Measuring Chinese psychological well-being with Western developed instruments

Low Intake of Total Antioxidant Nutrients as a Risk Factor for Incident Dementia in Older Adults: The Shanghai Aging Study

INTRODUCTION

Previous longitudinal studies reported the impact of antioxidant nutrients (ANs) on cognitive impairment in the older population, but the conclusions were inconsistent. This study aimed to verify the hypothesis that dietary intake of total AN was associated with incident dementia among older individuals.

METHODS

Community residents without dementia aged ≥60 years were prospectively followed up for an average of 5.2 years in the Shanghai Aging Study. At baseline, daily intakes of total dietary AN (the sum of carotene, vitamin C, vitamin E, lutein, and flavonoids) and energy were calculated based on an interviewer-administered food frequency questionnaire measuring the dietary intake over the past 1 year for each participant. A battery of neuropsychological tests was used to evaluate cognitive function, and a consensus diagnosis of dementia was made according to the DSM-IV criteria at baseline and follow-up.

RESULTS

Among 1,550 dementia-free participants, 135 (8.7%) incident dementia cases were identified during the average of 5.2 years of follow-up. Participants with low AN intake (<112 mg/day) had a significantly higher risk of incident dementia than those with high AN intake (≥112 mg/day) (hazard ratio 1.87, 95% confidence interval 1.26-2.77) after adjusting for age, gender, education, obesity, APOE-ε4, hypertension, diabetes, depression, baseline Mini-Mental State Examination score, and total energy intake. The significant association of total AN intake with incident dementia was only found in individuals ≥70 years.

CONCLUSION

Low total AN intake may be a risk factor for incident dementia among older adults. Maintaining sufficient AN intake may be beneficial against age-related cognitive decline.

The Association Between Relative Deprivation, Depression, and Youth Suicide: Evidence From a Psychological Autopsy Study

OBJECTIVE

Suicide is a serious public health concern in China. In the present study, we investigated the specific mechanisms underlying relative deprivation and suicide in rural China.

METHODS

A large psychological autopsy study was conducted in rural China, in which 392 suicides and 416 community-living controls were consecutively recruited. Multiple logistic regression analysis was used to assess the relationship between relative deprivation and suicide, with depression as a potential mediator.

RESULTS

Young people who experienced relative deprivation were at a greater risk of suicide and depression. Depression plays a mediating role in the relationship between relative deprivation and suicide.

LIMITATIONS

Due to the limitations of the data, we cannot know whether there is mutual causation between relative deprivation and depression. The self-reported relative deprivation may also produce some influence on the results.

CONCLUSIONS

The current findings demonstrate the importance of relative deprivation as one of the four sources of psychological strain to explain how relative status is associated with suicide. The findings also can be translated into the clinical and preventive practice for suicide.

Joint effect of testosterone and neurofilament light chain on cognitive decline in men: The Shanghai Aging Study

INTRODUCTION

The association of testosterone and cognitive decline is inconclusive, and its joint effect with neurofilaments light chain (NfL) remains largely unknown.

METHODS

A total of 581 non-demented older men in the Shanghai Aging Study were included. Blood total testosterone (TT), free testosterone (FT), and NfL were measured at baseline. The relationships between TT, FT, TT/FT-NfL, and cognitive decline were explored by Cox regression models.

RESULTS

During a median follow-up of 6.7 years, there was an inverse association between TT/FT and cognitive decline (TT, trend p = 0.004, Q1 vs Q4, hazard ratio [HR] = 4.39, 95% confidence interval [CI] = 1.60 to 12.04; FT, trend p = 0.002, Q1 vs Q4, HR = 5.29, 95% CI = 1.50 to 16.89). Compared to participants with high TT/FT-low NfL, those with low TT/FT-high NfL had significantly higher risks of cognitive decline (TT, HR = 5.10, 95% CI = 1.11 to 23.40; FT, HR = 6.14, 95% CI = 1.34 to 28.06).

DISCUSSION

Our findings suggest that the combination of testosterone and neurodegenerative markers may provide reliable predictive insights into future cognitive decline.

HIGHLIGHTS

Testosterone is inversely associated with cognitive decline in older men. There is a joint effect of testosterone and NfL on cognitive decline. Sex hormone and neurodegeneration may synergistically contribute to cognitive deterioration.

Relationship between social support and self-care ability among patients with breast cancer during rehabilitation: The multiple mediating roles of resilience and depression

AIMS

To identify the multiple mediating effects of resilience and depression between social support and self-care ability among patients with breast cancer during rehabilitation to provide reference for developing and implementing targeted interventions.

DESIGN

A cross-sectional study reported according to the STROBE checklist.

METHODS

A convenience sample of 320 patients with breast cancer during rehabilitation was recruited from one hospital in China. Data were collected from April to August 2022 using a self-report questionnaire, including the demographic and clinical information, Appraisal of Self-Care Agency Scale-Revised, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale-10 item, and Patient Health Questionnaire-9. The mediation analysis was conducted using the SPSS Process macro.

RESULTS

Self-care ability was positively associated with social support (β = .229) and resilience (β = .290), and negatively associated with depression (β = -.208). The relationship between social support and self-care ability was mediated by resilience and depression, respectively, and together in serial. The multiple mediating effects accounted for 34.0% of the total effect of social support on self-care ability.

CONCLUSION

Our findings identify resilience and depression as multiple mediators between social support and self-care ability and highlight the important roles of social support, resilience and depression in improving self-care ability.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should pay great attention to the underlying mechanisms of how social support affects patients' self-care ability during breast cancer rehabilitation. Integrated intervention programmes targeted at enhancing social support, building resilience and alleviating depression might be beneficial to the improvement of self-care ability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.

Religion, Psychological Strain, and Suicidality in China: A Preliminary Study

BACKGROUND

There is a lack of religiosity studies in China especially in relation to mental health and suicidality. In this research, we focus our studies on medical workers of which some studies reported to have higher stress, and to pilot our studies in this adult age-group.

DATA AND METHODOLOGY

Data were obtained by a questionnaire survey in a large public hospital in a big metropolitan city of China. The final sample consisted of 1012 respondents with 237 (23.4%) being male and 775 (76.6%) being female. The respondents were of three groups: (1) Believers (n = 34; 3.5%); (2) Non-Believers or Atheists (n = 547; 55.8%); and (3) Agnostics or Fence-Sitters (n = 400; 40.8%). Suicidality was measured by the NCS-Suicidality Scale, and standard measures were employed for other major variables.

FINDINGS

In line with other recent studies in China, the religion rate among the urban adults remained low (3.5%). However, about 40.8% of the respondents chose "don't know" and could be fence-sitters on the issue of religious belief. Many of them are involved in various folk beliefs which may not be considered as religious. The religious believers were at higher risk of suicidality and depression than the atheists and the fence-sitters. However, the fence-sitters were higher than the believers and atheists on psychological strains, and they were higher on depression compared to the atheists.

CONCLUSION

The religious believers and religious fence-sitters have higher psychopathologic risks and suicidal risk than the atheist group. Religion as of low prevalence in Chinese societies is a social value deviant from the norm and its practitioners are likely to be marginalized or stigmatized. The Strain Theory of Suicide is used for detailed explanations.

Predicting depressive symptom by cardiometabolic indicators in mid-aged and older adults in China: a population-based cross-sectional study

Objective

Depressive symptom is a serious mental illness often accompanied by physical and emotional problems. The prevalence of depressive symptom in older adults has become an increasingly important public health priority. Our study used cardiometabolic indicators to predict depressive symptom in middle-aged and older adults in China.

Methods

The data came from the China Health and Retirement Longitudinal Study 2011 (CHARLS2011), which was a cross-sectional study. The analytic sample included 8,942 participants aged 45 years or above. The study evaluated the relationship between cardiometabolic indicators and depression by measuring 13 indicators, including body mass index (BMI), waist circumference, waist-height ratio (WHtR), conicity index, visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), triglyceride glucose index (TyG-index) and its correlation index (TyG-BMI, TyG-waist circumference, TyG-WHtR). Binary logistic regression analysis was used to examine the association between thirteen cardiometabolic indicators and depressive symptom. In addition, the receiver operating characteristic (ROC) curve analysis and area under curve (AUC) were used to evaluate the predictive anthropometric index and to determine the optimum cut-off value.

Results

The study included 8,942 participants, of whom 4,146 (46.37%) and 4,796 (53.63%) were male and female. The prevalence of depressive symptom in mid-aged and older adults in China was 41.12% in males and 55.05% in females. The results revealed that BMI [AUC = 0.440, 95%CI: 0.422-0.457], waist circumference [AUC = 0.443, 95%CI: 0.425-0.460], WHtR [AUC = 0.459, 95%CI: 0.441-0.476], LAP [AUC = 0.455, 95%CI: 0.437-0.472], BRI [AUC = 0.459, 95%CI: 0.441-0.476], CVAI [AUC = 0.449, 95%CI: 0.432-0.467], TyG-BMI [AUC = 0.447, 95%CI: 0.429-0.465], and TyG-waist circumference [AUC =0.452, 95%CI: 0.434-0.470] were weak predictors of depressive symptom (p < 0.05) in males. In females, BMI [AUC = 0.470, 95%CI: 0.453-0.486], LAP [AUC = 0.484, 95%CI: 0.467-0.500], TyG-BMI [AUC = 0.470, 95%CI: 0.454-0.487], and TyG-waist circumference [AUC =0.481, 95%CI: 0.465-0.498] were weak predictors of depressive symptom (p < 0.05). On the other side, VAI, ABSI, conicity index and TyG index could not predict depressive symptom in middle-aged and older adults.

Conclusion

Most cardiometabolic indicators have important value in predicting depressive symptom. Our results can provide measures for the early identification of depressive symptom in middle-aged and older adults in China to reduce the prevalence of depressive symptom and improve health.

Apolipoprotein E ε4 Modifies the Effect of Possible Anticholinergic Drugs on Incident Dementia: The Shanghai Aging Study

OBJECTIVES

To validate the hypothesis that apolipoprotein E (APOE) ε4 modifies the effect of possible anticholinergic drugs (PACDs) on incident dementia among older adults.

DESIGN

A population-based prospective study.

SETTING AND PARTICIPANTS

Dementia-free older adults in an urban community in Shanghai, China.

METHODS

At baseline, PACDs were defined according to the Anticholinergic Cognitive Burden Scale. Standard daily dose (SDD) of PACDs was calculated. A battery of neuropsychological tests was used to assess cognition and the consensus diagnosis was conducted for incident dementia and Alzheimer's disease (AD). Multivariate Cox regression models were used to examine the association between PACD use and the risk of dementia and AD in APOE ε4 carriers and noncarriers.

RESULTS

We followed 1406 dementia-free participants for a median of 5.3 years and defined 117 incident dementia cases, among which 89 were AD. Only in APOE ε4 carriers was PACD use associated with incident dementia [hazard ratio (HR) 5.71; 95% CI 2.04-15.94] and AD (HR 5.73; 95% CI 1.77-18.54); SDD was positively associated with incident dementia (HR 2.42; 95% CI 1.32-4.44) and AD (HR 2.16; 95% CI 1.06-4.41).

CONCLUSIONS AND IMPLICATIONS

Using PACDs requires judicious consideration for the potential risk of dementia and AD in older adults carrying APOE ε4.

Education, neighborhood environment, and cognitive decline: Findings from two prospective cohort studies of older adults in China

INTRODUCTION

The impacts of education on cognitive decline across different neighborhood environments (NEs) have rarely been studied.

METHODS

We investigated and compared the associations between educational attainment and cognitive decline using data of 1286 participants from the Taizhou Imaging Study (TIS) and the Shanghai Aging Study (SAS).

RESULTS

Compared with low-educated participants, in TIS with disadvantaged NE, high-educated participants manifested a significantly slower decline in global cognition (.062 Z score per year, P < .001), memory (.054 Z score per year, P < .05), and attention (.065 Z score per year, P < .01), whereas in SAS with advanced NE, highly educated individuals exhibited a slower decline only in attention (.028 Z score per year, P < .05).

DISCUSSION

We observed the additive effect of educational attainment and NE on cognitive decline in older adults. Education is especially important for maintaining cognitive health in a disadvantaged environment.

Loneliness and depressive symptoms among men who have sex with men in China: A cross-sectional study

Background

While psychosocial problems and their related factors in men who have sex with men (MSM) have been well documented in developed countries, there are still not many studies addressing this issue in China and the results are inconsistent. This study aimed to assess the prevalence of loneliness and depressive symptoms among MSM, examine their associated factors, and investigate potential factors moderating the link between depressive symptoms and loneliness.

Methods

A cross-sectional study was conducted in Taizhou of Zhejiang Province in China between April and November 2021. Loneliness was assessed using the 3-item UCLA Loneliness Scale (UCLA-3), and depressive symptoms were measured using the Patient Health Questionaire-9 (PHQ-9). Data from 655 MSM were eligible for analysis. Logistic regression models were used to examine the associations between independent variables and the outcomes of loneliness and depression. The interaction terms were added in the models to assess the moderating effects.

Results

Of the MSM sample, 13.28 and 7.48% perceived loneliness and reported moderate-to-severe depressive symptoms, respectively. We found that participants who experienced loneliness were more likely to have younger age (OR 0.44, 95% CI 0.21, 0.93, 15-32 years as reference group), low social support (OR 3.60, 95% CI 2.14, 6.04), low self-esteem (OR 3.03, 95% CI 1.45, 6.32) and moderate-to-severe depressive symptoms (OR 5.45, 95% CI 2.66, 11.15). The participants with moderate-to-severe depressive symptoms were more likely to have low self-esteem (OR 6.78, 95% CI 3.08, 14.95) and feelings of loneliness (OR 5.51, 95% CI 2.66, 11.40). Stratified analyzes showed that the magnitude of the associations between depressive symptoms and loneliness varied in MSM with different age, marital status, and self-esteem.

Conclusion

Our study suggests that we need to pay attention to feelings of loneliness and depressive symptoms and their closely associated factors such as social support and self-esteem among MSM in China. The MSM who were young, not married, and had low self-esteem were especially vulnerable to the impact of depressive symptoms on loneliness.

Dietary calcium and magnesium intake and risk for incident dementia: The Shanghai Aging Study

Introduction

Calcium (Ca), magnesium (Mg), or the calcium to magnesium (Ca:Mg) ratio may affect the risk of dementia via complex mechanisms. The aim of this study was to evaluate the association of dietary Ca, Mg, and Ca:Mg ratio with dementia risk at the prospective phase of the Shanghai Aging Study.

Methods

We analyzed data from 1565 dementia-free participants living in an urban community who had measurements of dietary Ca and Mg intake derived from a food frequency questionnaire at baseline and incident dementia during follow-up.

Results

Over the 5-year follow-up, 162 (10.4%) participants were diagnosed with incident dementia by Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. Participants with the lowest tertile of dietary Ca (<339.1 mg/day) and Mg (<202.1 mg/day) had the highest incidence rates of dementia (3.3/100 person-years for Ca, 3.3/100 person-years for Mg) compared to those with higher Ca and Mg intake. In the subgroup with Ca:Mg ratios ≤ 1.69, Mg intake >267.5 mg/day was related to an increased risk for dementia (adjusted hazard ratio: 3.97, 95% confidence interval: 1.29-12.25).

Conclusions

Our findings suggest that high dietary intake of Mg is associated with an increased risk of dementia mainly among older adults with low Ca:Mg intake ratios. Proper balance of Ca to Mg in the diet may be critical to the relationship between Mg intake and risk of dementia.

Highlights

Participants with the lowest tertile of dietary calcium (Ca) and magnesium (Mg) had the highest incidence rates of dementia.In the subgroup with Ca:Mg ratios ≤1.69, Mg intake >267.5 mg/day was related to an increased risk for dementia.Balance of Ca to Mg in diet may be critical to the relationship between Mg intake and risk of dementia.

How does neighbourhood environment influence loneliness in later life in Urban China? The role of financial status

This study aimed to examine whether older adults' financial status moderated the association between neighbourhood environment (i.e. physical and social environment) and loneliness among older adults in urban China. A cross-sectional survey was collected from urban communities of Shanghai in mid-2020. The final analytic sample was 459 older adults (age range = 60-91 years; proportion of women: 55.8%). Multiple group analysis was applied to test the hypothesised model. A measurement model of community social capital (i.e. cognitive and structural dimensions of social capital), a crucial indicator of neighbourhood social environment, was first established in both high-income and low-income groups. Factor loading invariance was established in these two groups. The results show that structural social capital (i.e. organisation memberships, volunteering, social participation and citizenship activities) was negatively associated with loneliness among older respondents from the high-income group only, whereas better community security was significantly associated with lower levels of loneliness among low-income older respondents only. The findings imply that both structural social capital and household income should be considered as important indicators in needs assessment among lonely older adults. Future social policies and interventions should pay attention to enhancing the role of both social and physical neighbourhood environment among older adults.

Maternal mental health and social support from online communities during pregnancy

Social determinants of public health have gained increasing attention. This paper studied whether social support from online communities related to maternal mental health. We focused on online maternity communities that group users with a similar prenatal status to facilitate their exchange of personal experiences and knowledge about maternal caring during pregnancy. Such online maternity communities are getting increasingly popular and can be found across countries and societies. We invited users-currently pregnant and gave birth within 1 year at the time of the study-from one such community in China to participate in a survey. The survey measured their perceived social support (PSS) exclusively from the peer group in the online community, their mental health and newborns' birth outcomes (N = 500). Users reported high score in PSS from the online peer group which was comparable to the ones from family, significant other and friends in other studies. We used linear regression models to examine the effects of PSS on mental health and birth outcomes. We found that a one-point increase in the PSS score was associated with a 0.19-point (p < 0.1) decrease in the prenatal depression and a 0.26-point (p < 0.01) decrease in the postnatal depression, which was equivalent to 3% and 4.5% of the average respectively. Moreover, a one-point increase in the PSS score was associated with a 14.49-gram increase in a newborn's weight (p < 0.01).

Development of the Temporal Sense Scale (TSS) for General Populations

While measures of the subjective passage of time currently exist, few, if any, have been structured parsimoniously for use in general populations. The purpose of this study was to develop the Temporal Sense Scale (TSS) for general use in any population and test its validity with measures of positive and negative life evaluations in selected samples. Two randomly selected samples were collected in urban China. The first consisted of medical staff from a public hospital (), and the second consisted of heterogeneous nonmedical employees (). A self-administered questionnaire was used to identify demographics, life satisfaction, well-being, and temporal sense in both samples. Reliability and validity tests were performed on the TSS. Further analyses were conducted to examine the extent to which temporal sense was associated with positive psychological outcomes (well-being and life satisfaction) and psychopathologies (depression and suicidal ideation). The TSS showed high validity and strong internal reliability within both samples (Cronbach ). Fast temporal sense was positively associated with well-being and life satisfaction, and negatively associated with depression and suicidal ideation in both groups, even after controlling for age, gender, and other relevant factors. The TSS is presented as a valid measure of a general perception of the passage of time. Further, a general fast passage of time may be seen as an indicator of positive psychological outcomes such as life satisfaction and happiness, while a general negative passage of time is indicative of negative psychological outcomes, including depression and suicidal ideation. The Social Reference Theory is applied to account for the associations.

Effectiveness of a resilience-targeted intervention based on "I have, I am, I can" strategy on nursing home older adults' suicidal ideation: A randomized controlled trial

BACKGROUND

Despite the potential for benefit, resilience remains an emergent area in late-life mental health care, and evidence of resilience intervention for suicide among nursing home residents is especially limited. This study aims to evaluate the effects of a resilience-targeted program based on the "I have, I am, and I can" strategy on suicidal ideation and related problems.

METHODS

From the 562 nursing home residents who were contacted, 68 with suicidal ideation were recruited and then randomly assigned to a resilience intervention group (eight-week resilience training; n = 34) or a wait-list control group (eight-week health education; n = 34). Self-reported suicidal ideation, and depression and anxiety symptoms as outcomes, and resilience as potential mediators were assessed at baseline, postintervention, and one-month follow-up.

RESULTS

Resilience training participants reported significant improvement in suicidal ideation (group × time interaction x²=12.564, p = 0.002) and depression symptoms (x²=9.441, p = 0.009) compared to wait-list control group participants. Changes in resilience mediated the intervention's effects on changes in suicidal ideation and depression symptoms. Limitations The observed effects must be considered preliminary due to the small sample size.

CONCLUSIONS

The findings support the benefits of resilience training based on the "I have, I am, and I can" strategy in reducing suicidal ideation and suicide-related symptoms in nursing home older adults, and provide insight into possible mechanisms.

Exploring the gender difference in relationships between narcissism, competitiveness, and mental health problems among college students

ObjectiveThe current research examined the gender difference in relationships in terms of overt and covert narcissism, hypercompetitiveness, personal development competitiveness, and mental health problems, such as anxiety, depression, and stress symptoms among college students. Participants: 195 college students (mean age = 21.55 years) in Hong Kong. Method: Participants were invited to fill in standardized psychological instruments. Results: In all, 125 (62.1%) were females. The results revealed that males had higher levels of narcissism and competitiveness than females. Narcissism was associated with competitiveness in both genders. Covert narcissism was independently and positively related with depression, anxiety, and stress in both males and females. Hypercompetitiveness was independently and positively associated with mental health problems in females, but independent associations were not found in males. Conclusions: For the well-being of college students, those with covert narcissism and females with hypercompetitiveness should be monitored closely as they are more likely to have mental health problems.

The mediating role of perceived social support in the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders

WHAT IS KNOWN ON THE SUBJECT?: Individuals diagnosed with substance use disorders may perceive stigma and suffer from mental health problems. Perceived stigma is related to poor mental health among individuals diagnosed with substance use disorders. The social support deterioration deterrence model proposes that stressors (e.g. perceived stigma) negatively affect mental health via reduced perceived social support. To the best of the present authors' knowledge, the model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper used structural equation modelling to show that the social support deterioration deterrence model could explain the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders. Perceived support from family and perceived support from friends are mediators in the association between perceived stigma and depression among individuals diagnosed with substance use disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychosocial interventions to increase perceived support from family and friends would be helpful in addressing perceived stigma effects on mental health. ABSTRACT: Introduction Although the relationship between perceived stigma and mental health outcomes is documented in the existing literature, very few studies have investigated the mechanism linking perceived stigma and mental health outcomes among individuals diagnosed with substance use disorders. To the best of the present authors' knowledge, the social support deterioration deterrence model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. Aim/Question Guided by the social support deterioration deterrence model, the present study investigated the mediating role of perceived support from three types of social network members (i.e. significant others, family members, and friends) in the association between perceived stigma and depression in individuals diagnosed with substance use disorders. Method The study employed a cross-sectional survey design comprising 300 participants diagnosed with substance use disorders in Taiwan. Results Results of a structural equation modelling analysis indicated that perceived stigma was significantly associated with depression. The relationship between perceived stigma and depression was partially mediated by perceived family support and perceived friend support. Discussion Consistent with the prediction of the social support deterioration deterrence model, the negative effect of perceived stigma on depression for individuals diagnosed with substance use disorders is through the mediating effect of social support. Implications for practices Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders.

Frailty and Incident Depressive Symptoms During Short- and Long-Term Follow-Up Period in the Middle-Aged and Elderly: Findings From the Chinese Nationwide Cohort Study

OBJECTIVE

Prefrailty and frailty are two common conditions among older individuals. Recent studies have reported the association between frailty and depressive symptoms, but whether those conditions could predict depressive symptoms is still inconsistent in a few longitudinal studies. In our study, we aimed to estimate the cross-sectional and longitudinal associations between frailty and incident depressive symptoms in a nationally representative sample of community-dwelling middle-aged and older Chinese adults.

METHOD

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which included 17,284 adults aged ≥ 45 years. Participants were followed every two years using a face-to-face, computer-aided personal interview (CAPI) and structured questionnaire. We excluded participants with no follow-up data. The numbers of individuals who completed the baseline surveys were 2,579 and follow-up surveys were 839 for the short-term (2 years from 2011 to 2013) and 788 for the long-term (4 years from 2011 to 2015). In addition, Frailty was measured by the Fried criteria and depressive symptoms were estimated by the Chinese version of the Center for Epidemiologic Studies-Depression scale (CES-D). Logistic regression was used to analyze the odds ratio (OR), and 95% confidence interval (CI) for the cross-sectional associations of frailty and its components with depressive symptoms in the participants at baseline. Cox proportional hazards analysis was conducted using the hazard ratio (HR), and 95% confidence interval (CI) for the prospective associations of baseline frailty and pre-frailty and its component in the participants without depressive symptoms at baseline.

RESULTS

At baseline, 57.93% of participants had depressive symptoms and 55.84% had pre-frail and 11.63% had frailty. In the cross-sectional analysis, both pre-frailty (OR = 5.293, 95%CI 4.363-6.422) and frailty (OR = 16.025, 95%CI 10.948-23.457) were associated with depressive symptoms. In the longitudinal analysis, frailty [HR = 1.395 (0.966-2.013)] and pre-frailty [HR = 2.458 (0.933, 6.479)] were not significantly associated with incident depressive symptoms in a full-adjusted model among participants free of baseline depressive symptoms during the short-term. However, frailty [HR = 1.397 (1.017, 1.920)] and pre-frailty [HR = 2.992 (1.210, 7.397)] were significantly associated with incident depressive symptoms during the short term. In the components of frailty, slowness [HR = 1.597 (1.078, 2.366)] was associated with an increased risk of depressive symptoms onset during the short-term. Weakness [HR = 2.08 (1.055, 4.104)] and exhaustion [HR = 1.928 (1.297, 2.867)] were associated with increased risk of depressive symptoms onset during the short-term.

CONCLUSION

Among the middle-aged and older adults, frailty, pre-frailty did not predict depressive symptoms during 2 years of follow-up, when accounting for the potential confounders, slowness considered alone predicted depressive symptoms. Additionally, frailty, pre-frailty predicted depressive symptoms during 4 years of follow-up, when accounting for the potential confounders, weakness and exhaustion considered alone predicted depressive symptoms.

The role of the dominant attribution style and daily hassles in the symptoms of depression and anxiety

Cognitive theories of depression and anxiety posit that attribution bias plays a central role in the onset and maintenance of anxiety and depression. The main goal of the current study was to examine the association of the Weakest Link as an individual's dominant attribution style, and daily hassles, with depressive and anxious symptoms, and to examine the moderating effect of the Weakest Link on the relationships of daily hassles with depressive and anxious symptoms. 686 undergraduate students recruited from three universities completed questionnaires that measured dominant attribution style, daily hassles, and depressive symptoms and anxious symptoms. Moderation analysis showed that daily hassles and Weakest Link were independent predictors of both depressive and anxious symptoms. Individuals with high Weakest Link scores reported high levels of both depressive and anxious symptoms in the presence of high levels of daily hassles. In conclusion, the current study provides support for moderation effect of the dominant attribution style on the relationship between daily hassles and the symptoms of depression and anxiety.

Mental Health Outcomes among Chinese College Students over a Decade

Background: Economic growth in China has brought about significant social and psychological changes in society. Objective: This study aims to explore how the mental and psychological health of college students has changed over the past decade. Methods: We observed several cohort samples in a Chinese university over a decade and looked at five mental health outcomes, including suicidal ideation, depression, optimism, self-esteem, and perceived social support, throughout each year of testing. Results: Our study highlights the declining rates of suicidal ideation and depression, combined with relative stability and even small increases in optimism, self-esteem, and perceived social support across a range of demographic variables. Conclusions: The findings of this study imply that in the context of economic growth, stabilizing and improving positive mental health states can help prevent and reduce the risk of depression and suicidal ideation among college students. The study also highlighted the need for more public health campaigns and interventions in universities to help students cope with mental health problems.

Mediating Effects of Stigma and Depressive Symptoms in a Social Media-Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions.

OBJECTIVE

This study aims to explore the intervention mechanisms of a social media-based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period.

METHODS

We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants' QOL.

RESULTS

About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported.

CONCLUSIONS

These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media-based interventions that can address HIV-related stigma and alleviate depressive symptoms.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019.

Perceived social support, resilience and health self-efficacy among migrant older adults: A moderated mediation analysis

Migrant older adults become more disadvantaged in health due to aging and migration-related problems. This study aimed to examine the mediating role of resilience in the relationship between perceived social support and health self-efficacy, and to test whether gender moderated the mediating effect of resilience between perceived social support and health self-efficacy among migrant older adults. A total of 184 migrant older adults were recruited from five communities. Resilience played a partial mediating role in the relationship between perceived social support and health self-efficacy. Moreover, age moderated the relationship between resilience and health self-efficacy. The relationship between resilience and health self-efficacy was stronger in male older adults than female ones. These findings provide a better understanding of the effects of perceived social support and resilience on health self-efficacy, which could guide targeted interventions for community health nurses to promote health self-efficacy among migrant older adults.

Anxiety and depression among healthcare workers during the COVID-19 pandemic: a systematic umbrella review of the global evidence

OBJECTIVES

To summarise the evidence relating to the prevalence of anxiety and depression among healthcare workers (HCWs) during the COVID-19 pandemic.

DESIGN

An umbrella review of systematic reviews was undertaken using the Joanna Briggs Institute (JBI) methods.

DATA SOURCES

The Cochrane database of systematic reviews, JBI Evidence Synthesis, MEDLINE, Web of Science, PsycINFO, Embase and CINAHL were searched in March 2021 for reviews published in English.

ELIGIBILITY CRITERIA

Systematic reviews reporting the prevalence of anxiety and depression among HCWs during the COVID-19 pandemic. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed using the JBI critical appraisal tool for systematic reviews, and the degree of overlap in primary studies was calculated.

RESULTS

Ten systematic reviews (100 unique studies), including 169 157 HCWs from 35 countries were included. The prevalence of anxiety among all HCWs ranged from 22.2% (95% CI 21.3% to 23.1%) to 33.0% (95% CI 31.9% to 34.1%). The prevalence of anxiety among physicians (n=5820) was reported to be between 17% and 19.8% and for nurses (n=14 938) between 22.8% and 27%. The prevalence of depression among all HCWs ranged from 17.9% (95% CI 17.1% to 18.8%) to 36% (95% CI 34.9% to 37.1%). The prevalence of depression among physicians (n=643) and nurses (n=8063) was reported to be 40.4% and 28%, respectively.

CONCLUSIONS

There is wide variation evident in the presence of anxiety and depression among HCWs. In particular, the prevalence of depression among physicians was high. Strategies to reduce the incidence of anxiety and depression are urgently required.

PROSPERO REGISTRATION NUMBER

CRD42021238960.

Religious affiliation and suicidality among college students in China: A cross-sectional study across six provinces

BACKGROUND

Several past studies indicated that religious beliefs, orientation, and practice are protective of suicide. Findings from recent studies in China suggest that religiosity may contribute to increased suicidality. However, few studies have examined the associations between religious affiliation across different faiths and suicidality in China.

OBJECTIVE

The current study examines the association between religious affiliation and suicidality among college students in six provinces in China.

METHODS

We conducted a cross-sectional study involving 11,407 college students from six universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, and Shaanxi. We collected the data between October 2017 and March 2018 using self-report questionnaires. They included self-report measures of depression, psychache, hopelessness, self-esteem, social support, and life purpose.

RESULTS

Participants with a Christian affiliation had 1.5 times (95% CI: 1.14, 1.99, p = 0.004) higher odds of indicating an elevated suicide risk, 3.1 times (95% CI: 1.90, 5.04, p<0.001) higher odds of indicating a previous suicide attempt, and increased overall suicidality (B = 0.105, p < 0.001) after accounting for demographic and risk/protective factors. Christians also scored the highest in depression, psychache, hopelessness, and the lowest social support, self-esteem, and purpose in life. Muslims reported decreased suicidality (B = -0.034, p = 0.031). Buddhism/Daoism yielded non-significant results in the multivariate analyses.

CONCLUSIONS

Christian college students reported increased suicidality levels, perhaps due to public policies on religion. The decreased suicidality levels among Muslims may be attributed to higher perceived social support. The associations between religious affiliation and suicidality, depression, and hopelessness contrast sharply with US samples. This finding may be influenced by interactions between the religious denomination, individual, and social/political factors. This conclusion includes the possibility of anti-religious discrimination, which this paper did not investigate as a possible mediator and therefore remains a conjecture worthy of future investigation.

Associations between posttraumatic stress symptoms, perceived social support and psychological distress among disaster-exposed Chinese young adults: A three-wave longitudinal mediation model

Research has documented a strong association between perceived social support, posttraumatic stress symptoms (PTSS), and psychological distress (PD) among people exposed to natural disasters. However, the direction of associations between these factors remains unclear. This study examined possible mediational relationships among perceived social support, PTSS, and PD. A three-wave longitudinal design (6 months intervals) was employed in a sample of 341 Chinese university students (M_age = 21.24, SD = 2.72; 75.7% female) aged 18 to 34 who were directly exposed to a typhoon that occurred in Macao, China, during August 2017. Results indicated that perceived social support at T2 mediated the linkage between PTSS at T1 and PD at T3, and that PTSS at T2 significantly mediated the relationship between PD at T1 and perceived social support at T3. This three-wave longitudinal study highlights the key role of perceived social support on the aggravating effect of acute PTSS on long-term psychological problems, and demonstrates that adverse psychological health outcomes negatively affect the perception of supportive social resources in the context of a natural disaster.

Psychological characteristics of suicide attempters among undergraduate college students in China: a cross-sectional study

BACKGROUND

There is a need to understand the psychological characteristics of suicide attempters to prevent future suicide attempts. This study aims to examine potential differences between individuals who have attempted suicide and those who have not done so, on several risk and protective measures.

METHOD

Participants were 11,806 undergraduate students from seven provinces in China, of which 237 reported a non-fatal suicide attempt. We used the random numbers generator function within the SPSS to randomly select a control subset of 1185 participants to be used as the comparison group based on a 1:5 case-control ratio. Scores on three commonly used risk measures (depression, hopelessness, and psychache) and three protective measures (social support, self-esteem, and purpose in life) for suicidality were adopted to compare the responses of the two groups.

RESULTS

Suicide attempters had indicated higher Median scores for all three risk factor measurements. Suicide attempters also reported significantly lower Median scores for all three protective factor measurements compared to non-suicide attempters. The results suggest that the suicide attempters' group had higher risks of suicidality compared to the non-attempter group.

CONCLUSIONS

Suicide attempters continued to report higher scores of risk factors and lower scores of protective factors, indicating that they may continue to be at a higher likelihood of a suicide attempt. Key protective factors should be identified for each individual in order to deliver appropriate clinical interventions to reduce their risk of reattempting.

Kidney function and dementia risk in community-dwelling older adults: the Shanghai Aging Study

BACKGROUND

Association between kidney dysfunction and dementia has been studied in western cohorts, but with inconsistent conclusions which may be due to the different measurements of kidney function. We aim to verify the hypothesis that lower levels of kidney function would be associated with increased risk of incident dementia in Chinese elderly.

METHODS

One thousand four hundred twelve dementia-free participants aged 60 years or older from the Shanghai Aging Study were enrolled and followed up for 5.3 years on average. Glomerular filtration rate (GFR) was calculated by using combined creatinine-cystatin C CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Diagnoses of incident dementia and Alzheimer's disease (AD) were established using DSM-IV and NINCDS-ADRDA criteria based on medical, neurological, and neuropsychological examinations to each participant. Cox proportional regression was used to analyze the association of baseline GFR_crcys levels with incident dementia/AD, adjusting age, gender, education years, APOE-ε4, diabetes, hypertension, baseline Mini-Mental State Examination score, and proteinuria.

RESULTS

A total of 113 (8%) and 84 (7%) participants developed dementia and AD. Comparing to participants with high GFR_crcys (≥ 80 ml/min/1.73 m²), participants with low (< 67 ml/min/1.73 m²) and moderate GFR_crcys (67 ≤ GFR < 80 ml/min/1.73 m²) had increased risk of incident dementia with hazard ratios (HRs) of 1.87 (95% CI 1.02-3.44) and 2.19 (95% CI 1.21-3.95) after adjustment for confounders, respectively. Low (HR = 2.27 [95%CI 1.10-4.68]) and moderate (HR = 2.14 [95% CI 1.04-4.40]) GFR_crcys at baseline was also independently associated with incident AD after adjustments when comparing to high GFR_crcys. The significant association between GFR_crcys and dementia risk was observed in female but not in male participants.

CONCLUSIONS

GFR_crcys may be considered as a marker of an individual's vulnerability to the increased risk of cognitive decline.

Association of combined engagement in cognitive and physical activity with domain-specific cognitive function: The Shanghai Aging Study

OBJECTIVES

This cross-sectional study aimed to examine the association of the combined engagement in cognitive activity (CA) and physical activity (PA) with domain-specific cognition in community-dwelling older adults.

METHODS

We analysed data from 3192 dementia-free participants aged ≥50 years in the Shanghai Aging Study. CA was assessed using Shanghai Cognitive Activities Scale. PA was determined based on questionnaires and further transformed into metabolic equivalent values. We used multivariate linear and logistic regression models to estimate the β and odds ratio of CA, PA, or combined CA and PA and each neuropsychological test.

RESULTS

A high level of CA was associated with a better performance in most of the tests, except for the conflicting instructions task (CIT) and stick test (ST). In contrast, PA displayed no significant associations with any test. Engagement in high CA and high PA was associated with the best performance in Mini-Mental State Examination, recall in ST, categorisation in Modified Common Objects Sorting Test (MCOST), immediate recall, delayed recall, and recognition in Auditory Verbal Learning Test. Participants with "high CA and low PA" had the lowest risk of impairment in Go/No-Go correct tapping in CIT, rotate in ST, item naming, and category naming in MCOST, Trail Making Test (TMT)-A, and TMT-B.

CONCLUSIONS

Our study suggests that engagement in both high CA and high PA may be the most efficacious way to maintain various domains of cognition. A higher level of CA may help to preserve cognition among older individuals who have difficulties in performing PA.

Measurement Invariance of the Multidimensional Scale of Perceived Social Support Among Chinese and South Asian Ethnic Minority Adolescents in Hong Kong

Seven hundred adolescents (Chinese = 50%; South Asian ethnic minority = 50%) with mean age of 15.3 years (SD = 1.53). Multigroup confirmatory factor analysis was performed to assess measurement invariance of the MSPSS scale across Chinese and South Asian ethnic minority samples. Results show that the original three-factor structure of the MSPSS was supported in both samples. Measurement invariance was supported in terms of configural, metric, and partial scalar invariance. Given partial scalar invariance was achieved, the latent mean differences were compared across samples. Chinese adolescents had higher levels of all three types of social support when compared with their South Asian ethnic minority counterparts. The present study attempts to assess the measurement invariance of the MSPSS across ethnic groups in Asian society, which sheds light on future research that involves perceived social support among adolescents in Chinese culture contexts.

Relationship of social support and health-related quality of life among migrant older adults: The mediating role of psychological resilience

Migrant older adults are influenced by an accumulation of aging and adversities related to migration. This study aimed to evaluate the effects of psychological resilience and social support on health-related quality of life (HRQOL) among migrant older adults, and examine the mediating effect of psychological resilience between social support and HRQOL. A total of 149 migrant older adults were recruited from five communities in Chongqing, China. Social support and psychological resilience were positively associated with physical and mental HRQOL among migrant older adults. Psychological resilience had a partial mediating effect on the relationship between social support and physical and mental HRQOL. These findings provide a better understanding of how social support and psychological resilience work together to affect HRQOL, and it could guide the interventions to promote HRQOL among migrant older adults in the community.

Comparison of the performance of suicide ideation scales in adult patients with epilepsy in China

OBJECTIVE

The aims of this study were to evaluate and compare the performance of the Chinese version of the Suicide Ideation Scale-Current (SSI-C) and the Suicide Ideation Scale-Worst (SSI-W) as suicide ideation screening tools in patients with epilepsy (PWE).

METHODS

A consecutive sample of Chinese adult PWE recruited from a tertiary hospital completed the SSI-C and SSI-W and the suicidality module of the Chinese version of the Mini International Neuropsychiatric Interview (MINI) Plus 5.0.0.

RESULTS

A total of 260 consecutive PWE were recruited. The area under the curve (AUC) for the SSI-C was 0.831, and the optimal cutoff score was >1 (sensitivity 73%, specificity 91%); for the SSI-W, the AUC was 0.958, and the optimal cutoff score was >2 (sensitivity 94.6%, specificity 87.4%). The AUC for the SSI-W was larger than that for the SSI-C, and the two-factor structure was considered significant.

CONCLUSION

Our results showed that the SSI-C and SSI-W had good validity as suicidal ideation screening tools in PWE in southern China and can be recommended for clinical suicidal ideation screening. The SSI-W is a better suicidal ideation screening tool than the SSI-C according to the results of our study.

Can perception be altered by change of reference? A test of the Social Reference Theory utilizing college students' judgments of attractiveness

BACKGROUND

Social Reference Theory is relatively new in explaining and predicting social behaviors. Sophisticated empirical observations are needed to support and refine the theory. The theory proposes that (1) Any perception must be understood in the context of a reference; (2) without a reference, no perception exists; (3) changing the reference can change a person's perception; and (4) the reason different parties disagree on an issue is that they have difference references.

AIM

This current study was to provide evidence for the Social Reference Theory with a focus on the third of the four propositions: changing the reference can change a person's perception.

METHOD

A large sample of undergraduate students were randomly selected from a Chinese university and asked to participate in an online quasi-experimental survey to study the effect of changing a reference on subjects' evaluation of physical attractiveness. Subjects were asked to rate the attractiveness of an average-looking woman or man presented in the context of other photographs of either more attractive or less attractive women or men.

FINDINGS

These college students' perception of the targets' physical attractiveness were altered by a change of reference: an average image was rated high if the reference image was less attractive, and the same image was rated low if the reference was very attractive. Additionally, female respondents were more likely to be influenced by change of the reference than male respondents.

CONCLUSIONS

This study provided evidence for the proposition that changing the reference can change a person's perception.

A Chinese version of the chemotherapy-induced alopecia distress scale based on reliability and validity assessment in breast cancer patients

PURPOSE

Chemotherapy-induced alopecia is a common and emotionally traumatic side effect on breast cancer patients. In order to make up for the deficiency of measuring tools in China, our study aims at translating the chemotherapy-induced alopecia distress scale (CADS) into Chinese and evaluating the psychometric properties of the Chinese version of CADS (CADS-C) in breast cancer patients.

METHODS

The validity and reliability of CADS-C were measured by a questionnaire survey among 301 breast cancer patients from Chinese mainland. Construct validity was assessed through factor analysis and contrasted group comparisons. The validity of the content was examined by an experts group. The internal consistency and test-retest reliability were evaluated by calculating Cronbach's alpha and the intraclass correlation coefficient.

RESULTS

The content validity index was 0.94; a structure with three factors was revealed by exploratory factor analysis which explained 65.40% of the variance and proved by confirmatory factor analysis. The contrasted group comparisons showed significant differences among different degrees of alopecia. The average variance extracted and composite reliability and correlations between CADS and body image, quality of life and self-esteem proved the convergent validity. The Cronbach's alpha and the intraclass correlation coefficient of the total scale were 0.90 and 0.89 respectively, indicating satisfactory internal consistency and time stability.

CONCLUSION

The scale appears to be a reliable and valid tool to measure chemotherapy-induced alopecia distress among breast cancer patients in China.

Suicidality among Chinese college students: A cross-sectional study across seven provinces

BACKGROUND

Although the suicide rate in China has decreased over the past 20 years, there have been reports that the younger age group has been experiencing an increased incidence of completed suicide. Given that undergraduate groups are at higher risks of suicidality, it is important to monitor and screen for risk factors for suicidal ideation and behaviors to ensure their well-being.

OBJECTIVE

To examine the risk and protective factors contributing to suicidality among undergraduate college students in seven provinces in China.

METHODS

We conducted a cross-sectional study involving 13,387 college students from seven universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, Shaanxi, and Xinjiang. Data were collected using self-report questionnaires.

RESULTS

Higher scores in the psychological strain, depression, anxiety, stress, and psychache (psychological risk factors for suicidality) and lower scores in self-esteem and purpose in life (psychological protective factors against suicidality) were associated with increased suicidality among undergraduate students in China. Demographic factors which were associated with higher risks of suicidality were female gender, younger age, bad academic results, were an only child, non-participation in school associations, and had an urban household registration. Perceived good health was protective against suicidality.

CONCLUSIONS

Knowing the common risk and protective factors for suicidality among Chinese undergraduate students is useful in developing interventions targeted at this population and to guide public health policies on suicide in China.

The role of family absolute and relative income in suicide among Chinese rural young adults: mediation effects of social support and coping strain

BACKGROUND

suicide is a major public health issue in China. However, research on the impact of absolute and relative economic stats on suicide is scarce among the Chinese population, particularly rural young adults. Using a case-control psychological autopsy study design, we aimed to investigate the effect of family absolute and relative income on suicide among Chinese rural young adults and to further explore the potential mediating mechanism under these associations.

METHOD

the information of 393 suicide cases and 416 community living controls were collected for this study. A Binary Choice Model was used to analyze the association between family absolute and relative income and suicide risk, as well as potential mediating factors for these associations.

RESULTS

a much stronger association was found between relative income and suicide than between absolute income and suicide. Social support was a dominant mediator for the association between family relative income and suicide among both female and male young adults. Coping strain emerged as a mediating factor within the link between absolute income and suicide for males.

CONCLUSIONS

public health interventions to reduce suicide should pay more attention to relative income in addition to absolute income as potential targets for intervention, and how social support and coping strain act as mediating factors.

Psychological interventions to foster resilience in healthcare professionals

BACKGROUND

Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

AUTHORS' CONCLUSIONS

For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Brief Cognitive-based Psychosocial Intervention and Case Management for Suicide Attempters Discharged from the Emergency Department in Taipei, Taiwan: A Randomized Controlled Study

OBJECTIVE

We examined the effectiveness of brief cognitive-based psychotherapy plus standard case management in the prevention of further suicide attempts, clinical severity, and treatment adherence in a randomized clinical trial compared with standard case management.

METHOD

Among five hundred and ninety-seven patients presenting with suicide attempts, 147 participants were included. They were randomized into two groups. After a 6-session intervention over four months, all participants were re-evaluated at the 6th and 12th months.

RESULTS

At a 6-month assessment, the intervention had approximately halved the odds of following suicide attempts and doubled the odds of outpatient visits in comparison with standard case management, although the differences did not attain statistical significance. At a 12-month assessment, the two groups did not differ significantly in any of the outcome variables. Generalized linear mixed models indicated that intervention did not significantly decrease the subsequent suicide risk and severity of clinical symptoms, but it did increase psychiatric outpatient treatment adherence. The subgroup analysis revealed that the intervention increased the outpatient clinic visits only for repetitive attempters, not for first-time attempters.

CONCLUSIONS

Further studies are needed to test whether more intensive psychotherapy sessions might be more effective in decreasing the probability of further attempt and the severity of symptoms.

Validation of the Chinese version of the Scale for Suicide Ideation-Worst in adult patients with epilepsy

OBJECTIVE

The aim of this study was to validate the Chinese version of the Scale for Suicide Ideation-Worst (SSI-W) for screening suicide ideation in Chinese adult patients with epilepsy (PWE).

METHOD

A consecutive sample of Chinese adult PWE from a tertiary hospital completed the SSI-W and the suicidality module of the Chinese version of the Mini International Neuropsychiatric Interview (MINI) Plus 5.0.0.

RESULTS

A total of 269 PWE completed the scales. According to the MINI, 59 patients (21.9%) had suicidal ideation. The Cronbach's α coefficient for the SSI-W was 0.96. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the SSI-W was 0.957 (95% confidence interval [CI] = 0.935-0.980). With a cutoff score of 2 points, the SSI-W demonstrated the best psychometric properties: a sensitivity of 95.8%, a specificity of 87.3%, a positive predictive value (PPV) of 56.7%, and a negative predictive value (NPV) of 99.0%. The scores for items 11 (Reason for attempt) and 18 (Final acts) were not significantly different (p > 0.05) in patients with suicidal ideation, while the scores for the other items were significantly different between these groups of patients.

CONCLUSION

The Chinese version of the SSI-W proved to be a reliable and effective assessment tool for screening suicidal ideation in Chinese adult PWE.

Psychometric evaluation of the Multi-Dimensional Scale of Perceived Social Support in young adults with chronic health conditions

Introduction.

The Multi-Dimensional Scale of Perceived Social Support (MSPSS) is one of the most widely employed tools for measuring perceived social support from three sources: family, friends and a significant other. This study aimed to establish the factor structure of the MSPSS in young adults living with chronic health conditions (CHCs). It also aimed to examine the reliability and convergent validity of the tool.

Methods.

A cross-sectional quantitative design was applied. Participants (n = 123, 90 females) were students aged 18–25 years recruited from Colleges of Further Education in Ireland (mean age of 20.1 years, s.d. = 2.43). Participants completed the MSPSS and two subscales of the Medical Outcomes Study 36-item Short Form Health Survey that assessed social functioning and emotional well-being.

Results.

Exploratory factor analysis yielded a three-factor solution of the MSPSS in young adults living with CHCs. The three factors together explained 83% of the variance in MSPSS scores. All the items had high loadings on the factors (0.72–0.94). The MSPSS showed satisfactory reliability and convergent validity.

Conclusions.

These findings suggest that the MSPSS is a valid and reliable tool for measuring perceived social support from three sources in young adults living with CHCs. Social support has been associated with positive outcomes in young adults living with CHCs, thus it is imperative for researchers and clinicians to have access to psychometrically sound instruments to evaluate the construct.

Experiences of stigma and suicidal behaviors among rural-to-urban migrants: the mechanistic roles of depression and substance use

This study aims to examine the mechanisms of how experiences of stigma affect suicidal behaviors through depression and substance use among migrant workers in China. A sample of 641 young rural-to-urban migrants was recruited in Beijing, China. Participants were assessed on their sociodemographic characteristics, suicidal behaviors, experiences of stigma, depression, and substance use. Path analysis was used to examine the relationship between experiences of stigma and suicidal behaviors as well as the mechanistic roles of depression and substance use. The path model showed a good model fit. While the direct path from experiences of stigma to suicidal behaviors was not significant, the indirect paths between these two concepts were significant. Experiences of stigma were positively associated with both depression and substance use, which in turn were positively related to suicidal behaviors. The chain effect from experiences of stigma, depression, substance use to suicidal behaviors was also significant. To prevent and reduce suicidal behaviors among migrant workers, targeted interventions focusing on reducing experiences of stigma and improving mental and behavioral health are needed.

The impact of suicidal death of rural older people to their relatives: Results from a national psychological autopsy study in China

OBJECTIVE

The suicide pattern in China is changing to a predominance of older people. However, little is known about the impact of suicide on the family members of elderly decedents. The aim of this study was to evaluate whether the suicidal death of rural older adults in China increases the odds of depression or suicidal ideation among their relatives and to explore the associated risk factors.

METHODS

In a national psychological autopsy study in China, consecutive samples of suicide decedents aged 60 or above and matched living controls were enrolled in rural areas of three provinces. Univariate and multivariate analyses were performed to explore the occurrence and correlates of depression and suicidal ideation among relatives of elderly suicide decedents.

RESULTS

A total of 242 suicide decedents and 242 living controls were identified. We enrolled 245 relatives of suicide decedents and 205 relatives of living controls. No significant differences in depression or suicide ideation were found between the relatives of suicide decedents and living comparisons after controlling for socio-demographic characteristics (depression: 26.5% vs. 21.5%; suicide ideation: 5.7% vs. 2.9%). A mood disorder diagnosis in the suicide decedent (OR = 1.93, 95% CI 1.12-3.52) and a spouse relationship (OR = 3.62, 95% CI 1.40-9.34) were independent risk factors for depression among relatives of suicide decedents. Spouses (OR = 5.91, 95% CI 1.49-23.38) were more likely to have suicidal ideation than other relatives.

LIMITATIONS

there are methodological limitations in psychological autopsy studies.

CONCLUSIONS

It seems that the suicide of an older adult 2-6 months ago has no significant impact on depressive symptoms and suicidal ideation in their relatives. Proactive support should be provided for spouses of suicide decedents and those whose relatives have a mood disorder diagnosis.

Community-Based Cognitive Social Capital and Self-Rated Health among Older Chinese Adults: The Moderating Effects of Education

This study investigated the moderating role of education on the association between community-based cognitive social capital and self-rated health among older adults in urban Chinese communities. Data were derived from a community survey conducted in Suzhou, China, in November 2015. A sample of 456 respondents aged 60 or older completed interviews. Multiple-group analysis from a structural equation modeling perspective was adopted to examine the proposed model. The measurement model of community-based cognitive social capital featured four trust and reciprocity indicators. Measurement invariance was established across high and low education groups. Education was found to have a moderating effect on the association between community-based cognitive social capital and self-rated health, but only in the high education group. Education should be considered an important factor in future social capital policy and intervention plans. Policy and intervention implications are discussed.

A preliminary study of the clinical differences between dissociative and nondissociative depression in Hong Kong: implications for mental health practice

Depression is a serious public health issue, but not all patients with depression respond well to pharmaceutical treatments. Some scholars suggested that dissociation could be a marker indicating the types of patients with depression that may benefit more from psychosocial interventions than from pharmaceutical treatments. This study explored the possibility to differentiate dissociative depression and nondissociative depression in a clinical sample (N = 68) in the Chinese context, and discusses the potential implications for treatment considerations. Compared with the nondissociative group, the dissociative group reported higher occurrences of psychosocial etiological risk factors (e.g., childhood physical abuse, lack of help from family) and psychosocial-related symptoms (e.g., unstable relations, fear of abandonment, trauma-related flashbacks, somatization symptoms). Our initial findings revealed that patients with dissociative depression appeared to have distinct clinical features and might require more psychosocial interventions. Implications for health care research and practice are discussed.

Chinese Adolescents' Emotional Intelligence, Perceived Social Support, and Resilience-The Impact of School Type Selection

Choosing a school that can best assist children's development has become one of the major concerns of Chinese parents. To categorize schools by where students stay after school, this paper consider boarding schools or day schools as two major school types. This study examined the relationships among emotional intelligence (EI), perceived social support (from friends and family), and resilience for 493 Chinese adolescents (male = 249, female = 244; mean age = 13.9, SD = 0.71), and investigated how school type difference impacts these relationships. This research first used a moderator analysis to investigate the effects of trait emotional intelligence on resilience by perceived social support from family and friends, respectively. Results show that social support from family was non-significant, while support from friends was significant in moderating the relationship between EI and resilience. Furthermore, a moderated moderation analysis was used to understand if moderation by school type of perceived social support differs in the effect of trait EI on resilience. Results indicated that the magnitude of the moderation by social support from friends depended on school type. For students who have lower perceived friend support, boarding school experiences provided a stronger positive relationship between trait EI and resilience than day school experience. Ways to enhance students' perceived social support are discussed, along with the limitations of the current research and recommendations for future research.

Community-Based Cognitive Social Capital and Depressive Symptoms Among Older Adults in Urban China: The Moderating Role of Family Social Capital

The present study examined the moderating role of family social capital in the relationship between community-based cognitive social capital and depressive symptoms among community-dwelling older adults in urban China. Cross-sectional data were derived from a community survey conducted in Suzhou, China, in late 2015. Data from 441 respondents were included in the final analysis. Multiple group analysis was used to test the hypotheses. The latent construct of community-based cognitive social capital was based on trust and reciprocity indicators. Measurement invariance was established across groups with high or low family social capital. The results show that family social capital had a moderation effect on the relationship between community-based cognitive social capital and depressive symptoms. The effects of community-based cognitive social capital on depressive symptoms were higher among those with low family social capital. The findings demonstrate the interplay between family and community-based cognitive social capital. Policy and intervention implications are discussed.

Differential effects of unemployment on depression in people living with HIV/AIDS: a quantile regression approach

Unemployment is associated with depression in people living with HIV (PLWH). However, few studies have examined the effects of unemployment on PLWH with different levels of depression. The current study explores the plausible differential effects of unemployment on the different percentiles of depression in PLWH employing a quantile regression (QR) approach, based on a recent survey of 411 PLWH in China. Among participants, 47.7% had elevated depressive symptoms, and 23.8% were unemployed. The effects of unemployment on depression were statistically significant with a trend of initial increase followed by a decline at the quantile levels of 0.51-0.90 of depression. The maximum effect of unemployment status on depression was statistically significant at the 70th and 75th percentiles of depression (coefficient = 7.0, p < .01). Tailored strategies and interventions should be implemented to address the differential needs of PLWH with various levels of depressive symptoms.