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Fogarty A, Brown S, Gartland D, McMahon G, FitzPatrick K, Seymour M, Kimber M, MacMillan H, Giallo R. Patterns of intimate partner violence exposure across the first 10 years of life and children's emotional-behavioural outcomes at 10 years. CHILD ABUSE & NEGLECT 2024; 153:106814. [PMID: 38701670 DOI: 10.1016/j.chiabu.2024.106814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/14/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Childhood exposure to intimate partner violence (IPV) is associated with emotional-behavioural problems. However, little is known about children's emotional-behavioural outcomes following exposure to different long-term patterns of IPV. OBJECTIVE The current study aimed to investigate the emotional-behavioural functioning of children at 10 years of age following exposure to different patterns of IPV across the first 10 years of life. PARTICIPANTS AND SETTING Data for this study was drawn from the Mothers' and Young People's Study- a longitudinal study of 1507 first time mothers and their first born child. METHODS Women were recruited during pregnancy from six public hospitals in Victoria, Australia. Data was collected during pregnancy, and at one, four and ten years postpartum. Four patterns of IPV exposure were previously identified: (a) minimal IPV exposure; (b) early IPV; (c) Increasing IPV; and (d) persistent IPV. Logistic regression was used to assess associations between IPV exposure and emotional-behavioural outcomes. RESULTS Exposure to early, increasing, or persistent IPV was associated with increased odds of experiencing emotional-behavioural difficulties (OR 2.15-2.97). Children exposed to a persistent pattern of IPV experienced over 6 times the odds of conduct problems (OR = 6.15 CI = 2.3-16.44). CONCLUSIONS Children exposed to early, increasing, or persistent IPV experienced increased odds of emotional-behavioural problems at age 10, regardless of the duration or type of violence they were exposed to. However, children exposed to persistent IPV across childhood appeared to experience the highest odds of emotional-behavioural difficulties.
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Affiliation(s)
- Alison Fogarty
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia.
| | - Stephanie Brown
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; Department of General Practice, University of Melbourne, 780 Elizabeth St, Melbourne 3010, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia
| | - Grace McMahon
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia
| | - Kelly FitzPatrick
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia
| | - Monique Seymour
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia
| | - Melissa Kimber
- Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Faculty of Health Sciences, Oxford Centre for Child Studies, Hamilton, Ontario, Canada
| | - Harriet MacMillan
- Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Faculty of Health Sciences, Oxford Centre for Child Studies, Hamilton, Ontario, Canada; Pediatrics, Faculty of Health Sciences McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia
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Cotter G, Morreale K, Valdegas A, Fish M, Beebe R, Grasso D, Stover C, Tseng WL. Associations between trauma exposure and irritability within the family unit: a network approach. J Child Psychol Psychiatry 2024. [PMID: 38710637 DOI: 10.1111/jcpp.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Pediatric irritability is a pervasive psychiatric symptom, yet its etiology remains elusive. While trauma exposure may contribute to the development of irritability, empirical research is limited. This study examined the prevalence of irritability among trauma-exposed children, identified factors that differentiate trauma-exposed children with and without irritability, and employed a network analysis to uncover associations between irritability and trauma exposure in the family unit. METHODS Sample included 676 children (56.3% male, mean age = 9.67 ± 3.7 years) and their parents referred by the Connecticut Department of Children and Families to Fathers for Change - a psychotherapy intervention designed to reduce intimate partner violence (IPV) and child maltreatment. Child's trauma exposure, post-traumatic stress disorder (PTSD) symptoms, and irritability were assessed pre-intervention using self- and caregiver-report. Parents self-reported their childhood and adulthood trauma exposures, PTSD symptoms, irritability, psychopathology, and IPV. RESULTS Across caregiver- and child-reports, 16%-17% of children exhibited irritability. Irritable children experienced greater trauma exposure, interpersonal violence, emotional abuse, and PTSD severity. They had caregivers, particularly mothers, with greater trauma histories, IPV, and psychopathology. Network analysis revealed 10 nodes directly correlated to child's irritability including child's PTSD severity, parental IPV (specifically psychological violence), and parental psychopathology. CONCLUSIONS Results provide initial empirical evidence that pediatric irritability is linked to trauma exposure, suggesting trauma histories be considered in the diagnosis and treatment of irritability. Interventions addressing caregiver trauma, IPV, and psychopathology may ameliorate pediatric irritability. Future studies could benefit from adopting network approaches with longitudinal or time series data to elucidate causality and points of intervention.
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Affiliation(s)
- Grace Cotter
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
- Northeastern University, Boston, MA, USA
| | - Kristina Morreale
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | | | - Meghan Fish
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Rebecca Beebe
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Damion Grasso
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Carla Stover
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
| | - Wan-Ling Tseng
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
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Chen XY, Shi X, Li C, Fan F. Longitudinal associations between social support trajectories and quality of life mediated by depressive symptoms: A 10-year cohort study of Wenchuan earthquake. J Adolesc 2023; 95:1702-1714. [PMID: 37674388 DOI: 10.1002/jad.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Previous studies on associations between social support and quality of life (QoL) have usually employed a variable-centered approach, without considering individual variances in time-varying changes in social support. This study explores trajectories of social support and whether depressive symptoms mediate associations between social support trajectories and QoL 10 years after an earthquake. METHODS Seven hundred and forty-four Chinese adolescents exposed to the Wenchuan earthquake were surveyed on social support at 6-, 18-, and 24-months and depressive symptoms at 30-months postearthquake (T30m ). They provided valid data on QoL after 10 years of the earthquake (T10y ). The latent class growth analysis was used to estimate social support trajectories. Mediation analysis was then conducted to test whether depressive symptoms at T30m mediated associations between social support trajectories and QoL at T10y . RESULTS Three trajectories of social support were identified: low decreasing (31.6%), moderate decreasing (55.4%), and persistent high (13.0%) groups. Depressive symptoms significantly mediated the effects of social support trajectories (relative to the low support trajectory) on future QoL (95% CIs: 0.70-1.78 and 1.41-3.37 for moderate decreasing and persistent high groups, respectively). CONCLUSIONS Social support shows individual differences over time. Moderate and high social support trajectories improve 10-year QoL partly by reducing depressive symptoms. Therefore, interventions aimed at enhancing social support and reducing depressive symptoms may be more effective in enhancing QoL in the aftermath of disasters.
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Affiliation(s)
- Xiao-Yan Chen
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Xuliang Shi
- College of Education, Hebei University, Hebei, China
| | - Chao Li
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Fang Fan
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
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Fogarty A, Brown SJ, Gartland D, Mensah F, FitzPatrick KM, Giallo R. Mental health trajectories of women experiencing differing patterns of intimate partner violence across the first 10 years of motherhood. Psychiatry Res 2023; 325:115261. [PMID: 37244158 DOI: 10.1016/j.psychres.2023.115261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 05/29/2023]
Abstract
Intimate partner violence is commonly experienced by women and associated with poor mental health outcomes. Evidence regarding the patterns of IPV across time, and the associated long term course of depressive symptoms is lacking. The current study aimed to (a) identify patterns of physical and emotional IPV experienced by women over the 10 years since having their first child, and (b) identify trajectories depressive symptoms across the 10-year period for each pattern of IPV exposure. Data was drawn from the Mothers' and Young People's Study (MYPS), a longitudinal study of 1507 mothers and their first born child. Data was collected during pregnancy and at one, four, and ten years postpartum. Using Latent Class Analysis, four distinct classes of IPV were identified: (1) Minimal IPV, (2) Early IPV exposure, (3) Increasing IPV, and (4) Persistent IPV. Latent growth modelling revealed that all classes characterised by some IPV exposure experienced elevated trajectories of depressive symptoms in comparison to the minimal IPV class. Those experiencing increasing and persistent IPV experienced the most severe course of depressive symptoms.
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Affiliation(s)
- Alison Fogarty
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia.
| | - Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; Department of General Practice, University of Melbourne, 780 Elizabeth St, Melbourne 3010, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia
| | - Fiona Mensah
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia
| | - Kelly M FitzPatrick
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong, Australia
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FitzPatrick KM, Brown S, Hegarty K, Mensah F, Gartland D. Visualising Patterns in Women's Experiences of Intimate Partner Violence in the First 10 years of Motherhood. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:3055-3087. [PMID: 35642495 DOI: 10.1177/08862605221104518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Intimate partner violence (IPV) can involve patterns of physical, sexual and emotional abuse. Women typically experience physical IPV in combination with emotional IPV, while emotional IPV is often experienced in the absence of other types of IPV. There is very little known about women's experiences of these different types of IPV over time. The primary aim of this paper is to describe patterns in women's individual experiences of physical and/or emotional IPV across the first 10 years of motherhood. Data were drawn from a prospective pregnancy cohort of 1507 first-time mothers in Melbourne, Australia. Emotional, physical, and combined physical and emotional IPV were reported in the first, fourth and tenth year of motherhood using the Composite Abuse Scale. The overall prevalence of each type of IPV remained consistent across the three time-points, with emotional IPV alone being the most prevalent. There was substantial variability in women's experiences of IPV over time and there was no common progression from one type of IPV to another. Women were more likely to report IPV at more than one time-point if they experienced combined physical and emotional IPV, while for women who reported emotional or physical IPV alone this was more likely to be at a single time-point. A number of socio-demographic characteristics in early pregnancy were associated with a higher risk of reporting IPV at all three time-points, including being unemployed (RRR = 3.6; 95% CI: 2.1, 6.2) and being aged 18-24 years (RRR = 3.1; 95% CI: 1.8, 5.4). Knowledge of the variability and persistence of IPV in the first 10 years of motherhood, and factors associated with these experiences, can help tailor effective health and social service responses.
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Affiliation(s)
- Kelly M FitzPatrick
- 34361Murdoch Children's Research Institute, Melbourne, VIC, Australia
- 2281University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Brown
- 34361Murdoch Children's Research Institute, Melbourne, VIC, Australia
- 2281University of Melbourne, Melbourne, VIC, Australia
| | - Kelsey Hegarty
- 2281University of Melbourne, Melbourne, VIC, Australia
- Royal Women's Hospital, Melbourne, VIC, Australia
| | - Fiona Mensah
- 34361Murdoch Children's Research Institute, Melbourne, VIC, Australia
- 2281University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Deirdre Gartland
- 34361Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Chen XY, Lo CKM, Ho FK, Leung WC, Ip P, Chan KL. Changing Patterns of Intimate Partner Violence against Pregnant Women: A Three-Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14397. [PMID: 36361277 PMCID: PMC9656119 DOI: 10.3390/ijerph192114397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Intimate partner violence (IPV) against pregnant women adversely impacts women's and infants' health. This study aims to provide longitudinal evidence regarding how pregnant women's exposure to IPV changes over time. Additionally, we examine the risk and protective factors associated with these changes. In total, 340 pregnant women were recruited from an antenatal clinic in Hong Kong. IPV experiences and health conditions were assessed at pregnancy and at both 4 weeks and 3 years after childbirth. The women also reported adverse childhood experiences (ACEs), their family support, and perceived partner involvement. We found IPV prevalence among the study sample decreased from 22.9% before pregnancy to 13.5% during pregnancy, 14.7% at 4 weeks after childbirth, and 11.8% at 3 years after childbirth. We further found three types of IPV: 11.8% of women had a violent relationship (VR) persistently over time from pregnancy to 3 years after childbirth, 20.6% experienced decreased IPV (DVR), and 67.6% reported a nonviolent relationship (NVR) throughout the study period. VRs were associated with more severe mental health problems and higher ACEs. Family support and partner involvement may be protective factors for decreased IPV. Our present findings highlight the importance of identifying different IPV types over time to provide targeted intervention to the most vulnerable groups.
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Affiliation(s)
- Xiao Yan Chen
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Camilla K. M. Lo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Frederick K. Ho
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK
| | - Wing Cheong Leung
- Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ko Ling Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Wang X, Yin G, Guo F, Hu H, Jiang Z, Li S, Shao Z, Wan Y. Associations of Maternal Adverse Childhood Experiences with Behavioral Problems in Preschool Children. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20311-NP20330. [PMID: 34652992 DOI: 10.1177/08862605211050093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Investigations have found maternal adverse childhood experiences (ACEs) cause an intergenerational danger to their children's health. However, no study has investigated the effects of maternal ACEs on behavioral problems of preschool children in China and gender differences on these effects. This paper aims to investigate the role of maternal ACEs on behavioral problems of preschool children in China and explore gender differences as related to these behavioral problems. Stratified cluster sampling method was used to select 7318 preschool children from 12 districts in Hefei city, China. A questionnaire survey was conducted to collect information on maternal exposure to ACEs and Conners' Parent Rating Scales. Logistic regression was used to analyze the relationship between maternal ACEs and children's behavioral problems. The prevalence of behavioral problems in preschool children was 16.0%, while it was higher among girls (18.4%) than boys (13.92%) (χ2 = 27.979, p < 0.001). The rate of behavioral problems in children in the group of mothers with ACEs was higher than those without ACEs (all p < 0.05). Maternal ACEs were associated with increased risk of the behavior problems in preschool children (adjusted OR 2.91, 95% CI 2.45-3.45), and no gender difference (in girls 3.01, 2.38-3.81, in boys 2.79, 2.17-3.58, respectively) was found. Maternal ACEs were associated with increased risk of each type of the behavioral problems of preschool children, except that maternal emotional neglect was not associated with psycho-physical problems, impulse-activities, and anxiety. The only gender differences found were higher conduct problems related to maternal emotional abuse and ACEs and higher anxiety related to maternal physical abuse and community violence in girls compared with boys. Mothers exposured to ACEs are more likely to have children with behavioral health problems in preschool period. Further research is needed to explore the mechanisms by which maternal ACEs influence children's behavioral problems.
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Affiliation(s)
- Xiaoyan Wang
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Gangzhu Yin
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Feng Guo
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Haili Hu
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Zhicheng Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Shuqin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Ziyu Shao
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
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Zhang J, Lin G, Cai Q, Hu Q, Xu Y, Guo Z, Hong D, Huang Y, Lv Y, Chen J, Jiang S. The role of family and peer factors in the development of early adolescent depressive symptoms: A latent class growth analysis. Front Psychiatry 2022; 13:914055. [PMID: 36186869 PMCID: PMC9520917 DOI: 10.3389/fpsyt.2022.914055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Few studies have explored the trajectories of Chinese early adolescent depressive symptoms or comprehensively considered the factors of family and peers. The present study aimed to identify the trajectories of depressive symptoms in early adolescence using a school-based sample assessed in three waves. The study also examined whether family and peer factors were significant predictors. A total of 586 Chinese primary and middle school students participated in the survey. A growth mixture model was used to find the trajectories of depressive symptoms, and multinominal logistic regression was used to identify the predictors. Three trajectories were identified, including a stable-low class, an increasing class, and a high-decreasing class. Results indicated that gender, parental psychological aggression and neglect, parental psychological control, traditional bullying/cyberbullying victimization, and friendship quality were significant predictors. However, witnessing intimate partner violence, parental behavior control, and traditional bullying/cyberbullying perpetration could not significantly predict the trajectories. The findings of this study can provide an empirical basis for teachers and clinical interveners to determine different development trajectories of depressive symptoms and carry out prevention and intervention.
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Affiliation(s)
- Jiaying Zhang
- The Affiliated Wenzhou Kangning Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Applied Psychology in School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Guangyao Lin
- The Affiliated Wenzhou Kangning Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiaole Cai
- The Affiliated Wenzhou Kangning Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qian Hu
- School of Foreign Languages, Wenzhou Medical University, Wenzhou, China
| | - Yuan Xu
- Department of Applied Psychology in School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Zhaoming Guo
- Department of Applied Psychology in School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Defan Hong
- Department of Applied Psychology in School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yingying Huang
- Department of Applied Psychology in School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yijun Lv
- School of Innovation and Entrepreneurship, Wenzhou Medical University, Wenzhou, China
| | - Jing Chen
- Planning and Development Decision Institute (Higher Education Research Institute), Wenzhou Medical University, Wenzhou, China
| | - Suo Jiang
- The Affiliated Wenzhou Kangning Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Applied Psychology in School of Mental Health, Wenzhou Medical University, Wenzhou, China
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