Low mental health literacy and its association with depression, anxiety and poor sleep quality in Chinese elderly

Factors associated with mental health literacy and demand for mental health services among older adults in China: a cross-sectional study

BACKGROUND

There is limited research on mental health literacy (MHL) among Chinese older adults as well as their demand and willingness for mental health services (MHS). This study investigated the factors associated with them among Chinese older adults. Additionally, predictors of MHL as well as demand and willingness for MHS were compared between older adults living alone and those not living alone.

METHODS

This study is a cross-sectional study conducted among 494 older adults in Guangzhou, China. Sociodemographic characteristics, frequency of participating in community-based activities, mental health status, MHL, and demand and willingness for MHS were assessed through self-reported questions. A series of logistic regression analyses were conducted to examine factors associated with the MHL and demand and willingness for MHS.

RESULTS

The awareness rates for the three MHL-related questions were between 65.3% and 73.7%, and 62.0% and 69.6% of the participants indicated the demand and willingness, respectively, for MHS. Frequently participating in community-based activities increased the likelihood of awareness of the MHL-related questions (ORs = 2.92-4.18, CIs = [1.50,9.28]), as well as the demand and willingness for MHS (ORs = 2.16-2.24, CIs = [1.19,4.20]). Similar significant associations were found among the older adults who were not living alone but not among those living alone.

CONCLUSIONS

Based on the results of this study, policymakers and clinicians are advised to develop more targeted community-based activities for older adults and focus especially on those living alone to enhance their MHL and increase willingness for MHS.

Differences in depression prevalence among older adults in China before and during the COVID-19 pandemic: a systematic review and meta-analysis

Objective

Changes in the prevalence of depression during the COVID-19 (Coronavirus disease 2019) pandemic among older adults in China have not been systematically evaluated. We aimed to systematically summarize existing evidence to conduct a meta-analysis to quantify changes in the prevalence of depression before and during the COVID-19 pandemic.

Methods

The PubMed, Web of Science, Scopus, Embase, PsycINFO, China National Knowledge Infrastructure (CNKI), WangFang Data, CQVIP, and China Biology Medicine disc (CBMdisc) databases were searched from January 1, 2017, to November 20, 2024. Studies reporting the prevalence of depression among Chinese individuals aged 60 or older using validated diagnostic tools were included. A random-effects model was applied to estimate pooled prevalence, with subgroup analyses performed by demographic and socio-economic factors. Relative risks (RR) were calculated to compare prevalence across different pandemic stages.

Results

A total of 101 studies involving 264,758 participants were included. The pooled prevalence of depression among older adults was 25.8% (95% CI [21.7-29.9]) from 2017-2019 and 23.8% (95% CI [19.8-27.8]) from 2020-2023. During the early pandemic stage (January-April 2020), prevalence significantly decreased (RR = 0.849, P < .001) but increased in later stages, reaching 24.4% by 2021-2023. The prevalence of depression among older adults during the COVID-19 pandemic showed a significant increasing trend (P trend  < .001). Subgroup analyses revealed higher prevalence among females, rural residents, individuals with lower education levels, and those living alone.

Conclusion

Depression prevalence among older adults in China decreased during the early pandemic response but showed an increasing trend over time, reflecting the complex mental health impact of prolonged public health measures. Effective interventions are needed to address the specific needs of vulnerable subgroups during and beyond public health crises.

Impact of living environment on sleep quality in older adults and the mediating role of depression: a cross-sectional study

Sleep quality significantly affects the well-being of older adults. This study aimed to analyse the current state of sleep quality among older adults in China and to examine the effects of living environment and depression on sleep quality, as well as their interrelationship(s). A survey was conducted using a self-designed questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire Depression Scale (PHQ-9), targeting a sample of adults ≥ 60 years of age in the central province of China, yielding 6211 valid responses. Correlation analysis indicated that the living environment was negatively correlated with both depression and PSQI score (r = - 0.140, p < 0.01; r = - 0.174, p < 0.01). The living environment (β = - 0.049, p < 0.001) was a negative predictor of PSQI, while depression (β = 0.477, p < 0.001) was a positive predictor. Mediation analysis revealed that depression acted as a mediator between the living environment and sleep quality, contributing 61.7% of the overall effect. Further analysis through hierarchical regression and simple slope plotting indicated that in a favourable living environment, the impact of depression on sleep quality was more pronounced. These findings suggest that a supportive living environment has a protective effect against poor sleep hygiene among older adults and that depression plays a significant mediating role. Intervention strategies should focus on improving living environments and implementing mental health measures to enhance sleep quality among older adults.

Association Between Social Capital and Anxiety Among Older Adults in China: A Cross-Sectional Study

Purpose

Social capital is one key determinant of older adults' mental health, yet its link with various demographic variables and anxiety among older adults in China remains underreported. This study investigated whether there is an interactive effect of social capital and demographic factors on anxiety among Chinese older adults.

Methods

A sample of 5115 Chinese older adults (≥60 years old) was extracted from cross-sectional survey data in the 2018 Chinese Longitudinal Health and Longevity Study (CLHLS). Data on demographic characteristics, social capital, and anxiety were collected. Binary logistic regression models and a classification and regression tree model (CART) were performed to assess the association between social capital and anxiety.

Results

The finding of this study showed that the prevalence of anxiety among Chinese older adults was 13.04% (667/5115), subjects who were female (OR = 1.649; 95% CI: 1.336-2.036), with medium-level of annual family income (OR = 0.598; 95% CI: 0.476-0.751), with reporting 1-2 diseases (OR = 1.743; 95% CI: 1.322-2.298), with medium-level of interpersonal trust (OR = 0.668; 95% CI: 0.533-0.837), social participation (OR = 0.521; 95% CI: 0.390-0.696), social support (OR = 0.431; 95% CI: 0.264-0.703) were at a lesser risk of developing anxiety. We also noted the interactive relationship of social capital associated with anxiety, which indicated that special attention and efforts should be paid to older adults who were females, with lower interpersonal trust, annual family income, and lower social participation to maintain sound mental status.

Conclusion

Our findings indicate that social capital is associated with anxiety in Chinese older adults. This implies that social capital, especially in terms of gender, annual family income, interpersonal trust, and social participation may be significant for alleviating anxiety in later life.

Mental health literacy and its relationship with health-promoting behaviors of community-dwelling older adults: A latent profile analysis

OBJECTIVES

To explore the latent profiles of mental health literacy among community-dwelling older adults and analyze their relationship with health-promoting behaviors.

METHODS

A cross-sectional study was conducted among 321 community-dwelling older adults using a general information questionnaire, the Chinese version of the Mental Health Literacy Scale, and the Geriatric Health Promotion Scale. A latent profile analysis was performed to identify latent profiles of mental health literacy among community-dwelling older adults. Multiple logistic regression analysis was used to explore the predictive factors of different profiles. One-way ANOVA was applied to examine the relationship between profiles and health-promoting behaviors.

RESULTS

The mental health literacy of community-dwelling older adults was classified into three latent profiles: Profile 1, low mental health literacy group (21.81 %); Profile 2, medium mental health literacy group (46.42 %); and Profile 3, high mental health literacy group (31.78 %). Sex and living status were predictors of different profiles. The total score difference of health-promoting behaviors among the three profiles was statistically significant.

CONCLUSIONS

There is significant heterogeneity in mental health literacy among community-dwelling older adults. Promoting mental health literacy can effectively increase health-promoting behaviors. Targeted interventions for community-dwelling older adults in different profiles are recommended to improve their health-promoting behaviors.

Mental health literacy among older adults in Shanghai: a descriptive qualitative study

Background

The aging population in China is surging rapidly, and elderly individuals are at higher risk of multiple mental health issues. Improving the mental health literacy of older adults can help them recognize mental illness and adopt proactive measures, potentially improving their mental health status and supporting the goal of healthy aging.

Objective

To explore mental health literacy among older adults, providing a foundation for future interventions aimed at improving their mental health literacy.

Methods

Guided by the new conceptualization framework of mental health literacy developed by Jiang et al. the study involved 20 community-dwelling older adults from four communities in Shanghai who were selected through purposive sampling to participate in semi-structured interviews. Thematic analysis was employed to summarize and extract themes from the data.

Results

The qualitative analysis identified three primary themes and eight subthemes: inadequate knowledge about mental health and illnesses, negative intentions and attitudes toward maintaining mental health and preventing mental illnesses, and health behavior to promote mental health and prevent mental disorders.

Conclusion

This study reveals significant gaps in mental health literacy among older adults, underscoring the necessity for multifaceted interventions. It calls for concerted efforts from individuals, families, and society to bolster mental health knowledge, challenge stigma, and encourage supportive behaviors. By integrating these approaches with the 'Healthy China 2030' policy, we aim to enhance mental health literacy for the aged.

Characteristics and Associated Factors of Insomnia Among the General Population in the Post-Pandemic Era of COVID-19 in Zhejiang, China: A Cross-Sectional Study

Objective

This study aimed to analyze the changes in insomnia characteristics among the general population and explore associated factors during the COVID-19 pandemic and post-pandemic periods.

Methods

A cross-sectional study was conducted using an anonymous online survey. Questionnaires were administered at two-time points (T1: March 1-31, 2022; T2: March 1-31, 2023), which included an Insomnia Severity Index (ISI) and questions related to sleep risk factors, including the COVID-19 pandemic, familial influences, work and study conditions, social activities, physical health, use of electronic devices before sleep, sleep environment, food intake and exercise before sleep, etc. Insomnia characteristics were compared at two points, with logistic regression testing associations with sociodemographic covariates and risk factors. Six machine learning models were employed to develop a predictive model for insomnia, namely logistic regression, random forest, neural network, support vector machine, CatBoost, and gradient boosting decision tree.

Results

The study obtained 2769 and 1161 valid responses in T1 and T2, respectively. The prevalence of insomnia increased from 23.4% in T1 to 34.83% in T2. Univariate analyses indicated the factors of the COVID-19 pandemic, familial influences, social activity, physical health, food intake, and exercise before sleep significantly differed in T1 (p<0.05) between insomnia and non-insomnia groups. In T2, significant differences (p<0.05) were observed between the two groups, including the factors of the COVID-19 pandemic, family structure, work and study conditions, social activity, and physical health status. The random forest model had the highest prediction accuracy (90.92% correct and 86.59% correct in T1 and T2, respectively), while the pandemic was the most critical variable at both time points.

Conclusion

The prevalence and severity of insomnia have worsened in the post-pandemic period, highlighting an urgent need for effective interventions. Notably, the COVID-19 pandemic and physical health status were identified as significant risk factors for insomnia.

Initial development of a sleep health literacy scale

OBJECTIVES

Health literacy includes the skills necessary for effective communication with health professionals, understanding health instructions, and recognizing health needs. Our study aimed to create a novel measure of sleep health literacy-an individual's capacity to comprehend sleep-related information and navigate sleep-related healthcare services.

METHODS

The Sleep Health Literacy scale consists of two subscales: "Sleep Health Communication" (11 Likert-scale items assessing access to resources and communication with healthcare providers) and "Sleep Health Knowledge" (46 true/false items assessing specific knowledge of sleep health). The Sleep Health Literacy scale was completed by 154 undergraduate students (mean age=20.96years; 79.87% female) in study 1. In study 2, an additional sample of 251 participants (mean age=20.23years; 79.87% female) completed the Sleep Health Literacy scale, along with measures of convergent and discriminant validity.

RESULTS

Exploratory factor analysis results in study 1 revealed a two-factor structure for the "Sleep Health Communication" subscale ("comprehension" and "critical application"). The subscale demonstrated good internal consistency (α = 0.81) and inter-item and item-total correlations. On the "Sleep Health Knowledge" subscale, participants answered 76.36% of items correctly. In study 2, the Sleep Health Literacy had good convergent validity with Sleep Beliefs Scale and the All Aspect of Health Literacy Scale.

CONCLUSIONS

The Sleep Health Literacy scale offers a standardized measure to assess sleep health literacy, an understudied domain that has important links to health. This measure may allow researchers and clinicians to better understand how to improve sleep health. Further validation of the Sleep Health Literacy scale is warranted in more diverse samples.

Do Health Literate Older People Have Fewer Depressive Symptoms? Evidence from the Urban Areas of Western China

BACKGROUND

Previous research has indicated that health literacy has a good influence on the mental health among older adults. The current study aims to determine whether health literacy is linked to depressive symptoms in older adults in west China, and tries to detect the mechanisms underlying the linkage between health literacy and depressive symptoms in the Chinese context.

METHODS

Study data were obtained from a cross-sectional ageing health literacy survey conducted in 2017 in Western China, and 812 urban individuals aged 60 and older were selected.

RESULTS

Health literacy was associated with fewer symptoms of depression; additionally, older adults who reported harmonious family and filial piety, those with greater self-rated health, and those with a higher level of life satisfaction tended to have fewer depressive symptoms, whereas older individuals who reported a poor financial status and those with functional impairment had more depressive symptoms.

CONCLUSIONS

The findings indicate the protective role of health literacy against depressive symptoms among urban older adults. In addition, the findings also indicate the potential impact of financial strain and functional impairment on the development of depressive symptoms and show that other factors including a harmonious family, filial piety, self-rated health and life satisfaction are generally protective against depressive symptoms. Specific evidence is presented for the national action plans and public health strategies needed to reinforce and promote health literacy in the Chinese context. The current results also suggest that health education and promotion programs designed to strengthen financial assistance, functional improvement, family relationships, life satisfaction and self-rated health should gain a growing importance on the health agenda. Future longitudinal studies, mediation or moderator models, and structural equation modeling would be needed to identify a causal relationship, the moderating or mediating effect, and the possible pathways underlying the linkage between health literacy and depressive symptoms, respectively.

Mental health literacy in patients with acute myocardial infarction: a cross-sectional registry-based study

Introduction

This study aimed to explore mental health literacy (MHL) and its related factors in a cross-sectional, registry-based sample of patients after acute myocardial infarction (AMI).

Methods

All survivors of AMI between 2017 and 2019 from the Myocardial Infarction Registry Augsburg (n=1.712) received a postal questionnaire on MHL (Mental Health Literacy Scale (MHLS-GER)) and single questions on experiences with and information on mental disorders in 2023. The response rate was 49.9%. Logistic and linear regression models were used to investigate the associations between these variables and sociodemographic factors.

Results

In the sample of 855 patients (77.5% male, mean age 71.4 ± 10.9 years), 30.0% had experienced mental problems about 5 years after AMI. Among these, 17.4% received psychotherapy and 26.1% psychotropic drugs. Information about possible mental problems after their AMI was obtained from a physician by 30.8% of the patients and in a rehabilitation setting by 46.4%, respectively. Of the patients, 26.2% wished to receive more information on mental problems after AMI. MHLS-GER subscale scores ranged between and 54 ("Social distance") and 76 ("Information seeking") (best score 100). Age was the most important factor that was significantly associated with the report of mental health problems, a perceived lack of information, help seeking behavior and treatment, and MHL.

Discussion

Elderly and poorly educated patients were at risk of poor MHL. Further studies are required to specify the role of MHL in post-AMI life and health care.

Factors Predicting Mental Health Literacy in Older Adults: A Community-Based Cross-Sectional Study

PURPOSE

To determine mental health literacy (MHL) levels of older adults and the predictive factors of MHL.

METHOD

This cross-sectional study was conducted between October and December 2022, with 410 older adults aged ≥65 years. A Personal Information Form and the Mental Health Literacy Scale were used for data collection. Independent samples t test, analysis of variance, and multiple linear regression were used to analyze the data.

RESULTS

Significant predictors of MHL in older adults were being aged 65 to 69 years, being female, being a university graduate, having an income more than expenses, receiving information from a health professional, interest in mental health, having friends or family members with mental illness, and good perception of health.

CONCLUSION

Older adults were found to have low levels of MHL. Mental health professionals should focus on community-based education and interventions to increase the MHL levels of older adults. [Journal of Psychosocial Nursing and Mental Health Services, 62(10), 31-40.].

Empirical analysis of health-related behaviors among older Hakka adults: a latent class analysis

Background

Little is known about health-related behaviors of the older Hakka population in China. We aimed to explore the characteristics and correlates of health-related behaviors among older Hakka adults.

Methods

We used data from the China's Health-Related Quality of Life Survey for Older Adults 2018. Latent class analysis (LCA) defined latent classes of health-related behaviors for 1,262 older Hakka adults aged 60 and above. Generalized linear regression and multinomial logistic regression analysis were used to identify factors influencing the number and the latent classes of health-related behaviors, respectively.

Results

The LCA showed that the latent classes could be stratified as the risk group (14.82%), healthy group (55.71%), and inactive group (29.48%). Sex, age, years of education, current residence, living arrangement, average annual household income, and currently employed were associated with the number of healthy behaviors. Compared with the participants in the healthy group, widowed/others (OR = 5.85, 95% CI = 3.27, 10.48), had 15,001-30,000 (OR = 2.05, 95% CI = 1.21, 3.47) and 60,001 or higher (OR = 3.78, 95% CI = 1.26, 11.36) average annual household income, and currently employed (OR = 3.40, 95% CI = 1.99, 5.81) were highly associated with risk group. Additionally, the participants who are widowed/others (OR = 4.30, 95% CI = 2.70, 6.85) and currently employed (OR = 1.95, 95% CI = 1.27, 2.98) were highly associated with the inactive group.

Conclusion

This study identified factors specifically associated with older Hakka adults' health-related behaviors from an LCA perspective. The findings indicate that policymakers should give more attention to older adults living alone and implement practical interventions to promote health-related behaviors among them.

The influencing factors of health status among low-income individuals living alone in Wuxi, China

This study aimed to understand the health status of low-income individuals living alone and to identify influencing factors. Using systematic random sampling methods, low-income individuals living alone were randomly selected. Via telephone interviews, we gathered information about their general health status. A logistic regression model was used to analyze relevant factors about the physical health of this population. The study included 1583 low-income individuals living alone. The prevalence rate of all kinds of diseases in low-income living alone in this survey was 88.63%. The multifactorial logistic regression analysis revealed that the risk factors for illness in this population were age ≥ 60 (OR 1.842, 95% CI 1.135-2.926, P = 0.006), self-rated poor mental health (OR 2.538, 95% CI 1.128-3.828, P = 0.005), and self-rated poor hearing status (OR 2.781, 95% CI 1.586-3.647, P = 0.001). Being female (OR 0.469, 95% CI 0.178-0.821, P = 0.033) was identified as a protective factor. Low-income individuals living alone are a unique group who lack familial care and economic and social support, and are thus in a disadvantaged social position. Therefore, this population requires increased attention, especially regarding their physical health. Implementing targeted assistance policies to improve their health status and enhance their quality of life is essential.

Mediating roles of activities of daily living and depression on the relationship between sleep quality and health-related quality of life

This study aimed to explore the mediating effects of ADL and depression on the relationship between sleep quality and HRQOL among older people in rural China, while also exploring the moderating impact of loneliness. The study gathered data from a household survey conducted among 1587 Chinese rural older adults (mean age = 73.63 years). The collected data was analyzed using SPSS version 23.0 software (IBM, New York, USA) and the PROCESS macro version 4.0 program. The findings indicated a significant correlation between sleep quality, ADL, depression, loneliness and HRQOL. ADL and depression exhibited a chain mediation effect on the relationship between sleep quality and HRQOL. Notably, the association between sleep quality and HRQOL was entirely mediated by ADL and depression. Additionally, loneliness acted as a moderator in the relationship between ADL and HRQOL. The findings of this study suggest that interventions focusing on sleep quality should prioritize strategies for enhancing older adults' ADL and depression as integral components of promoting older adults' HRQOL.

Psychache status and associated contributing factors among the Hakka elderly in Fujian, China

BACKGROUND

Little is known about the state of psychological distress of the elderly in China, and research on specific subgroups such as Hakka older adults is almost lacking. This study investigates psychache and associated factors among Hakka elderly in Fujian, China.

METHODS

The data analysed in this study were derived from China's Health-Related Quality of Life Survey for Older Adults 2018. The Chinese version of the Psychache Scale (PAS) was used to assess the frequency and intensity of psychache in Hakka older adults. Generalized linear regression analysis was conducted to identify the main socio-demographic factors associated with psychache overall and its frequency and intensity.

RESULTS

A total of 1,262 older adults participated, with mean scores of 18.27 ± 6.88 for total PAS, 12.50 ± 4.79 for PAS-Frequency and 5.77 ± 2.34 for PAS-Intensity. On average, females scored higher than males on PAS-Frequency (β = 0.84, 95% CI = 0.34, 1.35) and PAS-Intensity (β = 0.48, 95% CI = 0.22, 0.73). Older adults currently living in towns (β = -2.18, 95% CI = -2.81, -1.54), with their spouse only (β = -3.71, 95% CI = -4.77, -2.65), or with children (β = -3.24, 95% CI = -4.26, -2.22) were more likely to score lower on PAS-Frequency. Conversely, older adults who were regular sleepers (β = -1.19, 95% CI =-1.49, -0.88) or lived with their spouse only (β = -1.25, 95% CI = -1.78, -0.72) were more likely to score lower on PAS-Intensity.

CONCLUSION

Among Hakka elderly, we found a higher frequency and greater intensity of psychache in females, those with poor health status, irregular sleepers, rural residents, solo dwellers, those with below CNY 10,000 in personal savings, and the medically uninsured. The study's findings indicate that policymakers should give more attention to the susceptible population and implement practical interventions to reduce their psychological burden.

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

BACKGROUND

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

METHOD

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

RESULT

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

LIMITATIONS

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

CONCLUSIONS

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

Healthier Dietary Patterns Are Associated with Better Sleep Quality among Shanghai Suburban Adults: A Cross-Sectional Study

BACKGROUND

More is to be explored between dietary patterns and sleep quality in the Chinese adult population.

METHODS

A cross-sectional study including 7987 Shanghai suburban adults aged 20-74 years was conducted. Dietary information was obtained using a validated food frequency questionnaire. Adherence to a priori dietary patterns, such as the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet (MD), was assessed. Sleep quality was assessed from self-reported responses to the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Logistic regression models adjusting for confounders were employed to examine the associations.

RESULTS

The overall prevalence of poor sleep (PSQI score ≥ 5) was 28.46%. Factor analysis demonstrated four a posteriori dietary patterns. Participants with a higher CHEI (ORQ4 vs. Q1: 0.81, 95% CI: 0.70-0.95), DASH (ORQ4 vs. Q1: 0.70, 95% CI: 0.60-0.82) or MD (ORQ4 vs. Q1: 0.75, 95% CI: 0.64-0.87) had a lower poor sleep prevalence, while participants with a higher "Beverages" score had a higher poor sleep prevalence (ORQ4 vs. Q1: 1.18, 95% CI: 1.02-1.27).

CONCLUSIONS

In Shanghai suburban adults, healthier dietary patterns and lower consumption of beverages were associated with better sleep quality.

Short Form of Mental Health Literacy Questionnaire for Adults: Psychometric Properties of Serbian Version

Mental health literacy (MHL) has been widely explored by researchers who focus on youth mental health. However, there is little data related to the validity and reliability of the tools for the assessment of MHL constructs. The present study aimed to adapt the short version of Mental Health Literacy Questionnaire for young adults in Serbian sample and examine its psychometric properties. Translation and adaptation of items were performed using the following procedures: item are translated from English or Serbian by a bilingual translator and using a think-aloud procedure, back-translation, semantic comparison of the translation, and analysis of the translated version by the original version of the manuscript. The sample consisted of 344 participants aged 17 to 25 years, which is in accordance with the recommended number of participants needed for quantitative instrument validation studies. Confirmatory factor, internal consistency, and external validity analyses were performed. The results supported the validity of a shorter version of the questionnaire (MHLq-SVa), composed of 16 items that fit with four previously defined MHL dimensions (knowledge, beliefs, help-seeking intentions, and self-help strategies). Internal consistency, between-factor correlations, and correlations with other relevant mental health constructs further supported the adequacy of the instrument's psychometric properties. We recommend the MHLq-SVa as valid and reliable measure for assessing MHL in young adults and encourage further exploration at more diverse and representative samples.

Topics Included in Health Literacy Studies in Asia: A Systematic Review

The study aimed to review general and specific health literacy studies in different countries in Asia to understand the progress of health literacy researches in the region. English-published studies with quantitative measurements of health literacy were collected through a systematic search in PubMed, Cochrane Library, Embase, and Web of Science, without publication dates limitation. A total of 156 articles on general health literacy, oral, mental, disease-specific health literacy, and eHealth literacy were collected. General health literacy was the most covered topic in 89 articles, followed by eHealth Literacy. Health literacy studies have been conducted in 16 countries and have been increasingly concerned in most of the countries in Asia. China had the largest number of articles, followed by Taiwan. Four studies had participants from more than one country. Education, age, health status, incomes, and living/residential area were significantly associated with health literacy levels in 156 studies, with the prevalence of 55.8%, 28.2%, 20.5%, 17.9%, and 10.9%, respectively. Lower health literacy was related to poorer health outcomes or lower quality of life in 71 studies.

The association between satisfaction with life and anxiety symptoms among Chinese elderly: a moderated mediation analysis

BACKGROUND

Previous studies have suggested that certain personal psychological variables (e.g., life satisfaction and cognitive function) and physical variables (e.g., body mass index [BMI]) are significantly associated with individuals' anxiety symptoms. However, relevant research on elderly is lagging and no studies have yet investigated the combined impact of these variables on anxiety. Thus, we conducted the present study to investigate the potential moderator role of BMI and the potential mediator role of cognitive function underlying the relationship between life satisfaction and anxiety symptoms in Chinese elderly based in Hong Kong.

METHODS

Sixty-seven elderly aged 65 years old and above were recruited from the local elderly community centres in this pilot study. Each participant underwent a systematic evaluation using the Satisfaction with Life Scale (SWLS), Hong Kong Version of the Montreal Cognitive Assessment (HK-MoCA), and the Hamilton Anxiety Rating Scale (HAM-A) and were measured for their body weight and height. Regression analysis using the bootstrapping method was employed to test the hypothesized moderated mediation model.

RESULTS

Our findings demonstrated the overall model accounted for 23.05% of the variance in scores of HAM-A (F (8, 57) = 2.134, p = 0.047) in Chinese elderly. There was a significant association between life satisfaction and anxiety symptoms (p = 0.031), indicating that individuals with higher life satisfaction were associated with less anxiety symptoms. Moreover, this relationship was positively moderated by BMI (b = 0.066, 95% CI [0.004, 0.128]), especially in Chinese elderly with BMI at a lower level (b = -0.571, 95% CI [-0.919, -0.224]) and an average level (b = -0.242, 95% CI [-0.460, -0.023]). No significant mediator role was detected for cognitive function (b = -0.006, 95% CI [-0.047, 0.044]) in our model.

CONCLUSIONS

Our findings suggest that increased life satisfaction can reduce anxiety symptoms among Chinese elderly as their BMI decreases (when BMI ranged between "mean - 1SD" and "mean" of the population). The significant interaction between psychological and physical factors underlying anxiety symptoms found in this study, presents a promising opportunity for translation into multi-level psychological and physical interventions for the management of anxiety in ageing patients during clinical practice.

Mental health literacy and suicidal ideation among Chinese college students: The mediating role of depressive symptoms and anxiety symptoms

BACKGROUND

Mental health literacy (MHL) is essential to mental health. Symptoms of depression and anxiety are significant antecedents and closely related to suicide among college students. Few studies have explored the mediating role of depressive and anxiety symptoms between MHL and suicidal ideation.

METHODS

5578 college students were included in the analysis. The online Wenjuanxing platform was used to collect data from November 2020 to March 2021. The bootstrapping method was used to test the mediating role of depressive and anxiety symptoms in the links between MHL and suicidal ideation.

RESULTS

Approximately 18.8 % of Chinese college students in our study reported having suicidal ideation. MHL exhibited a significant and negative correlation with depressive symptoms, anxiety symptoms, and suicidal ideation, whereas depressive and anxiety symptoms correlated significantly and positively with suicidal ideation. Compared with the lowest MHL quartile, the 3rd and 4th quartiles of MHL were associated with a significantly lower risk of suicidal ideation after adjusting for various confounding factors. Depressive and anxiety symptoms partially mediated the relationship between MHL and suicidal ideation, and the mediating effect of depressive symptoms was significantly greater than that of anxiety symptoms.

LIMITATIONS

This study was a cross-sectional survey. Future longitudinal studies on this relation are needed.

CONCLUSIONS

Depressive and anxiety symptoms mediate the relationship between MHL and suicidal ideation. Comprehensive school-based specific psychological education programs are needed to improve college students' MHL and change their attitudes toward mental health services.

Global prevalence of poor sleep quality in military personnel and veterans: A systematic review and meta-analysis of epidemiological studies

Poor sleep quality is prevalent among members of the military but rates of poor sleep quality vary between studies. This study examined the global prevalence of poor sleep quality in military personnel and veterans as well as possible moderators of prevalence differences between studies. PubMed, EMBASE, Web of Science, and PsycINFO were systematically searched from their inception dates to September 1, 2022. Studies were included if they were conducted on military personnel and/or veterans and prevalence estimates of poor sleep quality could be generated from assessments with standardized tools. A random-effects model was used to calculate the pooled prevalence and its 95% confidence intervals (CIs). Fifty-nine studies (N = 28,100) were included for analysis with sample sizes ranging from 14 to 8481. Two studies were rated as "high quality" (3.39%), while 57 were rated as "moderate quality" (96.61%). The overall pooled prevalence of poor sleep quality in military personnel and veterans was 69.00% (95% CI: 62.33-75.30%); pooled rates were 57.79% (95% CI: 49.88-65.50%) and 82.88% (95% CI: 74.08-90.21%) for active duty personnel and veterans, respectively. Subgroup analyses indicated study region, study design, sampling method, Pittsburg Sleep Quality Index cut-off values, and service type moderated prevalence of poor sleep quality. Meta-regression analyses indicated sample size, mean age, depression and posttraumatic stress disorder (PTSD) were associated with prevalence differences between studies. Poor sleep quality was more common in both active duty military personnel and veterans who were older and those who reported PTSD or depression. Regular monitoring of sleep quality and sleep hygiene should be promoted in this population. More relevant studies in middle- and low-income countries should also be conducted.

The relationship between living alone or not and depressive symptoms in older adults: a parallel mediation effect of sleep quality and anxiety

BACKGROUND

With modernization and ageing in China, the population of older adults living alone is increasing. Living alone may be a potential risk factor for depressive symptoms. However, no parallel mediation model analysis has investigated the mediating factors for living alone or not (living arrangements) and depressive symptoms.

METHODS

This cross-sectional study included a total number of 10,980 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 1699 of whom lived alone and 9281 of whom did not live alone. Binary logistic regression and parallel mediation effect model were used to explore the relationship between living alone or not and depressive symptoms and possible mediation effects. Bootstrap analysis was used to examine the mediation effect of living alone or not on depressive symptoms.

RESULTS

Compared to the participants who were not living alone, the living alone group had a higher rate of depressive symptoms. The binary logistic regression showed that after adjusting for other covariates, the risk of depressive symptoms was approximately 0.21 times higher for living alone compared to not living alone (OR = 1.21, 95% CI: 1.06, 1.37). Further, the results of the bootstrap analysis supported the partial mediating role of sleep quality and anxiety. Mediation analysis revealed that sleep quality and anxiety partially mediate the relationship between living alone and depressive symptoms (β = 0.008, 95% CI [0.003, 0.014]; β = 0.015, 95% CI [0.008, 0.024], respectively).

CONCLUSIONS

Sleep quality and anxiety were identified as partially parallel mediators between living alone or not and depressive symptoms. Older adults living alone with poorer sleep quality and more pronounced anxiety were positively associated with higher levels of depressive symptoms. Older adults living alone should be encouraged to engage in social activities that may improve sleep quality, relieve anxiety, and improve feelings of loneliness caused by living alone. Meanwhile, older adults living alone should receive attention and support to alleviate their depressive symptoms.

Depression and quality of life among Macau residents in the 2022 COVID-19 pandemic wave from the perspective of network analysis

Background

In the summer of 2022, Macau experienced a surge of COVID-19 infections (the 618 COVID-19 wave), which had serious effects on mental health and quality of life (QoL). However, there is scant research on mental health problems and QoL among Macau residents during the 618 COVID-19 wave. This study examined the network structure of depressive symptoms (hereafter depression), and the interconnection between different depressive symptoms and QoL among Macau residents during this period.

Method

A cross-sectional study was conducted between 26th July and 9th September 2022. Depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9), while the global QoL was measured with the two items of the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Correlates of depression were explored using univariate and multivariate analyses. The association between depression and QoL was investigated using analysis of covariance (ANCOVA). Network analysis was used to evaluate the structure of depression. The centrality index "Expected Influence" (EI) was used to identify the most central symptoms and the flow function was used to identify depressive symptoms that had a direct bearing on QoL.

Results

A total 1,008 participants were included in this study. The overall prevalence of depression was 62.5% (n = 630; 95% CI = 60.00-65.00%). Having depression was significantly associated with younger age (OR = 0.970; p < 0.001), anxiety (OR = 1.515; p < 0.001), fatigue (OR = 1.338; p < 0.001), and economic loss (OR = 1.933; p = 0.026). Participants with depression had lower QoL F (1, 1,008) =5.538, p = 0.019). The most central symptoms included PHQ2 ("Sad Mood") (EI: 1.044), PHQ4 ("Fatigue") (EI: 1.016), and PHQ6 ("Guilt") (EI: 0.975) in the depression network model, while PHQ4 ("Fatigue"), PHQ9 ("Suicide"), and PHQ6 ("Guilt") had strong negative associations with QoL.

Conclusion

Depression was common among Macao residents during the 618 COVID-19 wave. Given the negative impact of depression on QoL, interventions targeting central symptoms identified in the network model (e.g., cognitive behavioral therapy) should be developed and implemented for Macau residents with depression.

The prevalence of anxiety and its key influencing factors among the elderly in China

INTRODUCTION

With the rapid aging population, the mental health of older adults is paid more and more attention. Anxiety is a common mental health illness in older adults. Therefore, the study aimed to explore the current situation of anxiety and its factors among the elderly in China.

METHODS

Based on the data from 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), a total of 10,982 respondents aged 60 and above were selected. Generalized Anxiety Disorder (GAD-7) scale was used to assess the anxiety. Univariate and multivariate analysis were used to analyze the influencing factors of anxiety. Random forest was established to rank the importance of each influencing factors.

RESULTS

The results showed that the prevalence of anxiety among the elderly was 11.24%. Anxiety was mainly associated with 14 factors from five aspects: sociodemographic characteristics, health status, psychological state, social trust and social participation, among which loneliness related to psychological status was the most important factor.

DISCUSSION

The revelation of this study is that the present situation of anxiety among the elderly cannot be ignored, and it is necessary to take measures to prevent and control it from many aspects.

Prevalence of insomnia and its association with quality of life among Macau residents shortly after the summer 2022 COVID-19 outbreak: A network analysis perspective

BACKGROUND

The latest wave of the coronavirus disease 2019 (COVID-19) pandemic in Macau began on 18 June 2022 and was more serious than previous waves. Ensuing disruption from the wave is likely to have had a variety of negative mental health consequences for Macau residents including increased risk for insomnia. This study investigated the prevalence and correlates of insomnia among Macau residents during this wave as well as its association with quality of life (QoL) from a network analysis perspective.

METHODS

A cross-sectional study was conducted between 26 July and 9 September 2022. Univariate and multivariate analyses explored correlates of insomnia. Analysis of covariance (ANCOVA) examined the relationship between insomnia and QoL. Network analysis assessed the structure of insomnia including "Expected influence" to identify central symptoms in the network, and the flow function to identify specific symptoms that were directly associated with QoL. Network stability was examined using a case-dropping bootstrap procedure.

RESULTS

A total of 1,008 Macau residents were included in this study. The overall prevalence of insomnia was 49.0% (n = 494; 95% CI = 45.9-52.1%). A binary logistic regression analysis indicated people with insomnia were more likely to report depression (OR = 1.237; P < 0.001) and anxiety symptoms (OR = 1.119; P < 0.001), as well as being quarantined during the COVID-19 pandemic (OR = 1.172; P = 0.034). An ANCOVA found people with insomnia had lower QoL (F_(1,1,008) = 17.45, P < 0.001). "Sleep maintenance" (ISI2), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) were the most central symptoms in the insomnia network model, while "Sleep dissatisfaction" (ISI4), "Interference with daytime functioning" (ISI5), and "Distress caused by the sleep difficulties" (ISI7) had the strongest negative associations with QoL.

CONCLUSION

The high prevalence of insomnia among Macau residents during the COVID-19 pandemic warrants attention. Being quarantined during the pandemic and having psychiatric problems were correlates of insomnia. Future research should target central symptoms and symptoms linked to QoL observed in our network models to improve insomnia and QoL.