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Ekiz Erim S, Sert H. The effect of circadian timing program for evening-chronotype individuals with obesity on obesity management and sleep quality: A randomized controlled trial. Sleep Med 2024; 119:58-72. [PMID: 38652930 DOI: 10.1016/j.sleep.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES The study aimed to investigate the effect of the circadian timing program (SİZAP) developed for evening-chronotype individuals with obesity on obesity management and sleep quality. METHODS This single-site, randomized controlled trial with an experimental research design was registered in ClinicalTrials.gov. It was reported in accordance with the "Consolidated Standards of Reporting Trials" (CONSORT) randomized controlled trial guidelines. The study sample consisted of 38 evening-chronotype individuals with first-degree obesity, with 19 individuals in each study group. The intervention group's sleep hygiene training was conducted and their lifestyle changes were ensured through SİZAP. The control group followed their normal daily lifestyle. No intervention was made in terms of the dietary practices of both groups. Study data were collected using the personal information form, the anthropometric measurement form, the Horne and Ostberg Morning and Evening Questionnaire (MEQ), the Impact of weight on quality of life-lite (IWQOL-lite), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the sleep diary, and the data tracked via the website and smart bracelets. RESULTS It was determined that the participants in the SİZAP group had a statistically significant decrease in the anthropometric measurements and daytime sleepiness (p < 0.05). The sleep quality scores and the scores of the bodily functions sub-dimension of the quality of life scale were significantly better in the intervention group than in the control group (p < 0.05). CONCLUSION It was found that SİZAP is effective in obesity management in evening-chronotype individuals and increases weight loss success and sleep quality.
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Affiliation(s)
- Seçil Ekiz Erim
- Deparment of Internal Medicine Nursing, Faculty of Health Science, Kocaeli University, Kocaeli, Türkiye.
| | - Havva Sert
- Deparment of Internal Medicine Nursing, Faculty of Health Science, Sakarya University, Sakarya, Türkiye.
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Jie KY, Mohamad N, Mohd Adnan M, Mohd Nor NA, Abdul Hamid NF, Abllah Z. Factors associated with poor sleep quality among dental students in Malaysia. PeerJ 2024; 12:e17522. [PMID: 38948199 PMCID: PMC11214741 DOI: 10.7717/peerj.17522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/16/2024] [Indexed: 07/02/2024] Open
Abstract
Background Good sleep quality is crucial for dental students as they must have optimal cognitive function, memory, and decision-making to accomplish their learning requirements. This study aims to determine sleep quality, its associated factors, and the association between sleep quality and academic performance among dental students in Malaysia. Methods This cross-sectional study involved dental students at four public universities in Malaysia. A validated Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess their sleep quality. An additional self-administered questionnaire was employed to obtain the students' sociodemographic profile, lifestyle, and academic performance. The data were analysed using descriptive, chi-square, and multiple logistic regression. Results Three hundred eighty-four dental students participated in this study. About half of the dental students (51.6%) have poor sleep quality. The mean of sleep hours per night was 5.72 (SD 1.06). The sleep quality was significantly poor among Malay students (P = 0.023), students who stayed at hostel (P = 0.002), and those who consumed caffeinated drinks (P = 0.028). Multiple logistic regression analysis revealed that the poor sleep quality was significantly associated with self-perceived poor academic performance (Adjusted Odds Ratio (AOR) 2.95, 95% CI [1.25-6.96], P-value = 0.013) and students skipping class (AOR 1.70, 95% CI [1.00-2.91], P-value = 0.046). Conclusions Most of the dental students in Malaysia have poor sleep quality. Ethnicity, accommodation, and caffeine consumption were significantly associated with sleep quality. Awareness to sleep quality among dental students is needed to ensure they are able to cope with the challenging dental school learning environment.
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Affiliation(s)
- Khor Yong Jie
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Noraini Mohamad
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Munirah Mohd Adnan
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nor Azlida Mohd Nor
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Nor Faharina Abdul Hamid
- Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Zurainie Abllah
- Department of Paediatric Dentistry and Dental Public Health, Kulliyyah of Dentistry, IIUM Kuantan Campus, Kuantan, Pahang
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Alhaque Roomi MHA, Srivastava A, Girdhar N, Jha C, Thakur S. A Study of the Correlation Between Screen Time and Hypertension Among Young Adults in North India: A Cross-Sectional Analysis. Cureus 2024; 16:e51667. [PMID: 38313899 PMCID: PMC10838163 DOI: 10.7759/cureus.51667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Hypertension is a major risk factor for coronary artery disease. Due to the increased accessibility of smartphones over the past decade, there has been an increase in the screen time of adolescents and young adults. However, the relationship between screen time and hypertension has not been adequately studied. Our study aims to find a correlation between screen time and blood pressure (BP) among young adults. METHODS A cross-sectional analysis was performed on a sample of medical students (n = 210) from New Delhi, India. Participants' screen time was monitored over three weeks and BP was recorded using a standardized sphygmomanometer by auscultatory method. Exclusion criteria included known cases of hypertension (with or without ongoing treatment), smokers > five pack year, heavy alcoholics, and participants having sleep time of less than seven hours or more than nine hours per day. Screen time was correlated with BP readings using standard statistical methods. RESULTS Participants with screen time >390 minutes (six hours and 30 minutes), >420 minutes (seven hours), and >480 minutes (eight hours) had higher odds of elevated BP (OR: 1.86, 95% CI: 1.05-3.30; OR: 1.86, 95% CI: 1.04-3.30; OR: 1.87, 95% CI: 1.02-3.43, respectively) compared to students with screen time <390 minutes. The findings were consistent after excluding participants with high BMI based on the WHO and Asia-Pacific criteria, which also showed higher odds of elevated BP with screen time >390 minutes (OR: 3.21, 95% CI: 1.58-6.49 and OR: 3.92, 95% CI: 1.49-10.31, respectively). Regression analysis showed no significant linear correlation between screen time and BP (p > 0.05). However, a significant association was observed between BMI and elevated BP (p < 0.001). CONCLUSION This study revealed an association exists between screen time and BP.
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Affiliation(s)
| | - Abhishyant Srivastava
- Internal Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, New Delhi, IND
| | - Narinder Girdhar
- Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, New Delhi, IND
| | - Chaitannya Jha
- Internal Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, New Delhi, IND
| | - Shashwat Thakur
- Internal Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, New Delhi, IND
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Busa F, Csima MP, Márton JA, Rozmann N, Pandur AA, Ferkai LA, Deutsch K, Kovács Á, Sipos D. Sleep Quality and Perceived Stress among Health Science Students during Online Education-A Single Institution Study. Healthcare (Basel) 2023; 12:75. [PMID: 38200981 PMCID: PMC10778774 DOI: 10.3390/healthcare12010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/14/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
Recently, online education has been gaining prominence in university life. Our survey aimed to examine sleep quality and perceived stress levels among students at the University of Pécs Faculty of Health Sciences. A cross-sectional, quantitative, descriptive survey was conducted between February and March 2023. The online survey included the Hungarian versions of the internationally validated Athens Insomnia Scale (AIS) and Perceived Stress Scale (PSS). Statistical analysis involved descriptive statistics, independent t-tests, analysis of variance (ANOVA), and Mann-Whitney and Kruskal-Wallis tests (p < 0.05). We analyzed 304 responses, and females dominated (n = 270; 88.8%). Students in a relationship had significantly higher AIS scores (t = -2.470; p = 0.014). Medium average (2.50-3.49) students and those who rarely/never exercise showed significantly higher AIS and PSS (p ≤ 0.05). Students on the phone/watching a series during online education, daily laptop/TV use for more than 2 h, and pre-sleep use of smart devices for more than 60 min also negatively affected AIS and PSS scores (p ≤ 0.05). Nursing, physiotherapy, and radiography students were the most affected regarding insomnia and perceived stress (p ≤ 0.05). Our survey shows that excessive smart device use and lack of exercise are associated with higher stress levels and poorer sleep quality.
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Affiliation(s)
- Flóra Busa
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Vörösmarty Street 4, 7621 Pẻcs, Hungary; (F.B.); (M.P.C.); (Á.K.)
| | - Melinda Petőné Csima
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Vörösmarty Street 4, 7621 Pẻcs, Hungary; (F.B.); (M.P.C.); (Á.K.)
- Institute of Education, Hungarian University of Agriculture and Life Sciences, Guba Sándor Street 40, 7400 Kaposvár, Hungary
- Faculty of Health Science, Doctoral School of Health Sciences, University of Pẻcs, Vörösmarty Street 4, 7621 Pẻcs, Hungary; (J.A.M.); (N.R.)
| | - Johanna Andrea Márton
- Faculty of Health Science, Doctoral School of Health Sciences, University of Pẻcs, Vörösmarty Street 4, 7621 Pẻcs, Hungary; (J.A.M.); (N.R.)
| | - Nóra Rozmann
- Faculty of Health Science, Doctoral School of Health Sciences, University of Pẻcs, Vörösmarty Street 4, 7621 Pẻcs, Hungary; (J.A.M.); (N.R.)
- Faculty of Health Sciences, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, University of Pécs, Vörösmarty Street 4, 7621 Pécs, Hungary; (L.A.F.); (K.D.)
| | - Attila András Pandur
- Department of Oxyology, Faculty of Health Sciences, Emergency Care, University of Pécs, 7621 Pécs, Hungary;
| | - Luca Anna Ferkai
- Faculty of Health Sciences, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, University of Pécs, Vörösmarty Street 4, 7621 Pécs, Hungary; (L.A.F.); (K.D.)
- Department of Oxyology, Faculty of Health Sciences, Emergency Care, University of Pécs, 7621 Pécs, Hungary;
| | - Krisztina Deutsch
- Faculty of Health Sciences, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, University of Pécs, Vörösmarty Street 4, 7621 Pécs, Hungary; (L.A.F.); (K.D.)
- Department of Oxyology, Faculty of Health Sciences, Emergency Care, University of Pécs, 7621 Pécs, Hungary;
| | - Árpád Kovács
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Vörösmarty Street 4, 7621 Pẻcs, Hungary; (F.B.); (M.P.C.); (Á.K.)
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Nagyerdei 98, 4032 Debrecen, Hungary
| | - Dávid Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Vörösmarty Street 4, 7621 Pẻcs, Hungary; (F.B.); (M.P.C.); (Á.K.)
- Faculty of Health Science, Doctoral School of Health Sciences, University of Pẻcs, Vörösmarty Street 4, 7621 Pẻcs, Hungary; (J.A.M.); (N.R.)
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Schöllhorn I, Stefani O, Lucas RJ, Spitschan M, Slawik HC, Cajochen C. Melanopic irradiance defines the impact of evening display light on sleep latency, melatonin and alertness. Commun Biol 2023; 6:228. [PMID: 36854795 PMCID: PMC9974389 DOI: 10.1038/s42003-023-04598-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
Evening light-emitting visual displays may disrupt sleep, suppress melatonin and increase alertness. Here, we control melanopic irradiance independent of display luminance and colour, in 72 healthy males 4 h before habitual bedtime and expose each of them to one of four luminance levels (i.e., dim light, smartphone, tablet or computer screen illuminance) at a low and a high melanopic irradiance setting. Low melanopic light shortens the time to fall asleep, attenuates evening melatonin suppression, reduces morning melatonin, advances evening melatonin onset and decreases alertness compared to high melanopic light. In addition, we observe dose-dependent increases in sleep latency, reductions in melatonin concentration and delays in melatonin onset as a function of melanopic irradiance-not so for subjective alertness. We identify melanopic irradiance as an appropriate parameter to mitigate the unwanted effects of screen use at night. Our results may help the many people who sit in front of screens in the evening or at night to fall asleep faster, feel sleepier, and have a more stable melatonin phase by spectrally tuning the visual display light without compromising the visual appearance.
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Affiliation(s)
- Isabel Schöllhorn
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Basel, Switzerland
| | - Oliver Stefani
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Basel, Switzerland
| | - Robert J Lucas
- Centre for Biological Timing, Division of Neuroscience, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Manuel Spitschan
- Translational Sensory & Circadian Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Chronobiology & Health, TUM Department of Sport and Health Sciences (TUM SG), Technical University of Munich, Munich, Germany
- TUM Institute for Advanced Study (TUM-IAS), Technical University of Munich, Garching, Germany
| | - Helen C Slawik
- Clinical Sleep Laboratory, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland.
- Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Basel, Switzerland.
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Chen J, Tuersun Y, Yang J, Xiong M, Wang Y, Rao X, Jiang S. Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis. BMC MEDICAL EDUCATION 2022; 22:627. [PMID: 35982434 PMCID: PMC9388213 DOI: 10.1186/s12909-022-03683-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prevalence of depression symptoms among medical students is particularly high, and it has increased during the COVID-19 epidemic. Sleep quality and state-trait anxiety are risk factors for depression, but no study has yet investigated the mediating role of state-trait anxiety in the relationship between poor sleep quality and depression symptoms in medical students. This study aims to investigate the relationship among depression symptoms, sleep quality and state-trait anxiety in medical university students in Anhui Province. METHODS This was a cross-sectional survey of 1227 students' online questionnaires collected from four medical universities in Anhui Province using a convenience sampling method. We measured respondents' sleep quality, state-trait anxiety, and depression symptoms using three scales: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) and the Self-rating Depression Scale (SDS). We analysed the mediating role of STAI scores on the association between PSQI scores and SDS scores through the Sobel-Goodman Mediation Test while controlling for covariates. P < 0.05 was considered statistically significant. RESULTS A total of 74.33% (912) and 41.40% (518) of the respondents reported suffering from poor sleep quality and depression symptoms. Sleep quality, state-trait anxiety, and depression symptoms were positively associated with each other (β = 0.381 ~ 0.775, P < 0.001). State-trait anxiety partially mediated the association between sleep quality and depression symptoms (Sobel test Z = 15.090, P < 0.001), and this mediating variable accounted for 83.79% of the association when adjusting for potential confounders. Subgroup analysis further revealed that STAI scores partially mediated the association between PSQI scores and SDS scores in females and rural students and fully mediated the association between PSQI scores and SDS scores in males and urban students. CONCLUSIONS This study found that sleep quality and state-trait anxiety have a significant predictive effect on depression symptoms. State-trait anxiety mediated the relationship between sleep quality and depression symptoms, with a more complex mechanism observed among rural and female medical students. Multiple pathways of intervention should be adopted, such as encouraging students to self-adjust, providing professional psychological intervention and timely monitoring, enriching extracurricular activities, and making changes in policies regarding long shifts and working hours.
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Affiliation(s)
- Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
| | | | - Jiao Yang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Man Xiong
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Yueying Wang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Xinyi Rao
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Shuai Jiang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Institute for Hospital Management of Henan Province, Zhengzhou, China.
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Rebello LJ, Roberts AW, Fenuta AM, Cote AT, Bodner ME. Sleep Quality and Sleep Behaviors in Varsity Athletes: A Pilot Study. Front Sports Act Living 2022; 4:906663. [PMID: 35813053 PMCID: PMC9256907 DOI: 10.3389/fspor.2022.906663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
Sleep hygiene practices may hinder university athletes from obtaining quality sleep to support health and performance. We sought to provide a comprehensive evaluation of sleep quality and behaviors in varsity athletes using validated sleep questionnaires: the Athlete Sleep Screening Questionnaire (ASSQ) and the Athlete Sleep Behavior Questionnaire (ASBQ). Sixty-four (n = 64) athletes participated (54% female; 71% Caucasian). The mean age was 20.3 ± 1.7 years and the mean BMI was 23.3 ± 3.3. Fifty-one percent met the threshold for adequate sleep (7+ h) and 54% reported being somewhat/very satisfied with sleep quality. Global scores for ASSQ Sleep Difficulty and ASBQ sleep behaviors were significantly correlated (r = 0.31; p = 0.014) and not significantly different across age, academic year, or residence. According to the ASSQ, 11% and 24% were classified as having severe or moderate sleep problems, respectively. The ASBQ categorized 62% as having “poor” sleep behaviors. Notable sleep-influencing factors included a high frequency of emotional/cognitive processing of sport-performance issues (46.9%), frequent use of light-emitting devices before bed (90%), training after 7 pm (65%), and the use of sleep medication (19%). Half of the university athletes did not meet the thresholds for adequate sleep, and some may require a referral for clinical sleep issues. The majority of these athletes' sleep behaviors do not promote adequate sleep. The ASSQ shows utility to assess gradations in clinical sleep difficulty; the ASBQ could be used in concert with the ASSQ to discern “cognitive and physiological arousal” targets for use in educational workshops designed to promote optimal sleep hygiene in university athletes.
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Liu J, Teng Z, Chen Z, Wei Z, Zou T, Qin Y, Yuan H, Liu M, Chen J, Tang H, Xiang H, Wu H, Wu R, Huang J. Exploring the associations between behavioral health risk factors, abnormal eating attitudes and socio-demographic factors among Chinese youth: Survey of 7,984 vocational high school students in Hunan in 2020. Front Psychiatry 2022; 13:1000821. [PMID: 36419983 PMCID: PMC9676643 DOI: 10.3389/fpsyt.2022.1000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study investigated the associations between behavioral health risk factors (anxiety, depression, stress, insomnia, drinking, smoking) and abnormal eating attitudes among Chinese vocational high school students (CVHSS). Potential moderating relationships were also explored with relevant socio-demographic factors of the student's age, sex, rural or urban community, household income, family type and educational level of the father and mother. METHODS A total of 7,984 students from three vocational high schools in Hunan, China completed a questionnaire about their socio-demographic characteristics, alcohol use, smoking, and symptoms of depression, anxiety, stress (21-item version of the Depression Anxiety Stress Scale), insomnia (8-item Athens Insomnia Scale), and abnormal eating attitudes (19-item Chinese version of Eating Attitudes Test). RESULTS The prevalence rates for behavioral health problems among these students ranged widely depending on the risk factor: 42.5% insomnia, 41.3% anxiety, 26.2% depression, 14.4% stress, 13.7% drinking, and 8.3% smoking. Additionally, 61.7% of students were at-risk for at least one of these six behavioral health disorders. Abnormal eating attitudes were associated with depression (r = 0.422), anxiety (r = 0.490), stress (r = 0.490), and insomnia (r = 0.375), with all of these relationships being significant (p < 0.01) and large size statistical effects. However, other analyzes found that none of the socio-demographic background factors had meaningful associations with the behavioral health risk factors (0 of 28 tests) and very few background factors were associated with the abnormal eating attitude measures (only 3 of 35 tests). Females had higher levels than males on dieting and bulimia but not on the other two eating attitude components. CONCLUSIONS This study determined that behavioral health risk factors (sleep problems and anxiety in particular) were common among high school students in China and that mental health and sleep disorder risks also tended to co-occur in some students with abnormal eating attitudes. Therefore, prevention and early identification programs for behavioral risk factors are needed for this population. It is important to pay more attention to students with abnormal eating attitude-related symptoms, who may have also underlying mental health problems and need further evaluation.
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Affiliation(s)
- Jieyu Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ziwei Teng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zirong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zirou Wei
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tianxiang Zou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yue Qin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Yuan
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Xiang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Haishan Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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