Psychometric Properties of the Kessler 10 Scale in Chinese Parents of Children With Cancer

Psychometric Properties of the Kessler Psychological Distress Scale in a Sample of Adolescents from Ecuador

The Kessler psychological distress scale is a useful tool for identifying possible psychological problems and has been widely used in research and health services. Unfortunately, its application in various populations has not always been psychometrically supported. For this reason, the present study investigated the psychometric properties of its Spanish version in adolescents, verifying its factorial structure, measurement invariance by gender, internal consistency and the discrimination and difficulty parameters of its items according to the Item Response Theory (IRT). A sample of 5132 Ecuadorian adolescents was evaluated. The sample is equally distributed between male and female participants (50%) and basic and higher education (51% the former). All participants were between 11 and 20 years old. The results show that a 9-item version with correlated intercepts presents the best fit. In addition, it is invariant by gender at a strict level and has adequate internal consistency. IRT analyses indicated that all the items, except for item eight, present adequate discrimination and difficulty. Based on these results, we conclude that the 9-item version of the Psychological Distress Scale is the most appropriate for this population.

Child behavior problems and parental psychological distress in Chinese families of children with autism: The putative moderating role of parental social support and cultural values

The wellbeing of parents of children with autism residing in mainland China remains understudied. We aimed to examine whether and how parental perceived social support, individualism, and collectivism acted together to moderate the relationships between child behavior problems and parental psychological distress in Chinese parents of children with autism. With convenience and snowball sampling, data on 268 primary caregiver parents of children with autism were collected from an online cross-sectional survey. Linear regression analysis indicated that child behavior problems were significantly associated with increased psychological distress in Chinese parents of children with autism. There was no evidence to support the stress-buffering model of social support in moderation analysis of the association between child behavior problems and parental psychological distress. Nonetheless, increased social support was associated with lower levels of parental psychological distress. Moderated moderation analyses did not support a role for individualism or collectivism as a moderator of the putative buffering role of social support. However, there was evidence that parental individualism was associated with increased parental psychological distress. Our findings highlight that child behavior problems are a robust correlate of parental psychological distress, and parental social support may act as a compensatory factor promoting less psychological distress rather than having a protective role. The role of social support and cultural values in the wellbeing of parents of children with autism in China requires additional exploration, including longitudinal research designs.

Association between personality traits and psychological distress among postmenopausal women with coronary heart disease: A cross-sectional survey and mediation analysis

Postmenopausal women with negative personality characteristics are at an increased risk of psychological disorders, yet little is known about the mechanism underlying the relationship between type D personality and psychological distress in postmenopausal women with coronary disease. This study assessed the mediating roles of perceived social support and self-perceived burden in the relationship between type D and psychological distress based on the equity theory and stress-buffering model. Demographic characteristics, type D, psychological distress, perceived social support, and self-perceived burden were completed by 335 participants with self-reported questionnaires using a cross-sectional design in Southeast China. The results revealed that perceived social support and self-perceived burden both separately and serially mediated the relationship between type D personality and psychological distress. Effective intervention strategies aimed at improving perceived social support or reducing self-perceived burden may be beneficial in reducing psychological distress.

Translating and validating the sources of pressure scale: Job stressors among Chinese government employees

In recent years, stress-related suicides have been on the rise among Chinese government employees. Standardized instruments on job stress are abundant, but few of them have been administered and validated among Chinese government employees. Using convenience samples of Chinese government employees, this study aimed to translate and validate the Sources of Pressure Scale (SPS) of the Pressure Management Indicator (PMI), which is a comprehensive instrument on job stress developed by western researchers. Sample 1 participants (n = 278) filled out the PMI questionnaire and the Kessler Psychological Distress scale in person and sample 2 participants (n = 227) completed the same questionnaires online. Exploratory and confirmatory factor analyses were conducted using separate samples. Though the original SPS contained 40 items and eight dimensions, our analyses validated a much shorter version, with four dimensions encompassing 15 items: relationships (5 items), home-work balance (4 items), recognition (3 items), and personal responsibilities (3 items). Also reported in the study is evidence that the shortened version of the the PMI is the Sources of Pressure Scale is a reliable and valid measure of job stressors among Chinese government employees. Government agencies in China can use these findings to develop more relevant organizational-level interventions to reduce job stress and its detrimental consequences.

"Queer people are excellent caregivers, but we're stretched so very thin": Psychosocial wellbeing and impacts of caregiving among LGBTQI cancer carers

BACKGROUND

LGBTQI (lesbian, gay, bisexual, transgender, queer and/or intersex) communities are increasingly recognized as a vulnerable and high-risk population in oncology. LGBTQI cancer carers, including carers who are LGBTQI and other carers of LGBTQI people, experience many of the same stressors as LGBTQI patients but their support needs are often overlooked in the cancer literature.

METHOD

This mixed-methods study examined distress and quality of life in LGBTQI cancer carers. Online surveys were completed by 129 carers and 31 carers took part in a one-to-one semi-structured interview. Analyses of variance (ANOVAs) tested for differences in psychosocial outcomes and carer experiences by gender, sexuality, age, carer relationship and carer/patient LGBTQI status. Reflexive thematic analysis of interviews and open-ended survey responses facilitated in-depth examination of subjective experiences.

RESULTS

42.6% of participants reported high or very high distress. Distress was significantly positively correlated with discrimination in cancer care, health impact, financial impact and lack of family support; it was negatively correlated with comfort in LGBTQI sexuality and gender identity, social support and quality of life. Four themes were identified in thematic analysis of qualitative data: (1) Identity on the sidelines: LGBTQI sexuality and gender pushed aside during cancer caregiving; (2) Fear of being shut-out: rejection and exclusion of LGBTQI cancer carers; (3) Lack of support for LGBTQI caregivers; and (4) Closer and stronger relationships due to a culture of mutual caregiving.

CONCLUSIONS

LGBTQI cancer carers must contend with typical caregiving demands whilst also managing additional minority stressors, including discrimination, rejection from family, isolation from LGBTQI communities, and invisibility in healthcare and support services. Despite this, LGBTQI carers showed resilience in building their own mutually supportive networks to rally around the person with cancer, which were reported to ameliorate psychosocial vulnerabilities. Service providers need to recognize the needs of LGBTQI cancer carers through inclusive and reflective practices. This will facilitate trust and patient and carer sexuality and gender identity disclosure, with positive consequences for wellbeing and satisfaction with cancer care.

Predictors of self-regulation fatigue patterns in patients before total knee arthroplasty: A cross-sectional study

BACKGROUND

Patients with total knee arthroplasty encounter stressful events that consume their coping resources, resulting in self-control fatigue. Few studies have focused on this phenomenon.

AIM

To identify subgroups of patients before total knee arthroplasty according to the heterogeneous patterns of self-regulation fatigue and to analyse the predictors of subtypes.

METHODS

A total of 210 patients awaiting total knee arthroplasty were enrolled. Data of demographic characteristics, clinical characteristics, psychological and social factors were collected. Latent profile analysis was employed to define the subgroups. Predictors of patterns were identified using multinomial logistic regression.

RESULTS

Three latent classes were identified: the low, medium, and high self-regulation fatigue classes. For the high self-regulation fatigue class, lower levels of hope, social support, self-efficacy and education were major predictors.

CONCLUSION

These predictors of patients with different levels of self-regulation fatigue provide evidence for the identification of vulnerable populations and lay a foundation for targeted interventions.

Mapping the association between mental health and people's perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review

Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.

Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave)

Introduction

The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs.

Methods

During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors.

Results

Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing.

Conclusion

This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.

Association Between Sunlight Exposure and Mental Health: Evidence from a Special Population Without Sunlight in Work

Purpose

In recent years, mental health problems have become the most serious social problems worldwide. Past studies have proposed that some links exist between sunlight and mental health; however, relevant studies examining low-dose sunlight exposure populations are lacking. We conducted a study among a group of operating room nurses (ORNs) who work long hours in operating rooms and have limited sunlight exposure. We aim to add to and refine previous researches on the association between mental health and sunlight exposure in community population.

Patients and Methods

A total of 787 ORNs were interviewed and analyzed. Mental health, sunlight exposure duration, sociodemographic and work-related variables, and chronic diseases were evaluated. The Kessler 10 scale (K10) was used to assess participants' mental health status, and their sunlight exposure duration was assessed using their self-reports. Multiple linear regression analysis was adopted to examine the association between sunlight exposure and mental health.

Results

The average K10 score of ORNs was 25.41. ORNs exhibit poorer mental health than other populations. Poor mental health was negatively associated with greater sunlight exposure hours per day (β=-0.378) and sleep regularity (β=-3.341). Poor mental health was positively associated with chronic disease (β=3.514).

Conclusion

This study indicated that the positive association between sunlight exposure and mental health existed. Appropriate enhancement of sunlight exposure will be beneficial to mental health. Hospitals, related organizations and individuals should pay greater attention to ORNs' mental health and sunlight exposure conditions. More policy recommendations as well as building structure recommendations should be proposed.

What drives the adoption of online health communities? An empirical study from patient-centric perspective

BACKGROUND

Online health communities (OHCs) provide platforms for patients to seek advice from physicians and receive professional suggestions online. It can improve the efficiency of patients' diagnosis of simple diseases and alleviate hospital congestion. However, few empirical studies have comprehensively explored the factors influencing patients' intention to use OHCs through objective data. This study aims to fill this gap by identifying key factors that influence patients' acceptance of OHCs and proposing effective ways to promote the applications of OHCs in China.

METHODS

Based on the Unified Theory of Acceptance and Usage of Technology (UTAUT), extended with additional constructs identified with patients' information demands in OHCs, this study developed a research model and proposed nine hypotheses. An online survey involving 783 valid responses was conducted in China to collect data to validate the proposed model. Confirmatory factor analysis and partial least squares (PLS) path model were conducted for instrument validation and hypothesis testing.

RESULTS

Price value, eHealth literacy, and performance expectancy are the most prominent constructs in the study context. Interestingly, relation quality was also found to have a significant positive relationship with behavioral intention.

CONCLUSIONS

Based on these findings, OHC operators need to create a user-friendly platform, improve information quality, set reasonable prices, and establish consummate security systems. Physicians and related organizations can raise awareness and assist patients in developing the skills to appropriately comprehend and utilize information in OHCs. This study contributes to both technology adoption theory and practice.

Psychological distress and its associated factors among patients with chronic obstructive pulmonary disease in Hunan, China: a cross-sectional study

Patients with chronic obstructive pulmonary disease (COPD) experience a high risk for psychological distress. Understanding what factors contributing to this risk is vital for developing effective interventions to address COPD-related psychological distress. To examine psychological distress and its associated factors in COPD patients in China. This is a cross-sectional study. Using cluster random sampling, 351 COPD patients participated in and completed a questionnaire survey from June 2021 to January 2022. Instruments used in this research included a self-designed social-demographic questionnaire, the Kessler Psychological Distress Scale (K10), the COPD Knowledge Question, the Type D Personality Scale (DS-14), the COPD Assessment Test (CAT), and modified Medical Research Council Dyspnea Score (mMRC). Multivariate linear regressions were used in the final analysis. Among 351 COPD patients, 307 (or 87.5%) had psychological distress. Our univariate analysis indicated that psychological distress scores were significantly associated with monthly household income (F = 2.861, P < 0.05), exercise frequency (F = 4.039, P < 0.01), type D personality (t = 5.843, P < 0.01), years with COPD (r_s = 0.156, P < 0.01), frequency of acute exacerbation (r_s = 0.114, P < 0.05), mMRC score (r_s = 0.301, P < 0.01), and CAT score (r_s = 0.415, P < 0.01). Our final multivariate linear regression showed that exercise frequency (coefficient = -1.012, P < 0.01) was an independent protective factor of psychological distress in COPD patients, while type D personality (coefficient = 3.463, P < 0.001), mMRC score (coefficient = 1.034, P < 0.001) and CAT score were independent risk factors (coefficient = .288, P < 0.001). No relationship was observed between psychological distress and knowledge of COPD. Psychological distress is commonly presented among COPD patients in China. Findings from this study suggest promoting and increasing frequency of exercise will be beneficial in reducing psychological distress among COPD patients. This study also highlights the importance of assessing personality type, dyspnea, and impact of COPD on daily living for preventing and managing psychological distress due to COPD. In addition, Given the high rate of psychological distress among COPD patients, policymakers should consider making mental health resources easily available and accessible to this vulnerable population.

Five-Factor Personality Dimensions Mediated the Relationship between Parents' Parenting Style Differences and Mental Health among Medical University Students

BACKGROUND

Previous studies have identified the relationships between parental parenting style, personality, and mental health. However, the interactive influences between mother's and father's parenting styles on personality have been examined less often. To fill the gaps, the first aim of this study was to build the relationships between parental parenting style differences (PDs) and five-factor personality dimensions. The second aim was to test the mediating effect of five-factor personality dimensions on the relationships between parental parenting style differences and mental health.

METHODS

This is a cross-sectional study conducted among medical university students, and 2583 valid participants were analyzed. Mental health was measured by the Kessler-10 scale. The Chinese Big Five Personality Inventory brief version (CBF-PI-B) was used to access five-factor personality dimensions. PD was calculated by the short form of Egna Minnen av Barndoms Uppfostran. Linear regressions were conducted to analyze the associations between PD and five-factor personality dimensions. The SPSS macros program (PROCESS v3.3) was performed to test the mediating effect of five-factor personality dimensions on the associations between PD and mental health.

RESULTS

Linear regressions found that worse mental health was positively associated with PD (β = 0.15, p < 0.001), higher neuroticism (β = 0.61, p < 0.001), lower conscientiousness (β = -0.11, p < 0.001), lower agreeableness (β = -0.10, p < 0.01), and lower openness (β = -0.05, p < 0.05). The results also supported that PD was positively associated with lower conscientiousness (β = -0.15, p < 0.01), lower agreeableness (β = -0.09, p < 0.001), lower openness (β = -0.15, p < 0.001), and lower extraversion (β = -0.08, p < 0.001), respectively. The mediating effect of agreeableness or openness was supported for the relationships between PD and mental health.

CONCLUSION

These findings remind us of the importance of consistent parenting styles between mother and father, and they also can be translated into practices to improve mental health among medical university students.

Prevalence and associated factors of self-reported medical errors and adverse events among operating room nurses in China

Background

In recent decades, the prominence of medical errors (MEs) and adverse events (AEs) is fueled by several studies performed across the world. Correspondingly, a high prevalence of medical errors and adverse events have been reported. Operating room nurses (ORNs) were indispensable members of the operating process, and any kind of MEs or AEs from ORNs may cause serious results and even death to the patients. However, to the best of our knowledge, the prevalence and associated factors of MEs and AEs were never reported among ORNs in China, which is the largest country in population and health services quantity in the world.

Methods

This is a cross-sectional study, which was conducted among ORNs in China, and 787 valid questionnaires were analyzed in this study. MEs, AEs, gender, age, married status, religious belief, academic degree, manager or not, working years, working hours/week, physical disease, and mental health were evaluated in this study. MEs were evaluated by eight questions about the occurrence of eight kinds of MEs for the ORNs. For ORNs with MEs, further questions about clinical harm to the patients were interviewed, which analyzed AEs. Kessler 10 was used to evaluate the ORNs' mental health. Logistic regression was conducted to examine the factors associated with MEs and AEs.

Results

The prevalence of MEs and AEs was 27.7 and 13.9% among ORNs, respectively. The most frequent MEs that occurred among ORNs were from surgical instruments (9.1%), disinfection (9.0%), equipment and consumables (8.9%), and specimen management (7.8%). MEs were positively associated with lower working years, poor mental health, and physical disease. The physical disease was positively associated with AEs.

Conclusion

The prevalence of perceived MEs and AEs was at a higher level than other kinds of nurses. Fresh ORNs with physical and mental health problems were the risk population for MEs, and ORNs with physical disease were at a higher risk for AEs. All the findings implied that MEs and AEs were an important issue for ORNs, and ORNs with physical and mental health problems should be paid attention to control MEs and AEs.

Cross-Cultural Validation of the Chinese Version of the Health Promoting Activities Scale

IMPORTANCE

The Health Promoting Activities Scale (HPAS) measures the frequency of participation in health-promoting activities of mothers of children with disabilities. Translation of the HPAS into Chinese and validation of the Chinese version will enable its use with Chinese-speaking mothers of children with disabilities.

OBJECTIVE

To translate the HPAS into Chinese and assess its construct validity in relation to measures of well-being, mental health, and activity satisfaction.

DESIGN

Cross-cultural validation.

SETTING

Community.

PARTICIPANTS

Eight bilingual Chinese speakers were involved in the translation. Ethnic Chinese mothers of children with disabilities living in Australia, Singapore, or Taiwan (N = 89) were recruited via purposive snowball sampling. Participants self-selected to complete the Chinese e-survey.

OUTCOMES AND MEASURES

Translation was guided by recommended frameworks. The Chinese versions of the Warwick-Edinburgh Mental Well-being Scale (WEMWS), Personal Well-being Index (PWI), and Kessler Psychological Distress Scale-10 (K10) were used to determine construct validity. Internal reliability was investigated.

RESULTS

The Chinese version of the HPAS correlated significantly with satisfaction ratings (r = .45, p < .001; n = 87), WEMWS Total score (r = .61, p < .001; n = 85), PWI mean score (r = .44, p < .001; n = 84), and K10 total score (r = -.33, p = .002; n = 81). Internal reliability was moderate (Cronbach's α = .74).

CONCLUSIONS AND RELEVANCE

The Chinese version of the HPAS was found to be cross-culturally equivalent to the original HPAS and psychometrically sound for use with Chinese-speaking mothers of children with disabilities. What This Article Adds: This study provides an example of the cross-cultural validation process. The Chinese version of the HPAS is psychometrically sound and could be used as an outcome measure of Chinese mothers' participation in health-promoting activities.

Diagnostic Evaluation of Depression Screening Tools in Asian New Zealanders

This study aimed to compare the Kessler Psychological Distress Scale (K10) and Short-Form 12-Item Health Survey Mental Component Score (SF-12 MCS) for the effectiveness as screening tools for depression in Asian New Zealanders. A national, representative New Zealand Health Survey (NZHS) data set was used. In total, 1,277 participants were included in the analyses. The sensitivity and specificity values, as well as the areas under the receiver operating characteristics curves (AUROC), for the K10 and the SF-12 MCS scores were examined. The AUROCs for K10 and SF-12 MCS were 0.787 (95% CI [0.736, 0.837]) and 0.725 (95% CI [0.656, 0.793]), respectively. A less than optimal sensitivity and positive predictive value of K10 support the need to reexamine the optimal cut-off point according to the results of the Youden index. Strengthening the K10 predictive accuracy will increase the practical application among Asian populations.

Disaggregating the data: Diversity of COVID-19 stressors, discrimination, and mental health among Asian American communities

Much of the public discourse as well as research regarding the negative impact of COVID-19-related anti-Asian discrimination has been conducted at the broad racial group level, yet data aggregation masks critical points of diversity among Asian Americans. We conducted an online survey of 620 Asian American adults in December 2020 and examined whether there were any demographic differences-including by ethnic subgroup and Chinese street race (being Chinese or being mistaken as Chinese)-in their experiences of COVID-19-related stress, direct and vicarious discrimination, and psychological outcomes. Our analyses found that younger age was correlated with higher reports of pandemic stress, discrimination, distress, and worry. Female and U.S.-born participants reported higher levels of pandemic stress and vicarious discrimination, but there were no gender or nativity differences in levels of direct discrimination. Being uninsured was also related to higher levels of pandemic stress, discrimination, and distress. East Asian Americans reported significantly lower frequencies of direct anti-Asian discrimination than did South Asian or Southeast Asian Americans, but the ethnic subgroups did not differ in their reports of vicarious discrimination. Of note, Chinese street race was not associated with either direct or vicarious discrimination. Separate hierarchical regression analyses for East Asian, South Asian, and Southeast Asian participants revealed that, regardless of ethnicity, racial discrimination significantly contributed to psychological distress and worry beyond the effects of pandemic stress. However, the three groups varied in the demographic indicators and COVID-19 stressors that were associated with psychological outcomes. Pandemic stress was more strongly associated with negative outcomes among South Asian Americans than East Asian and Southeast Asian Americans, and neither direct nor vicarious discrimination were associated with mental health among South Asian Americans. Direct discrimination, compared to vicarious discrimination, was a particularly robust predictor of both distress and worry among East Asian Americans. For Southeast Asian Americans, direct discrimination significantly predicted higher levels of distress, whereas vicarious discrimination predicted higher levels of worry. Vicarious discrimination was not significantly related to distress across ethnic subgroups. Results suggest that practitioners and policy makers would benefit from attending to these within-group differences in Asian Americans' experiences during the pandemic.

Internalized Homonegativity and Mental Health Among Chinese Gay and Bisexual Cisgender Men: Exploring the Moderating Influences of Psychosocial and Sexual Identity Factors

Much research on Chinese gay and bisexual men has focused on sexual health and, in particular, HIV-related issues. However, relatively little research has considered psychosocial aspects of being a gay or bisexual man in China. The present study was designed to address this gap by examining psychosocial predictors of mental health from a minority stress perspective. Results from an online survey of 1,786 Chinese gay and bisexual cisgender men revealed that higher levels of internalized homonegativity predicted greater psychological distress and a lower sense of positive well-being. Higher self-esteem, social support, and resilience were strong predictors of lower psychological distress and higher well-being, but these psychosocial factors mostly did not moderate associations between internalized homonegativity and mental health. A stronger sense of sexual identity superiority weakened the associations between internalized homonegativity and both mental health measures, but sexual identity centrality only moderated the association between internalized homonegativity and positive well-being. This study is among the first to examine minority stressors and psychosocial factors, distinct from the HIV-focussed literature, in a Chinese context. These findings may inform interventions targeting increased self-esteem, social support, and resilience, which could be beneficial for the mental health of Chinese gay and bisexual cisgender men.

Predictors of psychological resilience trajectories in patients with knee arthroplasty: A longitudinal study

AIMS

To identify the different classes of total knee arthroplasty patients according to the heterogenous trajectories of psychological resilience and investigate the predictors for different patterns of resilience.

DESIGN

A prospective cohort study.

METHODS

A total of 210 patients with total knee arthroplasty from March to December 2021 were included. Baseline assessment (T0) data were collected before surgery and included demographic, biological (clinical characteristics), psychological (psychological resilience, self-efficacy, psychological distress, hope, medical coping mode) and social (social support) factors. Resilience measurements were repeated at 3 days after surgery (T1), the date of discharge (T2), and 1 month (T3) and 3 months (T4) after discharge. Latent growth mixture modelling was employed to define different resilience trajectories. Predictors of class membership were identified using multinomial logistic regression.

RESULTS

Data from 198 patients were analysed. Three latent classes were identified with similar patterns in different intercepts, showing a significant decrease in resilience from admission (T0) to 3 days after surgery (T1) followed by an increase from T1 to T4. The three trajectories of psychological resilience were named the stable-resilience class (65.66%), high-resilience class (17.68%), and low-resilience class (16.66%). Multinomial logistic regression showed that compared with the stable-resilience class, the high-resilience class was predicted by having a higher level of hope, having higher education, living in urban areas and having more children, while the low-resilience class was predicted by having lower levels of self-efficacy and hope, living in semirural areas, and having more children.

CONCLUSIONS

The three trajectories indicated that surgery was the major stressor influencing patients' psychological resilience and that patients in the low-resilience class needed to be intervened.

IMPACT

Predictors of patients in different classes provide evidence for the identification of vulnerable populations and lay a foundation for future research contributing to the development of targeted interventions for improving patients' psychological resilience. No patient or public contribution but the time points of investigation were decided based on our interviews with 12 total knee arthroplasty patients.

Associations among neuroticism, self-efficacy, resilience and psychological distress in freshman nursing students: a cross-sectional study in China

OBJECTIVES

The current study examines the mediating roles of resilience and self-efficacy and the moderating role of gender in the association between neuroticism and psychological distress in Chinese freshman nursing students (FNSs).

METHODS

A total of 1220 FNSs were enrolled from the Be Resilient to Nursing Career (ChiCTR2000038693) Programme and the following instruments were administered to them: NEO Five-Factor Inventory, General Self-Efficacy Scale, Connor-Davidson Resilience Scale and Kessler Psychological Distress Scale. A moderated mediation analysis and a generalised additive model analysis were performed.

RESULTS

The direct and indirect effects of neuroticism on psychological distress were significantly mediated by self-efficacy (B = 0.200, 95% CI 0.001 to 0.039), resilience (B = 0.021, 95% CI 0.007 to 0.038) and the interaction between self-efficacy and resilience (B = 0.016, 95% CI 0.005 to 0.028). The interactions between neuroticism and gender (β = 0.102, 95% CI 0.001 to 0.203, p<0.05) and between resilience and gender were significant (β = 0.160, 95% CI 0.045 to 0.275, p<0.01). A non-linear and positive association was confirmed between neuroticism and psychological distress.

CONCLUSIONS

Self-efficacy and resilience significantly mediate the relationship between neuroticism and psychological distress. Gender moderates the relationships between neuroticism and resilience and between resilience and psychological distress.

Psychological Distress, Anxiety, Family Violence, Suicidality, and Wellbeing in Pakistan During the COVID-19 Lockdown: A Cross-Sectional Study

Background and Objectives

The purpose of this study was to draw the attention toward the implications of COVID-19 and the related restrictions imposed worldwide especially in Pakistan. The primary objective was to highlight the levels of psychological distress, anxiety, family violence, suicidality, and well-being due to COVID-19 and the secondary objective was to associate it to social demographic factors.

Materials and Methods

It is designed as a cross-sectional study by employing an online questionnaire in the English language and obtaining responses using a snowball sampling technique. We used three validated measures including Kessler Psychological Distress Scale (K10), Generalized Anxiety Disorder (GAD-7) index and World Health Organization Well-Being Index (WHO-5).

Results

A sample of 420 participants was recruited from across Pakistan, with most participants were females (79%), students (89.8%) and belonging to Punjab (54%). Nearly one-fourth of the participants (23.8%) scored above the minimum value set for moderate or high psychological distress (K10 > 12). There was a higher prevalence of distress among females and resident of province Punjab. The majority of individuals reported that they were living with their family (94.5%) and more than half (52.6%) were neutral regarding their satisfaction with their living conditions. 40.5% believed that the lockdown has had a negative impact on their mental health. 31.4% have reported that they themselves have experienced abuse from a family member. 48.6% scored high on the GAD-7 scale and low wellbeing score was found among 80.2%. Students were found to be more vulnerable to mental illness and anxiety.

Conclusion

With the lockdown restrictions, psychosocial distress has become prevalent in Pakistan.

Patterns of perceived parenting styles and associations with night eating syndrome symptoms and correlates among Chinese adolescents: a latent profile analysis

PURPOSE

This paper aimed to explore the association between the patterns of perceived parenting styles and adolescents' night eating syndrome symptoms and correlates, including sleep quality, weight status, loss of control over eating, and psychological distress.

METHODS

A sample of 455 Chinese adolescents (54.5% females, aged 12-15 years) were included in the current study. Latent Profile Analysis (LPA) was adopted to examine the patterns of perceived parenting styles. The three-step approach was used to explore the differences in night eating syndrome symptoms and correlates between different profiles.

RESULTS

A four-profile solution was found to fit the data best, and the four profiles were labeled as positive parenting, negative parenting, highly engaged parenting, and lowly engaged parenting. Subsequent analyses showed that adolescents across profiles exhibited significant differences in night eating syndrome symptoms and correlates. Specifically, adolescents in the positive parenting profile generally had the lowest scores in night eating and its correlates, while those in the negative parenting group reported the highest scores in night eating and its correlates.

CONCLUSION

Using a person-centered approach (i.e., LPA), the present study identified four distinct patterns of perceived parenting styles in a sample of Chinese adolescents, with night eating and related symptomatology differing across each profile. Future interventions targeting night eating among adolescents may consider the potential influence from the patterns of perceived parenting styles to have a better intervention outcome.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Association Between Parental Parenting Style Disparities and Mental Health: An Evidence From Chinese Medical College Students

Background

The associations between parental parenting styles and adolescents' development and health problems were also identified in a series of studies. However, the interactive impact of mother's and father's parenting style was less reported, which was implied in previous studies. In this study, we aim to analyze the associations between parental parenting style disparities and mental health among medical college students.

Method

A cross-sectional study was conducted among medical college students in Shandong province, China, and 2,598 medical college students with parents were analyzed in this study. Items in a short form of Egna Minnen av Barndoms Uppfostran (EMBU) were used to calculate the parental parenting style disparities. Mental health was evaluated by the Kessler 10 scale.

Results

The results of linear regressions showed that parental nurture reject disparities (RDs, β = 0.50, p < 0.001), parental emotional warmth disparities (WDs, β = 0.33, p < 0.001), parental overprotective disparities (ODs, β = 0.25, p < 0.001), and total disparities in parenting styles (TDs, β = 0.15, p < 0.001) were associated with mental health among medical college students, respectively. The other associated factors were age, ethnicity, chronic disease, above average family economic status, and good parental relationship.

Conclusion

Our findings supported the positive association between parental parenting style disparities and mental health problems. Further studies can test the mechanism and intervention of the findings about the importance of parental parenting style consistence on mental health.

Measurement invariance of the Kessler Psychological Distress Scale (K10) among children of Chinese rural-to-urban migrant workers

INTRODUCTION

Kessler Psychological Distress Scale (K10) is a 10-item screening tool designed for nonspecific psychological distress. The current study aims to identify a best-fitting factor structure of the K10, and to test its cross-gender measurement invariance based on the structure.

METHODS

Using convenience sampling, we included 339 (n = 192 for boys and 135 for girls) children of Chinese rural-to-urban migrant workers in Hangzhou, China.

RESULTS

Confirmatory factor analysis for ordered-categorical measures revealed a two-factor structure as the best-fitting model, in which five items (hopeless, depressed, effort, severely depressed, and worthless) loaded on depression and the other five items loaded on anxiety (tired, nervous, severely nervous, restless, and severely restless). The model held at different levels of the measurement invariance testing, that is, full measurement invariance was not rejected in our sample, suggesting that gender differences as assessed with K10 reflect true differences. Structural invariance testing showed that girls in our sample showed significantly higher levels of depression and anxiety than boys.

CONCLUSION

These findings support that the K10 is suitable for gender-comparative research among children of Chinese migrant workers. Using the K10 as a screening tool among this population should be promoted. Limitations and directions for future research were discussed.

Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study

Background

eHealth literacy is significantly associated with patients’ online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients’ eHealth literacy regarding health information–seeking behavior and physician-patient communication in OHCs.

Objective

This study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory.

Methods

This was an empirical study, in which a research model consisting of 1 independent variable (patients’ eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information–seeking behavior in OHCs, and patients’ perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses.

Results

The survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients’ perceived quality of internet health information in OHCs. Patients’ eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information–seeking behavior, and perceived quality of internet health information in OHCs.

Conclusions

Results indicate that physician-patient communication, internet health information–seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients’ eHealth literacy to improve treatment efficiency; OHCs’ operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality.

Validation of the Chinese Version of the Body Image Acceptance and Action Questionnaire and the Mediating Role of Body Image Flexibility in the Relationship Between Body Dissatisfaction and Psychological Distress

The psychometric properties of the Chinese version of the Body Image Acceptance and Action Questionnaire (C-BI-AAQ) and its short form (C-BI-AAQ-5) were examined with a sample of Chinese undergraduates (n =1,068, 52.6% female). The factor structure, measurement reliability, measurement invariance across gender, and latent gender mean difference of the two scales were explored. Confirmatory factor analysis was used to examine the factor structure of the C-BI-AAQ and the C-BI-AAQ-5. The original one-factor structure was replicated for both the C-BI-AAQ and the C-BI-AAQ-5. Both the C-BI-AAQ and C-BI-AAQ-5 showed good internal consistency, test-retest reliability, and convergent and discriminant validity (e.g., relationship patterns in the expected directions with theoretically similar psychological flexibility, and with theoretically dissimilar body dissatisfaction, and psychological distress). The C-BI-AAQ-5 was shown to be equivalent to the C-BI-AAQ. Furthermore, strict measurement invariance across gender was confirmed for both the C-BI-AAQ and C-BI-AAQ-5, and latent mean difference tests showed that men had higher levels of body image flexibility than women. Thus, both the C-BI-AAQ and C-BI-AAQ-5 appear to be psychometrically sound instruments for use in the Chinese young adult population. In addition, body image flexibility measured by both the C-BI-AAQ and the C-BI-AAQ-5 fully mediated the relationship between body dissatisfaction and psychological distress.

An empowerment-psycho-behavioral program on neuropsychiatric symptoms in persons with mild cognitive impairment: Study protocol of a randomized controlled trial

AIMS

Neuropsychiatric symptoms (NPS) are highly prevalent among persons with mild cognitive impairment (PwMCI). However, the mainstay of treatments only focuses on cognitive training. This study develops an empowerment-psycho-behavioural programme to improve the NPS and other health outcomes of this preclinical cohort. The empirical effects and the participants' perception and experience of the programme will be explored.

DESIGN

This sequential mixed-method study comprises a single-blind randomized controlled trial and a qualitative study.

METHODS

This study will recruit 250 PwMCI from the community and randomize them to either the intervention group to receive a 13-week empowerment-psycho-behavioural programme which focuses on promoting cognitive coping and stress adaptation, or the control group to receive a health education programme which serves as an attention placebo with content unrelated to dementia. The primary outcome is NPS, and the secondary outcomes include cognitive function, subjective memory complaints and health-related quality of life. These outcomes will be measured at baseline, upon completing the programme and 4 weeks thereafter. A purposive sample of 30 participants from the intervention group will be interviewed for their engagement experience in the programme. This study received funding support in July 2020.

DISCUSSION

Given the high prevalence and detrimental effects of NPS on disease progression, effective management is yet to be determined. Underpinned by the Progressively Lowered Stress Threshold (PLST) Model, the empowerment-psycho-behavioural programme is designed. Results on the outcome-based evaluation and the patients' experience can advance the science in this under-addressed area.

IMPACT

This study enhances our understanding of the PLST Model in explaining the manifestations of NPS by the stress-coping disequilibrium at the early disease stage. It will shed important insight into the care management of MCI to attend both cognition function and psychological well-being in research and clinical context.

TRIAL REGISTRATION

This study is registered in the ClinicalTrials.gov (NCT04723667) and the HKU Clinical Trials Registry (HKUCTR-2915).

Family resilience is a protective buffer in the relationship between infertility-related stress and psychological distress among females preparing for their first in vitro fertilization-embryo transfer

The present study aimed to evaluate psychological distress and scrutinized whether family resilience plays a moderating role in the association between infertility-related stress and psychological distress among infertile females preparing for their first IVF-ET. A total of 492 infertile females completed self-reported measures including the Kessler 10 Psychological Distress Scale (K10), the fertility problem inventory (FPI), and the Family Resilience Assessment Scale (FRAS). The results showed 21 (65.2%) participants reported moderate or higher levels of psychological distress. While controlling for economic status, we found psychological distress to be positively linked to infertility-related stress (β=0.483, P<0.001), and negatively related to family resilience (β=-0.145, P=0.001). The simple slopes analysis showed that infertility-related stress had a weaker positive association with psychological distress for individuals at 1 SD (β = 0.443, P < 0.001) above the mean on family resilience compared to those at 1 SD (β = 0.537, P < 0.001) below the mean. Thus, it suggests that clinical practice should conduct family resilience-oriented interventions to facilitate family resilience among infertile females preparing for their first IVF-ET, with the goal to reduce psychological distress.

Short strides to important findings: A short interval longitudinal study of sleep quality, psychological distress and microstructure changes to the uncinate fasciculus in early adolescents

BACKGROUND

Developmental studies have shown adolescence is a period of ongoing white matter (WM) development, reduced sleep quality and the onset of many mental disorders. Findings indicate the WM development of the uncinate fasciculus (UF), a WM tract suggested to play a key role in mental disorders, continues throughout adolescence. While these studies provide valuable information, they are limited by long intervals between scans (1 to 4 years) leaving researchers and clinicians to infer what may be occurring between time-points. To allow inferences to be made regarding the impact that sleep quality may be having on WM development, longitudinal studies with much shorter between-scan intervals are required.

METHODS

The current study reports longitudinal data of self-reported sleep quality (PSQI), diffusion tensor imaging (DTI) measures of WM development and psychological distress (K10) for n = 64 early adolescents spanning the first twelve months (four time-points; Baseline, 4, 8, & 12 months) of the Longitudinal Adolescent Brain Study (LABS) study currently underway at the Thompson Institute.

RESULTS

Generalised Estimating Equation analysis showed a significant relationship between sleep quality and psychological distress over the four time-points. Reduced radial diffusivity and increased fractional anisotropy of the UF is also reported with increasing age suggesting that ongoing myelination is occurring. Adding sleep quality to the model, however, negatively impacted this myelination process.

CONCLUSION

These findings represent an important step towards elucidating how sleep, psychological distress and maturation of the UF may co-develop during early adolescence.

Analysis of Pediatric Oncology Nursing Research in Mainland China, 2008-2018

BACKGROUND

Up-to-date research from low- and middle-income countries is needed to inform local pediatric cancer nursing care and share best practices from these settings. Access to all current Chinese-language publications on pediatric oncology nursing research is limited because of a language barrier.

OBJECTIVE

The aim of this study was to document the volume, type of research study, and yearly and geographical distribution of published pediatric oncology nursing research in Mainland China and evaluate their content and quality.

METHODS

A systematic search was performed for published pediatric oncology research conducted by nurses in Mainland China (2008-2018), using 3 English databases and 3 Chinese databases. Included articles were evaluated using the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal for strength and quality of evidence.

RESULTS

A total of 133 articles were included: 106 in Chinese and 27 in English. Most studies showed level III evidence (88/133) and were rated as good quality (81/133). The most frequently researched topics were psychosocial care, clinical nursing practice, and psychometric testing, which accounted for 63.2% of all publications.

CONCLUSIONS

Progress in pediatric oncology nursing research capacity among Mainland China is promising. To gain higher-quality evidence and make existing evidence transferable for nursing practice, optimization of specific research topics is still needed.

IMPLICATIONS FOR PRACTICE

In Mainland China, developing interventions to address the symptoms of children with cancer and caregivers' psychosocial issues based on local nursing research should be prioritized. Some synthesized findings of this review may serve as guidance for the future of pediatric oncology nursing science in similar settings.

Associations between sleep quality and psychological distress in early adolescence

Background: Although numerous studies have reported an association between sleep quality and mental health, few have focused on this association exclusively in early adolescence. Targeting this age group is vital as many mental illnesses first emerge during adolescence and remain a significant burden throughout life. Method: In the current study n = 60 participants aged 12 years completed the Pittsburgh Sleep Quality Index (PSQI) and Kessler Psychological Distress Scale (K10). Results: Consistent with previous findings, bivariate correlations revealed significant positive linear relationships between K10 total score and (i) PSQI total score; (ii) sleep quality; (iii) daytime dysfunction; and (iv) sleep disturbance. However, contrary to previous findings, there was no significant correlation between K10 scores and sleep duration. Conclusion: The association between sleep quality and psychological distress in early adolescents provides some important clues about the role that sleep may play in predicting the onset of anxiety and depressive disorders. Longitudinal studies should be undertaken to investigate age-related changes in sleep and psychological distress.

The Impact of Treatment-Related Internet Health Information Seeking on Patient Compliance

Background: Patients are increasingly using technology to seek health information, particularly on treatments. Treatment-related internet health information-seeking behavior may have impact on patients' trust in their physicians and the patient-physician relationship. Therefore, understanding the impacts of treatment-related internet health information-seeking behavior on patient-physician relationship, especially patient compliance, from the perspective of trust is important. Methods: The established research model has two independent variables (emerging and mature treatment-related internet health information seeking), two mediators (cognition- and affect-based trust), and one dependent variable (patient compliance). All variables were measured using previously validated multiple-item scales. We collected data through a web-based questionnaire survey in China and obtained 336 valid responses. The questionnaire validity rate was 89.6% (336/375), and reliability and validity were acceptable. Finally, we used confirmatory factor analysis and structural equation modeling to test the hypotheses and develop the research model. Results: Cognition- and affect-based trust had a direct positive impact on patient compliance. Cognition-based trust had a direct positive impact on affect-based trust. Mature treatment-related internet health information seeking had a significant positive impact on patient compliance through patients' cognition- and affect-based trust in their physicians. However, the emerging treatment-related internet health information seeking indicated a nonsignificant impact on patients' cognition- and affect-based trust in their physicians. Conclusions: Providing patients with access to treatment-related internet health information will not have a negative impact on the patient-physician relationship. Instead, encouraging patients to seek treatment-related health information online can improve patient compliance. Physicians can also learn much about health information related to emerging treatments to enhance their professionalism and reliability.

The role of gender and self-esteem as moderators of the relationship between stigma and psychological distress among infertile couples

To determine if perceived stigma is positively associated with psychological distress, and examine if self-esteem has a moderating effect on the relationship between stigma and psychological distress among infertile Chinese couples. 369 infertile couples completed questionnaires including socio-demographic and clinical characteristics, stigma, self-esteem, and psychological distress. Stigma had a significant, positive association with psychological distress (r = 0.461, P < 0.01). Self-esteem moderated the association between stigma and psychological distress differently for men compared to women. Stigma had a positive, moderate association with psychological distress in men with high self-esteem compared to men with low self-esteem (t = 3.232, P < 0.01). However, there was no significant difference in the relationship between stigma and psychological distress between women with high and low self-esteem, tests of the simple slopes showed that non-significant difference of slopes between the two groups (t = -0.017, P = 0.987). The results indicate that self-esteem buffers the net effect of stigma on psychological distress in men but not women. Future research should focus on interventions that use self-esteem as a way to decrease the negative association of stigma with psychological distress, especially among men who are infertile and have low self-esteem.

Patterns of negative emotional eating among Chinese young adults: A latent class analysis

There is ample evidence suggesting that negative emotional eating is closely related to disordered eating behaviors. However, most previous studies on the topic focused only on emotional over-eating, but neglected emotional under-eating. Moreover, previous studies also mainly used variable-oriented methods by reducing negative emotional eating to a single dimension, which limits our understanding of individual differences in negative emotional eating. In this study, we used a person-oriented approach, latent class analysis (LCA), to examine the negative emotional eating patterns and to characterize these patterns in a sample of 1,068 Chinese young adults (52.6% females, aged 17-24 years). Negative emotional eating was measured by the Emotional Over-Eating and Emotional Under-Eating subscales of the Adult Eating Behavior Questionnaire. Four patterns, namely, "non-emotional eating" (38.9%), "emotional over- and under-eating" (15.4%), "emotional over-eating" (14.7%), and "emotional under-eating" (31.0%), were identified. Sex and BMI were found to be statistically significant predictors for negative emotional eating patterns. The identified four patterns showed significant differences in eating disorder symptoms and psychological distress. Particularly, participants in emotional over- and under-eating exhibited the highest level of eating disorder symptoms and psychological distress. Overall, this study identified four distinct negative emotional eating patterns, among which, the emotional over- and under-eating was the most problematic. Future studies regarding negative emotional eating and its impact on mental health may benefit from focusing not only on individuals with emotional over-eating, but also on those showing a mixed pattern of negative emotional eating.

Mental distress in orthodontic patients during the coronavirus disease 2019 pandemic

Introduction

The ongoing coronavirus disease 2019 (COVID-19) outbreak impacts the mental health of patients, health workers, and the public. The level of impact on the mental health of orthodontic patients in treatment is unknown. The objective of the study was to evaluate the mental health of orthodontic patients in China during the early stage of the pandemic.

Methods

An online survey was conducted on a convenience sample of anonymous participants. The questionnaire, in Chinese (Mandarin), comprised 5 sections. Sections 1-3 included demographic, epidemical, and orthodontic status of the patients. Section 4 assessed mental health-related to orthodontics. Section 5 was the Kessler-10 Mental Distress Scale. A total of 48 orthodontists were invited to distribute the questionnaires to their patients. Descriptive statistics, principal component analysis, K-means cluster analysis, and bivariate logistics regression analysis were performed with significance set at P <0.05.

Results

Questionnaires were collected from 558 patients (104 males, 354 females; mean age 24.78 ± 6.33 years). The prevalence of mental distress was 38% (174/458). Higher odds ratios were associated with female participants, missed appointments, and Hubei residence. The type of orthodontic appliance was associated with the anxiety of prolonged treatment duration. The manner of communication with patients regarding the postponement of appointments was associated with patients' concerns of prolonged treatment duration. The frequency of contact from dentists was associated with patients' independence.

Conclusions

Over one-third of orthodontic patients experienced mental distress during the pandemic. Multiple factors affected the level of anxiety of orthodontic patients, such as the type of orthodontic appliance, time since last dental visit, manner of communication with the orthodontist, and the localities of the pandemic progression.

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Thirty-eight percent of patients had orthodontic-related mental distress during the pandemic.

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Orthodontic patients in the epicenter revealed higher odds of mental distress.

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Orthodontists who contact patients personally might relieve their anxiety.

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Patients with invisible appliances felt less anxiety about the duration of treatment.

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The results could guide orthodontists from other countries with similar situations.

Investigating the association between sleep quality and diffusion-derived structural integrity of white matter in early adolescence

INTRODUCTION

Poor sleep quality has been linked to reduced neural connectivity through decreased white matter (WM) structural integrity. WM tract development has been shown to continue throughout adolescence with studies reporting positive correlations between diffusion-derived estimates of structural integrity and reduced sleep quality in adult samples. Few studies have investigated this relationship exclusively within a sample of young adolescents.

METHODS

N = 51 participants aged 12 years (M = 151.5 months, SD = 4 months) completed a self-report questionnaire which included the Pittsburgh Sleep Quality Index (PSQI) and underwent Diffusion Tensor Imaging (DTI) as part of their baseline assessment in the Longitudinal Adolescent Brain Study (LABS) being undertaken in Queensland, Australia. Fractional anisotropy (FA) were extracted using Tract-Based Spatial Statistics (TBSS) to investigate associations between sleep quality and WM integrity across the brain.

RESULTS

Significant correlations were found between the posterior limb of the internal capsule and the PSQI total sleep quality and sleep latency scores. There was also a significant difference in sleep duration between male and female participants.

CONCLUSION

These findings provide an important insight of the impact that sleep may have on early adolescent WM development. Ongoing longitudinal assessment of sleep on WM development across adolescence is likely to provide further important information about how WM maturation relates to variations in sleep quality as circadian rhythm changes occur during middle and late adolescence.

Psychometric evaluation of the modified Kessler seven-item version (K7) for measuring psychological distress using Rasch analysis: a cross-sectional study in a rural district of Bangladesh

OBJECTIVES

This investigation expected to validate the psychometric properties of the modified seven-item Kessler psychological distress scale (K7) for measuring psychological distress in healthy rural population of Bangladesh.

DESIGN

Cross-sectional study.

SETTING

Narail district, Bangladesh.

PARTICIPANTS

A random sample of 300 adults of age 18-90 years were recruited. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application known as CommCare.

OUTCOME MEASURE

Validation of the K7 was the major outcome. Sociodemographic factors were measured to assess for Differential Item Functioning to check if the tool functions equally in different factors. Rasch analysis was carried out for the validation of the K7 scale in the healthy rural population of Bangladesh. RUMM2030 was used for the analyses.

RESULTS

Results showed good overall fit, as indicated by a non-significant item-trait interaction (χ²=44.54, df=28, p=0.0245) compared with a Bonferroni adjusted p value of 0.007. Both item fit (mean=0.30, SD 1.22) and person fit residuals (mean=-0.18, SD 0.85) showed perfect fit. Reliability was very good as indicated by a Person Separation Index=0.85 and Cronbach's alpha=0.89. All individual items were ordered thresholds. The K7 scale showed adequate reliability, unidimensionality and was free from local dependency. The K7 scale also showed similar functioning for adults and older adults, males and females, no education and any level of education, and at least some financial instability versus no financial instability.

CONCLUSIONS

Validation of K7 scale confirmed that the tool is suitable for measuring psychological distress among the rural Bangladeshi population. Further research should validate the K7 scale in different rural settings in Bangladesh to determine a valid cut-off score for assessment of severity levels of psychological distress. The K7 scale should also be tested in other developing countries where sociodemographic characteristics are similar to those of Bangladesh.

Exploring the Effects of Patient Activation in Online Health Communities on Patient Compliance

Background: Online health communities (OHCs) are one of the developments related to online health. Patient compliance plays a vital role in improving health treatment outcomes. Patient activation is associated with patient activities in OHCs, such as physician-patient communication and health information seeking. In other words, OHCs influence patient compliance. Therefore, identifying the relationship between patient activation in OHCs and patient compliance is important for improved health outcomes. Methods: This study established a research model consisting of one independent variable (patient activation), four mediators (physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy), one dependent variable (patient compliance) and four control variables (gender, age, education level, and status). Data were obtained through a web-based survey, involving a total of 387 valid participants in China. These data were analyzed and tested through structural equation modeling and partial least squares. Results: Patient activation positively affects patient compliance through the mediation of physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy. Perceived information asymmetry has no direct effect on patient compliance. However, perceived information asymmetry affects patient compliance through the mediation of e-health literacy. Conclusions: Patient compliance is significantly affected by patient activation. Thus, physicians can achieve higher patient compliance by improving patient activation. Guaranteeing and improving the information quality in OHCs is essential for physicians and OHCs operators. Physicians should pay extra attention in cultivating patients' e-health literacy through communications and health information-seeking behaviors to further improve patient compliance.

An Empirical Study on Patients' Acceptance of Physician-Patient Interaction in Online Health Communities

In China, the utilization of medical resources is contentious, and a large of hospitals are seriously congested because of the huge population and uneven distribution of medical resources. Online health communities (OHCs) provide patients with platforms to interact with physicians and to get professional suggestions and emotional support. This study adopted the unified theory of acceptance and use of technology to identify factors influencing patients’ behavioral intention and usage behavior when interacting with physicians in OHCs. An investigation involving 378 valid responses was conducted through several Chinese OHCs to collect data. Confirmatory factor analysis and structural equation modelling were utilized to test hypotheses. Both the reliability and validity of the scales were acceptable. All five hypotheses were supported, and behavioral intention played a significant mediating role between independent variables and dependent variables. This study clarified the mechanism by which performance expectancy, effort expectancy, social influence and attitude toward using technology affect usage behavior through the mediation of behavioral intention in OHCs. These findings suggest that OHCs can change the actions of websites such as adopting some incentives to promote patients’ intention of interaction. Physicians should understand patients’ actual attitudes toward OHCs and try to guide patients in their interactions, improving the quality of physician–patient interaction.

Relationships between Stigma, Social Support, and Distress in Caregivers of Chinese Children with Imperforate Anus: A Multicenter Cross-Sectional Study

PURPOSE

This study was conducted to explore the relationships between stigma, social support, and distress in caregivers of children with imperforate anus (IA) and determine whether social support mediates the relationship between stigma and distress.

DESIGN AND METHODS

This cross-sectional study was conducted in three tertiary children's hospitals in Eastern China. Primary caregivers completed the Social Support Scale and the Chinese versions of the Parent Stigma Scale and Kessler Psychological Distress Scale, and provided their demographic information. The children's demographic and clinical data were also collected. The hypothesized relations were explored using structural equation modeling via the bootstrap method.

RESULTS

A total of 229 caregivers were enrolled. Distress was positively associated with stigma (r = 0.396, P < 0.01) and negatively associated with social support (r = -0.413, P < 0.01) in all dimensions (r = 0.314-0.346, P < 0.01). Stigma was also negatively correlated with social support (r = 0.280, P < 0.01). Furthermore, social support could partially mediate the relationship between stigma and distress (b = 0.135; 95% confidence interval: 0.072, 0.233).

CONCLUSIONS

Stigma can increase caregivers' distress, while social support can reduce it. Stigma can also negatively influence caregivers' social support. Therefore, stigma should be mitigated to enhance caregivers' social support and decrease their distress.

PRACTICE IMPLICATIONS

The study findings may aid in the identification of the psychological status of caregivers of children with IA, and also inform targeted intervention programs.

Psychological Distress and Risk of Myocardial Infarction and Stroke in the 45 and Up Study

Background The interplay between mental and physical health remains poorly understood. We investigated whether psychological distress is associated with risk of myocardial infarction (MI) and stroke in a population-based prospective study. Methods and Results We included participants without prior stroke/MI from the New South Wales 45 and Up Study. We categorized baseline psychological distress as low, medium, and high/very high on the 10-item Kessler Psychological Distress scale and identified stroke and MI through linkage to hospital admission and mortality records. We obtained sex and age-stratified adjusted and unadjusted hazard ratios for the association between psychological distress and MI and stroke. We investigated for interaction between psychological distress and each of age and sex. Among 221 677 participants, 16.2% and 7.3% had moderate and high/very high psychological distress at recruitment, respectively. During 4.7 (±0.98 SD) years of follow-up, 4573 MIs and 2421 strokes occurred. Absolute risk of MI and stroke increased with increasing psychological distress level. In men aged 45 to 79 years, high/very high versus low psychological distress was associated with a 30% increased risk of MI (fully adjusted hazard ratios, 1.30; 95% CI, 1.12-1.51), with weaker estimates in those aged ≥80 years. Among women, high/very high psychological distress was associated with an 18% increased risk of MI (adjusted hazard ratio, 1.18; 95% CI, 0.99-1.42) with similar findings across age groups. In the age group of participants aged 45 to 79 years, high/very high psychological distress and male sex had a supra-additive effect on MI risk. Similar estimates were observed for stroke, with high/very high psychological distress associated with a 24% and 44% increased stroke risk in men and women, respectively, with no evidence of interaction with age or sex. Conclusions Psychological distress has a strong, dose-dependent, positive association with MI and stroke in men and women, despite adjustment for a wide range of confounders.

Impact of Physician-Patient Communication in Online Health Communities on Patient Compliance: Cross-Sectional Questionnaire Study

Background

In China, the utilization of medical resources is tense, and most hospitals are highly congested because of the large population and uneven distribution of medical resources. Online health communities (OHCs) play an important role in alleviating hospital congestions, thereby improving the utilization of medical resources and relieving medical resource shortages. OHCs have positive effects on physician-patient relationships and health outcomes. Moreover, as one of the main ways for patients to seek health-related information in OHCs, physician-patient communication may affect patient compliance in various ways. In consideration of the inevitable development of OHCs, although they have several shortcomings, identifying how physician-patient communication can impact patient compliance is important to improve patients’ health outcomes through OHCs.

Objective

This study aimed to investigate the impact of physician-patient communication on patient compliance in OHCs through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance, using an empirical study based on the self-determination theory.

Methods

A research model was established, including 1 independent variable (physician-patient communication), 3 mediators (perceived quality of internet health information, decision-making preference, and physician-patient concordance), 1 dependent variable (patient compliance), and 4 control variables (age, gender, living area, and education level). Furthermore, a Web-based survey involving 423 valid responses was conducted in China to collect data, and structural equation modeling and partial least squares were adopted to analyze data and test the hypotheses.

Results

The questionnaire response rate was 79.2% (487/615) and the validity rate was 86.9% (423/487); reliability and validity are acceptable. The communication between physicians and patients in OHCs positively affects patient compliance through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Moreover, physician-patient communication exhibits similar impacts on the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Patients’ decision-making preference shows the weakest impact on patient compliance compared with the other 2 mediators. Ultimately, all 3 mediators play a partially mediating role between physician-patient communication and patient compliance.

Conclusions

We conclude that physician-patient communication in OHCs exhibits a positive impact on patient compliance; thus, patient compliance can be improved by guiding physician-patient communication in OHCs. Furthermore, our findings suggest that physicians can share high-quality health information with patients, discuss benefits, risks, and costs of treatment options with patients, encourage patients to express their attitudes and participate in health-related decision making, and strengthen the emotional connection with patients in OHCs, thereby decreasing patients’ misunderstanding of information and increasing concordance between physicians and patients. OHCs are required to not only strengthen the management of their published health information quality but also understand users’ actual attitudes toward information quality and then try to reduce the gap between the perceived and actual quality of information.

Impact of Personal Trust Tendency on Patient Compliance Based on Internet Health Information Seeking

Background: Personal trust tendency is an individual characteristic that can affect one's evaluation of others, behavior and its related outcomes. It may significantly affect one's health information seeking behavior and compliance. Therefore, this article aims at figuring out how personal trust tendency influences patient compliance through the internet health information seeking and patient satisfaction with it. Methods: Data were collected from 336 valid participants through an online survey in China. There are two independent variables: (1) cognition-based trust tendency and (2) affect-based trust tendency, three intervening variables (emerging internet health information seeking, conservative internet health information seeking, and satisfaction with internet health information), one dependent variable (patient compliance), and control variables. We performed confirmative factor analysis and structural equation modeling to test the hypotheses. Results: The cognition- and affect-based trust tendency positively affects patient compliance through the mediation of emerging and conservative internet health information seeking and satisfaction with internet health information. Surprisingly, strong positive relationships between affect-based trust tendency and emerging and conservative internet health information seeking were found, which are contrary to our initial hypothesis. Conclusions: Health information is considerably important when regarding health-related issues for individuals with cognition- and affect-based trust tendency. Physicians should encourage patients to seek health information on the internet and guide them to use internet health information that suits them. Information exchange and correlations should be involved in doctor-patient interactions. By following the suggestions just cited, better patient compliance can likely be obtained.

The Impact of Individuals' Attitudes Toward Health Websites on Their Perceived Quality of Health Information: An Empirical Study

Background: A growing number of patients have increasingly used health websites to search and gather health information. Nevertheless, few studies have focused on the driving factors of internet health information quality from the perspective of psychology. Accordingly, this study explores how the attitudes of individuals toward health websites affect their perceived quality of internet health information through the mediation of seeking behavior on treatment information by employing regulatory focus theory. Materials and Methods: We defined six hypotheses that both trust in health websites and expectancy of health websites have a positive impact on emerging and conservative treatment-related online health information seeking; emerging treatment seeking has a negative impact on internet health information quality; and conservative treatment seeking has a positive impact on internet health information quality. Emerging treatment refers to some therapies based on new technologies or research, which is barely used, whereas conservative treatment is more common among the medical field. An online survey involving 336 valid participants was conducted in China. In the research model, all variables were measured using multiple-item scales, and structural equation modeling was employed for testing the hypotheses. Results: The expectancy of health websites significantly affects conservative and emerging treatment-related online health information seeking, but trust in health websites does not. Moreover, trust in health websites strongly affects the expectancy of health websites, and attitudes toward health websites have a strong effect on conservative treatment-related online information seeking. The effect of conservative treatment-related online health information seeking was considerably larger than that of emerging treatment-related online health information seeking on perceived quality of internet health information. Conclusions: From the perspective of health websites operators and public hospitals, conservative treatment and online service might be worth providing and improving. Cooperation between health websites and hospitals might be a good choice.

Mature or Emerging? The Impact of Treatment-Related Internet Health Information Seeking on Patients' Trust in Physicians

Years of clinical trials have proven the maturity and safety of certain treatments, however, some of these mature treatments may not be highly effective. Several treatments have emerged through technological innovations, but their long-term safety, efficacy, and adverse effects remain unknown. At present, many patients seek information related to their treatments on the Internet, which may impact their attitudes towards different treatments and their trust in physicians. In this study, a research model was developed to examine how patients’ trust in their physicians is influenced by related online information on mature or emerging treatments. The hypotheses were tested using confirmatory factor analysis (CFA) and structural equation modelling (SEM). A total of 336 valid responses were collected through an online survey. Mature treatments related health information was found to significantly improve patients’ trust. Thus, physicians should pay more attention to mature treatments, and encourage their patients to seek related information online. Moreover, the quality of online information should be developed further to increase patients’ satisfaction. Physicians should also consider their patients’ psychological safety in communication with patients to strengthen their trust.

Relationship Between Internet Health Information and Patient Compliance Based on Trust: Empirical Study

Background

The internet has become a major mean for acquiring health information; however, Web-based health information is of mixed quality and may markedly affect patients’ health-related behavior and decisions. According to the social information processing theory, patients’ trust in their physicians may potentially change due to patients’ health-information-seeking behavior. Therefore, it is important to identify the relationship between internet health information and patient compliance from the perspective of trust.

Objective

The objective of our study was to investigate the effects of the quality and source of internet health information on patient compliance using an empirical study based on the social information processing theory and social exchange theory.

Methods

A Web-based survey involving 336 valid participants was conducted in China. The study included independent variables (internet health information quality and source of information), 2 mediators (cognition-based trust [CBT] and affect-based trust [ABT]), 1 dependent variable (patient compliance), and 3 control variables (gender, age, and job). All variables were measured using multiple-item scales from previously validated instruments, and confirmative factor analysis as well as structural equation modeling was used to test hypotheses.

Results

The questionnaire response rate was 77.16% (375/486), validity rate was 89.6% (336/375), and reliability and validity were acceptable. We found that the quality and source of internet health information affect patient compliance through the mediation of CBT and ABT. In addition, internet health information quality has a stronger influence on patient compliance than the source of information. However, CBT does not have any direct effect on patient compliance, but it directly affects ABT and then indirectly impacts patient compliance. Therefore, the effect of ABT seems stronger than that of CBT. We found an unexpected, nonsignificant relationship between the source of internet health information and ABT.

Conclusions

From patients’ perspective, internet health information quality plays a stronger role than its source in impacting their trust in physicians and the consequent compliance with physicians. Therefore, patient compliance can be improved by strengthening the management of internet health information quality. The study findings also suggest that physicians should focus on obtaining health information from health websites, thereby expanding their understanding of patients’ Web-based health-information-seeking preferences, and enriching their knowledge structure to show their specialization and reliability in the communication with patients. In addition, the mutual demonstration of care and respect in the communication between physicians and patients is important in promoting patients’ ABT in their physicians.

Prevalence and correlates of psychological stress among teachers at a national key comprehensive university in China

The present study investigated the levels of stress and associated factors in university teachers to provide a foundation for exploring strategies for preventing teacher stress. We conducted a cross-sectional survey using a composite questionnaire with the 10-item Kessler Psychological Distress Scale (K10) as the core at a comprehensive university located in northeast China. The number of effective respondents was 603. The average K10 score was 22.87 ± 8.18, and the positive rate (K10 > 21) was 54.06%. University teachers generally experienced high stress levels. The highest stress levels were observed in teachers whose academic title was lecturer or associate professor, according to a comprehensive consideration of several factors, including age, income, and teaching tenure. Teachers of engineering and agriculture and forestry have lower stress levels than teachers of other subjects. A lack of research funding and lack of routine rest on the weekends or on statutory holidays may increase teachers' stress, whereas regular exercise may reduce stress. Academic title promotion, scientific research pressure, and lack of routine breaks and physical exercise were the main sources of stress.

Cross-cultural adaptation and psychometric properties of the Kessler Scale of Psychological Distress to a traumatic brain injury population in Swahili and the Tanzanian Setting

BACKGROUND

To evaluate the psychometric properties of a Swahili version of the Kessler Psychological Distress scale in an injury population in Tanzania.

METHODS

Swahili version of the Kessler Psychological Distress scale was developed by translation and back-translation by a panel of native speakers of both English and Swahili. The translated instruments were administered to a sample of Tanzanian adults from a traumatic brain injury registry. The content validity, construct validity, reliability, internal structure, and external reliability were analyzed using standard statistical methods.

RESULTS

Both translated versions of the Kessler Psychological Distress scale were found to be reliable (>0.85) for all tested versions. Confirmatory factor analysis of one and two factor solution showed adequate results. Kessler Psychological Distress scale scores were strongly correlated to depression and quality of life (R>0.50).

CONCLUSIONS

This paper presents the first Swahili adaptations of the Kessler Psychological Distress scale as well as the first validation of these questionnaires in Tanzania. The instrument was found to have acceptable psychometric properties, resulting in a new useful tool for medical and social research in this setting.

The Kessler psychological distress scale: translation and validation of an Arabic version

Background

The Kessler Psychological Distress Scale has been widely used in assessing psychological distress among general and clinical populations from different cultural backgrounds. To our knowledge, however, researchers have not yet validated any translated versions in Arabic. The purpose of this study was to test the reliability and validity of Arabic translations of the ten item (K10) and six item (K6) versions among public sector employees in the Occupied Palestinian Territories.

Methods

As part of a larger research project on life satisfaction, researchers collected data from 234 Palestinian social workers in June and July of 2016. The survey included several mental health measures, including the K10, which were translated from English to Arabic by an experienced language expert. In the current study, we tested reliability by measuring internal consistency using Cronbach’s alpha coefficient. Next, we assessed factor structure using variance-covariance matrix with maximum likelihood estimation. Confirmatory factor analysis was performed to examine three competing models: unidimensional K10 model, unidimensional K6 model and two-factor K6 model. Fit indices and parameter estimates were reported. Last, convergent validity was examined by assessing correlations with Generalized Anxiety Disorder (GAD-7) and Somatic Symptoms Scale (SSS-8).

Results

The mean scores for the K6 and K10 were, respectively, 12.87 (SD = 4.02) and 21.8 (SD = 6.7), indicative of mild to moderate levels of distress. Scale reliability analysis showed satisfactory results on both K6 and K10 versions (Cronbach’s α = .81 (K6) and .88 (K10)). Among three competing models, the two-factor K6 scale demonstrated the best model fit with high factorial correlations (r = .60, p < .001). Moreover, the K6 has high convergent validity with GAD-7 (r = .66, p < .001) and SSS-8 (r = .61, p < .001).

Conclusion

Results indicated that the translated version of the two-factor K6 scale is a valid and reliable measurement of psychological distress. Our findings suggest that practitioners and researchers can use this instrument in screening and assessing psychological symptoms with Arabic-speaking populations.