Factor structure and measurement invariance of the Chinese version of the Center for Epidemiological Studies Depression (CES-D) scale among undergraduates and clinical patients

Novel Insight into the Association between Balneotherapy and Functional State and Health Perception in Chronic Low Back Pain: A Cross-Sectional Study

Background: Epidemiological data indicate that low back pain (LBP) affected 619 million people globally in 2020, representing a significant health and economic burden. Additionally, chronic LBP (cLBP) strongly impairs quality of life and leads to disability and premature retirement, thus emphasizing the need for providing deeper insight into the factors that affect treatment outcomes and for offering thorough guidance for the assessment and management of this condition. Taking into consideration the rising prevalence of cLBP and the knowledge gap referring to the overall health benefits of balneotherapy (BT), the aim of this study was to assess the effects of BT on functional status, quality of life, and psychological symptoms in patients with cLBP. Methods: Among 220 patients from the database, two groups were retrospectively identified: patients receiving conventional pharmacological therapy (CT) and patients receiving BT. The effectiveness of the treatment was assessed through a visual analog scale for pain intensity, EuroQol (EQ-5D), and the Work Ability Index Questionnaire. In order to provide deeper insight into the quality of life and also factors associated with functional status and mental health affected by BT, we also used the Short Form Health Survey Questionnaire and the Center of Epidemiologic Studies Depression Scale. Results: Both age and treatment protocol were found to have a significant impact on all observed parameters, i.e., older patients and those receiving CT tended to report lower overall health and physical functioning. On the other hand, BT was associated with better functionality and disability perception status. Conclusions: Understanding the association between individual perceptions of functionality and its emotional and social elements provides a basis for providing comprehensive guidelines and recommendations for cLBP management.

Nonrestorative sleep and its associated factors in Chinese adolescents and the moderation effects of coffee or tea consumption

BACKGROUND

Nonrestorative sleep (NRS) is related to numerous adverse outcomes. There is rare evidence of its associated factors, especially in Chinese adolescents. This study aimed to explore the factors associated with NRS in Chinese adolescents and the potential moderation effects of coffee or tea consumption.

METHODS

This cross-sectional study invited adolescents attending Grades 7-11 in Nanjing, China, to complete a self-administered questionnaire, including their NRS, stress, anxiety, physical symptoms, depression, sociodemographics, and lifestyles. Linear regressions were applied to investigate the associated factors of their NRS, with the moderation effects of coffee or tea consumption and other characteristics being tested by additionally including their interactions.

RESULTS

Totally 481 adolescents (49% male, age 15.5 ± 1.5 years) were enrolled, with the average global NRS score of 42.16 ± 7.57. Higher family income (β = 2.01, P = 0.007), longer sleep duration (β = 2.33, P = 0.011), and moderate after-class activity (β = 1.50, P = 0.044) contributed less NRS, while higher educational level (β = -2.60, P = 0.033), more coffee or tea consumption (β = -1.68, P = 0.013), physical symptoms (β = -3.85, P < 0.001), stress (β = -0.23, P = 0.005), anxiety (β = -1.54, P = 0.045), and depression (β = -0.13, P = 0.014) contributed more NRS. Females (β = 0.82, P = 0.005), older age (β = -0.46, P = 0.029), and higher education level (β = -1.68, P < 0.001) contributed less refreshment from sleep, more physical/medical symptoms of NRS, and less daytime function, respectively. Coffee or tea consumption moderated the associations of somatic symptoms (β = 0.25, P = 0.021), stress (β = 0.29, P = 0.022), anxiety (β = 0.27, P = 0.005), and depression (β = 0.17, P = 0.021) with NRS.

CONCLUSIONS

Longer sleep duration, moderate after-class activity, reduced coffee or tea consumption, and promotion of physical and mental health may help reduce adolescents' NRS. Coffee or tea consumption may help buffer the negative associations of somatic symptoms, stress, anxiety, and depression with NRS.

Effect of an Internet-based mental health promotion intervention among immigrant Chinese women: A quasi-experimental study

Background

Owing to a lack of social support, child-rearing Chinese women in Japan experience mental health disorders, such as depression and parenting stress. Effective interventions to improve the mental health of these women are lacking. This study aimed to develop an Internet-based mental health promotion intervention for this subsection of the population and evaluate the effectiveness of the intervention.

Methods

We used a quasi-experimental pre- and post-test design whereby the results of the intervention group were compared with those of a control group. Seventy-three child-rearing women were recruited from online groups of Chinese residents in Japan. In the Internet-based intervention, participants utilised an information provision application and attended online parenting workshops. The intervention group participated in the online workshops once a week for six weeks and accessed the application, whereas the control group did not. The outcome measures included the levels of mental health distress, depression, social support, and parenting stress. Data were collected from February to April 2022. Data analysis was performed using repeated-measures analysis of variance.

Results

Mental health distress (F = 16.478, p < 0.001, η2 = 0.210) and depression (F = 13.078, p = 0.001, η2 = 0.174) were significantly affected in the intervention group compared with the control group. There were no significant differences in social support and parenting stress between the groups. The Internet-based mental health promotion intervention was highly appraised by the participants.

Conclusions

This study developed an Internet-based mental health promotion intervention that involved an information provision application and parenting workshops. The intervention significantly reduced the mental health distress and depression of Chinese women in Japan but did not affect social support and parenting stress. The findings suggest that this intervention could be applied to foreign women with multicultural backgrounds in diverse settings to improve their psychological well-being.

Factor structure and measurement invariance of the 8-item CES-D: a national longitudinal sample of Chinese adolescents

BACKGROUND

The 8-item Center for Epidemiologic Studies Depression Scale (CES-D 8) has been widely used to measure depressive symptoms in many large-scale surveys. Due to its brevity, it can lower costs, relieve respondent burdens, and ensure data quality. However, its factor structure and measurement invariance across gender and time among adolescents have not been adequately evaluated. This study investigated its factor structure and measurement invariance across gender and time among adolescents.

METHODS

The data was drawn from the China Family Panel Studies (CFPS) conducted in 2018 and 2020, with 3099 participants (46.82% girls) aged 11 to 18 in 2018. First, exploratory and confirmatory factor analyses were used to examine the factor structure of the CES-D 8. Next, multi-group confirmatory factor analysis was conducted to test its measurement invariance across gender and time. Finally, a longitudinal cross-gender test was conducted to further confirm the stability of the scale.

RESULTS

A two-factor structure was identified among the adolescents, including Negative Symptoms and Diminished Happiness Feeling. Measurement invariance across gender and time, as well as the longitudinal cross-gender invariance, was supported, with configural, factor loadings, thresholds and residual invariance.

CONCLUSIONS

The factor structure of the CES-D 8 remains stable across gender and time among adolescents, indicating that it is a promising instrument for measuring depressive symptoms, especially in large-scale and longitudinal surveys.

Psychological Health and Risk Factors of College Students within the Context of the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

Students are a priority population in mental health research. This study aimed to explore the risk factors of anxiety and depression symptoms among college students in Chongqing, a megacity under the impact of COVID-19, and to provide a basis for determining the priorities of public health policies and implementing effective educational health care interventions.

METHODS

In this cross-sectional study conducted in Chongqing, China, the data came from web-based stratified random sampling. Anxiety and depression symptoms were measured by the Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Studies Depression Scale (CES-D), respectively, and risk factors were analyzed by logistic regression.

RESULTS

Data were obtained from 915 college students (34.75% were male, and 65.25% were female) with age (20.29 ± 1.51) in Chongqing, China. The prevalence rates of anxiety and depression were 19.78% and 22.62%, respectively. Logistic regression analysis revealed that the risk factors of anxiety symptoms were associated with junior years, sleep time of less than 6 h a day, influence on career planning, and depression symptoms. Comprehensive, science and engineering, and medicine disciplines, having siblings, poorer mastery of study, and anxiety symptoms were risk factors for developing depression symptoms.

CONCLUSIONS

During the pandemic, college students experienced varying degrees of anxiety and depression. Our research findings highlight the necessity of universities and relevant departments providing precise mental health education for college students under major public health emergencies.

Sex differences in the associations of non-medical use of prescription drugs with depressive and anxiety symptoms among undergraduates in China

BACKGROUND

Non-medical use of prescription drugs (NMUPD) and their association with depression and anxiety are becoming global concerns. Biological sex may introduce differential exposure to NMUPD or depressive/anxiety symptoms. However, few studies have investigated the potential sex differences in the associations of NMUPD with depressive/anxiety symptoms.

METHODS

Data were drawn from the 2019 School-based Chinese College Students Health Survey. A total of 30,039 undergraduates (mean age: 19.8 [SD: 1.3] years) from sixty universities/colleges in China completed standard questionnaires and were included in the study (response rate: 97.7 %).

RESULTS

In the final adjusted model, non-medical use of opioids (experimenters: β = 1.10, [95 % CI, 0.62 to 1.57]) or sedatives (frequent users: β = 2.98, [95 % CI, 0.70 to 5.26]) was associated with depressive symptoms, while non-medical use of opioids (frequent users: β = 1.37, [95 % CI, 0.32 to 2.42]) or sedatives (frequent users: β = 1.19, [95 % CI, 0.35 to 2.03]) was also associated with anxiety symptoms. Sex-stratified analyses indicated that lifetime opioids misuse was associated with depressive symptoms in both sexes but with anxiety symptoms only in males (β = 0.39, [95 % CI, 0.09 to 0.70]). The association of lifetime sedative misuse with depressive symptoms was greater in males, while the significant association with anxiety symptoms remained only in female (β = 0.52, [95 % CI, 0.14 to 0.91]).

LIMITATIONS

Causal inference cannot be made due to the cross-sectional nature of the data.

CONCLUSIONS

Our study suggests NMUPD is associated with depressive and anxiety symptoms among Chinese undergraduates, and the associations may differ by sex.

Helicopter Parenting and Emotional Problems in Chinese Emerging Adults: Are there Cross-lagged Effects and the Mediations of Autonomy?

Although evidence suggests that helicopter parenting causes emotional problems in emerging adults, how emotional problems in emerging adults affect helicopter parenting and the mediating role of autonomy in reciprocal relationships is little known. Therefore, this study collected data from 418 Chinese university students (80.1% female; M_age = 18.71, SD = 1.15) three times (in the second, fourth, and fourteenth months after enrollment) about perceived helicopter parenting, emotional issues (anxiety and depressive symptoms), and autonomy. The results of the cross-lagged panel models showed that emotional problems in emerging adults predicted the later assessment of helicopter parenting, the reverse relationship between the two variables was not the case. Emerging adults' emotional issues at Time 1 reduced their autonomy at Time 2, leading to increased helicopter parenting behaviors at Time 3. However, helicopter parenting at Time 1 did not affect emerging adults' autonomy at Time 2, which also had no relation to their emotional problems at Time 3. These findings suggest that helicopter parenting is more likely a reaction to maladjustment in emerging adults than an influencing factor. The research clarifies changes in parent-child interactions during the transition to adulthood and will help promote the adaptation of emerging adults in college.

A serial model of the interrelationship between perceived vulnerability to disease, fear of COVID-19, and psychological distress among teachers in South Africa

The current study examined the serial relationship between perceived vulnerability to disease, fear of COVID-19, anxiety, and psychological distress among school teachers. Participants were South African school teachers (n = 355) who completed the Perceived Vulnerability to Disease Questionnaire, Fear of COVID-19 Scale, trait scale of the State-Trait Anxiety Inventory, Beck Hopelessness Scale, and the Centre for Epidemiological Depression Scale. A path analysis confirmed that teachers who appraised themselves as more susceptible to disease, experienced heightened levels of fear of COVID-19, which led to heightened levels of anxiety, depression, and hopelessness. Specifically, germ aversion and perceived infectability were separately associated with heightened fear of COVID-19, which in turn was associated with heightened anxiety. This serial relationship was associated with heightened levels of hopelessness and depression. The current study extends research on the impact of the COVID-19 pandemic among a distinct subgroup of the population.