Technology dependence has long been a critical public health issue, especially among young people. With the development of AI chatbots, many individuals are integrating these tools into their daily lives. However, we have limited knowledge about the issues related to AI chatbot usage and dependence. Therefore, we conducted a cross-sectional survey to investigate AI chatbot usage behaviors and their association with mental health outcomes among Chinese university students. A total of 1004 students who met the inclusion criteria were included in the analysis. Our survey revealed that 45.8 % of students reported using AI chatbots in the last month, with most using them one to three days per week (78.5 %) and showing light (38.2 %) to moderate (37.6 %) dependence. University students who use AI chatbots exhibited significantly higher levels of depression (p < 0.01) and a greater proportion scoring in the moderate to high levels of depression compared to non-users (p < 0.01). Among these users, depression was directly associated with higher AI chatbot usage and dependence (β = 0.14 to 0.20, p < 0.05). However, no direct association was found between AI chatbot-related behaviors and mental well-being or resilience (p > 0.05). Nevertheless, resilience may be indirectly linked to AI chatbot usage/dependence via depression (β = -0.077 to -0.052; p < 0.05). In conclusion, AI chatbot usage is relatively common among university students, though overuse and severe dependence are infrequent. AI chatbot usage and dependence are associated with higher levels of depression; however, the causal relationship warrants further investigation.

In this study, we aimed to use network analyses to explore the gender-specific interactions between individual items of depressive symptoms, anxiety symptoms, and parenting styles in Chinese adolescents.

We conducted a cross-sectional study with a total of 5157 adolescents in 5 primary schools, 8 junior high schools, and 2 senior high schools in Shandong province, China. Male and female adolescents' networks were assessed in all grades using the Egna Minnen Betraffande Uppfostran (EMBU), the 9-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Assessment (GAD-7). Network differences by gender and educational stages were further assessed stratified. Network analysis was used to identify central items and edges with important associations between depressive symptoms, anxiety symptoms, and parenting styles. All analyses in this study were performed using the R program (version 4.3.2).

Parenting styles can influence the overall depressive network by acting on PHQ9 (Suicidal thoughts) through EMBU1 (Punishment denial) and EMBU2 (Emotional warmth) in adolescents. Parenting styles had displayed gender-specific emotional impacts on adolescents. EMBU1 (Punishment denial) affected the anxiety network in senior high school male adolescents by increasing GAD6 (Easily annoyed/Irritable) and impacting their depression network by reducing the PHQ6 (Failure). However, none of these effects were found in senior high school female adolescents.

The mood disorder and anxiety in male students were susceptible to the influence of the manner of upbringing. Depressive and anxiety symptom-specific issues related to parenting styles may be important in the development and maintenance of mood disorders in adolescents. Punishment rejection and emotional warmth might be the strong influencing factors.

Depression and anxiety are the most common mental disorders in the world. Screening tools allow early diagnosis and intervention, preventing disease progression and reducing years lost to disability. Internationally, the most widely used screening instruments for depression and anxiety symptoms are the Patient Health Questionnaire (PHQ-8) and the Generalised Anxiety Disorder (GAD-7). Both have been validated in various countries; however, these studies mostly focused on the adult population and clinical settings.

This study assessed the psychometric properties of the PHQ-8 and GAD-7 in adolescents and young adults in deprived urban areas of three of the largest Latin American cities. We evaluated the internal structure, measurement invariance, internal consistency, and divergent validity through correlations with the Manchester Short Assessment of Quality of Life (MANSA).

The study included 1056 adolescents (ages 15-16) and 1306 young adults (ages 20-24) from Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Peru). Confirmatory factor analysis was performed using the Weighted Least Squares Mean and Variance (WLSMV) adjusted estimator with polychoric matrices to assess the internal structure of the model. Measurement invariance was evaluated through multi-group factor analysis. Divergent validity was examined using Spearman's rho by correlating MANSA with the PHQ-8 and GAD-7. Finally, internal consistency was assessed with Cronbach's alpha and McDonald's omega.

Our study found that the PHQ-8 and the GAD-7 exhibited good goodness-of-fit indices for a one-dimensional model. Both scales achieved measurement invariance across different sociodemographic variables, including gender, country, education level, and age group. On the other hand, the PHQ-8 (rs = -0.52) and GAD-7 (rs = -0.46) showed a negative correlation with the MANSA, suggesting divergent validity between the higher scores on depressive and anxious symptoms are associated with lower quality of life. Finally, the PHQ-8 and GAD-7 showed adequate internal consistency in all cases evaluated (ω and α > 0.8).

Both the PHQ-8 and the GAD-7 showed good goodness-of-fit indices for a unidimensional theoretical model, adequate psychometric properties, and evidence of invariance for gender, age group, education level, and country. These findings highlight the reliability and versatility of these instruments in identifying urban young people with emotional distress in Latin America.

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.

Parenting styles and the developmental environment of adolescents in China have undergone significant changes. However, the development of parent-adolescent intimacy among contemporary Chinese adolescents and its impact on internalizing and externalizing problems remain unclear. To address this research gap, this study explored the development of father-child and mother-child intimacy during early and middle adolescence and examined their effects on internalizing and externalizing problems. Further, it investigates the potential gender differences in these developmental processes. In total, 1,370 early adolescents (M age T1 = 12.31, SD age T1 = 0.49; 51.17% girls) and 1381 middle adolescents (M age T1 = 15.19, SD age T1 = 0.50; 50.16% girls) participated in this one-year, three-wave longitudinal survey. The results showed that father-child and mother-child intimacy decreased over one year in early adolescents, while in middle adolescents, father-child intimacy increased, and mother-child intimacy decreased. Furthermore, the development of parent-child intimacy in both early and middle adolescents negatively predicted internalizing and externalizing problems one year later. Regarding sex differences, early adolescent girls had lower initial levels of father-child intimacy but higher initial levels of mother-child intimacy compared to boys. In middle adolescents, girls also showed higher initial levels of mother-child intimacy than boys. Additionally, the decline in father-child intimacy had a stronger impact on anxiety and aggression in early adolescent girls and a more significant effect on depression in middle adolescent girls. These findings offer new insights into how parent-child intimacy changes in Chinese adolescents and its impact on internalizing and externalizing problems, providing valuable guidance for targeted interventions.

Anxiety disorders are the most common mental health conditions worldwide, yet 65% of those affected do not access services. The high prevalence of anxiety and the low rate of intervention uptake highlight the urgent need to develop timely, scalable, and effective interventions suitable for adolescents. This study adapted existing single-session interventions (SSIs) to further develop an SSI focused on a growth mindset regarding negative emotions for adolescent mental health.

The study aims to compare the effectiveness of 4 SSIs, SSI of a growth mindset for anxiety (SIGMA), SIGMA with boosters (SIGMA-Booster), SSI of a growth mindset of personality (SSIGP), and an active control group (support therapy [ST]), in reducing adolescent anxiety.

Classes from each secondary school were randomized to 1 of 4 intervention conditions: SIGMA, SIGMA-Booster, SSIGP, or ST. Each intervention took approximately 45 minutes online. Participants reported on anxiety symptoms (primary outcome), depressive symptoms, suicidal/self-harming thoughts, perceived control, hopelessness, attitude toward help-seeking, and psychological well-being (secondary outcomes) at preintervention, 2-week follow-up, and 8-week follow-up. Participants also completed a feedback scale postintervention. Generalized estimating equations were used to examine the effectiveness of the SSIs.

A total of 731 adolescents from 7 secondary schools were randomized. The intent-to-treat analysis found a significant decrease in anxiety symptoms. The mean and 95% CI at baseline were 6.8 (6.0-7.6) for SIGMA-Booster, 6.5 (5.8-7.3) for SIGMA, 7.0 (6.2-7.7) for SSIGP, and 6.9 (6.1-7.7) for ST. At the 2-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.7 (4.9-6.5) for SIGMA, 5.4 (4.6-6.2) for SSIGP, and 5.7 (4.9-6.4) for ST. At the 8-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.3 (4.5-6.0) for SIGMA, 5.6 (4.8-6.4) for SSIGP, and 5.8 (5.1-6.6) for ST. These reductions were observed across all 4 groups. Moderation analysis found that participants with higher motivation for change, higher baseline anxiety scores, and fixed mindsets showed greater improvements in anxiety symptoms. Most participants (459/731, 62.8%) viewed the feasibility and acceptability of the SSIs positively.

The SSI for all 4 groups was effective in reducing anxiety and depression among adolescents over 8 weeks. Our data suggest the potential benefits of brief web-based interventions for adolescents, which could serve as scalable, destigmatized, and cost-effective alternatives to school-based programs. The intervention effects may have been underestimated, as this study did not exclude adolescents with minimal or no anxiety symptoms. Future studies should focus on the specific effects of interventions for adolescents with varying levels of anxiety symptoms.

ClinicalTrials.gov NCT05027880; https://clinicaltrials.gov/ct2/show/NCT05027880.

Studies have shown a reciprocal relationship between basic psychological need frustration and depressive symptoms in adolescents. However, the underlying pattern of this relationship remains unclear. This longitudinal study employed network analysis to examine the central nodes, bridge nodes, and dynamic changes in the network structure of psychological need frustration and depressive symptoms among 1,381 Chinese adolescents (51.85% girls; Mage = 15.17, SD = 0.49, range: 13-16). The results revealed that competence frustration, mood, fatigue, and worthlessness were central nodes, exhibiting strong connections with other nodes in the network. Furthermore, competence frustration and worthlessness functioned as bridge nodes, linking psychological need frustration with depressive symptoms. Notably, the network structure remained stable over time, with no significant changes observed. These findings highlight the critical role of competence frustration and worthlessness in the co-occurrence of psychological need frustration and depressive symptoms. Targeting these nodes in interventions may help reduce adolescent distress and improve mental health outcomes.

Alexithymia is defined as a difficulty in identifying and describing one's own emotions. It represents a risk factor for cognitive deficits and is frequently observed in individuals with depressive disorders. However, the relationship between alexithymia and neurocognitive function in major depressive disorder (MDD) is still unknown. This study aimed to explore the association between alexithymia and neurocognition in patients with MDD.

A total of 134 Chinese Han first-episode drug-naïve patients with MDD were recruited. The 20-item Toronto Alexithymia scale (TAS-20), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the 9-item Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder-7 items (GAD-7) was used to assess alexithymia, neurocognitive functioning, and emotion. Multivariable liner regression models were used to estimate the association between alexithymia and neurocognition. Interaction and stratified analyses were conducted according to age, gender, marital and education status.

Among the 134 patients with MDD, 55 participants (41%) had alexithymia. In the fully adjusted model, TAS total score (TAS-T) (β: -0.34, 95% CI: -0.61~ -0.07) and difficulty identifying feelings (DIF) (β: -0.8, 95% CI: -1.3~-0.31) were statistically significantly associated with immediate memory.

Higher level of alexithymia, particularly the difficulty identifying feelings facet, is associated with lower scores of immediate memory in patients with MDD.

Objectives: This longitudinal study was designed to examine the growth trajectory of depressive symptoms among early-stage college students and how the development of vigorous, moderate, and light leisure-time physical activity (LTPA) was related to the growth trajectory. Participants: Four hundred and eighty-eight first- and second-year undergraduate students completed measures of depressive symptoms and LTPA at the beginning, middle, and end of a semester. Methods: Latent growth mixture modeling (LGMM) was conducted. Results: On average, students reported mild levels of depressive symptoms with significant variability at the semester start, but the symptoms elevated over time. LGMM identified two trajectories: low/gradual (75.8%) and high/increasing (24.2%). For both groups, neither vigorous nor moderate LTPA development predicted the growth trajectory of depressive symptoms. However, the change of light LTPA was negatively and significantly associated with the growth trajectory. Even when controlling for covariances, increased light LTPA still had a unique effect on buffering depressive symptoms. Conclusion: There is great potential in targeting comprehensive LTPA strategies to improve college students' mental health and promote an active lifestyle.

Non-suicidal self-injury (NSSI) is a significant clinical concern in adolescents. The goal of this study was to evaluate the efficacy of group interpersonal psychotherapy (G-IPT) combined with treatment as usual (TAU) compared with TAU alone in treating adolescents with NSSI. A randomized controlled trial was conducted in a psychiatric outpatient clinic in Hubei Province, China, involving 52 adolescents 12 to 17 years of age diagnosed with NSSI. Participants were randomly assigned to either the G-IPT combined with TAU group (n=26), who received 12 additional G-IPT sessions, or the TAU-alone group (n=26). Outcomes were assessed using the Ottawa Self-Injury Inventory (OSI), 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Interpersonal Disturbances Scale (IDS), and Interpersonal Communication Scale (ICS) at pre-treatment [Time Zero (T0)], immediately after completion of G-IPT, or 12 weeks after baseline assessment in the TAU group [Time 1 (T1)], and 3 months after treatment [Time 2 (T2)]. Forty-eight participants completed all assessments. The primary outcomes included a reduction in NSSI frequency and an increase in participants' ability to resist NSSI. Results demonstrated reductions in the OSI item "NSSI in the last month" at T1 (P<0.001) and T2 (P=0.008), as well as significant improvements in the OSI item "Strength to resist NSSI" (P<0.001 at T1; P=0.001 at T2). Significant between-group and interaction effects were observed, indicating that G-IPT combined with TAU was more effective than TAU alone in reducing NSSI behaviors. These findings underscore the potential of G-IPT as an effective adjunct to TAU in clinical settings for adolescent NSSI intervention.

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.

In the digital age, the relationship between social media use and mental health has gained significant attention. Problematic social media use can negatively affect mental health, while mental health literacy plays a crucial role in mitigating these effects.

This study aimed to explore the relationships between problematic social media use, mental health literacy, and their interaction with depression among nursing students.

A convenience sample of 628 nursing students from a university was selected. Participants completed questionnaires assessing social media use, mental health literacy, and depressive symptoms. The tools used included the PHQ-9, the Youth Mental Health Literacy Scale, and the Problematic Use of Mobile Social Media Scale. Multiple logistic regression was performed to examine associations.

The average score for problematic social media use was 56.29 ± 16.22, with 159 students (24.84%) exhibiting problematic behaviors. The average depression score was 5.19 ± 5.32, with 296 students (46.25%) showing depressive symptoms. The average mental health literacy score was 82.46 ± 13.24, with 191 students (29.84%) demonstrating adequate literacy. Logistic regression analysis revealed that both problematic social media use and low mental health literacy were risk factors for depression, with additive and multiplicative interactions. Nursing students with both problematic social media use and low mental health literacy had the highest depression detection rate of 77.2% (88/114), with an odds ratio (OR) of 6.464.

Depression is prevalent among nursing students. Problematic social media use and low mental health literacy are significant risk factors for depression, and their interaction significantly increases the risk. Reducing problematic social media use and improving mental health literacy can help prevent depression and other negative emotional states among nursing students.

Gender identity is associated with adolescent depression, but the relationship remains unclear. To further clarify the relationship between gender identity and mental health, this study targets adolescents with significant fluctuations in gender identity, constructs a moderated mediation effect model, examines the relationship between gender identity and depression, and explores the mediating role of self-efficacy and the moderating role of family functioning, to provide scientific references for proposing effective psychological interventions for different gender identity groups.

Using whole group convenience sampling method, 2341 students from a school in Changsha, Hunan Province, were selected for the survey, and the Patient Health Questionnaire-9 items, the Family Care Index Scale, the General Self-Efficacy Scale-Schwarzer, and gender identity-related questions were used for the assessment of mental health.

The prevalence of depression was 40.5% among transgender adolescents, which was significantly higher than that of cisgender adolescents (15.6%). At the same time, gender identity, self-efficacy, family functioning, and depression constituted a moderated mediation model, with family functioning moderating the posterior path of this mediation process. Specifically, self-efficacy was progressively less predictive of depression as family functioning increased.

Transgender adolescents showed significantly poorer mental health than cisgender adolescents. There was a partial mediating effect of self-efficacy between gender identity and adolescent depression, with family functioning moderating the latter half of this mediation effect. This study advances our understanding of the relationship between depression and self-efficacy or family functioning in adolescents of different gender identities.

Depression among undergraduate health science students is increasingly recognized as a significant public health issue globally. These students face immense academic pressure, often leading to stress and mental exhaustion, particularly for students studying in a humanitarian crisis situation. However, there is a scarcity of information in this regard in higher education institutions in Somalia. Hence, this investigation was conducted to assess the prevalence of depression and its correlates health science students in Somalia.

A cross-sectional study was conducted on 321 health science students from some universities in Mogadishu, Somalia. The data was collected from students studying medicine, nursing and midwifery, laboratory science and public health at SIMAD university, Banadir university, Mogadishu university and Jamhuriya university, all located in Mogadishu. Simple random sampling based on class list was used to select the participants and a web-based self-administered Patient Health Questionnaire (PHQ-9) was used to screen for depression. The collected data were cleaned and checked for completeness before exporting into SPSS version 27 Statistical software for analysis, where descriptive statistics as well as logistic regression analysis was done to determine the independent predictors of the outcome variable. Significant association was determined at a 95% confidence interval and p-value < 0.05.

The prevalence of depression among the students was 58.6%. A total of 41.5% (133/321) of the participants were free from depression (Normal), while 30.8% had mild depression, 27.1% had moderate depression and 0.6% had severe depression. Analysis of the association between the sociodemographic variables and depressive state of the participant showed statistical significance (p-value = 0.045) for course of study. Students studying nursing and midwifery had the highest case of depression with 68.6% (59/86), followed by public health 66.7% (30/45), laboratory science 52.3% (34/65), and medicine having the least number of depressed students with 52.0% students (65/125). Similarly, gender of students was also found to be statistically significant (p-value = 0.001) with female students having 65% depression which is 41.1% of the total students studied.

The prevalence of depression among health science students in Mogadishu was high and positively associated with gender, having trouble with authorities, emotional problems, as well as experience of sexual abuse or violence. Hence, routine screening and monitoring of students' mental health state on the campus and providing mental health services is necessary to address this growing problem.

The effect of the long-term persistently elevated air pollutants, often referred to as air pollution waves, on sexual function has not been sufficiently addressed.

This nationwide cross-sectional study involved 12,157 participants, with 5496 females and 5039 males. PM waves were characterized by daily average PM concentrations surpassing Grade II thresholds of China's ambient air quality standards (PM2.5 > 75 μg/m3, PM10 > 150 μg/m3) for three or more consecutive days (3-8 days). Male sexual function was assessed through the International Index of Erectile Function-5 (IIEF-5) and the Premature Ejaculation Diagnostic Tool (PEDT), while female sexual function was evaluated using the Female Sexual Function Index (FSFI). A multivariate linear regression model was employed to investigate the link between PM wave exposure and sexual function.

Exposure to PM10 waves, defined as 3 (β = -0.0145, 95%CI = -0.0280, -0.0010), 4 (β = -0.0145, 95%CI = -0.0280, -0.0010), 5 (β = -0.0193, 95%CI = -0.0371, -0.0015), 6 (β = -0.0218, 95%CI = -0.0415, -0.0021), 7 (β = -0.0243, 95%CI = -0.0458, -0.0028), and 8 (β = -0.0243, 95%CI = -0.0458, -0.0028) consecutive days, negatively impacted IIEF-5 scores and male sexual function. Moreover, depression levels, as evaluated by the PHQ-9, played a mediating role in the connection between PM10 waves and IIEF-5 scores. The potentially vulnerable subgroups were the younger 20-30 and the low-income groups.

Our results suggest for the first time that PM10 waves are associated with decreased IIEF-5 scores, which are mediated by depression score PHQ-9, informing policy formulation for public health interventions and individual safeguarding.

The functional aspects of non-suicidal self-injury (NSSI) among adolescents represent a complex phenomenon requiring deeper understanding. While research has identified various NSSI functions, including emotional regulation, attention-seeking, and social avoidance, the field lacks comprehensive analysis of how these functions cluster into distinct profiles. Understanding these functional profiles is crucial for developing targeted interventions.

A cross-sectional study of 1,783 adolescents (1,464 girls, 318 boys) aged 12-18 years was conducted across 14 psychiatric or general hospitals in nine Chinese provinces. Participants completed the Functional Assessment of Self-Mutilation (FASM), which assesses 22 distinct NSSI functions across three primary dimensions: emotional regulation, attention-seeking, and social avoidance. Additional measures included the Patient Health Questionnaire (PHQ-9) for depression and Generalized Anxiety Disorder Scale (GAD-7) for anxiety symptoms. Latent profile analysis was employed to identify distinct patterns in NSSI functions, with model selection based on fit indices including AIC, BIC, entropy, and LMRT.

Latent profile analysis revealed four distinct functional profiles: low attention-seeking-high social avoidance (LA-HS, 19.7%), high attention-seeking-high social avoidance (HA-HS, 9.5%), low attention-seeking and social avoidance (LA-LS, 57.8%), and high attention-seeking-low social avoidance (HA-LS, 13.0%). The HA-HS profile demonstrated the most severe clinical presentation, showing significantly elevated scores in NSSI frequency (M = 26.160, SD = 9.771), anxiety (GAD-7: M = 16.265, SD = 4.951), and depression (PHQ-9: M = 20.612, SD = 6.003). The LA-HS profile showed the second-highest severity (NSSI: M = 25.800, SD = 10.058; GAD-7: M = 14.775, SD = 5.376; PHQ-9: M = 19.966, SD = 5.938). Both profiles also demonstrated significantly higher rates of suicidal ideation (HA-HS: 77.6%; LA-HS: 79.2%) compared to other profiles.

Our findings reveal distinct patterns in how adolescents utilize NSSI functionally, particularly regarding attention-seeking and social avoidance dimensions. These functional profiles show meaningful associations with psychological outcomes, suggesting that understanding NSSI functions, rather than just behaviors, may be crucial for assessment and intervention. The identification of these distinct functional profiles among Chinese adolescents highlights the importance of function-specific approaches in clinical assessment and treatment planning.

Mental healthcare was fundamentally altered during the COVID-19 pandemic, perhaps most prominently through the massive shift towards telehealth. Herein, we evaluated effects of the transition to teletherapy on treatment adherence and depressive symptoms for 3,476 patients at three outpatient psychiatric clinics, the majority of whom were low-income and experienced ethnoracial minoritization. Number of missed appointments decreased (mean: 6.27 vs. 3.77, p < .0001), and PHQ-9 scores decreased (mean: 8.17 vs. 6.82, p < .0001) between six months prior to and following the March 18, 2020 switch to telehealth. These conclusions held when adjusting for covariates including age, sex, race/ethnicity, and insurance status (i.e., socioeconomic status). Stratified analyses (i.e., adults, emerging adults, and youth) yielded the same conclusions, with the exception of emerging adults, for whom the PHQ-9 change was not significant. Results indicated the transition from in-person to teletherapy was associated with significantly reduced mean numbers of missed visits and depressive symptoms. Such results during this especially tumultuous period may underscore telehealth's effectiveness. Future research should explore whether there is a causal relationship between telehealth or mixed hybrid options, positive treatment outcomes, and prescriptive care delivery models, as well as applications of e-mental health tools for diverse, underserved patient populations.

Parent-adolescent emotion dynamics have attracted increasing attention in recent years because adolescence is a challenging period for both adolescents and parents. However, how emotions are coconstructed between parents and adolescents is less clear. This study examined whether mothers' and adolescents' emotion regulation strategy was linked with their own and each other's depression using the actor-partner interdependence model (APIM). The participants were 173 mother-adolescent pairs (Mother: Mage = 43.05 years old, SD = 3.78; Adolescent: Mage = 13.00 years old, SD = 0.90). The results showed that the more mothers used cognitive reappraisal, the lower their depression levels were; and the more mothers and adolescents used expressive suppression, the higher their levels of depression were. Additionally, maternal expressive suppression was associated with adolescent depressive symptoms. Moreover, the results revealed that for mothers with higher levels of expressive suppression, their adolescents' usage of expressive suppression was significantly positively related to adolescents' depression, while for those mothers with lower levels of expressive suppression, there was no significant correlation between adolescents' usage of expressive suppression and depression. The findings underscore the significance of recognising the interdependence and interconnected nature of emotions within parent-adolescent relationships for a comprehensive understanding of their emotional well-being.

Exposure to fathers' positive parenting has been associated reducing mental disorder symptoms during adolescence, evidence on the mechanisms underlying this association is lacking. One potential mechanism linking fathers' positive parenting and mental disorders is environmental sensitivity (ES). Here we studied whether the increased positive behaviors of both parents (1) separately, (2) relatively, (3) and jointly predict reduced depression, attention deficit hyperactivity disorder (ADHD) symptoms, suicidal ideation (SI), and increased well-being in Chinese adolescents. Additionally we investigated (4) whether ES moderates these relationships.

This study involving 7010 Chinese adolescents (55.6 % girls) aged 15 to 18 from six junior high schools in Shaanxi, China was conducted at four timepoints. ES was assessed using the Highly Sensitive Child (HSC) scale at ages 15 and 16, parental positive behaviors using the Parental Bonding Instrument (PBI) at ages 16 and 17, and psychopathology symptoms using the 9-item Patient Health Questionnaire (PHQ-9), Strengths and Difficulties Questionnaire (SDQ), and Positive and Negative Suicide Ideation (PANSI) Inventory at ages 17 and 18.

(1) Multilevel analyses revealed that increased positive parenting predicted reduced psychiatric disorder symptoms and improved well-being; (2) trend interaction indicated that the compensatory effect of fathers' positive parenting was stronger in alleviating mental problems in adolescents than that of mothers'; (3) Simple slope analyses suggested that both high levels of fathers' and mothers' positive parenting predicted fewer subsequent psychiatric disorder symptoms, particularly for sensitive adolescents.

This study was limited to its generalizability to the Western Chinese adolescents.

Substantial differences in the effects of positive paternal and maternal parenting highlight the important role of fathers' positive parenting in mental development, especially for highly sensitive adolescents.

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.

To explore the individual and interpersonal association between mental health knowledge (MHK) and depression in adolescents and one of their parents, and to explore whether gender differences exist between fathers and mothers in these associations.

Participants were 3456 father-adolescent dyads and 4478 mother-adolescent dyads, recruited from eight middle schools in Wuhan, who completed self-report assessments of MHK and depression from September to October 2021.

With the application of the actor-partner interdependence model, A positive actor effect between MHK and depression in adolescents was found. Adverse partner effects from fathers' MHK and mothers' MHK to adolescent depression were noted and showed no significant difference. Adolescents' depression was significantly associated with parental depression in both fathers and mothers.

It is implied that milder adolescent depression was associated with lower levels of adolescent MHK, along with higher levels of MHK in both fathers and mothers. For parents, it is important to emphasise the improvement of their own MHK and increase their attention to adolescent mental health problems, as this may contribute to enhancing the mental health of adolescents.

This study is instructive and related to family-based nursing interventions for mental health, emphasising the potential influence of parents in the family on adolescent depressive symptoms. The findings suggest that parental involvement should be encouraged and that the family's role in supporting the child's mental health should be recognised, contributing to the development of relevant policies.

This study highlights that higher parental MHK is associated with lower levels of adolescent depression, with no gender differences between fathers and mothers. Family-based nursing interventions that emphasise mental health education for parents may have an impact on improving depression in adolescents.

Guidelines were followed using the STROBE reporting method.

None.

Family caregivers are at a high risk for low quality of life due to caregiving-related stress. Caregivers' stress is commonly assessed using self-reported measures, which reflect relatively subjective and long-term stress related to caregiving, but objective biological markers of stress are rarely used for caregivers. The purposes of this study were (1) to determine whether caregiver characteristics were associated with stress assessed using a stress biomarker (serum cortisol) and a self-reported caregiving distress measure (Caregiver Burden Inventory) and (2) to determine the predictability of both stress measures for quality of life in caregivers of patients with heart failure.

Taiwanese family caregivers (N = 113; mean age, 54.5 years; 70.8% female) of patients with heart failure completed surveys including caregiving distress and quality of life measured by the Caregiver Burden Inventory and the Short Form-36 (physical and psychological well-being subscales), respectively, and provided blood samples for serum cortisol. Independent t tests, correlation, and hierarchical regression were conducted.

Single caregivers had higher serum cortisol levels than married caregivers ( P = .002). Men had significantly higher serum cortisol levels than women ( P = .010), but men reported lower caregiving distress than women ( P = .049). Both serum cortisol (β = -0.32, P = .012) and caregiving distress (β = -0.29, P = .018) were significant predictors of quality of life in the physical well-being scale while controlling for caregivers' characteristics and depressive symptoms. Serum cortisol (β = -0.28, P = .026) and caregiving distress (β = -0.25, P = .027) also predicted quality of life in the psychological well-being scale.

Serum cortisol and self-reported caregiving distress have similar predictability for quality of life in family caregivers of patients with heart failure. Reducing stress and caregiving distress is critical to improving quality of life in this population.

Understanding developmental trajectories and gender differences in depressive symptoms is clinically relevant. Discerning true differences across gender, age groups, and time is based on the often-neglected premise of measurement invariance (MI) of child and adolescent depression scales. In this systematic review, we assessed available evidence for MI across gender, age groups, and time for depression scales validated in children and adolescents, in studies with at least one assessment under age 18. A literature search using Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases identified 42 studies that examined MI. MI of eleven scales was tested in 1-9 studies per scale. Conclusions are hampered by different factor solutions tested within some scales. All included questionnaires showed preliminary evidence for MI across gender. Across some studies, crying had higher factor loadings in females compared to males, indicating that crying may be differently related to depression across gender. MI evidence was preliminary in just four scales across time, mostly confined to ages 13-17. One study showed developmental conclusions differed when non-invariance is not accounted for in observed scores. Overall, evidence for MI in child and adolescent depression scales is currently limited.

Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved.

This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems.

An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: "Have you ever considered committing suicide in the past 12 months?" Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling.

Among all participants, the prevalence of IGD and suicidal ideation was 16.95% (287/1693) and 43.06% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7% (indirect effect/total effect: 0.016/0.15), 30.0% (0.05/0.15), and 13.3% (0.02/0.15), respectively. The direct path remained statistically significant.

IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study.

Perceived Stress has been shown as a key contributor to sleep quality, but the underlying mechanism between perceived stress and sleep quality remains unknown. This study aimed to investigate the impact of perceived stress on sleep quality of college students and the chain mediating roles of presence of meaning in life (PML) and depression, as well as the moderating role of search for meaning in life (SML).

Participants were 8178 college students (4599 boys and 3579 girls; Mage = 19.10 years, SD = 1.08) who completed self-report questionnaire, including the Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), the Meaning in Life Questionnaire (MLQ), and the Patient Health Questionnaire-9 (PHQ-9).

The results showed that higher perceived stress was directly related to poorer sleep quality. This negative impact on sleep quality was mediated through the chained roles of PML and depression. Additionally, the study found that SML moderates the influence of perceived stress, PML and depression on sleep quality. Specifically, for individuals actively search for meaning, the adverse effects of perceived stress and depression on sleep quality are diminished. Concurrently, the positive influence of PML on sleep quality is enhanced.

This study revealed that the PML and depression mediate the effect of perceived stress on sleep quality, with SML playing a significant protective role. These results emphasize the necessity of integrating strategies to enhance PML and SML into interventions designed to improve emotion management and sleep quality among college students.

Major depressive disorder (MDD) is often accompanied by psychotic symptoms. However, few studies have examined the relationship between psychotic symptoms and endocrine factors in adolescent patients with MDD. Therefore, this study aimed to investigate the prevalence and related endocrine clinical factors of psychotic symptoms in Chinese adolescent patients with MDD.

In total, 601 patients (aged 12-18) with MDD were recruited. The Patient Health Questionnaire - 9 items (PHQ - 9) was utilized for assessing depressive symptoms. Psychotic symptoms were assessed through clinical interviews. Prolactin (PRL), thyroid-stimulating hormone (TSH), triiodothyronine (T3), free triiodothyronine (FT3), thyroxine (T4), and free thyroxine (FT4) were also measured.

The incidence of psychotic symptoms in adolescent patients with MDD was 22.6%. The findings demonstrated that age, self-harming behavior, PHQ-9 score, FT4, and normalized PRL were independently associated with psychotic symptoms in patients with MDD (All p < 0.05).

PRL and FT4 levels are more likely to be abnormally elevated in major depressive adolescents with psychotic symptoms. Prolactin and thyroid hormones in patients with MDD should be paid more attention.

Cross-sectional studies indicate that menstrual problems are related to poorer mental health; however, longitudinal studies are limited. This longitudinal study aimed to determine whether baseline menstrual characteristics were risk factors for incident and persistent mental health problems. The study was conducted among Chinese adolescent girls. Menstrual characteristics including menarche, menstrual cycle and menstrual pain were assessed at baseline, whereas mental health problems including PTSD, depression, anxiety, ADHD, insomnia, psychotic-like experiences, non-suicidal self-injury, suicide ideation, suicide plan, and suicide attempt were assessed at baseline (n = 1039) and at the 1-year follow-up (n = 946) by self-administered, structured questionnaires. Multiple logistic regressions were performed to examine whether menstrual characteristics were associated with incident (e.g., PTSD at follow-up but not baseline) and persistent (e.g., PTSD at both time points) mental health problems. The results demonstrated that early menarche was related to persistence of psychotic-like experiences; irregular menstruation was associated with higher rates of incident anxiety and insomnia, and persistent depression, anxiety, ADHD, insomnia, non-suicidal self-injury, suicide ideation, and suicide plan; menstrual pain was associated with elevated rates of incident PTSD and depression, and persistent depression, insomnia, psychotic-like experiences, non-suicidal self-injury, suicidal ideation, suicide plan, and suicide attempt. In conclusion, irregular menstruation and menstrual pain specifically contributed to the development of emotional problems and insomnia, and were associated with maintenance of the most mental health problems in early adolescence. The long-term effects of menstrual problems on mental health need further study.

Suicide attempts (SA) are a significant contributor to suicide deaths, and non-suicidal self-injury (NSSI) can increase the risk of SA. Many adolescents experience both NSSI and SA, which are affected by various factors. This study aimed to identify the risk factors and essential warning signs of SA, establish a predictive model for SA using multiple dimensions and large samples, and provide a multidimensional perspective for clinical diagnosis and intervention.

A total of 9140 participants aged 12-18 years participated in an online survey; 6959 participants were included in the statistical analysis. A multilayer perceptron algorithm was used to establish a prediction model for adolescent SA (with or without); adolescents with NSSI behavior were extracted as a subgroup to establish a prediction model.

Both the prediction model performance of the SA group and the NSSI-SA subgroup were strong, with high accuracy, and AUC values of 0.93 and 0.88, indicating good discrimination. Decision curve analysis (DCA) demonstrated that the clinical intervention value of the prediction results was high and that the clinical intervention benefits of the NSSI-SA subgroup were greater than those of the SA group.

Our study demonstrated that the predictive model has a high degree of accuracy and discrimination, thereby identifying significant factors associated with adolescent SA. As long as adolescents exhibit NSSI behavior, relative suicide interventions should be implemented to prevent future hazards. This study can provide guidance and more nuanced insights for clinical diagnosis as well as a foundation for clinical treatment.

Nomophobia (NMP) is a contemporary digital ailment referring to the improper utilization of smartphones which can have significant impacts on the physical and mental health of college students. However, as a result of unclear cutoff points, the proportion of people with NMP may be exaggerated. This study therefore aimed to determine the critical value of NMP and assess the extent to which Chinese college students are impacted by NMP using the Nomophobia Questionnaire (NMP-Q).

Latent profile analysis (LPA) and the receiver operating characteristic curve (ROC) were combined to determine the critical value based on NMP-Q scores using a large sample of 3,998 college students (Mage = 20.58; SD = 1.87).

Based on latent profile (i.e., at-risk NMP group), ROC revealed an optimal cut-off point of 73 (Sensitivity = 0.965, Specificity = 0.970, Accuracy = 0.968, AUC = 99.60%, Youden's index = 0.935), and the percentage of NMP students being 28.04%, with 1,121 participants identified as positive cases (probable cases). Positive cases were found to exhibit more severe depression and anxiety symptoms, with a higher proportion of females were observed in the positive group (N = 829; 73.95%).

These findings provide evidence that the proportion of NMP individuals may have been overestimated in the past. Furthermore, this study helps to validate the NMP-Q as a valid tool to identify NMP in college-aged individuals.

To investigate the prevalence and associated factors of suicidal ideation and suicide attempts among adolescent and young adults in China from December 14, 2022 to February 28, 2023, when COVID-19 restrictions were lifted.

Students in middle and high schools and colleges and universities in the province of Sichuan, China were asked to complete on-line cross-sectional surveys. Information was collected about sociodemographics, experiences related to the COVID-19 pandemic, suicidal ideation and suicide attempts. Participants also filled out the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 and the Social Support Rate Scale surveys. Factors associated with suicidal ideation or suicide attempts were explored using logistic regression.

Of the 82,873 respondents (aged 12 to 24 years), 21,292 (25.7%) reported having thought of suicide at least once in their lifetime, 10,382 (12.5%) reported having thought about suicide within the previous 12 months, and 1,123 (1.4%) reported having attempted it within the previous 12 months. Risk of lifetime suicidal ideation was higher among middle school students than among older students. Risk of suicidal ideation and risk of suicide attempts correlated directly with severity of symptoms of depression and anxiety, and inversely with level of social support. Greater risk of suicidal ideation and suicidal attempts was associated with: being female, living in an urban environment, attending a boarding school, currently being in love, having parents who divorced or remarried, having parents who exhibit non-authoritative parenting behavior, having higher family income, having been COVID-19 infected, having been quarantined for a long time, and being dissatisfied with one's education.

Suicidal ideation and suicide attempts remain prevalent among young people in China. The potential associated factors identified in our study may be useful for targeting appropriate psychosocial interventions and developing mental health policies.

Although aggression associated self-injury and suicidal ideation, but the specific impact of different subtypes of aggression is unclear. Therefore, the current study aims to quantify the associations between five subtypes of aggression, self-injury, and suicidal ideation in Chinese adolescents.

A total of 18,532 students were recruited in grades 7 to 12 using a stratified cluster sampling across five representative provinces in China. The Functional Assessment of Self-Mutilation (CH-FASM) and Buss and Warren's Aggression Questionnaire (BWAQ) assess self-injury and aggression, respectively.

During the last year, the proportion of self-injury, suicidal ideation, and self-injury plus suicidal ideation (SSI) were 13.4 %, 10.0 %, 12.4 %, respectively. Multivariate logistic regression indicated that hostility was associated with self-injury-only (OR = 1.033, 95 % CI = 1.021-1.044), suicidal ideation-only (OR = 1.075, 95 % CI = 1.061-1.088), and SSI (OR = 1.100, 95 % CI = 1.087-1.114) (all P < 0.001) across five subtypes of aggression. In gender stratification, physical aggression was risk factor for self-injury-only, suicidal ideation-only, and SSI (OR = 1.028, 95 % CI = 1.018-1.037, P < 0.001) in females. While anger was association with self-injury-only and suicidal ideation-only in males (P < 0.05).

This study was a cross-sectional design and self-reported questionnaire.

Hostility is a strong predictor of self-injury and suicidal ideation across five subtypes of aggression. There are gender differences in relationships. Prevention programs for adolescents' self-injury and suicidal ideation should consider different subtypes of aggression and gender differences.

Background: Preliminary evidence provides support for the proposition that there is a dissociative subtype of Complex posttraumatic stress disorder (CPTSD). Research on this proposition would extend our knowledge on the association between CPTSD and dissociation, guide contemporary thinking regarding placement of dissociation in the nosology of CPTSD, and inform clinically useful assessment and intervention.Objectives: The present study aimed to investigate the co-occurring patterns of CPTSD and dissociative symptoms in a large sample of trauma exposed adolescents from China, and specify clinical features covariates of such patterns including childhood trauma, comorbidities with major depressive disorder (MDD) and generalized anxiety disorder (GAD), and functional impairment.Methods: Participants included 57,984 high school students exposed to the coronavirus disease 2019 (COVID-19) pandemic. CPTSD and dissociative symptoms, childhood traumatic experience, and functional impairment were measured with the Global Psychotrauma Screen for Teenagers (GPS-T). Major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Latent class analysis (LCA) was employed to test the co-occurring patterns of CPTSD and dissociative symptoms. Analysis of covariance (ANCOVA) and chi-square tests were respectively used to examine between-class differences in continuous and categorical clinical covariates.Results: A 5-class model emerged as the best-fitting model, including resilience, predominantly PTSD symptoms, predominantly disturbances in self-organization (DSO)symptoms, predominantly CPTSD symptoms, and CPTSD dissociative subtype classes. The CPTSD dissociative subtype class showed the lowest level of functioning and the highest rates of MDD, GAD and childhood trauma.Conclusions: Our findings provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD, and inform for further research and clinical practice on traumatized individuals.

The psychological status of Chinese postgraduate students majoring in stomatology after the COVID-19 restrictions still remains unclear. The objective of this study is to evaluate the mental status through a cross-sectional survey and gather related theoretical evidence for psychological intervention on postgraduate students majoring in stomatology.

An online survey was administered, and subjective well-being, anxiety, stress and depression symptoms were assessed using the 5-item World Health Organization Well-Being Index (WHO-5), item Generalized Anxiety Disorder Scale (GAD-7), 10-item Perceived Stress Scale (PSS-10), and Patient Health Questionnaire-9 (PHQ-9), respectively, wherein suicidal ideation and sleep-related problems were measured with PHQ-9 and Insomnia Severity Index (ISI).

A total of 208 participants who completed one questionnaire were considered as valid. It was found that female respondents generally exhibited significantly higher levels of PSS-10, PHQ-9, and GAD-7 scores and shorter physical activity hours than male students. Students from rural areas demonstrated significantly higher levels of PHQ-9, suicidal ideation, and less portion of good or fair family economic support. Additionally, individuals from only-child families reported increased levels of activity hours (1.78 ± 2.07, p = 0.045) and a higher portion (55.10%, p = 0.007) of having clear future plan as compared with multiple-child families. The risk factors for anxiety symptoms (GAD-7 score) were higher scores of PSS-10 (OR = 1.15, 95% CI = 1.09-1.22), PHQ-9 (OR = 1.35, 95% CI = 1.22-1.49), and ISI-7 (OR = 1.14, 95% CI = 1.06-1.23), while owning a clear graduation plan was the protective factor (OR = 0.55, 95% CI = 0.31-0.98). Moreover, the risk factors for depressive symptoms (PHQ-9) included PSS-10 (OR = 1.10, 95% CI = 1.04-1.16), GAD-7 (OR = 1.38, 95% CI = 1.25-1.52), suicidal ideation (OR = 5.66, 95% CI = 3.37-9.51), and ISI-7 (OR = 1.17, 95% CI = 1.09-1.25). Approximately 98.08% of Chinese postgraduates studying stomatology reported experiencing at least moderate stress after the COVID-19 restrictions.

Within the limitations of this study, senior students were more inclined to stress, while anxiety symptoms were related to severer levels of stress, depression, and insomnia. Depressive symptoms were associated with higher levels of stress, anxiety, insomnia, suicidal ideation, and lower levels of self-reported well-being. Thus, psychological interventions for postgraduates should be timely and appropriately implemented by strengthening well-being, reasonably planning for the future, and good physique, thereby mitigating the psychological issues after COVID-19 restrictions.

Despite accumulating evidence regarding the impact of sleep disturbance on internalizing symptoms among adolescents, the underlying psychological mechanisms remain inadequately explored. This study aimed to investigate a conceptual framework elucidating how sleep disturbance influences internalizing symptoms in adolescents through the mediating role of self-control, with mindfulness as a moderator.

In this cross-sectional study, 1876 Chinese adolescents (Mage = 14.88 years, SD = 1.47 years, range = 12-19 years, 44.7% boys) completed the Youth Self-Rating Insomnia Scale (YSIS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Brief Self-control Scale (BSCS), and Mindful Attention Awareness Scale-Children (MAAS-C) to provide data on sleep-related variables, internalizing symptoms (anxiety and depression), self-control, and mindfulness, respectively. The PROCESS macro for SPSS was applied to perform moderated mediation analysis.

Sleep disturbance demonstrated a significant positive correlation with internalizing symptoms in adolescents, including anxiety (β = 0.481, p < 0.001) and depression (β = 0.543, p < 0.001). Self-control served as a mediator between sleep disturbance and two forms of internalizing symptoms. Moreover, mindfulness moderated the pathways from self-control to internalizing symptoms (for anxiety symptoms: β = 0.007, p < 0.001; for depression symptoms: β = 0.006, p < 0.001), and the mediating relationships were weaker for adolescents exhibiting higher levels of mindfulness.

Our findings enhance understanding of the impact, pathways, and influencing factors of sleep disturbance on adolescent internalizing symptoms, suggesting the importance of enhancing mindfulness levels in addressing self-control deficits and subsequently reducing internalizing symptoms among adolescents.

This study aimed to investigate the interplay between anxiety and depressive symptoms in Chinese college freshmen using the causal system perspective (CSP), which differs from the traditional common cause perspective (CCP) by providing an alternative explanation by attributing comorbidity to direct interactions among symptoms.

A convenience sample of 2,082 Chinese college freshmen (39.51% male, Mage = 18.61) from a normal university completed the Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9). Network analysis was conducted and evaluated as to centrality, stability, node predictability, and bridging features. Moreover, the moderated network model (MNM) was utilized to detect the moderation effects of gender in the comorbidity network.

The network of anxiety and depressive symptoms exhibited stability, characterized by the core symptoms of "restlessness", "lack of energy", and "excessive worry about control", as well as the bridging symptoms of "fearfulness", "sad mood", and "irritability". Notably, the nodes representing "uncontrollable worry" and "difficulty in relaxation" demonstrated the highest predictive power. Gender did not exert any moderating effects on the anxiety and depressive symptom network.

These results reinforce that certain anxiety or depressive symptoms are more central than others, and thus play a more vital role in the comorbid network. These findings highlight underlying potential targeting symptoms to consider in future interventions.

Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory.

This study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China.

A total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms.

Among the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ≥3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P<.001). A total of 5882 (21.8%) students reported having depression symptoms. After adjustment for sociodemographic status, lifestyle factors, academic performance, and experience of physical fighting, compared to students who did not engage in MSE, the prevalence ratios (PRs) for depression symptoms were 0.98 (95% CI 0.97-0.99) for those engaging in MSE once a week, 0.95 (95% CI 0.93-0.97) for 2 days/week, 0.93 (95% CI 0.90-0.96) for 3 days/week, 0.90 (95% CI 0.87-0.94) for 4 days/week, 0.88 (95% CI 0.84-0.93) for 5 days/week, 0.86 (95% CI 0.81-0.92) for 6 days/week, and 0.84 (95% CI 0.78-0.90) for 7 days/week, respectively.

The overall prevalence of meeting MSE recommendations among Chinese adolescents is low. The frequency of MSE was inversely associated with depression symptoms.