Mental health problems and associated school interpersonal relationships among adolescents in China: a cross-sectional study

Comparison of mental health networks across different educational stages

Mental health concerns are growing more prevalent among students of school age. This study employed network analysis to view mental health problems as a network of interconnected symptoms, and to compare how these networks vary across different stages of school age. A sum of 60, 465 Chinese students in Grades 4 through 12 were selected to participate in the Middle School Student Mental Health Inventory (MMHI-60). The mental health network and bridge centrality were assessed through network analysis. Network comparison tests were performed to compare the networks among elementary, junior high, and senior high school students. 12.2% of elementary school students, 22.1% of junior high school students, and 24.9% of senior high school students exceeded the threshold for overall mental health issues as defined by the MMHI-60. The network analysis indicated that anxiety emerged consistently as a central dimension of mental health issues across all educational levels; paranoid ideation was prevalent in both junior and senior high school, whereas emotional disturbance was particularly characteristic of elementary school. Upon comparing the network structures, it was found that the mental health network connectivity was more pronounced among senior high school students, indicating closer associations between dimensions in this group. Identifying core mental health dimensions and their unique connections in school-aged students at each stage, especially the strong links between dimensions in senior high school students, is crucial for creating successful mental health dimension prevention and intervention strategies for students in educational settings.

The impact of medical students' interpersonal relationships on their mental health: An analysis of the mediating effect of psychological capital

BACKGROUND

Medical students' academic studies, clinical practice, and career preparation expose them to specific pressures that significantly affect their mental well-being. Effective interpersonal relationships contribute to reducing these demands, and psychological capital is crucial in facilitating this process. It is crucial to investigate the interplay between interpersonal interactions and psychological capital to have a more profound comprehension of the psychological dynamics that impact the mental health of medical students.

MATERIALS AND METHODS

Five hundred questionnaires, including the Positive Psychological Capital Questionnaire (PPQ), Comprehensive Diagnostic Scale for Human Relationships (CDHR), and Symptom Self-Criticism Scale (SCL-90), were delivered at a medical university in May 2024 for this study.

RESULTS

The interpersonal relationships among medical students varied significantly depending on their involvement in social service activities (t = 2.83**, P < 0.01). Further investigation revealed notable variations in the psychological capital levels of medical students based on gender, involvement in student leadership, and participation in social services (t = 2.12*, P < 0.05; t = 2.19*, P < 0.05; t = 3.45***, P < 0.01). The link between interpersonal interactions, psychological capital, and mental health was statistically significant (-0.0495**; 0.502**; -0.452**, P < 0.01).

CONCLUSION

The relationship status of medical students exhibited a statistically significant variation based on their involvement in social service activities (t = 2.83**, P < 0.01). Additional investigation revealed notable variations in the psychological capital levels of medical students based on gender, engagement in student leadership, and involvement in social service (t = 2.12*, P < 0.05; t = 2.19*, P < 0.05; t = 3.45***, P < 0.01). The link between interpersonal interactions, psychological capital, and mental health was statistically significant (-0.0495**; 0.502**; -0.452**, P < 0.01).

Exploring the impact of interpersonal sensitivity on anxiety symptoms: the mediating role of psychological capital and social support among nursing students

BACKGROUND

As the demand for healthcare in society continues to rise, nursing students are likely to face various challenges related to their profession in the future. Anxiety symptoms have increasingly become a significant factor affecting their mental health. Given that nursing students are crucial to building the future nursing workforce, it is essential to prioritize their mental well-being. This study aims to explore the relationships between anxiety symptoms, interpersonal sensitivity, psychological capital, and perceived social support among nursing undergraduates.

METHODS

In April 2022, 1,885 nursing undergraduates at a university in eastern China participated in a survey using the Generalized Anxiety Disorder Questionnaire (GAD-7), the interpersonal sensitivity subscale of the SCL-90, the Multidimensional Scale of Perceived Social Support (MSPSS), and the Psychological Capital Questionnaire (PCQ-24). Statistical analysis was conducted using SPSS 24.0 and PROCESS v3.4 macro to assess the impact of interpersonal sensitivity on anxiety and the mediating roles of social support and psychological capital.

RESULTS

Anxiety showed a positive correlation with interpersonal sensitivity (r = 0.43) and negative correlations with perceived social support (r = -0.32) and psychological capital (r = -0.40), all significant (p < 0.001). Interpersonal sensitivity directly affects anxiety (β = 0.306, SE = 0.023, 95% CI [0.260, 0.352]). Psychological capital served as an independent mediator (β = 0.051, SE = 0.011, 95% CI [0.031, 0.075]) and also in a chain mediation with social support (β = 0.050, SE = 0.104, 95% CI [0.031, 0.072]).

CONCLUSION

Interpersonal sensitivity is a positive predictor of anxiety symptoms. Both psychological capital and social support effectively reduce interpersonal sensitivity and anxiety symptoms. Enhancing the availability of psychological capital and social support for nursing students is essential.

College students' psychology and behavior in the context of online public opinion: a cross-sectional study in Jiangsu Province, China

Background

With the rapid development of the Internet and the widespread use of social media, online public opinion has profoundly impacted the psychology and behavior of college students. College students are in a crucial stage of psychological development and self-awareness, making them highly sensitive to online information and easily influenced by online public opinion.

Methods

This study employed a cross-sectional design to explore the psychological adaptation and behavioral responses of college students to online public opinion. Data were collected from a convenience sample of 2,294 college students across four universities in Xuzhou City, Jiangsu Province, using an online questionnaire administered via Questionnaire Star. The study utilized three well-established scales: the Belief in a Just World (BJW) Scale, the Connor-Davidson Resilience Scale (CD-RISC), and the Internet Altruistic Behavior (IAB) Scale. Statistical analyses were conducted using SPSS 26.0, encompassing descriptive statistics, independent samples t-tests, ANOVA, correlation analysis, and multiple linear regression analysis, with a significance level set at p < 0.05. Any responses with missing or inconsistent data were excluded from the analysis, ensuring a final effective response rate of 95.7%.

Results

Among the 2,294 participants, 60.1% were female, 56.8% were from rural areas, and 57.4% were non-only children. Univariate analysis showed significant relationships between BJW scores and gender, family economic status, parents' attitudes, relationships with classmates, and emotional responses to negative online content (p < 0.001). CD-RISC scores were significantly related to only child status, family economic status, parents' attitudes, relationships with classmates, and emotional responses to negative online content (p < 0.05). IAB scores were significantly related to gender, grade level, family economic status, parents' attitudes, relationships with classmates, and emotional responses to negative online content (p < 0.05). Correlation analysis revealed significant associations among BJW, CD-RISC, and IAB. Multiple regression analysis identified key predictors for each scale, including gender, parents' attitudes, relationships with classmates, emotional responses to negative online content, and various other factors (p < 0.001).

Conclusion

In the context of online public opinion, targeted interventions by families and schools are needed to regulate the psychological and behavioral states of college students, promoting good mental health and positive behavior in the complex online environment.

The association between visual impairment, educational outcomes, and mental health: insights from eyeglasses usage among junior high school students in rural China

This study examined the association between visual impairment, visual impairment corrected by wearing eyeglasses, academic performance, and mental health among junior high school students in rural China. Visual acuity assessments were conducted on 19,425 junior high school students by trained medical and research professionals to determine the presence of visual impairment. All sample students were surveyed with a questionnaire that asked about individual and family characteristics, eyeglasses ownership, and educational aspirations and included a standardized math test. Students then completed an official Chinese simplified version of the Strengths and Difficulties Questionnaire (SDQ) to assess their mental health multidimensionally. Among our sample, 37.2% of them suffered from visual impairment, but only 43.4% of the visually impaired students wore proper eyeglasses. Approximately 9.3% of students were categorized as high risk for mental health problems based on their SDQ score. A significant positive association existed between impaired vision and poorer mental health, and eyeglasses usage was associated with better mental health among visually impaired students. For students with better academic performance, eyeglasses usage associated with better mental health. Eyeglasses usage shows a positive association with higher education aspiration both for students with better and worse academic performance. The significant positive relationship between eyeglasses usage and mental health may guide future interventions and policies designed to improve student mental health by supplying them with eyeglasses.

Bridging the relationship between physical exercise and mental health in adolescents based on network analysis

Although physical exercise has been recommended as a useful means of enhancing the mental health of adolescents, the exact mechanisms through which physical exercise plays a role are unclear. Both physical exercise and mental health are complex concepts with multiple facets, and traditional methods may constrain the manifestations of their mapping relationships. This research aimed to find the bridging connections between physical exercise and mental health. Mental health and physical exercise behaviors were assessed using the Symptom Checklist 90 (SCL-90) and the Adolescent Physical Activity Questionnaire (PAQ-A) in 9072 Chinese adolescents, respectively. Network analysis was utilized to construct the mental health-physical exercise network and to analyze the relationships between individual physical exercise behaviors and mental health symptoms. Core and bridging nodes were identified based on expected influence (EI) and bridge expected influence (BEI). Gender differences were also examined. The results revealed specific and distinct pathways between physical exercise and mental health (e.g., winter sports-obsessive-compulsive symptoms, winter sports-phobia). For both males and females, anxiety, depression, interpersonal sensitivity, ball sports, and evening activity were the most central symptoms/behaviors, reflecting their relative significance in their respective associations. The nodes with the highest BEI were obsessive-compulsive symptoms and physical education, showing negative associations with nodes in the other community. Furthermore, in the male group, somatization and winter sports stood out as the most positive bridge nodes. Conversely, in the female group, interpersonal sensitivity and sports games were the most positive bridge nodes. These findings illuminate the pathways linking physical exercise and mental health, supporting the implementation of physical exercise in a more elaborate way.

Characteristics of symptoms and development of psychological status in late Chinese adolescence

BACKGROUND

Many late adolescents experience a state of psychological sub-health, requiring early recognition and intervention. This study aims to assess the psychological state of late Chinese adolescents and uncover developmental trend of mental health through network analysis.

METHOD

We analyzed data from 9072 Chinese high school adolescents in Shandong Province surveyed in 2020-2021, and divided them into the normal, the suspected, and the abnormal groups based on Symptom Checklist 90 (SCL-90) scores. Network analysis was employed to identify the core symptoms and bridge symptoms across different states.

RESULTS

Anxiety and depression were the most central symptoms, without gender differences. Core symptoms, network structure, and network invulnerability varied across different psychological states. The abnormal group exhibited the highest value of natural connectivity, followed by the suspected and normal groups. This pattern extended to bridge networks. While not meeting diagnostic criteria, the suspected group demonstrated abnormalities in network edge invariance and global strength invariance.

LIMITATIONS

The cross-sectional design cannot establish causality, and biases in self-report measurements cannot be ignored.

CONCLUSION

Compared to traditional scale indicators, network structural characteristics may be a more sensitive assessment indicator.

How is parental psychological control associated with adolescent mental health in economically disadvantaged areas? The serial mediating role of psychological reactance and problematic smartphone use

INTRODUCTION

Adolescent mental health has been an issue of global concern, and the mental health of adolescents in economically disadvantaged areas may require additional research. The research delves into factors associated with economically disadvantaged areas' adolescent mental health, employing family systems theory, self-determination theory, and psychological reactance theory. Specifically, the present study which was done in Jingzhou country, an economically disadvantaged area of Hunan Province, China, aimed to examine the link between parental psychological control and adolescent mental health, as well as the mediating roles of psychological reactance and problematic smartphone use in this relationship.

METHODS

A sample of 1300 Chinese middle school students (620 girls, mean age = 14.22 ± 1.29) completed self-reported measures of parental psychological control, psychological reactance, problematic smartphone use, and adolescent mental health.

RESULTS

Results showed that parental psychological control was negatively associated with adolescent mental health. Psychological reactance and problematic smartphone use mediated the association between parental psychological control and adolescent mental health, separately and serially.

DISCUSSION

The findings of the present study enrich the literature on parenting styles and adolescent mental health in economically disadvantaged areas, and this provides an intervention perspective to reduce the negative impact of poor parenting on adolescent mental health in economically disadvantaged areas.

Development of a school-based programme for mental health promotion and prevention among adolescents in Nepal and South Africa

Introduction

Adolescence is a critical time for mental health promotion and prevention and establishing healthy behaviours. Implementing universal, school-based psychosocial interventions can improve short- and long-term health trajectories for adolescents. While these interventions may offer important opportunities for fostering skills and relationships, few school-based interventions have been developed for and tested in low- and middle-income countries (LMICs) where adolescent mental health needs may be significant and under-served. This manuscript details the development of a multi-component, universal school-based intervention, Health Action in ScHools for a Thriving Adolescent Generation (HASHTAG), for adolescents aged 12-15 years in Nepal and South Africa.

Methods and results

We describe HASHTAG's development over four phases, combining methods and results as each phase was iteratively conducted between 2018 and 2021. Phase 1 included a systematic review and components analysis, building from WHO guidelines for adolescent mental health. Seven components were strongly supported by the evidence: emotional regulation, stress management, mindfulness, problem-solving, interpersonal skills, assertiveness training, and alcohol and drug education. Phase 2 encompassed site selection, theory of change development, and formative research engagements; research teams in each site engaged adolescents and key adult stakeholders to identify priorities for intervention. Stakeholders voiced preferences for external facilitators and key content and delivery for intervention sessions. These findings informed Phase 3, a draft manual of HASHTAG, including a whole-school component, called Thriving Environment in Schools, and a classroom-based, six-session component, Thrive Together. In Phase 4, participants engaged in consultative workshops to review and contextualise content by country, preparing HASHTAG for implementation in a feasibility trial. Minor adaptations were made in Nepal, including using school nurses and adjusting take-home materials; both country's workshops identified practical considerations for implementing activities.

Conclusions

HASHTAG was designed around core evidence-based components to increase translatability across LMICs, while enabling country-specific tailoring to enhance feasibility. Future research will test whether this multi-component, whole-school approach can improve adolescent mental health.

The effect of social anxiety on teenagers' internet addiction: the mediating role of loneliness and coping styles

BACKGROUND & AIM

There is a lack of understanding of how social anxiety may affect Internet addiction among adolescents. Based on several theories, the purpose of this study was to investigate the multiple mediating roles of loneliness and coping styles in the association between social anxiety and Internet addiction in Chinese adolescents.

METHODS

This study used the Social Anxiety Scale, Internet Addiction Test, Loneliness Scale, and Simple Coping Style Questionnaire to investigate 1188 students in two junior high schools and senior high schools in Henan Province, China. We adopted Pearson's correlation analysis and the PROCESS Macro Model 81 in regression analysis to explore the relationships among social anxiety, loneliness, coping styles, and Internet addiction.

RESULTS

We found that social anxiety not only directly affects teenagers' Internet addiction, but also affects teenagers' Internet addiction through loneliness and coping styles.

CONCLUSIONS

These results emphasize the importance of improving social anxiety to reduce Internet addiction among adolescents. At the same time, it also emphasizes the need to reduce adolescents' loneliness and cultivating positive coping styles. In addition, this study has certain theoretical significance for teenagers' mental health and intervention studies on Internet addiction.

Multidimensional stressors and depressive and anxiety symptoms in adolescents: A network analysis through simulations

BACKGROUND

Existing research has established associations between various stressors and adolescent mental health, primarily from a variable-level perspective. However, a symptom-level understanding about which stressors and symptoms might play a important role is scarce.

METHODS

The sample consisted of 15,570 adolescents aged 10 to 19. Participants completed questionnaires which assessed multidimensional stressors, depressive symptoms, anxiety symptoms, and demographic information. Network analysis was conducted to explore the relationships between stressors and depressive and anxiety symptoms. Additionally, to identify effective targets for the treatment and prevention of adolescent mental health issues, symptom-specific intervention simulations were performed on the network to investigate changes in symptom values in response to the alleviation and aggravation of specific stressors and symptoms.

RESULTS

Findings revealed that academic stressors exhibited stronger associations with anxiety symptoms than other stressors, particularly nervousness. Family relationships were more closely linked to depressive symptoms than other stressors, particularly suicidal ideation. Academic stressors emerged as an effective intervention target, and uncontrollable worry as an important prevention target. With the exception of academic stressors, simulating aggravation interventions on symptoms resulted in more changes in overall symptom activation than alleviation interventions.

LIMITATIONS

A cross-sectional design did not uncover network changes over time and the sample was non-clinical.

CONCLUSIONS

This study highlights the importance of addressing academic stressors to alleviate adolescents' depressive and anxiety symptoms and reveals that uncontrollable worry is a key prevention target. The findings are helpful for clinicians and educators to develop effective strategies to protect adolescents' mental health.

Effects of Impulsivity and Interpersonal Problems on Adolescent Depression: A Cross-Lagged Study

The dynamic changes over time in the relationships between impulsivity, interpersonal problems, and depression warrant further exploration. This study delves into the roles of impulsivity and interpersonal issues in the progression of adolescent depression over a year, using a sample of 271 Chinese adolescents (51.7% male, Mage = 12.60 ± 0.69). At three time points, impulsivity levels were assessed with the Chinese version of the Barratt Impulsiveness Scale-11, interpersonal problems with the Adolescent Self-Rating Life Events Check List, and depression with the Center for Epidemiologic Studies Depression Scale. Results revealed that both impulsivity and interpersonal problems serve as risk factors for depression, but the primary risk factor shifted over time. In early middle school stages, impulsivity was the predominant risk factor, while in later stages, interpersonal problems became the primary risk factor. These findings carry significant implications for directing prevention efforts and interventions for adolescent depression.

Estimating bidirectional effects between social connectedness and mental health in adolescent students: Addressing biases due to endogeneity

Research on the bidirectional relationship between social connectedness and health/mental health in adolescents is scarce, with most studies on adults. Some of the existing studies exploited the availability of longitudinal data to provide evidence of the existence of a causal relationship, either from social connectedness to health or establish a bidirectional relationship. There are at least two weaknesses associated with earlier research to assess the size of the effects. As acknowledged in the literature, one relates to attributing causality to empirical findings, due to well-known but inadequately addressed endogeneity biases. The other relates to failure to account for potentially important covariates, sometimes due to data limitations, or because such variables are not frequently used in sociological research. Existing research predominantly finds that the strongest path is from social connectedness to health/mental health, with effect estimates modest in size. I followed a quasi-experimental strategy by modelling adolescent students' perceptions of social connectedness and mental health perceptions as potentially endogenous variables when estimating bidirectional effects. An instrumental variables (IV) modelling approach was followed, supplemented with a recently developed alternative approach to testing the exclusion restrictions of individual instruments. I exploited the rich information available in the PISA 2018 multi-country dataset, which allows for conditioning for a wide array of information on adolescent students' personal circumstances, self-reported personality-related attributes, relationships with parents; and school characteristics. I found that (1) accounting for endogeneity biases is important; and (2) as opposed to findings reported in the literature, the dominant effect is from mental health perceptions to social connectedness for both male and female participants. The policy relevance of the findings is that adolescent mental health should be the primary focus of interventions, i.e., identifying and treating mental health symptoms as a primary intervention and as a precursor to improving the social connectedness of adolescents.

The roles of parenting, resilience, and interpersonal relationships on adolescents' mental health and stress-related growth during COVID-19

BACKGROUND

The present longitudinal study investigated parenting style as a precursor for Chinese adolescents' stress-related growth and mental health difficulties during the COVID-19 pandemic, as well as the mediating roles of intrapersonal resilience and interpersonal relationships (i.e., peer and parent-adolescent).

METHODS

Chinese adolescents in a middle school (7th grade) and their parents in Beijing, China, were invited to complete a survey at two time points (T1: September 2020, T2: June 2021). A total of 206 adolescents (52.9% boys; Mage  = 12.90 years, SDage  = 0.33) and parents (17.5% fathers, 82.4% mothers; Mage  = 43.50 years, SDage  = 4.76 years) were included in this study.

RESULTS

Results showed that Chinese parents' authoritarian, not authoritative parenting, predicted adolescents' mental health difficulties nine months later. In addition, parent-adolescent relationships, but not peer relationships nor resilience, mediated the relations between parenting style and stress-related growth. Adolescents' resilience predicted fewer mental health difficulties.

CONCLUSION

It is important to target multiple ecologies (e.g., family) of adolescents for promoting positive adjustment.

Investigation of contemporary college students' mental health status and construction of a risk prediction model

BACKGROUND

Due to academic pressure, social relations, and the change of adapting to independent life, college students are under high levels of pressure. Therefore, it is very important to study the mental health problems of college students. Developing a predictive model that can detect early warning signals of college students' mental health risks can help support early intervention and improve overall well-being.

AIM

To investigate college students' present psychological well-being, identify the contributing factors to its decline, and construct a predictive nomogram model.

METHODS

We analyzed the psychological health status of 40874 university students in selected universities in Hubei Province, China from March 1 to 15, 2022, using online questionnaires and random sampling. Factors influencing their mental health were also analyzed using the logistic regression approach, and R4.2.3 software was employed to develop a nomogram model for risk prediction.

RESULTS

We randomly selected 918 valid data and found that 11.3% of college students had psychological problems. The results of the general data survey showed that the mental health problems of doctoral students were more prominent than those of junior college students, and the mental health of students from rural areas was more likely to be abnormal than that of urban students. In addition, students who had experienced significant life events and divorced parents were more likely to have an abnormal status. The abnormal group exhibited significantly higher Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scores than the healthy group, with these differences being statistically significant (P < 0.05). The nomogram prediction model drawn by multivariate analysis included six predictors: The place of origin, whether they were single children, whether there were significant life events, parents' marital status, regular exercise, intimate friends, and the PHQ-9 score. The training set demonstrated an area under the receiver operating characteristic (ROC) curve (AUC) of 0.972 [95% confidence interval (CI): 0.947-0.997], a specificity of 0.888 and a sensitivity of 0.972. Similarly, the validation set had a ROC AUC of 0.979 (95%CI: 0.955-1.000), with a specificity of 0.942 and a sensitivity of 0.939. The H-L deviation test result was χ2 = 32.476, P = 0.000007, suggesting that the model calibration was good.

CONCLUSION

In this study, nearly 11.3% of contemporary college students had psychological problems, the risk factors include students from rural areas, divorced parents, non-single children, infrequent exercise, and significant life events.

COVID-19 Stressful Life Events and Chinese Adolescents' Mental Health: Examining Resilience, Peer Relationship, and Parenting as Moderators

The current study examines intrapersonal characteristics or factors (i.e., resilience), peer (i.e., quality of peer relationships), and family processes (i.e., parental involvement, critical comparison) as potential risk and protective factors for mental health of Chinese adolescents during COVID- 19 pandemic. A total of 504 seventh-grade students (52% boys) and their caregivers in Beijing, China completed an online survey in September 2020. Youth reported experiencing various COVID-19-related stressful life events (i.e., conflicts with parents, poor learning environment and efficiency, family financial pressure), and about 15% reported slightly elevated scores of mental health difficulties. Findings suggested personal resilience and quality of peer relationship predicted positive mental health (i.e., covitality or co-occurrence of positive psychological dispositions) and less mental health difficulties. Parent's critical comparison intensified the negative link between stressful life events and youth mental health. Implications for promoting youth mental health as schools reopen are discussed.

Changes in social interaction, social relatedness, and friendships in Education Outside the Classroom: A social network analysis

Introduction

Social interaction is associated with many effects on the psychological level of children such as mental health, self-esteem, and executive functions. Education Outside the Classroom (EOtC) describes regular curricular classes/lessons outside the school building, often in natural green and blue environments. Applied as a long-term school concept, EOtC has the potential to enable and promote social interaction. However, empirical studies on this topic have been somewhat scant.

Methods

One class in EOtC (N  = 24) and one comparison class (N = 26) were examined in this study to explore those effects. Statistical Actor-Oriented Models and Exponential Random Graph Models were used to investigate whether there are differences between EOtC and comparison class regarding changes over time in social interaction parameters; whether a co-evolution between social interaction during lessons and breaks and attendant social relatedness and friendships exists; whether students of the same gender or place of residence interact particularly often (homophily).

Results

Besides inconsistent changes in social interaction parameters, no co-evolutional associations between social interaction and social relatedness and friendships could be determined, but grouping was evident in EOtC. Both classes showed pronounced gender homophily, which in the case of EOtC class contributes to a fragmentation of the network over time.

Discussion

The observed effects in EOtC could be due to previously observed tendencies of social exclusion as a result of a high degree of freedom of choices. It therefore seems essential that in future studies not only the quality of the study design and instruments should be included in the interpretation - rather, the underlying methodological-didactic concept should also be evaluated in detail. At least in Germany, it seems that there is still potential for developing holistic concepts with regards to EOtC in order to maximize the return on the primarily organizational investment of implementing EOtC in natural environments.

More Competition in Mind, Better Sleep at Night? The Mediating Role of Anxiety between Competitive Attitude and Sleep Quality

Previous studies have suggested that individuals with hypercompetitive attitude and interpersonal insecurity would have a high level of anxiety, and anxiety has been found to strongly impact on sleep quality. However, the associations between competitive attitudes and sleep quality have not been studied until now. The present study aimed to examine whether anxiety mediates the relationship between competitive attitudes and interpersonal relationships with sleep quality. This was a cross-sectional study with a total of 713 college students (age = 20.18 ± 2.16 years old; 78.8% female) recruited online to measure hypercompetitive attitude, personal development competitive attitude, interpersonal security, state anxiety and sleep quality. Path analysis models were conducted in this study. The path analysis models showed that both hypercompetitive attitude and interpersonal security had direct and indirect significant effects on poor sleep quality due to the mediating effect of state anxiety (β = 0.023, 95% bootstrapped CI: 0.005 to 0.047; β = -0.051, 95% bootstrapped CI: -0.099 to -0.010, respectively). However, personal development competitive attitude had only an indirect significant effect, but it had a negative role on poor sleep quality via state anxiety (β = -0.021, 95% bootstrapped CI: -0.042 to -0.008). The current study provided evidence that college students' competitive attitudes would impact sleep quality and highlighted the mediating role of state anxiety. The current findings suggested that individuals shifting their hypercompetitive thinking to concentrate on ability development would benefit their mental health.

Relationships among inferiority feelings, fear of negative evaluation, and social anxiety in Chinese junior high school students

Introduction

This study aimed to explore the relationship between feelings of inferiority and social anxiety in Chinese junior high school students. In addition, it examined the potential mediating effect of fear of negative evaluation in this relationship.

Methods

A survey was administered to a sample of 734 Chinese junior high school students. The Feelings of Inadequacy Scale, Brief Fear of Negative Evaluation Scale, and Social Avoidance Distress Scale were used.

Results

First, there were significant positive correlations between all subscales for the inferiority feelings, social anxiety, and fear of negative evaluation. Furthermore, fear of negative evaluation mediated the predictive effects of four inferiority subscales (i.e., self-esteem, academic ability, appearance, and physical ability) for social anxiety. However, the total score for the sense of inferiority and social confidence subscale lacked this mediating effect.

Conclusion

The inferiority feelings of self-esteem, academic ability, appearance, and physical ability may directly and indirectly predict social anxiety through fear of negative evaluation.

Intercultural sensitivity as a mediator in the relationship between implicit intercultural identification and emotional disturbance-An exploratory study of international high school students

Background

Intercultural adaptation is always associated with emotional disturbances. Intercultural communication competence, as an important competence of intercultural adaptation, involves implicit intercultural identification and intercultural sensitivity. Competence in these areas promotes the process of intercultural adaptation. Little is known about the relationship between intercultural communication competence and emotional disturbances in new students attending international high schools. The intercultural adaptation process of this population requires attention because of the increasing number of high school students attending international schools, and the fact that most of these teenagers are immersed in intercultural contexts for the first time.

Objective

This study aimed to investigate the prevalence of emotional disturbance in new students in an international high school and confirm the relationship among implicit intercultural identification, intercultural sensitivity, and emotional disturbances.

Methods

Study 1 was an investigation of the prevalence of emotional disturbance in 105 students in their 1st year at an international high school using the Self-rating Depression Scale and Self-rating Anxiety Scale. Of these students, 34 were invited to participate in Study 2 to further explore the relationship between intercultural sensitivity, implicit intercultural identification, and emotional disturbances using the Intercultural Sensitivity Scale and Single Category Implicit Association procedure.

Results

Study 1 indicated that 15.24% of students were affected by apparent depression and 10.48% had anxiety symptoms. Study 2 revealed that emotional disturbances significantly correlated with intercultural sensitivity (p < 0.01) and implicit intercultural identification (p < 0.01). The openness factor from intercultural sensitivity mediated the relationship between implicit intercultural identification and depression (ratio of indirect effect = 41.04%, p < 0.05) and anxiety symptoms (ratio of indirect effect = 34.65%, p < 0.05).

Conclusion

The study revealed that a significant proportion of students in the 1st year of international high school are affected by emotional difficulties. However, intercultural communication competence is a protective factor. Enhancing the international communication competence of senior students in international high schools is important to mitigate mental health challenges.

Difficulties in Adapting at School Among Nepalese Immigrant Children in Japan

Introduction

Japan has experienced a shift toward a multicultural society, and an increasing number of immigrant children have enrolled in its educational systems. Unforeseen experiences may affect the mental well-being of these children and undermine their holistic development; however, research is scarce. This article explores parents' concern on Nepalese children's experiences in Japanese schools. We aim to reveal the issues that may inform healthcare professionals and schools in best supporting immigrant students.

Methods

Qualitative survey methods were adopted in an online survey tool to access and collect data from 13 Nepalese parents whose children (age 6-18 years) attended the schools (elementary or junior high school) in four prefectures of Japan. Thematic analysis was used to analyze the data.

Results

The following four themes were identified: (i) interaction and relationship; (ii) feeling different and meals at school; (iii) academic exclusion-lack of assistance/review at home; and (iv) emotional distress, peer exclusion, and bullying.

Conclusion

Our findings suggest that because of the linguistic and cultural differences, children had difficulty communicating, leading to poor interpersonal relationships. Subjects reported changes in daily living patterns at home and school, and children felt different, shy, and unable to make friends or get involved. There were problems with school meals as well, and parents expressed concern over a lack of academic assistance. Some noteworthy emotional aspects were inability to be happy at school and bullying or exclusion from peers. They did, however, express the impression that Japanese students and teachers are cooperative. Overall, these findings have implications for schoolteachers, nurses, health personnel, parents, and others who promote the mental well-being and holistic development of children. This study provides a basis for mental health educational programs targeting the relationship between migrant and native students to create an inclusive society for all.

Perceived teacher support, peer relationship, and university students' mental health: The mediation of reality and Internet altruistic behaviors

Studying in universities is a crucial development stage for students, whose thoughts, feelings, and actions are affected by interactions with their teachers and peers. This study explored the relationships between perceived teacher support and mental health as well as those between peer relationship and mental health among university students, and examined the mediating effects of reality and Internet altruistic behaviors on these relationships. Perceived teacher support questionnaire, peer relationship satisfaction questionnaire, self-reported altruism questionnaire, Internet altruistic behavior questionnaire, and general health questionnaire were administered to 553 university students. Results demonstrated that perceived teacher support and peer relationship positively predicted reality and Internet altruistic behaviors and positively predicted mental health. Reality and Internet altruistic behaviors positively predicted mental health and exerted significant mediating effects on the correlations between perceived teacher support and mental health as well as those between peer relationship and mental health. The male and female students differed insignificantly in the mediating effects of reality and Internet altruistic behaviors. Therefore, no matter for males or females, teachers should provide sufficient support for the students and establish favorable relationships with them. Friendly relationships, comfort, and active communication among peer students are also essential for creating a healthy and harmonious interaction environment. Those various factors of the school have impacts on the mental health of university students through their altruistic behaviors. This study suggests that further emphasis on teacher support and peer relationship is needed to promote the positive development of altruistic behaviors among university students, and ultimately provide a viable contribution to the university students' mental health interventions.

The Effect of Perceived Social Support on the Mental Health of Homosexuals: The Mediating Role of Self-Efficacy

OBJECTIVE

The purpose of this study was to investigate the mental health of homosexual adults in China and to explore the effects of perceived social support and self-efficacy on mental health.

METHODS

Two hundred and nine homosexuals were recruited to participate in the online survey. The Perceived Social Support Scale, General Self-efficacy Scale, Self-rating Anxiety Scale and Self-rating Depression Scale were completed through a questionnaire website. Correlation analysis and mediation analysis were used to investigate the relationship between perceived social support, self-efficacy and mental health of homosexuals.

RESULTS

Description analysis showed the following: (1) In this study, 53.9% of the participants had depression symptoms and 46.7% had anxiety problems; (2) perceived social support, self-efficacy, anxiety and depression were significantly related to each other. The mediation effect analysis found that self-efficacy mediates between perceived social support and depression but does not mediate between perceived social support and anxiety.

CONCLUSIONS

The results demonstrated that in the context of Chinese collectivist culture, homosexuals have certain mental health problems, and their perceived social support and self-efficacy are critical protective factors for mental health. Our findings highlight the need to further strengthen social support and self-efficacy in mental health services for Chinese homosexuals.

Positive Childhood Experiences Associate with Adult Flourishing Amidst Adversity: A Cross Sectional Survey Study with a National Sample of Young Adults

The purpose of this study was to examine the prevalence of PCEs among young adults in Mainland China and the extent to which the cumulative number of PCEs moderates the associations between ACEs and flourishing in adulthood. Between August and November 2020, we used convenience and snowball sampling to recruit 9468 young adults, ages 18-35, enrolled in undergraduate or graduate programs at universities in Mainland China to participate in a survey, which included measures on flourishing, exposure to ACEs and PCEs, and demographic characteristics. Approximately 92% of participants reported experiencing seven to nine PCEs, with harmonious family relationships (96.9%), feeling supported by friends (96.8%) and being treated fairly at school (96.3%) being the most common PCEs reported. Results of the multiple regression indicated that the cumulative number of PCEs statistically significantly moderated the relation between the cumulative number of ACEs and flourishing (interaction term b = -0.060 [-0.071, -0.049], p < 0.001, adjusted R² = 0.183); as the number of ACEs increased up through eight ACEs, decreases in flourishing were smaller among those with higher numbers of PCEs. PCEs are common among young adults from Mainland China and serve a potential buffering effect against exposure to ACEs.

The Chain Mediating Effect of Network Behavior and Decision Self-Efficacy between Work Skills and Perceived Employability Based on Social Cognitive Theory

The purpose of this study is to investigate the chain mediating effects of networking behaviors and decision self-efficacy between work skills development and perceived employability. Structural equations modeling is used to analyze data collected from 813 Chinese students. The results show the following: first, the work skills development is positively correlated with perceived employability. Second, network behavior and decision self-efficacy each have a mediating effect between work skills development and perceived employability. Finally, this study found a chain mediating effect of network behavior and decision self-efficacy between work skills development and perceived employability. Therefore, this research shows that Work-Integrated Learning (WIL) needs to focus not only on skills development and employability outcomes but also on developing a strong network-based platform for stakeholders. In addition, higher education institutions and workplaces should also provide career guidance and counseling centers to help students build confidence in career decision-making and ensure students' mental health care and healthy career development.

The relationship between negative life events and mental health of overseas Chinese left-behind children: A moderated mediation model

To examine the factors influencing the mental health and sociality of overseas Chinese left-behind children, and to identify the protective mechanisms of their mental health, the current study investigated 568 overseas Chinese left-behind children. The age distribution of the sample ranges from 10 to 16 years, with an average age of 13.51 years and a standard deviation of 1.11. Using the Adolescent Self-Rating Life Events Checklist, Perceived Social Support Scale, General Self-Efficacy Scale and Mental Health Inventory of Middle-school Students, results showed that: (1) Perceived social support played a moderate mediate role in the relationship between negative life events and mental health. (2) The effect of negative life events on perceived social support was moderated by general self-efficacy. Negative life events of overseas Chinese left-behind children with higher self-efficacy were more likely to experience negative mental health. Conclusion: Perceived social support plays a moderating mediating role in the relationship between negative life events and mental health of overseas Chinese left-behind children.

A multilevel model of the help-seeking behaviors among adolescents with mental health problems

Objective

Mental health problems are highly prevalent among adolescents yet the utilization of mental health services among such a population is very low. This study was conducted to examine mental health problems and related help-seeking behaviors among a Chinese sample of adolescents.

Methods

A total of 3,480 students were recruited from four middle- and high schools in Changsha City, Hunan province, and completed an online questionnaire that assessed their general information, mental health problems including depression, anxiety, self-harm, and suicide ideation, as well as their help-seeking behaviors from both formal (including psychological teachers and mental health professionals) and informal sources (including family, friends, and teachers).

Results

The participants had a prevalence of 13.7% for depression, 11.5% for anxiety, 9.8% for self-harm, and 9.1% for suicide ideation. Although a high rate of help-seeking behaviors was observed (73.0%), most were concentrated in informal sources (99.3%), while only a small portion of participants resorted to formal sources (13.9%). Being female (OR: 1.45, 95% CI: 1.15-1.83), higher grade (OR: 1.32, 95% CI: 1.01-1.73), school mental health resources not available (OR: 1.39, 95% CI: 1.02-1.88), without suicide ideation (OR: 2.03, 95% CI: 1.42-2.90) were all associated with increased likelihood of formal help-seeking behaviors. On the other hand, complete middle school (OR: 0.36, 95% CI: 0.22-0.59), the middle level of academic ranking (OR: 0.64, 95% CI: 0.42-0.97), and higher father education levels (OR: 0.54-0.56, 95% CI: 0.33-0.90) were all associated with a decreased likelihood of formal help-seeking behaviors.

Conclusion

Our results showed a higher prevalence of help-seeking behavior for emotional or psychological problems during the past year. Compared to the high rate of informal help-seeking behaviors, students showed a lower propensity to seek formal help for their mental health problems, which may be explained by individual-level, family-level, and school-level factors. Our findings provide important implications for the development and popularization of targeted, needs-based mental health promotion and education programs in the future.

Moderating Effect of Gender and Engineering Identity on the Association between Interpersonal Relationships and Mental Health of Female Engineering Students

Influenced by factors such as gendered masculine culture within the engineering fields, female engineering students are facing increasing mental health issues. However, the effect of gender or engineering identity on the mental health distress of female engineering students was not well explored till now. This study adds to the current body of knowledge of mental health distress in female engineering students by proposing and verifying a moderating model based on social identity theory (SIT). The data were collected in June 2022 using a cross-sectional survey questionnaire distributed at five universities in eastern China (N = 376). A stepwise multiple regression analysis was performed to understand the relation between the tension of interpersonal relationships, the mental health distress female engineering students suffer from, and their gender or engineering identity. In our sample, 13.03%, 15.96%, and 14.36% of the female engineering students self-reported moderate to extremely severe stress, anxiety, and depression, respectively. Meanwhile, our results provide empirical evidence for the significantly positive relationship between the female engineering students' tension of interpersonal relationships and their mental health distress, including stress, anxiety, and depression. Moreover, we found that gender identity can enhance the positive relationships mentioned above, while engineering identity could weaken these relationships. These findings provide empirical evidence for the role of social identity theory in dealing with mental health problems among engineering students. Broadly, the results of this work inform that social identity and professional role identity should be considered when designing interventions to prevent mental health crises among college students.

Mental Health Problems and Associated Factors among High School Students in Shandong Province of China: A Cross-Sectional Study

Background: Although many studies have analyzed the mental health problems (MHP) of Chinese adolescents, the associations of Chinese high school students’ MHP with personal and family circumstances, parents’ educational level, physical activity, and school adaptation are rarely discussed. Methods: The participants were 9398 students who were randomly recruited from 30 high schools in Shandong, China. Self-reported questionnaires were used to collect data. Multivariate logistic regression models were used to investigate associations between MHP and related factors. Results: The positive rate of MHP among high school students was 27.0%. Female, intimate friends of the opposite sex, poor family economic status, father’s educational level of primary school or below, low social competence, and high antisocial behavior were significantly associated with higher odds of having MHP (p < 0.05). Students’ self-reported odds of having obsessive−compulsive disorder, interpersonal sensitivity, and depression were inversely related to their mother’s educational level. Compared with students who did not exercise, students who engaged in more than 30 min of physical activity 5−6 times per week had 60% lower self-reported odds of depression. Conclusions: We recommend strengthening the prevention, early detection, and treatment of MHP in high school students, especially those whose parents have low educational attainment, inactivity, and high disruptive behaviors.

Interventions in Chinese Undergraduate Students' Mental Health: Systematic Review

BACKGROUND

Over 30% of university students from 8 countries were afflicted with mental distress according to a World Health Organization survey. Undergraduate students in increasing numbers in China have also been reported to suffer from different mental problems. Various psychological distresses significantly impact their academic and daily life, thereby causing role impairments and unsatisfactory academic achievements. While the prevalence of, diverse underlying factors for, and interventions of social support in college students' mental health have extensively been investigated in China, there is no study exclusively focusing on the impact of interventions on their psychological well-being.

OBJECTIVE

The aim of this review was to identify and synthesize the interventions in the mental health concerns of Chinese undergraduate students studying in China reported in the literature to inform educational authorities, college and university management, students' affairs counselors, and mental health providers.

METHODS

We performed a systematic review and reported the research findings of previous studies according to the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. First, based on the predefined search strategy, keyword searches were performed in the PubMed and ProQuest databases to retrieve relevant studies. Subsequently, we screened the candidate articles based on predefined inclusion and exclusion criteria. Finally, we analyzed the included papers for qualitative synthesis.

RESULTS

We retrieved a total of 675 studies from the PubMed and ProQuest databases using the search strategy on March 15, 2022. Among these candidate studies, 15 that were not written in English, 76 duplicates, and 149 studies of other document types were removed before screening. An additional 313 studies were excluded in the screening process, with 73 articles ruled out for being not relevant to interventions, not related to mental health, or not focused on undergraduate students in the full-text review. As a result, 49 papers were eligible and included in this systematic review. In the qualitative synthesis, we divided the interventions reported in the selected studies into two categories: (1) social support from government authorities, university authorities, students' affairs counselors and teachers, family members, health care authorities and professionals, and the media (various online platforms), and (2) various coping strategies adopted by undergraduate students themselves. We identified further research on mental health interventions that may be delivered by digital medical platforms, conversational agents (eg, chatbots), and researchers.

CONCLUSIONS

This was the first systematic review of interventions to address the mental health concerns of Chinese undergraduate students studying in China. The categorization of reported interventions and the identification of new intervention channels can effectively inform stakeholders. Interventions for undergraduate students' mental health is a research topic worth further investigation.

School educational models and child mental health among K-12 students: a scoping review

BACKGROUND

The promotion of mental health among children and adolescents is a public health imperative worldwide, and schools have been proposed as the primary and targeted settings for mental health promotion for students in grades K-12. This review sought to provide a comprehensive understanding of key factors involved in models of school education contributing to student mental health development, interrelationships among these factors and the cross-cultural differences across nations and societies.

METHODS

This scoping review followed the framework of Arksey and O'Malley and holistically reviewed the current evidence on the potential impacts of school-related factors or school-based interventions on student mental health in recent 5 years based on the PubMed, Web of Science, Embase and PsycExtra databases.

RESULTS/FINDINGS

After screening 558 full-texts, this review contained a total of 197 original articles on school education and student mental health. Based on the five key factors (including curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) identified in student mental development according to thematic analyses, a multi-component school educational model integrating academic, social and physical factors was proposed so as to conceptualize the five school-based dimensions for K-12 students to promote student mental health development.

CONCLUSIONS

The lessons learned from previous studies indicate that developing multi-component school strategies to promote student mental health remains a major challenge. This review may help establish appropriate school educational models and call for a greater emphasis on advancement of student mental health in the K-12 school context among different nations or societies.

How Worries about Interpersonal Relationships, Academic Performance, Family Support, and Classmate Social Capital Influence Suicidal Ideation among Adolescents in Japan

Suicide is an important public health issue for adolescents. To investigate the risk and protective factors for adolescent suicide, a cross-sectional questionnaire-based survey was conducted at a junior high school (n = 379) in Japan in 2018. After obtaining survey data, we conducted univariate and logistic regression analyses to test for associations between suicidal ideation and several factors, including worries (i.e., about school life, interpersonal relationships at school, family life, interpersonal relationships at home, and academic performance), perceived support from school staff and family members, and social capital. In this context, the existence of trustful relationships between classmates was used as indicators of social capital. The results showed that the prevalence of suicidal ideation was 10.5%. The risk of suicidal ideation was increased by worries about 1) interpersonal relationships at school, 2) interpersonal relationships at home, and 3) academic performance, but was decreased by social support from family members and trusting relationships. Further, the rate of suicidal ideation was higher among students who expressed all these three worries when compared to those who expressed two or fewer worries. In addition, looking at students who expressed all these three worries simultaneously, the rate of suicidal ideation was higher among those with lower levels of support from family members and fewer trustful relationships. Our results suggest that the prevention of adolescent suicide should include strategies for reducing worries about interpersonal relationships at school/home and academic performance while finding ways to enhance family support and classmate social capital.

Clinical and Epidemiological Characteristics of Acute Poisoning in Children in Southwestern China: A Review of 1755 Cases from 2014 to 2020

Purpose

Acute poisoning is a major cause of disability and death in children, but there is a lack of large-scale and multicenter epidemiological data on acute poisoning in children.

Patients and Methods

The current study was a retrospective analysis of clinical data from 1755 children aged 0 to 14 years who were hospitalized between 01 January 2014 and 31 December 2020 in southwestern China.

Results

Acute poisoning was common in childhood, particularly in early childhood (607; 34.6%) and preschool (655; 37.3%), and most cases occurred in rural areas (1191; 67.9%). It was more common in boys (934; 53.2%) than in girls (821; 46.8%). In urban areas, poisoning was mainly caused by drugs (266; 47.2%), chemical agents (59; 10.5%), and alcohol (54; 9.6%). In rural areas, it was mainly caused by pesticides (620; 52.1%) and medications (213; 17.9%), the route of poisoning was usually the digestive tract (1671; 95.2%), in most cases the poisoning was accidental (1618; 92.3%), and pesticides (659; 37.5%) and medications (479; 27.3%) predominated. After timely treatment, the majority of patients had no substantial organ damage, sequelae, or disabilities, and mortality was low (17; 1.0%).

Conclusion

Acute poisoning is a frequent accident in childhood, mainly in infants and preschool children, mostly in rural areas, and poisoning mostly occurs via the digestive tract. Family and community education should be conducted to prevent poisoning.

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The Influence of Self-Esteem and Psychological Flexibility on Medical College Students' Mental Health: A Cross-Sectional Study

BACKGROUND

Mental health problems has become a major public health issue among medical students. Self-esteem and psychological flexibility were important associated factors for mental health, but their relations have not been discussed in medical students. The present study aimed to assess the status of mental health problems among medical students and identified whether psychological flexibility had a mediating role in the effects of self-esteem on the top three most common psychological symptoms.

METHODS

A total of 810 undergraduate students from 18 classes comprised in the sample. Nine dimensions of psychological symptoms was assessed by the Symptom Checklist-90-revised (SCL-90-R). Self-esteem was measured by the Self-esteem Scale (SES) and psychological flexibility was evaluated by the Acceptance and Action Questionnaire 2nd Edition (AAQ-II) and Cognitive Fusion Questionnaire (CFQ-F). Univariate analysis and logistic regression analysis were used to determine the relationship among the top three common psychological symptoms, self-esteem, psychological flexibility, and participants' characteristics. The mediating effect of psychological flexibility between self-esteem and psychological symptoms was detected by bootstrap method.

RESULTS

57.8% of the medical undergraduate students reported positive at least one of the nine psychological symptom dimensions assessed by the SCL-90-R and 13.8% of students had moderate or more severe symptoms. The symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression were the three most common psychological symptoms among the medical students. Meanwhile, self-esteem and psychological flexibility were negatively associated to the symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression. And, almost 50% effects of self-esteem on these three symptoms in medical students exert indirect effects through psychological flexibility.

CONCLUSIONS

Psychological distress was quite common in the Chinese medical students. The three most common psychological symptoms were successively obsessive-compulsiveness, interpersonal sensitivity, and depression. Low self-esteem and psychological inflexibility might be the risk factors for these top three symptoms, and psychological flexibility might play a mediating role in the effects of self-esteem on these psychological symptoms.

The potency of psychiatric questionnaires to distinguish major mental disorders in Chinese outpatients

BACKGROUND

Considering the huge population in China, the available mental health resources are inadequate. Thus, our study aimed to evaluate whether mental questionnaires, serving as auxiliary diagnostic tools, have efficient diagnostic ability in outpatient psychiatric services.

METHODS

We conducted a retrospective study of Chinese psychiatric outpatients. Altogether 1,182, 5,069, and 4,958 records of Symptom Checklist-90 (SCL-90), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), respectively, were collected from March 2021 to July 2022. The Mann-Whitney U test was applied to subscale scores and total scores of SCL-90, HAM-A, and HAM-D between the two sexes (male and female groups), different age groups, and four diagnostic groups (anxiety disorder, depressive disorder, bipolar disorder, and schizophrenia). Kendall's tau coefficient analysis and machine learning were also conducted in the diagnostic groups.

RESULTS

We found significant differences in most subscale scores for both age and gender groups. Using the Mann-Whitney U test and Kendall's tau coefficient analysis, we found that there were no statistically significant differences in diseases in total scale scores and nearly all subscale scores. The results of machine learning (ML) showed that for HAM-A, anxiety had a small degree of differentiation with an AUC of 0.56, while other diseases had an AUC close to 0.50. As for HAM-D, bipolar disorder was slightly distinguishable with an AUC of 0.60, while the AUC of other diseases was lower than 0.50. In SCL-90, all diseases had a similar AUC; among them, bipolar disorder had the lowest score, schizophrenia had the highest score, while anxiety and depression both had an AUC of approximately 0.56.

CONCLUSION

This study is the first to conduct wide and comprehensive analyses on the use of these three scales in Chinese outpatient clinics with both traditional statistical approaches and novel machine learning methods. Our results indicated that the univariate subscale scores did not have statistical significance among our four diagnostic groups, which highlights the limit of their practical use by doctors in identifying different mental diseases in Chinese outpatient psychiatric services.

Mental Disorders and Emotional Competence Among Chinese Adolescents Before and During COVID-19 Pandemic: A Longitudinal Mediation Model

Background: The outbreak of the COVID-19 pandemic has had a profound influence on the mental health and well-being of individuals across the globe. Emotional competence, defined as one's ability to recognize, understand, and manage their emotions, has been found linked with mental health problems (e.g., depression and anxiety) in previous studies. However, there is limited knowledge about the direction of the association between these factors among populations exposed to COVID-19. This study examined the possible mediation relationships between depression, anxiety, emotional competence, and COVID-19 exposure among Chinese adolescents. Methods: Responses from 7,958 Chinese adolescents who had previously taken part in a two-wave study before (December 23, 2019-January 13, 2020) and during COVID-19 (June 16, 2020-July 8, 2020) were analyzed (51.67% males, mean age = 11.74, SD = 2.15). Structural equation modeling with three covariates (i.e., age, gender, and ethnicity) was used to test the longitudinal mediation relationships between COVID-19 exposure and depression, anxiety via emotional competence. Results: Results indicated that the prevalence of depression (38.67 to 36.74%) and anxiety (13.02 to 12.77%) decreased from Time 1 to Time 2. The T2 emotional competence significantly mediated the relationship between T2 COVID-19 exposure and T2 anxiety (indirect effect [95% CI] = 0.011 [0.004-0.019], p < 0.05). T2 emotional competence also significantly mediated the relationship between T2 COVID-19 exposure and T2 depression (indirect effect [95% CI] = 0.013 [0.005-0.022], p < 0.05). The results indicated that T2 emotional competence had a significant and negative influence on T2 anxiety (β = -0.266, SE = 0.005, p < 0.001), and T2 depression (β = -0.326, SE = 0.029, p < 0.001). Conclusions: This longitudinal research study demonstrated the crucial role of emotional competence in influencing the severity of long-term mental health problems, and suggested that emotional competence interventions can be conducted to improve mental well-being among Chinese adolescents exposed to COVID-19.

Mental health of college students and associated factors in Hubei of China

Background

Although many studies have analyzed mental health problems in college students in China, the associations of mental health with individual and family circumstances, academic performance, and social support were rarely discussed.

Objectives

The study aimed to determine the mental health status and its associated factors among college students in China.

Methods

An online survey was conducted on 300 students selected through a cluster sampling strategy in a university in Hubei, China, tapping into sociodemographic characteristics of the participants, their mental health status measured by the modified Symptom Checklist-90 (SCL-90), and social support measured by the Social Support Rating Scale. Multivariate linear regression models were established to identify predictors of the SCL-90 scores.

Results

Mental health disorders were found in 8% of the respondents, with obsessive compulsive, interpersonal sensitivity and depression as the top three reported problems. Compared with the national population norms of university students in 2014, our study participants had higher scores in SCL-90. There were statistically significant difference in the Global Severity index (GSI) and all nine subscales scores (p<0.05). Poorer self-rated health, higher study pressure, and lower social support were significant predictors of higher SCL-90 scores (p<0.05) after adjustment for variations in other variables.

Conclusions

College students in Hubei, China may experience a range of different mental health problems, which are associated with their individual, study, and social circumstances.

Mental Health Problems and Associated Factors in Chinese High School Students in Henan Province: A Cross-Sectional Study

Approximately one in five adolescents experience mental health problems globally. However, studies on mental health problems in Chinese high school students are few. Therefore, this study examined the status and associated factors of mental health problems in high school students in China. A stratified two-stage cluster sampling procedure was adopted, leading to a final sample of 15,055 participants from 46 high schools in all 17 provincial cities of Henan province, China. Self-reported questionnaires were used to collect the data. A mental health problems variable was assessed using the Mental Health Inventory of Middle School Students. The positive rate of mental health problems among high school students was 41.8%, with a male predominance (43.3% versus 40.2% in females; p < 0.01). The most frequent mental health problem was academic stress (58.9%). Higher grades, physical disease, chronic constipation, alcohol consumption, engagement in sexual behavior, residence on campus, and living in nonurban areas and with single-parent families were significantly associated with higher odds of having mental health problems (p < 0.05). We suggest that the prevention of mental health problems in high school students be strengthened, especially in students with physical illnesses, unhealthy behaviors, and single-parent families.