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Abstract Background To explore the associations between anxiety and depression symptoms and academic burnout among children and adolescents in China, and to examine the role of resilience and self-efficacy in addressing academic burnout. Methods A total of 2,070 students in grades 4–8 were recruited from two primary and three middle schools in Shanghai, completed the Elementary School Student Burnout Scale (ESSBS), the Multidimensional Anxiety Scale for Children-Chinese (MASC-C), the Center for Epidemiological Studies Depression Scale (CES-D), the Connor-Davidson Resilience Scale (CD-RISC), and the General Self-Efficacy Scale (GSES), with 95.04% effective response rate. Multivariable regression analyses examining the associations between anxiety / depression symptoms and academic burnout (as well as the associations between resilience / self-efficacy and academic burnout) were performed using STATA 16.0 and SmartPLS 3.0. Results Anxiety symptoms (β = 0.124, p

ObjectiveThe measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children’s mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.MethodsA cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.ResultsResponses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63–0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81–0.97) and longer study time (OR, 0.82, 95% CI: 0.74–0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08–1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66–0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04–1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04–1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85–0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01–1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04–1.28) and older age (OR,1.12, 95% CI: 1.004–1.24).ConclusionA considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups.

Background: Mental health disorders are the leading cause of disability in youth globally. China has the world's second largest youth population with growing urban-rural inequalities. Guizhou is China's poorest province, and its rural youth mental health is seldom studied. Aims: (1) to examine the prevalence and gender differences in drug use, depressive symptoms, social support, and externalizing behaviors in adolescents from an underserved rural Guizhou community; (2) to compare these measures between our sample and an urban Beijing sample. Subject and methods: A cross-sectional study was conducted among children 12–14 years-old from rural Guizhou using the Global School-based Student Health Survey. Prevalence of 19 mental health risk factors and behaviors were examined and compared to those from a public urban Beijing sample. Associations of mental health variables with gender and rural residence were examined using multivariable logistic regression models in a combined analysis. Results: Mental health risk factors and behaviors were more prevalent in our rural sample for 9/19 surveyed items. Rural adolescent in our sample had higher risks in experiencing troubles due to drinking, loneliness, insomnia, hopelessness, poor social support and poor parental understanding, injuries, and absenteeism. Girls compared to boys had lower risks of excessive drinking, smoking, fighting, injures and being bullied. Conclusion: Rural adolescents from an underserved Guizhou community were significantly more vulnerable to mental health risk factors and behaviors compared to urban Beijing peers and gender mattered. Research on context- and gender-informed interventions is needed.

Objectives To examine the association between mental health and executive dysfunction in general adolescents, and to identify whether home residence and school location would moderate that association.Design A population-based cross-sectional study.Setting A subsample of the Shanghai Children’s Health, Education, and Lifestyle Evaluation-Adolescents project. 16 sampled schools in Shangrao city located in downstream Yangtze River in southeast China (December 2018).Participants 1895 adolescents (48.8% male) which were divided into three subpopulations: (A) adolescents who have urban hukou (ie, household registration in China) and attend urban schools (UU, n=292); (B) adolescents who have rural hukou and attend urban schools (RU, n=819) and (C) adolescents who have rural hukou and attend rural schools (RR, n=784).Measures The Depression Anxiety and Stress Scale-21 was used to assess adolescent mental health symptoms, and the Behaviour Rating Inventory of Executive Function (parent form) was applied to measure adolescent executive dysfunction in nature setting.Results Mental health symptoms were common (depression: 25.2%, anxiety: 53.0%, stress: 19.7%) in our sample, and the prevalence rates were lower among UU adolescents than those among the RR and RU, with intersubgroup differences in screen exposure time explaining most of the variance. We found the three types of symptoms were strongly associated with executive dysfunction in general adolescents. We also observed a marginal moderating effect of urban–rural subgroup on the associations: UU adolescents with depression (OR 6.74, 95% CI 3.75 to 12.12) and anxiety (OR 5.56, 95% CI 1.86 to 16.66) had a higher executive dysfunction risk when compared with RR youths with depression (OR 1.93, 95% CI 0.91 to 4.12) and anxiety (OR 1.80, 95% CI 1.39 to 2.33), respectively.Conclusions Rural adolescents experienced more mental health symptoms, whereas urban individuals with mental health problems had a higher executive dysfunction risk.

Background . Haiti lacks early childhood development data and guidelines in malnourished populations. Literature shows that developmental interventions are crucial for improving developmental outcomes malnourished children. This study examines the prevalence of early childhood development delays in a cohort of malnourished Haitian children and their associations with parental depression and self-efficacy. Methods . We used cross-sectional data from 42 patients 6 months to 2 years old in Saint-Marc, Haiti. We assessed their developmental status using the Ages and Stages Questionnaire. Parents were surveyed on depression symptoms and self-efficacy using validated surveys developed for low-resource settings. Demographic and socio-economic data were included. Prevalence of early childhood development delays and high parental depression risk were calculated. Multivariable logistic regression analyses were used to test whether parental depression risk and low self-efficacy were associated with a higher risk for childhood developmental delays. Results . Among participants, 45.2% (SD = 7.7%) of children with a recorded ASQ met age-specific cutoffs for developmental delay in one or more domains. 64.3% (SD = 7.4%) of parents were at high risk for depression. 47.6% (SD = 7.7%) of parents reported relatively low self-efficacy. Multivariable analysis showed that low parental self-efficacy was strongly associated with developmental delays (OR 17.5, CI 1.1-270.0) after adjusting for socioeconomic factors. Parental risk for depression was associated with higher odds (OR 4.6, CI 0.4-50.6) of children having developmental delays but did not reach statistical significance in this study. Conclusion . Parental self-efficacy was protectively associated with early childhood developmental delays in malnourished Haitian children. More research is needed to design contextually appropriate interventions.

Background: Perinatal mental health is important for the well-being of the mother and child, so the relatively high prevalence of perinatal mental health problems in developing settings poses a pressing concern. However, most studies in these settings focus on the demographic factors associated with mental health problems, with very few examing social factors. Hence, this study examines the prevalence of the depressive, anxiety and stress symptoms among pregnant women and new mothers in rural China, and the associations between these mental health problems and social factors, including decision-making power, family conflicts, and social support.Methods: Cross-sectional data were collected from 1,027 women in their second trimester of pregnancy to 6 months postpartum in four low-income rural counties in Sichuan Province, China. Women were surveyed on symptoms of mental health problems using the Depression, Anxiety, and Stress Scale (DASS-21) and social risk factors. Multivariate logistic regression analyses were conducted to examine social risk factors associated with maternal mental health problems, with results reported as odds ratios (OR) and 95% confidence intervals (CI).Results: Among all respondents, 13% showed symptoms of depression, 18% showed symptoms of anxiety, 9% showed symptoms of stress, and 23% showed symptoms of any mental health problem. Decision-making power was negatively associated with showing symptoms of depression (OR = 0.71, CI: 0.60–0.83, p < 0.001) and stress (OR = 0.76, CI: 0.63–0.90, p = 0.002). Family conflict was positively associated with depression (OR = 1.53, CI: 1.30–1.81, p < 0.001), anxiety (OR = 1.34, CI: 1.15–1.56, p < 0.001), and stress (OR = 1.68, CI: 1.41–2.00, p < 0.001). In addition, social support was negatively associated with depression (OR = 0.56, CI: 0.46–0.69, p < 0.001), anxiety (OR = 0.76, CI: 0.63–0.91, p = 0.002), and stress (OR = 0.66, CI: 0.53–0.84, p < 0.001). Subgroup analyses revealed that more social risk factors were associated with symptoms of anxiety and stress among new mothers compared to pregnant women.Conclusion: Perinatal mental health problems are relatively prevalent among rural women in China and are strongly associated with social risk factors. Policies and programs should therefore promote individual coping methods, as well as target family and community members to improve the social conditions contributing to mental health problems among rural women.

China is a large country where rapid development is accompanied by growing inequalities. How economic inequalities translate to health inequalities is unknown. Baseline health assessment is lacking among rural Chinese children. We aimed at assessing baseline student health of rural Chinese children and comparing them with those of urban children of similar ages. A cross-sectional study was conducted using the 2003 Global School-Based Student Health Survey among 100 students Grade 4 to 6 from rural Guizhou, China. Results were summarized and compared with public data from urban Beijing using multivariate logistic regression models. Rural children are more likely to not wash their hands before a meal (odds ratio [OR] = 5.71, P < .01) and after using the toilet (OR = 5.41, P < .01). They are more likely to feel sick or to get into trouble after drinking (OR = 7.28, P < .01). They are more likely to have used drugs (OR = 8.54, P < .01) and to have no close friends (OR = 8.23, P < .01). An alarming percentage of rural (8.22%) and urban (14.22%) children have had suicidal ideation in the past year (OR = 0.68, P > .05). Rural parents are more likely to not know their children’s whereabouts (OR = 1.81, P < .05). Rural children are more than 4 times likely to have serious injuries (OR = 4.64, P < .01) and to be bullied (OR = 4.01, P < .01). In conclusion, school-age rural Chinese children exhibit more health risk behaviors and fewer protective factors at baseline compared to their urban counterparts. Any intervention aimed at improving child health should take this distributive gap into consideration.

Many Chinese adolescents suffer from academic burnout, and parenting stress may be a risk factor. The mediating mechanisms underlying this relationship are less known. This study examines the association between parenting stress and adolescent academic burnout, and tests whether adolescent mental health symptoms such as depression and anxiety symptoms, positive psychological traits such as self-efficacy and resilience mediate this association. A total of 1805 students aged 11 to 14 years and their parents were recruited from three schools in Shanghai, China, using multi-stage convenient cluster sampling. Parenting Stress Index-Short Form, Elementary School Student Burnout Scale, Multidimensional Anxiety Scale for Children-Chinese, Center for Epidemiological Studies Depression Scale, Connor-Davidson Resilience Scale, and General Self-Efficacy Scale were completed by 98.52% of participants. Multivariable regression analysis and structural equation modeling were applied using SAS 9.4 and Mplus 8.3. Parenting stress was positively associated with adolescent academic burnout (β = 0.086, p < 0.001). Adolescent anxiety and depression symptoms (β = 0.046, p < 0.01), self-efficacy and resilience (β = 0.080, p < 0.001) significantly mediated this association with a chain mediating effect of 0.043 (p < 0.001). Adolescent mental health symptoms and positive psychological traits mediated the association between parenting stress and academic burnout. They can be targets for future interventions aiming at reducing academic burnout. [ABSTRACT FROM AUTHOR]

This study investigated the association between household characteristics, perceived family support (PFS), and the developmental outcomes (resilience, academic performance, and prosociality) among at-risk students. Our large sample included 1564 primary and secondary school students from poor rural China (M = 11.55 years old). Having a caregiver whose resilience score was in the top 50% of the sample was associated with a 0.48-point increase (or 0.31 d effect size), while having a migrant mother was correlated with a 0.26-point decrease (or 0.17 d effect size). PFS was a significant (p < 0.0001) mediator between household characteristics and developmental outcomes. Our study highlights the link between caregiver resilience and PFS, and the healthy functioning of disadvantaged students in a developing context. [ABSTRACT FROM AUTHOR]

This study conducts an exploratory analysis of the impacts of a center‐based early childhood development intervention on the mental health of caregivers, using data from a cluster‐randomized controlled trial of 1664 caregivers (Mage = 36.87 years old) of 6‐ to 24‐month‐old children in 100 villages in rural China. Caregivers and children in 50 villages received individual parenting training, group activities and open play space in village parenting centers. The results show no significant overall change in caregiver‐reported mental health symptoms after 1 year of intervention. Subgroup analyses reveal heterogeneous effects by caregiver socioeconomic status and identity (mother vs. grandmother). Findings suggest that early childhood development interventions without targeted mental health components may not provide sufficient support to improve caregiver mental health. [ABSTRACT FROM AUTHOR]

Objective: Few studies have reported blood lead levels (BLLs) in Haitian children, despite the known presence of lead from environmental factors such as soil, water, leaded paint and gasoline, improperly discarded batteries, and earthquakes. We sought to determine the prevalence of elevated blood lead levels (EBLLs) among healthy Haitian children. Methods: We enrolled children aged 9 months to 6 years from 3 geographic areas in Haiti (coastal, urban, and mountain) from March 1 through June 30, 2015. We obtained anthropometric measurements, household income, potential sources of lead exposure, and fingerstick BLLs from 273 children at 6 churches in Haiti. We considered a BLL ≥5 μg/dL to be elevated. Results: Of 273 children enrolled in the study, 95 were from the coastal area, 78 from the urban area, and 100 from the mountain area. The median BLL was 5.8 μg/dL, with higher levels in the mountain area than in the other areas (P < .001). BLLs were elevated in 180 (65.9%) children. The prevalence of EBLL was significantly higher in the mountain area (82 of 100, 82.0%; P < .001) than in the urban area (42 of 78, 53.8%) and the coastal area (56 of 95, 58.9%; P < .001). Twenty-eight (10.3%) children had EBLLs ≥10 μg/dL and 3 (1.1%) children had EBLLs ≥20 μg/dL. Exposure to improperly discarded batteries (P = .006) and living in the mountain area (P < .001) were significant risk factors for EBLLs. Conclusions: More than half of Haitian children in our study had EBLLs. Public health interventions are warranted to protect children in Haiti against lead poisoning. [ABSTRACT FROM AUTHOR]