The effect of early trauma on North Korean refugee youths' mental health: Moderating effect of emotional regulation strategies

Moderated mediation analyses: Exploring the complex pathways between school bullying and suicidal ideation among vocational school students in China

BACKGROUND

School bullying can affect adolescent suicidal ideation (SI), but the mediating and moderating effects behind this association are still unclear, especially for students in vocational schools.

OBJECTIVE

This study explored the relationship between school bullying and suicidal ideation (SI) among vocational school students in China, and it constructs a moderated mediation model to examine the mediating effects of physical anhedonia (PA) and social anhedonia (SA), as well as the moderating effects of cognitive reappraisal (CR) and expressive suppression (ES).

PARTICIPANTS AND SETTING

Convenience sampling was conducted. The sample included 13,675 vocational school students (57.7 % female) with an average age of 15.88 years (ranging from 13 to 21) from 13 vocational schools in Hainan Province, China.

METHODS

Participants completed questionnaires on demographics, school bullying, PA, SA, CR, ES, and SI.

RESULTS

The results showed that the prevalence rates of PA, SA, and SI among bullied students were significantly higher (40.7 %, 37.8 %, and 34.0 %, respectively). Mediation analysis revealed that school bullying had a significant indirect effect on SI through PA and SA (accounting for 42.4 % of the total effect), with SA being the key mediator. Moderated mediation analysis confirmed that CR moderated the mediating effects of school bullying via PA/SA on SI, and ES moderated the mediating effects of school bullying via SA on SI. ES did not moderate the relationship between school bullying and SA in the female group.

CONCLUSION

School bullying induces SI by impacting PA and SA, and CR and ES moderate this process. This provides theoretical support for developing effective intervention measures to alleviate the negative impact of bullying on mental health.

The important role of mothers during displacement: Direct and indirect effects of the refugee context on Syrian refugee children's mental health

Refugee children are at increased risk for mental health problems, including post-traumatic stress, depression, and externalizing problems. The refugee environment, maternal mental health, and parenting may reduce or exacerbate that risk. This study investigated their direct and indirect associations with child mental health cross-sectionally in a sample of Syrian refugee child-mother dyads in Lebanon in 2017-19. Mediating pathways were tested using structural equation modeling with 1446 dyads (child: Mage = 11.39, 52.1% females) and again 1 year later with 872 (child: Mage = 12.17, 53.1% females) of the original sample. Mediating pathways from the refugee environment through maternal mental health and parenting to child outcomes were detected, emphasizing the importance of a holistic approach to refugee mental health.

The role of self-esteem and emotion regulation in the associations between childhood trauma and mental health in adulthood: a moderated mediation model

BACKGROUND

High levels of childhood trauma (CT) have been observed in adults with mental health problems. Herein, we investigated whether self-esteem (SE) and emotion regulation strategies (cognitive reappraisal (CR) and expressive suppression (ES)) affect the association between CT and mental health in adulthood, including depression and anxiety symptoms.

METHODS

We performed a cross-sectional study of 6057 individuals (39.99% women, median age = 34 y), recruited across China via the internet, who completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Childhood Trauma Questionnaire (CTQ), Self-esteem Scale (SES), and Emotion Regulation Questionnaire (ERQ). Multivariate linear regression analysis and bias-corrected percentile bootstrap methodologies were used to assess the mediating effect of SE, and hierarchical regression analysis and subgroup approach were performed to examine the moderating effects of emotion regulation strategies.

RESULTS

After controlling for age and sex, we found that (1) SE mediated the associations between CT and depression symptoms in adulthood (indirect effect = 0.05, 95% confidence interval [CI]: 0.04-0.05, 36.2% mediated), and CT and anxiety symptoms in adulthood (indirect effect = 0.03, 95% CI: 0.03-0.04, 32.0% mediated); (2) CR moderated the association between CT and SE; and (3) ES moderated the association between of CT and mental health in adulthood via SE, and such that both the CT-SE and SE-mental health pathways were stronger when ES is high rather than low, resulting the indirect effect was stronger for high ES than for low ES.

CONCLUSIONS

These findings suggested that SE plays a partially mediating role in the association between CT and mental health in adulthood. Furthermore, ES aggravated the negative effect of CT on mental health in adulthood via SE. Interventions such as emotional expression training may help reduce the detrimental effects of CT on mental health.

TRIAL REGISTRATION

The study was registered on http://www.chictr.org.cn/index.aspx and the registration number was ChiCTR2200059155.

The effect of perceived stress on depression in college students: The role of emotion regulation and positive psychological capital

Introduction

College students have become a high prevalence group and vulnerable group of depression. The present study aims to explore the effect of perceived stress on depression in a sample of Chinese college students and proposes that both emotion regulation and positive psychological capital play a moderating role between the two, so as to provide rational intervention for the prevention of potential depression among college students.

Method

In this study, 1,267 college students (46.4% female) from a university in western China were selected for the study using a whole-group convenience sampling method.

Results

After controlling for gender, this study found that both cognitive reappraisal and positive psychological capital positively moderated the relationship between perceived stress and depression, and both significantly inhibited depression in high and low stress perceivers, and the inhibitory effect was more pronounced in high stress perceivers, but expression inhibition did not moderate the relationship between perceived stress and depression.

Discussion

The results suggest that college students can be helped to cope with the negative effects of perceived stress on depression by increasing the frequency of their use of cognitive reappraisal strategies and encouraging the accumulation of positive psychological capital. This study provides theoretical and practical implications for rational interventions for depression among college students.

Childhood maltreatment and impulsivity in offenders: Examining the mediating roles of self-compassion and cognitive reappraisal

BACKGROUND

The higher impulsivity of offenders in prison is a challenge for prison intervention. Childhood maltreatment, one of the factors closely related to the generation and development of impulsivity, is also prevalent in offenders. Therefore, it is critical to investigate the underlying paths that generate impulsivity in offenders who have experienced childhood abuse.

OBJECTIVE

Targeting positive protective factors, this study aimed to probe the mediating roles of self-compassion and cognitive reappraisal in the relationship between childhood maltreatment and impulsivity in offenders.

METHODS

The participants included 2643 offenders, 1534 males and 1109 females. Each participant completed the appropriate questionnaires to measure childhood maltreatment, impulsivity, self-compassion, and cognitive reappraisal. The PROCESS macro was used to perform the mediation analysis and hypothesis testing.

RESULTS

The findings showed that childhood maltreatment indirectly affected offenders' impulsivity through self-compassion and cognitive reappraisal, and the mediating effect of self-compassion was stronger than that of cognitive reappraisal. Further analyses found that sexual abuse indirectly affected impulsivity through self-compassion, and the remaining types of childhood maltreatment were associated with impulsivity in indirect pathways through self-compassion and cognitive reappraisal.

CONCLUSIONS

The results suggest that reinforcing practical training in self-compassion and cognitive reappraisal, especially the former, might facilitate the reduction of impulsive symptoms among offenders with backgrounds of childhood maltreatment.

War-related trauma linked to increased sustained attention to threat in children

Experiences of war and displacement can have profound effects on children's affective development and mental health, although the mechanism(s) underlying these effects remain unknown. This study investigated the link between early adversity and attention to affective stimuli using a free-viewing eye-tracking paradigm with Syrian refugee (n = 31, M_age  = 9.55, 12 female) and Jordanian non-refugee (n = 55, M_age  = 9.98, 30 female) children living in Jordan (March 2020). Questionnaires assessed PTSD, anxiety/depression, insecurity, distress, and trauma. Refugee children showed greater initial avoidance of angry and happy faces compared to non-refugee children, and higher trauma exposure was linked to increased sustained attention to angry stimuli. These findings suggest that war-related trauma may have differential effects on the early and later stages of affective processing in refugee children.

Psychometric Properties of the Korean version of the Emotion Regulation Questionnaire (K-ERQ) in a Clinical Sample

OBJECTIVE

The Emotion Regulation Questionnaire (ERQ) is one of the widely used instruments to assess emotion regulation skills in many countries, including Korea. However, its psychometric properties have not been validated within this population. Also, the ERQ has increasingly been used in studies with psychiatric patients despite a general lack of validation in clinical settings. Therefore, the present study aimed to investigate the psychometric properties of the Korean version of the ERQ (K-ERQ) using a clinical sample in Korea.

METHODS

One hundred and ninety-three psychiatric patients completed a packet of self-report measures, including K-ERQ, K-BDI-II, K-ASI-3, PCL-5-K, AUDIT-K. Confirmatory factor analysis (CFA) was administered to investigate the factor structure of the K-ERQ, and internal reliability and validity were examined.

RESULTS

Results of the CFA supported the two-factor structure, but only after the removal of one item. The K-ERQ showed good internal consistency reliability, and its concurrent validity was also confirmed. Cognitive reappraisal was negatively correlated with depression and alcohol use disorder-related symptoms, and expressive suppression was positively correlated with depression, anxiety sensitivity, posttraumatic stress disorder (PTSD)-related symptoms and alcohol use disorder-related symptoms. Significant group differences were found in the use of emotion regulation strategies; patients with PTSD reported the higher level of cognitive reappraisal than patients with depressive disorders, bipolar disorders, and attention-deficit hyperactivity disorder.

CONCLUSION

The 9-itemed K-ERQ is a reliable and valid tool to assess the emotion regulation strategies in a Korean clinical sample. Our study also adds preliminary evidence on the usefulness of the ERQ in clinical settings.

The relationship between childhood trauma and depressive symptom among Zhuang adolescents: Mediating and moderating effects of cognitive emotion regulation strategies

BACKGROUND

Not all adolescents who have endured childhood trauma will develop depressive symptom, nor will they all experience the same level of depressive symptom. According to previous research, cognitive emotion regulation strategies may explain a portion of the variance. Observe the connection between childhood trauma and depressive symptom and investigate whether cognitive emotion regulation strategies mediate or moderate this association.

METHODS

In October 2019, a cross-sectional study measuring childhood trauma, cognitive emotion regulation strategies, and depressive symptom among Zhuang adolescents was done in one senior high school and two junior highs in Chongzuo, Guangxi, China, using a self-report questionnaire. To examine the hypothesis of mediating and moderating effects, SPSS PROCESS was utilized.

RESULTS

In this study, there was a positive relationship between childhood trauma and depressive symptom, whereas there were positive correlations between expressive suppression and childhood trauma and depressive symptom (r = 0.380, 0.246, and 0.089, respectively, p < 0.01). The 5,000-sample bootstrap procedure revealed that the indirect relationship between the independent variable (childhood trauma or emotional abuse) and the dependent variable (depressive symptom) was statistically significant (β = 0.0154 95% CI: 0.0019, 0.0165, β = 0.0442 95% CI: 0.0008, 0.0117). The statistical significance of the interaction effect enhanced the R-square value of the moderating effect when the independent variable was the total childhood trauma score (ΔR2 = 0.0044, 0.0089).

CONCLUSIONS

Our findings corroborated the conclusion of prior research that cognitive emotion regulation strategies mediate and moderate the development of depressive symptom. Although we demonstrate that cognitive emotion regulation strategies play a mediating and moderating role in the relationships between childhood trauma and depressive symptom, the mediating effects on the relationships between the other types of childhood traumas, including physical abuse and neglect, sexual abuse, emotional neglect, and depressive symptom, did not emerge.

Refugee Children's Social-Emotional Capacities: Links to Mental Health upon Resettlement and Buffering Effects on Pre-Migratory Adversity

Refugee children who experience severe pre-migratory adversity often show varying levels of mental health upon resettlement. Thus, it is critical to identify the factors that explain which refugee children experience more vs. less healthy outcomes. The present study assessed child social-emotional capacities (i.e., emotion regulation, sympathy, optimism, and trust) as potential moderators of associations between child, parental, and familial pre-migratory adversities and child mental health (i.e., internalizing and externalizing symptoms) upon resettlement. Participants were N = 123 five- to 12-year-old Syrian refugee children and their mothers living in Canada. Children and mothers reported their pre-migratory adverse life experiences, and mothers reported their children's current social-emotional capacities, internalizing symptoms, and externalizing symptoms. Greater familial (i.e., the sum of children's and their mother's) pre-migratory adversity was associated with higher child internalizing and externalizing symptoms upon resettlement. Higher emotion regulation and optimism were associated with lower internalizing and externalizing symptoms, and higher sympathy was associated with lower externalizing symptoms. In contrast, higher trust was associated with higher internalizing symptoms. Finally, higher child optimism buffered against the positive association between familial pre-migratory adversity and child internalizing symptoms. In sum, select social-emotional capacities may serve as potential protective factors that support mental health and buffer against the deleterious effects of pre-migratory adversity in refugee children.

Factors Affecting Changes in the Mental Health of North Korean Refugee Youths: A Three-Year Follow-Up Study

This study identified factors affecting changes in depression of 64 North Korean refugee youths (NKRYs) aged 13 to 23 years (40 female) using follow-up data over a three-year period. We collected intrapersonal factors (emotional regulation strategies, resilience, quality of life) and external factors (psychological and practical support, family adaptation, and cohesion) to understand the preventative and risk factors affecting changes in depression. The trend of depression symptoms significantly increased, and the proportion of people classified as depressed (cut-off score = 21) increased steadily from 45.3% to 59.4% in the third year. In addition, we conducted a panel regression analysis, which showed that individual internal factors had a statistically significant effect on changes in depression. Specifically, expressive suppression of emotions was shown to increase depression over time. Resilience and life satisfaction were significant factors reducing depression in this study. On the other hand, external factors were not significantly related to changes over time in depression of NKRYs. Interventions for NKRYs at risk of depression are necessary and should include ways to enhance resilience and life satisfaction, and foster ego strength by recognizing emotions and promoting healthy emotional expression.

A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents

In the past decade, millions of children and adolescents have been forced to flee from protracted or newly erupted violent conflicts. Forcibly displaced children are particularly vulnerable for developing mental health problems. However, a timely and systematic review of the current evidence is lacking. We conducted a systematic review of factors contributing to the mental health of refugee children across different socio-ecological levels (individual, family, community, sociocultural). We systematically searched the databases Medline, PsycINFO, Web of Science, and Cochrane for English studies published in peer-reviewed journals between August 2010 and May 2020. Of the 2413 identified studies, 63 were included in the analyses. Only 24 studies were considered to be of high quality. Pre-migration individual (risk: exposure to war-related trauma, female gender) and post-migration family factors (risk: parental mental health problems and impaired parenting, protective: family cohesion) currently have the best evidence base. Post-migration community (protective: school connectedness, support by peers) and sociocultural factors (risk: discrimination and acculturative stress, protective: integrative acculturation) have gained some support in high-income settings. Prevention and intervention approaches should integrate factors across different socio-ecological levels. More longitudinal studies and research in low- and middle-income countries are needed to advance our knowledge on causal mechanisms behind factors contributing to refugee youth's mental health.

Trauma History and Mental Health of North Korean Defectors

Purpose of Review

This study aimed to review the mental health status of North Korean defectors (NKDs) and related factors. Interventions to promote their mental health and issues to be dealt with are also reviewed.

Recent Findings

NKDs are often exposed to multiple severely traumatic events, both in North Korea and surrounding their defection. Furthermore, they face sociocultural barriers in adapting to a new society. Past exposure to traumatic events, longer defection periods, forced repatriation, psychological factors, and acculturative stress such as perceived discrimination, low income, family violence, and health complaints contribute to negative effects on mental health and obstruct their adaptation to life in the Republic of Korea.

Summary

It is necessary to develop evidence-based programs to promote NKDs’ mental health and help them to adapt to their new society. An NKD cohort study would be helpful to reveal their long-term mental health prognoses and interactions with pre- and post-migration factors.