Roles of Self-Stigma, Social Support, and Positive and Negative Affects as Determinants of Depressive Symptoms Among HIV Infected Men who have Sex with Men in China

Preliminary testing for affiliate stigma scale: A reliable and valid stigma measure for caregivers of women with breast cancer

Objective

Families of breast cancer patients may face discrimination and societal rejection due to prevailing myths, misconceptions and causal beliefs related to breast cancer. This study aims to develop and validate a measurement tool that is sensitive to the affiliate stigma experienced by caregivers of women with breast cancer.

Methods

The scale was developed in two phases: (1) item generation based on interviews amongst 18 caregivers of women with breast cancer; (2) psychometric properties of the scale, including content validity, structural validity, and internal consistency reliability. Data were collected from May to June 2023 in 426 caregivers of women with breast cancer from 5 tertiary A hospitals.

Results

An exploratory factor analysis produced a 24-item scale across four dimensions, including internal stigma, social isolation, perceived stigma, and reaction. The scale showed good internal consistency and test-retest reliability. The total score of the scale was significantly and positively correlated with scores in caregiving burden and negatively correlated with scores in self-esteem and in social support. The item-level content validity index fell within the range of 0.8-1.0.

Conclusions

This is a valid and reliable instrument captured the spectrum of stigma relevant to caregivers of women with breast cancer and may serve as a unique instrument that can be used globally. This study is a step forward for stigma-related studies among caregivers of women with breast cancer and provides a reference for developing effective interventions for those with potentially stigmatized conditions.

Depression, positive affect, and sexual behavior: a moderated mediation model of drug use among men who have sex with men in Hong Kong

BACKGROUND

Drug use can be associated with poor mental health and risky sexual behaviors among men who have sex with men (MSM) and has become an important public health concern. The present study investigated the association between depression, positive and negative affect, number of sex partners, and drug use among MSM.

METHODS

A cross-sectional study was conducted among 420 MSM in Hong Kong. Participants completed a self-reported questionnaire that measured demographic characteristics, drug use, depression, sexual behaviors, and positive and negative affect. Hierarchical logistic regression was first conducted to examine the moderating role of the number of sex partners on the association between depression and drug use. A mediation model was then created to test the role of positive affect, negative affect and depression on drug use. A moderated mediation model was finally developed to test the overall associations.

RESULTS

After adjusting for significant demographic and other confounding factors, depression was positively associated with drug use (adjusted odds ratio [aOR] 1.05, 95 % confidence interval [CI] 1.02-1.09). The association between depression and drug use was positively moderated by number of sex partners. Positive affect significantly mediated the association between depression and drug use, exerting a negative indirect effect.

LIMITATIONS

The casual inference was constrained by the cross-sectional design.

CONCLUSIONS

Given the moderating role of the number of sex partners and the mediating role of positive affect on the association between depression and drug use, interventions to reduce drug use among MSM should aim to reduce risky sexual behaviors and promote mental health.

Development and internal validation of a depressive symptoms prediction model among the patients with cardiovascular disease who have recovered from SARS-CoV-2 infection in Wuhan, China: a cross-sectional study

BACKGROUND

Middle-aged  and elderly patients with cardiovascular disease (CVD) who have recovered from SARS-CoV-2 infection may experience depressive symptoms due to the physical and psychological impact of the pandemic.

OBJECTIVE

To investigate the prevalence and predictors of depressive symptoms among the middle-aged and elderly with CVD who have recovered from SARS-CoV-2 infection in Wuhan, China, and to develop a prediction model for depressive symptoms.

METHODS

A cross-sectional study was conducted among 462 former SARS-CoV-2 middle-aged and elderly patients with CVD in Jianghan District, Wuhan, China from June 10 to July 25, 2021. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Potential predictors of depressive symptoms were selected by the least absolute shrinkage and selection operator (LASSO) regression. A prediction model was developed by random forest (RF) and logistic regression models and compared by the area under the receiver operating characteristic curve (AUROC). The discrimination, calibration, and practical utility of the prediction model were evaluated by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Bootstrap sampling was used for internal validation.

RESULTS

The prevalence of depressive symptoms among the participants was 35.93%. The prediction model included age, stethalgia after recovery, insomnia after recovery, post-traumatic stress disorder (PTSD), anxiety, fatigue, and perceived social support as predictors. The AUROC of the logistic regression model was 0.909 (95%CI: 0.879 ~ 0.939), indicating good discrimination. The calibration curve showed good calibration. The DCA showed that the prediction model had a net benefit for a wide range of risk thresholds. The internal validation confirmed the stability of the prediction model.

CONCLUSION

Depressive symptoms are common among middle-aged and elderly CVD patients who have recovered from SARS-CoV-2 infection in Wuhan, China. A prediction model with satisfactory performance was developed to estimate the risk of depressive symptoms among this population. Interventions targeting long COVID symptoms and social support should be considered to prevent depressive symptoms in CVD patients.

The associations between coping resources and help-seeking intention in a sample of Chinese first-year medical students: mediation effects of coping strategies

BACKGROUND

Help-seeking is an adaptive coping process encompassing orientation, intention and actual behaviors. Help-seeking intention which promotes help-seeking behavior is a protective factor for mental health. However, the psychological paths for help-seeking intention in first-year medical students, a population vulnerable to mental health challenges, remain elusive. Thus, we aim to explore the associations between coping resources (i.e., perceived social support (PSS) and self-compassion) and formal/informal help-seeking intention, and to further test the mediating role of coping strategies (i.e., active coping and behavioral disengagement) in these relationships.

METHODS

The sample included 792 Chinese first-year medical students. Validated scale was used to assess PSS. The Self-compassion Scale Short Form (SCS-SF) and the Brief COPE were employed to evaluate self-compassion and coping strategies. Multiple linear regression and structural equation modeling (SEM) analyses were conducted.

RESULTS

Multiple regression analyses indicated that PSS, self-compassion, active coping, and behavioral disengagement were significantly associated with formal/informal help-seeking intention. SEM further demonstrated that active coping significantly mediated the relationships between PSS and formal/informal help-seeking intention, as well as the relationships between self-compassion and formal/informal help-seeking intention. Moreover, behavioral disengagement was found to significantly mediate the association between self-compassion and formal help-seeking intention.

CONCLUSIONS

The present study identified five significant mediation paths, indicating the intricate relationships between coping resources, coping strategies, and help-seeking intention. These findings offer actionable insights for interventions, suggesting that enhancing PSS and fostering self-compassion can promote active coping, reduce behavioral disengagement, and ultimately increase both formal and informal help-seeking intention among first-year medical students in China.

Investigating the relationship between social stigma and treatment adherence in type 2 diabetes patients at healthcare centers in Northwest Iran

BACKGROUND

The social stigma associated with type 2 diabetes is a significant global mental and social health issue that can hinder treatment adherence among patients. To address this concern, the present study aimed to examine the relationship between social stigma and treatment adherence levels in type 2 diabetes patients attending healthcare centers in northwest Iran.

METHODS

In this descriptive-correlation study, 432 patients with type 2 diabetes referred to Ardabil city health service centers were selected by simple random and multi-stage cluster method. The data collection tools included the personal-social profile form, type 2 diabetes stigma assessment scale (DSAS-2), and treatment adherence questionnaire. Data were analyzed using SPSS 26 software with descriptive statistics, independent t-tests, analysis of variance, a logistic linear regression model.

RESULTS

The results indicated that the average score for the total social stigma of type 2 diabetes among the studied samples was 59.27 ± 15.52. A high level of perceived social stigma was observed in 55.6% of the patients. The average score for treatment adherence was 97.46 ± 28.79, with an adherence situation at an average level (59.7%). An inverse relationship was identified between the social stigma of diabetes and adherence to treatment (r = -0.29, p < 0.001). Additionally, there was a significant relationship between the average score of social stigma of diabetes and variables such as gender and marital status, as well as between the average score of treatment adherence and the gender of patients. The stepwise multiple linear regression model revealed that 15.1% of the variance in treatment adherence could be explained by age, duration of the disease, and social stigma of diabetes.

CONCLUSION

The study found that, more than half of the patients had social stigma and reported their adherence to treatment as moderate. Also, there was an inverse and significant correlation between social stigma and treatment adherence. Therefore, it is necessary to provide psychological counseling services to reduce social stigma and teach the importance of adherence to treatment in these patients.

Uptake and hesitancy of the second booster dose of COVID-19 vaccine among the general population in China after the surge period of the COVID-19 pandemic: a large-scale national study

BACKGROUND

Although the second booster dose of COVID-19 vaccines is available, vaccine hesitancy among the public may have peaked due to the surge in infections caused by the Omicron variant. To improve coverage of the second booster dose, it is crucial to investigate the prevalence of vaccine hesitancy among the general population during this period and explore the reasons for this phenomenon.

METHODS

A cross-sectional survey was conducted between January 5 to February 9, 2023. Variables including sociodemographics, mental health, COVID-19 infection status, COVID-19 vaccination status, and vaccine hesitancy were collected. Univariate and multivariate logistic regression analysis were performed to identify factors associated with the hesitancy of the second booster dose of COVID-19 vaccine among the general population.

RESULTS

Among the 10,623 participants, the uptake rate of the second booster dose was 4.3%. Among those who did not receive the second booster dose, 43.6% expressed vaccine hesitancy. The highest hesitancy rate was observed among participants who had not completed primary immunization (71.4%), followed by those with chronic diseases (48.6%) and those aged 60 and above (33.2%). The COVID-19 vaccine hesitancy was higher among females, participants with high incomes, those with a history of COVID-19 infection, those with depressive symptoms and post-traumatic stress disorder, and those with adverse events after COVID-19 vaccination. Conversely, lower hesitancy was observed among students, participants aged 60 and above, those from southern China, and those with higher level of perceived social support.

CONCLUSIONS

COVID-19 vaccine hesitancy remains prevalent among the general population in China after the surge period of the pandemic. Crucial steps, such as raising public awareness of the benefits and potential side effects of regular COVID-19 vaccination, ensuring timely monitoring and disclosure of pandemic information, and implementing targeted measures to improve social support and mental health, should be taken. These efforts will be instrumental in reducing vaccine hesitancy, advancing vaccination campaigns, and effectively preparing for the potential future outbreaks.

Influence of symptom burden on social alienation in lung cancer patients receiving chemotherapy: the chain mediating effect of perceived social support and positive psychological capital

BACKGROUND

Social alienation is prevalent among lung cancer (LC) patients undergoing chemotherapy. Although previous research has established an association between social alienation and symptom burden, the mechanisms underlying this relationship remain not fully understood.

METHODS

This cross-sectional study used convenience sampling to select 378 LC patients undergoing chemotherapy from September 2022 to December 2023 at a tertiary care hospital in Guangzhou, China. Data collection was conducted using a proprietary Sociodemographic Information Questionnaire, MD Anderson Symptom Inventory (MDASI), Social Alienation Questionnaire, Perceptions of Social Support (PSS) Questionnaire, and Positive Psychological Capital (PPC) Questionnaire. To analyze chain-mediated effects, the PROCESS v3.3 Model 6 SPSS macro software was employed.

RESULTS

The analysis revealed that the burden of symptoms significantly exacerbates social alienation, as evidenced in the mediation effects model (Bootstrap 95% CI: 0.031, 0.092). Furthermore, the burden of symptoms indirectly diminishes PSS (Bootstrap 95% CI: 0.019, 0.057) and PPC (Bootstrap 95% CI: 0.002, 0.020). It is crucial to note that both PSS and PPC significantly mediate the relationship between symptom burden and social alienation, as evidenced (Bootstrap 95% CI: 0.001, 0.011).

CONCLUSIONS

The impact of symptom burden on social alienation is moderated through PSS and PPC, manifesting both directly and indirectly. Moreover, the influence of PPC tends to mitigate the mediating role of PSS. Clinical interventions aimed at bolstering PSS and augmenting PPC may potentially alleviate social alienation and enhance the quality of life for patients undergoing chemotherapy for LC.

Prevalence and influencing factors of suicidal ideation among doctors and nurses during the surge period of the COVID-19 pandemic in China: a multicenter cross-sectional study

BACKGROUND

From November 2022 to February 2023, China has experienced a surge period of COVID-19 pandemic and doctors and nurses working in hospitals have suffered from serious psychological crisis because of the medical crowding, which may result in the occurrence of suicidal ideation (SI). This study aims to explore the prevalence and influencing factors of SI during this surge phase.

METHODS

A multicenter cross-sectional study was conducted in China from 5 January 2023 to 9 February 2023. Data were collected by online questionnaires, with SI measured by a single item. Ordinal logistic regression analysis and stratified analyses were preformed to identify influencing factors.

RESULTS

A total of 5696 doctors and nurses were retained for further analysis, with 25.28% reporting SI during the COVID-19 surge phase. Participants experiencing anxiety symptoms or supporting other departments treating COVID-19 patients were more likely to report SI. Additionally, higher levels of resilience, mindfulness, and perceived social support were protective factors against SI.

CONCLUSION

During the COVID-19 surge phase, over a quarter of doctors and nurses in China suffered from SI, which should be of great concern. Tailored interventions should be implemented to alleviate SI among doctors and nurses when new infectious diseases outbreak in the future.

It Is a Catch-22 Situation! A Decade of Research Trends on Gay Wellbeing in China: A Bibliometric Analysis

The wellbeing of gay men in China is shaped by a combination of cultural, social, and political factors, yet research on this topic remains fragmented despite growing global interest in LGBTQ+ health. This study provides a comprehensive bibliometric analysis of research trends on wellbeing of gays (MSM) in China, using the PRISMA 2020 guidelines for a systematic search strategy and VOSviewer for bibliometric mapping. Data from Scopus were analyzed to examine publication output, top journals, and authors, along with a co-occurrence analysis of keywords and co-authorship networks across countries and authors. Results show a steady rise in publications over the past decade, particularly after 2015, revealing strong domestic collaboration and emerging international partnerships. The study identifies key contributing journals and themes, while revealing that most research remains narrowly focused on HIV/AIDS, leaving gaps in understanding gay wellbeing from broader societal and cultural perspectives. Surprisingly, very few studies specifically examine or measure overall wellbeing, whether using quantitative or qualitative approaches, and there is limited exploration of how cultural factors influence the experiences of gay men in China. These findings underscore the need for more holistic research approaches that move beyond public health and HIV prevention to address the psychological, social, and cultural dimensions of wellbeing.

Prevalence and influencing factors of occupational burnout among healthcare workers in the Chinese mainland during the late 2022 Omicron COVID-19 outbreak: a multicenter cross-sectional study

China witnessed an Omicron COVID-19 outbreak at the end of 2022. During this period, medical crowding and enormous pressure on the healthcare systems occurred, which might result in the occurrence of occupational burnout among healthcare workers (HCWs). This study aims to investigate the prevalence of occupational burnout and associated mental conditions, such as depressive symptoms, anxiety, PTSD symptoms, perceived social support, resilience, and mindfulness among HCWs of the Chinese mainland during the Omicron COVID-19 outbreak, and to explore the potential risk and protective factors influencing occupational burnout of HCWs. A multicenter cross-sectional study was conducted among HCWs working in the Chinese mainland from January 5 to February 9, 2023. A total of 6552 participants were recruited by convenience sampling. Data were collected on demographic characteristics, occupational burnout, depressive symptoms, anxiety, PTSD, perceived social support, resilience, and mindfulness by online questionnaires. Descriptive analyses were performed to describe the participants' demographic characteristics. Univariate-Multivariate analyses were used to determine the influencing factors of occupational burnout. The results showed that the prevalence of occupational burnout and associated mental disorders, such as depressive symptoms, anxiety, and PTSD in HCWs were 44.56%, and 70.75%, 47.87%, and 37.49%, respectively. Older age, female gender, higher income, more doses of COVID-19 vaccine, a higher level of mindfulness, resilience, and perceived social support were protective factors of occupational burnout. Working as nurses, in a department currently taking charge of the treatment of COVID-19 patients, perceived high risk of contracting COVID-19 due to work, perceived high work intensity, and a higher level of anxiety and depressive symptoms were risk factors of occupational burnout. Tailored interventions on perceived social support, resilience, and mindfulness should be implemented to alleviate occupational burnout and associated mental disorders among HCWs.

Community-based psychosocial support interventions to reduce stigma and improve mental health of people with infectious diseases: a scoping review

BACKGROUND

Stigma experienced by people with infectious diseases impedes access to care, leading to adverse psychosocial consequences. Community-based interventions could prevent or mitigate these consequences but lack robust evidence. This scoping review aimed to identify and critically appraise community-based psychosocial support interventions to reduce stigma and improve mental health for people affected by stigmatizing infectious diseases including tuberculosis (TB), HIV/AIDS, and leprosy.

METHODS

This was a scoping review of literature indexed in PubMed, Web of Science, Elton B. Stephens Company (EBSCO) database, as well as reports in the World Health Organization repository, published from January 2000 to June 2023. We included research articles and reports addressing stigma and mental health disorders among individuals with TB, HIV/AIDS, or leprosy and/or their household members in low- and middle-income and/or high TB burden countries. We extracted information regarding types of psychosocial interventions and their reported impact on health and psychosocial indicators.

RESULTS

Thirty studies were included in this review: 21 (70%) related to HIV/AIDS, seven (23%) leprosy, and two (7%) TB. Of these, eleven were quantitative studies, nine qualitative, and ten mixed-methods. Eleven community-based interventions were reported to reduce infectious disease-related stigma, predominantly internalized and enacted stigma, and improve adherence to medication, quality of life, health-related knowledge, depression symptoms, and psychosocial wellbeing. Most studies involved lay people in the community as supporters of those affected. The predominant reported mechanism of intervention effect was the ability of supporters to enable those affected to feel seen and listened to, to accept their diagnosis, to improve their self-esteem, and to facilitate continuation of their daily lives, and thereby reducing anticipated stigma, self-stigma, and mental illness. Adequate training for lay people was reported to be essential to ensure success of interventions.

CONCLUSIONS

This review identified a paucity of high-quality evidence relating to community-based interventions to reduce stigma for infectious diseases. However, such interventions have been reported to reduce stigma and improve mental health among people with HIV/AIDS, leprosy, and TB. Engaging affected communities and peers, through the conception, planning, training, implementation, and evaluation phases, was reported to be essential to optimise intervention uptake, impact, and sustainability.

Understanding psychological symptoms among Chinese college students during the COVID-19 Omicron pandemic: Findings from a national cross-sectional survey in 2023

During the Omicron pandemic in late 2022, this study surveyed Chinese students via an online questionnaire to assess their mental health status, prevalence of psychological symptoms, and associated factors. A nationwide cross-sectional survey of 4254 participants was conducted in seven regions of China from January 5 to February 9, 2023. Scales were utilized respectively to measure depressive symptoms, anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms, and perceived social support. Descriptive, univariate, and multivariable analyses were performed to identify associated factors. Protective factors against depressive symptoms include regular exercise and robust social support networks, while risk factors involve excessive alcohol consumption, comorbidities, Omicron infection, and irregular sleep patterns. Risk factors for anxiety symptoms include comorbidities, Omicron infection, living alone, and irregular sleep patterns, while social support emerges as a protective factor. For PTSD symptoms, regular exercise and strong social support systems are identified as protective measures, with risks associated with comorbidities, Omicron infection, and poor sleep quality. Students are particularly vulnerable during the pandemic due to their lifestyle and academic pressures. It's essential to bolster their social support and promote healthier habits.

Depressive symptoms and its multifaceted associated factors among young men who have sex with men facing the dual threats of COVID-19 and mpox in China

INTRODUCTION

The COVID-19 pandemic has significantly impacted the mental health of human beings since 2020, especially the young people and the pre-existing marginalized groups such as men who have sex with men (MSM). During the COVID-19 pandemic, the multi-country outbreak of mpox in 2022 additionally posed a significant stress on the most-affected communities (i.e., MSM). This study investigated the level of depressive symptoms and its multifaceted associated factors among Chinese young men who have sex with men (YMSM) in this unique period.

METHODS

In September 2022, a large-scale cross-sectional survey was conducted among YMSM aged 18-29 years across six representative provinces in China. Hierarchical regression analysis was performed to test the various types of associated factors of depressive symptoms.

RESULTS

Among the 2493 participants, 65.6 % (n = 1638) reported mild to severe depressive symptoms. The hierarchical regression analysis identified that depressive symptoms was significantly positively associated with unemployment, having substance use in the past 6 months, a higher level of MSM self-stigma, incompletion of COVID-19 vaccination, greater mpox risk perception, and presence of mpox related-like symptoms.

LIMITATIONS

This study used the facility-based sampling method to recruit the participants, which may lead to selection bias.

CONCLUSIONS

Chinese YMSM faced significant mental health challenges during the concurrent epidemics of COVID-19 and mpox, which was associated with their socio-economic status, risk behaviors, stigma, and multiple diseases-related variables. Proactive measures may hold promise as effective strategies for mitigating mental distress among marginalized groups during public health crises.

A hybrid type II effectiveness-implementation trial of a positive emotion regulation intervention among people living with HIV engaged in Ryan White Medical Case Management: protocol and design for the ORCHID study

BACKGROUND

The Ryan White Medical Case Management System, which serves more than half of people living with HIV (PLWH) in the USA, is an opportune setting for identifying and addressing depression among PLWH. A growing body of research suggests that interventions that promote positive emotion may lessen symptoms of depression and improve physical and psychological well-being among people experiencing a variety of health-related stress, including living with HIV. Research on how best to integrate standardized mental health screening and referral to evidence-based interventions in Ryan White Medical Case Management settings has the potential to improve the health and wellbeing of PLWH.

METHODS

This mixed-methods study will enroll up to N = 300 Ryan White clients who screen positive for depressive symptoms in ORCHID (Optimizing Resilience and Coping with HIV through Internet Delivery), a web-based, self-guided positive emotion regulation intervention. The study will be conducted in 16 Ryan White Medical Case Management clinics in Chicago, IL. Following pre-implementation surveys and interviews with Medical Case Managers (MCMs) and Supervisors to develop an implementation facilitation strategy, we will conduct a hybrid type 2 implementation-effectiveness stepped wedge cluster randomized trial to iteratively improve the screening and referral process via interviews with MCMs in each wedge. We will test the effectiveness of ORCHID on depression and HIV care outcomes for PLWH enrolled in the program. RE-AIM is the implementation outcomes framework and the Consolidated Framework for Implementation Research is the implementation determinants framework.

DISCUSSION

Study findings have the potential to improve mental health and substance use screening of Ryan White clients, decrease depression and improve HIV care outcomes, and inform the implementation of other evidence-based interventions in the Ryan White Medical Case Management System.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05123144. Trial registered 6/24/2021.

The link between anticipated and internalized stigma and depression: A systematic review

Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.

Patterns of sex behaviors and factors associated with condomless anal intercourse during the COVID-19 pandemic among men who have sex with men in Hong Kong: A cross-sectional study

OBJECTIVES

The present study examined the patterns of sex behaviors before and during COVID-19, and identified the factors associated with condomless anal intercourse during COVID-19 from individual, interpersonal, and contextual level among men who have sex with men (MSM) in Hong Kong.

METHODS

A cross-sectional study was conducted among MSM in Hong Kong. A total of 463 MSM completed a cross-sectional telephone survey between March 2021 and January 2022.

RESULTS

Among all participants, the mean number of regular sex partners, non-regular sex partners, and casual sex partners during the COVID-19 period were 1.24, 2.09, and 0.08 respectively. Among those who had sex with regular, non-regular, and casual sex partner during the COVID-19 period, respectively 52.4%, 31.8% and 46.7% reported condomless anal intercourse. Compared to the pre-COVID-19 period, participants reported significantly fewer number of regular and non-regular sex partners during the COVID-19 period. However, a higher level of condomless anal intercourse with all types of sex partners during the COVID-19 period was also observed. Adjusted for significant socio-demographic variables, results from logistic regression analyses revealed that perceived severity of COVID-19 (aOR = 0.72, 95% CI = 0.58, 0.88), COVID-19 risk reduction behaviors in general (aOR = 0.68, 95% CI = 0.48, 0.96), COVID-19 risk reduction behaviors during sex encounters (aOR = 0.45, 95% CI = 0.30, 0.66), condom negotiation (aOR = 0.61, 95% CI = 0.44, 0.86), and collective efficacy (aOR = 0.79, 95% CI = 0.64, 0.98) were protective factors of condomless anal intercourse with any type of sex partners during the COVID-19 period.

CONCLUSION

The COVID-19 control measures have caused a dramatic impact on the sexual behavior of MSM in Hong Kong. Interventions that promote condom use during the COVID-19 pandemic are still needed and such interventions could emphasize prevention of both COVID-19 and HIV.

"Shame on Me": Exploring the Role of Self-Stigma in Psychological Outcomes Among Type 2 Diabetes Patients in Hong Kong

BACKGROUND

Studies have suggested that type 2 diabetes mellitus (T2DM) are at risk of self-stigmatization (i.e., internalized sense of shame about having diabetes). Self-stigma has been found to be associated with poorer psychological outcomes among chronic disease patients; relevant studies examining such an association and its psychosocial mechanisms are scarce among Chinese T2DM patients. This study aimed to examine the association between self-stigma and psychological outcomes among T2DM patients in Hong Kong. Self-stigma was hypothesized to be associated with higher psychological distress and lower quality of life (QoL). Such associations were also hypothesized to be mediated by lower perceived social support, lower self-care self-efficacy, plus higher self-perceived burden to significant others.

METHODS

T2DM patients (N = 206) recruited from hospitals and clinics in Hong Kong were invited to complete a cross-sectional survey measuring the aforementioned variables.

RESULTS

After controlling for covariates, multiple mediation analysis results indicated the indirect effects from self-stigma to psychological distress via increased self-perceived burden (β = 0.07; 95% CI = 0.02, 0.15) and decreased self-care self-efficacy (β = 0.05; 95% CI = 0.01, 0.11) were significant. Moreover, the indirect effect from self-stigma to QoL via decreased self-care self-efficacy was also significant (β = -0.07; 95% CI = -0.14, -0.02). After considering the mediators, the direct effects from self-stigma to higher psychological distress and lower QoL remained significant (βs = 0.15 and -0.15 respectively, ps < .05).

CONCLUSIONS

Self-stigma could be linked to poorer psychological outcomes through increased self-perceived burden and decreased self-care self-efficacy among T2DM patients. Targeting those variables when designing interventions might facilitate those patients' psychological adjustments.

Characteristics and influencing factors of anticipated HIV stigma among HIV-negative/unknown MSM in China: A regression mixture model

BACKGROUND

Anticipated HIV stigma among men who have sex with men's (MSM) has a severe negative effect on their physical and mental health wellbeing and hence requires specific attention. The current study aims to identify the characteristics and the psychosocial influencing factors of anticipated HIV stigma in MSM using regression mixture model (RMM) and to determine the cut-off point of the seven-item Anticipated HIV Stigma Questionnaire (AHSQ) using the receiver operating characteristic (ROC) analysis.

METHODS

A cross-sectional study was conducted among HIV-negative/unknown MSM from Blued online platform in China from December 16th, 2020 to March 1st, 2021, enrolling 1394 participants. Data were collected on demographic characteristics, perceived social support, anticipated HIV stigma, depressive symptoms, and HIV knowledge. Latent profile analysis was performed to identify different profiles of anticipated HIV stigma level. Chi-square test, analysis of variance, and RMM analysis were conducted to explore the influencing factors in different profiles. ROC analyses were carried out to identify the cut-off value of anticipated stigma.

RESULTS

Among the participants, three profiles of anticipated stigma were identified: "low anticipated HIV stigma" (12.0%), "moderate anticipated HIV stigma" (52.1%), and "severe anticipated HIV stigma" (35.9%). RMM analysis showed that higher income and higher levels of knowledge were positively associated with moderate anticipated HIV stigma, whereas full-time job and social support were negatively associated with moderate anticipated HIV stigma; higher income, depressive symptoms, and knowledge were positively associated with severe anticipated HIV stigma, whereas minor ethnicity and social support were negatively associated with severe anticipated HIV stigma. ROC curve of the AHSQ showed that the optimal cut-off value of ≥16 could indicate positive anticipated HIV stigma.

CONCLUSION

The study focuses on the level of anticipated HIV stigma and its psycho-socio influencing factors among HIV-negative/unknown MSM. It provides evidence for implementing relevant psychological interventions to HIV-negative/unknown MSM.

Prevalence and influencing factors of PTSD symptoms among healthcare workers: A multicenter cross-sectional study during the surge period of the COVID-19 pandemic since December 2022 in the Chinese mainland

BACKGROUND

China has experienced a surge period of COVID-19 pandemic since December 2022. Healthcare workers (HCWs) were exposed to huge workload under high risk of being infected, and significant levels of trauma, which might cause Post-traumatic Stress Disorders (PTSD) symptoms in HCWs.

OBJECTIVES

To identify the prevalence of PTSD symptoms among HCWs in the Chinese mainland during the surge period of the COVID-19 pandemic; to explore their psycho-social factors of PTSD symptoms.

METHODS

A multicenter cross-sectional study was conducted among HCWs in Chinese mainland from January 5 to February 9, 2023, covering seven geographical regions. 6552 participants were recruited by convenience sampling. Data were collected on demographic characteristics, work-related factors, and psychological factors by online questionnaires. Univariate analysis and binary logistic regression were used to determine the influencing factors of PTSD symptoms.

RESULTS

The prevalence of PTSD symptoms among HCWs was 37.49 %. A higher level of mindfulness, resilience, and perceived social support were protective factors. Female gender, nurses, higher educational attainment, married status, more working years, higher perceived risk of contracting COVID-19 due to work, and higher perceived work intensity were risk factors.

CONCLUSION

High prevalence of PTSD symptoms among HCWs necessitates psychological interventions. Tailored interventions, designed by professional psychiatrists, should be tailored to address the stressors. A comprehensive approach, incorporating mindfulness, resilience-building, and perceived social support enhancement, is vital to bolster the mental well-being of HCWs exposed to traumatic events, thus mitigating the impact of PTSD effectively. Additionally, it is essential to provide support to HCWs with other potential risk factors.

The association between stigma and wellbeing in an Italian cohort of PLWH: The role of social support and personal factors

Our aim was to assess the association between different types of stigma and physical, behavioural and emotional wellbeing, and to evaluate whether these associations were mediated by the level of social support, age, education, sex and time from HIV diagnosis in an Italian cohort of people living with HIV (PLWH). We enrolled 96 PLWH and had them complete a cross-sectional online survey that included the "HSS-12", the "SF-12" and the "DASS-21". We performed linear regression analyses to explore the associations between the HSS-12 scores and cART adherence, viral load, SF-12 and DASS-21 scores, and a mediation analysis to identify mediators in the significant associations. We showed that higher level of depression and worse perception of mental health were significantly associated with higher HSS-12 "personalised stigma" (p = .009, p = .020) "disclosure concerns" (p = .012, p = .039), "concerns about public attitudes" (p =.007, p = .005) and "negative self-image" scores; (p < .001, p = .001); worse perception of physical health status was associated with higher HSS-12 "personalised stigma" scores (p = .018); higher level of anxiety and stress were associated with higher "negative self-image" scores (0.001 and p < .001). The association between higher HSS-12 "negative self-image" and higher levels of depression, anxiety and stress were mediated by lower age (a*b = +0.10; a*b = +0.12; a*b = +0.11). This study may have important implications for clinical practice as it contributes to understanding the characteristics and consequences of HIV-related stigma in a population of PLWH with excellent viroimmunological status and therapeutic adherence.

Factors contributing to emotional distress when caring for children with imperforate anus: a multisite cross-sectional study in China

Background

Imperforate anus (IA) has a life-long impact on patients and their families. The caregivers of children with IA (CoCIA) might experience distress, which could be detrimental to them physically and mentally. However, there are limitations in the related studies. This study aimed to investigate the prevalence of IA and the associated factors contributing to the distress experienced by CoCIA.

Methods

A cross-sectional study was conducted in three tertiary children's hospitals from November 2018 to February 2019. Distress was assessed using the Chinese version of the Kessler Psychological Distress Scale, and possible determinants were assessed by the Caregiver Reaction Assessment, the Parent Stigma Scale, the Parent Perception of Uncertainty Scale, and the Social Support Scale. Demographic and clinical information was also collected. Multiple regression analysis was performed to explore the association between variables.

Results

Out of 229 CoCIA, 52.9% reported experiencing a high level of distress or above. The data analysis revealed that health problems associated with caregiving, stigma, uncertainty, social support, and children who underwent anal reconstruction surgery 1 year before or earlier could significantly predicate caregivers' distress, and these factors could explain 50.1% of the variance.

Conclusions

The majority of the caregivers of children with IA experience high levels of distress, particularly when their children undergo anal reconstruction surgery 1 year before or earlier. Additionally, health problems related to caregiving, stigma, uncertainty, and low social support could significantly predicate caregivers' distress. It is important for clinical staff to be aware of the prevalent situation of caregivers' distress and to make targeted interventions focused on addressing modifiable factors that should be carried out in family-based care.

The effectiveness of e-health on reducing stigma, improving social support and quality of life among people living with HIV: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Many people living with HIV reported poor quality of life, which was primarily due to HIV-related stigma and the lack of social support. Compared with face-to-face interventions, e-health interventions are reported to have potential to help people living with HIV improve their adherence to antiretroviral therapy, promote their management of HIV and depressive symptoms. However, in the literature, the effectiveness of e-health interventions in helping people living with HIV reduce stigma, improve social support and quality of life is unclear.

OBJECTIVE

To examine the effectiveness of e-health interventions in reducing stigma and improving social support and quality of life among people living with HIV.

DESIGN

This study is a systematic review and meta-analysis of randomized controlled trials following the Cochrane Handbook guidelines and PRISMA2020.

METHODS

A comprehensive search was conducted from inception to 1st December 2022 in six databases: PubMed, CINAHL Plus with Full Text, PsycINFO (Ovid), Embase, Web of Science, and CENTRAL (Ovid), and an updated search took place on 11st June 2023. Two authors independently screened the studies and extracted the data. Cochrane's bias risk tool for randomized controlled trials was used to examine the methodological quality of the included studies. The intervention effect was estimated by calculating the standardized mean difference (SMD) and 95 % confidence interval (CI) using Review Manager 5.3. A sensitivity analysis was conducted to test the rigor of the pooled results using one-study-out method. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Nine studies met eligibility criteria and were included in this review. The results of the meta-analysis showed that e-health interventions could statistically significantly reduce stigma (SMD: -0.29, 95 % CI: [-0.48, -0.10], p = 0.002) and improve quality of life (SMD = 0.49, 95 % CI: [0.30, 0.68], P < 0.001), but had no significant effects on social support (SMD = -0.01, 95 % CI: [-0.48, 0.46] P = 0.96).

CONCLUSIONS

E-health interventions could reduce stigma and improve quality of life among people living with HIV. More studies are needed to further explore if e-health interventions can improve the social support for people living with HIV and investigate how to integrate e-health interventions into the existing health models to help people living with HIV treat and manage HIV/AIDS.

REGISTRATION

The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42022373299).

Prevalence and influencing factors of depressive and anxiety symptoms among hospital-based healthcare workers during the surge period of the COVID-19 pandemic in the Chinese mainland: a multicenter cross-sectional study

BACKGROUND

From November 2022 to February 2023, the Chinese mainland experienced a surge in COVID-19 infection and hospitalization, and the hospital-based healthcare workers (HCWs) might suffer serious psychological crisis during this period. This study aims to assess the depressive and anxiety symptoms among HCWs during the surge of COVID-19 pandemic and to provide possible reference on protecting mental health of HCWs in future infectious disease outbreaks.

METHODS

A multicenter cross-sectional study was carried out among hospital-based HCWs in the Chinese mainland from 5 January to 9 February 2023. The PHQ-9 (nine-item Patient Health Questionnaire) and GAD-7 (seven-item Generalized Anxiety Disorder Questionnaire) were used to measure depressive and anxiety symptoms. Ordinal logistic regression analysis was performed to identify influencing factors.

RESULTS

A total of 6522 hospital-based HCWs in the Chinse mainland were included in this survey. The prevalence of depressive symptoms among the HCWs was 70.75%, and anxiety symptoms was 47.87%. The HCWs who perceived higher risk of COVID-19 infection and those who had higher work intensity were more likely to experience depressive and anxiety symptoms. Additionally, higher levels of mindfulness, resilience and perceived social support were negatively associated with depressive and anxiety symptoms.

CONCLUSION

This study revealed that a high proportion of HCWs in the Chinese mainland suffered from mental health disturbances during the surge of the COVID-19 pandemic. Resilience, mindfulness and perceived social support are important protective factors of HCWs' mental health. Tailored interventions, such as mindfulness practice, should be implemented to alleviate psychological symptoms of HCWs during the COVID-19 pandemic or other similar events in the future.

The relationship between social support and depression among HIV-positive men who have sex with men in China: the chain mediating role of psychological flexibility and hope

Introduction

HIV and mental health problems are a global syndemic. One key issue is that the significant mental health problems among people vulnerable to acquiring or living with HIV have not been fully addressed. Access to social support has been one of the biggest challenges for HIV-positive men who have sex with men (HIV+ MSM). Lower social support has been linked to more severe depression symptoms. However, the mechanisms underlying the association between social support and depression in HIV+ MSM are unclear. Two possible mediators include hope and psychological flexibility. This study aimed to examine the relationship between social support and depression in HIV+ MSM and to explore the single mediating effects of hope and psychological flexibility and the chain mediating effect of these two variables on this relationship.

Methods

A convenience sample was used to recruit participants from the designated HIV/AIDS hospital in Changsha city, Hunan Province of China. A total of 290 HIV+ MSM completed questionnaires.

Results

Our findings showed that hope mediated the relationship between social support and depression in HIV+ MSM. Furthermore, the chain mediation model confirmed a direct negative association between social support and depression, but this relationship was largely mediated by the chain effects of hope and psychological flexibility.

Conclusions

Integrating hope and psychological flexibility into interventions may provide better mental health support for HIV+ MSM and improve their wellbeing and quality of life.

Investigation into the psychological impact of the COVID-19 pandemic for people living with HIV

BACKGROUND

People living with HIV (PLWH) report high levels of anxiety. This study assessed the prevalence of COVID-19-related anxiety in PLWH.

METHODS

Participants were recruited from two UK HIV clinics (01/03/2020 - 30/05/2022) and asked to complete the Coronavirus Anxiety Scale. The proportion with scores ≥9 (cut-off for dysfunctional pandemic-related anxiety) and ≥1 (reporting of any pandemic-related anxiety) were analysed.

RESULTS

115 PLWH were included, predominantly identifying as male (83.5%, n = 96), white (58.3%, n = 67) and reporting post-secondary education (82.6%, n = 95), with a median age of 51 years (range 22-93). Median CAS score was 0, with 4.4% scoring ≥9 (n = 5). More women scored ≥9 than men (16.7% (n = 3) and 2.1% (n = 2) respectively). Black African (13.6%, n = 3) and Other Ethnic Minority PLWH (25%, n = 2) had a greater proportion of scores ≥9 than White/Asian PLWH (both 0%). SARS-CoV-2 exposure was associated with scores greater than 1 but not greater than 9. CAS score was not associated with lower CD4 (<350 cells/mm3), detectable HIV viral load (≥50 copies/ml), or a history of pre-pandemic anxiety.

CONCLUSIONS

Pandemic-related anxiety was low, but we identified a sub-population reporting dysfunctional pandemic related anxiety. Future work should further investigate the psychological impact of the pandemic on this group.

Prevalence and risk for symptoms of PTSD among survivors of a COVID-19 infection

COVID-19 pandemic has profound psychological effects worldwide and the psychological sequelae will persist for a long time among COVID-19 survivors. This cross-sectional study aimed to explore the prevalence of PTSD and its associated risk factors in COVID-19 survivors of the first wave pandemic. Demographics questionnaire, the Impact of Events Scale-Revised, the Pittsburgh Sleep Quality Index, the Fatigue Scale-14, the Resilience Style Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. The propensity score-matching (PSM) method was employed to adjust covariate or confounding variables in order to derive more accurate conclusions. After PSM, adjusted odds ratios and 95% confidence intervals were determined by binary conditional logistic regression. A total of 1541 COVID-19 survivors were included firstly and 15.2% reported PTSD symptoms, 1108 participants left after PSM. Four risk factors were identified: higher severity of COVID-19 infection, fatigue, COVID-19 related stigma and poor sleep quality. When designing psychological interventions to alleviate PTSD symptoms of COVID-19 survivors, reducing stigma and fatigue, and improve their sleep quality are suggested.

The mediating role of social support between HIV stigma and sexual orientation-based medical mistrust among newly HIV-diagnosed gay, bisexual, and other men who have sex with men

HIV-related stigma and medical mistrust are significant challenges to addressing HIV inequities among gay, bisexual, and other men who have sex with men (MSM). HIV-related stigma is associated with high levels of medical mistrust, but there is limited knowledge regarding the mechanisms that link these variables. We examined the potential mediating roles of social support and coping in the relationship between perceived HIV stigma and sexual orientation based-medical mistrust among newly HIV-diagnosed MSM. We hypothesized that HIV-related stigma would be associated with mistrust and that social support, and coping would mediate this relationship. Data were obtained from 202 newly HIV-diagnosed (<1 year) MSM receiving care at community HIV clinics in New York. A path model indicated that HIV stigma was directly related to greater sexual orientation based medical mistrust, and that this relationship was mediated by social support. However, coping did not mediate the relationship between HIV stigma and mistrust. Efforts to increase social support and decrease stigma are critical for strengthening relationships between MSM and HIV care networks. Future research should assess the feasibility of designing and implementing interventions focused on increasing social network support and improving trust in the medical community among newly HIV-diagnosed MSM.

Factors associated with improvements in symptoms of anxiety and depression among gay, bisexual and other men who have sex with men (gbMSM) in Vancouver, Canada: A prospective cohort study

BACKGROUND

Depression and anxiety are commonly experienced among gay, bisexual and other men-who-have-sex-with-men (gbMSM). We explored factors associated with improvements in mental health symptoms among gbMSM with abnormal depression and anxiety scores over a period of four years, in Vancouver, Canada.

METHODS

Sexually active gbMSM ≥16 years of age were recruited using respondent-driven sampling from February 2012 to February 2015. Participants completed a computer-assisted questionnaire which included the Hospital Anxiety and Depression Scale (HADS), and psychometric scales to measure loneliness, self-esteem and social connectedness, every 6 months until July 2019. Generalized linear mixed models were used to assess factors associated with normal/borderline HADS scores (<11) following a previous abnormal score (≥11) for each of anxiety and depression subscales.

RESULTS

We recruited 694 participants, of whom 580 had at least one follow-up visit. Across all visits, 43.6 % of participants ever had abnormal anxiety scores and 16.2 % ever had abnormal depression scores. Among those with abnormal anxiety scores, 34.9 % of follow-up visits demonstrated reductions in anxiety scores. Among those with abnormal depression scores 51.0 % of follow-up visits demonstrated reductions in depression scores. Reductions in anxiety scores were associated with increased self-esteem, decreased loneliness and the number of gbMSM seen/spoken to in the previous month. Reductions in depression scores were associated with increased self-esteem, decreased loneliness and having a regular partner.

CONCLUSION

Improvements in mental health symptoms were frequently observed. Social connectedness was related with improved anxiety and depression symptoms. Interventions to improve social connectedness may help to improve mental health for gbMSM.

Social Support, Internalized HIV Stigma, Resilience and Depression Among People Living with HIV: A Moderated Mediation Analysis

Internalized HIV stigma has been associated with depression among people living with HIV (PLWH). However, it is still unclear whether resilience would mediate the association between internalized HIV stigma and depression and how this indirect effect would be moderated by social support. Data were collected from 402 PLWH in South Carolina using a cross-sectional survey. Data were fitted using a path model that specified the extent to which internalized HIV stigma and depression were related through resilience and how this effect was moderated by social support. Sociodemographic characteristics were included in the model as covariates. The indirect effect of internalized HIV stigma on depression through resilience was statistically significant for high social support but not for low social support. To mitigate negative impacts of internalized HIV stigma on mental health of PLWH, intervention efforts should integrate multilevel components for promoting both resilience and social support.

Individual-, Interpersonal- and Institutional-Level Factors Associated with HIV Stigma Among Youth in Kenya

HIV stigma remains a barrier in achieving optimal HIV treatment. We studied the prevalence and predictors of HIV stigma among adolescents and youth with HIV (AYWHIV) ages 15-24 years in Western Kenya. Of 1011 AYWHIV, 69% were female with a median age of 18 years. Most (59%) attended adolescent clinic days, and 40% attended support groups. One-quarter (27%) had experienced physical, 18% emotional, and 7% sexual violence. The majority of AYWHIV (88%) reported disclosure concerns, 48% reported perceived community stigma, 36% experienced, and 24% internalized stigma. Compared to AYWHIV attending adolescent clinics, those in general/adult clinics had higher internalized stigma. Similarly, having dropped out of school was associated with higher internalized stigma. AYWHIV in sexual relationships had higher experienced stigma and disclosure concerns. Lastly, exposure to violence was associated with higher experienced, internalized, perceived community stigma and disclosure concerns. These risk factors can be targeted when developing stigma-prevention interventions.

Perceived stigma among discharged patients of COVID-19 in Wuhan, China: A latent profile analysis

Background

Perceived stigma has greatly influenced the life quality of the COVID-19 patients who recovered and were discharged (RD hereafter). It is essential to understand COVID-19 stigma of RD and its related risk factors. The current study aims to identify the characteristics of perceived COVID-19 stigma in RD using latent profile analysis (LPA), to explore its psycho-social influencing factors, and to determine the cut-off point of the stigma scale using receiver operating characteristic (ROC) analysis.

Methods

A cross-sectional study was conducted among COVID-19 RD in 13 communities in Jianghan District, Wuhan City, Hubei Province, China from June 10 to July 25, 2021, enrolling total 1,297 participants. Data were collected on demographic characteristics, COVID-19 perceived stigma, post-traumatic stress disorder (PTSD), anxiety, depression, sleep disorder, fatigue, resilience, social support, and peace of mind. LPA was performed to identify different profiles of perceived COVID-19 stigma level. Univariate analysis and multinominal logistic regression analysis were conducted to explore the influencing factors in different profiles. ROC analyses was carried out to identify the cut-off value of perceived stigma.

Results

Among the participants, three profiles of perceived stigma were identified: "low perceived COVID-19 stigma" (12.8%), "moderate perceived COVID-19 stigma" (51.1%), and "severe perceived COVID-19 stigma" (36.1%). Multinominal logistic regression analysis revealed that older age, living with other people, anxiety, and sleep disorder were positively associated with moderate perceived COVID-19 stigma, while higher educational level was negatively associated with moderate perceived COVID-19 stigma. Female, older age, living with other people, anxiety, and sleep disorder were positively associated with severe perceived COVID-19 stigma, while higher educational level, social support, and peace of mind were negatively associated with severe perceived COVID-19 stigma. ROC curve of the Short Version of COVID-19 Stigma Scale (CSS-S) for screening perceived COVID-19 stigma showed that the optimal cut-off value was ≥ 20.

Conclusion

The study focuses on the issue of perceived COVID-19 stigma and its psycho-socio influencing factors. It provides evidence for implementing relevant psychological interventions to COVID-19 RD.

The relationship between HIV-related stigma and HIV self-management among men who have sex with men: The chain mediating role of social support and self-efficacy

HIV infection becomes a manageable disease, and self-management is one of the key indicators of achieving optimal health outcomes. Men who have sex with men (MSM) living with HIV face many psychosocial challenges when managing HIV infection, such as sexual minority pressure and HIV-related stigma. Higher perceived HIV-related stigma had been related to low self-management. However, the mechanisms underlying the association between HIV-related stigma and HIV self-management are unclear. Two possible mediators include social support and self-efficacy. This study aimed to examine the relationship between HIV-related stigma and HIV self-management among MSM living with HIV and to explore the single mediating effect of social support and self-efficacy and the chain mediating effect of these two variables on this relationship in China. Convenience sampling was used to recruit participants from the Center for Disease Control (CDC) in Changsha City, Hunan province, China. A total of 459 MSM living with HIV completed questionnaires regarding sociodemographic and disease-related information, HIV-related stigma, social support, self-efficacy, and HIV self-management. Descriptive statistics analysis, one-way ANOVA, independent t-tests, Pearson's bivariate correlation, and multiple regression were conducted using the SPSS v24.0. Process macro in SPSS was used to analyze the single and chain mediating effect among variables. Our findings showed that the indirect and total effect of HIV-related stigma on HIV self-management was significant, while the direct effect was not statistically significant. Social support and self-efficacy mediated the relationship between HIV-related stigma and HIV self-management, respectively. Moreover, the chain mediating model confirmed that the association between HIV-related stigma and HIV self-management was mediated by social support and self-efficacy sequentially. Future interventions focusing on improving HIV self-management among MSM living with HIV should consider a multi-faced approach.

Influencing factors of anxiety and depression of discharged COVID-19 patients in Wuhan, China

Objectives

This study is intended to assess the prevalence of depression and anxiety in individuals who had recovered from COVID-19 and been discharged from hospital (RD hereafter) in Wuhan, China, and to explore the factors associated with these mental disorders.

Methods

Participants of this study were the RD who were infected at the beginning of the outbreak from 13 communities in Jianghan District of Wuhan City, Hubei Province, China by convenience sampling in mid-2021. The Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, the Resilience Style Questionnaire, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis, and logistic regression analysis were used to describe and analyze the data and to examine the factors associated with the mental health status of this population.

Results

In total, we recruited 1601 participants from 3059 COVID-19 patients, and 1541 participants completed the questionnaire survey, with a response rate of 96.25%. Finally, 1297 participants met the inclusion and exclusion criteria in this study, of whom 28.8% and 37.9% reported mild to severe levels of anxiety and depression symptoms. Perceived better mental health status during hospitalization, higher frequency of alcohol use per week, peace of mind, higher education level, and resilience were negatively associated with anxiety, while stigma and history of psychological or emotional counseling before infection was positively associated with anxiety. More severe clinical classification of COVID-19 and stigma (AOR = 1.057, P<0.001) were both positively associated with depression, while perceived better mental health status during hospitalization (AOR = 0.564, P<0.001), higher frequency of alcohol use per week (AOR = 0.462, P = 0.004), peace of mind (AOR = 0.857, P<0.001), and social support (AOR = 0.972, P = 0.034) were negatively associated with depression.

Conclusions

Tailored interventions on reducing stigma, enhancing mindfulness and social support should be taken into account to alleviate anxiety and depression among RD.

Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study

BACKGROUND

Parents play central roles in adolescents' socialization, behavioral development, and health, including the development of internet gaming disorder (IGD). However, longitudinal research on the parental predictors of adolescent IGD is limited.

OBJECTIVE

This study aimed to investigate the reciprocal associations between various parental factors and adolescent IGD using 2-wave cross-lagged models.

METHODS

A sample of 1200 year-one high school students in central China completed a baseline assessment in 2018 (mean age 15.6 years; 633/1200, 52.8% male) and a follow-up survey in 2019. IGD was measured using the 9-item DSM-5 IGD Symptoms checklist. Perceptions related to parental variables, including psychological control, parental abuse, parental support, and the parent-child relationship, were also collected from the adolescents.

RESULTS

Of all the participants, 12.4% (148/1200) and 11.7% (140/1200) were classified as having IGD at baseline (T1) and follow-up (T2), respectively. All 4 cross-lagged models fit the data well (range for the comparative fit index .91-.95; range for the standardized root mean square residual .05-.06). Parental support (β=-.06, P=.02) and parental abuse (β=.08, P=.002) at T1 predicted IGD symptoms at T2, while parental psychological control (β=.03, P=.25) and a positive relationship with parents (β=-.05, P=.07) at T1 had nonsignificant effects on IGD symptoms at T2, when controlling for background variables. In addition, IGD symptoms at T1 did not predict parental factors at T2.

CONCLUSIONS

The findings suggest that parental factors may be significant predictors of adolescent IGD. Health interventions should consider involving parents to increase the effectiveness of treatment to prevent and reduce adolescent IGD.

Affective Profiles and Psychosocial Adjustment among Chinese Adolescents and Adults with Adverse Childhood Experiences: A Person-Centered Approach

PURPOSE

Two studies were conducted to explore the patterns of positive affect (PA) and negative affect (NA) while considering collectivist cultural specificity (dialecticism) and to examine the associations of affective profiles with psychosocial adjustment.

METHODS

We used two Chinese samples, one comprising adults with adverse childhood experiences (N = 488) and one comprising ordinary adolescents (N = 635). The participants completed scales on PA, NA, and psychosocial adjustment, including mental health problems (depressive symptoms, anxiety), personal strengths (self-esteem, gratitude, resilience), and life satisfaction.

RESULTS

Three profiles were identified through latent profile analysis: well-adjusted (high PA, low NA), low affective (low PA, low NA), and moderate affective (moderate PA, moderate NA). Participants in the well-adjusted profile had the fewest mental health problems (depressive symptoms, anxiety) and scored highest on personal strengths (self-esteem, gratitude, resilience) and life satisfaction. Participants in the low affective profile had fewer mental health problems than those in the moderate affective profile.

CONCLUSION

Individual differences and cultural variations should be considered when exploring affective profiles. Future interventions aimed at promoting affective well-being should accommodate dialecticism and individual differences in the target population.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-022-00566-7.

Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White-Funded Clinics in Chicago

BACKGROUND

To reduce the impact of depression on people living with HIV, we are implementing a clinic-based behavioral health screener and referral to Optimizing Resilience and Coping with HIV through Internet Delivery, an evidenced-based intervention. We used the Consolidated Framework for Implementation Research to identify contextual barriers and facilitators in advance of implementation.

SETTING

Sixteen Chicagoland area Ryan White Medical Case Management sites.

METHODS

We conducted a sequential mixed-methods study with medical case managers and supervisors. Participants completed an online survey assessing Consolidated Framework for Implementation Research domains, scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Survey results informed a purposive sampling frame and interview protocol. Interviews were analyzed by rapid qualitative analysis.

RESULTS

On average, survey respondents (n = 58) slightly agreed with positive views of team culture, learning climate, and implementation readiness (mean = 3.80-3.87). Potential barriers included intervention complexity (mean = 3.47), needed human resources (mean = 2.71-3.33), and only slight agreement with relative advantage over existing screening/referral systems (mean = 3.09-3.71). Qualitative results (n = 15) identified low advantage for clinics with robust behavioral health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation.

CONCLUSIONS

Ryan White Medical Case Management sites are a generally favorable context for the implementation of the interventions. As illustrated in an implementation research logic model, barriers will be addressed through deploying strategies proposed to impact clinic- and individual-level outcomes, including electronic prompts (reduce complexity), training on Optimizing Resilience and Coping with HIV through Internet Delivery as a complement to other behavioral health services (increase relative advantage), and feedback during implementation (strengthen rewards/incentives).

Changes in Mental Health Among People with HIV During the COVID-19 Pandemic: Qualitative and Quantitative Perspectives

People with HIV (PWH) are at risk for adverse mental health outcomes, which could be elevated during the COVID-19 pandemic. This study describes reasons for changes in mental health among PWH during the pandemic. Data come from closed- and open-ended questions about mental health changes from a follow-up to a cohort study on PWH in Florida during part of the COVID-19 pandemic (May 2020-March 2021). Qualitative data were analyzed using thematic analysis. Among the total sample of 227 PWH (mean age 50.0, 49.7% men, 69.2% Black/African American, 14.1% Hispanic/Latino), 30.4% reported worsened mental health, 8.4% reported improved mental health, and 61.2% reported no change. The primary reasons for worsened mental health were concerns about COVID-19, social isolation, and anxiety/stress; reasons for improved mental health included increased focus on individual wellness. Nearly one-third of the sample experienced worsened mental health. These results provide support for increased mental health assessments in HIV treatment settings.

HIV testing and related factors among 50 years and older MSM in China: results from a cross-sectional study

ABSTRACTHIV prevalence has increased continuously, and the age groups most afflicted by the epidemic have also shifted to people aged above 50 years. Informed by the theory of HBM, we aimed to investigate related factors associated with regular HIV testing behavior. Cross-sectional data were collected using online questionnaire from geosocial networking (GSN) mobile application (apps) for MSM during May 2020 (N = 1259). Data were analyzed by univariate and multivariate logistic regression. Around 62.0% (n = 781) had received HIV testing before. Participants being divorced/widowed (AOR = 1.5,95%CI:1.1-2.0), being aware of HIV/AIDS-related knowledge (AOR = 1.8,95%CI:1.4-2.3), having disclosed sexual orientation (AOR = 1.9,95%CI:1.5-2.5), ever had sexually transmitted infections symptoms (STIs)before (AOR = 2.4,95%CI:1.8-3.2), having had≥2 sexual partners (AOR = 1.8,95%CI:1.4-2.3) and with high self-efficacy (AOR = 1.1,95%CI:1.0-1.1) were more likely to receive HIV testing. Findings suggest that many Chinses MSM aged 50 and above have not been tested for HIV. Interventions for promoting HIV testing should focus on expanding scales of HIV/STIs screening, providing HIV/AIDS-related knowledge, creating a more supportive social environment and improving self-efficacy of HIV testing.

Effects of Psychological Distress and Coping Resources on Internet Gaming Disorder: Comparison between Chinese and Japanese University Students

The high prevalence of Internet gaming disorder (IGD) among Asian youth indicates an urgent need to identify protective factors and examine their consistency across Asian cultures in order to facilitate cost-effective interventions. Based on the transactional theory of stress and coping, this study collected data of 1243 online gamers (45% males; 18-25 years) through an anonymous survey from universities in China and Japan and investigated whether three coping resources (i.e., mindfulness, coping flexibility, and social support) serve to protect Chinese and Japanese youth from the impact of psychological distress on IGD tendency. After adjusting for the measurement non-invariance across samples, we found that Japanese students reported higher levels of IGD tendency and psychological distress than Chinese students. The results of multiple-group SEM analyses showed that, after controlling for other predictors, mindfulness served as the strongest protective factor against IGD across samples. Moreover, the buffering effect of mindfulness on the association between psychological distress and IGD tendency of female (but not male) students was observed. Our findings highlighted the cross-cultural invariance of the impact of psychological distress and coping resources on IGD in Chinese and Japanese youth, which can be considered in future IGD prevention programs.

Symptoms of internet gaming disorder among male college students in Nanchong, China

BACKGROUND

This study aimed to evaluate the presence of symptoms of Internet Gaming Disorder (IGD) and examined associations between IGD and depressive symptoms, family and peer support among male college students in Nanchong, China.

METHODS

A cross-sectional study was conducted among 2533 male students in three colleges. Background characteristics, depressive symptoms, family and peer support and IGD information were collected. Binary logistic regression was performed to access the relationship between variables and IGD. PROCESS macro was used to examine the mediation analysis of family and peer support on the relationship between depressive symptoms and IGD.

RESULTS

The estimated presence of symptoms of IGD was 11.6%. The most commonly endorsed items were escapism, continuation and preoccupation both among total participates and the IGD group. In the binary logistic regression, general expenditure per month, depressive symptoms, and family and peer support revealed their significance in associations with IGD. Adjusted for the significant background variable, depressive symptoms and family and peer support remained significance. Additionally, family and peer support would attenuate the relationship between depressive symptoms and IGD.

CONCLUSIONS

This study found that one in ten male college students reported clinically significant IGD symptoms, which indicate that IGD is an important public health problem in Nanchong, China.

Association between relationship adaptation and Internet gaming disorder among first-year secondary school students in China: Mediation effects via social support and loneliness

Adolescents encounter numerous challenges and need to restructure their social relationships when they enter secondary schools. Relationship adaptation is critical and failure in adaptation may be associated with Internet gaming disorder (IGD). This novel study investigated the association between relationship adaptation and IGD and related mediation mechanisms via social support and loneliness among first-year secondary school students in Shanghai and Xi'an, China in 2018. Of 2573 participants, the prevalence of IGD was 13.1%. Relationship adaptation, social support, and loneliness were all significantly associated with IGD. The association between relationship adaptation and IGD was fully mediated by three indirect paths, including relationship adaptation → social support → IGD (effect size = 35.5%), relationship adaptation → loneliness → IGD (effect size = 34.3%), and relationship adaptation → social support → loneliness → IGD (effect size = 6.1%). In conclusion, the observed high prevalence of IGD among first-year secondary school students in China was associated with poor relationship adaptation. The full mediation effects via social support and loneliness suggest that modification of these two psychosocial attributes may effectively reduce the harmful impacts of poor relationship adaptation on adolescent IGD. Future longitudinal studies are warranted to confirm the findings.

Association of Health Insurance and Documentation with Stigma and Social Support Among Myanmar Migrants with Tuberculosis Before and During Thailand's Policy on Border Closure Due to COVID-19: a Cross-Sectional Study

OBJECTIVE

The objective of this study was to assess the effect of health insurance and documentation status on tuberculosis (TB)-related stigma and social support before and during Thailand's policy on border closure.

METHODS

A cross-sectional study was conducted in two TB clinics in Mae Sot district, a border area of Thailand. Myanmar migrants with new TB were interviewed before (between September 2019 and March 2020) and during Thailand's policy (between April 2020 and January 2021). We used multiple linear regression models to assess the association of health insurance and documentation status with stigma and social support before and during the policy on border closure.

RESULTS

Of 229 migrants diagnosed new TB recruited, 117 and 112 were interviewed before and during Thailand's policy on border closure. The relationship of stigma with health insurance and documentation status was modified by the policy. Migrants with health insurance reported significantly lower stigma during the policy compared to those without health insurance, whereas documented migrants had lower stigma before the policy compared to undocumented migrants. No significant association of health insurance and documentation status with social support was observed. Ethnicity, perceived TB severity and education level were also independently associated with TB-related stigma.

CONCLUSION

The relationships between health insurance, documentation status and TB-related stigma were modified by Thailand's policy on border closure among Myanmar migrants with TB in a border area of Myanmar and Thailand. Promotion of health insurance and well-planned documentation for migrants should be more discussed and strengthened among stakeholders and policymakers.

Methodologies of Stigma-Related Research Amongst Men Who Have Sex With Men (MSM) and Transgender People in Asia and the Pacific Low/Middle Income Countries (LMICs): A Scoping Review

Much stigma-related research focuses on marginalized populations, including men who have sex with men (MSM) and transgender people. The importance of research in this area is widely recognized, however methodologies and measures vary between studies. This scoping review will collate existing information about how stigma-related research has been conducted in low/middle income countries (LMICs) within the Asia Pacific region, and will compare research designs, sampling frameworks, and measures. Strengths and limitations of these studies will inform recommendations for future stigma-related health research. A methodological framework for scoping studies was applied. Searches of Psych INFO, Scopus, ProQuest, Global Health and PubMed were used to identify articles. Stigma-related research amongst MSM and transgender communities, published between 2010 and 2019 in LMICs within the Asia Pacific region were included. A total of 129 articles based on 123 different studies were included. Of the 129 articles 51.19% (n = 66) were quantitative; 44.96% (n = 57) were qualitative and 3.88% (n = 5) were mixed methods studies. The majority of studies (n = 57; 86.36%) implemented a cross sectional survey. In-depth interviews (n = 20, 34.48%) were also common. Only 3.88% of studies utilized mixed-methods design. Non-probabilistic and probabilistic sampling methods were employed in 99.22 and 0.78% of studies respectively. The most common measures used in quantitative studies were the Center for Epidemiological Study on Depression (CES-D) (n = 18) and the Self Stigma Scale (SSS) (n = 6). Strengths and limitations proposed by researchers included in this review are summarized as lesson learnt and best practices in stigma-related research.

"Only My Husband and My Doctor Know. And You, Girls": Online Discussions of Stigma Coping Strategies for Russian Surrogate Mothers

(1) Background: Gestational surrogacy is the most common type of surrogacy today. Although technologically well-developed and legal in many countries, it challenges and even contradicts the basic traditional concepts of family, motherhood, and gender roles. In the present study, we examined the types of stigma coping strategies surrogate mothers discussed in an online support group in post-Soviet Russia. (2) Method: We conducted a qualitative thematic analysis of 15,602 posts on a Russian-language online support group for surrogate mothers. (3) Findings: group members discussed four types of coping strategies: stigma internalization, stigma avoidance, group identification, and stigma challenging. Nevertheless, these strategies varied across the surrogate motherhood stages. Group members advised each other on specific strategies to use to cope with the state of discreditable (invisible) stigma (i.e., during the first few months of their pregnancies), with different strategies for when the pregnancies became visible and they risked becoming discredited people. Furthermore, group members disclosed that they used these strategies even when they returned to their previous family and work routines. Theoretically, our findings challenge Goffman's classic theoretical dichotomy and coping research concerning discreditable (invisible) and discredited (visible) stigma. (4) Conclusion: Our findings indicate that surrogate mothers anticipate experiencing stigma and therefore plan for it by discussing potential coping strategies in the online group. Moreover, any intervention designed to cater to the needs of surrogate mothers must, therefore, take into consideration the social needs of their entire family.

Associations between antiretroviral therapy-related experiences and mental health status among people living with HIV in China: a prospective observational cohort study

BACKGROUND

Mental health problems (e.g., depression and anxiety) are among the most commonly reported comorbidities of HIV. Antiretroviral therapy (ART) coverage has increased sharply. The purposes of this prospective cohort study were to investigate the ART-related experiences and whether they were associated with mental health problems among a sample of people living with HIV undergoing ART in China.

METHODS

The participants were 400 people living with HIV who had started ART for the first time in Guangzhou city. They were followed-up 1-year after ART initiation. Probable depression and moderate/severe anxiety were measured at baseline and Month 12, while experiences related to ART (e.g., side effects and regained self-confidence) were measured at Month 6. Univariate and multivariate logistic regressions were used to explore the associations between baseline characteristics, ART-related experiences and mental health status.

RESULTS

Among the 300 participants (75.0%) who completed all three surveys, a significant decline in prevalence of probable depression (23.0% at baseline vs. 14.0% at Month 12, P = 0.002) and moderate/severe anxiety (14.7% at baseline vs. 8.7% at Month 12, P = 0.023) was observed during the follow-up period. After adjustment for mental health status and potential confounders at baseline, a number of ART-related experiences at Month 6 were associated with probable depression and/or moderate/severe anxiety measured at Month 12. Improved physical health, relationships with sexual partners, and self-confidence were associated with decreased mental health issues, while the side effects of ART, AIDS-related symptoms, and inconvenience in daily life due to ART use were associated with increased mental health issues.

CONCLUSIONS

ART-related experiences were associated with mental health problems, tailored mental health promotion interventions targeting these experiences are needed.

The Holistic Health Status of Chinese Homosexual and Bisexual Adults: A Scoping Review

Background: Same-sex marriage is currently not legalized in China, despite the considerably large number of homosexual and bisexual Chinese populations. At the same time, their holistic health status remains unclear. This is the first scoping review conducted to comprehensively examine all the available literature and map existing evidence on the holistic health of homosexual and bisexual Chinese. Methods: This scoping review used the framework of Arksey and O'Malley and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). A comprehensive search strategy was carried out across 20 English (EN) and Chinese (both traditional and simplified) electronic databases from January 1, 2001, to May 31, 2020. Two reviewers conducted the reference screening and study selection independently and consulted a third senior reviewer whenever a consensus must be achieved. Data extraction was conducted using a structured data form based on the Cochrane template, after which a narrative synthesis of the findings was performed. Results: A total of 2,879 references were included in the final analysis, with 2,478 research articles, 167 reviews, and 234 theses. Regarding the study populations, the vast majority of studies centered on men only (96.46%), especially men who have sex with men (MSM). Only 1.32% of the studies targeted female sexual minorities. The geographical distribution of all research sites was uneven, with most of them being conducted in mainland China (95.96%), followed by Hong Kong (2.05%), Taiwan (2.02%), and Macau (0.06%). Regarding the specific study focus in terms of the health domain, around half of the studies (45.93%) focused on sexual health only, and an additional quarter of the studies (24.15%) investigated both sexual health and social well-being. Meanwhile, the studies focusing on mental health only accounted for approximately 15% of the total. Conclusions: This scoping review revealed that previous research focused more on male than female sexual minorities, on disease-centered surveys than person-centered interventions, and investigations on negative health conditions than positive health promotion. Therefore, investigations centered on the female sexual minorities and corresponding person-centered interventions are highly needed. Review Registration: The protocol of this review has been registered within Open Science Framework (https://osf.io/82r7z) on April 27, 2020.

Development and validation of the conservation of resources scale for COVID-19 in the Chinese adult general population

Globally, the coronavirus disease 2019 (COVID-19) pandemic has caused severe and multi-dimensional resource losses among individuals. The Conservation of Resource (COR) theory postulates that resource loss generates related stress responses. It can suitably be applied to understand the pandemic's encompassing adverse consequences. Yet, no assessment tool exists. This study hence developed and validated the COR Scale for COVID-19 (CORS-COVID-19) to facilitate relevant research. The five hypothesized domains included losses in financial resource, family resource, future control, fun, and social resource. A population-based random telephone survey interviewed 300 Chinese adults in the general population in Hong Kong, China during April 3-10, 2020. The levels of different types of resource losses were high (especially for loss in fun). The 5-factor structure identified by factor analysis matches with the five hypothesized dimensions. Its psychometric properties are acceptable, including good internal consistency, content validity (the correlations between the items and their respective subscales were stronger than that between the items and the other four subscales), concurrent validity (significant correlations between the scale/subscale scores and both emotional distress due to COVID-19 and satisfaction with living in Hong Kong), and convergent validity (significant correlations between specific subscales and corresponding external variables). Relatively high floor effects were detected in some subscales. The scale, which is the first of the types to assess resource losses during a pandemic, can provide theory-based understandings/assessment about the negative impacts of COVID-19. It also facilitates warranted comparisons across countries and time periods in future studies.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-01933-y.

Mindfulness-based online intervention on mental health and quality of life among COVID-19 patients in China: an intervention design

BACKGROUND

COVID-19 can lead to increased psychological symptoms such as post-traumatic stress disorder (PTSD), depression, and anxiety among patients with COVID-19. Based on the previous mindfulness-based interventions proved to be effective, this protocol reports a design of a randomized controlled trial aiming to explore the efficacy and possible mechanism of a mindful living with challenge (MLWC) intervention developed for COVID-19 survivors in alleviating their psychological problems caused by both the disease and the pandemic.

METHODS

In April 2021, more than 1600 eligible participants from Hubei Province of China will be assigned 1:1 to an online MLWC intervention group or a waitlist control group. All participants will be asked to complete online questionnaires at baseline, post-program, and 3-month follow-up. The differences of mental health status (e.g. PTSD) and physical symptoms including fatigue and sleeplessness between the COVID-19 survivors who receiving the online MLWC intervention and the control group will be assessed. In addition, the possible mediators and moderators of the link between the MLWC intervention and target outcomes will be evaluated by related verified scales, such as the Five Facets Mindfulness Questionnaire. Data will be analyzed based on an intention-to-treat approach, and SPSS software will be used to perform statistical analysis.

DISCUSSION

The efficacy and potential mechanism of MLWC intervention in improving the quality of life and psychological status of COVID-19 survivors in China are expected to be reported. Findings from this study will shed light on a novel and feasible model in improving the psychological well-being of people during such public health emergencies. Trial registration Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000037524; Registered on August 29, 2020, http://www.chictr.org.cn/showproj.aspx?proj=60034 .

Effect of stress and avoidant coping on depression and the moderating role of age among men who have sex with men: Findings from a 6-month prospective cohort study

BACKGROUND

Men who have sex with men (MSM) are at increased risk of mental health problems. Few studies have examined the risk factors for mental health problems of Chinese MSM and identified potential moderators using a longitudinal design.

OBJECTIVES

The present study examined the effect of stress and avoidant coping on depression among MSM, and the moderating role of age on such relationship.

METHODOLOGY

A 6-month observational prospective cohort study was conducted among Chinese MSM. Respectively 592 and 402 MSM completed a survey at baseline and 6-month follow-up.

RESULTS

The prevalence of probable depression was 36.1% at baseline and 34.1% at 6-month follow-up. After adjusting for background characteristics and baseline depression score, both stress (β = .22, p<.05) and avoidant coping (β = .14, p<.05) showed significant positive relationship with depression at 6-month follow-up. The interaction effect of age and stress / avoidant coping was also significant. The effect of stress on depression was stronger among younger MSM, and the effect of avoidant coping on depression was significant among younger MSM but non-significant among older MSM.

CONCLUSIONS

Mental health promotion for MSM should reduce stress and avoidant coping, and specific intervention should be designed for younger MSM.

Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study

BACKGROUND

Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented.

OBJECTIVE

We aimed to identify factors that are associated with pregnant women's intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China.

METHODS

A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis.

RESULTS

More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19-related lockdowns in participants' cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants' intentions to seek help from mental health services.

CONCLUSIONS

Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers.