The Perceived Stress Scale-10 (PSS-10) is reliable and has construct validity in Chinese patients with systemic lupus erythematosus

Perceived social support, self-management, perceived stress, and post-traumatic growth in older patients following stroke: Chain mediation analysis

Stroke is a potentially traumatic event that can lead to both positive changes associated with post-traumatic growth (PTG) and enduring mental distress. This study aimed to investigate the association between perceived stress and PTG among older postsurvivors, as well as to explore the potential mediating role of perceived social support and self-management in this relationship. A cross-sectional study was conducted to recruit 354 older poststroke survivors from 2 tertiary hospitals in Shenyang, China, between January 2022 and October 2023. Various multidimensional scales were utilized to measure perceived stress, perceived social support, self-management, and PTG. Structural equation modeling was employed by Amos 24.0 to analyze the mediating pathways. The average score of PTG was 50.54 ± 22.69 among older poststroke patients. Pearson analysis revealed significant associations between perceived stress, perceived social support, self-management, and PTG (all P < .01). The mediation model showed that perceived stress could both direct influence PTG (Effect = -0.196, 95% CI = [-0.259, -0.129]), and indirectly impact PTG through perceived social support (Effect = -0.096, 95% CI = [-0.157, -0.044]), through self-management (Effect = -0.033, 95% CI = [-0.064, -0.012]), and sequentially through perceived social support and self-management (Effect = -0.007, 95% CI = [-0.017, -0.002]), accounting for 58.9%, 28.8%, 9.9%, and 2.1% of the total effect, respectively. These findings confirmed the mediating roles of perceived social support and self-management between perceived stress and PTG among older poststroke survivors. This provides valuable insights into developing targeted social intervention programs to improve stroke management among older survivors.

The feasibility of Technology, Application, Self-Management for Kidney (TASK) intervention in post-kidney transplant recipients using a pre/posttest design

BACKGROUND

Weight gain after a kidney transplant remains a major problem that can lead to adverse effects on morbidity and mortality. The posttransplant phase provides a window of opportunity to improve the engagement of self-management of care for lifestyle modifications for diet and physical activity. The purpose of our study was to (1) test the feasibility of recruitment, retention, and adherence for using the Technology, Application, Self-Management for Kidney (TASK) intervention in post-kidney transplant recipients (≥ 18 years of age) at baseline, 4, 8, and 12 weeks; and (2) estimate the preliminary effects of the TASK intervention in producing change over time for blood pressure (BP), weight, fruits/vegetable intake, fiber intake, sodium intake, self-efficacy to exercise, and perceived stress.

METHODS

This study used a 12-week pre/posttest design using to test the feasibility of the TASK intervention. We applied paired t-tests and McNemar's test to compare the outcomes at weeks 4, 8, and 12.

RESULTS

We met our recruitment goal (N = 20) and found a 15% attrition rate (n = 3) at Week 12. Adherence rate among the study completers for recording daily food intake was 83-94% over the 12 weeks and for recording daily physical activity was 17-33% over the 12 weeks. We observed improvements over time for BP, weight, fruits/vegetable intake, fiber intake, and sodium intake; these differences were non-significant, although clinically important. We did find a significant difference from baseline to 12 weeks in weight reduction (p = 0.02), self-efficacy to exercise (p = 0.003), and perceived stress (p = 0.04).

CONCLUSIONS

The data suggest the TASK intervention was feasible for kidney recipients to use and resulted in weight control, increased self-efficacy to exercise, and decreased perceived stress.

TRIAL REGISTRATION

ClinicalTrials.gov #:NCT05151445.

Psychometric testing of the 10-item perceived stress scale for Chinese nurses

BACKGROUND

Nurses bear a lot of stressors at work. The 10-item Perceived Stress Scale (PSS-10) is a widely used self-reported scale for measuring the global perception of stress. However, there is a lack of use of the PSS-10 in Chinese nurses. This study aimed to test the psychometric properties of the PSS-10 among Chinese nurses.

METHODS

A total of 708 Chinese nurses completed the PSS-10, the Big Five Inventory (BFI), and the Depression Anxiety and Stress Scale (DASS). Confirmatory factor analysis (CFA) tested the factor structure of the PSS-10. Cronbach's α and test-retest correlation examined the scale reliability. Pearson correlation and hierarchical regression analyses tested the convergent, discriminant and criterion validity of the PSS-10.

RESULTS

CFA revealed that a two-factor model fits the structure of the PSS-10 in Chinese nurses (χ2/df = 6.25, p < 0.001; comparative fit index [CFI] = 0.94, non-normal fit index [NNFI] = 0.92, Tucker-Lewis index [TLI] = 0.91, root mean square error of approximation [RMSEA] = 0.08, standardized root mean square residual [SRMR] = 0.05). The scale demonstrated adequate internal consistency (α = 0.86) and test-retest reliability (r = 0.66, p < 0.001), satisfactory convergent and discriminant validity with relations to Big Five personalities, as well as good criterion validity such that the PSS-10 score could explain incremental variance in predicting anxiety, depression and stress.

CONCLUSIONS

Our findings suggest that PSS-10 is a reliable and valid measure of perceived stress among Chinese nurses and can be used in future research and practice on stress management and coping in Chinese nurses.

The Perceived Stress Scale is essentially unidimensional: Complementary evidence from ancillary bifactor indices and Mokken analysis

Stress is a significant contributor to physical and mental health. However, there is considerable variability in response to stress, underscoring the role of stress perception in health outcomes. Perceptions of stress are influenced by socio-demographic and cultural factors. The Perceived Stress Scale (PSS) has been used extensively to assess stress among different populations and for cross-cultural comparisons. Given its wide-ranging application, the rigorous assessment of its psychometric properties is necessary to solidify its standing as a dependable measure. The scale was originally conceptualized as unidimensional but there has been controversy regarding its factor structure, leading to various factor models. Conclusions about the structure of the PSS were largely based on fit indices in confirmatory factor analysis and often did not go beyond fit indices. In addition, classical test theory indices are sample dependent and it is not surprising that instruments can exhibit different properties in different samples. Over reliance on fit indices can lead to overly simplistic interpretations of underlying dimensionality. Hence, the current study extends this research by using item response theory and examining ancillary bifactor indices to determine the amount of variance explained by the total scale and subscales. Participants were students (n = 322) at a South African institution who completed the PSS and a demographic questionnaire. Fit indices in confirmatory factor analysis indicated that a one-factor model, a bifactor model and a correlated-two factor model fit the data to an acceptable degree (GFI > 0.95, CFI > 0.90, RMSEA <0.08). Ancillary bifactor indices supported the essential unidimensionality of the scale as the two subscales accounted for 18.9 % and 17.2 %, of the variance, respectively, while the total scale accounted for 63.9 % of the variance. This was confirmed by Mokken analysis, which indicated that all the items loaded on one scale. The unidimensionality of the PSS suggests that it can be an effective clinical screening tool and that it is easily adaptable across different populations and contexts, enabling standardized comparisons. However, it may lose sensitivity to cultural differences in how stress is perceived and experienced. Hence, integrating the PSS with tailored assessments would facilitate a more robust and inclusive approach to stress assessment in various settings and populations. The study did not take specific sources of stress into account and was conducted among a distinct population group. Future studies undertaken among diverse populations and linking global stress with the impact of stressful life events are needed to further confirm our results and understand the interconnection between these factors.

Anxiety, Depression, Perceived Stress, and Burnout Among Chinese Researchers: A Cross-Sectional Nationwide Study

Purpose

Depression and anxiety have a significant impact on an individuals' work and personal life alike. The mental health of researchers is a significant concern worldwide. This study investigated the mental health status of Chinese researchers specifically and explored the moderating effects of perceived stress on the influence of low self-accomplishment on anxiety and depression.

Methods

The online survey platform "Survey Star" was used to create a questionnaire to be distributed to researchers, with 949 questionnaires retrieved. The general information questionnaire, 10-item Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Maslach Burnout Inventory General Survey (MBI-GS) were used for this investigation. Pearson's correlation analysis was performed to investigate correlations among the relevant variables. Model 8 of PROCESS 3.3 program was used to analyze the moderating effects of perceived stress.

Results

Among the 949 participants, 570 (60.1%) reported symptoms of depression and 431 (45.4%) had symptoms of anxiety, with about one in six reporting symptoms of self-harm or suicidal ideation. Perceived stress was found to moderate the effect of low self-accomplishment on depression and anxiety.

Conclusion

Here we show that researchers exhibit a high rate of depression and anxiety symptoms. Perceived stress is also shown to play a moderating role on the influence of low self-accomplishment on anxiety and depression. Thus, reducing perceived stress levels can help to improve the mental health of researchers.

Association between psychological vulnerability and glaucoma progression: Protocol for a multicenter prospective cohort study in South Korea

INTRODUCTION

Mental health is a significant concern for patients diagnosed with glaucoma, as visual impairment can have a profound impact on psychological well-being. Conversely, psychological vulnerability in glaucoma patients can negatively influence treatment adherence to ocular hypotensive therapy, thereby potentially exacerbating disease progression in a vicious cycle. The study protocol proposed herein aims to explore the impact of psychological states such as anxiety, depression, and stress on both medication adherence and progression of glaucoma.

MATERIALS AND METHODS

This study is to be a prospective multicenter study conducted at four tertiary medical centers. Patients recently diagnosed with glaucoma and not yet treated will be enrolled. Anxiety, depression, and stress scales will be administered at baseline, one year, and two years, along with glaucomatous assessments to be performed every six months. Validated questionnaires (Generalized Anxiety Disorder Assessment [GAD-7], Patient Health Questionnaire [PHQ-9], and Perceived Stress Scale-10 [PSS-10]) will assess anxiety, depression, and stress, respectively. The primary objective is to correlate post-diagnosis psychological status with medication adherence and disease progression. The effects of pre- and post-diagnosis changes in anxiety, depression, and stress on disease progression will be analyzed. Kaplan-Meier survival analysis and logistic regression will be performed to identify clinical characteristics associated with increased risk of developing anxiety, depression, and stress in glaucoma patients.

Perceived Stress Mediating the Association Between Mindfulness and Resilience Among Registered Nurses

Purpose

Resilience continues to be an important concept in the nursing profession due to its significant role in personal healthcare, patients' healthcare, and leadership. The present study examined the mediating role of perceived stress in the association between mindfulness and resilience among registered nurses in order to understand their importance among those in the Taiwanese nursing profession.

Materials and Methods

Between October and November 2021, a total of 816 registered nurses participated in a cross-sectional survey including psychometric measures assessing perceived stress (Chinese Perceived Stress Scale-10), mindfulness (Chinese Mindful Attention Awareness Scale), and resilience (Chinese Questionnaire of Resilience).

Results

Results indicated that perceived stress mediated the association between mindfulness and resilience (standardized coefficient = 0.251, p<0.001), although there was no significant association between mindfulness and resilience (standardized coefficient = 0.042, p=0.16). This suggests that perceived stress may function as both distress and eustress because mindfulness was not directly associated with resilience but indirectly via perceived stress.

Conclusion

Nurses and their administrators should focus on different ways of coping with stress so that they become more resilient in facing other stressors. Future studies may be conducted to examine the mediating role of perceived stress in the association between other coping strategies and resilience among registered nurses.

Psychometric review of the perceived stress scale under CFA and Rasch models in Lima, Peru

Stress is a public health disease that is increasing rapidly in the population worldwide, so it is necessary to take measures for detection and evaluation, through short scales. The purpose of the study was to analyze the psychometric properties of the Perceived Stress Scale (PSS) in a sample made up of 752 people with an age range of 18 to 62 years (M = 30.18, DE = 10.175), of whom 44% (331) were women and 56% (421) men, from Lima, Peru. The results, by means of confirmatory factor analysis and the Rasch model, confirmed the global adjustment of a 12-item (PSS-12) version with the presence of two orthogonal factors independent of each other, and also demonstrated the metric equivalence according to gender and adequate internal consistency. These results allow us to recommend the use of the PSS-12 in the Peruvian population for the measurement of stress.

Marital status and perceived stress in men with advanced prostate cancer: A randomized-controlled trial of cognitive behavioral stress management

OBJECTIVE

Relationship status predicts numerous outcomes among medical populations. Few interventions evaluate the role of marital status on response to psychosocial treatment, and no such studies exist within advanced prostate cancer (APC). This study examined whether marital status modified the effect of a cognitive behavioral stress management (CBSM) intervention on perceived stress.

METHODS

Men with APC (N = 190) were randomized to 10-week CBSM or a health promotion (HP) intervention (#NCT03149185). The Perceived Stress Scale assessed perceived stress at baseline and 12-month follow-up. Medical status and sociodemographics were captured at enrollment.

RESULTS

Participants were mostly White (59.5%), non-Hispanic (97.4%), heterosexual (97.4%) men, 66.8% of whom were partnered. Neither condition nor marital status predicted perceived stress change at follow-up. However, a significant interaction was found between condition and marital status (p = 0.014; Cohen's f = 0.07), such that partnered men who received CBSM and unpartnered men who received HP reported greater reductions in perceived stress.

CONCLUSION

This is the first study to assess the impact of marital status on psychosocial intervention effects among men with APC. Partnered men derived greater benefit from a cognitive-behavioral intervention and unpartnered men equally benefitted from a HP intervention. Further research is necessary to understand the mechanisms underlying these relationships.

Development and preliminary testing of the cancer-related fatigue comprehensive assessment scale in cancer survivors

BACKGROUND

Tailored management of cancer-related fatigue (CRF) is important for effective coping; however, it has been hindered by the lack of a comprehensive tool that assesses both symptoms and treatable influencing factors.

AIMS AND OBJECTIVES

The aim was to develop a cancer-related fatigue comprehensive assessment scale (CRF-CAS) and assess its psychometric properties.

DESIGN

This was a mixed-method study.

METHODS

The study included two phases which were conducted in Zhejiang Province, China. In phase one, a literature search, brainstorming sessions, Delphi studies, cognitive interviews and a pilot study were conducted to construct and revise CRF-CAS indicators. In phase two, a questionnaire-based survey was conducted among cancer survivors. Item analysis was used to select and optimize indicators. Cronbach's α was calculated for reliability analysis. Validity analysis included concurrent validity and structural validity.

RESULTS

A 93-item tool was initially constructed. Phase one ended with revision and optimization. The preliminary scale included five dimensions (CRF symptoms, physical activity, cognitive-emotional status, sleep status, nutritional status) and 30 items. The mean item-content validity index (I-CVI) and scale-level CVI universal agreement (S-CVI/UA) were .98, and the adjusted mean values of Kappa for indicators ranged from .91-1, as evaluated by the expert group. The Pearson correlation coefficient between the CRF-CAS and criterion scales ranged from .337-.862. Cronbach's α coefficient ranged from .624-.728. Respondents agreed that the scale was acceptable for administration and that it contributed to decision-making in fatigue management. Confirmatory factor analysis (CFA) indicated that the CRF-CAS fit well.

CONCLUSIONS

The construction process of the CRF-CAS, involving panel discussion and expert and participant evaluations, was shown to be scientific and feasible. The CRF-CAS had relatively good validity and reliability in version 5 of its preliminary scale, which requires further improvement in future studies.

Coping with burnout and the impact of the COVID-19 pandemic on workers' mental health: A systematic review

Introduction

The COVID-19 pandemic had a negative impact on the psychological wellbeing of workers worldwide. Certain coping styles may increase burnout risk. To investigate the relationship between burnout and coping styles, a systematic review was performed.

Methods

Following the PRISMA statements, three databases were screened up until October 2022, including research articles written in English language and investigating the relationship between burnout and coping strategies in workers. The quality of articles was assessed by the Newcastle-Ottawa Scale.

Results

The initial search resulted in 3,413 records, 15 of which were included in this review. Most studies were performed on healthcare workers (n = 13, 86.6%) and included a majority of female workers (n = 13, 86.7%). The most used burnout assessment questionnaire was the Maslach Burnout Inventory (n = 8, 53.3%), and the most used coping assessment tool was the Brief-COPE (n = 6, 40.0%). Task-related coping was a protective factor for burnout in all four studies investigating its correlation with burnout dimensions. Two of the four studies investigating emotion-oriented coping found that it was protective while the other two found that it was predictive of burnout. All five studies investigating avoidance-oriented coping and burnout dimensions found that this coping style was predictive of burnout.

Discussion

Task-oriented and adaptive coping were protective for burnout, avoidance-oriented, and maladaptive coping were predictive factors of burnout. Mixed results were highlighted concerning emotion-oriented coping, suggesting that different outcomes of this coping style may depend on gender, with women relying more on it than men. In conclusion, further research is needed to investigate the effect of coping styles in individuals, and how these correlates with their unique characteristics. Training workers about appropriate coping styles to adopt may be essential to enact prevention strategies to reduce burnout incidence in workers.

Burnout and associative emotional status and coping style of healthcare workers in COVID-19 epidemic control: A cross-sectional study

Objective

The aim of this study was to evaluate the prevalence of burnout, clinical anxiety, depression, and insomnia and to estimate the associations of adverse emotional status, coping style, and level of self-efficacy with burnout of healthcare workers in the Shenzhen Longgang District Frontline District Headquarters of COVID-19 epidemic control, China.

Methods

In this cross-sectional study, 173 staff completed the anonymous questionnaires of the Maslach Burnout Inventory, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), Insomnia Severity Index (ISI), General Self-efficacy Scale, and Simplified Coping Style Questionnaire electronically (https://www.wjx.cn/) in June 2022. Hierarchical logistic regression was used to explore the associated factors of burnout in this study.

Results

The prevalence of burnout in our participants (defined as high emotional exhaustion or high depersonalization) was 47.40%, and reduced personal accomplishment was 92.49%. The prevalence of clinically significant depression (the cutoff score of ≥15), anxiety (the cutoff score of ≥10), and insomnia (the cutoff score of ≥15) was 11.56, 19.08, and 19.08%, respectively. There was a degree of overlap between burnout and other measures of adverse mental status, most notably for anxiety (odds ratio, 27.049; 95% CI, 6.125–117.732; p &lt; 0.001). Hierarchical logistic regression demonstrated that burnout was strongly associated with anxiety (OR = 23.889; 95% CI, 5.216–109.414; p &lt; 0.001) and negative coping style (OR = 1.869; 95% CI, 1.278–2.921; p &lt; 0.01) independently.

Conclusion

Medical staff involved in COVID-19 epidemic control in the post-epidemic era were at high risk of burnout, and most of them were in low personal accomplishment. Reducing anxiety and improving coping style by medical management institutions from the system level may be effective in alleviating burnout in healthcare workers.

Dynamic changes in brain structure in patients with post-traumatic stress disorder after motor vehicle accident: A voxel-based morphometry-based follow-up study

Objectives

To investigate the dynamic changes of emotional and memory-related brain regions in post-traumatic stress disorder (PTSD) patients and trauma-exposed subjects, who experienced motor vehicle accident (MVA).

Materials and methods

Functional Magnetic Resonance imaging (fMRI) and general data were collected from trauma victims who had experienced MVA within 2 days, and their social support and coping style were evaluated. The PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) is used for screening and diagnosis. Subsequently, 17 PTSD patients and 23 car accident trauma-exposed individuals completed a second fMRI scan at 2 months. Data were analyzed by using voxel-based morphometry (VBM) to examine the volume changes of relevant brain regions. Correlation analysis was used to assess the correlation between the regions of interest (ROIs) and the total scores on the clinical scales. Subsequently, the relationship between the total PCL-5 scores and the individual dimensions of the Simplified Coping Style Questionnaire (SCSQ) and the Social Support Rate Scale (SSRS) was studied.

Results

In comparison with the control group, the results showed a reduction in right SFG volume in the PTSD group at 2 months. Similarly, a comparison within the PTSD group revealed a reduction in the left STG volume at 2 months. Compared with the control group, PTSD patients showed a more negative coping style and worse performance in objective and subjective support. In addition, the total PCL-5 scores were negatively associated with positive coping, objective support, and subjective support.

Conclusion

The occurrence of PTSD may be related to reduced volume of the right SFG and left STG, and that patients with PTSD receive less social support and tend to cope in a negative manner in the face of stressful events. These results suggest that within 2 months of the MVA, changes in gray matter volume have occurred in some brain regions of those suffering from PTSD. We believe the results of our study will provide useful insights into the neuropsychological mechanisms underlying PTSD.

Development of a nomogram prediction model for depression in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease with depression as one of its most common symptoms. The aim of this study is to establish a nomogram prediction model to assess the occurrence of depression in patients with SLE. Based on the Hospital Anxiety and Depression Scale cutoff of 8, 341 patients with SLE, recruited between June 2017 and December 2019, were divided into depressive and non-depressive groups. Data on socio-demographic characteristics, medical history, sociopsychological factors, and other risk factors were collected. Between-group differences in clinical characteristics were assessed with depression as the dependent variable and the variables selected by logistic multiple regression as predictors. The model was established using R language. Marital status, education, social support, coping, and anxiety predicted depression (p < 0.05). The nomogram prediction model showed that the risk rate was from 0.01 to 0.80, and the receiver operating characteristic curve analysis showed that the area under the curve was 0.891 (p < 0.001). The calibration curve can intuitively show that the probability of depression predicted by the nomogram model is consistent with the actual comparison. The designed nomogram provides a highly predictive assessment of depression in patients with SLE, facilitating more comprehensive depression evaluation in usual clinical care.

Abnormal spontaneous neural activity in hippocampal-cortical system of patients with obsessive-compulsive disorder and its potential for diagnosis and prediction of early treatment response

Early brain functional changes induced by pharmacotherapy in patients with obsessive-compulsive disorder (OCD) in relation to drugs per se or because of the impact of such drugs on the improvement of OCD remain unclear. Moreover, no neuroimaging biomarkers are available for diagnosis of OCD and prediction of early treatment response. We performed a longitudinal study involving 34 patients with OCD and 36 healthy controls (HCs). Patients with OCD received 5-week treatment with paroxetine (40 mg/d). Resting-state functional magnetic resonance imaging (fMRI), regional homogeneity (ReHo), support vector machine (SVM), and support vector regression (SVR) were applied to acquire and analyze the imaging data. Compared with HCs, patients with OCD had higher ReHo values in the right superior temporal gyrus and bilateral hippocampus/parahippocampus/fusiform gyrus/cerebellum at baseline. ReHo values in the left hippocampus and parahippocampus decreased significantly after treatment. The reduction rate (RR) of ReHo values was positively correlated with the RRs of the scores of Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and obsession. Abnormal ReHo values at baseline could serve as potential neuroimaging biomarkers for OCD diagnosis and prediction of early therapeutic response. This study highlighted the important role of the hippocampal-cortical system in the neuropsychological mechanism underlying OCD, pharmacological mechanism underlying OCD treatment, and the possibility of building models for diagnosis and prediction of early treatment response based on spontaneous activity in the hippocampal-cortical system.

The Association Between Perceived Risk of COVID-19, Psychological Distress, and Internet Addiction in College Students: An Application of Stress Process Model

The closed-off management of the university during coronavirus disease 2019 (COVID-19) may be associated with an elevated odds of psychological and behavioral issues among college students. We aimed to use the stress-process model to explore the potential mechanisms for this phenomenon. A total of 924 college students were recruited via posters, peer referrals, and class attendance. Among them, 82 (9%) were probable depression, 190 (20.8%) were probable anxiety, and 69 (7.5%) were internet addiction. Parallel mediation was used to test this theoretical model. For personal resources, the perceived risk of COVID-19 was positively associated with psychological distress via negative coping style (β = 0.051) and internet addiction via negative coping style or self-esteem (β = 0.023 for negative coping style, β = 0.015 for self-esteem). For social resources, the perceived risk of COVID-19 was positively associated with psychological distress and internet addiction via roommate relationships (β = 0.19 for psychological distress, β = 0.046 for internet addiction). Negative coping styles and roommate relationships are possible psychological mechanisms linking the perceived risk of COVID-19, psychological distress, and internet addiction.

Psychological Health and Sleep Quality of Medical Graduates During the Second Wave of COVID-19 Pandemic in Post-epidemic Era

Recently, a COVID-19 virus variant spread rapidly in Guangzhou, China, causing public panic. This study aimed to understand the psychological and sleep-related consequences of the secondary outbreak of the pandemic on medical students. In this cross-sectional survey-based study, participants anonymously completed structured questionnaires online from June 8–22, 2021. We collected participants' demographic and general information. Anxiety, depression, and sleep quality were measured using the Zung Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Protective factors were assessed using the Coping Style Questionnaire (CSQ). Uni- and multivariate logistic regression analyses were performed examining factors associated with mental health and sleep quality problems. During the second wave of the pandemic in local outbreak areas in Guangzhou, China, more than one-third of medical students' mental health and sleep quality were affected. The prevalence of anxiety, depression, and poor sleep quality were 27.54%, 27.58%, and 18.19%, respectively. Students belonging to the Class of 2019, aged over 29 years, those with siblings, and those whose hometowns were in other provinces were more prone to the three health problems. Factors associated with an increased risk of mental health problems were vaccination status (adjusted odds ratio 1.603–1.839) and diet status (adjusted odds ratio 1.62–1.929). Positive coping styles served as protective factors (p < 0.05). We discovered that completed vaccination status, good diet, and positive coping styles were related to good mental health and sleep quality.

Psychological Impacts of COVID-19 in Dental Patients are Moderated and Mediated by Hospital-Infection-Control-Policy and Satisfaction-with-Life: A Prospective Observational Dental-COVID Study

Introduction

COVID-19 pandemic has imposed nation-wide lock-downs which severely impacted day-to-day lifestyle and caused anxiety, stress and fear among patients taking medical care including dental treatments. These psychological behaviors have also been observed during the strategic relaxation of social restrictions (Unlock). However, potential effect of these psychological behavior in endodontic cases have not been probed. Here, it is of great interest to explore the magnitude and buffering effect of two important psychological resources: satisfaction-with-life, and confidence in hospital-infection-control-policy in relation with COVID-19 risk perception on psychological impact due to fear for COVID-19.

Methods

Patients visiting Dental Clinic & Research Center for endodontic procedures were randomly asked to fill survey questionnaire, and were later enrolled as per the study criteria. The study carried out in two phases: from 15 Sept 2020 to 15 Dec 2020 (restrained confinement; Unlock 1.0); and from 16 Dec 2020 to 12 Feb 2021 (mild confinement; Unlock 2.0) with total sample size of 136. We used data collection tools such as fear-of-COVID-19 scale (FCV-19), perceived-stress-scale (PSS), modified-dental-anxiety-scale (MDAS), satisfaction-with-life scale (SWLS), COVID-19 risk perception, and confidence in hospital-infection-control-policy for COVID-19.

Results

A double moderation and dual moderated mediation structured model were used to establish the correlation of various parameters using SPSS (version 25.0) software suite. Confidence in hospital-infection-control-policy and SWLS were negatively correlated with FCV-19, MDAS, and PSS. Risk perception of COVID-19 was found to positively associated with FCV-19, MDAS, and PSS.

Discussion

Patient’s confidence in hospital-infection-control-policy for COVID-19 and SWLS acted as independent moderator for FCV-19 and mental distress. FCV-19 and risk perception were found to be lower during mild confinement (Unlock 2.0), and were also the positive predictors of PSS; and negative predictors of SWLS. The higher SWLS correlated very well with lower COVID-19 risk perception, concerning PSS and MDAS.

Post-traumatic Growth and Psychological Resilience During the COVID-19 Pandemic: A Serial Mediation Model

Although the World Health Organization (WHO) has issued guidelines for managing to contain, mitigate, and limit of the COVID-19. However, it is more essential to highlight the urgency and importance of evaluating social functioning and mental health status during the pandemic. College students have experienced serious problems and have had to overcome many negative situations brought about by the pandemic. Accordingly, the present study intended to use Chinese college students as sample to examine the positive adoption and changes during the ongoing COVID-19. Guided by literatures in this filed, we explored the internal mechanism of post-traumatic growth affecting psychological resilience, and considered about mediation roles of positive coping styles and cognitive reappraisal. A total of 463 college students from universities in China effectively completed online questionnaires. The result indicated that these four variables were positively correlated with each other (ps < 0.001). More importantly, our findings proved a direct and positive effect on psychological resilience. Positive coping styles and cognitive reappraisal, respectively, mediated the relationship between post-traumatic growth and psychological resilience. Over all, the hypothesized serial model conclusively fits the data: students with high-level post-traumatic growth tended to report increased use of positive coping strategies, which further facilitated their cognitive reappraisal, and subsequently, promoted their psychological resilience. The findings obtained in this study will provide a theoretical basis and possible viable strategies for both targeted crisis intervention and psychological trauma recovery plans.

Preconception Dietary Patterns and Associations With IVF Outcomes: An Ongoing Prospective Cohort Study

There is a lack of research on preconception diet and reproductive outcomes conducted in the Chinese population using individual assessment. Between April 2017 and April 2020, 2,796 couples undergoing in vitro fertilization treatment were recruited in this ongoing prospective cohort, and 1,500 eligible couples were included in the final analysis. A validated semi-quantitative food frequency questionnaire was used to evaluate the maternal preconception diet. Other lifestyle factors, including smoking status, psycho-mental status, sleep quality, and physical activity, were also assessed. Five dietary patterns were identified using principal component analysis, namely "Fruits-Vegetables-Dairy-Eggs," "Fish/Seafood-Animal blood," "Tubers-Beans-Cereals," "Puffed food-Candy-Bakery," and "Dried Fruits-Organs-Rice." After adjusting for multiple confounders, we detected that the women who are more inclined to the "Fruits-Vegetables-Dairy-Eggs" pattern and less adherent to the "Tubers-Beans-Cereals" were more likely to achieve normally fertilized eggs and transferable embryos. Regarding pregnancy outcomes, we observed that a lower "Puffed food-Candy-Bakery" score and a higher "Dried fruits-Organs-Rice" score were related to a higher likelihood to achieve biochemical pregnancy. In terms of pregnancy complications, an inverse association between "Fish/Seafood-Animal blood" and hypertensive disorders was observed. We further clustered the dietary patterns based on the proportion of food groups consumed and found that dairy intake was beneficial to embryo quality, while frequent rice consumption was associated with a higher risk of macrosomia. Notably, in the stratified analysis, we observed that the positive relationship between the "Fruit-Dairy-Vegetables-Eggs" score and normal fertilization and the inverse association of the "Fish/Seafood-Animal blood" score with hypertensive disorders during pregnancy were exhibited only among women with body mass index ≥25 kg/m2. In conclusion, pre-treatment diets might be an important target for intervention to achieve a better reproductive outcome.

Psychometric properties and correlates of Chinese version of Perceived Stress Scale (CPSS-10) in people with common mental disorders with different employment Statuses

Background/objectives

Several studies have indicated that stress is associated with common mental disorders, and work stress trebles the risk of developing them. However, a validated assessment tool for measuring and establishing psychological stress correlates in this group of clients remains unavailable. The objectives of the present study were to examine the psychometric properties of the Chinese version of the Perceived Stress Scale-10 (CPSS-10) on people with common mental disorders with different employment statuses and explore its correlates.

Methods

Two hundred and fifty-two participants with common mental disorders were recruited. The data were analysed through exploratory factor and confirmatory analyses to investigate construct validity. The convergent and discriminant validities were examined based on their correlation with other measures, while the internal consistency was estimated using Cronbach's α coefficient. A t-test was used to detect differences between groups. The CPSS-10 correlates were explored using multiple linear regression analysis.

Results

Principal component analysis with varimax rotation yielded two factors, which accounted for 63.82% of the total variance, while confirmatory factor analysis confirmed its factor structure. The CPSS-10 had a positively moderate to strong correlation with other measures, thereby indicating its acceptable convergent and discriminant validities. The internal consistency ranged from acceptable to good for the two subscales and ten overall items, while the item-total correlation was adequate except for the seventh item. There were no group differences in gender nor employment status. Finally, the CPSS-10 predictors were studied.

Conclusion

The CPSS-10 is a reliable and valid instrument for people with common mental disorders with different employment statuses.

Delayed-Onset PTSD and Coping Strategies of Chinese College Students During the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) has become a pandemic, and many Chinese college students both in China and abroad were house-quarantined. This study aimed to investigate the prevalence and symptoms of delayed-onset post-traumatic stress disorder (PTSD) and coping strategies among Chinese overseas and domestic college students during this pandemic. A questionnaire was opportunistically distributed to Chinese college students studying both domestically and abroad six months after the COVID-19 outbreak. The questionnaire consisted of IES-R, SCSQ, and SSRS. The average score of delayed-onset PTSD in our population was 21.411 (full mark, 88 points), which reflected a total high level of delayed-onset PTSD symptoms. Statistical differences were shown between students who have been back to universities during the pandemic or not in the hyperarousal dimension (p = 0.016). Three coping strategies were recognized to influence the respondent's delayed-onset PTSD symptoms, and there was a significant correlation between social support and the coping strategies students chose. A moderate to high level of delayed-onset PTSD was observed among both Chinese overseas and domestic college students 6 months after the COVID-19 outbreak. The useful coping strategies and powerful social supports are significantly important to help them stay mentally healthy and alleviate delayed-onset PTSD during the COVID-19 pandemic.

The Effects of Perceived Stress and Cortisol Concentration on Antiretroviral Adherence When Mediated by Psychological Flexibility Among Southern Black Men Living with HIV

This pilot study investigates the correlation between psychological stress and antiretroviral therapy (ART) adherence and plasma HIV RNA (viral load) as mediated by psychological flexibility among Black men in the south. Data were collected from 48 HIV-positive, low income Black men. Results indicate a strong positive correlation between perceived stress and psychological inflexibility (adjusted for age and income r_s = 0.67; p < 0.001), a negative correlation between psychological inflexibility and ART adherence (adjusted r_s = - 0.32; p = 0.03), a negative correlation between perceived stress and ART adherence (adjusted r_s = - 0.45; p = 0.006), and a negative correlation between ART adherence and viral load (adjusted r_s = - 0.37; p = 0.04). Our findings suggest stress decreases adherence to ART and viral suppression among Black men living with HIV. However, psychological flexibility did not mediate the relationship between stress and treatment adherence. Hair cortisol concentrations were high (mean of 34.2 pg/mg), but uncorrelated with adherence.

Subjective Family Socioeconomic Status and Peer Relationships: Mediating Roles of Self-Esteem and Perceived Stress

This study explored the relationships between subjective family socioeconomic status (FSES), self-esteem, perceived stress, and perceived peer relationships among Chinese adolescents. A total of 1,353 adolescents (age range: 15-19 years) were asked to complete a questionnaire. Mediation analysis revealed that subjective FSES influenced perceived peer relationships in three ways: first, through the mediating effect of perceived stress; second, through the mediating effect of self-esteem; and third, through the serial mediating effects of perceived stress and self-esteem. The results remained significant after controlling for parental education. In addition, a contrast analysis showed no significant differences in the mediating effects of self-esteem and perceived stress. Thus, we suggest that steps should be taken to improve adolescents' self-esteem and reduce their stress through training interventions and preventive measures, to help them improve their perceived peer relationships and reduce adverse effects associated with low subjective FSES.

Associations of Caregiving Knowledge and Skills With Caregiver Burden, Psychological Well-Being, and Coping Styles Among Primary Family Caregivers of People Living With Schizophrenia in China

Background: There is a lack of clarity regarding the correlation of caregiving knowledge and skills with caregiving experiences of people living with schizophrenia (PLSs). To address this gap, this comprehensive study examines the relationships of caregiving knowledge and skills to the primary family caregiver's experiences of burden, psychological well-being (stress, anxiety, depression, caregiving rewarding feelings), and coping styles in China. Methods: A total of 395 primary family caregivers of PLSs were enrolled in a cross-sectional study between May 2019 and September 2019. Each family caregiver was independently assessed on caregiving knowledge and skills, caregiver burden, and psychological well-being, as well as coping styles. Results: A higher level of caregiving knowledge and skills was positively correlated with less stress (b = -0.48, P < 0.001), anxiety (b = -0.23, P = 0.029), depression (b = -0.29, P = 0.013), and more caregiving rewarding feelings (b = 0.54, P < 0.001). Also, caregivers with more knowledge and skills were more inclined to adopt positive coping strategies (b = 0.44, P < 0.001). Despite these differences, caregivers with different levels of caregiving knowledge and skills reported comparable caregiver burden (b = 0.11, P = 0.705) and the use of a passive coping style (b = 0.10, P = 0.169). Conclusion: Caregiving knowledge and skills are a reliable predictor of psychological well-being and active coping among the primary family caregivers of PLSs. These findings inform the development of psychoeducational interventions to support family caregivers of PLSs.

Validation of the Hospital Anxiety and Depression Scale and the Perceived Stress Scale and psychological features in patients with periodontitis

BACKGROUND

To investigate the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) and 10-item Perceived Stress Scale (PSS-10) in patients with periodontitis and to evaluate the psychological features of patients with periodontitis.

METHODS

Overall, 460 individuals with periodontitis were enrolled. The HADS and the PSS-10 were administered to all patients. Methodology testing included the exploratory factor analysis, the confirmatory factor analysis (CFA), test-retest reliability, as well as internal consistency.

RESULTS

Regarding the CFA results of the HADS, as well as the PSS-10, a bifactor model fitted the data best. The Cronbach alpha value, as well as the intra-class correlation coefficients value of the two measures were all >0.70. The anxiety, depression, distress manifestations, and moderate-to-high perceived stress prevalence were 35.2%, 18.2%, 24.6%, and 43.9%, respectively. Severity of periodontitis, age, smoking, and disease comorbidities were identified as independent prognosticators of the presence of psychological manifestations in periodontitis.

CONCLUSION

The HADS and the PSS-10 can be used as general measures for psychological assessment in patients with periodontitis.

Assessing mental stress on myocardial perfusion and myocardial blood flow in women without obstructive coronary disease: protocol for a mechanistic clinical trial

INTRODUCTION

Two-thirds of women with symptoms of angina have 'angina with no obstructive coronary artery disease' (ANOCA). Growing evidence supports the use of coronary artery function testing for the diagnosis of ANOCA. Research into the prevalence of mental stress-induced myocardial ischaemia (MSIMI) among women with ANOCA is lacking. MSIMI is common in clinically stable patients with coronary artery disease. It is not associated coronary stenosis but is a prognostic risk factor. Here, we describe the rationale and protocol for a mechanistic clinical trial to test the following hypotheses: (1) that MSIMI is more common in women with ANOCA women than in age-matched and sex-matched controls, and (2) MSIMI is associated with mental stress-induced myocardial blood flow (MBF) change but not with adenosine vasodilator stress-induced MBF change.

METHODS AND ANALYSIS

This is a mechanistic clinical trial. 84 women with confirmed ANOCA and 42 aged-matched healthy women (neither angina symptoms nor coronary stenosis) are to be recruited for mental and adenosine vasodilator stress tests. Positron emission tomography CT with ammonia N-13 will be used to evaluate the myocardial perfusion and MBF changes between stress and rest. MSIMI is defined as a summed difference score (SDS) of ≥3 and adenosine stress-induced myocardial ischaemia is defined as an SDS of ≥4. Other assessments include Reactive Hyperemia Index for microvascular endothelial function, peripheral arterial tonometry or digital vasomotor response, and a series of blood and psychometric tests.

ETHICS AND DISSEMINATION

This mechanistic clinical trial was approved by the Ethics Committee of Guangdong Provincial People's Hospital. Findings will be disseminated through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT03982901; Pre-results.

Moral Decision-Making, Stress, and Social Cognition in Frontline Workers vs. Population Groups During the COVID-19 Pandemic: An Explorative Study

On March 9, 2020, Italy has gone into "lockdown" because of COVID-19 pandemic, with a national quarantine. All non-essential working activities and schools of all levels have been temporarily closed: consequently, the entire population have been forced to dramatically change their daily habits. The pandemic raised important psychological, moral, social, and economic issues. Our research focused on the moral decision-making of people during an emergency. This paper reports two studies. The aim of Study 1 was to evaluate moral decision-making, level of perceived stress, ability of mentalizing and empathy in university students and Italian workers. 224 front-line workers (FLW), 413 second-line workers (SLW), and 663 university students (US), during Italian Phase 1 of lockdown, completed an online questionnaire. The results of Study 1 showed that participants in the FLW group are more likely to choose utilitarian solutions and judge as morally acceptable actions finalized to saving lives of more people if this requires sacrificing a low number of individuals. At the same time, decision-making was experienced as less unpleasant and less arousing with respect to the other two groups, demonstrating a greater ability to keep emotional control under pressure. In Study 2, we compared the same variables used in Study 1, selecting two professional categories from the FLW group engaged in emergency during COVID-19, namely healthcare providers (n = 82) and public safety personnel (n = 117). Our results showed that healthcare providers were more stressed and emotionally involved than public safety personnel, with higher empathic concern and arousal in moral decision-making. We suggest it is essential providing immediate psychological support and monitoring physical and emotional well-being for workers in the front-line during emergencies like the COVID-19 pandemic, in order to prevent experiences of moral distress or mental health problems.

Development and Feasibility of a Mobile Health-Supported Comprehensive Intervention Model (CIMmH) for Improving the Quality of Life of Patients With Esophageal Cancer After Esophagectomy: Prospective, Single-Arm, Nonrandomized Pilot Study

BACKGROUND

Patients with esophageal cancer often experience clinically relevant deterioration of quality of life (QOL) after esophagectomy owing to malnutrition, lack of physical exercise, and psychological symptoms.

OBJECTIVE

This study aimed to evaluate the feasibility, safety, and efficacy of a comprehensive intervention model using a mobile health system (CIMmH) in patients with esophageal cancer after esophagectomy.

METHODS

Twenty patients with esophageal cancer undergoing the modified McKeown surgical procedure were invited to join the CIMmH program with both online and offline components for 12 weeks. The participants were assessed before surgery and again at 1 and 3 months after esophagectomy. QOL, depressive symptoms, anxiety, stress, nutrition, and physical fitness were measured.

RESULTS

Of the 20 patients, 16 (80%) completed the program. One month after esophagectomy, patients showed significant deterioration in overall QOL (P=.02), eating (P=.005), reflux (P=.04), and trouble with talking (P<.001). At the 3-month follow-up, except for pain (P=.02), difficulty with eating (P=.03), dry mouth (P=.04), and trouble with talking (P=.003), all other QOL dimensions returned to the preoperative level. There were significant reductions in weight (P<.001) and BMI (P=.02) throughout the study, and no significant changes were observed for physical fitness measured by change in the 6-minute walk distance between baseline and the 1-month follow-up (P=.22) or between baseline and the 3-month follow-up (P=.52). Depressive symptoms significantly increased 1 month after surgery (P<.001), while other psychological measures did not show relevant changes. Although there were declines in many measures 1 month after surgery, these were much improved at the 3-month follow-up, and the recovery was more profound and faster than with traditional rehabilitation programs.

CONCLUSIONS

The CIMmH was feasible and safe and demonstrated encouraging efficacy testing with a control group for enhancing recovery after surgery among patients with esophageal cancer in China.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR-IPR-1800019900); http://www.chictr.org.cn/showprojen.aspx?proj=32811.

The Role of Active Coping in the Relationship Between Learning Burnout and Sleep Quality Among College Students in China

Learning burnout negatively influences students' learning and well-being. Sleep quality is directly related to students' health and learning outcomes. Research indicates that sleep quality and coping style may be associated with learning burnout. However, the interrelationship among learning burnout, sleep quality, and coping style has not yet been fully studied. This study aimed to explore the relationship between sleep quality and learning burnout and examine whether coping mediates this relationship in Chinese university students. A total of 228 undergraduate students were recruited to participate in this research. The Simplified Coping Style Questionnaire (SCSQ), Learning Burnout Questionnaire (LBQ), and Pittsburgh Sleep Quality Index-Chinese (PSQI-C) were employed to collect data. The results showed the following: (1) poor sleep quality had a positive association with learning burnout, and (2) active coping style mediated the effects of poor sleep quality on learning burnout and the dimensions of learning burnout (depression and low sense of achievement). The findings of the current study contribute to knowledge of learning burnout and provide theoretical evidence for further educational interventions.

Associations Among Depressive Symptoms, Childhood Abuse, Neuroticism, Social Support, and Coping Style in the Population Covering General Adults, Depressed Patients, Bipolar Disorder Patients, and High Risk Population for Depression

BACKGROUND

Exposure to childhood abuse has been identified as a salient risk factor for the development of depression. However, the mediating factors between childhood abuse and depressive symptoms have not been sufficiently elucidated. This study aims to investigate the mediating effects of neuroticism, social support, and coping style between childhood abuse and depressive symptoms in population covering general adults, depressed patients, bipolar disorder patients, and high risk population for depression.

METHODS

This is a cross-sectional study. Five validated questionnaires were used to measure the psychological outcomes (Childhood Trauma Questionnaire CTQ-SF, Eysenck Personality Questionnaire EPQR-S, Social Support Rating Scale SSRS, Simplified Coping Style Questionnaire SCSQ, and Patient Health Questionnaire-9 PHQ-9) of 312 participants. Multiple regressions and structural equation modeling (SEM) were used to conduct data analysis.

RESULTS

Multiple regression analysis and SEM showed a significant association between childhood emotional abuse and depression symptoms. Neuroticism, use of social support, and active coping style were important mediating variables of this association. The R 2 for our model was 0.456, indicating that 45.6% of the variability in depressive symptoms can be explained by the model.

CONCLUSION

This study suggested that neuroticism, active coping, and use of social support play important role in mediating the effects of childhood abuse on adult depressive symptoms.