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Zhang J, Huang Z, Wang W, Zhang L, Lu H. Development and validation of a nomogram for predicting depressive symptoms in dentistry patients: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37635. [PMID: 38579067 PMCID: PMC10994422 DOI: 10.1097/md.0000000000037635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/26/2024] [Indexed: 04/07/2024] Open
Abstract
Depressive symptoms are frequently occur among dentistry patients, many of whom struggle with dental anxiety and poor oral conditions. Identifying the factors that influence these symptoms can enable dentists to recognize and address mental health concerns more effectively. This study aimed to investigate the factors associated with depressive symptoms in dentistry patients and develop a clinical tool, a nomogram, to assist dentists in predicting these symptoms. Methods: After exclusion of ineligible participants, a total of 1355 patients from the dentistry department were included. The patients were randomly assigned to training and validation sets at a 2:1 ratio. The LASSO regression method was initially employed to select highly influrtial features. This was followed by the application of a multi-factor logistic regression to determine independent factors and construct a nomogram. And it was evaluated by 4 methods and 2 indicators. The nomograms were formulated based on questionnaire data collected from dentistry patients. Nomogram2 incorporated factors such as medical burden, personality traits (extraversion, conscientiousness, and emotional stability), life purpose, and life satisfaction. In the training set, Nomogram2 exhibited a Concordance index (C-index) of 0.805 and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.805 (95% CI: 0.775-0.835). In the validation set, Nomogram2 demonstrated an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.810 (0.768-0.851) and a Concordance index (C-index) of 0.810. Similarly, Nomogram1 achieved an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.816 (0.788-0.845) and a Concordance index (C-index) of 0.816 in the training set, and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.824 (95% CI: 0.784-0.864) and a Concordance index (C-index) of 0.824 in the validation set. Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) indicated that Nomogram1, which included oral-related factors (oral health and dental anxiety), outperformed Nomogram2. We developed a nomogram to predict depressive symptoms in dentistry patients. Importantly, this nomogram can serve as a valuable psychometric tool for dentists, facilitating the assessment of their patients' mental health and enabling more tailored treatment plans.
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Affiliation(s)
- Jimin Zhang
- Department of Stomatology, No. 903 Hospital of PLA Joint Logistic Support Force (Xi Hu Affiliated Hospital of Hangzhou Medical College), Hangzhou, China
| | - Zewen Huang
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, China
| | - Wei Wang
- Department of Psychology, The Education University of Hong Kong, Tai Po, China
| | - Lejun Zhang
- School of Psychology, South China Normal University, Guangzhou, China
| | - Heli Lu
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Biserni C, De Groot BO, Fuermaier ABM, de Waard D, Enriquez-Geppert S. Post-COVID fatigue: Reduced quality-of-life associated with clinically relevant fatigue in mild disease courses. Neuropsychol Rehabil 2024:1-25. [PMID: 38380901 DOI: 10.1080/09602011.2024.2314874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/20/2023] [Indexed: 02/22/2024]
Abstract
Fatigue is a pervasive symptom experienced by many individuals after COVID-19. Despite its widespread occurrence, fatigue remains a poorly understood and complex phenomenon. Our aim is to evaluate the subjective experience of mental fatigue after COVID-19 and to assess its significance for daily life functioning. In this online questionnaire study (N = 220), the Fatigue Severity Scale (FSS), World Health Organization Quality-of-Life assessment (WHOQoL) and a subjective severity rating of the COVID-19 disease progression were used. For our statistical analyses we utilized independent samples t-tests, one-way ANOVA with post-hoc analyses, and a multiple regression. As expected our findings revealed the COVID group reported significantly higher levels of subjective fatigue compared to the control group. Moreover, there was a significant difference between experienced fatigue across the four severity groups. Participants who had a milder course of disease also experienced severe subjective fatigue. Subjective fatigue explained 40% variance in quality-of-life. In conclusion, severe subjective fatigue appears to be associated with increased self-reported COVID-19 symptom severity and lower quality-of-life but is already observable in milder cases. This underscores, firstly, the importance of considering also less severe cases and, secondly, the need to develop rehabilitation and psychological interventions for fatigue.
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Affiliation(s)
- Chiara Biserni
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Bob O De Groot
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Dick de Waard
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Stefanie Enriquez-Geppert
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
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Yang TW, Kim YS, Kim DH, Yeom JS, Kwon OY. Felt stigma proportion in people living with epilepsy: A systematic review. Seizure 2023; 111:87-97. [PMID: 37556985 DOI: 10.1016/j.seizure.2023.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Numerous inventories to identify felt stigma (FS) in people living with epilepsy (PLWE) have been developed. Past studies have mainly focused on the relationship between FS scores and clinical factors, making it challenging to delineate FS proportions and compare FS between groups. We aimed to integrate FS proportions in PLWE and compare them by continent. METHODS We searched MEDLINE, EMBASE, the Cochrane Library, Web of Science, and Scopus. Among the identified studies, we chose the ones providing an FS proportion measured by Jacoby's Stigma Scale (JSS) and its revised version (JSS-R) in PLWE. We applied the random-effects model. RESULTS A total of 63 datasets from 47 studies were included. There were 29,924 PLWE, with 14,323 of them experiencing FS. The overall FS proportion was 48.4%. Of these datasets, 51 used JSS, and 12 used JSS-R. The FS proportions were 44.9% for the former and 62.1% for the latter, with significant heterogeneity. In the intercontinental comparison with 51 datasets employing JSS, the difference in FS proportions was insignificant: 51.2% in Africa, 47.2% in Europe, 35.4% in Asia, and 28.8% in the Middle East. Furthermore, the meta-regression revealed that the year of each primary study did not influence the FS proportion. CONCLUSION Among PLWE, FS proportions depended on the choice of a measurement tool. When measured using JSS, the FS proportion was 44.9%, while it was 62.1% when evaluated with JSS-R. Even though the FS proportions were integrated differently, no substantial differences were observed between continents.
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Affiliation(s)
- Tae-Won Yang
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Young-Soo Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Do-Hyung Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Department of Pediatrics, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Oh-Young Kwon
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea; Institute of Medical Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
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Mail Gurkan Z, Sengul Y, Guven Ekiz T, Tantik Pak A. Effect of alexithymia and difficulty of emotion regulation, neuroticism, low extraversion, and suicidality on quality of life in epilepsy. Epilepsy Behav 2022; 135:108887. [PMID: 36037582 DOI: 10.1016/j.yebeh.2022.108887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The objective of this study was to investigate alexithymia, emotion dysregulation, suicidality, and personality traits in people with epilepsy (PWE) and to evaluate their effects on quality of life. MATERIALS AND METHODS Forty-six consecutive PWE and forty healthy control subjects (HC) were recruited for the study. Both PWE and HC were interviewed and completed the following questionnaires: Toronto Alexithymia Scale-20(TAS-20), Difficulties in Emotion Regulation Scale (DERS), Eysenck Personality Questionnaire, Suicidal Ideation Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, and Quality Of Life In Epilepsy-31. RESULTS TAS-20 and difficulty identifying feelings which was the subgroup of TAS-20, scores of total and non-acceptance, goals, impulse, strategies, and clarity subgroups of DERS were statistically significantly higher in PWE (p = 0.01, 0.004, 0.01, 0.07, 0.009, 0.06, 0.01, respectively). Considering the personality characteristics, neuroticism was more common in PWE, while extraversion was less common. Suicidal ideation and anxiety scores were higher in PWE than HC (p = 0.02, p = 0.003). Anxiety, suicidal ideation, neuroticism, alexithymia and emotion dysregulation had a negative relationship on quality of life. (r = -0.54, p < 0.001; r = -0.54, p < 0.001; r = -0.62, p < 0.001; r = -0.32, p = 0.02; r = -0.52, p < 0.001). CONCLUSION Difficulty identifying feelings, dysregulation of emotions especially nonacceptance, goals, impulse, strategies, and clarity are common in PWE. Anxiety, suicidal ideation, neuroticism, alexithymia, and emotion dysregulation had a negative impact on quality of life. Each of these are important for psychosocial wellbeing of our patients and must be questioned considering their effects on quality of life.
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Affiliation(s)
- Zahide Mail Gurkan
- Neurology Department of Gaziosmanpasa Training and Research Hospital, Gaziosmanpasa, Istanbul, Turkey.
| | - Yıldızhan Sengul
- Neurology Department of Çanakkale Onsekiz Mart University Çanakkale, Turkey
| | - Tugce Guven Ekiz
- Neurology Department of Gaziosmanpasa Training and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Aygul Tantik Pak
- Neurology Department of Gaziosmanpasa Training and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
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Noda Y, Asano K, Shimizu E, Hirano Y. The mediating effect of symptoms of posttraumatic stress disorder and depression on the relationship between personality traits and quality of life in emergency service workers. Compr Psychiatry 2022; 116:152327. [PMID: 35643052 DOI: 10.1016/j.comppsych.2022.152327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 05/07/2022] [Accepted: 05/13/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Emergency service workers are often exposed to fatalities during accidents or disasters. Therefore, they may be more prone to experiencing posttraumatic stress disorder (PTSD) and depression. It has been shown that these comorbid disorders are related to personality traits and quality of life (QOL). METHODS We hypothesized that mental disorders, such as symptoms of PTSD and depression, mediate the relationship between personality traits, as measured on the 10-Item Personality Inventory (TIPI), and QOL, as measured on the MOS 36-item Short-Form Health Survey (SF-36). RESULTS Participants were aged 23-61 years. Questionnaires were sent to 373 participants, 220 of whom returned responses. A direct effect was found between two subscales of the TIPI (Extraversion and Emotional stability) and mental component summary scores of the SF-36 (Extraversion: β = 0.154, p < .001; Emotional stability: β = 0.179, p < .001), which indicated partial mediation. A significant indirect effect was revealed between two personality traits and mental health summary scores (Extraversion: β = 0.058, p < .001; Emotional stability: β = 0.087, p < .001). We also found a direct effect of extraversion scores of the TIPI on role/social component summary scores of the SF-36 (β = 0.084, p < .05). However, none of the 95% confidential intervals was significant, which indicated full mediation, and the indirect effect was significant (β = 0.023, p < .01). Sensitivity analysis indicated that a direct effect between extraversion scores of the TIPI and role/social component summary scores of the SF-36 was significant, which indicated partial mediation. CONCLUSIONS The findings of direct and indirect effects highlight the importance of identifying effective methods for protecting individuals from developing symptoms of PTSD and depression; moreover, they may help improve QOL. The capacity of dealing with incidents among emergency service workers may vary depending on their personality traits. Therefore, the screening of mental health states that includes a personality trait inventory may be valuable.
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Affiliation(s)
- Yoshikazu Noda
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan; Department of Nursing, Teikyo University of Science, 34-1 Senjumotomachi, Adachi-ku, Tokyo 120-0041, Japan.
| | - Kenichi Asano
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan; United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 268-0856, Japan; United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan
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Wu Y, Huang K, Wen S, Xiao B, Feng L. Validation of the Chinese Version of the Stigma Scale of Epilepsy. Front Neurol 2022; 13:796296. [PMID: 35197923 PMCID: PMC8858795 DOI: 10.3389/fneur.2022.796296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose This study was carried out to test the validity and reliability of the Chinese version of the Stigma Scale of Epilepsy (SSE), with aim to better understand the public stigmatizing attitudes of epilepsy in China and help elucidate stigma determinants for interventions. Methods The SSE was translated into Simplified Chinese Mandarin. In this study, most of the participants were enrolled via convenience sampling by randomly distributing questionnaires on the streets and parts of the participants were recruited by an online platform named Wenjuanxing. We assessed the psychometric properties of the SSE in 310 Chinese native-speaker. Cronbach's alpha was tested for reliability. Index of Content Validity (CVI) was calculated. Exploratory and confirmatory analysis were used to explore the factor structure and verify the validity of SSE. Results The Cronbach's alpha is 0.936 for the overall scale, and the CVI value is greater than 0.78. The exploratory factor analysis (EFA) extracted SSE six factors: the fear of seizure attacks (factor 1), sympathy for patients with epilepsy (PWEs) (factor 2); difficulties faced by PWEs (factor 3); speculation on PWEs' feeling (factor 4); discrimination against PWEs (factor 5); and knowledge about epilepsy (factor 6). The item 13 was proven to be problematic and has been eliminated. The confirmatory factor analysis (CFA) ensured the great construct validity (χ2/SD = 1.725, goodness of fit index (GFI) = 0.916, and root mean square error of approximation (RMSEA) = 0.048), convergent validity (the factor loads of each item corresponding to each latent variable >0.6, average variance extracted (AVE) > 0.5, and composite reliability (CR) > 0.7), and discrimination validity (all of the absolute value of correlation coefficient are <0.5,and less than the square root of AVE) of the SSE. Conclusions The Chinese version of the SSE scale was a valid and reliable tool to measure epilepsy-associated stigma in the Chinese society.
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Affiliation(s)
- Yuanxia Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Kailing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shirui Wen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Li Feng
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Lee SA. Felt stigma in seizure-free persons with epilepsy: Associated factors and its impact on health-related quality of life. Epilepsy Behav 2021; 122:108186. [PMID: 34252827 DOI: 10.1016/j.yebeh.2021.108186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We investigated felt stigma in seizure-free persons with epilepsy with regard to associated factors and its impact on health-related quality of life (HRQoL). METHODS This cross-sectional study included 81 patients who had been seizure free for at least 2 years and 52 controls who had only had one seizure in the last 2 years. All patients completed the Stigma Scale, Quality of Life in Epilepsy Inventory-31 (QOLIE-31), short form of the Eysenck Personality Questionnaire-Revised (EPQ-RS), Hospital Anxiety Depression Scale (HADS), Rosenberg Self-esteem Scale, and the enacted stigma questionnaire. RESULTS The proportion of felt stigma was not significantly different between controls (25%) and patients in seizure remission (21%). A stepwise logistic regression analysis revealed that enacted stigma and higher EPQ-RS Neuroticism scores were more likely to be associated with felt stigma of patients in remission. Quality of Life in Epilepsy Inventory-31 scores were significantly higher in patients in seizure remission than in controls. In the stepwise linear regression analysis, felt stigma was not associated with the total QOILE-31 scores. Sobel tests showed that felt stigma had indirect effects on the QOLIE-31 scores through EPQ-RS Neuroticism scores, but its statistical significance was lost after controlling for the presence of enacted stigma, anxiety, and depressive symptoms. CONCLUSION One-fifth of seizure-free patients continued to feel stigmatized, even though they had not had a seizure in more than 2 years. Experience of enacted stigma and a neurotic personality trait were the most important correlates of felt stigma for these patients. Health-related quality of life was significantly better in patients in remission than in patients with rare seizures. Felt stigma was not a significant or independent factor associated with worse HRQoL in patients in remission.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Huang Z, Zhang L, Wang J, Xu L, Li Y, Guo M, Ma J, Xu X, Wang B, Lu H. The structural characteristics and influential factors of psychological stress of urban residents in Jiangxi province during the COVID-19 pandemic: cross sectional study. Heliyon 2021; 7:e07829. [PMID: 34485727 PMCID: PMC8405985 DOI: 10.1016/j.heliyon.2021.e07829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/14/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To explore the structural characteristics and influential factors of psychological stress of urban residents in Jiangxi province during the COVID-19 pandemic through a survey of psychological stress, personality traits, family function and life satisfaction. METHODS By the convenient sampling, 1422 urban residents from Jiangxi province were assessed with Eysenck Personality Questionnaire Short Scale (EPQ-RSC), Psychological Questionnaires for Emergent Events of Public Health (PQEEPH), Family APGAR Scale (APGAR) and Satisfaction With Life Scale (SWLS). The relation among personality traits, psychological stress, family function and life satisfaction during the COVID-19 pandemic was analyzed by using the canonical correlation analysis and the serial mediation model. RESULTS (1) Among the estimated correlation coefficients, the first two pairs were significant (P < 0.001 in each). (2) In the first pair of canonical variables, the loadings of neuroticism and neurasthenia were the higher (0.94, 0.70). (3) Neuroticism and life satisfaction mediated the relationship between family function and neurasthenia (β neuroticism = -0.174; 95%CI:-0.224, -0.134; β life satisfaction = -0.034, 95%CI:-0.012, -0.062), respectively. In addition, serial mediation analyses indicated that the association of family function and neurasthenia is mediated by neuroticism and life satisfaction in a sequential manner (β = -0.010; 95%CI:-0.020, -0.004). CONCLUSIONS During the COVID-19 pandemic, neuroticism was closely related to psychological stress of urban residents, especially neurasthenia. In addition, the serial mediating effect of neuroticism and life satisfaction played an important role in the process of family function influencing neurasthenia. These findings contributed to a more comprehensive understanding of the influential factors for psychological stress of urban residents during the COVID-19 pandemic.
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Affiliation(s)
- Zewen Huang
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lejun Zhang
- School of Psychology, South China Normal University, Guangzhou, Guangdong, China
| | - Junyu Wang
- School of Computer Science and Information Security, Guilin University of Electronic Technology, Guilin, Guangxi, China
| | - Lu Xu
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yin Li
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ming Guo
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jingbo Ma
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xi Xu
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Biyi Wang
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Heli Lu
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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