Perceived stigma among discharged patients of COVID-19 in Wuhan, China: A latent profile analysis

Development and internal validation of a depressive symptoms prediction model among the patients with cardiovascular disease who have recovered from SARS-CoV-2 infection in Wuhan, China: a cross-sectional study

BACKGROUND

Middle-aged  and elderly patients with cardiovascular disease (CVD) who have recovered from SARS-CoV-2 infection may experience depressive symptoms due to the physical and psychological impact of the pandemic.

OBJECTIVE

To investigate the prevalence and predictors of depressive symptoms among the middle-aged and elderly with CVD who have recovered from SARS-CoV-2 infection in Wuhan, China, and to develop a prediction model for depressive symptoms.

METHODS

A cross-sectional study was conducted among 462 former SARS-CoV-2 middle-aged and elderly patients with CVD in Jianghan District, Wuhan, China from June 10 to July 25, 2021. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Potential predictors of depressive symptoms were selected by the least absolute shrinkage and selection operator (LASSO) regression. A prediction model was developed by random forest (RF) and logistic regression models and compared by the area under the receiver operating characteristic curve (AUROC). The discrimination, calibration, and practical utility of the prediction model were evaluated by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Bootstrap sampling was used for internal validation.

RESULTS

The prevalence of depressive symptoms among the participants was 35.93%. The prediction model included age, stethalgia after recovery, insomnia after recovery, post-traumatic stress disorder (PTSD), anxiety, fatigue, and perceived social support as predictors. The AUROC of the logistic regression model was 0.909 (95%CI: 0.879 ~ 0.939), indicating good discrimination. The calibration curve showed good calibration. The DCA showed that the prediction model had a net benefit for a wide range of risk thresholds. The internal validation confirmed the stability of the prediction model.

CONCLUSION

Depressive symptoms are common among middle-aged and elderly CVD patients who have recovered from SARS-CoV-2 infection in Wuhan, China. A prediction model with satisfactory performance was developed to estimate the risk of depressive symptoms among this population. Interventions targeting long COVID symptoms and social support should be considered to prevent depressive symptoms in CVD patients.

Development and validation of a machine learning-based predictive model for compassion fatigue in Chinese nursing interns: a cross-sectional study utilizing latent profile analysis

BACKGROUND

Compassion fatigue is a significant issue in nursing, affecting both registered nurses and nursing students, potentially leading to burnout and reduced quality of care. During internships, compassion fatigue can shape nursing students' career trajectories and intent to stay in the profession. Identifying those at high risk is crucial for timely interventions, yet existing tools often fail to account for within-group variability, limiting their ability to accurately predict compassion fatigue risk.

OBJECTIVES

This study aimed to develop and validate a predictive model for detecting the risk of compassion fatigue among nursing students during their placement.

DESIGN

A cross-sectional study was used to capture the prevalence and associations of compassion fatigue among nursing interns, as it allows for timely assessment of key influencing factors without requiring long-term follow-up.

METHODS

A convenience sampling strategy was used to recruit 2256 nursing students from all ten public junior colleges in Hunan province in China between December 2021 and June 2022. Participants completed questionnaires assessing compassion fatigue, professional identity, self-efficacy, social support, psychological resilience, coping styles, and demographic characteristics. Predictors were selected based on prior literature and theoretical frameworks related to compassion fatigue in nursing. Latent profile analysis was used to classify compassion fatigue levels, and potential predictors were identified through univariate analysis and least absolute shrinkage and selection operator (LASSO) regression. Eight machine learning algorithms were applied to predict compassion fatigue, with performance assessed through cross-validation, calibration, and discrimination metrics. The best-performing model was further validated to ensure robustness.

RESULTS

A three-profile model best fits the data, identifying low (55.73%), moderate (32.17%), and severe (12.10%) profiles for compassion fatigue. Generally, an area under the curve (AUC) above 0.700 is acceptable, and above 0.800 indicates good predictive performance. The AUC values for the eight machine learning models ranged from 0.644 to 0.826 for the training set and 0.651 to 0.757 for the test set, indicating moderate to good discriminatory ability. The eXtreme Gradient Boosting (XGBoost) performed best, with AUC values of 0.840, 0.768, and 0.731 in the training, validation, and test sets, respectively. Shapley Additive Explanation (SHAP) analysis interpreted the model by quantifying the contribution of each variable to the prediction, revealing that psychological resilience, professional identity, and social support were the key contributors to the risk of compassion fatigue. A user-friendly, web-based prediction tool for calculating the risk of compassion fatigue was developed.

CONCLUSIONS

The XGBoosting classifier demonstrates excellent performance, and implementing the online tool can help nursing administrators manage compassion fatigue effectively. It holds practical value for nursing education and practice by supporting early detection and intervention. Future research should validate its use across settings, and longitudinal studies could assess its long-term impact.

Current status and influencing factors of fear of surgery in patients with oral and maxillofacial tumors

OBJECTIVES

This study aimed to investigate the incidence and severity of surgical fear in patients with oral and maxillofacial tumors.

METHODS

The survey participants were composed of patients with oral and maxillofacial tumors, who were scheduled to undergo surgery. A general information questionnaire, the Surgical Fear Questionnaire (SFQ), the Patient Health Questionnaire (PHQ)-9, and the Generalized Anxiety Disorder (GAD)-7 score were used for the investigation.

RESULTS

A total of 203 patients were investigated. Among them, 85.22% had fear of surgery. The median score of SFQ was 20, and the quartile was (6, 36). The patients were categorized into none, mild, moderate, and severe groups according fear level. Gender, diabetes, obvious discomfort before surgery, PHQ-9, and GAD-7 scores were the variables with statistical difference in each fear level. Multifactor analysis showed that women were more likely to have moderate and severe fear than men (OR=2.19, P=0.03; OR=2.72, P=0.01), patients with obvious preoperative discomfort symptoms were more inclined to have no fear (OR=4.73, P=0.02), and patients with diabetes were more likely to have severe fear (OR=3.33, P=0.02). The incidence rates of depression and anxiety were 31.03% and 24.63%, respectively. The incidence of anxiety and depression in patients with severe fear was 40.00%. Surgical fear was moderately positively correlated with anxiety (r=0.491, P<0.001) and depression (r=0.514, P<0.001).

CONCLUSIONS

The fear of surgery in patients with oral and maxillofacial tumors is common and distributed in all levels. Medical staff can screen and assess patients with moderate and severe fear of surgery in accordance with the influencing factors and implement targeted interventions to reduce fear of surgery, anxiety, and depression on the basis of the source of fear.

Characteristics and influencing factors of anticipated HIV stigma among HIV-negative/unknown MSM in China: A regression mixture model

BACKGROUND

Anticipated HIV stigma among men who have sex with men's (MSM) has a severe negative effect on their physical and mental health wellbeing and hence requires specific attention. The current study aims to identify the characteristics and the psychosocial influencing factors of anticipated HIV stigma in MSM using regression mixture model (RMM) and to determine the cut-off point of the seven-item Anticipated HIV Stigma Questionnaire (AHSQ) using the receiver operating characteristic (ROC) analysis.

METHODS

A cross-sectional study was conducted among HIV-negative/unknown MSM from Blued online platform in China from December 16th, 2020 to March 1st, 2021, enrolling 1394 participants. Data were collected on demographic characteristics, perceived social support, anticipated HIV stigma, depressive symptoms, and HIV knowledge. Latent profile analysis was performed to identify different profiles of anticipated HIV stigma level. Chi-square test, analysis of variance, and RMM analysis were conducted to explore the influencing factors in different profiles. ROC analyses were carried out to identify the cut-off value of anticipated stigma.

RESULTS

Among the participants, three profiles of anticipated stigma were identified: "low anticipated HIV stigma" (12.0%), "moderate anticipated HIV stigma" (52.1%), and "severe anticipated HIV stigma" (35.9%). RMM analysis showed that higher income and higher levels of knowledge were positively associated with moderate anticipated HIV stigma, whereas full-time job and social support were negatively associated with moderate anticipated HIV stigma; higher income, depressive symptoms, and knowledge were positively associated with severe anticipated HIV stigma, whereas minor ethnicity and social support were negatively associated with severe anticipated HIV stigma. ROC curve of the AHSQ showed that the optimal cut-off value of ≥16 could indicate positive anticipated HIV stigma.

CONCLUSION

The study focuses on the level of anticipated HIV stigma and its psycho-socio influencing factors among HIV-negative/unknown MSM. It provides evidence for implementing relevant psychological interventions to HIV-negative/unknown MSM.

Profiles in neglect of older adult care workers in a long-term care facility: a latent profile analysis

Background

Neglect is a common form of abuse, and long-term care facilities record higher incidences of this abuse. Given that older adult care workers are the main workforce in these facilities, their neglectful behavior requires public health attention. Internal individual characteristics can lead to older adult abuse, and managing workers who abuse older adults may require various methods. This study aimed to identify the profiles of neglect among older adult care workers in long-term care facilities and explore the influencing factors of neglect.

Methods

In this cross-sectional study, a convenience sample of older adult care workers from 15 long-term care facilities in Shandong Province (N = 421) completed a questionnaire on the characteristics associated with neglect. Latent profile analysis was used to identify distinct neglect profiles and promote the understanding of individual characteristics associated with varying levels of neglect. One-way analysis of variance and multivariate logistic regression analyses were used to examine the population characteristic differences.

Results

Older adult care workers exhibited three neglect profiles, namely, the "low-risk group," "medium-risk group," and "high-risk group." Males, participants with no employment qualification certificate, and those who did not attend regular training represented the majority of those in the "high-risk group." Participants with a monthly income of more than ¥ 4,000 and nursing 1-2 older adults simultaneously represented the majority of those in the "low-risk group."

Conclusion

Long-term care facility administrators should tailor interventions to individual care worker profiles to reduce neglect behaviors and improve care levels.

Unraveling socioeconomic determinants of health-related behavior, reception of information, and perceptions on disease disclosure at the time of the COVID-19 pandemic: did health insurance curb the disparities in the Philippines?

BACKGROUND

The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on access to information, disease perception and the adoption of preventive behaviors in the context of a public health emergency such as the COVID-19 pandemic.

METHODS

This study employed a cross-sectional design using the Philippine Demographic and Health Survey (DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted. Predicted probabilities were reported for the analysis of moderating effects.

RESULTS

Findings show that individual and householdsocioeconomic determinants affected health-behavior and access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing.

CONCLUSION

It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits that increase proficiency in navigating through the healthcare system. Further research may focus on examining pathways by which health insurance or social policies may be used to leverage responses to public health or environmental emergencies.

Difference in the risk of discrimination on psychological distress experienced by early wave infected and late wave infected COVID-19 survivors in Japan

The psychological distress experienced by coronavirus disease of 2019 (COVID-19) survivors after recovery from the illness is amplified by discrimination endured because of their infection status. However, the difference in the risk of facing discrimination and risk of experiencing psychological distress in the early and late waves of the COVID-19 pandemic remain unclear. This study aimed to investigate whether the risk of facing discrimination because of infection status was lower in the early or late waves and whether risk of discrimination on psychological distress was more serious in later, rather than earlier waves. We conducted two online surveys to collect data from survivors divided into two groups. The participants with scores of five or more on the Kessler Psychological Distress Scale were identified as having experienced psychological distress. The participants were identified as having experienced discrimination based on infection status if they had endured being blamed, some type of discrimination, or having themselves or their families maligned. The timing of infection was split into infected during early waves of the pandemic for 2021 participants and infected during later waves of the pandemic for 2022 participants. Modified Poisson regression analyses were performed using experiences of discrimination as criteria and timing of infection as predictors. Modified Poisson regression analyses were further performed using the presence of psychological distress as a criteria and experiences of discrimination and timing of infection as the criteria, in addition to interaction effect of these es. The data of 6010 participants who were infected in early waves and 5344 participants who were infected in later waves were analyzed. The risks of being blamed, some forms of discrimination, and participants and their families being maligned were significantly lower in the group who were infected in later waves than those infected in earlier waves. Experiences of discrimination were highly associated with psychological distress in those infected in later waves than those infected in earlier waves, while only being blamed showed a significant association. Risk of discrimination was found to be lower in those infected in later waves, whereas risk of discrimination on psychological distress was shown to be more serious in those infected in later waves. Therefore, we submit that it is more important to support COVID-19 survivors who face discrimination, than it is to attempt to decrease the current discriminatory climate caused by the COVID-19 pandemic.

The impact of empathy, sensation seeking, anxiety, uncertainty, and mindfulness on the intercultural communication in China during the COVID-19

Objective

This study seeks to explore factors that have shaped the intercultural communication effectiveness (ICE) of international students (IS) during the COVID-19 pandemic. Theoretical predictions of anxiety uncertainty management (AUM) are considered to assess the ICE of IS who stayed in China throughout the COVID-19 pandemic. The prime causal factors of AUM theory (anxiety, uncertainty, and mindfulness) are included with empathy and sensation, seeking to examine their impact on ICE among IS in China.

Methods

A quantitative research design was designed to survey IS via convenience samples from across China with a total of 261 IS from 42 different cultural backgrounds responding to invitations to participate in a Chinese-English survey. Well-established measurement tools were adopted to measure empathy (Cultural Empathy scale), sensation seeking (Brief Sensation Seeking Scale), anxiety (Intercultural Anxiety scale), uncertainty (Intercultural Uncertainty scale), mindfulness (Cognitive and Affective Mindfulness Scale-Revised), and ICE (Perceived Effectiveness of Communication scale).

Findings

The findings revealed that anxiety (t = -3.61, p < 0.05) and uncertainty (t = -2.51, p < 0.05) had a negative impact on ICE. However, mindfulness (t = 3.93, p < 0.05), empathy (t = 3.60, p < 0.05), and sensation seeking (t = 7.93, p < 0.05) had a positive influence on ICE. Furthermore, the moderating effect of mindfulness is affirmed in this study.

Conclusion

This study has reconfirmed the theoretical reasonings and applicability of AUM theory with the addition of empathy and sensation seeking by IS in the cultural context of China during the COVID-19 pandemic.