Chinese school adolescents' stress experience and coping strategies: a qualitative study

Effects of Parental Psychological Control on Attitudes Toward Seeking Professional Psychological Help in Senior High School Students: Serial Mediating Effects of Rejection Sensitivity and Social Withdrawal

The purpose of the current study was to examine the serial mediating effects of rejection sensitivity and social withdrawal on parental psychological control and attitudes toward seeking professional psychological help among senior high school students. In November 2022, 648 students completed a self-report questionnaire. The parental psychological control scale, senior high school students' rejection sensitivity scale, social withdrawal scale, and attitudes toward seeking professional psychological help scale were used for measurement. Correlation analysis showed parental psychological control and rejection sensitivity were positively correlated with social withdrawal (r = 0.387, 0.466, 0.495, all p < 0.001). Parental psychological control and rejection sensitivity were significantly negatively correlated with social withdrawal and attitudes toward seeking professional psychological help (r = -0.325, -0.324, -0.397, all p < 0.001). Mediating effect analysis indicated that parental psychological control had a significant direct effect on attitude toward seeking professional psychological help, and rejection sensitivity and social withdrawal had significant serial mediating effects among parental psychological control and attitudes toward seeking professional psychological help in senior high school students. These aspects warrant attention as they play significant roles in influencing students' willingness to seek psychological assistance. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 47-55.].

Exploring symptom-level associations between anxiety and depression across developmental stages of adolescence: a network analysis approach

BACKGROUND

Anxiety and depression often co-occur during adolescence, but the associations between symptoms of these two disorders in this developmental period are not yet fully understood. Network analysis provides a valuable approach to uncover meaningful associations among symptoms and offers insights for prevention and intervention strategies. This study aimed to investigate symptom-level associations between anxiety and depression using network analysis and to identify core symptoms, bridge symptoms, and differences in network structure across different stages of adolescence.

METHODS

The cross-sectional study was conducted in March 2022 in Shenzhen, China. Participants completed the Generalized Anxiety Disorder Scale-7 and Patient Health Questionnaire Depression Scale, along with demographic questionnaires assessing age and gender. Chinese adolescents aged 10 to 17 who were in Grades 5 or 6 of elementary school, Grades 1 or 2 of middle school, or Grades 1 or 2 of high school, and who could comprehensively understand and read Chinese were recruited as participants. Students in Grade 3 of middle and high schools were excluded due to their upcoming high school or college entrance examinations. Based on age, participants were categorized into early, middle, and late developmental stages of adolescence.

RESULTS

"Loss of control" was among the most central symptoms in the comorbidity network throughout all three developmental stages; "excessive worry" and "anhedonia" emerged as the core symptoms in early adolescence, and "restlessness" as the core symptom in late adolescence. "Anhedonia," "sad mood," and "fatigue" were identified as bridge symptoms between anxiety and depression across all three developmental stages of adolescence. The global strength of the network in middle adolescence was significantly higher compared to the other two stages.

CONCLUSION

These findings highlight the core and bridge symptoms that require special attention and intervention at each stage of adolescence. Moreover, significantly higher network connectivity in middle adolescence suggests this is a critical period for intervention to prevent the development of comorbid mental disorders.

The feasibility, acceptability and efficacy of an app-based intervention (the Coping Camp) in reducing stress among Chinese school adolescents: A cluster randomised controlled trial

OBJECTIVES

This study aimed to determine the efficacies of the Coping Camp app in reducing stress, depression, and anxiety and improving stress-coping behaviours and mental health wellbeing. Additionally, feasibility and acceptability of Coping Camp were evaluated.

METHODS

In this unblinded cluster RCT, 540 participants from two high schools in China were randomly assigned to the Coping Camp intervention (n = 6 classes; 275 students) or treatment as usual (n = 5 classes; 265 students) at the class level. Coping Camp was an automated self-help app, consisting of 11 sessions delivered over 11 weeks, with primary outcomes including perceived stress, depression, anxiety, stress-coping behaviours, and mental health well-being. All outcomes were assessed at baseline, post-intervention (11 weeks), and follow-up (19 weeks), with efficacy analysed using linear mixed models and feasibility/acceptability measured by a 5-point Likert scale and qualitative feedback.

RESULTS

At post-intervention and follow-up assessments, 75.4% and 81.7% of participants respectively attended. On average, participants logged in for 8.56 out of 11 sessions. Compared to the control group, the intervention group had significant reductions in levels of perceived stress (p = 0.01, d = 0.15 at T1; p < 0.001, d = 0.18 at T2), anxiety (p = 0.11; d = 0.08 at T1; p = 0.01; d = 0.13 at T2) and depression (p = 0.04, d = 0.11 at T1; p = 0.05, d = 0.10 at T2) but did not have a greater increase in stress-coping behaviours (p = 0.10 at T1; p = 0.97 at T2) or mental health wellbeing (p = 0.93 at T1; p = 0.08 at T2). The average ratings for each session were above 4, and qualitative feedback showed that most participants found the intervention to be "great," "good," and "useful."

CONCLUSIONS

The Coping Camp is feasible, acceptable and effective in stress management among Chinese school adolescents.

Exploring factors affecting Chinese adolescents' perceived usefulness and engagement with a stress management app: a qualitative study

Introduction

Providing adolescents with stress management interventions via mobile apps has potential for overcoming barriers to traditional in-person services, such as stigma, cost and travel. However, the effectiveness remains uncertain and engagement level remains low. Therefore, it is essential to understand adolescents' user experience of such apps, however, such research is scarce. This study aimed to address this research gap by exploring factors affecting Chinese adolescents' perceived usefulness and engagement of a stress management app, which was developed for them.

Methods

A qualitative study design involving focus group interviews and inductive thematic analysis was adopted. A purposive sampling method was employed, resulting in five focus groups (n = 39 adolescents).

Results

Two themes emerged: (1) mechanism and determinants of usefulness and (2) facilitators and barriers to engagement. The app was found to be helpful in managing chronic and simple stressors by promoting positive behavior, cognition, and physical changes. Relevance to real-life situations, peer support, and planning and monitoring features were found to increase usefulness. Participants suggested adding one-on-one chat support for managing acute stressors. Multimedia, logical content arrangement, combining psychoeducation and skills training, gamification, customization, and an appealing user interface were engaging factors for adolescents, whilst text-heavy content, pedagogical and monotonous tones, technical issues were found to disengage adolescents.

Conclusion

Stress management apps should involve simple and evidence-based coping skills training, target adolescents' real-life problems, promote positive peer influence, address both chronic and acute stressors. Additionally, such apps should have logical arrangement of content, be interactive and customizable, and involve multimedia and gamification features to engage adolescents.