03 %), and the chain mediating role of negative affect and sleep quality (indirect effect = 0.06, percentage of total effect = 19.86 %). Social support moderated the adverse influence of negative affect on sleep quality. Social support decreases the impact of negative affect on sleep quality. Specifically, the association between negative affect and sleep quality was stronger for college students with low (bsimple = 0.44, p < 0.001) social support than those with high (bsimple = 0.32, p < 0.001) social support.

IMPLICATIONS

The results advanced our understanding of how academic stress affects college students' depression. These findings provide implications on the cultivation of stress coping strategies, promotion of emotion regulation skills, exaltation of sleep quality, and improvement of the social support level aiming for future depression preventions and interventions. Specific measures include setting up psychological health courses, teaching emotion management strategies, and establishing web-based programme steming from acceptance and commitment therapy. It should be noted that the cross-sectional design means the causal associations among the variables could not be determined.

Prevalence of common mental disorders among medical students in China: a systematic review and meta-analysis

Background

The prevalence of mental distress is common for medical students in China due to factors such as the long duration of schooling, stressful doctor-patient relationship, numerous patient population, and limited medical resources. However, previous studies have failed to provide a comprehensive prevalence of these mental disorders in this population. This meta-analysis aimed to estimate the prevalence of common mental disorders (CMDs), including depression, anxiety, and suicidal behaviors, among medical students in China.

Methods

We conducted a systematic search for empirical studies on the prevalence of depression, anxiety, suicide attempt, suicide ideation, and suicide plan in Chinese medical students published from January 2000 to December 2020. All data were collected pre-COVID-19. The prevalence and heterogeneity estimations were computed by using a random-effects model and univariate meta-regression analyses.

Results

A total of 197 studies conducted in 23 provinces in China were included in the final meta-analysis. The prevalence data of depression, anxiety, suicide attempt, suicide ideation, and suicide plan were extracted from 129, 80, 21, 53, and 14 studies, respectively. The overall pooled crude prevalence for depression was 29% [38,309/132,343; 95% confidence interval (CI): 26%-32%]; anxiety, 18% (19,479/105,397; 95% CI: 15%-20%); suicide ideation, 13% (15,546/119,069; 95% CI: 11%-15%); suicide attempt, 3% (1,730/69,786; 95% CI: 1%-4%); and suicide plan, 4% (1,188/27,025; 95% CI: 3%-6%).

Conclusion

This meta-analysis demonstrated the high prevalence of CMDs among Chinese medical students. Further research is needed to identify targeted strategies to improve the mental health of this population.

Investigation of contemporary college students' mental health status and construction of a risk prediction model

BACKGROUND

Due to academic pressure, social relations, and the change of adapting to independent life, college students are under high levels of pressure. Therefore, it is very important to study the mental health problems of college students. Developing a predictive model that can detect early warning signals of college students' mental health risks can help support early intervention and improve overall well-being.

AIM

To investigate college students' present psychological well-being, identify the contributing factors to its decline, and construct a predictive nomogram model.

METHODS

We analyzed the psychological health status of 40874 university students in selected universities in Hubei Province, China from March 1 to 15, 2022, using online questionnaires and random sampling. Factors influencing their mental health were also analyzed using the logistic regression approach, and R4.2.3 software was employed to develop a nomogram model for risk prediction.

RESULTS

We randomly selected 918 valid data and found that 11.3% of college students had psychological problems. The results of the general data survey showed that the mental health problems of doctoral students were more prominent than those of junior college students, and the mental health of students from rural areas was more likely to be abnormal than that of urban students. In addition, students who had experienced significant life events and divorced parents were more likely to have an abnormal status. The abnormal group exhibited significantly higher Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scores than the healthy group, with these differences being statistically significant (P < 0.05). The nomogram prediction model drawn by multivariate analysis included six predictors: The place of origin, whether they were single children, whether there were significant life events, parents' marital status, regular exercise, intimate friends, and the PHQ-9 score. The training set demonstrated an area under the receiver operating characteristic (ROC) curve (AUC) of 0.972 [95% confidence interval (CI): 0.947-0.997], a specificity of 0.888 and a sensitivity of 0.972. Similarly, the validation set had a ROC AUC of 0.979 (95%CI: 0.955-1.000), with a specificity of 0.942 and a sensitivity of 0.939. The H-L deviation test result was χ2 = 32.476, P = 0.000007, suggesting that the model calibration was good.

CONCLUSION

In this study, nearly 11.3% of contemporary college students had psychological problems, the risk factors include students from rural areas, divorced parents, non-single children, infrequent exercise, and significant life events.

The mediating effects of dysfunctional attitudes and moderating effect of sex between stressful life events and depressive symptoms among Chinese college students

Stressful life events (SLEs) closely correlates with depressive symptoms. Although vulnerability-stress model suggests SLEs interacted with dysfunctional attitudes (DA) to predict depression, the mediation role of DA is poorly understood. Therefore, this study intended to investigate the mediating role of DA and the moderating role of sex between SLEs and self-reported depression. A cross-sectional survey was conducted with a sample of 7769 Chinese college students. Participants were assessed in terms of self-reported SLEs, DA and depression variables. Results showed that there were significant sex differences in both SLE and DA. DA mediated the association between SLE and self-reported depression. The moderated mediation model analysis showed that the interaction of SLEs and sex significantly predicted DA in mediator variable model and self-reported depression in dependent variable model. Results indicated that DA partially mediated the association between SLEs and self-reported depression, and sex moderates the association between SLEs and both DA and self-reported depression, which females have bigger changes of DA and depressive symptoms across low and high levels of SLEs than males.

Association between depression and macrovascular disease: a mini review

Depression and macrovascular diseases are globally recognized as significant disorders that pose a substantial socioeconomic burden because of their associated disability and mortality. In addition, comorbidities between depression and macrovascular diseases have been widely reported in clinical settings. Patients afflicted with coronary artery disease, cerebrovascular disease or peripheral artery disease exhibit an elevated propensity for depressive symptoms. These symptoms, in turn, augment the risk of macrovascular diseases, thereby reflecting a bidirectional relationship. This review examines the physiological and pathological mechanisms behind comorbidity while also examining the intricate connection between depression and macrovascular diseases. The present mechanisms are significantly impacted by atypical activity in the hypothalamic-pituitary-adrenal axis. Elevated levels of cortisol and other hormones may disrupt normal endothelial cell function, resulting in vascular narrowing. At the same time, proinflammatory cytokines like interleukin-1 and C-reactive protein have been shown to disrupt the normal function of neurons and microglia by affecting blood-brain barrier permeability in the brain, exacerbating depressive symptoms. In addition, platelet hyperactivation or aggregation, endothelial dysfunction, and autonomic nervous system dysfunction are important comorbidity mechanisms. Collectively, these mechanisms provide a plausible physiological basis for the interplay between these two diseases. Interdisciplinary collaboration is crucial for future research aiming to reveal the pathogenesis of comorbidity and develop customised prevention and treatment strategies.

Exploring the effects of health behaviors and mental health on students' academic achievement: a cross-sectional study on lebanese university students

BACKGROUND

High academic achievement, an important determinant of future success, is known to be influenced by many factors including dietary behavior, lifestyle and mental health, among others. The objectives of the current study were to explore university students' nutritive habits, daily lifestyle, and mental status, and to scrutinize the associations between these factors and students' academic achievement.

METHODS

A cross-sectional study was conducted among students of a private Lebanese university, using an electronic survey. Diet, eating habits, physical activity, sleep, and smoking were evaluated, and mental health was assessed using a validated Arabic version of the combined Depression, Anxiety, Stress Score (DASS-8). Academic achievement was measured using the Subjective Academic Achievement Scale (SAAS).

RESULTS

A total of 1677 students participated in the questionnaire. The results of a linear regression taking the SAAS score as the dependent variable, showed that students who have a non-scientific versus scientific major (Beta = 0.53), and having breakfast ≥ 4 days per week compared to less than 2 days (Beta = 0.28) were significantly associated with higher SAAS scores. More psychological distress (Beta = - 0.06) and a higher number of days of eating out (Beta = - 0.07) were significantly associated with lower SAAS scores.

CONCLUSIONS

This is the first investigation on a Lebanese university students' academic success in relation to lifestyle and mental profiles. Better academic achievement was demonstrated by students having healthier dietary and lifestyle habits, as well as less distressing mental status. Such results, in light of the compounded and unprecedented crises with which Lebanon has been assailed, suggest the need to focus on promoting healthy habits among students in higher education as a possible driver of better academic success.

Roles of survival situation and personality temperament in the relationship between life stress and depression of higher vocational college students

BACKGROUND

Higher vocational college students face more life stress, which can easily result in depression and hinder their healthy growth. This study aimed to explore the roles of survival situation and personality temperament in the relationship between life stress and depression.

METHODS

A self-compiled "College Students' Life Stress and Mental Health Questionnaire" was used to survey 4800 students in a Chinese higher vocational college. The questionnaire consisted of five subscales: life stressors scale, stress response scale, depression scale, personality temperament types scale, and survival situations scale. The sample included 4705 students, of whom 3449 (73.30%) were males and 1256 (26.70%) were females, with 990 urban students (21.04%), 3715 rural students (78.96%). The age of the participants ranged from 17 to 33 years. The data were analyzed using SPSS v26, PROCESS v3.3, and AMOS v23.

RESULTS

(1) The depression rate of higher vocational students was 18.10% (with a severe depression rate of 1.60%). Life stress could explain 43.80% of depressive episodes (p < 0.01), (2) Among survival situations, the depression degree and rate of students in adversity were the highest (M = 1.56, 24.10%), (3) Among temperament types, the depression degree and rate of melancholic students were the highest (M = 2.13, 36.05%), (4) Survival situation and personality temperament had significant moderating interaction effects on depression caused by life stress (p < 0.01), students in adversity and depressive temperament were more susceptible, (5) Survival situations moderated three paths of the "life stressors-stress response-depression" partial mediation model, and personality temperament types moderated "stress response-depression" path.

CONCLUSION

Prosperity and sanguine temperament are protective factors of depression caused by life stress in higher vocational students. Dilemma, adversity and melancholic temperament are risk factors of depression caused by life stress in higher vocational students.

Gender-based differences in interaction effects between childhood maltreatment and problematic mobile phone use on college students' depression and anxiety symptoms

BACKGROUND

Childhood maltreatment and problematic mobile phone use are risk factors for depression and anxiety symptoms among college students. However, how the interaction between the two factors affects depression and anxiety has yet to be validated. This study aimed to investigate the independent and interaction effects of childhood maltreatment and problematic mobile phone use on depression and anxiety among college students and explored gender-based differences in these associations.

METHOD

A cross-sectional study was conducted from October to December 2019. We collected data from 7623 students at two colleges in Hefei and Anqing cities in Anhui Province, China. Multinomial logistic regression models were performed to explore the associations of childhood maltreatment and problematic mobile phone use with depression and anxiety symptoms and their interaction effects on depression and anxiety symptoms.

RESULTS

Childhood maltreatment and problematic mobile phone use were significantly associated with increased risk of depression and anxiety symptoms (P < 0.001). Moreover, following adjustments for covariates, there was a multiplicative interaction between childhood maltreatment and problematic mobile phone use on depression and anxiety symptoms (P < 0.001). Gender-based differences were also observed in the associations. For instance, depression was more common in males and male students with childhood maltreatment were at higher risk of depression-only symptoms.

CONCLUSION

Focusing on childhood maltreatment and problematic mobile phone use could facilitate a reduction in the occurrence of depression and anxiety symptoms in college students. Furthermore, it is necessary to develop gender-targeted intervention strategies.

Analysis of Psychiatric Symptoms and Suicide Risk Among Younger Adults in China by Gender Identity and Sexual Orientation

Importance

Younger adults in China who are transgender and gender nonconforming (TGNC) and lesbian, gay, and bisexual (LGB) experience high levels of minority stress (eg, stigma and bullying) and adverse mental health symptoms. However, there is a lack of research documenting mental health disparities compared with their cisgender and heterosexual peers. Studies that disaggregate TGNC and LGB individuals and are conducted in nonmetropolitan regions are also needed.

Objectives

To examine whether younger adult students' psychiatric symptoms and suicide risk vary by sexual orientation and gender identity and identify risk factors within LGB younger adults and TGNC younger adults.

Design, Setting, and Participants

This cross-sectional study surveyed students at 63 universities in Jilin Province, China, between October 24 and November 18, 2021. Analyses were completed May 6, 2022.

Exposures

Gender identity (TGNC vs cisgender) and sexual orientation (LGB vs heterosexual).

Main Outcomes and Measures

Psychiatric outcomes included depression, anxiety, traumatic stress, and nonsuicidal self-injury (NSSI), which were measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Trauma Screening Questionnaire, and self-reported NSSI behaviors. The Suicide Behaviors Questionnaire-Revised was used to assess suicide risk.

Results

The analytic sample included 89 342 younger adults (mean [SD] age, 19.60 [1.75] years), including 51 438 assigned female at birth and 37 904 assigned male at birth. The sample included 2352 individuals who were TGNC, 6501 who were cisgender LGB, and 80 489 who were cisgender heterosexual. Compared with their cisgender heterosexual peers, TGNC and LGB younger adults were more likely to experience increased psychiatric symptoms across categories and suicide risk, as well as more severe forms of symptoms. In particular, overall suicide risk was 43.03% among TGNC individuals, 36.21% among LGB individuals, and 11.70% among cisgender heterosexual younger adults. Controlling for demographic variables and compared with cisgender heterosexual peers, TGNC young adults had higher odds of suicide risk (adjusted odds ratio, 5.38; 95% CI, 4.94-5.86; P < .001) and of past-year NSSI (adjusted odds ratio, 6.55; 95% CI, 5.87-7.30; P < .001). Separate within-group analyses for LGB and TGNC younger adults highlighted the vulnerability of bisexual women and gender nonbinary groups, as well as the relevance of minority stress-related risk factors, including peer bullying and assault and loneliness.

Conclusions and Relevance

This study noted disparities of mental health issues among LGB, transgender, or queer or questioning younger adults in China and suggests a high urgency to address psychological health and prevent suicide in this population. Targeted public health initiatives may be needed to reduce stigma and discrimination, train competent health care professionals, and create affirmative mental health policies and systems of care.

Psychological Distress, Depression, and Anxiety in Nursing Students: A Longitudinal Study

The aim of this longitudinal study is to determine how stressful life events, psychological distress, depressive symptoms, and anxiety change in a cohort of students from one nursing faculty during the education process and to document the factors related to psychological distress, depressive symptoms, and anxiety during the fourth year of education. The General Health Questionnaire (GHQ-12), the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI) were applied to students within the faculty of nursing within the first week of the 2018-2019 academic year. All students were asked to answer a questionnaire measuring their possible stressful life events (first timepoint). The process was repeated for the same students again in the fourth year (second timepoint). The changes between the two timepoints were examined. Nursing students' GHQ-12 and STAI scores and averages increased significantly from first timepoint to second timepoint (p < 0.05). There was a significant increase in the prevalence of depressive symptoms for the ≥21 cut-off point of BDI in the fourth year of the study cohort. A significant increase in perceived stress levels between the two timepoints was also found for numerous stressful life events. As a result of linear regression, "dissatisfaction with major" was found as a determinant on all scale scores. The psychological indicators increased significantly in nursing students during their education. Interventions to reduce stress, anxiety, and psychological distress are needed to improve the mental health status of nursing students.

Mechanisms of paeoniaceae action as an antidepressant

Paeoniflorin (PF) has been widely used for the treatment of depression in mice models, some Chinese herbal compound containing PF on treating depression, such as Xiaoyao San, Chaihu-Shugan-San, Danggui Shaoyao San etc. Many experiments are also verifying whether PF in these powders can be used as an effective component in the treatment of depression. Therefore, in this review the antidepressant effect of PF and its mechanism of action are outlined with particular focus on the following aspects: increasing the levels of monoamine neurotransmitters, inhibiting the HPA axis, promoting neuroprotection, enhancing neurogenesis in the hippocampus, and elevating levels of brain-derived neurotrophic factor (BDNF). This review may be helpful for the application of PF in the treatment of depression.

Measuring childhood trauma in young adults with depression: A latent profile analysis

Childhood traumas are important risk factors for depression in young adults. However, the co-occurrence of childhood traumas is complex, and the specific effects of different types of childhood traumas on depression need further exploration. The aim of this study was to assess the co-occurrence of childhood traumas and the impact of different profiles of childhood trauma on depression. A total of 1053 young adults with depression in China participated. PHQ-9, SHAPS, GAD-7, CTQ-SF, and NLES were evaluated. Latent profile analysis (LPA) was conducted to identify profiles of childhood trauma. The effects of different childhood trauma profiles on depression, anxiety, and anhedonia were assessed using stepwise linear regression. LPA suggested three profiles: no or low childhood traumas, moderate childhood trauma with emotional abuse and childhood neglect, and high childhood trauma with high levels of all trauma types. Regression analyses suggested that high levels of emotional abuse and childhood neglect significantly affected anhedonia. Childhood adverse events cluster in young adults with depression, allowing grouping into three distinct profiles. Specific childhood trauma patterns predict anhedonia symptoms in adult depression.

Preference of Virtual Reality Games in Psychological Pressure and Depression Treatment: Discrete Choice Experiment

BACKGROUND

Virtual reality (VR) can be used to build many different scenes aimed at reducing study-related stress. However, only few academic experiments on university students for preference testing have been performed.

OBJECTIVE

This study aims to assess the preference of VR games for stress and depression treatment using a discrete choice experiment (DCE).

METHODS

A total of 5 different attributes were selected based on the depression therapy parameters and attributes related to VR: (1) treatment modality; (2) therapy duration; (3) perceived remission rate; (4) probability of adverse events; and the (5) monthly cost of adding treatment to a discrete choice experiment. By comparing different attributes and levels, we could draw some conclusions about the depression therapy testing preference for university students; 1 university student was responsible for VR scene development and 1 for participant recruitment.

RESULTS

The utility value of different attributes for "0% Probability of adverse events" was higher than others (99.22), and the utility value of VR treatment as the most popular treatment method compared with counseling and medicine treatment was 80.95. Three parameter aspects (different treatments for depression) were statistically significant (P<.001), including "0%" and "50%" of "Probability of adverse events" and "¥500" (a currency exchange rate of ¥1 [Chinese yuan]=US $0.15 is applicable) of "The monthly cost of treatment." Most individuals preferred 12 months as the therapy duration, and the odds ratio of "12 months" was 1.095 (95% CI 0.945-1.270) when compared with the reference level (6 months). Meanwhile, the cheapest price (¥500) of depression therapy was the optimum choice for most students.

CONCLUSIONS

People placed great preference on VR technology psychological intervention methods, which indicates that VR may have a potential market in the treatment of psychological problems. However, adverse events and treatment costs need to be considered. This study can be used to guide policies that are relevant to the development of the application of VR technology in the field of psychological pressure and depression treatment.

Value of imaging examinations in diagnosing lumbar disc herniation: A systematic review and meta-analysis

Purpose

To systematically review the clinical value of three imaging examinations (Magnetic Resonance Imaging, Computed Tomography, and myelography) in the diagnosis of Lumbar Disc Herniation.

Methods

Databases including PubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP were electronically searched to collect relevant studies on three imaging examinations in the diagnosis of Lumbar Disc Herniation from inception to July 1, 2021. Two reviewers using the Quality Assessment of Diagnostic Accuracy Studies-2 tool independently screened the literature, extracted the data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-DiSc 1.4 software and Stata 15.0 software.

Results

A total of 38 studies from 19 articles were included, involving 1,875 patients. The results showed that the pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.89 (95%CI: 0.87-0.91), 0.83 (95%CI: 0.78-0.87), 4.57 (95%CI: 2.95-7.08), 0.14 (95%CI: 0.09-0.22), 39.80 (95%CI: 18.35-86.32), 0.934, and 0.870, respectively, for Magnetic Resonance Imaging. The pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.82 (95%CI: 0.79-0.85), 0.78 (95%CI: 0.73-0.82), 3.54 (95%CI: 2.86-4.39), 0.19 (95%CI: 0.12-0.30), 20.47 (95%CI: 10.31-40.65), 0.835, and 0.792, respectively, for Computed Tomography. The pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.79 (95%CI: 0.75-0.82), 0.75 (95%CI: 0.70-0.80), 2.94 (95%CI: 2.43-3.56), 0.29 (95%CI: 0.21-0.42), 9.59 (95%CI: 7.05-13.04), 0.834, and 0.767 respectively, for myelography.

Conclusion

Three imaging examinations had high diagnostic value. In addition, compared with myelography, Magnetic Resonance Imaging had a higher diagnostic value.

The Relationship Between Psychological Flexibility and Depression, Anxiety and Stress: A Latent Profile Analysis

Purpose

To explore the potential classification of psychological flexibility (PF) among Chinese college students, analyze whether there is group heterogeneity in PF, and discuss the differences in the latent profile of PF in the negative emotions of depression, anxiety, and stress.

Methods

A total of 1769 college students were investigated using the Psychological Flexibility Questionnaire and Depression-Anxiety-Stress Self-rating Scale, and heterogeneity was tested by latent profile analysis.

Results

The PF of college students can be divided into three latent profiles: self-contradiction group (19.2%), high PF group (34.1%), and low PF group (46.7%). The scores of depression, anxiety, and stress are significantly different among the groups.

Conclusion

There is obvious group heterogeneity in the PF of college students, and they can be divided into the self-contradiction group, the high PF group, and the low PF group. The self-contradiction and low PF groups score significantly higher on the negative emotions of depression, anxiety, and stress than the high PF group.

The Big Five Personality Traits as Predictors of Negative Emotional States in University Students in Taiwan

Negative emotional states, such as stress, anxiety, and depression, are prevalent in university students. Personality traits have been shown to be associated with a wide range of behaviors in students, such as academic motivation, achievement, and social well-being. The aim of this study was to investigate the association between the Big Five personality traits and negative emotion states in university students in Taiwan. A cross-sectional study was conducted on 580 university students in Taiwan. Negative emotional states were evaluated using the Depression Anxiety Stress Scale-21 (DASS-21) and the Big Five personality traits were measured using the 48-item Big Five Inventory. A hierarchical linear regression analysis was used to assess the factors associated with DASS-21 scores. Neuroticism (standardized beta [std. β] = 0.45, p < 0.001) and openness (std. β = 0.12, p = 0.003) were significantly associated with DASS-21 scores, while agreeableness (std. β = -0.10, p = 0.007) was significantly and inversely associated with DASS-21 scores. Personality traits could be used to identify students at risk of negative emotional states and to undertake appropriate preventive strategies.

Intolerance of uncertainty and future career anxiety among Chinese undergraduate students during COVID-19 period: Fear of COVID-19 and depression as mediators

Uncertainty is mushrooming throughout COVID-19, and intolerance of uncertainty (IoU) nudges people into mental health difficulties involving fear, depression, and anxiety. The objective of this study was to investigate the role of depression and fear of COVID-19 (FoC) in the association between IoU and future career anxiety (FCA) among Chinese university students during the COVID-19 pandemic. This study involved 1,919 Chinese undergraduate students from 11 universities in eight Chinese cities with an online self-administered survey that included demographic information, IoU, FoC, depression, and FCA completed by all participants. Our study demonstrated a positive relationship between IoU and FCA and the chain mediation effect of FoC and depression. Thus, understanding how FoC affects FCA not only informs university career professionals and assists students in preparing for employment, but also motivates schools to offer career opportunities workshops and, most importantly, provides mental health support to help students effectively cope with uncertainty and overcome COVID-19-related stress.

The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university

PURPOSE

To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP).

DESIGN AND METHODS

A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews.

FINDINGS

A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up.

PRACTICE IMPLICATIONS

This screen model can be used in early detection for undergraduates with HRDP from large general samples.

A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China

BACKGROUND

Among Chinese college students, the burden of depression is considerably high, affecting up to 30 % of the population. Despite this burden, few Chinese students seek mental health treatment. In addition, depression is highly comorbid with other mental health disorders, such as anxiety. Scalable, transdiagnostic, evidence-based interventions are needed for this population.

OBJECTIVE

The study will evaluate the effectiveness of a World Health Organization transdiagnostic digital mental health intervention, Step-by-Step, to reduce depressive and anxiety symptoms and improve well-being compared with enhanced care as usual and its implementation in a Chinese university community.

METHODS

A type 1 effectiveness-implementation two-arm, parallel, randomized controlled trial will be conducted. The two conditions are 1) the 5-session Step-by-Step program with minimal guidance by trained peer-helpers and 2) psychoeducational information on depression and anxiety and referrals to local community services. A total of 334 Chinese university students will be randomized with a 1:1 ratio to either of the two groups. Depression, anxiety, wellbeing, and client defined problems will be assessed at pre-intervention, post-intervention, and 3-month follow-up. Endline qualitative interviews and focus group discussions will be conducted to explore SbS implementation among service users, university staff, and stakeholders. Data will be analysed based on the intent-to-treat principle.

DISCUSSION

Step-by-Step is an innovative approach to address common mental health problems in populations with sufficient digital literacy. It is a promising intervention that can be embedded to scale mental health services within a university setting. It is anticipated that after successful evaluation of the program and its implementation in the type 1 hybrid design RCT study, Step-by-Step can be scaled and maintained as a low-intensity treatment in universities, and potentially extended to other populations within the Chinese community.

TRIAL REGISTRATION

ChiCTR2100050214.

Using network analysis to identify central symptoms of college students' mental health

BACKGROUND

Mental health problems are becoming increasingly common among college students, including depression, anxiety and sleep disturbances, which can affect their daily life and learning and even lead to suicide. The purpose of this study was to explore the gender differences in mental health symptoms among Chinese college students.

METHODS

The study population included 29,099 college students. All participants were assessed with the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7), the Insomnia Severity Index (ISI), and the Suicidal Behaviors Questionnaire-Revised (SBQ-R). We assessed and compared network and centrality in females and males separately, as well as students with suicidal ideation.

RESULTS

Satisfaction with current sleep pattern (I4), worry about different things (A3) and irritable (A6) appeared to be the most central symptoms in the female network. In the male network, satisfaction with current sleep pattern (I4), tired or little energy (D4) and feeling down, hopeless (D2) were the most central symptoms. In both suicidal ideation networks, the top five central symptoms included four anxiety symptoms and one sleep symptom.

LIMITATIONS

This study used cross-sectional data and could not examine the dynamic relationship between symptoms.

CONCLUSION

There were gender differences in college students' mental health network. In addition to poor quality sleep, the central symptoms of the female network were anxiety symptoms, while those of the male were mainly depression symptoms. There were no gender difference in the suicidal ideation network and the central symptoms were anxiety symptoms and difficulty falling asleep.

Athlete students lead a healthier life than their non-athlete peers: A cross-sectional study of health behaviors, depression, and perceived health status among university students

Some studies show that athlete students are more likely to engage in health-risk behaviors with negative health consequences, while others suggest that they lead a healthier life than their non-athlete peers. Given these inconsistent results, this study aims to compare health behaviors, depression, and perceived health status between athlete and non-athlete students, and explore the associations between health behaviors and health outcomes. An online questionnaire survey including Heath Habits Scale for five health-risk behaviors and five health-promoting behaviors, Patient Health Questionnaire-9 (PHQ-9), and 5-point scale for perceived health status was conducted in Beijing Sports University in March 2021. Data from 372 athlete students and 252 non-athlete students aging from 18 to 22 were included in this study. Chi-squared tests and t-tests were used to determine differences between athlete and non-athlete samples, and logistic regression analyses were conducted to examine the associations of health behaviors with depression and perceived health status. The significance level was p &lt; 0.05. The results show that compared with non-athlete students, athlete students perform better in health habits (10.01 vs. 8.27), report lower proportion of depression (44.6% vs. 54.4%) and higher proportion of good health (77.2% vs. 55.6%). Health behaviors, such as getting adequate sleeping, participating in vigorous physical activity, overeating, and smoking, were significantly associated with health outcomes of athlete students. The findings may contribute to the better understanding of health behaviors in athlete students and warrant continued attention on mental health and health habits in this population.

Childhood maltreatment and depressive symptoms among Chinese college students: A moderated mediation model of adult attachment styles and physical activity

BACKGROUND

Previous research has investigated the independent effects of childhood maltreatment, adult attachment, and physical activity, on depressive symptoms. However, explanatory mechanisms linking childhood maltreatment to current depressive symptoms are poorly understood. This study investigated the mediating role of adult attachment between childhood maltreatment and depressive symptoms among college students and explored the moderating effect of physical activity in the mediating pathway.

METHODS

The data for the present study were gathered in three waves with 6-month lags. A total of 3662 Chinese college students completed anonymous questionnaires concerning demographic variables, childhood maltreatment, and depressive symptoms in Wave 1, adult attachment and physical activity in Wave 2, and depressive symptoms in Wave 3.

RESULTS

Childhood maltreatment and adult attachment were significantly associated with depressive symptoms, identifying a mediating role of adult attachment in the relationship between childhood maltreatment and depressive symptoms, and a moderating role of physical activity between attachment anxiety and depressive symptoms in the mediating pathway.

LIMITATIONS

This study utilized self-reported questionnaires for data collection purposes, which could constitute key study limitations.

CONCLUSIONS

These findings highlight the need to consider early stress factors (childhood maltreatment), social psychological factors (adult attachment), and potential protective factors (physical activity) simultaneously when evaluating the occurrence and development of depressive symptoms.

EEG microstate temporal Dynamics Predict depressive symptoms in College Students

Previous studies on resting-state electroencephalographic responses in patients with depressive disorders have identified electroencephalogram (EEG) parameters as potential biomarkers for the early detection and diagnosis of depressive disorders. However, these studies did not investigate the relationship between resting-state EEG microstates and the early detection of depressive symptoms in preclinical individuals. To explore the possible association between resting-state EEG microstate temporal dynamics and depressive symptoms among college students, EEG microstate analysis was performed on eyes-closed resting-state EEG data for approximately 5 min from 34 undergraduates with high intensity of depressive symptoms and 34 age- and sex-matched controls with low intensity of depressive symptoms. Five microstate classes (A-E) were identified to best explain the datasets of both groups. Compared to controls, the mean duration, occurrence, and coverage of microstate class B increased significantly, whereas the occurrence and coverage of microstate classes D and E decreased significantly in individuals with high intensity of depressive symptoms. Additionally, the presence of microstate class B was positively correlated with participants' Beck Depression Inventory-II (BDI-II) scores, and the presence of microstate classes D and E were negatively correlated with their BDI-II scores. Further, individuals with high intensity of depressive symptoms had higher transition probabilities of A→B, B→A, B→C, B→D, and C→B, with lower transition probabilities of A→D, A→E, D→A, D→E, E→A, E→C, and E→D than controls. These results highlight resting-state EEG microstate temporal dynamics as potential biomarkers for the early detection and timely treatment of depression in college students.

Interventions in Chinese Undergraduate Students' Mental Health: Systematic Review

BACKGROUND

Over 30% of university students from 8 countries were afflicted with mental distress according to a World Health Organization survey. Undergraduate students in increasing numbers in China have also been reported to suffer from different mental problems. Various psychological distresses significantly impact their academic and daily life, thereby causing role impairments and unsatisfactory academic achievements. While the prevalence of, diverse underlying factors for, and interventions of social support in college students' mental health have extensively been investigated in China, there is no study exclusively focusing on the impact of interventions on their psychological well-being.

OBJECTIVE

The aim of this review was to identify and synthesize the interventions in the mental health concerns of Chinese undergraduate students studying in China reported in the literature to inform educational authorities, college and university management, students' affairs counselors, and mental health providers.

METHODS

We performed a systematic review and reported the research findings of previous studies according to the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. First, based on the predefined search strategy, keyword searches were performed in the PubMed and ProQuest databases to retrieve relevant studies. Subsequently, we screened the candidate articles based on predefined inclusion and exclusion criteria. Finally, we analyzed the included papers for qualitative synthesis.

RESULTS

We retrieved a total of 675 studies from the PubMed and ProQuest databases using the search strategy on March 15, 2022. Among these candidate studies, 15 that were not written in English, 76 duplicates, and 149 studies of other document types were removed before screening. An additional 313 studies were excluded in the screening process, with 73 articles ruled out for being not relevant to interventions, not related to mental health, or not focused on undergraduate students in the full-text review. As a result, 49 papers were eligible and included in this systematic review. In the qualitative synthesis, we divided the interventions reported in the selected studies into two categories: (1) social support from government authorities, university authorities, students' affairs counselors and teachers, family members, health care authorities and professionals, and the media (various online platforms), and (2) various coping strategies adopted by undergraduate students themselves. We identified further research on mental health interventions that may be delivered by digital medical platforms, conversational agents (eg, chatbots), and researchers.

CONCLUSIONS

This was the first systematic review of interventions to address the mental health concerns of Chinese undergraduate students studying in China. The categorization of reported interventions and the identification of new intervention channels can effectively inform stakeholders. Interventions for undergraduate students' mental health is a research topic worth further investigation.

Depression mediates the association between insula-frontal functional connectivity and social interaction anxiety

High rates of comorbidity between depression and anxiety are frequently observed. However, few studies have investigated the relationship between depression and social interaction anxiety using a dimensional approach. The current study aimed to explore the associations between depression and social interaction anxiety with a multivariate approach in a comparably large dataset (n = 194, 95 males). All participants completed a structural and a resting‐state functional magnetic resonance imaging (fMRI) scan and self‐report measures of depression via Beck's Depression Inventory II and social interaction anxiety by social interaction anxiety scale. Voxel‐based morphometry (VBM) results first identified grey matter volumes of insula were positively correlated with depression dimension scores. Next, whole brain seed‐to‐voxel analyses were conducted using a VBM‐identified insula as a seed region to examine associations between depression/social anxiety and functional connectivity. The results suggested that a significant positive effect of depression/social anxiety was found on the connectivity between insula and dorsal lateral prefrontal cortex (dlPFC). Moreover, variations in depression meditated the association between insula‐dlPFC connectivity and social interaction anxiety. Overall, the results indicate that individual differences in depression relate more to insula‐dlPFC coupling compared to social interaction anxiety.

Translation, cultural adaptation, and validation of the Brazilian Portuguese version of the Higher Education Stress Inventory (HESI-Br)

OBJECTIVES

There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI).

METHODS

The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence.

RESULTS

EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach's α ≥ 0.72 and McDonald's ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups.

CONCLUSION

The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil.

Arbuscular mycorrhizal fungi from acidic soils favors production of tomatoes and lycopene concentration

BACKGROUND

Tomato is widely consumed throughout the world for its flavor and nutritional value. This functional food largely depends on the implementation of new strategies to maintain the nutraceutical value, e.g. lycopene concentration, and overcome the challenges of sustainable production and food security. The use of arbuscular mycorrhizal fungi (AMF)-based biostimulants represents one of the most promising tools for sustainable management of agricultural soils, being fundamental for organic food production, reducing fertilizers and pesticides use, and decreasing environmental damage. This study aimed at elucidating whether native arbuscular mycorrhizal fungi (AMF) could positively affect tomato yield and lycopene concentration.

RESULTS

Native AMF inoculum consisted of two inoculum types: the single species Claroideoglomus claroideum, and a mix of Scutellospora calospora, Acaulospora laevis, Claroideoglomus claroideum, and Claroideoglomus etunicatum. At the end of the study up to 78% of the root system was colonized by single inoculum. Tomato diameters in single and mix mycorrhizal plants showed increases of 80% and 35% respectively. Fresh weights were 84% and 38% higher with single and mix inocula compared with the controls, respectively. The lycopene concentration in tomato fruits of plants with single and mix inoculum was higher than controls. The lycopene concentration was 124.5% and 113.9% greater in single and mix than non-inoculated plants.

CONCLUSION

Tomato diameters, fresh weight and lycopene concentration was significantly higher in plants colonized by AMF compared with uninoculated plants. Results suggest that the role of single species Claroideoglomus claroideum could generate better plant performance due to its high production of extraradical mycelium. © 2021 Society of Chemical Industry.

Core self-evaluation as mediator between depressive symptoms and suicidal ideation in adolescents

OBJECTIVES

To explore the role of core self-evaluation in mediating between depressive symptoms and suicidal ideation in Chinese adolescents.

METHODS

We used the cluster sampling method to analyze 11,563 students from five primary and secondary schools in China for depressive symptoms, core self-evaluation, and suicidal ideation using the following scoring scales: Core Self-Evaluation Scale (CSES), Center for Epidemiologic Survey Depression Scale (CES-D), the Second Edition of the Beck Depression Inventory (BDI- II), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Adolescent Self-Rating Life Events Checklist (ASLEC).

RESULTS

The incidence of depression was 29.7%; anxiety, 34.2%; and suicidal ideation, 28.0%. Core self-evaluation was a protective factor for suicidal ideation [OR 0.947, 95% CI 0.937-0.959, p<0.001]. Conversely, depression as measured by the CSES score was a risk factor for suicidal ideation (OR 1.084, 95% CI 1.073-1.096, p<0.001), as were anxiety as measured by the SCARED score (OR 1.011, 95% CI 1.006-1.016, p<0.001) and adolescent life events according to ASLEC score groups (OR 1.524, 95% CI 1.434-1.621, p<0.001). Core self-evaluation mediated the relationship between depression and suicidal ideation with an effect size of 13.9%.

CONCLUSIONS

Better core self-evaluation is a protective factor against suicidal ideation and mediates the relationship between depression and suicidal ideation. We may be able to reduce the risk of suicidal ideation and therefore suicide among adolescents by improving their core self-evaluation.

Childhood Experiences and Psychological Distress: Can Benevolent Childhood Experiences Counteract the Negative Effects of Adverse Childhood Experiences?

Background

Childhood experiences can exert a huge impact on adult psychological conditions. Previous studies have confirmed the effects of adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) on psychological distress (e.g., stress, depression, and suicidal ideation) separately, but few studies explored a combined effect of ACEs and BCEs on psychological distress. The aim of this study was to explore a combined effect of ACEs and BCEs on psychological distress among Chinese undergraduates.

Methods

Participants were undergraduates aged 17–24 years (N = 1,816) and completed a self-reported questionnaire. A series of regression analyses were conducted to examine the association between childhood experiences and psychological distress.

Results

A total of 65.7% of undergraduates had BCEs, 27.1% of undergraduates had ACEs, and 12.9% of undergraduates had ACEs and BCEs simultaneously. Logistic regression analysis indicated that undergraduates who experienced high ACEs were more likely to have a high risk of psychological distress [odds ratio (ORs) = 1.46, 1.84, and 3.15 for uncertainty stress, depressive symptoms, and suicidal ideation, respectively], while undergraduates who experienced High BCEs were less likely to have psychological distress (ORs = 0.33, 0.22, and 0.32 for uncertainty stress, depressive symptoms, and suicidal ideation, respectively) compared with Low-Both group. The combined effect of ACEs and BCEs (High-Both group) could also play as a protective factor in uncertainty stress (OR = 0.56) and depressive symptoms (OR = 0.47).

Conclusion

Our findings suggested that ACEs and BCEs could not only predict the psychological distress independently, but also BCEs could counteract the negative effect of ACEs in psychological problems. There is an even greater need to identify and support the victims of ACEs and to increase BCEs in early childhood.

Interparental Conflict and Early Adulthood Depression: Maternal Care and Psychological Needs Satisfaction as Mediators

Previous research has identified exposure to interparental conflict (IPC) in childhood as a risk factor for young adults’ depression. However, there is still a lack of understanding of the underlying mediating mechanisms of this association. Driven by the spillover hypothesis, the present study investigated whether maternal antipathy and neglect, and in turn unmet psychological needs, mediated the relation between IPC and early adulthood depression in a sample of 347 undergraduate students (M = 23.27 years; SD = 0.86; 57.05% women) in China. The participants completed self-report measures of IPC, maternal care, satisfaction of basic psychological needs, and depression. Structural equation modeling revealed that: (a) IPC was positively associated with early adulthood depression; (b) this association was sequentially mediated by inadequate maternal care (i.e., antipathy and neglect) and by unsatisfied psychological needs. These findings suggest that efforts to prevent depression should focus on reducing not only IPC, but also inadequate maternal care and unmet psychological needs.