The current study compared symptom networks between individuals exhibiting resilience and non-resilience trajectories of adaptation two years after the COVID-19 outbreak.

A population-representative sample (N = 906) reported symptoms of anxiety and depression in February-July 2020 (T1), March-August 2021 (T2), and September 2021-February 2022 (T3), as well as symptoms of post-traumatic stress disorder (PTSD) and adjustment disorder (AD) at T3. After differentiating between individuals with resilience and non-resilience trajectories using growth mixture modeling, network analyses were conducted to investigate group differences in T3 network symptoms (undirected and directed).

Despite non-significant group differences (M = 0.184, p = .380; S = 0.096, p = .681), distinctive qualitative characteristics were observed between networks. Difficulty relaxing was identified as the single root cause in the more diffused resilience network, with anxiety and depressive symptoms as additional starting points in the non-resilience network, which was more interconnected into clusters with clear-cut diagnostic boundaries. Sad mood demonstrated a transdiagnostic communicative role across common mental disorders.

Our results contribute to the understanding of anxiety-depression-PTSD-AD symptom networks in resilient and non-resilient individuals by highlighting the consequences of heterogeneity in adaptation capacity in the development of pandemic-related psychopathology.

The outbreak of Mpox in China has rendered the promotion of effective preventive measures among susceptible populations particularly crucial. We aimed to explore the correlates and develop a model for Mpox vaccination intention.

We distributed a questionnaire to a sample of 2403 men who have sex with men to investigate whether they would get a Mpox vaccine. The participants were randomly split into a training set and a testing set in a ratio of 3:1. We screened relevant variables by the least absolute shrinkage and selection operator (LASSO) regression analysis and included them into a Mpox vaccination intention model, which used a multivariate logistic regression analysis and presented the findings as a nomogram. We used the receiver operating characteristic curve, calibration curve, Kolmogorov-Smirnov test, lift test, and population stability index to test the validity and stability of the model.

Of the 2403 participants in our sample, 87.1% intended to get an Mpox vaccine. Five of the thirty-one screened variables, i.e. Mpox knowledge, social support, vaccination internal rewards, vaccination external rewards, and vaccination response efficacy, were included in the vaccination intention model. The model demonstrated strong risk differentiation (Kolmogorov-Smirnov value = 0.46), moderate predictive power (training area under the curve = 0.7709), and good calibration fit, indicating robust performance.

Our proposed model has a good performance and is highly stable, while our findings suggest that governments should design targeted public health strategies, integrating social engagement and leveraging peer and community education to promote Mpox vaccination.

This study investigates the psychometric properties of the Mutuality Scale in a sample of patient-caregiver dyads following a recent episode of coronary heart disease. A cross-sectional analysis was conducted. Factorial validity was tested with confirmatory factory analysis. Internal consistency reliability was investigated with the model-based internal consistency reliability index. Pearson's correlation coefficient was used to test convergent validity between mutuality and other theoretical and empirical variables associated with it. We included 150 patient-caregiver dyads (patient: mean age 65 years, 77% males, 71% married; caregiver: mean age 54 years, 21% males, 71% married). The CFA testing the theoretical four-factors (love, shared pleasurable activities, shared values, and reciprocity) of mutuality demonstrated adequate fit to the data in both the patient and caregiver version of the scale. Reliability estimates were adequate for the whole scale (model-based internal consistency index = 0.95). Significant positive correlations were observed between mutuality and self-care behaviors, and caregiver preparedness, supporting convergent validity. The Mutuality Scale demonstrated satisfactory structural and convergent validity and reliability in patient-caregiver dyads after the onset of a coronary heart disease event.

Adverse childhood experiences (ACEs) are associated with long-lasting and multifaceted consequences for mental health. Despite established dose-response effects of ACEs on mental health, the specificity of ACE pattern effects remains understudied, especially on executive function. This study aims to explore how specific patterns of ACEs, beyond just cumulative scores, differentially impact emotional symptoms, personality and cognitive function. This study recruited 2515 college students from several universities in northern China. Demographic characteristics, depression, anxiety, borderline personality traits, and executive function (Wisconsin Card Sort Test) were assessed. Latent class analysis was used to identify patterns of ACEs. Data were analysed using χ2-test, ANCOVA, and multivariate linear regression methods. Pattern-oriented and cumulative-oriented approaches were compared to predict the effects of ACEs. Three distinct patterns of ACEs were identified: low adversity (LA), multiple adversity (MA), and family environment adversity (FA). FA with the highest number of ACEs was uniquely linked to executive function impairments, while both MA and cumulative ACEs significantly predicted higher anxiety, depression, and borderline personality traits. The pattern-oriented method was more sensitive to capturing the diverse outcomes of executive function impairment than cumulative scores. Our findings highlight the importance of moving beyond cumulative scores and considering specific ACEs patterns to understand their differential impact on mental health. Identifying FA as a distinct pattern with specific consequences for executive function offers valuable insights into developing targeted prevention strategies tailored to specific risk profiles.

Family caregivers of breast cancer patients often experience significant psychological challenges, including depression, anxiety, and fear of cancer recurrence (FCR), yet these issues receive insufficient attention. This study aims to explore the heterogeneity of FCR among family caregivers and identify distinct subgroups based on their FCR levels.

A cross-sectional survey was conducted with 866 family caregivers of breast cancer patients at two tertiary hospitals in Guangzhou, Guangdong Province. All participants completed the Fear of Cancer Recurrence Scale (FCR-7), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Scale (GAD-7) to assess their levels of FCR, depression, and anxiety. Latent class analysis (LCA) was used to identify subgroups of FCR, and multiple logistic regression analyses were performed to explore factors influencing FCR.

Three distinct subgroups of FCR were identified: low FCR group (16.17%), moderate FCR group (13.16%), and high FCR group (70.67%). Predictors of higher FCR included lower income, higher anxiety, and higher depression levels.

Family caregivers of breast cancer patients exhibit varying levels of FCR, with significant predictors being income, anxiety, and depression. Targeted interventions (e.g., psychoeducation, stress management, mindfulness exercises, and cognitive-behavioral therapy) that address these factors may help improve the mental health and well-being of family caregivers.

The mental health burden among adolescents has been increasing, impacting individuals even before formal diagnosis of common mental disorders. Although personality traits, as key indicators of mental health conditions, play a crucial role in the development of mental disorders, there is a gap regarding the trait-to-symptom pathways and similarities and differences between adolescents and young adults.

A total of 860 adolescents and 1751 young adults participated in this study. The Chinese Big Five Personality Inventory assessed the Big Five traits, while depression and anxiety symptoms were measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. Network analysis computed the bridging centrality of Big Five traits and elucidated trait-to-symptom pathways. Furthermore, network comparison was applied to compare network structure between adolescents and young adults.

In both age groups, neuroticism exhibited a transdiagnostic activating effect on depression and anxiety. Conscientiousness demonstrated the strongest protective effect against depression, whereas agreeableness was most protective against anxiety. In both samples, neuroticism primarily influenced symptoms associated with negative emotions and thoughts. Comparatively, extraversion exhibited a significant increasing protective effect against depression throughout adolescence, while neuroticism increasingly activated anxiety symptoms.

This study highlights the potential to utilize personality traits for early detection and precise intervention in adolescent populations, providing actionable insights. By identifying the level of neuroticism, we can effectively detect high-risk adolescent individuals prior to formal diagnosis. By delineating the neuroticism-to-symptom pathways, we can implement targeted intervention on their pathological interactions.

This study aims to explore the impact of the timing (day vs. night) and location (green space vs. non-green space) of outdoor physical activity on college students' mental health. We designed a cross-sectional study based on self-reported data, asking participants to recall their physical activity and mental health status over the past month through a questionnaire. Specifically, a survey was conducted at a university in Chongqing, collecting data on outdoor physical activity and mental health indicators (including anxiety, depression, mental well-being, life satisfaction, happiness, and stress) from 418 students (75 females). The questionnaire was distributed via an online platform, allowing students to complete it using either their mobile phones or computers. The data collection took place in December 2024. The results showed that about half of the participants preferred engaging in outdoor physical activity in the nighttime, with most choosing green spaces. Regression analysis revealed that participants who engaged in outdoor physical activity at night had significantly lower anxiety levels compared to those who engaged in outdoor physical activity during the day (mean difference (MD) = -1.015; 95% CI = -1.974 to -0.055; p = 0.038). Additionally, compared to participants who engaged in outdoor physical activity in green spaces, those who engaged in physical activity in non-green spaces reported lower levels of mental well-being (MD = -1.531; 95% CI = -2.480 to -0.582; p = 0.002) and subjective happiness (MD = -0.462; 95% CI = -0.917 to -0.007; p = 0.047). Sensitivity analysis indicated that, for those who participated in nighttime activities, engaging in outdoor physical activity in green spaces was associated with higher levels of mental well-being (MD = 2.025; 95% CI = 0.810 to 0.324; p = 0.001) and happiness (MD = 0.583; 95% CI = 0.026 to 1.140; p = 0.040). Sensitivity analysis also revealed slight gender differences; however, the findings related to females should be interpreted with caution due to the insufficient sample size. Overall, despite some differences in time and location choices, engaging in outdoor physical activity at night in green spaces appears to associate with college students' health, particularly their happiness and mental well-being. This study provides preliminary evidence of the potential benefits of nighttime green outdoor physical activity for improving college students' mental health and offers directions for future research in this area.

Emerging research suggests a positive association between Internet gaming disorder (IGD) and suicidal behaviors. However, existing studies predominantly focus on suicidal ideation rather than suicide attempts and often do not adequately control for potential psychological confounders. The mechanism linking IGD to suicidality remains unclear. This study aims to assess the independent association between IGD and suicidal behaviors and to examine the mediating role of sleep disturbance among Chinese adolescents. We recruited 135,174 middle school students from Zigong City using cluster sampling. Data on demographics, suicidal ideation, and suicidal attempts were collected. IGD was assessed using the Internet Gaming Disorder Scale-Short Form. Mental distress, including depression, anxiety, hyperactivity/inattention, conduct problems, sleep problems, and psychotic experiences, was evaluated using standardized questionnaires. Multiple logistic regression models and mediation analysis were conducted. The prevalence rates of IGD, suicidal behaviors, suicidal ideation, and suicide attempts were 1.6%, 16.7%, 11.9%, and 9.8%, respectively. Adolescents with IGD showed a significantly higher risk for suicidality: nearly 60% reported suicidal behaviors, 50% reported suicidal ideation, and 40% reported suicide attempts. Both IGD and gaming usage were independently linked to suicidal behaviors. Sleep disturbance partially mediated the relationship between IGD and suicidal behaviors, accounting for 47.0% of the total effect. Our studies call for timely and regular assessments for suicidality and sleep disturbance in IGD. Targeted interventions addressing sleep disturbance might reduce suicidal risk among adolescents with IGD.

Insufficient sleep on weekdays among adolescents and its negative effects on mental health is a concerning public health issue. This study examined the relationship between weekday sleep duration, weekend compensatory sleep (WCS), and psychotic-like experiences (PLEs) in a large sample of Chinese adolescents.

A total of 39,731 junior high school students were recruited in this cross-sectional study. A self-report questionnaire was used to assess sleep duration, social-demographical characteristics, anxiety and depressive symptoms, and PLEs. Logistic regression and stratified analysis were performed to explore the associations between WCS and PLEs.

The prevalence of current PLEs was 12.4 % in this study. The average weekday sleep duration among adolescents was 7.7 ± 1.0 h. 93.2 % of participants reported WCS, with an average duration of 1.8 ± 1.6 h. WCS was significantly associated with a lower risk of PLEs (OR = 0.79, 95 % CI: 0.70-0.90). Moreover, 0-2 h of WCS was linked to a reduced risk of PLEs, regardless of whether students with weekday sleep duration <8 h (OR = 0.74, 95 % CI: 0.61-0.91) or ≥8 h (OR = 0.69, 95 % CI: 0.57-0.82). However, the significant role of WCS >2 h against PLEs was observed only among adolescents with weekday sleep duration <8 h (OR = 0.79, 95 % CI: 0.65-0.97).

WCS was associated with a lower risk of PLEs in adolescents, particularly those with insufficient weekday sleep. These findings highlight the importance of sufficient sleep and the potential benefits of compensatory sleep on adolescents' mental health.

The Inventory of Statements About Self-Injury (ISAS) is a widely utilized scale for evaluating the 13 potential functions that motivate non-suicidal self-injury(NSSI) behaviors. However, its validation for assessing such motivation in a Chinese context is still lacking.

The main objective was to access the validation of ISAS as an instrument in Chinese young population.

A total of 1,106 completed online self-report questionnaires were collected, with 167 reporting a history NSSI. The age range of these individuals was 12 to 24 years old, comprising 74 female and 93 male participants. The factor structure and construct validity were calculated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The correlations of the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Brief Self-Control Scale (BSCS), the Self-Rating Idea of Suicide Scale (SIOSS), and the Chinese version of the ISAS were tested using bivariate correlation analyses.

The internal consistencies of the Chinese version of the ISAS were good to excellent, with 0.788- 0.950 and 0.80-0.949 in the sports group and the junior high school group, respectively. EFA and CFA exhibited a good two-factor structure model (NFI = 0.942, CFI = 0.974, IFI = 0.974, RMSEA = 0.068, SRMR = 0.043, CMIN/DF = 1.762). Moreover, the scores of the functions of the ISAS were correlated with depression (r=0.208, p<0.01), anxiety (r=0.223, p<0.01), suicidal ideation (r=0.322, p<0.01), and low self-control (r=-0.230, p<0.01).

This study validates the Chinese ISAS as a reliable NSSI measure, identifies a two-factor structure, and aims to inform targeted interventions and future research on self-injury behaviors among Chinese adolescents.

To explore the impact of life rules (including individual's life habits and life patterns, such as diet, sleep, and learning styles) on mental health and behavioral problems among adolescent and youth students after the lifting of COVID-19 restrictions in Sichuan, China and analyze the influencing factors of life rules.

An online survey was conducted in middle schools, high schools, colleges and universities in Sichuan Province, China, from December 14, 2022, to February 28, 2023. Demographic information, COVID-19 epidemic-related questions, behavioral and mental health information were collected. Pearson chi-square tests and One-way ANOVA were used to compare the differences of drinking/smoking, suicidal ideation and attempts, internet addiction, anxiety, depression and PTSD among groups with different life rules. Multiple logistic regression analysis was used to analyze the influencing factors of life rules.

A total of 82,873 eligible participants (aged 12-24 years) were included in this study, 40,519 participants (48.9%) reported that their life rules were partially impacted by the COVID-19 pandemic, and 6,461 participants (7.8%) reported that their life rules were severely disrupted. A total of 61.2% of participants partially recovered their life rules, and 8.6% of participants did not recover their life rules. There were statistically significant differences among different groups in terms of drinking/smoking habits, frequency of drinking/smoking in the past year, volume of drinking/smoking, internet addiction, anxiety and depression symptoms, PTSD, suicidal ideation and attempts (all P < 0.01). There were significant differences in the degree of impact and recovery of life rules among different genders, residence, grade, family economic level, home study status, academic level, infection and isolation status (all P < 0.01).

Adolescent and youth students with disrupted life rules during and after the COVID-19 pandemic had significantly more mental health and behavioral problems. Targeted and specific psychosocial interventions should be urgently needed to reduce the mental health and behavioral problems among students.

This cross-sectional study aimed to investigate the prevalence rate of perceived gender discrimination and its associations with suicidal ideation and suicide attempts, as well as the mediating roles of depressive symptoms and anxiety symptoms in Chinese adolescents. From October 2021 to March 2022, we adopted a multi-stage stratified cluster random sampling method to recruit students from grades 7-12 in China. A total of 79,211 adolescents aged 10-19 years from eight provinces completed the survey with valid data for the current study. Data were weighted to adjust for unequal probabilities of selection and differential response as well as to post-stratify the sample to match the population distribution. The weighted prevalence rate of perceived gender discrimination was 3.5% in Chinese adolescents, with girls having a higher prevalence rate than boys (5.5% vs.1.7%; P-value < 0.001). In the full-adjusted model, perceived gender discrimination was associated with a higher likelihood of suicidal ideation (OR, 2.16; 95% CI, 1.93-2.42) and suicide attempts (OR, 1.62; 95% CI, 1.39-1.88). Mediation analyses showed that depressive symptoms and anxiety symptoms significantly mediated 39.5% and 5.7% of the association between perceived gender discrimination and suicidal ideation, respectively, and depressive symptoms and anxiety symptoms significantly mediated 54.3% and 7.0% of the association between perceived gender discrimination and suicide attempts, respectively. These findings suggest the need for targeted interventions to reduce gender discrimination against adolescents, especially girls, which might help prevent their suicidal behaviors and mental health problems.

While previous cross-sectional studies have suggested a link between psychotic-like experiences (PLEs) and internet addiction (IA), longitudinal evidence remains scarce. This study aimed to explore the prospective relationship between IA and PLEs among college students.

A total of 636 college students (80 % female) were assessed in November 2022 and again one year later. IA was measured using the Internet Addiction Diagnosis Questionnaire (IADQ), and PLEs were assessed with the 16-item Prodromal Questionnaire (PQ-16). Demographic, psychological, and environmental factors were collected and controlled. Multiple logistic regression and cross-lagged panel analyses examined the longitudinal associations between IA and PLEs.

At baseline, the prevalence of IA and PLEs was 11.3 % and 16.8 %, respectively. Higher baseline IADQ scores (Adjusted odds ratio = 1.035; 95 % confidence interval = 1.002-1.069; p = 0.036) were independently associated with an increased risk of PLEs at follow-up, while baseline PQ-16 scores were not linked to later IA. Cross-lagged panel analysis revealed that IA at baseline predicted later PLEs (β = 0.082, p = 0.043), whereas baseline PLEs did not predict IA (β = 0.049, p = 0.255). Specifically, IA predicted unusual thoughts (β = 0.122, p = 0.003) and negative PLEs (β = 0.111, p = 0.008), but not perceptual abnormalities (β = 0.040, p = 0.301).

IA may be an independent risk factor for PLEs in college students, particularly for unusual thoughts and negative PLEs, but not for perceptual abnormalities. Targeted interventions addressing IA may help reduce PLEs.

Although there is a growing awareness of the co-occurrence of internet gaming disorder (IGD) with other mental health problems, the specific patterns of how these symptoms interact over time, especially across different age groups, remain unclear. The current study utilizes cross-lagged panel network modeling (CLPN) to investigate the dynamic, longitudinal relationships among symptoms of IGD, depression and anxiety among adolescents across time, and how these connections change with different developmental stages. A total of 3296 middle and late adolescents who have finished 3-time points research were included in the present study. Significant differences were found between middle and late adolescents in the structures and strengths of the contemporaneous and longitudinal networks. For middle adolescents, symptoms tended to predict subsequent symptoms within the same disorder. However, late adolescents showed a stronger trend of symptoms being interconnected across comorbid conditions. Feelings of worthlessness & hopelessness were the most impactful symptoms for middle adolescents in the short term and they continued to significantly affect late adolescents in the long term. In addition, restless and suicide or self-harm were the most important bridge symptoms for middle and late adolescents, respectively. This study emphasizes the importance of developing targeted intervention strategies focusing on both central and bridging symptoms of the comorbid conditions of IGD, depression, and anxiety in adolescence. Recognizing distinct adolescents' needs, interventions should be tailored to effectively address the unique challenges at different developmental stages.

Self-management refers to the behaviors and strategies individuals employ to manage their health conditions. For people living with HIV (PLWH), it encompasses medication adherence, health monitoring, symptom management, lifestyle maintenance and seeking emotional support. While previous studies on the factors influencing self-management in PLWH are predominantly cross-sectional, longitudinal studies are scarce. This nine-year longitudinal study aimed to investigate the trajectories of psychosocial characteristics in PLWH and their effects on self-management. A total of 265 PLWH were assessed for psychosocial factors, including stigma, depression, anxiety, and social support, at baseline and at one-, five- and nine-year follow-ups. Self-management was evaluated at the nine-year follow-up. Psychosocial trajectories were identified using latent growth trajectory models (LGMM), and associations with self-management were analyzed via multiple linear regression. The majority of participants exhibited a low-level decline in depression (79.6%) and rising social support (54.3%). The high-level decline depression group demonstrated the lowest self-management scores (b = -4.67, 95% CI: -8.166 to -1.175). Multivariate analysis revealed significant associations between self-management and exercise (b = 5.360, 95% CI: 3.934-6.786), depressive symptoms (b = -0.168, 95% CI: -0.305 to -0.031) and social support (b = 0.182, 95% CI: 0.101-0.264). These findings emphasize the need for continuous monitoring and targeted interventions to improve self-management in PLWH.

The prevalence of Generalized Anxiety Disorder (GAD) has increased rapidly, highlighting the importance of its detection using quick tools applicable to men and women from different countries.

To analyze the psychometric properties of the Generalized Anxiety Disorder Test (GAD-7) by gender and country in Latin America and the Caribbean (LAC).

A cross-sectional e-health study with 12,124 participants from 15 LAC countries (54.32% women, 45.68% men) was conducted, including participants from Argentina (7.3%), Bolivia (6.7%), Colombia (10.3%), Chile (6.9%), Costa Rica (4.9%), El Salvador (5.7%), Ecuador (7.2%), Guatemala (4.7%), Panama (5.1%), Paraguay (5.7%), Peru (8.6%), Puerto Rico (5.8%), the Dominican Republic (6.6%), Uruguay (6.3%), and Venezuela (8.2%). All participants completed the GAD-7 scale digitally.

A unidimensional structure of the GAD-7 was confirmed, explaining 70% of the variance. The model fit indices were adequate (RMSEA = 0.062; CFI = 0.997; TLI = 0.995; SRMR = 0.017; p < 0.001), and the factor loadings for each item were satisfactory (> 0.70). Additionally, the factor structure showed measurement invariance between genders and countries, with adequate fit indices at all levels (configural, metric, scalar, and strict), suggesting that the measurements are equivalent in both contexts. Finally, the internal consistency of the GAD-7 was high, with a McDonald's Omega coefficient of 0.91.

The GAD-7 exhibits a factor structure that is equivalent across genders and countries, demonstrating its validity and reliability for the rapid detection of GAD symptoms in different countries within the region.

The anxiety of doctoral students in school has consistently been a major concern in society and the medical community, stemming from pressures, such as the pursuit of identity within highly professional and fiercely competitive academic communities, the urgent drive for high-level original scientific research output, and the need to break through the limits of personal ability to complete in-depth academic training. Current research has focused on the prevalence of, causes of, and intervention strategies for anxiety among doctoral students, but it still exhibits deficiencies, such as overly generalized analytical methods, neglect of the diversity within the doctoral student population, and the incomplete theoretical framework for the mechanisms of influence. Therefore, our study aims to examine the anxiety status of different categories of doctoral students and to explore their anxiety intervention mechanisms. Specifically, we employ a mixed research method combining quantitative and qualitative approaches to address issues, such as the influencing factors of anxiety in different types of doctoral students, the mechanisms of action of each factor, and the formation of an influence mechanism framework. The results indicate that anxiety is prevalent among doctoral students, with the key influencing factors being gender, age, love and marriage pressure, and self-perception. Full-time and part-time doctoral students exhibit different anxiety states and causes on account of varying pressures related to graduation, employment, and family factors. Our research distinguishes the heterogeneity of anxiety among different types of doctoral students in China, innovatively constructing a set of anxiety intervention mechanisms for doctoral students. It aims to provide policy insights for the adjustment of their anxiety and hopes to offer novel perspectives and exemplary references for the theoretical research and practical exploration of doctoral students' anxiety in other countries around the world.

Existing research indicates high prevalence of emotional problems among adolescents with excessive academic burden, yet the underlying reasons are not well understood. This study aimed to explore loneliness, physical activity, and sleep as potential mediating pathways between academic burden and emotional problems in adolescents.

A longitudinal cohort study was conducted among middle and high school students in Taizhou City, Zhejiang Province, China, with data collected at three time points. The study included 2965 adolescents, with a mean age of 15.2 years (SD = 1.7), of whom 48.0% were female. Most participants came from families with middle to high economic status (94.8%). Structural equation modeling was employed to analyze the direct associations between academic burden (measured by study time and academic stress) and depressive and anxiety symptoms. Additionally, the indirect associations were explored through three mediators: loneliness, physical activity, and sleep.

Higher academic stress at T1 was directly associated with more severe depressive symptoms at T3. Sleep (indirect effect 0.11, 95% CI 0.09-0.13), loneliness (0.10, 0.08-0.11) and physical activity (0.01, 0.002-0.012) at T2 mediated the relationship, accounting for 31.0%, 26.8%, and 1.8% of the total association of academic stress, respectively. For anxiety symptoms, sleep (0.11, 0.09-0.14) and loneliness (0.07, 0.05-0.08) mediated the association of academic stress with longitudinal mediation effect sizes of 34.1% and 20.6%, respectively. Study time was only associated with the outcomes indirectly via academic stress.

Our results highlight the importance of behavioral and psychosocial differences related to academic burden in understanding the severity of mental health problems in adolescents.

The school-vacation cycle may have impacts on the psychological states of adolescents. However, little evidence illustrates how transition from school to vacation impacts students' psychological states (e.g. depression and anxiety).

To explore the changing patterns of depression and anxiety symptoms among adolescent students within a school-vacation transition and to provide insights for prevention or intervention targets.

Social demographic data and depression and anxiety symptoms were measured from 1380 adolescent students during the school year (age: 13.8 ± 0.88) and 1100 students during the summer vacation (age: 14.2 ± 0.93) in China. Multilevel mixed-effect models were used to examine the changes in depression and anxiety levels and the associated influencing factors. Network analysis was used to explore the symptom network structures of depression and anxiety during school and vacation.

Depression and anxiety symptoms significantly decreased during the vacation compared to the school period. Being female, higher age and with lower mother's educational level were identified as longitudinal risk factors. Interaction effects were found between group (school versus vacation) and the father's educational level as well as grade. Network analyses demonstrated that the anxiety symptoms, including 'Nervous', 'Control worry' and 'Relax' were the most central symptoms at both times. Psychomotor disturbance, including 'Restless', 'Nervous' and 'Motor', bridged depression and anxiety symptoms. The central and bridge symptoms showed variation across the school vacation.

The school-vacation transition had an impact on students' depression and anxiety symptoms. Prevention and intervention strategies for adolescents' depression and anxiety during school and vacation periods should be differentially developed.

COVID-19 has led to reports of fatigue and sleep problems. Brain function changes underlying sleep problems (SP) post-COVID-19 are unclear.

This study investigated SP-related brain functional connectivity (FC) alterations.

Fifty-five COVID-19 survivors with SP (COVID_SP) and 33 without SP (COVID_NSP), matched for demographics, completed PSQI and underwent rs-fMRI at baseline and 2-month follow-up. Correlations between FC and clinical data were analyzed by Pearson correlation analysis with Gaussian random field (GRF) correction. The repeated-measures analysis of variance (R-M ANOVA) was completed to explore the interaction with time.

At baseline, COVID_SP exhibited elevated FC: right precentral gyrus (PrG) with left lateral occipital cortex (LOcC)/right PrG, left inferior parietal lobule (IPL) with right superior frontal gyrus (SFG), left hippocampus with right inferior frontal gyrus (IFG). Higher FC between left hippocampus and right SFG correlated with PSQI scores. At 2-month follow-up, decreased FC implicated in emotion regulation, executive function, and memory; increased FC in semantics, attention, and auditory-visual processing. The changes in these regions are correlated with the scores of PSQI, GAD, and PHQ. The Repeated-Measures Analysis of Variance (R-M ANOVA) revealed a significant time interaction effect between sleep and various emotion scales. Moreover, the analysis of the functional connectivity between the right PrG and the right PrG as well as that between the left IPL and the right SFG also discovered a significant time interaction effect.

This study provides insight into the changes in brain function associated with SP after COVID-19. These changes may partially explain the development of SP, and they also changed over time.

Anxiety is widespread among adolescents, and research has shown that this condition can profoundly affect their mental, emotional, and physical well-being. The purpose of this study was to analyze gender differences in anxiety levels among adolescents and to explore the influencing factors and pathways.

A total of 3601 adolescents were included in this study (age: 15.14±1.97 years; male: 48.76%). Gender, age, school category, grade, duration of sleep, duration on Internet, anxiety and several social factors were investigated by online questionnaire. Teachers were responsible for organizing students to fill out the questionnaire. The Generalized Anxiety Disorder (GAD-7) was applied to measure participants' anxiety levels over the past 2 weeks. An Ordinal Logistic Regression measured risk factors of anxiety, while a path analysis was used to estimate the structural relationship between risk factors and anxiety.

The severity of anxiety in female was higher. Approaching graduation, lack of sleep, poor peer relationships, poor ability to complete tasks, and unwillingness to seek help when in a bad mood were risk factors for anxiety in both male and female adolescents. Among female, prolonged Internet access is a risk factor for anxiety. The fit indices for the modified models were appropriate (male: GFI=0.999, IFI=0.996, TLI=0.976, CFI=0.995, AGFI=0.990, RMSEA=0.021, SRMR=0.016; female: GFI=0.997, IFI=0.990, TLI=0.971, CFI=0.990, AGFI=0.990, RMSEA=0.020, SRMR=0.018).

The female adolescents might have higher levels of anxiety, that academic stress, sleep, peer relationships, competence, and level of social support might be influence factors on anxiety in adolescents, and that "daily duration on Internet" might not be the risk factor in male adolescent.

Generalized anxiety has significantly increased in the general population during and after the COVID-19 pandemic, highlighting the need for rapid screening tools. In this context, the present study analyzed the psychometric properties and internal consistency of the Generalized Anxiety Disorder Scale (GAD-7) in healthcare workers and the general population in Latin America. A cross-sectional e-health study was conducted, surveying 11,279 Latin Americans online using snowball sampling. The sample included healthcare professionals, hospital populations, community members from various occupations, and university students from six countries (Argentina, Bolivia, Ecuador, Chile, Colombia, and Peru). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed separately for each country. Additionally, the instrument's internal consistency was evaluated by calculating McDonald's W index and item-total correlations based on the final items. The EFA revealed a unidimensional structure comprising the seven items of the instrument, which explained between 62.8% and 66.1% of the variance (KMO = between .900 and .910; p < .000). The CFA confirmed adequate fit indices for each country. The omega index ranged from 0.85 (Peru: CI = 0.800-0.884) to 0.95 (Argentina-Bolivia: CI = 0.901-0.985), and item-total correlations were high, ranging from .642 to .869, demonstrating the instrument's reliability. In conclusion, the findings of this study indicate that the GAD-7 is a valid and reliable instrument for assessing generalized anxiety symptoms in the Latin American population.

Circadian rhythm-related individual differences such as chronotypes (morningness/eveningness) are associated with mental health though not elucidated in circadian-disrupted populations such as flight attendants. International flight attendants (n = 288) aged 21 to 55 (70.8% female, 76.4% white) completed an online survey assessing chronotypes, attachment, depression, and anxiety to investigate the associations between these variables. Results showed a prevalence of intermediate (41.6%) and evening types (40.6%). Evening chronotype was associated with and significantly predicted depression but not anxiety. Individuals who scored higher in attachment anxiety or avoidance had higher levels of depression and anxiety. Exploratory mediation showed that attachment avoidance partially mediated the relationship between anxiety and depression. Overall, chronotypes and attachment are implied as transdiagnostic factors for mental health outcomes and highlighted using a Chrono-Attachment Health Model. Further research is needed to confirm these findings among flight attendants and shift workers.

Caregiving for people with mental illness (PwMI) could be burdensome, especially for informal caregivers. However, there is a scarcity of research investigating caregiving burden among informal caregivers of PwMI in China at the national level. To fill this gap, this study examined the prevalence of caregiving burden, depression, and anxiety, as well as their associated factors, among a cross-sectional sample of informal caregivers of PwMI in China.

Data were collected via an online survey between June and November 2023. Caregiving burden, depression, and anxiety were measured by the Zarit Burden Interview, the Patient Health Questionnaire, and the Generalized Anxiety Disorder Scale. Information on caregivers' sociodemographic, care recipients' sociodemographic and disease-related, and caregiving-related characteristics was also collected. Hierarchical regression analyses were performed to identify associated factors of caregiving burden, depression, and anxiety.

A total of 1,224 informal caregivers of PwMI in China were included in the final analysis. 72.1% of the participants had high caregiving burden, 53.5% had moderate to severe depression, and 43.1% had moderate to severe anxiety. Caregiving burden, depression, and anxiety were inter-correlated with each other but exhibited different profiles of associated factors. The most important factors associated with all the three outcomes were disease-related characteristics, particularly care recipients' symptom stability, medication compliance, and insight. Informal caregivers of males with mental illness had higher levels of caregiving burden, depression, and anxiety than those of females. There was a lack of differentiation in caregiving burden, depression, and anxiety based on care recipients' diagnosis. Formal or common-law marriage was a protective factor for caregiver depression and anxiety but not for caregiving burden.

Informal caregivers of PwMI in China experienced a high level of caregiving burden, depression, and anxiety. Urgent actions are needed to relieve caregiving burden, depression, and anxiety among informal caregivers of PwMI in China.

Prevalence of psychological symptoms among Chinese university students is relatively high globally, and most students cannot receive timely treatment. Therefore, exploring protective factors for these symptoms is crucial. In this study, the aim was to examine the independent and joint associations of physical activity (PA) and mindfulness with symptoms of depression, anxiety, and internet addiction. Due to the simplicity of implementation in a university context, a cross-sectional survey was conducted in China in 2022. Participants were recruited through online advertisements, in which 710 Chinese university students met the eligibility criteria and were included in the analysis. Participants were then classified into four groups according to their PA and mindfulness levels. Adjusted nominal logistic regression models controlled for age and sex were fitted to examine the independent and joint associations of PA and mindfulness with symptoms of depression, anxiety, and internet addiction. When examined independently, high PA was associated with lower odds of depressive, anxiety, and internet addiction symptoms, while high mindfulness was associated with lower odds of depressive symptoms. When examining the joint effect, compared to students with low PA and low mindfulness, those with high PA and low mindfulness had a lower risk of depressive and internet addiction symptoms, while students with high PA and high mindfulness reported the lowest odds of depressive, anxiety, and internet addiction symptoms. The current study found that a combination of PA and mindfulness was associated with a lower risk of psychological symptoms. Future studies are suggested to confirm the joint effects of PA and mindfulness on mental health using experiment design.

School climate and school identification are important features of the school environment and potential determinants of adolescent internet gaming disorder (IGD).

This novel study investigated their joint effects on IGD and related mediation mechanisms via the interpersonal factor of teacher-student relationship and the individual factors of academic stress and anxiety.

A large-scale cross-sectional study was conducted among adolescent internet gamers of junior, senior, and vocational middle schools in Taizhou City, China, from February to March 2022 (N=5778). Participants self-administered an anonymous, structured questionnaire in classrooms. Adjusted logistic regression and structural equation modeling (SEM) were used for data analysis.

Among all participants, the prevalence of IGD was 8% (461/5778). The 4 school climate subscales (student-student relationship subscale: adjusted odds ratio [ORa] 0.88, 95% CI 0.85-0.91; student-staff relations subscale: ORa 0.87, 95% CI 0.84-0.90; academic emphasis subscale: ORa 0.88, 95% CI 0.85-0.91; shared values approach: ORa 0.88, 95% CI 0.85-0.90), the school identification subscale (ORa 0.85, 95% CI 0.83-0.88), and teacher-student relationship (ORa 0.80, 95% CI 0.76-0.84) were significant protective factors against IGD, while academic stress (ORa 1.18, 95% CI 1.14-1.23) and anxiety (ORa 1.16, 95% CI 1.14-1.18) were risk factors of IGD. The SEM showed that the negative associations between school climate and IGD and between school identification and IGD were mediated via (1) three 2-step paths, each involving a single mediator-teacher-student relationship, academic stress, and anxiety, respectively-and (2) two 3-step paths involving 2 mediators-teacher-student relationship and academic stress first, respectively, and then anxiety. The direct effect of school climate on IGD was statistically nonsignificant (ie, full mediation with effect size ranging from 4.2% to 20.4%), while that of school identification was statistically significant (ie, partial mediation with effect size ranging from 4.5% to 38.2%).

The relatively high prevalence of IGD among Chinese adolescents may be reduced through school-based interventions to improve school climate and school identification. Such improvements may reduce the levels of risk factors of IGD (poor teacher-student relationship, academic stress, and anxiety) and hence the risk of IGD. Future longitudinal and intervention studies are needed to confirm the findings.

The 24-hour movement guidelines (24-HMG) include screen time (ST), sleep duration, and physical activity. Previous studies have explored the associations of adherence to the 24-HMG with depression and anxiety symptoms among adolescents, ignoring changes in behaviors. This study aimed to examine whether changes in adherence to the 24-HMG were associated with depression and anxiety symptoms among adolescents.

We recruited adolescents from Shenzhen, China in 2021 and followed them up 1 year later. Changes in adherence to the individual 24-HMG were categorized into four groups: persistent non-adherence, adherence to non-adherence, non-adherence to adherence, and persistent adherence. Changes in the numbers of adherence to the overall 24-HMG were obtained by subtracting the number of guidelines adhered to in wave 2 from that in wave 1.

We included 12,570 participants aged 9-18 years with 52.2% boys. Compared with persistent non-adherence for the ST/sleep duration guideline, non-adherence to adherence and persistent adherence were associated with lower depression and anxiety symptoms, but adherence to non-adherence was not. Changes in adherence to the physical activity guideline were not related to outcomes. The β coefficients (95% CIs) for each point increase in changes in the numbers of adherence to guidelines were - 0.58 (- 0.69, - 0.47) and - 0.43 (- 0.53, - 0.33) for depression and anxiety symptoms, respectively. The association of persistently adhering to sleep guideline with anxiety symptoms and the associations of changes in the numbers of adherence to the 24-HMG had sex differences.

Maintaining and strengthening healthy movement behaviors to meet more guidelines of the 24-HMG, especially sleep and ST, may be beneficial for preventing depression and anxiety symptoms in adolescents.

This study investigates the sleep patterns among vocational college students and examines their association with anxiety and depression amidst the ongoing normalization of COVID-19 management strategies.

In the period of January to February 2022, a comprehensive survey was conducted involving a random sample of 3,300 students. By employing face-to-face interviews, data on general demographics, along with levels of anxiety, depression, and sleep quality, were meticulously gathered and analyzed.

Out of the 3,049 questionnaires deemed valid for analysis, the prevalence rates for anxiety, depression, and insomnia were found to be 9.7, 14.1, and 81.9%, respectively. Through regression analysis, several factors were identified as significant predictors of insomnia: female gender, a self-perceived average or poor family economic status over the last year, moderate psychological stress due to the pandemic and its associated restrictions, extended daily screen time during the pandemic, absence of a routine physical exercise regime, significant disruption or alteration of daily life routines due to the pandemic, presence of anxiety and depression symptoms during the pandemic, and only partial restoration of normal life routines post-pandemic control measures (p < 0.001, p < 0.005, or p < 0.050). A strong correlation was observed among the symptoms of anxiety, depression, and insomnia (all p < 0.001). The correlation between stress and depression, depression and insomnia, and anxiety and insomnia were 0.824, 0.714, 0.620, respectively, (all p < 0.001).

Given the substantial impact of abrupt or prolonged crisis events, it is imperative to develop and implement specific intervention strategies aimed at safeguarding the psychological well-being of college students.

Persons with physical disabilities are more likely to suffer from psychological symptoms and inferiority feelings, and social support plays an important role in improving those symptoms. However, the interaction between psychological symptoms, inferiority feelings and social support is yet to be understood.

A cross-sectional study was conducted to investigate anxiety, depression, and inferiority feelings among individuals with physical disabilities in a Chinese sample. The questionnaire included the Generalized Anxiety Disorder 7, Patient Health Questionnaire 9, Self-designed Disability Questionnaire, and Social Support Rating Scale including three dimensions: subjective social support, objective social support and utilization of social support.

Out of the 1,453 respondents with physical disabilities, 49.7, 60.4, and 62.5% reported experiencing anxiety, depression, and inferiority feelings, respectively. Factors such as time since identification of physical disabilities, comorbidities, daily travel, social interaction, internet use, subjective social support, and inferiority feelings were found to be associated with anxiety or depression symptoms among physically disabled individuals. Subjective social support was found to be associated with inferiority feelings, which partly mediated the effect of subjective social support on anxiety symptoms by 37.4% and depression symptoms by 28.7%.

This study highlights the importance of addressing the psychological well-being of physically disabled individuals in addition to their physical rehabilitation. Psychological intervention strategies should focus on improving subjective social support and reducing inferiority feelings, particularly among vulnerable groups.

Network modeling has been suggested as an effective method to explore intricate relationships among antecedents, mediators, and symptoms. In this study, we aimed to investigate whether the severity of depressive symptoms in college students affects the multivariate relationships among anhedonia, smartphone addiction, and mediating factors.

A survey was conducted among 1347 Chinese college students (587 female) to assess depressive symptoms, anhedonia, addictive behaviors, anxiety, and insomnia. The participants were categorized the non-depressive symptom (NDS) and depressive symptom (DS) groups based on a cut-off score of 5 on the 9-item Patient Health Questionnaire-9. Network analysis was performed to investigate the symptom-to-symptom influences of symptoms in these two groups.

The network of the DS group was more densely connected than that of the NDS group. Social anticipatory anhedonia was a central factor for DS, while withdraw/escape (one factor of smartphone addiction) was a central factor for NDS. The DS group exhibited greater strength between the PHQ9 score and social anticipatory anhedonia, as well as between the PHQ9 score and alcohol misuse score, compared to the NDS group. On the other hand, the NDS group had higher strength between anxiety and feeling lost, as well as between anxiety and withdraw/escape, compared to the DS group.

The findings suggest that there is a close relationship between social anhedonia, smartphone addiction, and alcohol consumption in the DS group. Addressing on ameliorating social anhedonia and smartphone addiction may be effective in preventing and managing depression in college students.

Despite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.

Adolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.

Results suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.

Data from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

To examine the cross-sectional and longitudinal bidirectional associations of depression and anxiety symptoms with the development of obesity over time among children and adolescents in different age groups from childhood to young adulthood.

This is a three-wave longitudinal study that included >200,000 school-aged children between 5 and 18 years. Participants were assessed at baseline, 6 months, and 12 months. Depression and anxiety symptoms, as well as participants' weight and height, were collected at each assessment. The cross-sectional associations between obesity and depression or anxiety were examined through ANOVA and Chi-square tests. Multivariable logistic regression analyses were performed to investigate their longitudinal bidirectional associations.

The prevalence of obesity reached a peak in the age group between 12 and 14 years. Concurrently, higher mean BMI and obesity prevalence were associated with more severe symptoms of depression and anxiety in each age group (ps < 0.001). Longitudinally, depression and anxiety significantly increased the risk of development of obesity over time (odds ratios [ORs] = 1.08 to 1.77). Moreover, obesity significantly aggravated the risk of development of depression (ORs = 1.17 to 1.68) and anxiety (ORs = 1.25 to 1.71) over time and hindered the alleviation of depressive (ORs = 0.68 to 0.79) and anxiety symptoms (ORs = 0.73 to 0.74).

Findings suggest that there were bidirectional associations between obesity and psychological distress. It may be important to continuously track BMI and psychological conditions for children and adolescents over time to avoid the reinforcement of their negative reciprocal interactions.

Internet gaming disorder (IGD) becomes a growing concern during the digital era, especially with the pandemic's social distancing measures. It is essential to comprehend the psychosocial predictors and impacts of IGD.

A two-wave annual panel study was conducted in Zigong, China, utilizing regional sampling through school-based surveys involving upper primary school to high school students. Data were collected in October 2020 (T1, N = 94,020) and October 2021 (T2, N = 60,551). Self-report data were collected on demographic information, internet gaming behavior, and other mental health factors. Cross-lagged panel models (CLPM) were employed to estimate the bidirectional relationships between the variables.

At T1, 65,643 (72.6 %) participants identified as gamers; at T2, this number decreased to 42,213 (69.7 %). T1 IGD symptoms demonstrated predictability for all T2 psychological variables. Within the framework of the CLPM examining the interplay between IGD symptoms, anxiety symptoms, and hyperactivity/inattention, we uncovered significant reciprocal cross-lagged effects between these variables over time. The relationship between T1 IGD symptoms and T2 anxiety symptoms had age-specific differences, with 13-15-year-old boys displaying the highest coefficient, which decreased for the 16-18 age group.

Our study is subject to potential recall bias associated with self-reported retrospective data. Additionally, our analysis assumes temporal ordering between variables, an assumption that may not always hold in complex systems.

There are reciprocal relationships between IGD symptoms, anxiety symptoms, and hyperactivity/inattention in adolescents, underscoring the imperative need for comprehensive strategies aimed at addressing the impact of IGD on mental health and overall well-being.

The number of culturally diverse adolescents in South Korea has reached 290,000 and is increasing every year; however, they still represent only 2.5% of the total adolescent population in middle and high schools, making them a minority. Adolescents experiencing cultural diversity are psychologically vulnerable because they grow up in bicultural environments and experience prejudice. Given the nature of generalized anxiety disorder, which can be exacerbated by stress, these adolescents may face an increased risk of developing the disorder not only because of developmental stress but also because of the stress of cultural adaptation. To identify the prevalence of generalized anxiety disorder among adolescents with cultural diversity, we analyzed related factors. Based on the results, strategies have been proposed to reduce anxiety in adolescents with cultural diversity and generalized anxiety disorders.

This study used data from the 16th - 18th Korea Youth Risk Behavior Survey. Factors associated with generalized anxiety disorders were identified based on the social determinants of the health framework. Statistical analyses were conducted using IBM SPSS 25.0, and statistical methods were used for complex samples.

Among adolescents with cultural diversity, 12.8% exhibited generalized anxiety disorders. Among the structural factors, economic status, mother's education level, and gender were significantly associated with the disorder, whereas among the psychosocial factors, suicidal ideation, depressive mood, loneliness, perceived stress level, and subjective health status were significant factors influencing it.

The factors identified in our research can be used as a resource for the early identification of culturally diverse adolescents who are vulnerable to generalized anxiety disorders. To prevent generalized anxiety disorder among adolescents with cultural diversity, school or community nurses can implement interventions to reduce loneliness or stress management programs.