The Effect of Social Support on Mental Health in Chinese Adolescents During the Outbreak of COVID-19

Protective and risk factors of anxiety in children and adolescents during COVID-19: A systematic review and three level meta-analysis

BACKGROUND

In order to gain a deepened understanding of the impact of public health emergency and to develop effective interventions and preventions, this study aimed to evaluate risk and protective factors associated with anxiety in children and adolescents and to explore potential moderators in the background of COVID-19 within the framework of socio-ecological model.

METHODS

A literature search was conducted in Web of Science, MEDLINE, PubMed, Scopus, EBSCO, ScienceDirect, Emerald, and CNKI for studies published from early 2020 to early 2023 that examined factors associated with anxiety among children and adolescents with age range of 6 to 17 years old. Random effects models and a three-level meta-analytic approach were used.

RESULTS

In total, 141 articles and 1,018,171 subjects were included, with 1002 effect sizes extracted. 32 protective factors and 48 risk factors were examined, yielding significance for 14 protective factors and 29 risk factors, including individual factors (e.g., gender, logOR = -0.37, 95 % CI [-0.47, -0.27], p < 0.001; age, logOR = -0.12, 95 % CI [-0.22, -0.02], p = 0.02; emotional functioning, logOR = -1.45, 95 % CI [-1.84, -1.05], p < 0.001; pre-existing condition logOR = 0.94, 95 % CI [0.58, 1.30], p < 0.001; electronic device or internet addiction, logOR = 1.81, 95 % CI [0.74, 2.88], p < 0.001), family factors (e.g., family socioeconomic status, logOR = -0.25, 95 % CI [-0.39, -0.10], p < 0.001; family functioning, logOR = -1.31, 95 % CI [-1.60, -1.02], p < 0.001; anxiety level of caregiver, logOR = 1.06, 95 % CI [0.75, 1.37], p < 0.001), community factors (e.g., overall social support, logOR = -0.93, 95 % CI [-1.84, -1.05], p < 0.001; school burden, logOR = 0.56, 95 % CI [0.21, 0.90], p = 0.002), and COVID-19-related factors (e.g., higher exposure risk in local community or city, logOR = 0.48, 95 % CI [0.17, 0.78], p = 0.002; distant learning, logOR = 0.73, 95 % CI [0.19, 1.28], p = 0.008; COVID-19-related distress, logOR = 1.42, 95 % CI [0.55, 2.29], p = 0.001;). The majority of studies showed no publication bias. Age group moderated the relationship between gender and level of anxiety (F (1,96) = 4.42, p = 0.038), and no other moderator showed significance.

LIMITATIONS

This study does not reveal causality but correlation in nature, and our findings should be interpretated with caution.

CONCLUSIONS

Public health emergencies could bring challenges to the mental health of children and adolescents. Prevention and intervention strategies for children and adolescents with high risks, and family-based and community-based programs should be encouraged to buffer the adverse impact on children and adolescents. This study has been prospectively registered at PROSPERO (registration number: CRD42022316746).

The effects of tennis on depressive symptoms and pro-social behaviors in university students: the mediating role of appreciative social support

Aims

This research aimed to explore the impact of tennis on depressive symptoms and pro-social behaviors among college students, while also delving into the intermediary function of social support navigation.

Materials and methods

Utilizing a suite of psychological evaluations and social support instruments, the study compared the levels of depressive symptoms and pro-social behaviors between collegiate tennis athletes and their non-athlete peers.

Results

The findings revealed an inverse relationship between the duration of tennis engagement and the presence of depressive symptoms (β = -0.234, p <0.001), alongside a direct positive association with pro-social tendencies (β = 0.222, p < 0.001). Further scrutiny uncovered a substantial link between the degree to which participants valued social support and their experiences of depressive symptoms (indirect effect = -0.212, 95%CI = -0.036 ~ -0.009) and pro-social behaviors (indirect effect = 0.025, 95%CI = 0.009 ~ 0.044). Notably, the valuation of social support served as a conduit for the beneficial effects of tennis on these outcomes within the collegiate population. Consequently, the evidence from this investigation underscores the salutary influence of tennis on the psychological well-being and social conduct of college students, highlighting the pivotal role of understanding and leveraging social support.

Conclusion

These insights offer valuable direction for fostering mental health and social proficiency in the university setting and advocate for the integration of sports as a viable component in mental health strategies.

Physical activity in adolescents of different family socioeconomic status: the moderating role of gender

Background

To investigate the association between family socioeconomic status (SES) and the physical activity (PA) levels of adolescents, as well as the moderating effect of gender on this relationship.

Methods

A total of 10,327 Chinese adolescents aged 12-17 were recruited to complete questionnaires regarding their SES and PA levels. "Physical Activity Questionnaire for Children and Adolescents Aged 7-18 Years" was utilized to examine the specific items, intensity, duration, and frequency of PA. The Kruskal-Wallis test and the Mann-Whitney U test were employed to compare PA time among adolescents across different groups. To analyze the interaction effect between gender and SES, the Scheirer-Ray-Hare test was conducted using R software. Additionally, SPSSAU was utilized to examine the moderating effect of gender and SES on PA.

Result

(1) Different intensities of PA: Overall, the times for LPA, MPA, VPA, MVPA, and TPA in the low SES group were 190 (100, 400) minutes, 190 (80, 400) minutes, 60 (0, 160) minutes, 290 (150, 570) minutes, and 580 (345, 925) minutes, respectively.The duration of PA at each intensity level in the low SES group was significantly lower compared to that in the middle and high SES groups (all P-values < 0.05). (2) Different PA types: The low SES group exhibited the shortest durations for both transportation PA (260 min) and exercise PA (155 min), while household PA was the longest (15 min)(all P-values < 0.05). (3) Moderating effect test: After controlling for relevant variables, the interaction term coefficient between gender and SES was statistically significant (B = -19.141, t = -2.059, P < 0.05).

Conclusion

Adolescents from low SES backgrounds exhibited the lowest levels of MVPA and TPA, which were mainly manifested in transportation PA and exercise PA. Gender moderates the relationship between SES and MVPA, with different SES levels having a more pronounced effect on PA in boys than in girls.

Association of COVID-19 Pandemic with Newly Diagnosed Anorexia Nervosa Among Children and Adolescents in Japan

Background and Objectives: The COVID-19 pandemic globally has negative effects on mental health. Research from Western countries, such as the US, Canada, Australia, and Europe, shows that the COVID-19 pandemic is associated with an increased trend of anorexia nervosa (AN) among children and adolescents. However, the trend after the pandemic in Eastern countries, including Japan, is not well-understood, and it remains unclear whether the pandemic is associated with the trend in these countries. This study aimed to examine the association between the COVID-19 pandemic and the newly diagnosed AN among children and adolescents in Japan. Materials and Methods: Using the nationwide multi-hospital database in Japan, we analyzed the clinical outpatient data in the departments of pediatrics, psychosomatic medicine, and psychiatry. The participants comprised children and adolescents aged 7-19 years newly diagnosed with AN from January 2017 to January 2022. An interrupted time series analysis was used to compare the trends of newly diagnosed AN before and after the COVID-19 pandemic. Estimating the changes in the trends over the pandemic was performed using a Poisson regression model. Results: The total cases of newly diagnosed AN were 41 cases diagnosed in 38 months (1.08 cases per month) before the pandemic and 34 in 23 months (1.48 cases per month) after the pandemic. Notably, in the 7-14 age group, the cases per month increased from 0.74 to 1.13 cases per month over the period. Before the pandemic, a decrease in cases was observed (Incidence Rate Ratio [IRR] = 0.961; 95% CI = 0.932-0.990). Conversely, the after-pandemic period showed a contrasting trend, with increased cases (IRR = 1.096; 95% CI = 1.032-1.176). Furthermore, the number and cases per month in boys increased over the period, from 1 to 5 cases and from 0.03 to 0.22 cases per month, compared to girls from 28 to 26 cases and from 1.05 to 1.26 cases per month. Conclusions: Our findings suggest that sociocultural differences at a national level may not affect the trend of AN after the pandemic. The pandemic and lifestyle changes after the pandemic occurred in both Western and Eastern countries. Considering that, individual, parental, and peer factors related to the pandemic and the consequent lifestyle changes may be more associated with the development of AN. Further research in different countries is needed to elucidate the mechanisms of AN and the long-term impact of the pandemic.

Interpersonal relationship patterns of left-behind adolescents with family and school systems members and their associations with mental health: A latent profile analysis

BACKGROUND

The absence of parents owing to relocation from rural to urban areas has a detrimental effect on the mental health of adolescents in China. Previous studies have examined interpersonal relationships (IRs) and psychological health using a variable-centered approach based on group differences. Few studies have employed person-centered approaches to identify specific patterns of IRs in a large sample of Chinese left-behind adolescents (LBA), and little is known about the association between these profiles and psychological health.

OBJECTIVE

To identify interpersonal relationship patterns of LBA with family and school systems members using latent profile analysis (LPA) and to examine their association with psychological health.

PARTICIPANTS AND SETTING

The sample included 4724 LBA aged 11-18 years recruited from Chongqing City and Sichuan Province, China (Mage = 15.41, SD = 1.63 years, 46.2 % female).

METHODS

Interpersonal relationships of LBA were conceptualized as father-child, mother-child, teacher-student, and student-student relationships.

RESULTS

LPA identified four profiles: low school-low family relationships (6.4 %, profile 1), high school-medium family relationships (21.4 %, profile 2), medium school-medium family relationships (56.2 %, profile 3), and high school-high family relationships (15.9 %, profile 4). These four profiles significantly differed in the four IRs. Multivariate analysis of covariance (MANCOVA) revealed that positive (i.e., life satisfaction, self-esteem, social adaption, and psychological suzhi) and negative mental health indicators (i.e., anxiety, depression, aggressive behavior, Internet addiction, and school bullying) varied across the four profiles. The psychological health of LBA differed according to their IRs. Profile 4 exhibited higher levels of positive psychological health and lower levels of negative psychological health compared to all other types of LBA. Importantly, profile 2 had fewer negative mental health than profile 1 and profile 3.

CONCLUSIONS

These findings elucidate the heterogeneous typologies of IRs in LBA and underscore the crucial role of school and family relationships in promoting the mental health of LBA. Therefore, strengthening both school and family IRs may reduce the prevalence of negative psychological health among LBA.

The bidirectional relationship between perceived social support and moral sensitivity in adolescents: Evidence from longitudinal study and weekly diary method

INTRODUCTION

Moral sensitivity, the ability to perceive moral issues, plays a crucial role in societal development and progress. Previous studies have highlighted the significance of perceived social support as a key factor influencing moral sensitivity.

METHOD

Based on the conservation of resources theory, this pioneering study investigates the association between perceived social support and moral sensitivity at both trait and state levels, employing a longitudinal study and a weekly diary method. In Study 1, the relationship between perceived social support and moral sensitivity was examined across two waves (T1 and T2) with 454 adolescents, spaced at 1-year intervals. Study 2 utilized a weekly diary method to observe 109 adolescents over a 7-week period.

RESULTS

Study 1 revealed that (1) T1 perceived social support positively predicted T2 moral sensitivity, while (2) T1 moral sensitivity did not positively predict T2 perceived social support. Study 2 demonstrated that: (1) weekly perceived social support positively predicted weekly moral sensitivity, and (2) weekly moral sensitivity also positively predicted weekly perceived social support.

CONCLUSION

In summary, our findings indicate that over an extended period, perceived social support predicts moral sensitivity. Additionally, in the short term, a bidirectional predictive relationship exists between perceived social support and moral sensitivity. These findings bridge an academic gap and offer crucial theoretical insights into the development of individual moral sensitivity from the perspective of perceived social support.

Adolescents' offline and online social support: A study on latent groups and their relationship with mental health

INTRODUCTION

The internet has become a common space for adolescents to connect with others and find information. However, it remains unclear whether online encounters can serve as new sources of social support for Chinese adolescents. The present study aimed to identify distinct patterns in Chinese adolescents' social support from both offline and online sources and to examine how these patterns relate to individual and family factors and adolescents' mental health conditions.

METHODS

Data were obtained from a cross-sectional survey of 1031 Chinese adolescents (47.1% female, mean age = 13.67) in Foshan, Guangdong province. Latent profile analysis was performed with Mplus. Associations between the identified classes and auxiliary variables were examined with the "R3STEP" procedure and the DCON command in Mplus.

RESULTS

We identified four groups. Three groups showed consistent patterns in terms of receiving social support from offline and online sources, namely, the high support group (24.8%), moderate support group (43.8%), and low support group (15.3%), respectively. The fourth group received a moderate level of offline but low level of online support (16%), named the moderate offline-low online support group. The groups differed in individual and family characteristics. Higher support was associated with higher life satisfaction, lower depression, and social anxiety, but also higher problematic internet use. Overall, the moderate offline-low online support group showed better mental health than the other groups.

CONCLUSIONS

Our study extends social support research by revealing heterogeneity in adolescents' social support patterns. The findings encourage a balanced use of offline and online support.

A new way to conceptualize intolerance of uncertainty among adolescents: Embracing the network perspective

Intolerance of uncertainty (IU), a pivotal transdiagnostic risk factor in psychopathology, is defined as a dispositional incapacity to withstand uncertainty distress, driving maladaptive cognitive, emotional and behavioural reactions to uncertainty. However, the intricate interplay among these components, particularly in adolescents, remains underexplored; yet understanding this interplay is crucial for supporting mental health. To address this gap, we employed a network approach to conceptualize IU in 5672 non-clinical Chinese adolescents (Mage = 14.13 years, SDage = 1.96 years, range = 10-19 years, 46.6% boys), combining graphical Gaussian models (GGM) and directed acyclic graphs (DAG). Our analyses revealed a tripartite network comprising cognitive, behavioural and emotional components. Notably, 'frustration' and 'work with hindrance' emerged as key drivers, while 'catastrophizing belief' served as a critical bridge linking different components. These findings underscore the importance of alleviating uncertainty-induced frustration and enhancing coping skills for behavioural impediments to mitigate adolescent IU. Additionally, therapeutic interventions should prioritize modifying and re-evaluating catastrophizing beliefs related to uncertainty.

Overtime work and Chinese workers' physical and mental health: The mediating role of social support and work value awareness

BACKGROUND

China was once called the world's factory. Chinese workers had long weekly working hours. However, the empirical results of the relationship between overtime work and workers' health are mixed and remain inconclusive.

OBJECTIVE

This study aimed to investigate how overtime work influenced workers' physical and mental health and the role of lifestyles, social support, and work value awareness.

METHODS

Data from the China Labor-force Dynamics Survey 2016 (N = 14,205) was used. The instrumental variable approach was employed to overcome the endogeneity problem between overtime work and workers' health. The bootstrapping method was conducted to elicit the role of lifestyles, social support, and work value awareness.

RESULTS

The results indicated that overtime work significantly and negatively influenced Chinese workers' physical and mental health. The results of the bootstrapping suggested that workers' social support and work value awareness partially mediated the relationship between overtime work and their physical and mental health. However, the mediating role of lifestyles was insignificant.

CONCLUSION

Through using big data with national representativeness, this study suggests that overtime work negatively influences Chinese workers' physical and mental health. Our findings provide policy implications for improving workers' health rights and well-being in emerging economies.

Social support and self-efficacy during early adolescence: Dual impact of protective and promotive links to mental health and wellbeing

This study aimed to assess the impact of sources of social support and dimensions of self-efficacy on psychological symptoms and mental wellbeing among early adolescents. A total of 274 adolescents aged 10-14 from Darjeeling, India, participated in the study. The Multidimensional Scale of Perceived Social Support (MSPSS) and Self-Efficacy Questionnaire for Children (SEQ-C) were utilized to assess dimensions of protective/promotive factors. Nested multivariable regression models assessed associations between age, gender, social support, and self-efficacy on psychological symptoms (internalising, externalising, and total difficulties) and mental wellbeing outcomes (mental wellbeing, optimism, and resilience). Results indicated that 13% of early adolescents screened positive for clinical depression and 44% reported poor mental wellbeing. Emotional and academic self-efficacy, along with family support, were significantly associated with reduced psychological symptoms. Conversely, social, and academic self-efficacy, along with support from friends, were linked to higher levels of mental wellbeing. Regression analyses revealed that dimensions of social support and self-efficacy explained a greater proportion of variability in mental wellbeing outcomes (R2 = 0.37-0.64) than in psychological symptom outcomes (R2 = 0.19-0.22), suggesting a stronger promotive effect on mental wellbeing compared to a protective effect on psychological symptoms during early adolescence. Findings suggest the urgent need for early mental health intervention to strengthen systems of social support and support self-efficacy among early adolescents. Multi-level or sequential interventions that target protective and promotive factors are a key strategy to addressing the global youth mental health crisis.

Mental health problems during the COVID-19 pandemic among residents of Jimma town: a cross-sectional study

The COVID-19 pandemic presents an unprecedented challenge to community wellbeing and mental health. However, quantifiable information on the extent of mental health problems and associated factors due to the pandemic is still lacking in low-income countries. Thus, this study aimed to investigate the levels of depression, anxiety, and stress and their association with risk and resilience factors among residents of Jimma town in Southwestern Ethiopia. A community-based cross-sectional study was conducted between October 2021 and November 2021. Data were collected from 1196 adult Jimma town residents selected through multi-stage sampling. The following scales were used for the cross-sectional assessment of depressions, anxiety and stress and their associations: depression, anxiety, and stress-21(DASS-21), World Health Organization (WHO) wellbeing, University of California, Los Angeles Loneliness Scale (UCLA), Childhood trauma questionnaire, and brief resilience scales. A pre-tested, interviewer-completed questionnaire was used for data collection. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with depression, anxiety, and stress. Odds ratios consistent with 95% CI were used to report the presence of an association between risk and resilience factors and the outcome variable at a P-value < 0.05. Overall, 963 (80.53%) respondents had divergent DASS-21 score findings. Specifically, 27.68%, 31.52% and 21.32% experienced depression, anxiety, and stress respectively. Higher DASS-21 scores were associated with the presence of one or more COVID-19 risk factors for anyone close to the participants (AOR = 1.53, 95% CI 1.03-2.27), feelings of stress/burden (β = 1.09, 95% CI 1.07-1.12), positive coping (β = 1.044, 95% CI 1.01-1.07), loneliness (β = 1.063, 95% CI 1.04-1.08), and childhood trauma (β = 1.03, 95% CI 1.01-1.04). In contrast, lower DASS-21 scores were associated with beliefs about the necessity of solidarity-based behavior (β = 0.94, 95% CI 0.90-0.98), resilience (β = 0.92, 95% CI 0.87-0.97) and wellbeing (β = 0.90, 95% CI 0.87-0.94). In the course of the COVID-19 pandemic in 2021, symptoms of depression, anxiety, and stress in the study community were prevalent, and associated with numerous risk and resilience factors. Although causality cannot be inferred, these findings underscore the importance of strengthening mental health services and may guide COVID-19 prevention and treatment strategies.

Screen time trajectories and psychosocial well-being among Chinese adolescents: a longitudinal study

BACKGROUND

While the association between screen time (ST) and psychosocial well-being has been extensively examined, limited studies have investigated the dynamic patterns of ST, and their impact on subsequent psychosocial well-being among adolescents. Therefore, this longitudinal study aimed to examine the association between ST trajectories and the subsequent psychosocial well-being among Chinese adolescents.

METHODS

Data were drawn from the Longitudinal Study of Adolescents' Mental and Behavioral Well-being Research (Registration No. ChiCTR1900022032). The final analysis included 1480 participants who completed baseline and two follow-up surveys. Standardized measures were employed to assess ST and multiple psychosocial well-being, including depressive symptoms, anxiety, externalizing problems, and coping style. Group-based trajectory modeling and generalized linear mixed models were performed.

RESULTS

Over the two-year follow-up period, two distinct ST trajectories emerged: continued high (298 [20.1%]) and continued low (1182 [79.9%]). Compared with those in the continued low ST group, adolescents in the continued high group exhibited a higher likelihood of presenting depressive symptoms (β = 0.97, 95% CI = 0.43 ~ 1.50), anxiety symptoms (β = 0.29, 95% CI = 0.05 ~ 0.53), and emotional problems (β = 0.35, 95% CI = 0.22 ~ 0.48), and were less likely to demonstrate prosocial behavior or employ positive coping style. The stratified analysis demonstrated that the aforementioned associations only existed among female adolescents.

CONCLUSIONS

Persistent high exposure to ST was associated with an increased odds of emotional problems and a decreased probability of engaging in prosocial behavior and positive coping style, with particularly noteworthy effects observed among female adolescents. These findings underscore the importance of reducing ST exposure to improve the psychological well-being of adolescents.

How Does Perceived Social Support Impact Mental Health and Creative Tendencies Among Chinese Senior High School Students?

The senior high school period is a critical phase for the proliferation of mental health problems, as well as a key period for cognitive development among adolescents. Due to the importance of support from the external environment for students, this study aims to explore and verify the protective role of social support in the mental health and creative tendencies of senior high school students, as well as its mechanisms and boundary conditions. Based on a survey of 1463 Chinese senior high school students, a moderated mediation model was constructed. The results showed that (1) perceived social support significantly negatively predicts mental health problems and significantly positively predicts creative tendencies; (2) self-esteem mediates the impact of perceived social support on both mental health problems and creative tendencies; (3) perceived stress not only moderates the impact of self-esteem on mental health problems and creative tendencies, but also moderates the mediating effect of self-esteem. The findings of this study shed light on the positive impact of social support and the self-esteem it nurtures during the senior high school years. These insights offer valuable recommendations for practitioners aiming to prevent mental health issues and foster creative tendencies among senior high school students.

Parental emotional support, self-efficacy, and mental health problems among adolescents in Hong Kong: a moderated mediation approach

Introduction

Early signs of mental health issues may develop into severe mental illnesses over time. The influence of parental emotional support on adolescent mental health problems is well acknowledged. However, prior research has predominantly focused on psychological symptoms, often neglecting the somatic symptoms associated with mental health. Additionally, there has been insufficient exploration of the mediating role of self-efficacy and the relationship between socioeconomic status (SES) and adolescent mental health, particularly within the context of Hong Kong.

Methods

Using data from 3,613 adolescents aged 15 years from 109 schools in Hong Kong who participated in the Programme for International Student Assessment 2018, this study explored the relationship between parental emotional support and two dimensions of adolescent mental health symptoms (psychological and somatic symptoms), and the mediating effect of self-efficacy and the moderating role of SES.

Results

We found that parental emotional support significantly reduced psychological and somatic symptoms, primarily by enhancing self-efficacy. MoreovSES moderated these relationships, with the impact of parental emotional support on psychological symptoms being more pronounced among adolescents from lower SES backgrounds.

Discussion

This study deepens the understanding of the mechanisms underlying adolescent mental health in Hong Kong. By highlighting the importance of parental emotional support and self-efficacy, as well as the moderating effect of SES, the findings offer valuable insights for effective interventions aimed at improving adolescent mental health.

Perceived changes in peer relationships and behavioral health among college students during covid-19

Objective: Covid-19 has resulted in changes to college students' daily lives due to recommendations to socially distance. Social distance is likely to affect youths' peer relationships at a time when these relationships remain important for development. Participants and Methods: The current study utilized survey data to examine perceived changes in peer relationships and the association with behavioral health among 275 college students (Mage = 18.69, SD =.72) during the fall/spring of 2020-2021. Results: Quantitative results indicated that participants reported significant perceived decreases in peer support but did not report significantly worse quality of closest friendships. Qualitative responses from an open-ended survey question supported these quantitative results suggesting that although many participants perceived decreases in quality of relationships, there was also the perception that friendships became closer. Participants who perceived decreased peer relationship support and quality were more likely to report depressive symptoms and loneliness when compared to participants who perceived no changes.

Post-traumatic Reactions and Social-Emotional Competence Among Chinese High School Students Experiencing COVID-19 Lockdown: A Network Analysis

In the post-pandemic era, psychological traumas have emerged as major mental health issues. However, the post-traumatic reactions and their connections with social-emotional competence among high school students experiencing COVID-19 lockdown have not been adequately explored. This study aimed to reveal the characteristics of their positive and negative post-traumatic reactions, and their connections with social-emotional competence. Network analysis was used on data from 1096 Chinese high school students who experienced COVID-19 lockdown. Measures included the DSECS-S, the PTGI and the PC-PTSD-5. The results revealed that "Valuing life" and "Recalling unwillingly" were identified as core factors of post-traumatic reactions, while "Having close friendships", "Getting along well with others" and "Respecting others' emotions" played a bridging role in connecting the communities of social-emotional competence and post-traumatic reactions. This study enriches research on post-traumatic reactions, emphasizing the importance of implementing social-emotional competence programs to tackle mental health crises.

Bidirectional associations between sleep and anxiety among Chinese schoolchildren before and after the COVID-19 lockdown

The COVID-19 pandemic has critical implications for mental health in children. This study examined how the COVID-19 lockdown affected sleep duration and anxiety symptoms in Chinese school-aged children and the bidirectional association between sleep and anxiety before and during the COVID-19 lockdown. A school-based longitudinal cohort study was conducted to examine the relationship between sleep duration and anxiety scores before and after the COVID-19 lockdown from January to May 2020. Generalized estimating equations model was used to identify variables that contributed to the changes in sleep duration. The bidirectional relationship between sleep duration and anxiety symptoms was explored by cross-lagged analysis. 7681 children completed two waves of surveys were included in the analysis. The daily exercise duration, anxiety symptoms, and sleep duration decreased significantly during the lockdown compared with that before the lockdown. Based on generalized estimating equations model, older age, secondary school, and higher anxiety scores of participants were positively associated with sleep duration, while female and no COVID-19 infection history were negatively associated with it. Cross-lagged analysis showed higher anxiety score of children before the lockdown was significantly associated with shorter sleep duration during the lockdown; and shorter sleep duration of children before the lockdown was also significantly associated with a higher anxiety score during the lockdown. Under the context of the COVID-19 pandemic, there were longitudinal, bidirectional associations between children's anxiety symptoms and sleep duration. For school students, mental health services and sleep education should be considered in the daily health education curriculum.

Factors associated with an increased risk of anxiety among adolescents during the COVID-19 lockdown in the French Grand Est area

The COVID-19 pandemic has impacted adolescent mental health worldwide. The current study aims to assess the feelings of French adolescents and the factors related to anxiety among these adolescents during the first lockdown due to COVID-19. A sample of 284 French adolescents from the Grand Est region aged 12-18 years completed an online survey evaluating their pandemic-related anxiety symptoms, behaviors, and feelings regarding the contingent strategies of lockdown that were taken and their living and learning conditions, family relationships, and social support. The Generalized Anxiety Disorder Scale (GAD-6) was used to assess anxiety. Data on parents' mental health status were also collected. A word cloud was generated to visualize respondents' feelings according to word use frequency. Cross-sectional analysis with linear regression was performed to identify the factors associated with a higher level of anxiety in adolescents. Higher anxiety scale scores were observed among females than among males (β = 1.2; P = 0.0005), among adolescents experiencing conflicts at home (β = 0.9; P = 0.03) and difficulties in isolation (β = 1.1; P = 0.02) than among those who did not report any difficulty, and among those working less than 2 h a day (β = 1.1; P = 0.003) than among those working more. Anxiety scale scores were lower in adolescents with higher family social support (β = -0.66; P < 0.001) and those with parents with no anxiety (β = -2.28; P < 0.001), lower anxiety (β = -1.38; P = 0.018), and higher mental health-related quality of life (β = -0.04; P = 0.03). These findings suggest a need to support interventions targeting parents' anxiety, develop strategies to increase family support, and establish consistent work schedules for children.

Evaluation of Resilience and Mental Health in the "Post-Pandemic Era" among University Students: Protocol for a Mixed-Methods Study

BACKGROUND

The mental well-being of university students has been a growing concern in Public Health and has been exacerbated by the COVID-19 pandemic. The pandemic (including the post-pandemic era) introduced and exacerbated a variety of potential stressors for vulnerable individuals and communities, resulting in an increase in mental health issues among university students. Resilience, as a process, is the ability of a system to adapt and grow in the face of adversity. This is a crucial aspect to consider when examining the coping of university students in critical situations such as COVID-19.

OBJECTIVE

This study aims to assess the association between resilience and mental health outcomes among university students in Cyprus during the post-COVID-19 pandemic era.

METHODS

A parallel embedded mixed methods research design will be utilized to assess resilience, measured by the Conner-Davidson Resilience Scale (CD-RISC), the COVID-19 Impact Scale (CIS) and mental health outcomes measured by the Symptom Checklist 90-Revised (SCL 90-R), during the COVID-19 post-pandemic era (January 2022-July 2024) among university students in the Republic of Cyprus. The study will be conducted in two stages: a pilot study followed by the main study. Quantitative data will be collected through a web-based survey, while qualitative data will be obtained through in-person focus groups designed to capture participants' experiences. Participants will be recruited using a proportional quota sampling approach to achieve representativeness based on predefined demographics. The study protocol has been approved by the Cyprus Bioethics Committee (approval no: EEC/EP/2023/31).

DISCUSSION

This study is expected to broaden our understanding of the intricate interactions between the COVID-19 pandemic's impact, resilience, and mental health outcomes. The focus on university students' psychological wellbeing is consistent with the call by the WHO to focus on mental health (World Health Organization, 2019).

Suicidal ideation and suicide attempts among students aged 12 to 24 after the lifting of COVID-19 restrictions in China: prevalence and associated factors

Objective

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

Methods

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

Results

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

Conclusions

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

Can sports participation be a protective factor against suicide-related outcomes in adolescents: a systematic review

Background

Suicide-related outcomes among adolescents have become a serious public health problem worldwide. Emerging evidence suggests that sports participation may interact with suicide-related outcomes. The objective of this systematic review is to systematically review and summarize the association between sports participation and suicide-related outcomes among adolescents.

Design

A systematic review according to PRISMA Statement (International Platform of Registered Systematic Review and Meta-Analysis Protocols registration: INPLASY202330072) https://inplasy.com/inplasy-2023-3-0072/.

Methods

The literature search was conducted in three electronic databases: Web of Science, PubMed, and EBSCOhost.

Results

A total of 16 studies (12 cross-sectional studies, 4 prospective studies) met the inclusion criteria were evaluated. Strong consistent evidence was found for the negative association between suicidal ideation, suicide attempts, and sports participation among adolescents. There was insufficient evidence to support consistency in the association between sports participation and suicide plans, and no evidence regarding gender differences between sports participation and these suicide-related outcomes. Furthermore, there was heterogeneity in the measures of sports participation and suicide-related outcomes across the included studies.

Conclusion

Evidence suggests that more sports participations are associated with lower suicidal ideation and suicide attempts in adolescents. However, the directionality of the observed associations should be examined based on more high-quality longitudinal studies in the future.

Parental and Adolescents' Anxiety during the COVID-19 Outbreak in Rural China: The role of Parent-child Communication

Purpose

It has been suggested that the intergenerational transmission of anxiety may be an important contributor to the high prevalence of anxiety in adolescents. The objectives of this study are to examine whether and how parental anxiety is related to adolescent's anxiety and to explore the associations of parental anxiety and parent-child communication with adolescents' anxiety across different grades.

Methods

The current survey was conducted online from February 8th to February 27th, 2020.The questionnaires were distributed and retrieved through a web-based platform. A total of 6196 Chinese rural adolescents from grade seven to twelve (age ranging from 11 to 18 years old) were included.

Results

In this study, parental anxiety was significantly associated with higher adolescent anxiety (β = 0.14, p < 0.001) and this association was statically strongest at grade twelve. Besides, children with problematic parent-child communication related to COVID-19 reported elevated anxiety (β = 0.05, p < 0.01). In contrast, effective parent-child communication about COVID-19 mitigated the level of anxiety transmitted from parent to child (β = -0.04, p < 0.05).

Conclusions

During the COVID-19 epidemic, parents' anxiety was related to adolescents' anxiety. In addition, parent-child communication plays a moderating role in the above relationship. These findings emphasize the importance of implementing more psycho-education programs that specifically target parents' emotion regulation and effective communication abilities to ameliorate the psychopathological symptoms of parents and their children.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-023-00609-y.

A formative evaluation of 'Mind Matters: Overcoming Adversity and Building Resiliency' with Hispanic adolescents prior to and during Covid-19

Youth living in poverty are more likely to experience cumulative stressors including multiple adverse childhood events. Further, the Covid-19 pandemic has disproportionality affected Hispanic youth and communities, leading to unprecedented levels of trauma. This research responded to a need for a youth resiliency-building program in an urban and impoverished area with a majority Hispanic population. We conducted a formative evaluation of a youth intervention entitled Mind Matters: Overcoming Adversity and Building Resilience, which aims to help youth overcome adversity and to build resilience via psychoeducation and skill development. Just prior to the pandemic in the United States (August-December, 2019), youth (N=12) participated in Mind Matters as part of an after-school program. Immediately following, we utilized focus groups to solicit youth's perspectives on the acceptability of the program, what they had learned, content areas they liked best, and their recommendations for program improvement. Follow-up phone interviews were also conducted three months later (March 2020) while youth were at home as a result of the pandemic. Youth enjoyed the program and were able to apply skills learned to cope with stress in their daily lives and across ecological contexts. Findings point to the program as particularly well-suited to older adolescents. During the pandemic, most youth continued to utilize self-soothing and mindfulness skills to emotionally self-regulate while facing challenges related to home schooling. Findings highlight the importance of trauma-resiliency programming for youth and offer recommendations to practitioners utilizing the Mind Matters program.

Emotional - Behavioral Difficulties and Prosocial Behaviour among Vietnamese Adolescents: the Role of Social Support

Background

In recent decades, a high prevalence of mental health problems among adolescents has been reported worldwide. In Vietnam, mental health problems such as emotional and behavioural difficulties are relatively common in the adolescent age group.

Objective

This study aimed to estimate the prevalence of emotional-behavioural problems and prosocial behaviours in Vietnamese adolescents and identify the role of social support in these adolescents' strengths and difficulties.

Methods

A population sample of 582 adolescents from sixth to ninth grade from four secondary schools in Vietnam voluntarily participated by completing the Strengths and Difficulties Questionnaire (α = .64) and the Social Support Scale (α = .90).

Results

The research results revealed that Vietnamese adolescents suffered from considerable levels of emotional-behavioural difficulties and prosocial behaviour problems. Through multible regression analysis, support from their families significantly predicted to decrease students' emotional and behavioural symptoms (β\< 0; p\< .05) and increasing prosocial behaviours (β> 0; p \< .05). In contrast, friend support only contribute to protecting adolescents from behavioural problems (β = -.18; p \< .05) and encouraged prosocial behaviours (β = .22; p \< .05).

Discussion

Family support had a central role in its positive contribution to reducing emotional-behavioural and prosocial behaviour problems. Friend support only decreased behavioural problems and encouraged prosocial behaviours. These results are interpreted that educators could limit adolescents' emotional-behavioural difficulties and encourage prosocial behaviours through social support from their families and friends.

Mental health problems among adolescents during the COVID-19 pandemic: a repeated cross-sectional study from Sweden

OBJECTIVE

Most international studies have concluded that exposure to the COVID-19 pandemic was associated with worse mental health. Sweden implemented lighter restrictions than many other countries. We evaluated the association between changes in exposure of COVID-19 restrictions and changes in mental health problems among Swedish adolescents.

METHOD

Repeated cross-sectional data were derived from the Stockholm school survey, mandatory for all students in municipal schools and voluntary for students in private schools. Unexposed students were assessed in the year 2020 and exposed were assessed in 2022. Mental health was assessed using items similar to the psychosomatic problem scale. All variables were dichotomised, and a non-parametric logistic regression was used to evaluate associations.

RESULTS

A significant positive association was found between exposure of COVID-19 restrictions and self-reports of five to seven mental health problems a week for girls (odds ratio (OR) 1.29, 95% confidence interval (CI) 1.18-1.41), but a non-significant association was found for boys (also after controlling for relevant covariates). Among boys and girls (shown), changes in mental health during the pandemic were moderated by social support from parents (OR 2.23, 95% CI 1.98-2.51), bullying victimisation (OR 2.24, 95% CI 2.06-2.66), a sensation-seeking temperament (OR 1.40, 95% CI 1.24-1.58) and school achievement (OR 1.34, 95% CI 1.18-1.51).

CONCLUSIONS

Compared with boys, adolescent girls self-reported worse mental health following COVID-19 exposure. Girls may have been more affected by social distancing regulations in Sweden during the pandemic than boys and may require additional psychosocial support post-pandemic. Social support from parents may play an important role.

The longitudinal impact of the COVID-19 pandemic on adolescents' internalizing symptoms, substance use, and digital media use

The present study examined the long-term effects of the COVID-19 pandemic on adolescent internalizing symptoms, substance use, and digital media use before and during the pandemic. A nationally representative longitudinal cohort of 3718 Israeli adolescents aged 12-16 at baseline completed measures of internalizing symptoms (anxiety, depression, and somatization), the prevalence of substance use (i.e., previous 30-day use of tobacco, alcohol, and cannabis), and average daily use of internet/television, video games, and social media. Social support and daily routines were assessed as potential protective factors for mental health. Data were collected in 10 public schools at four measurement points: before the Covid-19 outbreak (September 2019), after the first wave lockdown (May 2020), after the third wave lockdown (May 2021), and after the fifth wave of the pandemic (May 2022). Multi-level mixed models were used to analyze the longitudinal data. The results showed significant increases in internalizing symptoms, substance use (tobacco, alcohol, and cannabis), and daily screen time from the start of the study to the 33-month follow-up. Social support and daily routines moderated the increases in internalizing symptoms and digital media use. These findings highlight the need for public and educational mental health services to address the continuing impact of the pandemic on adolescents.

Prevalence and predictors of prenatal depression during the COVID-19 pandemic: A multistage observational study in Beijing, China

OBJECTIVE

While growing psychological health issues among pregnant women during the COVID-19 pandemic have been clearly validated, most research was conducted in countries with relatively lax quarantine measures. This study aimed to compare the prevalence of prenatal depression among pre-, peak-, and post-COVID-19 in Beijing, the region with a stringent response policy in China. We also explore predictors of prenatal depression throughout the outbreak.

METHODS

We investigated prenatal depression among 742 pregnant women who received antenatal checkups in Beijing from March 28, 2019 to May 07, 2021 using the Edinburgh Postnatal Depression Scale and associative demographic, pregnancy-related, and psychosocial characteristics were measured. The phase was divided into pre-, peak-, and post-COVID-19 in light of the trajectory of COVID-19. Pearson's Chi-square test was used after the examination of confounders homogeneity. The bivariable and multivariable logistic regression was conducted to explore predictors.

RESULTS

The pooled prevalence of prenatal depression was 11.9% throughout the COVID-19 pandemic. Rates at different phases were 10.6%, 15.2%, and 11.1% respectively and no significant difference was observed. Multivariable logistic regression revealed that history of mental illness, number of boy-preference from both pregnant women and husband's family, social support, occupation, and living space were independent predictors of prenatal depression in Beijing.

CONCLUSION

Our data suggested that the impact of this pandemic on prenatal depression in Beijing appears to be not significant, which will strengthen confidence in adhering to current policy for decision-makers and provide important guidance for the development of major outbreak control and management policies in the future. Our findings may also provide a more efficient measure to identify high-risk pregnant women for professionals and help raise gender equity awareness of pregnant women and their husbands' families. Future studies should focus on the value of targeted care and family relations on the mental health of pregnant women.

A longitudinal study on the effects of social support on self-stigma, psychiatric symptoms, and personal and social functioning in community patients with severe mental illnesses in China

BACKGROUND

Few studies have examined whether social support contributes to better consequences among chronic patients with severe mental illnesses (SMI) in their community recovery stage and whether self-stigma would be a mechanism through which social support impacts psychiatric symptoms and personal and social functioning.

AIMS

This study aimed to examine prospective associations of social support with long-term self-stigma, psychiatric symptoms, and personal and social functioning, and to investigate whether self-stigma would mediate the associations of social support with psychiatric symptoms and personal and social functioning among patients with SMI.

METHODS

A total of 312 persons with SMI (schizophrenia and bipolar disorder) in their community recovery stage participated in the study. Social support, self-stigma, psychiatric symptoms, and personal and social functioning were evaluated at baseline. The follow-up assessment was conducted at 6 months with the baseline measures except for social support. Hierarchical linear regression and mediation analysis were performed.

RESULTS

The results showed that baseline social support predicted decreases in stigma (β = -.115, p = .029) and psychiatric symptoms (β = -.193, p < .001), and increases in personal and social functioning (β = .134, p = .008) over 6 months, after adjusting for relevant covariates. Stigma at 6 months partially mediated the association between baseline social support and 6-month psychiatric symptoms (indirect effect: β = -.043, CI [-0.074, -0.018]). Stigma and psychiatric symptoms at 6 months together mediated the association between baseline social support and 6-month personal and social functioning (indirect effect: β = .084, 95% CI [0.029, 0.143]).

CONCLUSION

It is necessary to provide comprehensive social support services and stigma reduction interventions at the community level to improve the prognosis of SMI.

The association between family adaptability and adolescent depression: the chain mediating role of social support and self-efficacy

Objective

Previous research has shown a correlation between family adaptability and adolescent depression. However, there is a lack of studies that have investigated the underlying mechanism between family adaptability and adolescent depression. Based on the Ecological Systems Theory, this study aims to investigate the link between family adaptability and depression in adolescents, mediated by the sequential roles of social support and self-efficacy.

Methods

The sample consisted of 1086 students randomly selected from seven public middle schools in Shandong Province, Eastern China. All the participants filled in the structured self-report questionnaires on family adaptability, social support, self-efficacy, and depression. The data were analyzed using SPSS 25.0 and Structural Equation Modeling (SEM) in AMOS 24.0.

Results

The findings of this study are as follows: (1) Family adaptability is negatively associated with adolescent depression; (2) Social support plays a mediating role between family adaptability and adolescent depression; (3) Self-efficacy plays a mediating role between family adaptability and adolescent depression; (4) Social support and self-efficacy play a chain mediation role between family adaptability and adolescent depression.

Conclusion

It is suggested that early interventions and support should be provided to facilitate adolescents' family adaptability, social support, and self-efficacy, thus reducing their depression and improving mental health of adolescents.

Common mental disorders and associated factors among adult chronic kidney disease patients attending referral hospitals in Amhara Regional State

Common mental disorders (CMDs) are a wide term that includes disorders like depression, anxiety, and somatic manifestations. Chronic kidney disease (CKD) patients are at high risk of developing a common mental disorders, which leads to a lower survival rate, poor clinical outcome, longer hospitalization, increased health-care utilization, difficulty adhering to medications, an increased risk of initiation of dialysis, poor quality of life, and an increased risk of mortality. However, there is limited study done related to common mental disorders and associated factors among chronic kidney disease patients in Ethiopia. This study aimed to assess the prevalence of common mental disorders and associated factors among chronic kidney disease patients attending referral hospitals in Amhara Regional State. An institution-based cross-sectional study design was conducted at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals from January to April 2020. The study participants were selected using systematic random sampling techniques. Common mental disorders were assessed using the Self-Reporting Questionnaire-Falk Institute (SRQ-F) tool. Data were entered into Epi Data Version 3.0 then exported into STATA 14 for analysis. Both bivariable and multi-variable binary logistic regressions were done to identify factors associated with common mental disorders. In multivariable logistic regression analysis, variables with a p-value of ≤ 0.05 were declared as a statistically associated with common mental disorders. In this study, 424 CKD patients were included, with a response rate of 100%. Among screened CKD patients, 40.8% was positive for common mental disorders, with a 95% CI (36-45%). Independent predictors of common mental disorders among CKD patients were poor social support [(AOR 3.1, 95% CI (1.67-5.77)], family history of mental disorders, [AOR 3.6, 95% CI (1.12-11.8)], comorbidity [AOR 1.7, 95% CI (1.03-2.78)], being female [AOR 2.69, 95% CI (1.72-4.20)], and duration of CKD (AOR 3.5; 95% CI (2.28-5.54). Two out of five CKD patients screened for CMDs were found to be positive. Common mental disorders were more common among CKD patients with poor social support, a family history of mental disorders, comorbidity, being female, and the duration of CKD. Therefore, screening CKD patients for common mental disorders is recommended.

Long-Term Trends and Sociodemographic Inequalities of Emotional/Behavioral Problems and Poor Help-Seeking in Adolescents During the COVID-19 Pandemic

PURPOSE

During the first 3 years of the coronavirus disease (COVID-19) pandemic, we investigated the long-term trends of emotional/behavioral problems and poor help-seeking behavior in adolescents and examined the sociodemographic inequalities in these trends.

METHODS

A multiwave cross-sectional survey was conducted in Japan from October-November 2020, June-July 2021, and June-July 2022 using an anonymous questionnaire. Trends of emotional/behavioral problems (e.g., emotional symptoms, hyperactivity/inattention, and total difficulties) and poor help-seeking were tested using a chi-squared test with Bonferroni correction. The effects of sociodemographic factors (grade, gender, country of origin, and number of parents) on emotional/behavioral problems and poor help-seeking were examined by two mixed-effect logistic regression models: (1) with fixed effects for years and sociodemographic factors and (2) stratified by years if the interaction terms between years and each sociodemographic factor were significant.

RESULTS

The prevalence of total difficulties and emotional symptoms was the highest in 2021. The number of adolescents reporting hyperactivity/inattention and poor help-seeking increased between 2020 and 2021 and remained high in 2022. Inequalities in emotional/behavioral problems and poor help-seeking behavior were found with respect to all sociodemographic factors.

DISCUSSION

Despite the persistent emotional/behavioral problems, the results suggested that the number of adolescents who were unable to seek help increased during the COVID-19 pandemic. Additionally, heterogeneities in the trends with respect to grade, gender, country of origin, and number of parents were detected. Prioritized supports targeting those with sociodemographic disadvantages may be needed to mitigate these inequalities in response to the pandemic.

The Effects of COVID-19 on the Mental Health of Children and Adolescents: A Review

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has profoundly affected global health and well-being. As part of the Coronaviridae family, SARS-CoV-2 joins a diverse group of viruses found in both humans and various animal species, including bats, camels, and cats. The pandemic has led to widespread social isolation, reduced physical activity, and significant lifestyle changes, posing potential risks to individuals' mental and emotional health. This review aims to explore the implications of COVID-19 on the mental health of children and adolescents, given the limited attention this population has received in the medical literature. Multiple research studies in several countries have found that the COVID-19 pandemic is associated with greater stress levels, depression, anxiety, insomnia, drug misuse, and other mental health challenges among young individuals. Understanding the long-term effects of the pandemic on mental health is crucial for developing effective interventions and support systems to promote resilience and well-being in children and adolescents. Even after the pandemic ends, it is crucial to prioritize understanding the long-term impacts of the pandemic on mental health, integrating findings into public health strategies, addressing mental healthcare disparities, and fostering resilience in children and adolescents. Achieving these objectives requires collaborative efforts across various sectors to ensure equitable access to mental health resources and the implementation of sustainable solutions for the well-being of young people in the aftermath of the pandemic.

A Dangerous Curve: Impact of the COVID-19 Pandemic on Brace Treatment in Adolescent Idiopathic Scoliosis

STUDY DESIGN

Observational Cohort study.

OBJECTIVES

We aim to document the abandon and irregular compliance rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression.

METHODS

We reviewed a database of AIS patients recruited between March and September 2020. We included AIS patients under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with self-reported Good-Compliance (GC) to treatment and those who had a Bad-Compliance (BC). Data analysis included biometric and radiographic data at first visit and last follow-up and percentage of progression. Unpaired student-t tests and Chi2 were used for comparison.

RESULTS

152 patients met inclusion criteria. 89 patients (age:12.1y.o.±1.4) reported good adherence to treatment, while 63 patients (age:12.7y.o.±1.8) were not compliant. Within the BC group, 18 patients reported irregular brace wear, while 45 had completely abandoned treatment (abandon rate of 29%). The GC cohort started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +.65°±7.5; mean progression rate was -4.6%. However, the BC cohort started with a mean MT curve of 27° and finished with 32°, with a mean increase of +5°±8 and a mean progression rate of -13%. The differences between the 2 cohorts were statistically significant (P = .0002). Six patients from the BC group progressed and were offered surgery.

CONCLUSION

The abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates.

LEVEL OF EVIDENCE

III.

Depression, anxiety, lower sleep quality and social support in square cabin hospitals during Shanghai's COVID-19 lockdown, China

Objectives

To investigate and compare the associated factors of depression, anxiety, and other psychological differences between patients with Corona Virus Disease 2019 quarantined in square cabin hospitals (SCH) and isolation wards (IW) in China.

Methods

Cluster sampling method was performed during Shanghai's Two-Month Lockdown in 2022. Hospital Anxiety and Depression Scale Depression subscale (HADS-D), 7-tiem Generalized Anxiety Disorder Scale (GAD-7), Pittsburgh sleep quality index (PSQI), and Perceived Social Support Scale (PSSS) were used to investigate psychological differences.

Results

The HADS-D and GAD-7 scores of SCH patients were significantly higher than those in IW (p < 0.001; p = 0.0295). Sleep latency (SCH-IW = -3.76, p < 0.001), sleep duration (SCH-IW = -2.22, p < 0.05), habitual sleep efficiency (SCH-IW = -4.11, p < 0.001), sleep disturbance (SCH-IW = -3.59, p < 0.001) and use of sleep medication (SCH-IW = -5.18, p < 0.001) of SCH patients were significantly worse. Depression was the main emotional problem of quarantined patients. Patients in SCH had lower social support. Sleep disorders and the lowest oxygen saturation ≤ 93% were risk factors for depression, while social support and child status were protective factors. Myalgia and constipation were risk factors for anxiety, while marital status was the protective factor.

Conclusion

Patients quarantined in SCH had higher risks of depression and anxiety, lower sleep quality and social support. Somatic discomfort and sleep disorders exacerbated depression and anxiety, which could be ameliorated by social support and taken into consideration in future SCH construction.

Social experiences and youth psychopathology during the COVID-19 pandemic: A longitudinal study

The early stages of the COVID-19 pandemic and associated stay-at-home orders resulted in a stark reduction in daily social interactions for children and adolescents. Given that peer relationships are especially important during this developmental stage, it is crucial to understand the impact of the COVID-19 pandemic on social behavior and risk for psychopathology in children and adolescents. In a longitudinal sample (N=224) of children (7-10y) and adolescents (13-15y) assessed at three strategic time points (before the pandemic, during the initial stay-at-home order period, and six months later after the initial stay-at-home order period was lifted), we examine whether certain social factors protect against increases in stress-related psychopathology during the pandemic, controlling for pre-pandemic symptoms. Youth who reported less in-person and digital socialization, greater social isolation, and less social support had worsened psychopathology during the pandemic. Greater social isolation and decreased digital socialization during the pandemic were associated with greater risk for psychopathology after experiencing pandemic-related stressors. In addition, children, but not adolescents, who maintained some in-person socialization were less likely to develop internalizing symptoms following exposure to pandemic-related stressors. We identify social factors that promote well-being and resilience in youth during this societal event.

Risk Factors and Trends in Adolescent's Suicide Attempt Rates Before and After the Coronavirus Disease 2019 Pandemic

BACKGROUND

Understanding adolescents' mental health during the coronavirus disease 2019 (COVID-19) pandemic and identifying those most at risk is an urgent public health challenge. This study explored the trend of suicide attempts and the association between loneliness, family financial stress, and suicide attempts during the COVID-19 pandemic among adolescents.

METHODS

Data of the 2020 to 2022 Korea Youth Risk Behavior Surveys for adolescents aged 13-18 years were used. Multivariate logistic regression analyses were performed to examine the association between suicide attempts, family financial stress, and loneliness during the COVID-19 pandemic.

RESULTS

The trend of suicide attempt rates was lowest in 2020 (1.9%, 1,034 out of 53,534) and it showed an increasing trend with rates of 2.2% (1,159 out of 53,445) in 2021 and 2.5% (1,271 out of 50,455) in 2022. The risk of suicide attempt was higher among adolescents who experienced financial stress (in 2020: adjusted odds ratio [AOR], 1.53, 95% confidence interval [CI], 1.26-1.88; in 2021: AOR, 1.63, 95% CI, 1.03-1.54) and felt lonely (in 2020: AOR, 2.19, 95% CI, 1.78-2.70; in 2021: AOR, 2.65, 95% CI, 2.16-3.26; in 2022: AOR, 1.3, 95% CI, 1.04-1.55) than those who did not.

CONCLUSION

The COVID-19 pandemic affected the suicide attempts of adolescents, with financial stress and feelings of loneliness closely linked to this impact. Although the pandemic nears its end, the persistent risk of suicide attempts among adolescents remains a concern. Therefore, it is imperative to implement targeted screening and interventions to address adolescent suicide risk.

A Survey Study on the Factors Affecting Breastfeeding Self-Efficacy Among Postpartum Women in Mother-Infant Separation Wards

Background

Self-efficacy serves as a crucial predictor for successful breastfeeding. The standard practice in maternal wards is mother-baby rooming-in, which is believed to enhance breastfeeding rates post-delivery. However, in certain maternal wards, mother-baby separation continues to occur due to diverse factors.

Objectives

The objective of this study is to examine the self-efficacy levels of mothers in mother-infant separation wards and identify the factors that influence their self-efficacy.

Methods

A cross-sectional study was undertaken in 2022 at a hospital in Macau, involving 290 postpartum women in mother-infant separation wards. A self-designed questionnaire encompassing demographic details and breastfeeding information was utilized. Additionally, the Chinese version of the Breastfeeding Self-Efficacy Scale (BSES) and the Social Support Scale (SSRS) were employed. SPSS26.0 software was used to analyze the data. p < .05 indicated statistically significant differences.

Results

The average breastfeeding self-efficacy score among the women was 96.03 ± 23.07, which accounted for 64% of the total score. The factors influencing breastfeeding self-efficacy were ranked based on their impact power as follows: previous experience of breastfeeding, intended length of breastfeeding, employment status, and the number of breastfeeding sessions during hospitalization after childbirth (p < .05). These four factors collectively explained 34.7% (R2 = 0.347) of the variations in breastfeeding self-efficacy scores. A weak but positive correlation was observed between postpartum women's breastfeeding self-efficacy and social support for the mothers (r = .341, p < .001).

Conclusion

The breastfeeding self-efficacy scores of postpartum women were found to be at a moderate level. Mother-infant separation during the postpartum period has an impact on breastfeeding self-efficacy, but the impact can be managed. When developing programs to enhance postpartum mothers' breastfeeding self-efficacy, it is important to consider their individual and social circumstances, as well as the advantages and disadvantages associated with mother-infant separation during the postpartum period.

Assessing the health, social, educational and economic impact of the COVID-19 pandemic on adolescents in low- and middle-income countries: a rapid review of the literature

COVID-19 has caused profound health, social, educational and economic devastation around the world, especially among the lives of adolescents in low- and middle-income countries. This paper looks at a wide array of outcomes impacting adolescents' daily lives including health (mental, physical, sexual and reproductive health, vaccine perceptions and overlap between these topics), social relationships (family and peer), education and socio-economic disparities. Both scientific and grey literature between December 2019 and February 2022 were sought from PubMed, Google Scholar and organisations conducting research among adolescents, and coded. A total of 89 articles were included, 73% of which were peer-reviewed; 37% of the articles were from WHO's Western Pacific region; 62% of the articles were cross-sectional; 75% were quantitative. Three major topics emerged in more than half the articles: mental health (72%), education (61%) and socio-economic ramifications (55%). However, there were regional differences in topics and many of them overlapped. The results indicate that, where there has been research, almost all findings have been linked to worse mental health during the pandemic. Overall, remote education was seen as a negative experience. The ramification of school closures on future aspirations, in particular early school leaving, highlights the importance of prioritising education during future pandemics based on the situation within the country. Gender and other disparities have made marginalised adolescents vulnerable to the economic ramifications of containment measures. Given the risks identified, there is a pressing need to put adolescents at the centre of establishing priorities for their health agenda for post-pandemic recovery.

The impact of COVID-19 and the confinement on the secondary level students of the Eastern region of Morocco

Context

In March 2020, Morocco announced the first COVID-19 case and implemented preventive measures, including home confinement.

Aims

Monitoring the psychological effects and prevalence among high- and middle-school students.

Settings and Design

This study is cross-sectional, carried online.

Methods and Materials

The survey was conducted by publishing an online questionnaire between May 14, 2020 and June 14, 2020, which included inquiries about socio-demographic data, the conditions of home confinement, activities carried out during confinement, and medical history and sleep patterns. To assess depressive disorder, anxiety disorders, and stress, the survey employed the "DSRS-c," "SCARED," and "PSS10" scales, respectively.

Statistical Analysis Used

Data were received on Google forms coded by Excel 2010 and analyzed by IBM SPSS Statistics 22.

Results

Out of the 689 participants, 73.7% were females; the mean age was 16.08 years (standard deviation 1.48). 94.8% of subjects reported changes in sleep habits, and 41.4% of adolescents had high levels of depressive symptoms, while 50.7% had high levels of anxiety symptoms. Several factors were significantly associated with anxiety and depressive symptoms, including being a girl (P = 0.000), being a high-school student (P = 0.011), economic struggles during the pandemic (P = 0.003), doubting the necessity of home confinement (P = 0.000), spending over 3 hours a day on social networks and video games (P = 0.000), dropping out of remote learning (P = 0.000), having a psychiatric history (P = 0.000), having chronic illnesses in the family (P = 0.002), and changes in sleep habits (P = 0.000).

Conclusions

The study found high prevalence of depression, anxiety, and stress symptoms among students during the pandemic, emphasizing the need for mental health awareness and support.

Relationship between perceived social support and mental health among Chinese college football athletes: a moderated mediation model

Previous researches have confirmed that perceived social support has a profound effect on individuals' mental health. However, the effects and potential mechanisms of perceived social support on mental health of college athletes are still largely unknown, especially during and after the COVID-19 pandemic. Thus, the aim of this study was to explore the relationship between perceived social support and mental health in college football athletes, and to evaluate whether hopelessness and psychological pressure affected this relationship. A sample of 672 Chinese college football athletes (37.9% girls; Mage = 20.43 years; SDage = 1.68) were investigated with the Perceived Social Support Scale (PSSS), the Kessler Psychological Distress Scale (K10), the Beck Hopelessness Scale (BHS) and the Perceived Stress Scale (PSS). Surveys were voluntary and anonymous. The findings revealed that, after adjusting for demographic factors, hopelessness mediated the relationship between Chinese college football athletes' perceived social support and their mental health. Furthermore, psychological pressure moderated the negative association between perceived social support and hopelessness, and the association was stronger for them with high-level psychological pressure. These results underline the need for focused strategies in the prevention and treatment of mental health issues among Chinese college football athletes.

Social networks and the mental health among Chinese older adults: the mediating role of loneliness and moderating role of Internet use

Background

Although a large body of research suggests that social networks from family and friends are important factors in protecting the mental health of older adults, we know little about the mediating and moderating mechanisms behind this relationship. Using China as an example, this study aims to investigate a comprehensive model that includes social networks, loneliness, Internet use, and mental health outcomes in the older population.

Methods

We analyzed data from 7,648 Chinese older people over 60 using the 2018 CLASS survey. We studied how various social networks affect their mental health. Using SPSS's PROCESS macro, we first employed descriptive statistics to examine the characteristics of the participants and calculate the correlations of core variables. Then, we assessed whether loneliness mediated this relationship and tested the moderated mediation effect of Internet use. Our findings shed light on these complex dynamics.

Results

The statistics indicate a positive correlation between social networks and mental health. Furthermore, mediation models revealed that loneliness moderates the relationship between social networks and mental health. In addition, moderated mediation models revealed that Internet use played a distinct function in the family networks model compared to the friend networks model. Internet use moderates explicitly the effects of family networks on loneliness and friend networks on mental health.

Conclusion

The findings emphasize the importance of differentiating the types of social networks to understand their impact on older adults well-being, encouraging policymakers, medical professionals, and families to adopt more targeted approaches when devising policy interventions and medical strategies, especially for older individuals with insufficient social support. Additionally, we urge governments to recognize the varying types of social networks among older populations and harness the protective effects of Internet technology on their well-being within a digital society.

A review of mental health disparities during COVID-19: Evidence, mechanisms, and policy recommendations for promoting societal resilience

Social and economic inequality are chronic stressors that continually erode the mental and physical health of marginalized groups, undermining overall societal resilience. In this comprehensive review, we synthesize evidence of greater increases in mental health symptoms during the COVID-19 pandemic among socially or economically marginalized groups in the United States, including (a) people who are low income or experiencing homelessness, (b) racial and ethnic minorities, (c) women and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) communities, (d) immigrants and migrants, (e) children and people with a history of childhood adversity, and (f) the socially isolated and lonely. Based on this evidence, we propose that reducing social and economic inequality would promote population mental health and societal resilience to future crises. Specifically, we propose concrete, actionable recommendations for policy, intervention, and practice that would bolster five "pillars" of societal resilience: (1) economic safety and equity, (2) accessible healthcare, including mental health services, (3) combating racial injustice and promoting respect for diversity, equity, and inclusion, (4) child and family protection services, and (5) social cohesion. Although the recent pandemic exposed and accentuated steep inequalities within our society, efforts to rebuild offer the opportunity to re-envision societal resilience and policy to reduce multiple forms of inequality for our collective benefit.

Anxiety in Children and Adolescents in the Covid-19 Pandemic: A Systematic Review

The aim of this study was; to define the anxiety and anxiety-related factors experienced by children/adolescents during the Covid-19 pandemic on a global scale. Study data were collected between 15.04.2021 and 30.04.2021 by using keywords (child, children, adolescents, adolescents, mental health, anxiety, anxiety and stress) in Turkish and English. The data sources of this study are PubMed, Web of Science, and Google Scholar t. As a result of the evaluations, a total of n=6185 articles were reached from all databases. After the evaluation of the full texts, the study was completed with n=31 articles. Eleven of the articles evaluated in this study were published in China. The anxiety prevalence of children and adolescents varies between 1.84-45.0%. As a result of the evaluated studies; It has been observed that women, those with chronic-psychiatric diseases, those who are older, separated from family members, migrant children and adolescents are more likely to experience anxiety. Some of the anxiety symptoms of children and adolescents are nervousness, irritability, anxiety, and suicidal ideation. In conclusion, anxiety levels and anxiety-related factors of children and adolescents living in various countries of the world during the Covid-19 pandemic were determined.

Associations over the COVID-19 pandemic period and the mental health and substance use of youth not in employment, education or training in Ontario, Canada: a longitudinal, cohort study

BACKGROUND

The economic shutdown and school closures associated with the COVID-19 pandemic have negatively influenced many young people's educational and training opportunities, leading to an increase in youth not in education, employment, or training (NEET) globally and in Canada. NEET youth have a greater vulnerability to mental health and substance use problems, compared to their counterparts who are in school and/or employed. There is limited evidence on the association between COVID-19 and NEET youth. The objectives of this exploratory study included investigating: longitudinal associations between the COVID-19 pandemic and the mental health and substance use (MHSU) of NEET youth; and MHSU among subgroups of NEET and non-NEET youth.

METHODS

618 youth (14-28 years old) participated in this longitudinal, cohort study. Youth were recruited from four pre-existing studies at the Centre for Addiction and Mental Health. Data on MHSU were collected across 11 time points during the COVID-19 pandemic (April 2020-August 2022). MHSU were measured using the CoRonavIruS Health Impact Survey Youth Self-Report, the Global Appraisal of Individual Needs Short Screener, and the PTSD Checklist for DSM-5. Linear Mixed Models and Generalized Estimating Equations were used to analyze associations of NEET status and time on mental health and substance use. Exploratory analyses were conducted to investigate interactions between sociodemographic characteristics and NEET status and time.

RESULTS

At baseline, NEET youth were significantly more likely to screen positive for an internalizing disorder compared to non-NEET youth (OR = 1.92; 95%CI=[1.26-2.91] p = 0.002). No significant differences were found between youth with, and without, NEET in MHSU symptoms across the study time frame. Youth who had significantly higher odds of screening positive for an internalizing disorder included younger youth (OR = 1.06, 95%CI=[1.00-1.11]); youth who identify as Trans, non-binary or gender diverse (OR = 8.33, 95%CI=[4.17-16.17]); and those living in urban areas (OR = 1.35, 95%CI=[1.03-1.76]), compared to their counterparts. Youth who identify as White had significantly higher odds of screening positive for substance use problems (OR = 2.38, 95%CI=[1.72-3.23]) compared to racialized youth.

CONCLUSIONS

Our findings indicate that sociodemographic factors such as age, gender identity, ethnicity and area of residence impacted youth MHSU symptoms over the course of the study and during the pandemic. Overall, NEET status was not consistently associated with MHSU symptoms over and above these factors. The study contributes to evidence on MHSU symptoms of NEET youth.

Changes in physical activity level of adolescents and its relationship with mental health during regular COVID-19 prevention and control

PURPOSE

This study aimed to analyze the impact of regular prevention and control of COVID-19 on the physical activity level (PAL) of adolescents and the relationship between PAL and mental health.

METHODS

Using the convenience sampling method, two stages of the on-site cross-sectional investigation were conducted in 11 middle schools in Guiyang City in China. There were 1132 participants who completed the Physical Activity Questionnaire for old children (PAQ-C) in October 2020, and 1503 participants who completed the PAQ-C and Mental Health Inventory of Middle-school students (MMHI-60) in October 2021. All participants reported their demographic data. Descriptive, quantitative statistics were used for data analysis. One-way ANOVA was used to explore associations between PAL and mental health.

RESULTS

The results of statistical analysis showed a gradual yearly increase in the PAL of teenagers, and the PAL of male junior middle school students has a significant increase (p < .05); while that of adolescents in Grade 10 significantly decreased (p < .001). There is a statistically significant correlation between adolescents' mental health (except for anxiety) and PAL (p < .05). The overall abnormal rate of mental health was 27.9%; The PAL and the total mean score of mental health had a negative correlation (p < .001). There was a significant difference between mental health scores and corresponding PAL (p < .001). Furthermore, there are statistically significant differences in scores of mental health factors corresponding to varying PAL among junior high school students and male students (p < .05).

CONCLUSIONS

The regular epidemic prevention and control measures had significant adverse effects on the PAL of girls and high school adolescents, especially Grade 10 adolescents. Improving adolescents' PAL can promote their mental health. Interventions based on PAL slightly lower than the level recommended in the physical activity guidelines can bring significant mental health effects.

Contact with Nature in Social Deprivation during COVID-19: The Positive Impact on Anxiety

The 2019 outbreak of the novel coronavirus disease (COVID-19) had a devastating impact on millions of people worldwide. Following the constantly changing course of the pandemic, the Italian government massively restricted public and private life to prevent the further spread of the virus. Unfortunately, lockdown policies negatively impacted many people's mental and physical health. Numerous studies recognized an essential role of urban green areas in promoting human well-being. The present study aims to evaluate the effect of personal dispositions towards nature, measured using the connectedness to nature scale (CNS) and actual contact with green spaces (CwN) on human well-being (i.e., anxiety) and medicine intake during COVID-19 lockdowns. A total of 637 Italian residents answered a survey aimed at gathering information about the above variables. A series of path analyses were performed. The results showed that the CNS was positively associated with the CwN, and the latter, in turn, was negatively associated with anxiety. Finally, anxiety was positively related to medicine intake. In sum, these results identify the positive role of person-nature relationships for individual well-being during COVID-19 restrictions.

Social connectedness at the playground before and after COVID-19 school closure

Social connectedness at school is crucial to children's development, yet very little is known about the way it has been affected by school closures during COVID-19 pandemic. We compared pre-post lockdown levels of social connectedness at a school playground in forty-three primary school-aged children, using wearable sensors, observations, peer nominations and self-reports. Upon school reopening, findings from sensors and peer nominations indicated increases in children's interaction time, network diversity and network centrality. Group observations indicated a decrease in no-play social interactions and an increase in children's involvement in social play. Explorative analyses did not reveal relations between changes in peer connectedness and pre-lockdown levels of peer connectedness or social contact during the lockdown period. Findings pointed at the role of recess in contributing to children's social well-being and the importance of attending to their social needs upon reopening.

Brief Report: The Influence of the COVID-19 Pandemic on the Physical, Social, and Mental Health of Black and Latinx Young People With HIV in the United States

BACKGROUND

Whereas national attention has been paid to the ongoing mental health crises among young people triggered by the COVID-19 pandemic, less is known about the social, physical and psychological impacts of COVID-19 on young people living with HIV, especially racial/ethnic minorities.

SETTING

Online survey of participants across the U.S.

METHOD

A national cross-sectional survey of non-Latinx Black and Latinx young adults (18-29) living with HIV. Between April and August 2021, participants answered survey questions about several domains (eg, stress, anxiety, relationships, work, quality of life) that were worsened, improved, or unchanged during the pandemic. We ran a logistic regression estimating the self-reported impact of the pandemic on these domains between 2 age groups (ages 18-24 versus 25-29).

RESULTS

The sample size was 231 (186 non-Latinx Black, 45 Latinx) and mainly male (84.4%) and gay identified (62.2%). Nearly 20% of participants were 18-24 years old and 80% were ages 25-29. Participants who were 18-24 years old reported 2-3 times the odds for having worse sleep quality and mood and greater stress, anxiety, and weight gain compared with those 25-29 years old.

CONCLUSION

Our data provide a nuanced picture of the negative impacts that COVID-19 had on non-Latinx Black and Latinx young adults living with HIV in the U.S. Given that these adults represent a priority population for HIV treatment outcomes, it is critical to better understand the ongoing toll that these dual pandemics have on their lives.

Changes in depressive and anxiety symptoms during COVID-19 in children from the PROGRESS cohort

BACKGROUND

We assessed associations between maternal stress, social support, and child resiliency during the COVID-19 pandemic in relation to changes in anxiety and depression symptoms in children in Mexico City.

METHODS

Participants included 464 mother-child pairs from a longitudinal birth cohort in Mexico City. At ages 8-11 (pre-COVID, 2018-2019) and 9-12 (during COVID, May-Nov 2020) years, depressive symptoms were assessed using the child and parent-reported Children's Depressive Inventory. Anxiety symptoms were assessed using the child-reported Revised Manifest Anxiety Scale. Linear regression models were used to estimate associations between maternal stress, social support, and resiliency in relation to changes in depressive and anxiety symptoms. We additionally assessed outcomes using clinically relevant cut-points. Models were adjusted for child age and sex and maternal socioeconomic status and age.

RESULTS

Higher continuous maternal stress levels during the COVID-19 pandemic were associated with increases in depressive symptoms (β: 0.72; 95% CI: 0.12, 1.31), and higher odds of clinically relevant depressive and anxiety symptoms in the children.

CONCLUSIONS

Maternal stress during the pandemic may increase mental health symptoms in pre-adolescent children. Additional studies are needed that examine the long-term pandemic-related impacts on mental health throughout the adolescent years.

IMPACT

In this longitudinal cohort study of children in Mexico City, we observed that depressive symptoms were higher from before to during the pandemic. Maternal stress surrounding the pandemic may increase mental health symptoms in pre-adolescent children. Child resiliency may help to protect against pandemic-related stressors.

Socioeconomic factors, perceived stress, and social support effect on neonatal nurse burnout in China: a cross-sectional study

BACKGROUND

Neonatal nurses' working environments are highly stressful, and burnout is common. This study examines the effect of socioeconomic factors, perceived stress, and social support on neonatal nurse burnout.

METHODS

A total of 311 neonatal nurses participated in this study. They were administered a validated Maslach Burnout Inventory. The study employed a 14-item perceived stress scale (PSS-14) and a social support rate scale (SSRS) to examine stress, socioeconomic factors, and lifestyles.

RESULTS

Of the neonatal nurses, 40.19% had burnout, 89.60% had mild burnout, and 10.40% had moderate burnout; no neonatal nurse experienced severe burnout. Young nurses and those with low technical skills, poor interpersonal relationships, irregular diet, and insufficient rest were exposed to burnout (all p < 0.05).Most burnout nurses experienced moderate-severe perceived stress, and their PSS-14 scores were higher (all p < 0.05).The scores for objective social support, subjective social support, utilization of social support, total SSRS scores, and the level of social support were all lower in burnout nurses (all p < 0.05). Perceived stress was correlated positively and significantly with emotional exhaustion and personal accomplishment (all p < 0.05). Social support correlated significantly with and reduced personal accomplishments (p < 0.05). Age, poor interpersonal relationships, perceived stress, and social support were all independent factors associated with neonatal nurse burnout (all p < 0.05).

CONCLUSION

The prevalence of burnout in neonatal nurses was higher than average. Socioeconomic factors, higher perceived stress, and lower social support contribute to neonatal nurse burnout. Nursing managers should pay attention to socioeconomic factors, perceived stress, and social support among neonatal nurses and employ strategies to reduce neonatal nurse burnout.