Clustering of lifestyle factors and the relationship with depressive symptoms among adolescents in Northeastern China

Mediating effect of menopausal symptoms between the lifestyle and depressive symptoms

PURPOSE

This study aimed to explore relationship between lifestyle and depressive symptoms and evaluated the mediating effect of menopausal symptoms.

METHODS

This was a secondary analysis of a survey in Hunan Province, China. We selected 3190 women aged 40 to 55 into final analyses. Menopausal and depressive symptoms were assessed by the Kupperman Menopausal Index and the 9-item Patient Health Questionnaire, respectively. A self-administered questionnaire was used to collect demographic and lifestyle information.

RESULTS

The prevalence of depressive symptoms was 19.5%. After adjusting for demographic variables, passive smoking, drinking, and intensity of physical activity were positively associated with depressive symptoms. Frequency of exercise was a protective factor for depressive symptoms (AOR = 0.783, 95%CI: 0.446-0.991). Excess or restricted sleep duration was associated with higher probability of having depressive symptoms (AOR = 1.746, 95% CI: 1.324-2.304). Menopausal symptoms partially mediated the relationship between lifestyle and depressive symptoms.

CONCLUSION

Findings highlighted the importance of menopausal symptoms in the relationship between the lifestyle and depressive symptoms, and provided a possibility that active lifestyle might improve depression symptoms among women at perimenopause through changes in sex hormones.

Examining the influence of mental health and structural determinants of health on the stage of motivational readiness for health behaviour changes: A path analysis study

This study explores the influence of mental health and structural determinants of health on motivational readiness for health behaviour change in 1462 Spanish primary healthcare users. Chi-square test and structural equation modelling were performed. Results showed that depression and anxiety were negatively associated with being in the action stages of motivational readiness for a healthy diet and physical activity. This association was statistically significant only for motivational readiness for a healthy diet and depression (β = - 0 . 076 ; p = 0 . 046 ). Furthermore, women and workers were more likely to be in the action stages of motivational readiness for a healthy diet while older adults and adults with higher health-related quality of life were more likely to be in the action stages of motivational readiness for physical activity. The present study suggests that structural (being older, being a woman and being employed) and intermediary (suffering from depression and higher health-related quality of life) determinants of health influence motivational readiness for health behaviour changes.

Health enhancing behaviors in early adolescence: an investigation of nutrition, sleep, physical activity, mindfulness and social connectedness and their association with psychological distress and wellbeing

Introduction

Nutrition, sleep and physical activity are termed the "big three" health enhancing behaviors (HEB) associated with psychological distress and wellbeing. This study sought to understand differential associations between an expanded group of HEB (nutrition, sleep, physical activity, mindfulness, social connectedness) and psychological distress/wellbeing in early adolescents.

Methods

Correlational and regression analyses were conducted in N=103 (51% females) adolescents (12.6 ± 0.3 years of age) recruited from the Longitudinal Adolescent Brain Study.

Results

Higher scores on sleep, social connectedness and mindfulness scales were significantly associated with lower psychological distress scores. While higher scores on social connectedness and mindfulness scales were significantly associated with higher wellbeing scores. When adjusting for sex, nutrition, sleep, social connectedness and mindfulness accounted for a significant proportion of variance in the psychological distress model whereas physical activity and social connectedness accounted for a significant proportion of the variance in the wellbeing model.

Discussions

Overall findings make a strong case for expansion of the "big three" HEB to include mindfulness and social connectedness, especially given social connectedness emerged as the strongest predictor of both psychological distress and wellbeing. In addition, this research suggests that early adolescent nutrition, sleep quality, and mindfulness should be prioritized in efforts to reduce risk of difficulties, and physical activity prioritized as a protective factor for wellbeing in this population. Findings have implications for interventions, emphasizing the importance of addressing HEB factors comprehensively and tailoring strategies to the unique needs of early adolescents to foster positive mental health outcomes.

The Connection between Sleep Patterns and Mental Health: Insights from Rural Chinese Students

BACKGROUND

The association between sleep patterns and young students' mental health, which is crucial for their development, remains understudied in rural China. Therefore, the relationship between sleep patterns and mental health among primary and junior high school students in rural China was examined.

METHOD

A total of 1592 primary and junior high school students from rural areas of Gansu Province were surveyed, and the Depression Anxiety and Stress Scale (DASS) was utilized to assess mental health, alongside self-reported data on their daily sleep patterns.

RESULTS

Significant sleep inadequacies were identified: 28% of students received less than 8 h of sleep on weekdays, and 19% went to bed later than recommended. On weekends, 38% of students had delayed bedtimes, though only 7.2% received less than 8 h of sleep. Notably, a "U-shaped" relationship was uncovered between sleep duration and mental health for students on weekends, with optimal mental health correlated with receiving 10-11 h of sleep, while both shorter and longer sleep durations on weekends worsened outcomes. This pattern is absent on weekdays. Additionally, adequate sleep and an earlier bedtime was linked to a 6-8% decrease in mental health risks.

CONCLUSIONS

These findings provide valuable insights for policymakers seeking to enhance student mental well-being in rural settings, emphasizing the importance of implementing measures that promote balanced sleep habits among young students.

Patterns of unhealthy lifestyle and their associations with depressive and anxiety symptoms among Chinese young adults: A latent class analysis

BACKGROUND

There is little evidence on the association between patterns of unhealthy lifestyle and mental health among young adults.

METHOD

This study included a total of 28,978 young adults aged 18 to 44 years old in Guangdong province in south China, which was conducted from September to December in 2022. We used latent class analysis to classify the patterns of unhealthy lifestyle among young adults and used multiple logistic regression to explore their associations with depressive and anxiety symptoms.

RESULT

The weighted prevalence of depressive and anxiety symptoms were 28.0 % and 19.5 %, respectively. The cumulative effect of unhealthy lifestyles on depressive and anxiety symptoms was significant. Five patterns of unhealthy lifestyle were classified. Compared to the relatively healthy lifestyle class, the class with more unhealthy lifestyles (OR = 6.54, 95 % CI: 5.70-7.51) and insufficient sleep (OR = 6.16, 95 % CI: 4.92-7.70) had higher risk for depressive and anxiety symptoms. Meaningfully, having adequate mental health literacy could reduce the risk of depressive and anxiety symptoms from unhealthy lifestyle by half.

LIMITATIONS

The cross-section design study limited causal inferences, and the self-report information may lead to recall bias.

CONCLUSIONS

Unhealthy lifestyles have a negative impact on depressive and anxiety symptoms through independent, cumulative and combined effects, and they could be interrelated. Unhealthy lifestyle patterns differed in younger population by socio-demographic characteristics and mental health literacy. Health-care professionals and policymakers may provide programs to intervene multiple unhealthy lifestyles and improve mental health literacy by integrating healthy lifestyle education to promote youngers' mental health.

Associations between 24-h movement behaviors and indicators of mental health and well-being across the lifespan: a systematic review

Researchers have adopted a variety of analytical techniques to examine the collective influence of 24-h movement behaviors (i.e., physical activity, sedentary behaviors, sleep) on mental health, but efforts to synthesize this growing body of literature have been limited to studies of children and youth. This systematic review investigated how combinations of 24-h movement behaviors relate to indicators of mental ill-being and well-being across the lifespan. A systematic search of MEDLINE, PsycINFO, Embase, and SPORTDiscus was conducted. Studies were included if they reported all three movement behaviors; an indicator of mental ill-being or well-being; and were published in English after January 2009. Samples of both clinical and non-clinical populations were included. A total of 73 studies (n = 58 cross-sectional; n = 15 longitudinal) met our inclusion criteria, of which 47 investigated children/youth and 26 investigated adults. Seven analytical approaches were used: guideline adherence (total and specific combinations), movement compositions, isotemporal substitution, profile/cluster analyses, the Goldilocks method and rest-activity rhythmicity. More associations were reported for indicators of mental ill-being (n = 127 for children/youth; n = 53 for adults) than well-being (n = 54 for children/youth; n = 26 for adults). Across the lifespan, favorable benefits were most consistently observed for indicators of mental well-being and ill-being when all three components of the 24-h movement guidelines were met. Movement compositions were more often associated with indicators of mental health for children and youth than adults. Beneficial associations were consistently observed for indicators of mental health when sedentary behavior was replaced with sleep or physical activity. Other analytic approaches indicated that engaging in healthier and more consistent patterns of movement behaviors (emphasizing adequate sleep, maximizing physical activity, minimizing sedentary behaviors) were associated with better mental health. Favorable associations were reported less often in longitudinal studies. Collectively, these findings provide further support for adopting an integrative whole day approach to promote mental well-being and prevent and manage mental ill-being over the status quo of focusing on these behaviors in isolation. This literature, however, is still emerging-for adults in particular-and more longitudinal work is required to make stronger inferences.

Clustering of Multilevel Factors Among Children and Adolescents: Associations With Health-Related Physical Fitness

BACKGROUND

To identify the clustering characteristics of individual-, family-, and school-level factors, and examine their associations with health-related physical fitness.

METHODS

A total of 145,893 Chinese children and adolescents aged 9-18 years participated in this cross-sectional study. The 2-step cluster analysis was conducted to identify clusters among individual-, family-, and school-level factors. Physical fitness indicator was calculated through sex- and age-specific z scores of forced vital capacity, standing long jump, sit-and-reach flexibility, body muscle strength, endurance running, and body mass index.

RESULTS

Three, 3, and 5 clusters were automatically identified at individual, family, and school levels, respectively. Students with low physical fitness indicator were more likely to be in the "longest sedentary time and skipping breakfast" cluster (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.12-1.24), and "physical inactivity and insufficient protein consumption" cluster (OR = 1.07; 95% CI, 1.02-1.12) at individual level, the "single children and high parental education level" cluster (OR = 1.15; 95% CI, 1.10-1.21), and "no physical activity support and preference" cluster (OR = 1.30; 95% CI, 1.25-1.36) at family level, and the "physical education occupied" cluster (OR = 1.06; 95% CI, 1.01-1.11), and "insufficient physical education frequency" cluster (OR = 1.16; 95% CI, 1.08-1.24) at school level. Girls were more vulnerable to individual- and school-level clusters, while boys were more susceptible to family clusters; the younger students were more sensitive to school clusters, and the older students were more susceptible to family clusters (P-interaction < .05).

CONCLUSIONS

This study confirmed different clusters at multilevel factors and proved their associations with health-related physical fitness, thus providing new perspective for developing targeted interventions.

Association between duration of electronic screen use for non-educational purposes and depression symptoms among middle and high school students: a cross-sectional study in Zhejiang Province, China

Background

Existing literature on the association of electronic screen use duration with depression among adolescents is contradictory. The current study aimed to elucidate the association between duration of electronic screen use for non-educational purposes and depression symptoms among middle and high school students in Zhejiang Province, China.

Methods

A cross-sectional study of 27,070 students in grades 7-12 from 376 middle and high schools was conducted through an anonymous self-administered questionnaire between April and June 2022. Poisson regression was utilized to examine the association between electronic screen use duration for non-educational purposes and depression symptoms.

Results

Of the 27,006 eligible students, 51.6% (13932) were boys and the mean (SD) age was 15.6(1.7) years. The overall prevalence of symptoms of depression was 22.4% (95%CI 21.4-23.4); girls (27.6%, 26.2-29.0) had a higher prevalence than boys (17.7%, 16.7-18.8). After adjustment for socio-demographic status, lifestyle factors, self-perceived health, academic performance, loneliness and sadness, compared to those who did not use electronic screens for non-educational purposes, the prevalence ratios (PRs) for depression symptoms were 1.03 (95% CI 1.02-1.04) for those exposed to electronic screens for <1 h/day, 1.07 (1.05-1.09) for 1.0-1.9 h/day, 1.10 (1.07-1.13) for 2.0-2.9 h/day, 1.14 (1.10-1.18) for 3.0-3.9 h/day, 1.18 (1.12-1.23) for 4.0-4.9 h/day, and 1.21 (1.15-1.29) for ≥5 h/day.

Conclusion

Duration of electronic screen use for non-educational purposes was positively associated with symptoms of depression among middle and high school students, even with a relatively short daily duration of use.

The associations between screen time and mental health in adolescents: a systematic review

BACKGROUND

Adolescents have extensive use of screens and, they have common complains related to mental health. Here a systematic review was done to understand the association between screen time and adolescent's mental health.

METHOD

This review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA. An update search was performed in January 2023 with the following keywords: "screen time," "adolescent," and "mental health" on PubMed, PsycINFO and Scopus databases.

RESULTS

50 articles were included, most have found associations between screen exposure and mental health in adolescents. The most used device by adolescents was the smartphone and the use on weekdays was associated with diminished mental well-being. Social media use was negatively associated with mental well-being and, in girls, associated at higher risk for depression.

CONCLUSION

Excessive screen time in adolescents seems associated with mental health problems. Given the profusion and disparity of the results, additional studies are needed to clarify elements such as the screen content or the interaction of adolescents with different screen devices.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022302817.

Combinations of Physical Activity, Sedentary Behavior, and Sleep Duration and Their Associations With Physical, Psychological, and Educational Outcomes in Children and Adolescents: A Systematic Review

We conducted a systematic review to evaluate combinations of physical activity, sedentary behavior, and sleep duration (defined as "movement behaviors") and their associations with physical, psychological, and educational outcomes in children and adolescents. MEDLINE, CINAHL, PsychInfo, SPORTDiscus, PubMed, EMBASE, and ERIC were searched in June 2020. Included studies needed to 1) quantitatively analyze the association of 2 or more movement behaviors with an outcome, 2) analyze a population between 5 and 17 years of age, and 3) include at least an English abstract. We included 141 studies. Most studies included the combination of physical activity and sedentary behavior in their analyses. Sleep was studied less frequently. In combination, a high level of physical activity and a low level of sedentary behavior were associated with the best physical health, psychological health, and education-related outcomes. Sleep was often included in the combination that was associated with the most favorable outcomes. Sedentary behavior had a stronger influence in adolescents than in children and tended to be associated more negatively with outcomes when it was defined as screen time than when defined as overall time spent being sedentary. More initiatives and guidelines combining all 3 movement behaviors will provide benefit with regard to adiposity, cardiometabolic risk factors, cardiorespiratory fitness, muscular physical fitness, well-being, health-related quality of life, mental health, academic performance, and cognitive/executive function.

Cluster analysis and potential influencing factors of boars with different fertility

The fertility of boars is intimately tied to the pig farm's economic benefits. This study aimed to rapidly categorize boars of different fertility and investigate the factors influencing the categorization using the production data in a large pig farm in northern China, including 11,163 semen collection records of Yorkshire boars (215), 11,163 breeding records and 8770 records of farrowing performance of Yorkshire sows (4505), as well as 4720 records of selection indices (sire line index and dam line index) for boars and sows (215 and 4505) between 2017 and 2020. The boar population was classified by two-step cluster analysis, followed by factor analysis to minimize the dimensionality of data variables and eliminate multicollinearity, and then using ordinal logistic regression model to investigate the risk variables impacting boar fertility categorization. Results showed that the two-step clustering divided the 215 boars into three subgroups: high-fertility (n = 61, 28.4%), medium-fertility (n = 127, 59.1%) and low-fertility (n = 27, 12.6%). The high-fertility boars were shown to be substantially greater than the medium-fertility or low-fertility boars (p < 0.05) in average total litter size, number of born alive, and number of healthy piglets of mated sows. Compared with low-fertility boars, the high-fertility boars were also significantly higher (p < 0.05) in the pregnancy rate and farrowing rate of mated sows. However, the three boar subgroups showed no difference (p > 0.05) in semen quality information (average sperm motility, average sperm density, and average sperm volume). Collinearity diagnosis indicated severe multicollinearity among the 20 data variables, which were reduced to 8 factor variables (factors 1-8) by factor analysis, and further collinearity diagnosis exhibited no multicollinearity among the 8 factor variables. Ordered logistic regression analysis revealed a significant and positive correlation (p < 0.05) of boar fertility with factor 2 (average total litter size, number of born alive, number of healthy piglets), factor 4 (average number of weak piglets and average weak piglet rate), factor 6 (sire line index of boars and dam line index of boars), factor 8 (pregnancy rate and farrowing rate), highlighting factor 2 as the most important factor influencing the classification of boar fertility. Our results indicate that the two-step cluster analysis can be used as a simple and effective method to screen boars with different fertility and that farm producers should pay attention to the recording of the reproductive performance of the mated sows due to its role as the risk factor for classification of boar fertility.

Cluster Analysis of Sleep Time and Adolescent Health Risk Behaviors

Adolescents are prone to multiple health risk behaviors. These might lead to insufficient sleep, which is inconducive to adolescent growth. Therefore, this study explored the impact of a cluster of adolescent health risk behaviors on sleep time, providing a reference for designing relevant intervention measures. From November to December 2019, a stratified cluster sampling method was used to sample middle and high schools in 4 functional districts of Chongqing, China. A total of 8546 participants were selected for a questionnaire survey. Two-step clustering helped identify the health risk behavior clusters. Multivariate logistic regression models helped examine the association between the different clusters and sleep time. The rate of insufficient sleep was 65.8%. Three types of clusters were identified, namely (1) high-risk (poor) cluster (17.3%), (2) low physical activity (medium) cluster (55.1%), and (3) low-risk (good) cluster (27.6%). The high-risk and low physical activity clusters showed that the adjusted OR values of 1.471 (1.266-1.710) and 1.174 (1.052-1.310) were significantly associated with insufficient sleep (P < .001). Adolescent health risk behaviors were clustered, and different clusters had different sleep time. Schools authorities and healthcare practitioners should formulate effective intervention measures according to the characteristics of different clusters to promote healthy growth among adolescents.

A multiple health behaviour change intervention to prevent depression: A randomized controlled trial

OBJECTIVE

To examine the effectiveness of a 12-month MHBC intervention in the prevention of onset depression in primary health care (PHC).

METHODS

Twenty-two PHC centres took part in the cluster-randomized controlled trial. Patients were randomized to receive either usual care or an MHBC intervention. The endpoints were onset of major depression and reduction of depressive symptoms in participants without baseline depression at a 12-month follow-up.

RESULTS

2531 patients agreed and were eligible to participate. At baseline, around 43% were smokers, 82% were non-adherent to the Mediterranean diet and 55% did not perform enough physical activity. The intervention group exhibited a greater positive change in two or more behaviours (OR 1.75 [95%CI: 1.17 to 2.62]; p = 0.006); any behaviour (OR 1.58 [95%CI: 1.13 to 2.20]; p = 0.007); and adherence to the Mediterranean diet (OR 1.94 [95%CI: 1.29 to 2.94]; p = 0.002), while this increase was not statistically significant for smoking and physical activity. The intervention was not effective in preventing major depression (OR 1.17; [95% CI 0.53 to 2.59)]; p = 0.690) or reducing depressive symptoms (Mean difference: 0.30; [95% CI -0.77 to 1.36]; p = 0.726) during follow-up.

CONCLUSIONS

As compared to usual care, the MHBC intervention provided a non-significant reduction in the incidence of major depression.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03136211.

The relationship between unhealthy lifestyle patterns and depressive symptoms among residents in Beijing, China: A community-based cross-sectional study

Introduction

Depression is a prevalent mental disorder that has an irreversible impact on people's health status. Unhealthy lifestyles are modifiable and influence mental health significantly. The purpose of this study was to explore the impact of different unhealthy lifestyles and their patterns on depressive symptoms.

Methods

The data for this study were obtained from the 2017 Community Diagnostic survey in Daxing District, Beijing. It was a cross-sectional study that included 6,252 samples. The Patient Health Questionnaire version 9 was used to measure depressive symptoms, and the self-administered questionaires were used to investigate five unhealthy lifestyles, including sleep deprivation, the inadequate intake of fruits and vegetables, physical inactivity, smoking, and excessive alcohol consumption. Respondents were assigned 1 point for each of their unhealthy lifestyles, and their overall unhealthy lifestyle scores were calculated. The total scores of unhealthy lifestyles ranged from 0 to 5. Descriptive analyses and Firth's logistic regression model were used to analyze the relationship between unhealthy lifestyle and depression symptoms.

Results

It was found that 12.1% of the participants had depressive symptoms. The respondents whose unhealthy lifestyle scores were 2 (OR1.45, 95%CI:1.01 to 2.12), 3 (OR2.29, 95%CI:1.57 to 3.42), 4 (OR 3.04, 95%CI:1.96 to 4.76), or 5 (OR4.08, 95%CI:2.09 to 7.78) were more likely to experience depressive symptoms in comparison with those whose unhealthy lifestyle scores were 0, and the OR increased with the unhealthy lifestyle scores. When the participants had 3 or more unhealthy lifestyles at the same time, different combination patterns of unhealthy lifestyles showed a different effect on depression. The OR was 3.01 (95%CI:1.45 to 5.95) for the combination of sleep deprivation-insufficient intake of fruit and vegetables-excessive alcohol consumption, and was 2.89 (95%CI:1.52 to 5.25) for the combination of sleep deprivation-insufficient intake of fruit and vegetables-physical inactivity-excessive alcohol consumption.

Discussion

The co-existence of multiple unhealthy behavioral lifestyles are associated with depressive symptoms. Among the five unhealthy lifestyles, sleep deprivation and the inadequate intake of fruits and vegetables may have a greater impact on depression.

Gender differences in the association between lifestyle behaviors and mental health among psychiatrists in China

INTRODUCTION

Mental health symptoms are common among health professionals and the influence of lifestyle behaviors on psychiatrists' mental health is insufficiently understood. Based on a nationwide sample, we aimed to survey the lifestyle behaviors and mental health status among psychiatrists, and to identify the co-occurrence and gender differences in lifestyle behaviors.

METHODS

Data were collected through an anonymous questionnaire among psychiatrists in China. Depression, Anxiety and Stress Scale - 21 (DASS-21) was used to evaluate mental health symptoms. Latent class analysis (LCA) was used to explore the co-occurrence of lifestyle behaviors. The multivariate logistic regression model was used to examine the effects of demographic and lifestyle factors.

RESULTS

4520 psychiatrists were included in the analysis with 11.5 % of them reporting smoking, 10 % reporting alcohol misuse, 35.2 % reporting physical inactivity, and 23.1 % reporting insomnia. The prevalence of depression, anxiety and stress symptoms were 29.2 %, 34.5 %, and 12.2 %, respectively. Significant gender differences were found in smoking (P < 0.001), alcohol misuse (P < 0.001), and physical inactivity (P < 0.001), but not in insomnia. Based on these four high-risk health behaviors above, three lifestyle behavior clusters with huge gender differences were identified through the LCA. Accordingly, the unhealthy lifestyle classes, though defined differently for males and females, were significantly associated with depression, anxiety, and stress.

CONCLUSIONS

The co-occurrence and significant gender differences in multiple lifestyle behaviors exist in this group, highlighting the need for gender-specific comprehensive interventions against mental health symptoms and the urgency of promoting their well-being.

Relationship between physical activity, screen-related sedentary behaviors and anxiety among adolescents in less developed areas of China

This study aimed to explore the association between physical activity, screen-related sedentary behaviors, and anxiety. The current study used latent profile analysis (LPA) to identify homogenous subtypes of anxiety among adolescents in less-developed areas of China. Data were aggregated from 6 schools in the less-developed areas of China in September 2018. In total, 900 students were evaluated using the 100-item Mental Health Test (MHT) and Youth Risk Behavior Surveillance System (YRBSS) questionnaire. The LPA was conducted to explore the potential classification of anxiety, which makes full use of all the sample data and explore heterogeneous classifications within groups. Logistic regression was used for the multifactor analysis. A P value <.05 was considered statistically significant. The entropy value suggested that the model with 3 latent profile was the best choice. There were 223 adolescents in the severe anxiety group, accounting for 24.78%. Logistics regression analysis of anxiety revealed that the risk of severe anxiety in boys was lower (odds ratio [OR] = 0.317, P < .001) than in girls. Students had a significantly lower probability of suffering from severe anxiety in using cellphones or computers ≤ 2 hours/day than those used cellphones or computers＞2 hours/day (OR = 0.391, P = .004). Decreasing screen-related sedentary behaviors should be a target of community and school-based interventions, because high screen-related sedentary behaviors were associated with higher odds of anxiety among adolescents in less developed area of China.

Lifestyle Prescription for Depression with a Focus on Nature Exposure and Screen Time: A Narrative Review

Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.

Lifestyle Behaviors and Depressive Symptoms in Chinese Adolescents Using Regression and fsQCA Models

The study was to compare the performance of the regression models and fuzzy set qualitative comparative analysis (fsQCA) models in analyzing the possible effects of sociodemographic variables (age and sex) and lifestyle behaviors (physical activity, sedentary time, sleep duration, physical education class and screen time) on depressive symptoms in adolescents. This cross-sectional surgery was conducted among 726 adolescents in Jilin Province of China, selected by random cluster sampling. The regression model showed that age, physical education (PE) class and sleep duration were associated with depressive symptoms. Meanwhile, the fsQCA models showed that shorter physical activity, PE class and sleep duration as well as longer sedentary and screen time were related to higher levels of depressive symptoms. Both regression and fsQCA models indicated that promoting lifestyle behaviors could affect depressive symptoms. Considering the differences between the two methods, they are not superior to the other method, but complementary and should be used in other studies at the same time.

Prevalence of Sleep Problems Among Chinese Medical Students: A Systematic Review and Meta-Analysis

BACKGROUND

Sleep is a necessary physiological process, which is closely related to cognitive function, emotion, memory, endocrine balance, and immunity. The prevalence of sleep problems continues to rise in Chinese medical students, which has a potential influence on living and work.

OBJECTIVE

This study aimed to observe the prevalence of sleep problems among medical students in China.

METHOD

The included cross-sectional studies on the prevalence of sleep problems of medical students in China were retrieved from PubMed, Embase, the Cochrane Database of Systematic Reviews, CNKI, and Wanfang database. An 11-item checklist recommended by the Agency for Healthcare Research and Quality was adopted to evaluate the methodological quality of the included studies. Software Stata 12.0, SPSS 26.0, and R were used to analyze the data. Registration: PROSPERO, CRD 42021237303.

RESULT

The prevalence of sleep problems among Chinese medical students was 27.38%. The subgroup analysis showed significant differences in the prevalence of sleep problems among different regions, educational backgrounds, grades, and University types. The region, latitude, and gross domestic product (GDP) were significant heterogeneous sources of sleep problems. The prevalence is positively correlated with latitude and negatively correlated with GDP per capita. Regular screening and appropriate intervention are recommended for these mental health problems.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021237303, identifier: CRD42021237303.

The Independent, Joint, and Additive Associations of Physical Activity and Self-Compassion on Depression Symptoms Among Chinese College Students

Background

Physical activity and self-compassion are closely related to individuals' mental health (eg, depression). However, most studies only examined their independent roles in mental health without considering the potential interaction between the two variables. The present study aimed to investigate the independent and joint associations between physical activity (PA) and self-compassion (SC) on depression symptoms and examine the additive interaction between PA and SC.

Methods

A cross-sectional design was utilized in the present descriptive study. By recruiting participants via social media platforms, 1846 Chinese college students completed International Physical Activity Questionnaire Short Form, the Self-Compassion Scale-Short Form, the 9-item Patient Health Questionnaire, and items regarding socio-demographic information. Independent and joint roles of low-level PA (LPA) and low-level SC (LSC) on depression symptoms were examined by logistic regression models. Additive interaction between LPA and LSC on depression symptoms was examined by the following indices: relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S). Socio-demographic variables were included in the models as covariates.

Results

Both LPA (OR = 1.47 [1.16, 1.86]) and LSC (OR = 5.74 [3.89, 8.45]) were independently associated with higher probability of depression symptoms. Combining LPA and LSC led to an additive interaction and greatly increased the odds of depression symptoms (OR = 9.62 [5.38, 17.22]; RERI = 2.47 [0.19, 4.75], AP = 0.25 [0.05, 0.44], S = 1.38 [1.02, 1.87]).

Conclusion

Both LPA and LSC were associated with an increased risk of depression symptoms. Moreover, combining LPA and LSC may develop an additive risk for depression symptoms. Future research and clinical intervention could integrate PA and SC to find a better way to resist depression symptoms.

Changes in Physical Activity and Sedentary Behavior in Chinese Young Adults during the COVID-19 Pandemic: A Repeated-Measure Study throughout One Year

Though we know physical activity (PA) decreased while sedentary behavior (SB) increased compared to that before the COVID-19 pandemic, little is known about subsequent changes in PA and SB throughout one year in the post-pandemic era. This study aimed to examine the changes in PA and SB in a sample of Chinese young adults using a four-wave repeated-measure design during the pandemic. A total of 411 participants provided self-reported data of sociodemographic characteristics (e.g., sex, age), PA, and SB. Nonparametric tests and generalized estimating equations were conducted. Results revealed significant changes in moderate to vigorous PA (MVPA), light PA (LPA), and SB. The MVPA of Wave 1, 2, and 3 was significantly less than that of Wave 4 (p < 0.001); the LPA of Wave 1 and 2 was significantly less than that of Wave 4; the SB of Wave 1 was significantly more than that of Wave 4 (p < 0.05). Being female was the only predictor of changes in MVPA (Beta = −0.311, p< 0.001). Being female (Beta = 0.115, p = 0.003) and perceived family affluence (Beta = −0.059, p< 0.001) were predictors of changes in SB. As such, PA was less, while SB was more during the early stages of the pandemic. With the progress of the pandemic stages, health behaviors in young adults have been gradually improved. Sex and perceived family affluence were two important factors in predicting health behaviors. Our results can inform efficient policies or interventions in the COVID-19 era and future similar public health events.

The Association between Lifestyle Changes and Psychological Distress during COVID-19 Lockdown: The Moderating Role of COVID-Related Stressors

The COVID-19 pandemic and the accompanying circumstances (lockdown and social distancing) have been found to cause lifestyle habit changes. While negative changes (adopting risky behaviors) are known to be associated with high psychological distress, the effect of positive changes (adopting health-enhancing behaviors) has yet to be investigated. This study examined the association between the nature of changes and psychological distress, in addition to the moderating effect of “COVID-related stressors”. Online questionnaires, completed by 1969 participants, assessed the following: lifestyle changes due to COVID-19 with regard to cigarette smoking, alcohol consumption, physical activity, sleep quality, and eating habits; COVID-related stressors; Depression, Anxiety, and Stress Scale. Positive and negative changes were associated with higher psychological distress compared to no lifestyle change, and there was a moderating effect of COVID-related stressors in the association between COVID-related lifestyle changes and distress. In conclusion, to reduce psychological distress in overwhelming circumstances such as the COVID-19 pandemic, people should carefully consider whether to make changes in their lifestyle habits before doing so, even if these changes are perceived as positive and health-enhancing. Furthermore, efforts should be focused on reducing the perception of stress from COVID-19 by working on personal and mental perceptions of the situation.

Prevalence of depression among Chinese medical students: A systematic review and meta-analysis

The prevalence of depression continues to increase among medical students in China, and higher than that of other majors, which is a potential risk for medical students and their patients. This study aimed to observe the prevalence of depression in Chinese medical students and also the correlation between them. All cross-sectional studies on the prevalence of depression in Chinese medical students were retrieved from PubMed, Embase, the Cochrane Database of Systematic Reviews, CNKI, and Wanfang. An 11-item checklist recommended by the Agency for Healthcare Research and Quality was adopted to evaluate the methodological quality of the included studies. Software Stata 12.0 was used to analyze the data. Registration: PROSPERO, CRD42020169681. The prevalence of depression among medical students in China was 27%. The subgroup analysis showed significant differences in the prevalence of depression in different regions. The sleep quality was a significant heterogeneous source of depression. Medical students with sleep disorders were more than three times as likely to report depression. The prevalence of depression in Chinese medical students is relatively high, and medical students with sleep disorders are more likely to have depression problems. Regular screening and appropriate intervention are recommended for these mental health problems.

Prevalence and factors associated with depressive and anxiety symptoms in a Chinese population with and without cardiovascular diseases

BACKGROUND

Few data have reported the prevalence of depressive and anxiety symptoms in patients with cardiovascular disease (CVD) in China. Our study aimed to estimate the prevalence and related risk factors of these mental health symptoms.

METHODS

A total of 47841 participants from seven regions of China were enrolled by a two-stage, stratified, community-based, clustering sampling strategy between 2014 and 2016. Data of sociodemographic status and medical history were collected through a standard questionnaire. The Center for Epidemiologic Studies Depression Scale and Zung's self-rating anxiety scale were used to screen depressive and anxiety symptoms.

RESULTS

Among 47588 individuals who completed the self-report questionnaires, the weighted prevalence of depressive symptom was 2.9% and that of anxiety symptom was 1.5%. In females with heart failure (HF) and stroke, prevalence of either depressive and anxiety symptoms were 15.1% and 13.8%, respectively; while 9.4% and 8.4% for the male counterparts. Among patients with ≥ any 3 specific CVDs, the prevalence of having either depressive or anxiety symptoms were 13.1% and 6.8% for females and males, respectively. Younger age, female, unmarried, lower income, and disease history of atrial fibrillation, HF and stroke tend to link with higher risks of mental health symptoms.

LIMITATIONS

Cross-sectional study.

CONCLUSION

A high proportion of patients with CVD had depressive and anxiety symptoms. Screening for mental health symptoms is more important in higher-risk populations who are at younger age, being female, unmarried, with low income, and with diagnoses of atrial fibrillation, HF, and stroke.

Social support and depressive symptoms among physicians in tertiary hospitals in China: a cross-sectional study

BACKGROUND

Social support is an important factor for individual's mental health. However, the association between social support and depressive symptoms among physicians in China' tertiary hospitals has not been explored. This study aimed to investigate its association among physicians stratifying by sex.

METHODS

Six hundred fifty-six physicians were enrolled from 12 tertiary hospitals of Shandong Province, China. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Social support was evaluated using the Social Support Rating Scale. Multiple linear regression analysis was used to examine the relationship between social support and depressive symptoms among physicians.

RESULTS

The prevalence of depressive symptoms was 42.3% and the average social support score was 38.82 ± 7.53 among physicians. Lower subjective social support scores (male: β = - 0.317, p < 0.001; female: β = - 0.241, p < 0.001) and lower objective social support scores (male: β = - 0.218, p = 0.038; female: β = - 0.277, p = 0.035) were associated with high depressive symptoms among physicians. Lower support utilization scores (β = - 0.472, p < 0.001) were associated with high depressive symptoms among male physicians.

CONCLUSIONS

Chinese physicians had a higher prevalence of depressive symptoms and lower social support than the Chinese general population. Objective and subjective social support were inversely associated with depressive symptoms among male and female physicians while support utilization was inversely associated with depressive symptoms among male rather than female physicians. It is critical to improve physicians' mental health through strengthening social support in China.

Lifestyle habits and depressive symptoms in Norwegian adolescents: a national cross-sectional study

Background

This study’s purpose was to examine the association between a broad range of lifestyle habits and depressive symptoms in Norwegian adolescents.

Methods

This study was based on national, self-reported, cross-sectional data from the Ungdata Surveys, conducted in 2017–2019. The target group comprised 244,250 adolescents (ages 13–19). Binominal logistic regression was used to analyse the association between lifestyle habits (physical activity, social media use, gaming, dietary habits, smoking, smokeless tobacco, alcohol intoxication) and depressive symptoms. The outcome measure was defined as a high level of depressive symptoms (≥80th percentile). Separate analyses were performed for boys and girls, and all models were adjusted for perceived family economy, parental higher education and age.

Results

The odds of having depressive symptoms were significantly lower among those who reported being physically active at least 3 times per week (OR; boys: 0.81, girls: 0.83), used social media ≤3 h per day (OR; boys: 0.65, girls: 0.70), engaged in gaming ≤3 h per day (OR; boys: 0.72, girls: 0.77), were non-smokers (OR; boys: 0.74, girls: 0.72) and had not experienced alcohol intoxication during the previous 12 months (OR; boys: 0.66, girls: 0.67). Furthermore, the results indicated a significant inverse association between depressive symptoms and high consumption of a range of healthy food items and low consumption of unhealthy food and beverages among girls. Similar tendencies were found among boys (OR; 0.77–0.91). Finally, higher adherence to healthy lifestyle habits was associated significantly with lower odds of having depressive symptoms among both genders (OR; boys: 0.40, girls: 0.52).

Conclusions

A healthier lifestyle was associated with lower odds of having depressive symptoms. Additional research is needed to confirm a possible causal relationship.

Moving More and Sitting Less as Healthy Lifestyle Behaviors are Protective Factors for Insomnia, Depression, and Anxiety Among Adolescents During the COVID-19 Pandemic

PURPOSE

This study aimed to investigate associations of physical activity time (PAT) and sitting time (ST) independently and jointly with insomnia, depressive and anxiety symptoms among Chinese adolescents in the context of COVID-19.

METHODS

A cross-sectional study including 965 adolescents (mean age = 15.26, SD = 0.46) was conducted in May 2020. PAT, ST and the symptoms of insomnia, depression and anxiety were assessed with the International Physical Activity Questionnaire Short Form, the Youth Self-Rating Insomnia Scales, the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder scale via an online survey platform. Logistic regression was used to analyze the association between COVID-19-related fear, PAT, ST and combinations of PAT and ST with insomnia, depressive and anxiety symptoms.

RESULTS

COVID-19-related fear was associated with higher odds of insomnia, depressive and anxiety symptoms. PAT was associated with lower odds of insomnia and depressive symptoms, while ST was associated with higher odds of these three symptoms. After combining PAT and ST, the group with both low PAT and high ST was set as the referent. For insomnia, groups with low ST reported significantly lower odds of symptoms. For depression, groups with high PAT and/or low ST reported lower odds of symptoms. Regarding anxiety, only the group with both high PAT and low ST reported lower odds of symptoms. Generally, group with both high PAT and low ST reported lower odds of the three symptoms than the referent.

CONCLUSION

COVID-19-related fear was a risk factor for developing insomnia, depressive and anxiety symptoms among Chinese adolescents. Fortunately, moving more and sitting less were good for sleep and mental health in Chinese adolescents during the pandemic. Educators should help adolescents to be more physically active in their daily life in the primary prevention of adolescent insomnia, depression and anxiety.