A Resilience-Based Intervention Programme to Enhance Psychological Well-Being and Protective Factors for Rural-to-Urban Migrant Children in China

Positive Development Patterns in Left-Behind Adolescents: Do Resilience and Making Sense of Adversity Have Beneficial Effects?

Purpose

Despite increased attention to the positive development of left-behind adolescents, research findings remain inconclusive. Utilizing latent profile analysis, we identified various positive development profiles among the left-behind adolescents and explored the association between resilience and positive development profiles, alongside the mediating role of making sense of adversity.

Methods

A multi-stage cluster sampling procedure was employed, randomly selecting four provinces-Zhejiang, Guangdong, Henan, and Jiangxi-from the central and coastal regions. The sample comprised 718 left-behind adolescents recruited from primary and junior high schools across grades 4, 5, 7, and 8. Three scales were utilized, and analyses included latent profile analysis and mediation analysis.

Results

Three latent subgroups of positive development among left-behind adolescents were identified: low, moderate, and high. Those with higher resilience and positive perceptions of adversity tended to belong to the high group rather than the low (β = -0.45, p < 0.001; β = -0.09, p < 0.001) or moderate group (β = -0.23, p < 0.001; β = -0.04, p < 0.05). Left-behind adolescents with higher negative perceptions of adversity tended to belong to the high group rather than the moderate group (β = -0.07, p < 0.01). Mediation analysis revealed that resilience facilitated the development of positive appraisals of adversity, subsequently increasing the likelihood of being categorized into the high (95% CI of -0.09 to -0.03) or moderate group (95% CI of -0.05 to -0.01) rather than the low group.

Conclusion

These findings hold significant implications for intervention formulation. Educators should focus on strengthening resilience and fostering positive perceptions of adversity among the low group. For the moderate group, maintaining moderate negative perceptions of adversity may stimulate the intrinsic potential for positive development more effectively.

Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises

BACKGROUND

Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health.

OBJECTIVES

To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure).

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour.

MAIN RESULTS

We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults.

AUTHORS' CONCLUSIONS

To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.

Long-term effects of various experiences of parental migration on adult health: A nationwide survey in China

BACKGROUND

Despite numerous literature studies on the short-term effects of diverse experiences of being left-behind, migrant, or both on children, the research on their long-term effects remains inadequate. The purpose of current study is to explore the long-term impact of being left-behind, migrant or experiencing both during childhood on health in adulthood. Simultaneously, we investigate the impact of psychological resilience on adults in the presence of diverse experiences of parental migration.

METHOD

A total of 2,371 samples were selected from 28 provinces in China, consisting of 656 participants who had been left behind but never migrated (PLBNM), 205 participants who had migrated but never been left behind (PMNLB), 265 participants who had both been left behind and migrated (PLBM), and 1,245 participants who had no left-behind/migrant experiences (NLBM). The mental health, health condition, and psychological resilience were measured using the 12-item General Health Questionnaire (GHQ-12), Self-Rated Health, and the Connor-Davidson Resilience Scale (CD-RISC), respectively.

RESULTS

The results of the regression model indicated that PLBNM (OR = 2.10, 95% CI [1.59, 2.77], p < .001), PMNLB (1.93, [1.27, 2.94], p < .01), and PLBM (2.01, [1.37, 2.94], p < .001) displayed lower self-rated health compared to NLBM. However, only PLBNM (1.29, [1.05, 1.58], p < .05) reported higher mental health problems compared to NLBM. Our results also showed a strong association between psychological resilience and adults' lower self-rated health (0.72, [0.64, 0.82], p < .001).

CONCLUSION

The negative long-term impact of various experiences regarding being left-behind, migrant, or both, on adult's mental health and self-rated health were more pronounced. The Chinese government ought to create unique policy frameworks that offer assistance to those adults.

A social emotional learning intervention to reduce psychosocial difficulties among rural children in central China

Programmes based on social emotional learning (SEL) have been effective in reducing psychosocial difficulties in a number of countries. In Mainland China, there has been no empirical research on the prevention of children's psychosocial difficulties using the SEL approach. This study aimed to assess whether an adapted version of the SEL programme can reduce psychosocial difficulties of primary school children in rural China. The intervention consisted of 16 weekly 90-min class sessions, conducted among 206 children aged 8-12 years (with 290 controls) in a poor rural area of Central China. Self-report questionnaires were administered at baseline, post-intervention and 5-month follow-up. The results suggested that the programme (1) can reduce children's total difficulties (measured using the Strength and Difficulties Questionnaire) at post-intervention (d = -0.18) and 5-month follow-up (d = -0.19), (2) was more effective among children experiencing verbal abuse (d = -0.21) or physical abuse (d = -0.24) from caregivers and (3) was popular among more than 90% of the participants. The programme is cheap, easy to implement and can be delivered in school hours. Therefore, it has clear potential for replicability and sustainability.

Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries

BACKGROUND

There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma.

OBJECTIVES

To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021.

SELECTION CRITERIA

Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs.

DATA COLLECTION AND ANALYSIS

Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2.

MAIN RESULTS

Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants).

AUTHORS' CONCLUSIONS

The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.

Impact of migration on oral health outcomes of children in multi-beneficial kindergartens in Nanning, Southern China: a cross-sectional study

OBJECTIVE

To explore the effect of children's migration on their oral health outcomes in multi-beneficial kindergartens in Jiangnan District, Nanning, China, and to provide a basis for improving the oral health of migrant children.

METHODS

A cross-sectional study was conducted among 470 children aged 5 years in Jiangnan District, Nanning, Guangxi. A questionnaire was used to collect information on their demographic and socioeconomic background, migration experience, eating habits, oral hygiene behaviours and utilization of dental care services. Dental caries of primary teeth was examined using the decayed, missing, and filled teeth (dmft) index recommended by the World Health Organization. Dental caries experience and oral health-related behaviours were compared between migrant and resident children. The impact of children's migration attributes on their oral health outcomes was examined by univariate and multivariate analyses.

RESULTS

Among the examined children, 52.3% were migrant children. The prevalence of caries among the children in multi-beneficial kindergartens was 78.3%, and the mean number of dmft was 5.73 ± 5.00. The prevalence of caries was 81.7% for migrant children and 74.6% for resident children (p = 0.060). No significant difference was found in the mean numbers of DMFT between migrant children and resident children (5.96 ± 4.81 vs. 5.47 ± 5.20, p = 0.139). There were significant differences in the frequency of tooth brushing (p = 0.023) and parental help with tooth brushing (p = 0.008), typical use of fluoride (p = 0.012), regular dental check-ups (p = 0.003) and experience of dental fillings for caries (p < 0.001) between migrant and resident children. The multivariate logistic regression analysis showed that among the children with caries, the proportion of resident children who had regular dental check-ups was 1.720 times higher than that of migrant children (95% CI = 1.155 ~ 2.560), and resident children were more likely to have caries filled than migrant children (OR = 3.313, 95% CI = 1.585 ~ 6.927).

CONCLUSION

Oral health status and oral health behaviours were poor among children in multi-beneficial kindergartens in Nanning, China, and migration might be a significant predictive indicator for the poor utilization of dental care services by children. The government departments should make special policy to promote the children's oral health in multi-beneficial kindergartens, and invest more to cover the migrant children's utilization of oral health services.

Self-efficacy, reflection, and resilience as predictors of work engagement among English teachers

Introduction

Given the significant role of work engagement of teachers in educational contexts, some scholarly attention has been directed to exploring the predictors of this construct. Against this backdrop, this study aimed to investigate the predictors of teacher work engagement among Chinese English as a foreign language (EFL) teachers by testing a model that includes teacher self-efficacy, teacher reflection, and teacher resilience.

Methods

To achieve this goal, 512 EFL teachers were invited to participate in an online survey, which consisted of four questionnaires. The construct validity of the measures was confirmed through confirmatory factor analysis. Then, structural equation modeling was utilized to examine the relationships between the variables.

Results

The findings indicated that teacher self-efficacy, teacher reflection, and teacher resilience were direct predictors of work engagement, and teacher self-efficacy had an indirect effect on work engagement via teacher reflection and resilience. Similarly, teacher reflection also had an indirect impact on work engagement through teacher resilience.

Discussion

These results have important implications for teacher education programs. The significance of these predictors of work engagement among EFL teachers highlights the importance of fostering self-efficacy, reflection, and resilience among teachers in order to promote their work engagement. Further research can explore ways to enhance these predictors through training and support programs for teachers.

How does parental emotion regulation influence Chinese migrant children's resilience? The chain mediating role of self-efficacy and hope

To examine the chain mediating role of self-efficacy and hope in the relationship between parental emotion regulation and migrant children's resilience, the study investigated 745 migrant children (mean age = 12.9, SD = 1.5, 371 boys) from four schools and their parents in Guiyang City, Guizhou Province, China. All children were asked to complete the Adolescent Resilience Scale, the General Self-Efficacy Scale, and the Children's Hope Scale. Their parents completed the Parental Emotion Regulation Questionnaire. Structural equation modeling showed that parental emotion regulation could not only directly influence children's resilience but also indirectly influence it through two paths: the independent mediating role of self-efficacy and the chain mediating role of self-efficacy and hope. These findings contribute to a deeper understanding of how parental emotion regulation influences migrant children's resilience and provide important practical guidance for enhancing migrant children's resilience.

Development and Validation of Safe Motherhood-Accessible Resilience Training (SM-ART) Intervention to Improve Perinatal Mental Health

Perinatal mental health issues in women can lead to a variety of health complications for both mother and child. Building resilience can strengthen coping mechanisms for pregnant women to improve their mental health and protect themselves and their children. The study aims to develop and validate the contextual and cultural appropriateness of the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention for pregnant women in Pakistan. A three-phase approach was used to develop and validate an intervention that promotes resilience in pregnant women. Phase I comprised a needs assessment with stakeholders (pregnant women and key informants) to elicit opinions regarding module content. In Phase II, an intervention to build resilience was developed with the help of a literature review and formative assessment findings, and Phase III involved the validation of the intervention by eight mental health experts. The experts assessed the Content Validity Index (CVI) of the SM-ART intervention on a self-developed checklist. The resultant SM-ART intervention consists of six modules with strong to perfect CVI scores for each of the modules. Qualitative responses endorsed the strengths of the intervention as having innovative and engaging activities, contextual and cultural relevance, and a detailed, comprehensive facilitator guide. SM-ART was successfully developed and validated and is now ready for testing to promote the resilience of pregnant women at risk of perinatal mental illness.

Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis

BACKGROUND

Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care.

OBJECTIVE

We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance.

RESULTS

Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were -0.61 (95% CI -0.78 to -0.44; n=67 comparisons) for depression and -0.73 (95% CI -0.93 to -0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I²=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high.

CONCLUSIONS

Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal.

TRIAL REGISTRATION

PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709.

Influence of home chaos on preschool migrant children's resilience: A moderated mediation model

Increasing attention has been drawn to the development of preschool migrant children's resilience recently. Resilience refers to the positive internal strengths and qualities of individuals in adverse situations, and is an essential psychological quality for preschool migrant children to cope with adversity. Home chaos as a risk factor, has an important impact on the development of individual's resilience, but the specific mechanisms under which home chaos works have yet to be explored, especially for preschool migrant children. Based on resilience model theory, 3,135 preschool migrant children and their families were surveyed and a moderated mediating effect mode was constructed to test the effect of home chaos on preschool migrant children's resilience. The results showed that after controlling for gender and age, home chaos significantly and negatively predicted preschool migrant children's resilience. Family resilience played a mediating role in the relationship between home chaos and preschool migrant children's resilience. Meanwhile, social support positively moderated the mediating effects of family resilience. The findings of this study suggested that low home chaos was conducive to promoting family resilience, which in turn fostered children's resilience, and that social support could play its protective role in weakening the negative effects of home chaos and this had certain guiding implications for the development of resilience in preschool migrant children.

Social Support and Loneliness among Chinese Rural-to-Urban Migrant Children: A Moderated Mediation Analysis of the Roles of Social Competence and Stress Mindset

Social support has been an important social-contextual protective factor against loneliness. However, how individual-level protective factors, such as social competence and a positive stress mindset, may jointly influence the relationship between social support and loneliness is less known. This study examined to what extent the link between social support and loneliness would be mediated by social competence and moderated by stress mindset among migrant children. In total, 198 rural-to-urban migrant children aged 10-14 years (56.1% girls) in Beijing, China, completed a set of self-reported questionnaires. A moderated mediation analysis was performed. We found that perceived social support was associated with a lower level of loneliness, and this association was significant only for migrant children holding a positive stress mindset (indicated by a high ratio of the stress-is-a-challenge mindset to the stress-is-a-threat mindset). Notably, across children with different stress mindsets, perceived social support was indirectly related to a lower level of loneliness through greater social competence. Our findings suggest that social competence and a stress-is-a-challenge mindset are important individual-level protective factors for migrant children to overcome loneliness. Social competence can carry the effect of social support, and a stress-is-a-challenge mindset can optimize the effect of environmental resources on mental health.

Examining the mediator and moderator of the link between Migration-Related stress and depression amongst Chinese migrant children

Migration-related stress is detrimental to children's mental health, yet little is known about the potential mechanisms behind this association. This study examines the mediating role of inflow city identity in the association between migration-related stress and depression and the moderating role of social participation amongst Chinese migrant children. A sample of 484 migrant children aged 8-17 years is randomly recruited through a cross-sectional survey in Kunming, China. Inflow city identity partially mediates the association between migration-related stress and migrant children's depression. Moreover, social participation moderates the above relationship. The direct and indirect effects are significant for migrant children with low social participation but insignificant for migrant children with high social participation. This study deepens the theoretical understanding of the underlying mechanism between migration stress and psychological distress and provides practical implications for preventing mental disorders in Chinese migrant children.

Experiencing Pregnancy during the COVID-19 Lockdown in Poland: A Cross-Sectional Study of the Mediating Effect of Resiliency on Prenatal Depression Symptoms

The COVID-19 pandemic in Poland brought uncertainty, not only to the general population but also to women preparing for childbirth, which increased the risk of mental health illnesses during this special period of life. Resilience, which refers to positive adaptation or the ability to maintain good mental health, can be a protective factor against the development of psychiatric problems such as depressive symptoms. This study aimed to assess the protective role of resilience in the relationship of such risk factors as traumatic childbirth perception and pandemic-related pregnancy stress with prenatal depressive symptoms. The study was performed at the end of the first wave of the COVID-19 pandemic. A total of 80 pregnant women took part. A mediation analysis, an independent t-test, and a Pearson correlation analysis were conducted. The lower resilience group declared the inclusion of slightly more participants (n = 41; 51.2%); 39 women (48.8%) demonstrated a higher risk of prenatal depression. The analysis revealed a significant direct effect between pandemic-related stress and prenatal depression (βc = 0.285, SE = 0.05, t = 2.63, p < 0.05) as well as between pandemic-related stress and resilience (βa = −0.283, SE = 0.07, t = −2.61, p < 0.05) and between resilience and prenatal depression (βb = −0.585, SE = 0.07, t = −6.34, p < 0.001). After the introduction of resilience as a mediator, the strength of the relationship not only decreased, but also ceased to be statistically significant (βc′ = 0.120, SE = 0.04, t = 1.29, p = 0.19), which indicates that it was in a full mediation state (R2 = 0.39, F = 25.31, p < 0.001; Z = 2.43, p < 0.05). The results indicate that in pregnant women, a high level of resilience protects them from the effects of pandemic-related stress on perinatal depression symptoms.

Effects of structural-economic and socio-relational exclusion on well-being of Chinese migrant children

Social exclusion is a widely accepted risk factor for child well-being, but relatively little is known about its dynamics and effect on multiple well-being domains. This study aims to extend prior research by examining the influencing mechanisms of structural-economic and socio-relational exclusion on the physical, psychological, behavioural and educational well-being of Chinese migrant children. Multi-stage cluster random sampling is used to recruit a sample of migrant children (N = 484; M_age  = 11.65 years; 52.9% girls) in Kunming, China, and structural equation modelling is used for data analysis. Results indicate that a high level of structural-economic exclusion predicts a high level of socio-relational exclusion, which, in turn, leads to low levels of physical, psychological, behavioural and educational well-being among migrant children. This study not only contributes to the understanding of the dynamic effects of social exclusion but also provides practical implications for social policy and interventions to reduce social exclusion and improve the well-being of Chinese migrant children.

Intercultural Competence Predicts Intercultural Effectiveness: Test of an Integrative Framework

Why does someone thrive in intercultural situations; while others seem to struggle? In 2014, Leung and colleagues summarized the literature on intercultural competence and intercultural effectiveness into a theoretical framework. This integrative framework hypothesizes that the interrelations between intercultural traits, intercultural attitudes and worldviews, and intercultural capabilities predict the effectiveness with which individuals respond to intercultural situations. An empirically verified framework can contribute to understanding intercultural competence and effectiveness in health care workers, thus contributing to more equity in health care. The present study sets out to test this integrative framework in a specific health care context. Future health care practitioners (N = 842) in Flanders (Belgium) were questioned on all multidimensional components of the framework. Structural equation modeling showed that our data were adequate to even a good fit with the theoretical framework, while providing at least partial evidence for all hypothesized relations. Results further showed that intercultural capabilities remain the major gateway toward more effective intercultural behavior. Especially the motivation and cognition dimensions of cultural intelligence seem to be key factors, making these dimensions an excellent target for training, practical interventions, and identifying best practices, ultimately supporting greater intercultural effectiveness and more equity in health care.

The effect of peer education based on adolescent health education on the resilience of children and adolescents: A cluster randomized controlled trial

BACKGROUND

An increasing number of children and adolescents have reported mental health problems, and resilience is a protective factor against these problems. Therefore, the aim of the study is to verify the effect of peer education based on adolescent health education on adolescent resilience.

METHOD

A cluster randomized controlled trial was conducted including 1,613 students who were divided into an intervention group (19 classes, 732 participants) and a control group (24 classes, 881 participants). One-year peer education was performed in the intervention group, and the control group had no interventions. The Resilience Scale for Chinese Adolescents by Yueqin Hu and a self-designed basic information questionnaire were used to collect data. Chi-square test and rank-sum test were used to compare the differences of demographic characteristics between the two groups. A linear mixed model was used to compare the changes of resilience between the two groups after intervention, and the intra-cluster correlation coefficient (ICC) was calculated. A generalized linear mixed model (GLMM) was used to verify the effect of peer education on adolescent resilience. The significance was set at P < 0.05.

RESULTS

After intervention, compared with the control group, the intervention group showed significant improvement in target focus, emotion adjustment, interpersonal assistance and total resilience (P < 0.05). The ICC range was 0.003 to 0.034. The GLMM results indicated that peer education based on adolescent health education had significant effects on adolescents' target focus (β = 0.893, P = 0.002), emotional adjustment (β = 1.766, P < 0.001), interpersonal assistance (β = 1.722, P = 0.016) and total mental resilience (β = 5.391, P < 0.001), and the effect was greater for boys than for girls.

CONCLUSIONS

Peer education based on adolescent health education is effective for improving adolescents' target focus, emotional adjustment, interpersonal assistance, and total resilience, especially for males. Future research should devote more attention to positive cognition and family support as well as gender differences.

Impact of parental divorce versus separation due to migration on mental health and self-injury of Chinese children: a cross sectional survey

BACKGROUND

There has been an increasing prevalence of parental separation in China due to divorce or migration for work in recent decades. However, few studies have compared the impacts of these two types of separation on children's mental health. This study aimed to investigate how parental divorce and parental migration impact children's mental health and self-injurious thoughts and behaviors (SITB), while considering positive factors, including parent-adolescent communication and psychological resilience.

METHODS

We randomly recruited participants in grades 5-8 from 18 schools in 2 counties in Anhui Province. A self-administered questionnaire was conducted to measure children's mental health, SITB, parent-adolescent communication, psychological resilience, and socio-demographic characteristics.

RESULTS

Data from 1026 children with both parents migrating (BLBC), 1322 children with one parent migrating (SLBC), 475 children living in a divorced family (DC) and 1160 children with non-migrating parents (NLBC) were included. Regression model results showed that, compared to the other three groups (BLBC, SLBC, NLBC), DC exhibited higher internalizing problems (p < 0.05), higher externalizing problems (p < 0.01), less prosocial behaviors (p < 0.05), and higher rates of suicidal ideation (SI) (p < 0.05) and non-suicidal self-injury (NSSI) behaviors (p < 0.05) when adjusting for social-demographic variables. However, when further adjusting for parent-adolescent communication and psychological resilience, DC no longer had higher levels of internalizing problems, externalizing problems, NSSI and SI than left-behind groups (BLBC, SLBC).

CONCLUSIONS

The experience of separation from divorced parents had stronger negative effects on the mental health of children than was observed in LBC. The Chinese government should design special policy frameworks that provide support to DC.

Resilience of adolescents, though weakened during pandemic-related lockdown, serves as a protection against depression and sleep problems

Adolescents facing adversities are susceptible to depression and sleep problems. Resilience is an important protective mechanism for coping with adversity. During the COVID-19 pandemic, adolescents faced hardships including being pulled from their schools and being unable to socialize with friends during mandated lockdowns. We had three aims in this study. First, we sought to test whether Chinese adolescents' resilience was strengthened, maintained, or weakened during the COVID-19 lockdown. Second, we sought to test whether adolescents' resilience predicted depressive symptoms and in turn, sleep problems. Third, we sought to examine the role social support may play. In a partially-longitudinal survey study, we demonstrated via a within-subject t-test and its Bayesian equivalent that Chinese adolescents' resilience weakened during the lockdown compared with before the pandemic. However, resilience remained an important predictor: A mediation model demonstrated that higher resilience was associated with fewer depressive symptoms, which in turn predicted fewer sleep problems. Moreover, we found that social support moderated this mediation: Strong social support reduced the negative effects of low resilience levels. These results help shed light on the fragility of resilience, its importance for adolescents' mental health when facing adversity, and how we might support adolescents experiencing social distancing mandates or who are otherwise isolated from their peers.

Left-Behind Children, Parent-Child Communication and Psychological Resilience: A Structural Equation Modeling Analysis

This study aims to examine the role of parental migration status and parent communication in the psychological and related behavioral status of left-behind children and their psychological resilience. A cross-sectional survey was conducted in Anhui Province of China, and a questionnaire survey was conducted with 1992 teens using the Chinese version of the Parent-Adolescent Communication Scale (PACS), Connor-Davidson Resilience Scale (CD-RISC), and Strength and Difficulties Questionnaires (SDQ). Compared with the never left-behind group, left behind children had relatively lower PACS, CD-RISC and SDQ scores. Absence of parents is related with poorer psychological resilience, while good parent communication is related with better psychological resilience. Better psychological resilience is related to fewer psychological problems regardless of parental migration status. Currently left-behind status demonstrated a negative influence on psychological resilience, while never left-behind status had a positive effect. Interventions are needed to enhance psychological resilience of left-behind children to prevent psychological and related behavioral problems.

Latent profiles and transition of perceived parental control and their relationship with the psychosocial well-being among rural-to-urban migrant adolescents

The present study examined what, if any, patterns of parental control are associated with multiple indicators of psychosocial well-being and whether changes in these patterns over time predict subsequent psychosocial well-being. Latent profile analyses and latent transition analyses were applied to identify subgroups of parental control and transitions of these patterns over time among rural-to-urban migrant adolescents who participated in two waves of surveys with 6-month interval in 2014 (N_T1  = 660, N_T2  = 553). Multivariate logistic regression was conducted to explore their relationship with psychosocial well-being. Four latent profiles were identified based on levels of parental control at wave 1 and wave 2, respectively. The high psychological and behavioral control (HPHB) group was associated with worse psychosocial well-being whereas the low psychological control and high behavioral control (LPHB) group exhibited opposite relationships. Six transitioning groups were identified: "stably low-risk" (14.92%), "stably medium-risk" (7.37%), "stably high-risk" (24.49%), "floating LPHB" (26.52%), "high-decreasing" (15.10%), and "low-increasing" (11.60%) groups. The "stably high-risk" and "low-increasing" groups showed a higher risk in psychosocial well-being. Youth exhibiting higher risks of parental control (i.e. individuals in HPHB groups and higher-risk transition patterns over time) should prioritize for interventions and services.

From Stressful Experiences to Depression in Chinese Migrant Children: The Roles of Stress Mindset and Coping

Migrant children are at high risk for depression, though the exact mechanism is still unclear. This study investigated whether and how different stress mindsets (threat vs. challenge) and coping strategies (avoidant vs. approach) mediated the association between stressful experiences and depression in migrant children, and whether these relationships would be moderated by gender. One hundred and ninety-eight rural-to-urban migrant children (56.0% girls; M_age = 11.8 years) in Beijing, China, completed self-administered measures of stressful experiences, threat and challenge mindsets, coping strategies, and depression. Path analysis was conducted to examine the proposed mediation model. A dual-pathway model of stress coping was discovered: (1) a stress-threat-avoidance-depression pathway, in which threat mindset and avoidant coping mediated the association between stressful experiences and depression, and (2) a challenge-approach-enhancement pathway, in which approach coping mediated the association between challenge mindset and fewer depressive symptoms, without being influenced by stressful experiences. The dual-pathway mechanism did not vary by gender, and it can explain the greater vulnerability of girls to depression. Together, findings suggest that stressful events, threat mindset, and avoidant coping act as risk factors for depression, whereas challenge mindset and approach coping can function as protective factors to counteract the impacts of stressful experiences and promote psychological well-being among migrant children.

Measuring resilience in children: a review of recent literature and recommendations for future research

PURPOSE OF REVIEW

Understanding variability in developmental outcomes following exposure to early life adversity (ELA) has been an area of increasing interest in psychiatry, as resilient outcomes are just as prevalent as negative ones. However, resilient individuals are understudied in most cohorts and even when studied, resilience is typically defined as an absence of psychopathology. This review examines current approaches to resilience and proposes more comprehensive and objective ways of defining resilience.

RECENT FINDINGS

Of the 36 studies reviewed, the most commonly used measure was the Strengths and Difficulties Questionnaire (n = 6), followed by the Child Behavior Checklist (n = 5), the Resilience Scale for Chinese Adolescents (n = 5), the Rosenberg Self-Esteem Scale (n = 4), and the Child and Youth Resilience Scale (n = 3).

SUMMARY

This review reveals that studies tend to rely on self-report methods to capture resilience which poses some challenges. We propose a complementary measure of child resilience that relies on more proactive behavioral and observational indicators; some of our preliminary findings are presented. Additionally, concerns about the way ELA is characterized as well as the influence of genetics on resilient outcomes prompts further considerations about how to proceed with resiliency research.