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Yinmei Yang,1 Lili Lu,2 Tom Chen,3 Shangyuan Ye,3 Mohammedhamid Osman Kelifa,1 Na Cao,1 Qian Zhang,4 Tonger Liang,5 Wei Wang6 1School of Health Sciences, Wuhan University, Wuhan, Hubei, 430071, People’s Republic of China; 2Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China; 3Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02115, USA; 4Department of Dermatology, General Hospital of Jincheng Coal Mining Group, Jincheng, Shanxi, 048006, People’s Republic of China; 5Department of General Practice, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China; 6School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of ChinaCorrespondence: Wei WangSchool of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of ChinaTel +86-15152118260Email weiwang90@163.comLili LuDepartment of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of ChinaTel +86-15905204534Email lulili1990@163.comIntroduction: The outbreak of the coronavirus disease 2019 (COVID-19) poses an unprecedented challenge to healthcare workers (HCWs) globally. This study investigated potential factors related to depression, anxiety, and stress in a sample of Chinese HCWs during the peak of the COVID-19 epidemic.Methods: An online survey was distributed to Chinese HCWs using respondent-driven sampling. Data were collected between February 13th and February 20th, 2020, immediately following the COVID-19 contagion peak in Hubei. A total of 1208 respondents were eligible for analysis. Mental health problems and social support were measured by the Depression Anxiety Stress Scales-21 (DASS-21) and the Perceived Social Support Scale (PSS).Results: The prevalence rates of depression, (DASS-depression > 9) anxiety (DASS-anxiety > 7) and stress (DASS-stress > 14) were 37.8%, 43.0% and 38.5%, respectively. Multivariate logistic regressions revealed that stress, anxiety, and depression were positively related to lower levels of social support, longer working hours, discrimination experience and workplace violence. The scarcity of medical equipment was correlated with increased stress and depression. Chinese HCWs working at COVID 19 designated hospitals were more likely to report anxiety. Additionally, volunteering to work in the frontline health facilities was inversely associated with depression.Conclusion: Mental health problems among Chinese HCWs were alarming during the peak of the COVID-19 epidemic. Health facilities require appropriate and standing services that address the mental health of healthcare workers, particularly during epidemic outbreaks.Keywords: depression, anxiety, stress, COVID-19, pandemic, healthcare workers, mental health

This study aimed at exploring gender disparity in disability and identifying related disablement process factors among Chinese oldest-old. Data came from eight waves of the Chinese Longitudinal Healthy Longevity Study (CLHLS). A hierarchical logistic Age-Period-Cohort (A-P-C) model was used to estimate the trend of gender disparity, and related disablement process factors were further decomposed by the Oaxaca-Blinder decomposition. Our results found that women had higher disabilities than men. The age-based trend of gender disparity in Instrumental Activities of Daily Living (IADL) continued to decline; that in Functional Limitation (FL) increased at first and then declined. The cohort-based trend of gender disparity in IADL showed a decreasing trend with each subsequent cohort; that in FL showed an increasing trend. Among the disablement process factors, health behaviors and social supports were the most important contributors to gender disparity in disability. The disability was higher for women than men, and the gender differences were attenuated at very old ages. To reduce gender disparities in disability, more attention should be paid to relevant factors of gender disparity in disability.

Objective: This study aimed to examine age and cohort trends in disability among Chinese older adults and explore the disablement process factors that may explain the cohort trends in disability., Methods: This study used data from five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A hierarchical logistic growth model was used to analyze the A-P-C effects and the contributors of cohort trends., Results: ADL, IADL, and FL among Chinese older adults showed increasing age and cohort trends. FL was more likely to result in IADL disability than ADL disability. Among the disablement process factors, gender, residence, education, health behavior, disease, and family income contributed to most of the cohort trends in disability., Conclusions: As older adults face increasing disability trends, it is necessary to distinguish age and cohort trends and develop more effective interventions according to relative contributors to prevent disability among them., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Pan, Cao, Kelifa and Luo.)

Previous studies have linked poor family support and adverse childhood experiences (ACEs) to increased risk of depression; however, little is known about the interplay between the two when it comes to their effects on depression. Therefore, the current study examined if family support moderated the cumulative effect of ACEs on depression. Based on data from a migrant survey in Shiyan, Hubei Province, in 2019 ( N = 1,326), this study used the ordinary least squares method to analyze the effect of ACEs on depression and evaluate whether family support moderated this effect. Higher exposure to ACEs and lower scores of family support were associated with higher depression levels in adulthood. The moderation model indicated that family support significantly moderated the relationship between ACEs and depression. Appropriate interventions to reduce depression should target internal migrants with history of ACEs. Community nurses should consider ACEs as an integral part of psychosocial assessment. Negative effects of ACEs can be reduced through teaching skills that increase effective family interaction and maintain supportive family networks. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (3), 19-25.].

Background: Suicide among adolescents is a huge public health concern around the world. Although childhood abuse has been established as a substantial risk factor for suicide behaviours, potential mediators in this relationship remain unclear. Objective: This study aimed to examine the mediating roles of school connectedness and psychological resilience in the association between childhood abuse and suicidal ideation among Chinese high school students. Methods: The sample involved 1607 adolescents from four high schools in Central China. Structural equation modelling (SEM) was conducted to investigate the mediation effects of school connectedness and psychological resilience on the relationship between childhood abuse and suicidal ideation. Results: The prevalence of suicidal ideation during the past week was 21.9%. Childhood abuse was positively related to the development of suicidal ideation directly and indirectly through school connectedness and psychological resilience. School connectedness and psychological resilience were also partial mediators of all three types of childhood abuse (emotional abuse, physical abuse and sexual abuse) when the types were examined separately. Conclusions: Suicidal ideation was widespread among Chinese high school students. Psychological resilience and school connectedness could attenuate the detrimental impact of childhood abuse on suicidal ideation. Findings underscore the improvement of psychological resilience and the connection to the school would be beneficial to suicide prevention among Chinese adolescents with childhood abuse.

Aim: To elucidate the effects of workplace violence on turnover intention among Chinese health care workers, and to identify the potential mediators in this relationship., Background: Workplace violence has emerged as a crucial determinant of turnover intention for health care workers., Methods: A cross-sectional survey was conducted among Chinese health care workers (N = 1,063) between 13 and 20 February 2020. Mediation effects were tested using structural equation modelling with weighted least squares mean and variance adjusted (WLSMV) estimator., Results: Workplace violence had both direct and indirect effects on turnover intention among Chinese health care workers. Specifically, perceived social support, mental health and perceived social support together with mental health partially mediated the relationship between workplace violence and turnover intention., Conclusions: Chinese health care workers experiencing violence during the COVID-19 outbreak were more likely to report turnover intention. Enhancing social support and reducing mental health problems would be beneficial in decreasing the detrimental effects of workplace violence on turnover intention., Implications for Nursing Management: Ensuring health care workers' health and safety is vital in reducing turnover intention, which in turn ascertains continuity of health care delivery. Health care managers should develop targeted interventions to improve social support and prevent post-violence mental health problems., (© 2021 John Wiley & Sons Ltd.)

Background: Adolescent depression is a major public health concern worldwide, and depressive symptoms among adolescents in Chinese secondary school increase with grade. Although numerous studies noted that childhood abuse was associated with the development of depression in adolescents, the underlying mediators involved in this pathway remain unclear. Therefore, our study aims to explore whether psychological resilience and school connectedness mediate the association between childhood abuse and depression among Chinese adolescents., Methods: A cross-sectional survey was carried out among 1607 adolescents at four high schools located in Henan Province, Central China. Structural equation modeling was performed to determine whether psychological resilience and school connectedness mediate the influence of childhood abuse on depression., Results: Findings revealed that childhood abuse was directly (β = 0.410, p < 0.001) and indirectly (β = 0.141, p < 0.001) related to depression. Specifically, psychological resilience (β = 0.018, p = 0.009), school connectedness (β = 0.087, p < 0.001), and school connectedness together with psychological resilience (β = 0.036, p < 0.001) partially mediated the relationship between childhood abuse and depression., Conclusions: The detrimental impact of childhood abuse on adolescents' depression may be reduced by fostering psychological resilience and school connectedness., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to identify disability trajectories and discover early disablement process factors associated with disability trajectories among older adults in China., Study Design: This is a prospective cohort study., Methods: Data were obtained from five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2005 to 2018). The multitrajectory modelling approach was used to estimate the joint trajectories of activity of daily living (ADL) disability and instrumental activity of daily living (IADL) disability. A multinomial regression model was used to investigate how baseline disablement process factors among individuals aged 65-95 years are related to joint disability trajectory groups., Results: We identified three typical joint ADL and IADL disability trajectories. Demographic characters, social participation, community services, disease, impairment and functional limitations can all impact the disability trajectories among older adults., Conclusions: The joint ADL and IADL disability trajectories of older adults are increasing, and the Chinese government should pay more attention to disability process elements to improve disability interventions among older adults., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates., Methods: Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being., Results: 86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = -0.096, 95% CI -0.176, -0.033), multiple ACEs (β = -0.338, 95% CI -0.498, -0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being., Conclusions: Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems., (© 2021. The Author(s).)

Background: As a key health risk, the prevalence of overweight has been strikingly increasing worldwide. This study aimed to disentangle the net age, period, and cohort effects on overweight among Chinese adults by gender., Methods: Data came from the Chinese General Social Survey from 2008 to 2015, which was a repeated cross-sectional survey ( n  = 55,726, aged 18 and older). χ 2  or  t tests were used to estimate the gender disparities in overweight and socioeconomic status (SES). A series of hierarchical age-period-cohort cross-classified random-effects models were performed using SAS version 9.4 to estimate the overall and gender-specific temporal trends of overweight, as well as the association between SES and overweight. Further, a series of line charts were used to present the age and cohort variations in overweight., Results: After controlling for covariates, significant age and cohort effects were observed among adults in China (b = 0.0205, p < 0.001; b = 0.0122, p < 0.05; respectively). Specifically, inverted U-shaped age effects were identified for both genders, with a high probability of overweight occurring in middle age (b = -0.0012, p < 0.001). Overweight was more prevalent among men than women before 60 years old, and this trend reversed thereafter (b = -0.0253, p < 0.001). Moreover, men born during the war (before 1950) and reform cohorts (after the 1975s) demonstrated a substantial decline in overweight, while men born in 1950-1975 showed an increasing trend in overweight prevalence (b = 0.0378, p < 0.05). However, the cohort effect on women was not statistically significant. Additionally, a higher SES was related to an elevated probability of overweight., Conclusion: Gender-specific age and cohort effects on the prevalence of overweight were observed among Chinese adults. Both China and other developing countries need to pay attention to the coming obesity challenge and related health inequality. Full life-cycle overweight prevention interventions should focus on middle-aged adults, men born in the war and reform eras, and adults with a higher SES., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

This study aimed to ascertain the patterns of human immunodeficiency virus (HIV) risk behaviors among young men who have sex with men (YMSM) and explore the relationships between personality traits and patterns of HIV risk behaviors. Three hundred and seventy-five YMSM were recruited from March to December 2013, in central China. Latent class analysis (LCA) was utilized to identify underlying subgroups of HIV risk behaviors; multinomial logistic regression was used to examine predictors of HIV risk behaviors patterns. LCA identified four latent classes: low risk (LR), moderate risk (MR), high risk (HR), and drug use (DU). YMSM reporting high levels of sexual sensation seeking (SSS) tended to be classified to the MR class [adjusted odds ratio (aOR) = 2.96, 95% confidence interval (CI) = 1.33-6.57] and HR class (aOR = 13.77, 95% CI = 3.06-61.96) than the LR class. Those with low degrees of self-control were more likely to be in the HR class (aOR = 4.06, 95% CI = 1.11-14.83) and DU class (aOR = 4.64, 95% CI = 1.50-14.32), compared to LR class. These findings highlight the significance of personality traits on predicting HIV risk behaviors. Future HIV interventions should prioritize YMSM with high SSS and low self-control.

Background: Adverse childhood experiences (ACEs) are well recognized remote risks for adulthood depression. However, proximal processes for this relationship is still an ongoing research endeavor, particularly among college students living in resource-limited settings. The mechanism of the impact of ACEs on depression may be attributed to mediators such as psychological resilience and current stressful events (CSEs)., Methods: Data was obtained using a cross-sectional study from a national representative sample of college undergraduates in Eritrea (N = 507). To explain the mediated effect of ACEs on depression, a mediation analysis using structural equation modeling (SEM) was performed., Results: ACEs were found to have both direct (β = 0.102, p = 0.023) and indirect (β = 0.216, p < 0.001) effects on depression. The indirect effect was negatively mediated by psychological resilience and positively by CSEs. Respondents with higher levels of psychological resilience reported lower depressive symptoms and lower ACEs scores, while those with higher scores of either CSEs or ACEs reported more depressive symptoms., Conclusions: The impact of ACEs on depression may be reduced by managing current stressors and building students' psychological resilience., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Little is known about the patterns of HIV disclosure and the predictors of such group memberships. Therefore, our study aimed to explore the relationship between HIV disclosure patterns and psychosocial factors. From July to August 2016, totally 466 people living with HIV (PLWH) were recruited from a tertiary hospital. Latent class analysis was performed to ascertain HIV disclosure patterns, and multinomial logistic regression was used to examine predictors of HIV disclosure patterns. Four classes were identified and characterized as the systematic disclosure (11.2%), systematic concealment (39.5%), disclosure to spouse (29.0%), and disclosure to parents (20.4%). Relative to the systematic concealment class, respondents of the systematic disclosure and disclosure to spouse classes were more likely to report a high level of social support (adjusted odds ratio (aOR) = 1.112, 95% CI = 1.039-1.189; aOR = 1.144, 95% CI = 1.084-1.208). PLWH in the disclosure to spouse class tended to have increased perceived stigma (aOR = 1.040, 95% CI = 1.008-1.073). These findings provide practical implications for effective intervention targeting the different subgroups. Urgent attention should be paid to perceived stigma and social support to encourage PLWH to disclose their HIV status.