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BackgroundThe efficacy and safety of deep transcranial magnetic stimulation (dTMS) as an intervention for schizophrenia remain unclear. This systematic review examined the efficacy and safety of dTMS for schizophrenia.MethodsA systematic search of Chinese (WanFang and Chinese Journal Net) and English databases (PubMed, EMBASE, PsycINFO, and Cochrane Library) were conducted.ResultsThree randomized clinical trials (RCTs) comprising 80 patients were included in the analyses. Active dTMS was comparable to the sham treatment in improving total psychopathology, positive symptoms, negative symptoms, and auditory hallucinations measured by the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Auditory Hallucinations Rating Scale (AHRS), respectively. Only one RCT reported the effects on neurocognitive function measured by the Cambridge Neuropsychological Test Automated Battery (CANTAB), suggesting that dTMS may only improve one Stockings of Cambridge measure (i.e., subsequent times for five move problems). All three studies reported overall discontinuation rates, which ranged from 16.7% to 44.4%. Adverse events were reported in only one RCT, the most common being tingling/twitching (30.0%, 3/10), head/facial discomfort (30.0%, 3/10), and back pain (20.0%, 2/10).ConclusionThis systematic review suggests that dTMS does not reduce psychotic symptoms in schizophrenia, but it shows potential for improving executive functions. Future RCTs with larger sample sizes focusing on the effects of dTMS on psychotic symptoms and neurocognitive function in schizophrenia are warranted to further explore these findings.

ObjectiveThe coronavirus disease (COVID-19) and the public health responses were associated with a huge health burden, which could influence sleep quality. This meta-analysis and systematic review examined the prevalence of poor sleep quality in COVID-19 patients.MethodsPubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 27, 2022. Prevalence rates of poor sleep were analyzed using a random effects model.ResultsTotally, 24 epidemiological and 12 comparative studies with 8,146 COVID-19 patients and 5,787 healthy controls were included. The pooled prevalence of poor sleep quality based on the included studies was 65.0% (95%CI: 59.56–70.44%, I2 = 97.6%). COVID-19 patients had a higher risk of poor sleep quality compared to healthy controls (OR = 1.73, 95% CI: 1.30–2.30, p

ObjectiveThis systematic review of randomized controlled studies (RCTs) and observational studies evaluated the efficacy and safety of stanford neuromodulation therapy (SNT) for patients with treatment-resistant depression (TRD).MethodsA systematic search (up to 25 September, 2023) of RCTs and single-arm prospective studies was conducted.ResultsOne RCT (n = 29) and three single-arm prospective studies (n = 34) met the study entry criteria. In the RCT, compared to sham, active SNT was significantly associated with higher rates of antidepressant response (71.4% versus 13.3%) and remission (57.1% versus 0%). Two out of the three single-arm prospective studies reported the percentage of antidepressant response after completing SNT, ranging from 83.3% (5/6) to 90.5% (19/21). In the three single-arm prospective studies, the antidepressant remission rates ranged from 66.7% (4/6) to 90.5% (19/21). No severe adverse events occurred in all the four studies.ConclusionThis systematic review found SNT significantly improved depressive symptoms in patients with TRD within 5 days, without severe adverse events.

BackgroundThe COVID-19 pandemic has greatly affected treatment-seeking behaviors of psychiatric patients and their guardians. Barriers to access of mental health services may contribute to adverse mental health consequences, not only for psychiatric patients, but also for their guardians. This study explored the prevalence of depression and its association with quality of life among guardians of hospitalized psychiatric patients during the COVID-19 pandemic.MethodsThis multi-center, cross-sectional study was conducted in China. Symptoms of depression and anxiety, fatigue level and quality of life (QOL) of guardians were measured with validated Chinese versions of the Patient Health Questionnaire – 9 (PHQ-9), Generalized Anxiety Disorder Scale – 7 (GAD-7), fatigue numeric rating scale (FNRS), and the first two items of the World Health Organization Quality of Life Questionnaire - brief version (WHOQOL-BREF), respectively. Independent correlates of depression were evaluated using multiple logistic regression analysis. Analysis of covariance (ANCOVA) was used to compare global QOL of depressed versus non-depressed guardians. The network structure of depressive symptoms among guardians was constructed using an extended Bayesian Information Criterion (EBIC) model.ResultsThe prevalence of depression among guardians of hospitalized psychiatric patients was 32.4% (95% CI: 29.7–35.2%). GAD-7 total scores (OR = 1.9, 95% CI: 1.8–2.1) and fatigue (OR = 1.2, 95% CI: 1.1–1.4) were positively correlated with depression among guardians. After controlling for significant correlates of depression, depressed guardians had lower QOL than non-depressed peers did [F(1, 1,101) = 29.24, p

BackgroundThe 2019 novel coronavirus disease (COVID-19) outbreak affected people’s lifestyles and increased their risk for depressive and anxiety symptoms (depression and anxiety, respectively hereafter). We assessed depression and anxiety in residents of Macau during “the 6.18 COVID-19 outbreak” period and explored inter-connections of different symptoms from the perspective of network analysis.MethodsIn this cross-sectional study, 1,008 Macau residents completed an online survey comprising the nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder Scale (GAD-7) to measure depression and anxiety, respectively. Central and bridge symptoms of the depression-anxiety network model were evaluated based on Expected Influence (EI) statistics, while a bootstrap procedure was used to test the stability and accuracy of the network model.ResultsDescriptive analyses indicated the prevalence of depression was 62.5% [95% confidence interval (CI) = 59.47–65.44%], the prevalence of anxiety was 50.2% [95%CI = 47.12–53.28%], and 45.1% [95%CI = 42.09–48.22%] of participants experienced comorbid depression and anxiety. “Nervousness-Uncontrollable worry” (GADC) (EI = 1.15), “Irritability” (GAD6) (EI = 1.03), and “Excessive worry” (GAD3) (EI = 1.02) were the most central symptoms, while “Irritability” (GAD6) (bridge EI = 0.43), “restlessness” (GAD5) (bridge EI = 0.35), and “Sad Mood” (PHQ2) (bridge EI = 0.30) were key bridge symptoms that emerged in the network model.ConclusionNearly half of residents in Macau experienced comorbid depression and anxiety during the 6.18 COVID-19 outbreak. Central and bridge symptoms identified in this network analysis are plausible, specific targets for treatment and prevention of comorbid depression and anxiety related to this outbreak.

BackgroundThere is a vast amount of evidence-based medicine research on the major depressive disorder (MDD) available in the literature, however, no studies on the overall performance, productivity and impact of such research have been published to date. This study explored and mapped the research outputs of MDD-related systematic reviews and meta-analyses (SR/MA) from a bibliometric perspective.MethodsRelevant data were retrieved with search terms on MDD, systematic review and meta-analysis.ResultsA total of 4,870 papers with 365,402 citations published from 1983 to 2022 were included in the analysis. The publication output has grown steadily over time with the most publications originating from the USA (1,020; 20.94%), the UK (516; 10.60%) and China (448; 9.20%). The research collaborations between countries were most frequent between the USA and UK (266; 5.46%). Journal of Affective Disorders (379; 7.78%) was the most productive journal, while Cuijpers P was the most productive author (121; 2.48%), and University of Toronto (569; 11.78%) was the most productive institution. The top 10 most cited articles on MDD-related SR/MA had citations ranging from 1,806 to 3,448. The high-frequency keywords were mainly clustered into four themes, including psychiatric comorbidities, clinical trials, treatment, and brain stimulation in MDD.ConclusionThe rapid increase in the number of SR/MA of MDD in recent years highlights the importance of this research field. Psychiatric comorbidities, clinical interventions, and treatment of MDD have been identified as hot topics, while biological mechanisms in MDD are likely to be an emerging research priority.

BackgroundThis study was designed to investigate the prevalence and predictors of depression in patients after pacemaker implantation during the COVID-19 pandemic in addition to identifying specific depressive symptoms associated with quality of life (QOL) using network analysis (NA).MethodsThis cross-sectional, observational study was conducted in China between July 1, 2021, and May 17, 2022. Descriptive analysis was used to calculate depression prevalence. Univariate analyses were used to compare differences in demographic and clinical characteristics between depressed and non-depressed patients following pacemaker implantation. Binary logistic regression analysis was used to assess factors independently associated with depression. Network analysis “expected influence,” and flow function indexes were used to identify symptoms central to the depression network of the sample and depressive symptoms that were directly associated with QOL, respectively. Network stability was examined using a case-dropping bootstrap procedure.ResultsIn total, 206 patients implanted with a pacemaker met the study entry criteria and completed the assessment. The overall prevalence of depression (PHQ-9 total score ≥ 5) was 39.92% [95% confidence interval (CI) = 29.37−42.47%]. A binary logistic regression analysis revealed that patients with depression were more likely to report a poor health status (p = 0.031), severe anxiety symptoms (p < 0.001), and fatigue (p < 0.001). In the network model for depression, “Sad mood,” “Poor Energy,” and “Guilt” were the most influential symptoms. “Fatigue” had the strongest negative association with QOL, followed by “Sad mood” and “Appetite”.ConclusionDepression is common among patients having undergone pacemaker implantation during the COVID-19 pandemic. Anxiety, central symptoms of depression (i.e., “Sad mood”, “Poor Energy”, and “Guilt”) and depressive symptoms linked to QOL (i.e., “Sad mood”, “Appetite”, and “Fatigue”) identified in this study are promising targets for interventions and preventive measures for depression in patients who have undergone pacemaker implants.

BackgroundDepression commonly occurs in heart failure patients, and negatively influences quality of life and disease prognosis. This study explored heart failure and depression-related research from a bibliometric perspective.MethodsRelevant publications were searched on June 24, 2022. The Bibliometrix package in R was used to conduct quantitative analyses including the trends in publications, and related countries, articles, authors and keywords. VOSviewer software was used to conduct the visualization map on co-word, co-author, and institution co-authorship analyses. CiteSpace software was used to illustrate the top keywords with citation burst.ResultsA total of 8,221 publications in the heart failure and depression-related research field were published between 1983 and 2022. In this field, the United States had the most publications (N = 3,013; 36.65%) and highest total citation (N = 149, 376), followed by China, Germany, Italy and Japan. Author Moser and Duke University were the most productive author and institution, respectively. Circulation is the most influential journal. Apart from “heart failure” and “depression,” “quality of life,” “mortality” and “myocardial infarction” were the most frequently used keywords in this research area; whereas more recently, “self care” and “anxiety” have been used more frequently.ConclusionThis bibliometric analysis showed a rapid growth of research related to heart failure and depression from 1989 to 2021, which was mostly led by North America and Europe. Future directions in this research area include issues concerning self-care and anxiety about heart failure. As most of the existing literature were published in English, publications in other languages should be examined in the future.

BackgroundThe latest wave of the coronavirus disease 2019 (COVID-19) pandemic in Macau began on 18 June 2022 and was more serious than previous waves. Ensuing disruption from the wave is likely to have had a variety of negative mental health consequences for Macau residents including increased risk for insomnia. This study investigated the prevalence and correlates of insomnia among Macau residents during this wave as well as its association with quality of life (QoL) from a network analysis perspective.MethodsA cross-sectional study was conducted between 26 July and 9 September 2022. Univariate and multivariate analyses explored correlates of insomnia. Analysis of covariance (ANCOVA) examined the relationship between insomnia and QoL. Network analysis assessed the structure of insomnia including “Expected influence” to identify central symptoms in the network, and the flow function to identify specific symptoms that were directly associated with QoL. Network stability was examined using a case-dropping bootstrap procedure.ResultsA total of 1,008 Macau residents were included in this study. The overall prevalence of insomnia was 49.0% (n = 494; 95% CI = 45.9–52.1%). A binary logistic regression analysis indicated people with insomnia were more likely to report depression (OR = 1.237; P < 0.001) and anxiety symptoms (OR = 1.119; P < 0.001), as well as being quarantined during the COVID-19 pandemic (OR = 1.172; P = 0.034). An ANCOVA found people with insomnia had lower QoL (F(1,1,008) = 17.45, P < 0.001). “Sleep maintenance” (ISI2), “Distress caused by the sleep difficulties” (ISI7) and “Interference with daytime functioning” (ISI5) were the most central symptoms in the insomnia network model, while “Sleep dissatisfaction” (ISI4), “Interference with daytime functioning” (ISI5), and “Distress caused by the sleep difficulties” (ISI7) had the strongest negative associations with QoL.ConclusionThe high prevalence of insomnia among Macau residents during the COVID-19 pandemic warrants attention. Being quarantined during the pandemic and having psychiatric problems were correlates of insomnia. Future research should target central symptoms and symptoms linked to QoL observed in our network models to improve insomnia and QoL.

BackgroundA growing number of studies has implicated oxidative stress in the pathophysiology of psychiatric disorders including schizophrenia. The aim of this study was to explore the field of schizophrenia and oxidative stress-related research from a bibliometric perspective.MethodsAll relevant publications on schizophrenia and oxidative stress were obtained from Web of Science Core Collection (WOSCC) database from its inception date to November 8, 2022. VOSviewer software was used to examine co-authorships and co-occurring keywords. R software was used to present the main characteristics of publications and cooperation frequency among countries. CiteSpace was used to investigate keywords with the strongest citation bursts.ResultsA total of 3,510 publications on schizophrenia and oxidative stress were included. The United States had the largest number of publications (26.1%), and international collaborations. University of Melbourne was the most productive institution, while Schizophrenia Research was the most productive journal in this field. Apart from “schizophrenia” and “oxidative stress”, the terms “prefrontal cortex”, “brain” and “nitric oxide” were among the most frequently used keywords.ConclusionsIn conclusion, research on the association between oxidative stress and schizophrenia has received growing attention in the academic literature that is expected to continue its upward trajectory during the next two decades. Existing research suggests there has been a transition from research focused on pathways to animal models, and subsequently to clinical applications. Intervention studies on oxidative stress and schizophrenia are likely to be an important focus of related work in the near future.

IntroductionThe amygdala plays an important role in stress responses and stress-related psychiatric disorders. It is possible that amygdala connectivity may be a neurobiological vulnerability marker for stress responses or stress-related psychiatric disorders and will be useful to precisely identify the vulnerable individuals before stress happens. However, little is known about the relationship between amygdala connectivity and subsequent stress responses. The current study investigated whether amygdala connectivity measured before experiencing stress is a predisposing neural feature of subsequent stress responses while individuals face an emergent and unexpected event like the COVID-19 outbreak.MethodsData collected before the COVID-19 pandemic from an established fMRI cohort who lived in the pandemic center in China (Hubei) during the COVID-19 outbreak were used to investigate the relationship between amygdala connectivity and stress responses during and after the pandemic in 2020. The amygdala connectivity was measured with resting-state functional connectivity (rsFC) and effective connectivity.ResultsWe found the rsFC of the right amygdala with the dorsomedial prefrontal cortex (dmPFC) was negatively correlated with the stress responses at the first survey during the COVID-19 outbreak, and the rsFC between the right amygdala and bilateral superior frontal gyri (partially overlapped with the dmPFC) was correlated with SBSC at the second survey. Dynamic causal modeling suggested that the self-connection of the right amygdala was negatively correlated with stress responses during the pandemic.DiscussionOur findings expand our understanding about the role of amygdala in stress responses and stress-related psychiatric disorders and suggest that amygdala connectivity is a predisposing neural feature of subsequent stress responses.

BackgroundPost-traumatic stress symptoms (PTSS) are commonly reported by psychiatric healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic and negatively affect quality of life (QOL). However, associations between PTSS and QOL at symptom level are not clear. This study examined the network structure of PTSS and its connection with QOL in psychiatric healthcare personnel during the COVID-19 pandemic.MethodsThis cross-sectional study was carried out between March 15 and March 20, 2020 based on convenience sampling. Self-report measures including the 17-item Post-Traumatic Stress Disorder Checklist – Civilian version (PCL-C) and World Health Organization Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were used to measure PTSS and global QOL, respectively. Network analysis was used to investigate the central symptoms of PTSS and pattern of connections between PTSS and QOL. An undirected network was constructed using an extended Bayesian Information Criterion (EBIC) model, while a directed network was established based on the Triangulated Maximally Filtered Graph (TMFG) method.ResultsAltogether, 10,516 psychiatric healthcare personnel completed the assessment. “Avoidance of thoughts” (PTSS-6), “Avoidance of reminders” (PTSS-7), and “emotionally numb” (PTSS-11) were the most central symptoms in the PTSS community, all of which were in the Avoidance and Numbing domain. Key bridge symptoms connecting PTSS and QOL were “Sleep disturbances” (PTSS-13), “Irritability” (PTSS-14) and “Difficulty concentrating” (PTSS-15), all of which were within the Hyperarousal domain.ConclusionIn this sample, the most prominent PTSS symptoms reflected avoidance while symptoms of hyper-arousal had the strongest links with QOL. As such, these symptom clusters are potentially useful targets for interventions to improve PTSS and QOL among healthcare personnel at work under pandemic conditions.

Background and aimsDepression often triggers addictive behaviors such as Internet addiction. In this network analysis study, we assessed the association between Internet addiction and residual depressive symptoms in patients suffering from clinically stable recurrent depressive disorder (depression hereafter).Materials and methodsIn total, 1,267 depressed patients were included. Internet addiction and residual depressive symptoms were measured using the Internet Addiction Test (IAT) and the two-item Patient Health Questionnaire (PHQ-2), respectively. Central symptoms and bridge symptoms were identified via centrality indices. Network stability was examined using the case-dropping procedure.ResultsThe prevalence of IA within this sample was 27.2% (95% CI: 24.7–29.6%) based on the IAT cutoff of 50. IAT15 (“Preoccupation with the Internet”), IAT13 (“Snap or act annoyed if bothered without being online”) and IAT2 (“Neglect chores to spend more time online”) were the most central nodes in the network model. Additionally, bridge symptoms included the node PHQ1 (“Anhedonia”), followed by PHQ2 (“Sad mood”) and IAT3 (“Prefer the excitement online to the time with others”). There was no gender difference in the network structure.ConclusionBoth key central and bridge symptoms found in the network analysis could be potentially targeted in prevention and treatment for depressed patients with comorbid Internet addiction and residual depressive symptoms.

ObjectivesThe growing rate of retraction of scientific publications has attracted much attention within the academic community, but there is little knowledge about the nature of such retractions in schizophrenia-related research. This study aimed to analyze the characteristics of retractions of schizophrenia-related publications.Materials and methodsThe Web of Science was searched for eligible studies. A bibliometric analysis was conducted to describe the characteristics of the retractions using R software and Excel 2019. Content analysis was conducted to examine the essential components of retraction notices.ResultsA total of 36 retracted publications with 415 citations were identified from 1997 to 2021, of which, 83.3% occurred in the last decade. The overall retraction rate was 0.19%, with most of them (29; 80.56%) from the United Kingdom. The retractions were published in 33 journals, and the 2020 IFs ranged between 0.17 and 49.96 (Median = 3.93). The retractions involved 21 research areas, particularly in Psychiatry (19; 52.78%), Neurosciences and Neurology (10; 27.78%), and Psychology (7; 19.44%). Data issues (17; 42.22%), administrative errors of the publishers (5; 13.89%), and study design (4; 11.11%) were the top three reasons for retractions.ConclusionThis study provides an insight into retractions of schizophrenia-related publications. Institutional governance should be further strengthened to improve the scrutiny of publications, prevent continuing citations, and erroneous propagation after retraction.

BackgroundCognitive impairment is a major health concern in older adults. Few studies have examined the association between environmental factors and cognitive impairment, especially in high altitude areas. In this study, the prevalence of cognitive impairment in older adults living in high altitude was compared with those living in low altitude areas.MethodsThis was a comparative study conducted at Qinghai (high altitude group), and Guangzhou (low altitude group), China. Cognition, depressive symptoms and quality of life (QOL) were assessed using the Montreal Cognitive Assessment (MoCA), Patient Health Questionnaire (PHQ-9) and WHO Quality of Life brief version–WHOQOL-BREF, respectively.ResultsAltogether, 644 older adults (207 in Qinghai and 437 in Guangzhou) completed the assessment. The prevalence rate of cognitive impairment was 94.7% (95% CI: 91.6–97.7%) in older adults living in the high altitude area, while the corresponding figure was 89.2% (95% CI: 86.3–92.1%) in the low altitude area. After controlling for covariates, the high altitude group appeared more likely to have cognitive impairment (OR = 2.92, 95% CI: 1.23–6.91, P = 0.015) compared with the low altitude group. Within the high altitude group sample, multinomial logistic regression analysis revealed that older age (aged 74 and above) was significantly associated with higher risk of severe cognitive impairment (OR = 3.58, 95%CI: 1.44–8.93, P = 0.006), while higher education level (secondary school and above) was associated with decreased risk of moderate cognitive impairment (OR = 0.43, 95%CI: 0.22–0.85, P = 0.006). Within the high altitude group, QOL did not differ significantly between normal/mild, moderate and severe cognitive impairment subgroups across physical [F(1, 207) = 1.83, P = 0.163], psychological [F(1, 207) = 1.50, P = 0.225], social [F(1,207) = 2.22, P = 0.111] and environmental domains [F(1,207) = 0.49, P = 0.614].ConclusionThis study found that cognitive impairment was more common among older adults living in the high altitude area. Regular screening and appropriate interventions should be provided to older adults in need.

BackgroundBipolar disorder (BD) is often misdiagnosed, leading to poor treatment outcomes. Thus, accurate assessment of BD is of great importance, including in BD adolescents. The aim of the study was to explore the psychometric properties of the 33-item Hypomania Checklist-External Assessment (HCL-33-EA) in depressed adolescents.MethodsThe study was conducted between March and November 2020 in Beijing, China. Depressed adolescents aged between 13 and 17 years (N = 260) with BD (N = 147) or major depressive disorder (MDD) (N = 113) diagnosed according to the International Classification of Diseases, Tenth Revision (ICD-10) were recruited. Patients’ hypomanic symptoms were assessed by their carers using the HCL-33-EA.ResultsThe HCL-33-EA showed high internal consistency (Cronbach’s alpha = 0.82) with two factorial dimensions. The Receiver Operating Characteristic (ROC) curve analysis revealed an area under the ROC curve (AUC) value of 0.61 (95% confidence interval (CI): 0.54–0.67). The optimal cut-off score of 7 generated the best combination of sensitivity (0.81) and specificity (0.37) for discriminating between adolescents with BD and MDD.ConclusionThe HCL-33-EA, with a two-factor structure, seems to be a useful tool for screening for BD in depressed adolescents. However, the high sensitivity and low specificity of the HCL-33-EA at the optimal cut-off value of 7 indicate that the HCL-33-EA needs to be further refined for young patients.

BackgroundHypomanic symptoms between bipolar-I disorder (BD-I) and bipolar-II disorder (BD-II) are often indistinguishable in clinical practice. This study compared the network structure of hypomanic symptoms between patients with BD-I and BD-II.MethodsThe 32-item Hypomania Checklist (HCL-32) was used to assess hypomanic symptoms. Network model was generated in BD-I and BD-II patients. Centrality index of strength was used to quantify the importance of each symptom in the network. The Network Comparison Test (NCT) was used to assess the differences in hypomanic symptoms between BD-I and BD-II patients.ResultsAltogether, 423 patients with BD (BD-I: 191 and BD-II: 232) were included. The most central symptom was HCL17 “I am more flirtatious and/or am more sexually active” (strength BD–I = 5.21) and HCL12 “I have more ideas, I am more creative” (strength BD–II = 6.84) in BD-I and BD-II samples, respectively. The results of NCT showed that four nodes (HCL12 “I have more ideas, I am more creative,” HCL17 “I am more flirtatious and/or am more sexually active,” HCL23 “My thoughts jump from topic to topic,” and HCL31 “I drink more alcohol”) were significantly different between the BD-I and BD-II samples. Two edges (HCL3 “I am more self-confident”–HCL17 “I am more flirtatious and/or am more sexually active,” and HCL10 “I am physically more active (sport, etc.)”–HCL24 “I do things more quickly and/or more easily”) were significantly stronger in BD-I compared to BD-II patients.ConclusionThe network structure of hypomanic symptoms is different between BD-I and BD-II patients. Interventions targeting the respective central symptoms and edges should be developed for BD-I and BD-II separately.

BackgroundBipolar disorders (BD) are severe mental illnesses that are often misdiagnosed or under-diagnosed. The self-report 33-item Hypomania Checklist (HCL-33) and the 33-item Hypomania Checklist – external assessment (HCL-33-EA) are well-validated scales for BD symptom detection. This study compared the network structure, central symptoms, and network stability of hypomanic symptoms measured by the HCL-33 vs. the HCL-33-EA.MethodsThis cross-sectional study was conducted from January to December 2019. Adolescents (aged between 12 and 18 years) with BD were recruited from the outpatient department of Child Psychiatry, First Affiliated Hospital of Zhengzhou University. All participants were asked to complete the HCL-33, and their caregivers completed the HCL-33-EA. Network analyses were conducted.ResultsA total of 215 adolescents with BD and their family caregivers were recruited. Node HCL17 (“talk more,” node strength = 4.044) was the most central symptom in the HCL-33 network, followed by node HCL2 (“more energetic,” node strength = 3.822), and HCL18 (“think faster,” node strength = 3.801). For the HCL-33-EA network model, node HCL27 (“more optimistic,” node strength = 3.867) was the most central node, followed by node HCL18 (“think faster,” node strength = 3.077), and HCL17 (“talk more,” node strength = 2.998). In the network comparison test, there was no significant difference at the levels of network structure (M = 0.946, P = 0.931), global strength (S: 5.174, P = 0.274), or each specific edge (all P’s > 0.05 after Holm–Bonferroni corrections) between HCL-33 and HCL-33-EA items. Network stabilities for both models were acceptable.ConclusionThe nodes “talk more” and “think faster” acted as central symptoms in BD symptom network models based on the HCL-33 and HCL-33-EA. Although the most prominent central symptom differed between the two models (“talk more” in HCL-33 vs. “more optimistic” in HCL-33-EA model), networks based on each measure were highly similar and underscored similarities in BD symptom relations perceived by adolescents and their caregivers. This research provides foundations for future studies with larger sample sizes toward improving the accuracy and robustness of observed network structures.

BackgroundSymptoms of depression and pain often overlap, and they negatively influence the prognosis and treatment outcome of both conditions. However, the comorbidity of depression and pain has not been examined using network analysis, especially in the context of a pandemic. Thus, we mapped out the network connectivity among the symptoms of depression and pain in Wuhan residents in China during the late stage of the COVID-19 pandemic.MethodsThis cross-sectional study was conducted from May 25, 2020 to June 18, 2020 in Wuhan, China. Participants' depressive and pain symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ9) and a pain numeric rating scale (NRS), respectively. Network analyses were performed.ResultsIn total, 2,598 participants completed all assessments. PHQ4 (fatigue) in the depression community showed the highest strength value, followed by PHQ6 (worthlessness) and PHQ2 (depressed or sad mood). PHQ4 (fatigue) was also the most key bridge symptom liking depression and pain, followed by PHQ3 (sleep difficulties). There were no significant differences in network global strength (females: 4.36 vs. males: 4.29; S = 0.075, P = 0.427), network structure-distribution of edge weights (M = 0.12, P = 0.541), and individual edge weights between male and female participants.ConclusionDepressive and pain symptoms showed strong cross-association with each other. “Fatigue” was the strongest central and bridge symptom in the network model, while “sleep difficulties” was the second strongest bridge symptom. Targeting treatment of both fatigue and sleep problems may help improve depressive and pain symptoms in those affected.

BackgroundBody appreciation (BA hereafter), which reflects approval, acceptance, and respect for one's body while also rejecting media-promoted appearance ideals as the only form of human beauty, is an important aspect of positive body image. Much of the BA literature has been conducted on samples from Western nations but less is known about BA or its correlates in Asian cultural contexts wherein concerns with body image are also common. Toward addressing this gap, we examined gender differences in BA and its associations with common psychiatric symptoms (i.e., depressive symptoms, anxiety symptoms, and suicidality) within a national college student sample from China.MethodThis cross-sectional, nationwide study was conducted between December 27, 2020, and January 18, 2021, based on snowball sampling. Aside from measures of demographics and background factors, Chinese versions of the Body Appreciation Scale-2 (BAS-2), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and a standard item on suicidal ideation and planning were administered to assess BA, depressive and anxiety symptoms, and suicidality, respectively.ResultsIn total, 2,058 college students (665 men, 1,393 women) in China were assessed. An analysis of covariance revealed that the men had a significantly higher average BA level than did women [F(1,2058) = 13.244, P < 0.001, Cohen's d = 0.193]. Hierarchical multiple regression analyses revealed BA was negatively associated with symptoms of depression, anxiety, and suicidality within the entire sample (depressive symptoms, β = −0.129, P < 0.001; anxiety symptoms, β = −0.101, P < 0.001; suicidality, OR = 0.788 P = 0.020) and among women (depressive symptoms, β = −0.172, P < 0.001; anxiety symptoms, β = −0.131, P < 0.001; suicidality, OR = 0.639 P = 0.001) but not men.ConclusionChinese college women reported lower BA than their male peers did. Furthermore, among women but not men, elevations in BA corresponded with protective mental health experiences including lower levels of depressive symptoms, anxiety symptoms and suicidality. Findings underscore the potential utility of including BA in mental health assessments of Chinese college students, especially women. Findings also provide foundations for continued research on interventions to increase BA among at-risk young women in China.

Objectives: The misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD) is common in depressed older adults. The self-rated HCL-33 and its external assessment version (HCL-33-EA) have been developed to screen for hypomanic symptoms. This study compared the screening ability of these two instruments to discriminate BD from MDD.Methods: A total of 215 patients (107 with BD and 108 with MDD) and their carers were recruited. Patients and their carers completed the HCL-33 and HCL-33-EA, respectively. The consistency of the total score and the positive response to each item between the two scales was calculated with the intraclass correlation coefficient (ICC) and Cohen's kappa coefficient separately. Receiver operating characteristics (ROC) curves were drawn for both instruments. The optimal cut-off points were determined according to the maximum Youden's Index. The areas under the ROC curve (AUC) of the HCL-33 and HCL-33-EA were calculated separately and compared. The sensitivity and specificity at the optimal cut-off values were also calculated separately for the HCL-33 and HCL-33-EA.Results: The intraclass correlation coefficient (ICC) between the total scores of the HCL-33 and HCL-33-EA was 0.823 (95% CI = 0.774–0.862). The positive response rate on all items showed high agreement between the two instruments. ROC curve analysis demonstrated that the total scores of both HCL-33 and HCL-33-EA differentiated well between MDD and BD, while there was no significant difference in the AUCs between the two scales (Z = 0.422, P = 0.673). The optimal cutoff values for the HCL-33 and HCL-33-EA were 14 and 12, respectively. With the optimal cutoff value, the sensitivities of the HCL-33 and HCL-33-EA were 88.8% and 93.5%, and their specificities were 82.4% and 79.6%.Conclusion: Both the HCL-33 and HCL-33-EA had good screening ability for discriminating BD from MDD in depressed older adults.

Background: Depressive symptoms are common in older adults. Developing rapid self-report tools is essential to measure the presence and severity of depressive symptoms in older adults. This study evaluated the psychometric properties of the Quick Inventory of Depressive Symptomatology—Self-Report (QIDS-SR) scale for use in depressed older adults.Methods: A total of 238 depressed older adults were included in the study. The Montgomery–Asberg Depression Rating Scale (MADRS) and the QIDS-SR were administered to assess the severity of depressive symptoms. Cronbach's alpha coefficient, Spearman rank correlations, and principal component analysis were performed to estimate the internal consistency, convergent validity, and factorial structure of the QIDS-SR, respectively.Results: The Cronbach's alpha for the QIDS-SR was acceptable (α = 0.64). Item–total correlation analyses showed that the items of concentration/decision-making, involvement, energy level, and agitation/retardation had high correlation with the QIDS-SR total score (all correlation coefficients ≥0.60). The QIDS-SR total score was significantly correlated with the MADRS total score (r = 0.53, p < 0.001), demonstrating acceptable convergent validity. Factor analysis revealed the unidimensional structure of the QIDS-SR.Conclusions: The QIDS-SR appears to be a reliable and valid self-report scale for estimating the severity of depressive symptoms in depressed older adults.

Background: Suicidality is common in major depressive disorder (MDD), but there has been no systematic review published about all aspects of suicidality. This meta-analysis and systematic review compared the prevalence of the whole range of suicidality comprising suicidal ideation (SI), suicide plan (SP), suicide attempt (SA), and completed suicide (CS), between patients with MDD and non-MDD controls.Methods: Major international (PubMed, PsycINFO, Web of Science, EMBASE) and Chinese (Chinese Nation Knowledge Infrastructure and WANFANG) databases were systematically and independently searched from their inception until January 12, 2021.Results: Fifteen studies covering 85,768 patients (12,668 in the MDD group and 73,100 in the non-MDD group) were included in the analyses. Compared to non-MDD controls, the odds ratios (ORs) for lifetime, past month, past year, and 2-week prevalence of SI in MDD were 2.88 [95% confidence interval (CI) = 0.30–27.22, p = 0.36], 49.88 (95% CI = 2–8.63, p < 0.001), 13.97 (95% CI = 12.67–15.41, p < 0.001), and 24.81 (95% CI = 15.70–39.22, p < 0.001), respectively. Compared to non-MDD controls, the OR for lifetime SP in MDD was 9.51 (95% CI = 7.62–11.88, p < 0.001). Compared to non-MDD controls, the ORs of lifetime and past-year prevalence of SA were 3.45 (95% CI = 1.58–7.52, p = 0.002), and 7.34 (95% CI = 2.14–25.16, p = 0.002), respectively, in MDD patients. No difference in the prevalence of CS between MDD and controls was found (OR = 0.69, 95% CI = 0.23–2.02, p = 0.50).Conclusions: MDD patients are at a higher risk of suicidality, compared to non-MDD controls. Routine screening for a range of suicidality should be included in the management of MDD, followed by timely treatment for suicidal patients.Systematic Review Registration: Identifier [INPLASY202120078].

Background: Since the Coronavirus disease 2019 (COVID-19) pandemic emerged, Internet usage has increased among adolescents. Due to this trend, the prevalence of Internet addiction disorder (IAD) may have increased within this group. This study examined the prevalence of IAD and its correlates among clinically stable adolescents with psychiatric disorders in China during the COVID-19 outbreak.Method: A multi-center, cross-sectional study was carried out between April 29 and June 9, 2020 in three major tertiary mental health centers in China. IAD and depressive symptoms were assessed using the Internet Addiction Test (IAT) and the 9-item Patient Health Questionnaire (PHQ-9), respectively.Results: A total of 1,454 adolescent psychiatric patients were included in final analyses. The prevalence of IAD was 31.2% (95% CI: 28.8–33.6%) during the COVID-19 pandemic. A multiple logistic regression analysis revealed that poor relationships with parents (P < 0.001, OR = 2.34, 95%CI: 1.49–3.68) and elevated total PHQ-9 scores (P < 0.001, OR = 1.19, 95%CI: 1.16–1.21) were significantly associated with higher risk for IAD while longer daily physical exercise durations (P = 0.04, OR = 0.67, 95%CI: 0.46–0.98) and rural residence (P = 0.003, OR = 0.62, 95%CI: 0.46–0.85) were significant correlates of lower risk for IAD.Conclusions: IAD was common among adolescent patients with clinically stable psychiatric disorders during the COVID-19 pandemic; regular physical exercise, healthy relationships with parents and fewer symptoms of depression were associated with lower risk within this population.

Aripiprazole, metformin, and paeoniae–glycyrrhiza decoction (PGD) have been widely used as adjunctive treatments to reduce antipsychotic (AP)-induced hyperprolactinemia in patients with schizophrenia. However, the comparative efficacy and safety of these medications have not been previously studied. A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety between aripiprazole, metformin, and PGD as adjunctive medications in reducing AP-induced hyperprolactinemia in schizophrenia. Both international (PubMed, PsycINFO, EMBASE, and Cochrane Library databases) and Chinese (WanFang, Chinese Biomedical, and Chinese National Knowledge infrastructure) databases were searched from their inception until January 3, 2019. Data were analyzed using the Bayesian Markov Chain Monte Carlo simulations with the WinBUGS software. A total of 62 RCTs with 5,550 participants were included in the meta-analysis. Of the nine groups of treatments included, adjunctive aripiprazole (1:1) was associated with the lowest rate of all-cause discontinuation compared to placebo (posterior odds ratio = 0.45, 95% CI = 0.10, 3.13) and adjunctive aripiprazole (>10 mg/day) was associated with fewer total adverse drug events than placebo (posterior OR = 0.93, 95% CI = 0.65, 1.77) and other eight treatment groups. In addition, when risperidone, amisulpride, and olanzapine were the primary AP medications, adjunctive paeoniae/glycyrrhiza = 1:1, aripiprazole 10 mg/day were the most effective treatments in reducing the prolactin levels, respectively. Adjunctive aripiprazole, metformin, and PGD showed beneficial effects in reducing AP-induced hyperprolactinemia in schizophrenia, with aripiprazole (

Background: Depression has been a common mental health problem during the COVID-19 epidemic. From a network perspective, depression can be conceptualized as the result of mutual interactions among individual symptoms, an approach that may elucidate the structure and mechanisms underlying this disorder. This study aimed to examine the structure of depression among residents in Wuhan, the epicenter of the COVID-19 outbreak in China, in the later stage of the COVID-19 pandemic.Methods: A total of 2,515 participants were recruited from the community via snowball sampling. The Patient Health Questionnaire was used to assess self-reported depressive symptoms with the QuestionnaireStar program. The network structure and relevant centrality indices of depression were examined in this sample.Results: Network analysis revealed Fatigue, Sad mood, Guilt and Motor disturbances as the most central symptoms, while Suicide and Sleep problems had the lowest centrality. No significant differences were found between women and men regarding network structure (maximum difference = 0.11, p = 0.44) and global strength (global strength difference = 0.04; female vs. male: 3.78 vs. 3.83, p = 0.51), a finding that suggests there are no gender differences in the structure or centrality of depressive symptoms.Limitations: Due to the cross-sectional study design, causal relationships between these depressive symptoms or dynamic changes in networks over time could not be established.Conclusions: Fatigue, Sad mood, Guilt, and Motor disturbances should be prioritized as targets in interventions and prevention efforts to reduce depression among residents in Wuhan, in the later stage of the COVID-19 pandemic.

Background: There are few studies on the epidemiology of depression, insomnia, and their association with quality of life (QOL) in older adults living in rural China. This study examined the prevalence of depressive and insomnia symptoms, and their association with QOL in community-dwelling older adults in a rural area in Anhui province, China.Methods: This was a cross-sectional study conducted in the rural areas of four cities (Hefei, Huaibei, Anqing, and Xuancheng) in Anhui province between July and October, 2019 using random sampling method. All community-dwelling residents from the selected villages who met the study entry criteria were invited to participate in this study. Depressive and insomnia symptoms and QOL were assessed with the Chinese version of self-reported Center for Epidemiological Survey Depression Scale (CES-D), the Insomnia Severity Index (ISI) and the 26-item World Health Organization Quality of Life Brief version (WHOQOL-BREF), respectively.Results: A total of 871 older adults were included. The prevalence of overall depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms were 34.0% [95% confidence intervals (95% CI): 30.8–37.1%], 45.7% (95% CI: 42.4–49.0%) and 20.3% (95% CI: 17.6–23.0%), respectively. Older adults with depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms had lower scores in QOL compared to those without. Depressive symptoms were positively associated with living with families [Odd Ratio (OR) = 1.82, 95% CI: 1.31–2.54] and negatively associated with current drinking (OR = 0.49, 95% CI: 0.33–0.72). Insomnia symptoms were negatively associated with fair and good financial status (fair: OR = 0.53, 95% CI = 0.38–0.75; good: OR = 0.30, 95% CI = 0.14–0.64) and current drinking (OR = 0.64, 95% CI = 0.45–0.93), and positively associated with more frequent major medical conditions (OR = 1.32, 95% CI = 1.16–1.51). Comorbid depressive and insomnia symptoms were positively associated with living with families (OR = 2.02, 95% CI = 1.36–3.00), and negatively associated with fair and good financial status (fair: OR = 0.61, 95% CI = 0.41–0.89; good: OR = 0.34, 95% CI = 0.12–0.95) and current drinking (OR = 0.57, 95% CI = 0.35–0.92).Conclusion: Depressive and insomnia symptoms were common in older adults living in rural areas in China. Considering the negative health outcomes caused by depressive and insomnia symptoms, regular screening and effective treatments should be developed for this population.

Background: Nursing students who suffer from co-occurring anxiety experience added difficulties when communicating and interacting with others in a healthy, positive, and meaningful way. Previous studies have found strong positive correlations between Internet addiction (IA) and anxiety, suggesting that nursing students who report severe IA are susceptible to debilitating anxiety as well. To date, however, network analysis (NA) studies exploring the nature of association between individual symptoms of IA and anxiety have not been published.Objective: This study examined associations between symptoms of IA and anxiety among nursing students using network analysis.Methods: IA and anxiety symptoms were assessed using the Internet Addiction Test (IAT) and the Generalized Anxiety Disorder Screener (GAD-7), respectively. The structure of IA and anxiety symptoms was characterized using “Strength” as a centrality index in the symptom network. Network stability was tested using a case-dropping bootstrap procedure and a Network Comparison Test (NCT) was conducted to examine whether network characteristics differed on the basis of gender and by region of residence.Results: A total of 1,070 nursing students participated in the study. Network analysis showed that IAT nodes, “Academic decline due to Internet use,” “Depressed/moody/nervous only while being off-line,” “School grades suffer due to Internet use,” and “Others complain about your time spent online” were the most influential symptoms in the IA-anxiety network model. Gender and urban/rural residence did not significantly influence the overall network structure.Conclusion: Several influential individual symptoms including Academic declines due to Internet use, Depressed/moody/nervous only while being off-line, School grades suffering due to Internet use and Others complain about one's time spent online emerged as potential targets for clinical interventions to reduce co-occurring IA and anxiety. Additionally, the overall network structure provides a data-based hypothesis for explaining potential mechanisms that account for comorbid IA and anxiety.

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused psychological distress and heavy burden in medical professionals. This study examined the prevalence of fatigue and its association with quality of life (QOL) in clinicians working in ophthalmology and otolaryngology departments during the COVID-19 pandemic in China.Methods: This was a cross-sectional national online survey conducted between March 15 and March 20, 2020 in China. The severity of fatigue, depression and QOL were measured using the Numeric Rating Scale (NRS), the 9-item Patient Health Questionnaire (PHQ-9), and the World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF), respectively.Results: In total, 3,912 clinicians completed the survey (2,155 in ophthalmology department, and 1,757 in otolaryngology department); 2,049 [52.4%; 95% confidence interval (CI) = 50.8–53.9%] reported fatigue (NRS score ≥ 4). Multiple logistic regression analysis revealed that junior clinicians [Odds ratio (OR) = 0.82, 95% CI = 0.68–1.00, P = 0.045] had lower risk of fatigue; while clinicians working in tertiary hospitals (OR = 1.23, 95% CI = 1.02–1.49, P = 0.029), and the presence of more severe depressive symptoms (PHQ-9 total score ≥ 5; OR = 7.40, 95% CI = 6.29–8.70, P < 0.001) were independently associated with higher risk of fatigue. After controlling for covariates, clinicians with fatigue had significantly lower QOL compared with those without [F(1, 3, 911) = 283.75, P < 0.001].Conclusion: Fatigue was common in clinicians working in ophthalmology and otolaryngology departments during the COVID-19 pandemic. Considering the negative impact of fatigue on clinicians' QOL, health authorities and policymakers should conduct regular screening for fatigue and develop preventive strategies for frontline clinicians working under excessive stress.

Background: Prevalence estimates of major depressive disorder (MDD) among adults in China have varied widely between studies. In this systematic review and meta-analysis, the overall prevalence of MDD in the Chinese population was estimated from published epidemiological studies and potential moderators that account for variability in estimates were assessed.Methods: A systematic literature search was conducted in PubMed, EMBASE, Web of Science, PsycINFO, China National Knowledge Internet (CNKI), and WanFang databases to identify relevant studies. Data analyses were conducted using the Comprehensive Meta-Analysis Version 2.0.Results: Forty studies comprising 1,024,087 subjects were included. The pooled point, 12-month, and lifetime prevalence rates of MDD in China were 1.1% (95% CI: 0.9–1.4%), 1.6% (95% CI: 1.0–2.5%), and 1.8% (95% CI: 1.5–2.2%), respectively. Subgroup and meta-regression analyses revealed gender, marital status, survey year, being published in English language, use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic systems and age as significant moderators of MDD prevalence.Conclusion: The overall prevalence of MDD in the Chinese population appears to be lower than that of most countries, but the rates have been increasing over time and are elevated in particular demographic subgroups. Due to the negative consequences of MDD, effective preventive measures, early identification, and timely treatments are still important and should be offered to those in need.

Background: Bipolar disorder (BD) is a severe psychiatric disorder that is often misdiagnosed and under-diagnosed in clinical settings. The 33-item Hypomania Checklist (HCL-33) is a newly developed self-administered scale for BD detection, while the 33-item Hypomania Checklist-external assessment (HCL-33-EA) is a version of the HCL-33 for external rating used by patient's carer (e.g., family member or friend). We aimed to compare the screening abilities between the HCL-33 and the HCL-33-EA, and evaluate the screening consistency between the two scales.Methods: The data were collected from 269 patients with diagnosed BD (n = 84) or major depressive disorder (MDD) (n = 185). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) between the HCL-33 and the HCL-33-EA for BD were compared against clinician diagnosis as the gold standard.Results: Using Youden's index, the optimal cut-off value of the HCL-33 is 20, while the corresponding figure for HCL-33-EA is 11. Using Youden's index, the HCL-33-EA showed a better performance than the HCL-33 (0.51 vs.0.41). The HCL-33-EA was more sensitive in correctly identifying BD patients from MDD patients than the HCL-33 (0.83 vs. 0.59), while the HCL-33 presented better specificity than the HCL-33-EA (0.82 vs. 0.68). There was significant screening consistency between the two scales (p < 0.001).Conclusions: Both scales have acceptable psychometric properties in detection BD from MDD. Use of the two scales should be considered based on the assessment purpose in clinical research or daily practice (i.e., prefer sensitivity or specificity). Noticeably, the current sample size is insufficient and future studies are recommended to further evaluate the scales.

Objective: Depressive symptoms (depression hereafter) is common in older adults, and closely associated with environmental factors. This study compared the prevalence of depression in older adults living in high-altitude and low-altitude regions, and their association with quality of life (QOL).Method: A total of 632 older nursing home residents were included, with 425 participants living in low-altitude and 207 participants living in high-altitude regions. Depression and QOL were assessed using standardized instruments.Results: The prevalence of depression was 26.9% (95% CI: 23.43–30.37%) in the whole sample of older nursing home residents, with 11.1% (95% CI: 8.01–14.05%) in those living in low-altitude and 59.4% (95% CI: 52.68–66.17%) in those living in high-altitude regions. Multiple logistic regression analysis revealed that living in low-altitude region (P < 0.001, OR = 0.07, 95% CI: 0.04–0.12) was associated with lower risk of depression, while perception of poor health status (P < 0.001, OR = 3.86, 95% CI: 1.98–7.54) and having insomnia (P < 0.001, OR = 4.76, 95% CI: 2.99–7.56) were associated with higher risk of depression. QOL was significantly lower in physical (F(1,632) = 35.421, P < 0.001), psychological (F(1,632) = 20.777, P < 0.001), social (F(1,632) = 8.169, P < 0.001) and environmental domains (F(1,632) = 11.861, P < 0.001) in those with depression.Conclusion: Depression was common in older nursing home residents especially those living in the high-altitude region. Considering the negative impact of depression on QOL and functional outcomes, routine screening and timely treatment of depression should be implemented in this population.

Aims: Carers of psychiatric patients often suffered from mental and physical burden during the coronavirus disease 2019 (COVID-19) pandemic due to the lack of mental health services. This study investigated the pattern of fatigue and its association with quality of life (QOL) among the carers of patients attending psychiatric emergency services during the COVID-19 pandemic.Methods: In this cross-sectional study, carers of patients attending psychiatric emergency services during the COVID-19 pandemic were consecutively included. Fatigue, insomnia symptoms, depressive symptoms, and QOL were assessed with standardized instruments.Results: A total of 496 participants were included. The prevalence of fatigue was 44.0% (95% CI = 39.6–48.4%). Multivariate logistic regression analysis revealed that fatigue was positively associated with higher education level (OR = 1.92, P < 0.01) and more severe depressive (OR = 1.18, P < 0.01) and insomnia symptoms (OR = 1.11, P < 0.01). ANCOVA analysis revealed that the QOL was significantly lower in carers with fatigue compared with those without (P = 0.03).Conclusions: Fatigue was common among carers of patients attending psychiatric emergency services during the COVID-19 pandemic. Considering the adverse impact of fatigue on QOL and other health outcomes, routine screening and appropriate intervention for fatigue are warranted for this subpopulation.

Background: The prevalence of post-traumatic stress symptoms (PTSS) in COVID-19 survivors is unclear. This study examined the prevalence of PTSS and its association with quality of life (QOL) among COVID-19 survivors during the post-COVID-19 era in China.Methods: This was a comparative, cross-sectional study. PTSS, depressive symptoms, and QOL were assessed with standardized instruments.Results: A total of 134 COVID-19 survivors and 214 non-infected controls (healthy controls hereafter) were recruited. Among COVID-19 survivors, the PTSS prevalence was 18.66% (95%CI: 11.98–25.34%), which was significantly higher than that (5.61%, 95%CI: 2.50–8.71%) of healthy controls (P < 0.001). After controlling for covariates, an analysis of covariance (ANCOVA) showed that COVID-19 survivors had a higher PTSS total score than did healthy controls [F(1,348) = 4.664, P = 0.032]. A separate ANCOVA revealed there were no significant differences in overall QOL between COVID-19 survivors with and without PTSS [F(1,348) = 1.067, P = 0.304]. A multiple logistic regression analysis showed that more severe depressive symptoms were significantly associated with PTSS in COVID-19 survivors (OR = 1.425, P < 0.001).Conclusions: PTSS were more severe in COVID-19 survivors compared to healthy controls in the post-COVID-19 era. Considering their negative impact on daily life and functional outcomes, regular assessment and appropriate treatments of PTSS should be conducted in COVID-19 survivors.

Background: This study examined the prevalence of depressive symptoms (depression hereafter) and its association with quality of life (QOL) among pregnant and postnatal women in China.Methods: In this multi-center, cross-sectional study, 1,060 pregnant and postnatal women from eight hospitals were assessed. Depression and QOL were measured using the Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life Questionnaire - brief version, respectively.Results: The prevalence of depression was 7.45% (95% CI: 5.87–9.04%) in the sample. Women with depression had lower QOL in physical, psychological, social and environmental domains compared to those without. Women with physical comorbidities were more likely to suffer from depression (OR = 2.391, 95% CI = 1.384–4.130, P = 0.002).Conclusion: Due to its negative association with QOL, increased attention should be paid to depression in pregnant and postnatal women. Regular screening assessment and preventive measures should be adopted to reduce risk of depression in this population.

Background: Health professionals including nurses have experienced heavy workload and great physical and mental health challenges during the coronavirus disease 19 (COVID-19) pandemic, which may affect nursing students' career choices. This study examined the changes in nursing students' career choices after the onset of the COVID-19 pandemic in China.Methods: This study was conducted in five University nursing schools in China between September 14, 2020 and October 7, 2020. Career choices before and after the COVID-19 pandemic were collected and analyzed.Results: In total, 1,070 nursing students participated in the study. The reported choice of nursing as future career increased from 50.9% [95% confidence interval (CI): 47.9–53.9%] before the COVID-19 pandemic to 62.7% (95%CI: 59.8–65.6%) after the onset of COVID-19 pandemic. Students who chose nursing as their future career following the COVID-19 outbreak had less severe depression and anxiety compared to those who did not choose nursing, but the associations of depression and anxiety with career choice disappeared in multivariable analyses. Binary logistic regression analysis revealed that male gender [odds ratio (OR) = 0.68, 95% CI: 0.50–0.91], rural residence (OR = 1.53, 95%CI: 1.17–2.00), fourth year students (OR = 0.50, 95%CI: 0.35–0.72), negative experiences during the COVID-19 pandemic (OR = 0.66, 95%CI: 0.47–0.92), and good health (OR = 4.6, 95%CI: 1.78–11.87) were significantly associated with the choice of nursing as future career after the onset of the COVID-19 pandemic.Conclusions: The COVID-19 pandemic appeared to have a positive influence on the career choice of nursing among Chinese nursing students.

Background: Workplace violence is a major concern for clinicians worldwide. There has been little data on the epidemiology of workplace violence against frontline clinicians during the COVID-19 pandemic. This study examined the pattern of workplace violence and its association with quality of life (QOL) against frontline clinicians during the outbreak of COVID-19 pandemic in China.Methods: A cross-sectional online study was conducted in China between March 15 and March 20, 2020. Frontline clinicians' experience with workplace violence was measured with six standardized questions derived from the Workplace Violence Scale, while anxiety, depressive, and insomnia symptoms, and QOL were measured using the General Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Insomnia Severity Index, and the World Health Organization Quality of Life Questionnaire, respectively. Univariate analyses, multivariable logistic regression analyses, and structural equation modeling (SEM) were conducted.Results: A total of 15,531 clinicians completed the assessment; 2,878 (18.5, 95% CI = 17.92–19.14%) reported workplace violence during the outbreak of the COVID-19 pandemic (verbal violence: 16.1%; physical violence: 6.9%). According to multivariable models, key correlates of workplace violence were male gender, longer work experience, higher education level, smoking, working in the psychiatry or emergency department, working in tertiary hospitals, being involved in direct care of infected patients, having infected family/ friends/ colleagues, and frequently using social communication programs. Clinicians working in inpatient departments were less likely to report workplace violence compared to those working in outpatient departments. SEM analysis revealed that both violence and emotional disturbances (anxiety, depression, and insomnia) directly affected QOL (standardized direct effect = −0.031, and −0.566, respectively, P < 0.05), while emotional disturbances partly mediated the association between work violence and QOL (standardized indirect effect = −0.184, P < 0.05).Conclusion: Frontline clinicians were vulnerable to workplace violence during the COVID-19 pandemic. Due to the negative impact of workplace violence on quality of care and clinicians' QOL, health authorities and policymakers should take effective measures to reduce workplace violence against clinicians.

Background: Constipation is a common but often ignored side effect of antipsychotic treatment, although it is associated with adverse outcomes. The results of the efficacy and safety of traditional Chinese herbal medicine (TCM) in treating constipation are mixed across studies. This is a systematic review and meta-analysis of randomized controlled trials (RCTs) of the efficacy and safety of TCM compared to Western medicine (WM) in treating antipsychotic-related constipation.Methods: Major international electronic (PubMed, EMBASE, Cochrane Library, and Web of Science) and Chinese (Wanfang, WeiPu VIP, SinoMed, and CNKI) databases were searched from their inception to November 29, 2020. Meta-analysis was performed using the random-effects model.Results: Thirty RCTs with 52 arms covering 2,570 patients in the TCM group and 2,511 patients in the WM group were included. Compared with WM, TCM alone was superior regarding the moderate response rate [risk ratio (RR) = 1.165; 95% confidence interval (CI): 1.096–1.238; P < 0.001], marked response rate (RR = 1.437; 95% CI: 1.267–1.692; P < 0.001), and remission rate (RR = 1.376; 95% CI: 1.180–1.606; P < 0.001) for constipation, while it was significantly associated with lower risk of rash (RR = 0.081; 95% CI: 0.019–0.342; P = 0.001). For the moderate response rate, meta-regression analyses revealed that publication year (β = −0.007, P = 0.0007) and Jadad score (β = 0.067, P < 0.001) significantly moderated the results. For the remission rate, subgroup and meta-regression analyses revealed that the geographical region (P = 0.003), inpatient status (P = 0.035), and trial duration (β = 0.009, P = 0.013) significantly moderated the results.Conclusions: The efficacy of TCM for antipsychotic-related constipation appeared to be greater compared to WM, while certain side effects of TCM, such as rash, were less frequent.

Background: The novel coronavirus (COVID-19) has had a detrimental impact on individuals' psychological well-being; however, a multi-country comparison on the prevalence of suicidal ideation due to the virus is still lacking.Objectives: To examine the prevalence and correlates of suicidal ideation among the general population across 10 countries during the COVID-19 pandemic.Materials and methods: This was a cross-sectional study which used convenience sampling and collected data by conducting an online survey. Participants were sourced from 10 Eastern and Western countries. The Patient Health Questionnaire (PHQ-9) was used to measure the outcome variable of suicidal ideation. Ordinal regression analysis was used to identify significant predictors associated with suicidal ideation.Results: A total of 25,053 participants (22.7% male) were recruited. Results from the analysis showed that the UK and Brazil had the lowest odds of suicidal ideation compared to Macau (p < 0.05). Furthermore, younger age, male, married, and differences in health beliefs were significantly associated with suicidal ideation (p < 0.05).Conclusions: The findings highlight the need for joint international collaboration to formulate effective suicide prevention strategies in a timely manner and the need to implement online mental health promotion platforms. In doing so, the potential global rising death rates by suicide during the pandemic can be reduced.

Background: Accurate and reliable self-report measurement tools examining depressive symptoms are scant in child psychiatry. This study assessed the psychometric properties of the Chinese Version of the Quick Inventory of Depressive Symptomatology-Self-Report (C-QIDS-SR) in depressed adolescents in China.Methods: Adolescents with major depressive episodes or bipolar depressive episodes were assessed using the C-QIDS-SR. The structure validity of the C-QIDS-SR was estimated using principal component analysis with varimax rotation.Results: A total of 246 depressed adolescents were included in the study. Cronbach's alpha was 0.77. The correlation coefficient between the baseline and endpoint assessments was 0.49 (p < 0.001), whereas, the correlation coefficient between the C-QIDS-SR and the Hamilton Rating Scale for Depression−17 items (HAMD-17) was 0.63 (p < 0.001). Principal component analysis with varimax rotation demonstrated the unidimensional structure of the C-QIDS-SR.Conclusion: The C-QIDS-SR is a reliable and valid instrument with acceptable psychometric properties to measure depressive symptoms in adolescents.

Objective: Poor mental health is associated with impaired social functioning, lower quality of life, and increased risk of suicide and mortality. This study examined the prevalence of poor general mental health among older adults (aged 65 years and above) and its sociodemographic correlates in Hebei province, which is a predominantly agricultural area of China.Methods: This epidemiological survey was conducted from April to August 2016. General mental health status was assessed using the 12-item General Health Questionnaire (GHQ-12).Results: A total of 3,911 participants were included. The prevalence of poor mental health (defined as GHQ-12 total score ≥ 4) was 9.31% [95% confidence interval (CI): 8.4–10.2%]. Multivariable logistic regression analyses found that female gender [P < 0.001, odds ratio (OR) = 1.63, 95% CI: 1.29–2.07], lower education level (P = 0.048, OR = 1.33, 95% CI: 1.00–1.75), lower annual household income (P = 0.005, OR = 1.72, 95% CI: 1.17–2.51), presence of major medical conditions (P < 0.001, OR = 2.95, 95% CI: 2.19–3.96) and family history of psychiatric disorders (P < 0.001, OR = 3.53, 95% CI: 2.02–6.17) were significantly associated with poor mental health.Conclusion: The prevalence of poor mental health among older adults in a predominantly agricultural area was lower than findings from many other countries and areas in China. However, continued surveillance of mental health status among older adults in China is still needed.

Objective: Insomnia is a major health challenge in the general population, but the results of the gender differences in the epidemiology of insomnia have been mixed. This is a meta-analysis to examine the gender difference in the prevalence of insomnia among the general population.Methods:Two reviewers independently searched relevant publications in PubMed, EMBASE, PsycINFO, Web of Science from their inception to 16 April 2019. Studies that reported the gender-based prevalence of insomnia according to the international diagnostic criteria were included for analyses using the random-effects model.Results:Eventually 13 articles were included in the meta-analysis. The pooled prevalence of insomnia in the general population was 22.0% [n = 22,980, 95% confidence interval (CI): 17.0–28.0%], and females had a significantly higher prevalence of insomnia compared with males (OR = 1.58, 95% CI: 1.35, 1.85, Z = 5.63, p < 0.0001). Subgroup analyses showed that greater gender difference was associated with the use of case-control study design and consecutive sampling method. Meta-regression analyses also revealed that higher proportion of females and better study quality were significantly associated with greater gender difference.Conclusions:This meta-analysis found that the prevalence of insomnia in females was significantly higher than males in the included studies. Due to the negative effects of insomnia on health, regular screening, and effective interventions should be implemented in the general population particularly for females.

The 2019 novel coronavirus (COVID-19) pandemic is associated with increases in psychiatric morbidity, including depression. It is unclear if people with depressive symptoms understand or apply COVID-19 information differently to the general population. Therefore, this study aimed to examine associations between depression, health beliefs, and face mask use during the COVID-19 pandemic among the general population in Hong Kong. This study gathered data from 11,072 Hong Kong adults via an online survey. Respondents self-reported their demographic characteristics, depressive symptoms (PHQ-9), face mask use, and health beliefs about COVID-19. Hierarchical logistic regression was used to identify independent variables associated with depression. The point-prevalence of probable depression was 46.5% (n = 5,150). Respondents reporting higher mask reuse (OR = 1.24, 95%CI 1.17–1.34), wearing masks for self-protection (OR = 1.03 95%CI 1.01–1.06), perceived high susceptibility (OR = 1.15, 95%CI 1.09–1.23), and high severity (OR = 1.33, 95%CI 1.28–1.37) were more likely to report depression. Depression was less likely in those with higher scores for cues to action (OR = 0.82, 95%CI 0.80–0.84), knowledge of COVID-19 (OR = 0.95, 95%CI 0.91–0.99), and self-efficacy to wear mask properly (OR = 0.90 95%CI 0.83–0.98). We identified a high point-prevalence of probable major depression and suicidal ideation during the COVID-19 outbreak in Hong Kong, but this should be viewed with caution due to the convenience sampling method employed. Future studies should recruit a representative probability sample in order to draw more reliable conclusions. The findings highlight that COVID-19 health information may be a protective factor of probable depression and suicidal ideation during the pandemic. Accurate and up-to-date health information should be disseminated to distressed and vulnerable subpopulations, perhaps using digital health technology, and social media platforms to prompt professional help-seeking behavior.

BackgroundDepressive symptoms are common in empty-nest elderly in China, but the reported prevalence rates across studies are mixed. This is a meta-analysis of the pooled prevalence of depressive symptoms (depression hereafter) in empty-nest elderly in China.MethodsTwo investigators independently conducted a systematic literature search in both English (PubMed, EMBASE, PsycINFO, Web of Science, and Cochrane Library) and Chinese (CNKI and Wan Fang) databases. Data were analyzed using the Comprehensive Meta-Analysis program.ResultsA total of 46 studies with 36,791 subjects were included. The pooled prevalence of depression was 38.6% (95%CI: 31.5–46.3%). Compared with non-empty-nest elderly, empty-nest elderly were more likely to suffer from depression (OR=2.0, 95%CI: 1.4 to 2.8, P

ObjectiveThis meta-analysis examined the prevalence of poor sleep quality and its associated factors in patients with hypertension in China.MethodsBoth English (PubMed, PsycINFO, EMBASE) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched. The random-effects model was used to estimate the prevalence of poor sleep quality in Chinese patients with hypertension. The funnel plot and Egger’s tests were used to assess publication bias.ResultsThe prevalence of poor sleep quality in 24 studies with 13,920 hypertensive patients was 52.5% (95% confidence interval [CI]: 46.1–58.9%). In contrast, the prevalence of poor sleep quality in six studies with 5,610 healthy control subjects was 32.5% (95% CI: 19.0–49.7%). In these studies, compared to healthy controls, the pooled odds ratio (OR) of poor sleep quality was 2.66 (95% CI: 1.80–3.93) for hypertensive patients. Subgroup and meta-regression analyses revealed that patients in hospitals were more likely to have poor sleep quality than patients in the community. Studies with smaller sample size, studies using convenience or consecutive sampling and those published in Chinese reported higher prevalence of poor sleep quality. Furthermore, poor sleep quality was more common in older and male hypertensive patients, while the proportion of poor sleep quality was negatively associated with survey year.ConclusionAppropriate strategies for screening, prevention, and treatment of poor sleep quality in this population should be developed.

BackgroundLittle empirical evidence is known about the sleep quality of frontline health professionals working in isolation units or hospitals during the novel coronavirus disease (COVID-19) outbreak in China. This study thus aimed to examine the prevalence of poor sleep quality and its demographic and correlates among frontline health professionals.MethodsThis is a multicenter, cross-sectional survey conducted in Liaoning province, China. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI).ResultsA total of 1,931 frontline health professionals were recruited. The prevalence of poor sleep quality was 18.4% (95%CI: 16.6%–20.11%). Multivariate logistic regression analysis found that older age (OR=1.043, 95%CI=1.026–1.061, P < 0.001), being nurse (OR=3.132, 95%CI=1.727–5.681, P < 0.001), and working in outer emergency medical team (OR=1.755, 95%CI=1.029–3.064, P=0.039) were positively associated with poor sleep quality. Participants who were familiar with crisis response knowledge were negatively associated with poor sleep quality (OR=0.70, 95%CI=0.516–0.949, P=0.021).ConclusionThe prevalence of poor sleep quality was relatively low among frontline health professionals during the COVID-19 epidemic. Considering the negative impact of poor sleep quality on health professionals’ health outcomes and patient outcomes, regularly screening and timely treatments are warranted to reduce the likelihood of poor sleep quality in health professionals.

BackgroundSleep disturbance is common in perinatal and postnatal women, but the epidemiology of sleep problems is highly variable in these populations. This was a meta-analysis that examined the prevalence of poor sleep quality and its correlates among perinatal and postnatal women.MethodsA systematic search of both international and Chinese databases (PubMed, EMBASE, PsycINFO, Web of Science, CNKI, and Wangfang) was performed. Studies with data on sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) were included.ResultsForty-two studies were included for analyses. The prevalence of poor sleep quality was 54.2% (95% CI: 47.9–60.5%) in perinatal and postnatal women, with 44.5% (95% CI: 37.6–51.6%) in perinatal women and 67.2% (95% CI: 57.6–75.5%) in postnatal women. The pooled total PSQI score was 7.54 ± 0.40 (95% CI: 6.75–8.33), while the average PSQI component scores varied from 0.13 ± 0.04 for use of sleeping medication to 1.51 ± 0.17 for habitual sleep efficiency. Maternal age, study site, survey year, comorbidity, PSQI cut-off value, and quality assessment score had significant moderating effects on the prevalence of poor sleep quality.ConclusionGiven the negative impact of poor sleep quality on health outcomes and well-being, regular screening for poor sleep quality and effective interventions should be conducted for this population.