How are illness representations of gambling disorder associated with gambling behaviors? A latent profile analysis.

Gambling disorder (GD) is a behavioral addiction that causes serious harm to individuals' mental health and social functioning. This study aimed to explore whether gamblers' illness representations (IR) for GD are related to disordered and/or controlled patterns of gambling under the framework of commonsense model of self-regulation (CSM). Based on CSM, different facets of IR do not exist in isolation but together form a total illness schema; we hence used a person-centered analysis method, latent profile analysis (LPA), to classify gamblers by their overall IR for GD (including consequences, personal and treatment control, timeline cyclical, emotional representations, and coherence) into groups and then tested whether these groups differed in GD symptoms, controlled gambling behaviors, and help-seeking intention. An anonymous online survey was conducted on a social media platform, and valid responses from 589 past-year adult gamblers were collected. LPA results supported a four-profile model, revealing four profiles of GD representations: the weak-perception profile, average profile, tensed-up profile, and rational profile. Significant differences were found in all outcome variables in these four profile groups. In particular, the rational group exhibited the lowest levels of GD symptoms and impaired behavioral control, the highest levels of responsible and controlled gambling, and the highest levels of help-seeking intention, whereas the weak-perception group reported the lowest levels of responsible and controlled gambling behaviors. The findings provide empirical support for the application of CSM to addictive behaviors, as well as preliminary evidence for the potential use of CSM-based interventions for GD prevention.

Association Between Internet Gaming Disorder and Suicidal Ideation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study.

BACKGROUND: Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved. OBJECTIVE: This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems. METHODS: An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: "Have you ever considered committing suicide in the past 12 months?" Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling. RESULTS: Among all participants, the prevalence of IGD and suicidal ideation was 16.95% (287/1693) and 43.06% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7% (indirect effect/total effect: 0.016/0.15), 30.0% (0.05/0.15), and 13.3% (0.02/0.15), respectively. The direct path remained statistically significant. CONCLUSIONS: IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study.

Validation of the psychoactive substance refusal Self-Efficacy Questionnaire (PSRSEQ) in adolescent case-clients of social workers in Hong Kong.

BACKGROUND: Self-efficacy is a key concept in various behavioral theories. Refusal self-efficacy is important in understanding issues related to psychoactive substance use. To facilitate related research, this study translated and validated the Chinese version of the 14-item Psychoactive Substance Refusal Self-efficacy Questionnaire (PSRSEQ) among adolescents. There is a debate about whether such a refusal self-efficacy scale should be unidimensional or multidimensional. METHODS: A survey was conducted among 601 adolescent case-clients of social workers in Hong Kong from July 2021 to June 2022. Various psychometric properties were examined. RESULTS: The confirmatory factor analysis (CFA) supported the original 3-factor structure of the PSRSEQ (emotional relief, opportunistic, and social facilitation refusal self-efficacy), which showed satisfactory psychometric properties (internal consistency, convergent validity in terms of significant negative correlations with the intention of psychoactive substance use in the next year and psychoactive substance use behavior in the past six months, and the absence of floor effect) but ceiling effect was obvious. Notably, unacceptable discriminant validity of one subscale and strong correlations among the three subscales were observed. In another set of analyses using two split-half subsamples, the exploratory factor analysis identified a 1-factor 14-item structure, which was confirmed by CFA and showed satisfactory psychometric properties. CONCLUSIONS: The 1-factor PSRSEQ, instead of the one having a 3-factor structure, was preferred and recommended to assess psychoactive substance refusal self-efficacy among Chinese adolescents. It is warranted to validate the scale in other adolescent and age groups in future studies.

Efficacy of a theory-based and setting-based intervention in promoting strength training among older adults in Hong Kong: A clustered randomized controlled trial.

The present study aimed to examine the efficacy of an intervention, based on the Health Belief Model (HBM) and social support, in promoting strength training (ST) among older adults. A two-arm clustered randomized controlled trial (RCT) was conducted among 235 older adults from eight elderly centers in Hong Kong. The intervention group engaged in a 6-month intervention comprising ST sessions, exercise consultations, social gatherings, and a buddy program, while the control group participated in social gatherings. Assessments were conducted at baseline (Month 0), post-intervention (Month 6), and 3-month follow-up (Month 9), with primary outcome being the prevalence of meeting the American College of Sports Medicine (ACSM) recommendations of ST. Results showed that the intervention group reported significantly higher prevalence of meeting ACSM recommendations for ST at both post-intervention and follow-up. Linear mixed models showed significant interaction effect between condition and time on perceived susceptibility of sarcopenia and muscle strength and significant condition effect on self-efficacy for ST, perceived severity of sarcopenia, perceived barriers of ST, and intention to perform ST. Findings suggest that the intervention, guided by HBM and social support, improves older adults' ST participation, muscle strength, perceptions on sarcopenia, and self-efficacy for ST, which offers great potential for broader application in other settings.

Patterns of sex behaviors and factors associated with condomless anal intercourse during the COVID-19 pandemic among men who have sex with men in Hong Kong: A cross-sectional study.

OBJECTIVES: The present study examined the patterns of sex behaviors before and during COVID-19, and identified the factors associated with condomless anal intercourse during COVID-19 from individual, interpersonal, and contextual level among men who have sex with men (MSM) in Hong Kong. METHODS: A cross-sectional study was conducted among MSM in Hong Kong. A total of 463 MSM completed a cross-sectional telephone survey between March 2021 and January 2022. RESULTS: Among all participants, the mean number of regular sex partners, non-regular sex partners, and casual sex partners during the COVID-19 period were 1.24, 2.09, and 0.08 respectively. Among those who had sex with regular, non-regular, and casual sex partner during the COVID-19 period, respectively 52.4%, 31.8% and 46.7% reported condomless anal intercourse. Compared to the pre-COVID-19 period, participants reported significantly fewer number of regular and non-regular sex partners during the COVID-19 period. However, a higher level of condomless anal intercourse with all types of sex partners during the COVID-19 period was also observed. Adjusted for significant socio-demographic variables, results from logistic regression analyses revealed that perceived severity of COVID-19 (aOR = 0.72, 95% CI = 0.58, 0.88), COVID-19 risk reduction behaviors in general (aOR = 0.68, 95% CI = 0.48, 0.96), COVID-19 risk reduction behaviors during sex encounters (aOR = 0.45, 95% CI = 0.30, 0.66), condom negotiation (aOR = 0.61, 95% CI = 0.44, 0.86), and collective efficacy (aOR = 0.79, 95% CI = 0.64, 0.98) were protective factors of condomless anal intercourse with any type of sex partners during the COVID-19 period. CONCLUSION: The COVID-19 control measures have caused a dramatic impact on the sexual behavior of MSM in Hong Kong. Interventions that promote condom use during the COVID-19 pandemic are still needed and such interventions could emphasize prevention of both COVID-19 and HIV.

The Vicious Cycle between Loneliness and Problematic Smartphone Use among Adolescents: A Random Intercept Cross-Lagged Panel Model.

Despite extensive research on the psychological impacts of digital technology, the nuanced dynamics between adolescent loneliness and problematic smartphone use, particularly across different educational levels and genders, remain underexplored. This study aims to fill this gap by employing a Random Intercept Cross-Lagged Panel Model to dissect the bidirectional relationship between loneliness and problematic smartphone use among adolescents, with a focus on the moderating roles of educational levels and gender. Engaging 3132 students from various educational institutions in China, the research conducted a three-wave longitudinal analysis across 2022-2023. The final number of participants included 1120 adolescents (53.5% female; age in 2022: M = 14.57 years, SD = 1.57). Results reveal that loneliness significantly predicts problematic smartphone use, but not vice versa, highlighting a unidirectional influence. The study uncovers crucial differences across educational levels and gender, emphasizing the stronger effect of loneliness on problematic smartphone use among junior high students and female adolescents. These findings underscore the complexity of adolescent loneliness and its relationship with digital behavior, suggesting a need for tailored interventions considering both gender and developmental stages.

Effectiveness of a WHO self-help psychological intervention to alleviate stress among healthcare workers in the context of COVID-19 in China: a randomised controlled trial.

AIMS: To examine the effectiveness of Self-Help Plus (SH+) as an intervention for alleviating stress levels and mental health problems among healthcare workers. METHODS: This was a prospective, two-arm, unblinded, parallel-designed randomised controlled trial. Participants were recruited at all levels of medical facilities within all municipal districts of Guangzhou. Eligible participants were adult healthcare workers experiencing psychological stress (10-item Perceived Stress Scale scores of ≥15) but without serious mental health problems or active suicidal ideation. A self-help psychological intervention developed by the World Health Organization in alleviating psychological stress and preventing the development of mental health problems. The primary outcome was psychological stress, assessed at the 3-month follow-up. Secondary outcomes were depression symptoms, anxiety symptoms, insomnia, positive affect (PA) and self-kindness assessed at the 3-month follow-up. RESULTS: Between November 2021 and April 2022, 270 participants were enrolled and randomly assigned to either SH+ (n = 135) or the control group (n = 135). The SH+ group had significantly lower stress at the 3-month follow-up (b = -1.23, 95% CI = -2.36, -0.10, p = 0.033) compared to the control group. The interaction effect indicated that the intervention effect in reducing stress differed over time (b = -0.89, 95% CI = -1.50, -0.27, p = 0.005). Analysis of the secondary outcomes suggested that SH+ led to statistically significant improvements in most of the secondary outcomes, including depression, insomnia, PA and self-kindness. CONCLUSIONS: This is the first known randomised controlled trial ever conducted to improve stress and mental health problems among healthcare workers experiencing psychological stress in a low-resource setting. SH+ was found to be an effective strategy for alleviating psychological stress and reducing symptoms of common mental problems. SH+ has the potential to be scaled-up as a public health strategy to reduce the burden of mental health problems in healthcare workers exposed to high levels of stress.

Negative emotions mediate the association between the topology of the complex brain network and smartphone use disorder: A resting-state EEG study.

Background: Increasing research has examined the factors related to smartphone use disorder. However, limited research has explored its neural basis. Aims: We aimed to examine the relationship between the topology of the resting-state electroencephalography (rs-EEG) brain network and smartphone use disorder using minimum spanning tree analysis. Furthermore, we examined how negative emotions mediate this relationship. Methods: This study included 113 young, healthy adults (mean age = 20.87 years, 46.9% males). Results: The results showed that the alpha- and delta-band kappas and delta-band leaf fraction were positively correlated with smartphone use disorder. In contrast, the alpha-band diameter was negatively correlated with smartphone use disorder. Negative emotions fully mediated the relationship between alpha-band kappa and alpha-band diameter and smartphone use disorder. Furthermore, negative emotions partially mediated the relationship between delta-band kappa and smartphone use disorder. The findings suggest that excessive scale-free alpha- and delta-band brain networks contribute to the emergence of smartphone use disorder. In addition, the findings also demonstrate that negative emotions and smartphone use disorder share the same neural basis. Negative emotions play a mediating role in the association between topological deviations and smartphone use disorder. Discussion: To the best of our knowledge, this is the first study to examine the neural basis of smartphone use disorder from the perspective of the topology of the rs-EEG brain network. Therefore, neuromodulation may be a potential intervention for smartphone use disorder.

School climate and school identification as determinants of smoking conventional cigarettes or vaping among adolescents in China: Stress-coping mediation mechanisms.

INTRODUCTION: Smoking conventional cigarettes or vaping (SV) poses significant health threats to adolescents. School climate and school identification are key elements of the school environment and potential factors of SV. Based on the Stress Coping Theory, the mediations between school climate/school identification and SV, via perceived stress/active coping, were examined. METHODS: A cross-sectional survey was conducted among secondary school students from February to March 2022 in Taizhou, China. Structural equation modeling was used. RESULTS: The prevalence of SV among the 7526 participants was 4.7% (singular use of conventional cigarettes: 3.2%; singular use of electronic cigarettes: 3.6%; dual use: 2.1%). School climate, school identification, and active coping were positively, and perceived stress (family stress, academic stress, and peer-related stress) were negatively associated with SV. The association between school climate and SV was fully mediated via: 1) school climate → perceived stress → SV; 2) school climate → active coping → SV; and 3) school climate → perceived stress → active coping → SV. The effect sizes were 52.1%, 43.8%, and 6.3%, respectively. Similar partial mediation mechanisms were found between school identification and SV, with relatively small effect sizes (<10%). CONCLUSIONS: This study observed the prevalence of SV among Chinese secondary school students. School climate and school identification had both significant direct and indirect (via perceived stress/active coping) effects on SV. Positive school environments may reduce students' stress and promote active coping. The stress coping mechanisms explained the association between school climate and SV better than between school identification and SV.

Men who have sex with men were more depressed than their counterparts because of lower social support and higher loneliness: A comparative survey among Chinese university students.

BACKGROUND: Poor mental health is prevalent among men who have sex with men (MSM), including MSM university students (MSMUS), causing a significant burden on their health and society. The study aimed to compare the difference in levels of depressive symptoms between Chinese MSMUS and non-MSMUS and test the mediating roles of social support and loneliness in the relationship between MSM status and depressive symptoms among male university students. METHODS: From June to October 2018, a total of 305 MSMUS and 2447 non-MSMUS from two cities in Sichuan province (China) were investigated using questionnaires. RESULTS: The proportion of depression in the MSMUS and non-MSMUS groups was 54.1 % and 36.4 %, respectively. MSM status, social support, and loneliness were all significantly associated with depressive symptoms among Chinese university students. Structural equation modelling showed that the association between MSM status and depressive symptoms was partially mediated by three indirect paths, including 1) via social support (mediated proportion = 19.4 %), 2) via loneliness (mediated proportion = 19.3 %), and 3) via social support and then loneliness (mediated proportion = 16.1 %). CONCLUSIONS: Depression was prevalent among university students in China, especially MSMUS. The findings increased our understanding of the mediating roles of social support and loneliness in the link between MSM status and depressive symptoms among Chinese male university students, which have great implications for designing interventions to improve their mental health. LIMITATION: The cross-sectional study design limited causal inferences.

Level and factors of support for the Living with the Virus policy in a Chinese adult general population: a mediation analysis via positive and negative attitudes toward the policy.

Background: This study investigated the public's support for the Living with the Virus (LWV) policy, its associated factors, and related mediations at a time when more countries were considering adopting the LWV policy amid the COVID-19 pandemic. Methods: A random, population-based telephone survey was conducted among 500 Chinese adults in Hong Kong during March/April 2022. Results: 39.6% of the participants were supportive/strongly supportive of the LWV policy. Perceived efficacy of the control measures was negatively associated with the support and was partially mediated via the perception that the policy would greatly improve the economy/daily life of the policy. Perceived physical harms of the Omicron variant was negatively associated with the support and was fully mediated via perceived negative impacts of the policy. 26.2%/54.6% believed that the policy would improve the economy/daily life greatly; about 40% perceived negative impacts on deaths and the medical system due to the policy. COVID-19 ever infection did not significantly moderate the studied associations. Conclusion: The public was split regarding the support for the LWV policy and whether it would cause better economy/daily life, unnecessary deaths, and the collapse of the medical system. Health communication is needed in shifting toward the LWV policy.

The intention to get COVID-19 booster vaccination and its association with cognitive and emotional factors: A survey of Chinese COVID-19 infected people in Hong Kong.

BACKGROUND: Although the pandemic has ended officially, COVID-19 remains impactful. Booster COVID-19 vaccination is still needed to protect individuals against COVID-19 and the disease's harmful consequences. This study investigated the prevalence of the intention to get booster COVID-19 vaccination after receiving the COVID-19 diagnosis and its associated factors among people reporting prior COVID-19. METHODS: A population-based anonymous telephone survey was conducted in Hong Kong, China from June to August 2022 among Chinese people reporting prior COVID-1 between February and August 2022 and having taken up ≥2 doses of COVID-19 vaccines prior to COVID-19 diagnosis. RESULTS: The prevalence of the intention to get booster vaccination was 59.2 %. Older age (>60 years), being currently married, not employed full-time, and having chronic diseases were positively associated with the intention to get booster vaccination. Adjusted for the background factors, higher levels of the cognitive factors of perceived susceptibility to COVID-19, perceived acquired moderate-to-strong immunity against COVID-19, and perceived adequate knowledge of COVID-19 were positively associated with the intention to get booster vaccination; stronger perceived severity of prior infection despite vaccination was negatively associated with the intention outcome. In contrast, stronger mental distress due to COVID-19, illness concern, and emotional representation were positively associated with the intention. Self-perceived long COVID status was not a significant factor. DISCUSSION: The prevalence of the intention to get booster COVID-19 vaccination was limited, especially among younger people reporting prior COVID-19. Health promotion is still required among people reporting prior COVID-19 and may emphasize the significant cognitive factors positively associated with the intention. Future studies are needed to confirm the findings, clarify the role of emotional factors on booster vaccination, and explore other factors of the intention to get booster vaccination among people reporting prior COVID-19.

Illness representation of COVID-19 affected public's support and anticipated panic regarding the living with the virus policy: a cross-sectional study in a Chinese general population.

Background: There is a global trend for countries to adopt the Living with the Virus (LWV) policy regarding COVID-19. Little is known about the public's supportiveness and emotional responses (e.g., anticipated panic) related to this policy. Such responses may be associated with illness representations of COVID-19 (i.e., how people think and feel about COVID-19). This novel topic was investigated in this study to facilitate policy-making and health communication. Methods: A random, population-based telephone survey interviewed 500 adults aged ≥18 of the Hong Kong general adult population from March to April 2022. Results: The prevalence of the public's support and anticipated panic regarding the LWV policy, which were negatively correlated with each other, was 39.6 and 24.2%, respectively. The illness representation constructs of consequences, timeline, identity, illness concern, and emotional representations were negatively associated with supportiveness and positively associated with anticipated panic regarding the LWV policy. Illness coherence was significantly associated with policy support but not with anticipated panic. The associations between personal control/treatment control and supportiveness/anticipated panic were statistically non-significant. Moderation analyses showed that the above significant associations were invariant between those with and without previous COVID-19 infection. Conclusion: Policymakers need to be sensitized about the public's supportive/unsupportive attitude and potential worry (panic) when adopting the LWV policy. Such attitudes/emotional responses may be affected by people's illness representations of COVID-19. In general, those who found COVID-19 involving a milder nature and less negative emotions would be more supportive and anticipated less panic under the LWV policy.

Levels and Determinants of COVID-19 Vaccination at a Later Phase among Chinese Older People Aged 60 Years or Older: A Population-Based Survey.

The early attainment of high COVID-19 vaccination rates can minimize avoidable hospitalizations/deaths. The fifth wave COVID-19 outbreak in Hong Kong caused >9000 deaths, and most of them were unvaccinated older people. This study hence investigated determinants of taking the first dose vaccination at a later phase (Phase 3: during the fifth wave outbreak, i.e., February-July 2022) versus two earlier phases (Phase 1: first six months since vaccine rollout, i.e., February-July 2021; Phase 2: six months prior to the outbreak, i.e., August 2021-January 2022) via a random telephone survey among 386 ever-vaccinated Hong Kong older people aged ≥60 (June/July 2022). A total of 27.7%, 51.1%, and 21.3% took the first dose at Phase 1, Phase 2, and Phase 3, respectively. Unfavorable perceptions related to COVID-19/vaccination, exposure to conflicting/counter-information about the suitability of older people's vaccination from various sources, unsupportive family influences prior to the outbreak, and depressive symptoms were significantly associated with taking the first dose at Phase 3 instead of Phase 1 and Phase 2. To speed up COVID-19 vaccination and avoid unnecessary deaths, the government and health professionals should rectify misinformation, provide clear/consistent information for older people and their family members, and focus on those having depressive symptoms at an earlier stage of the pandemic.

The mediating role of resilience on the association between family satisfaction and lower levels of depression and anxiety among Chinese adolescents.

PURPOSE: This study aimed to explore the association between family satisfaction, resilience, and anxiety and depression among adolescents, and the mediating role of resilience in these relationships. METHODS: A cross-sectional study was conducted among grade 8 to 9 students from 4 secondary schools in Hong Kong. A total of 1,146 participants completed the survey. RESULTS: Respectively 45.8% and 58.0% of students scored above the cut-off for mild anxiety and mild depression. Results from linear regression analyses showed that family satisfaction was positively associated with resilience, and both family satisfaction and resilience were and negatively associated with anxiety and depression. The mediating effects of resilience on the relationship between family satisfaction and anxiety/ depression (26.3% and 31.1% effects accounted for, respectively) were significant. CONCLUSIONS: Both family satisfaction and resilience have important influence on adolescent mental health. Interventions that seek to promote positive family relationships and resilience of adolescents may be effective in preventing and reducing anxiety and depression symptoms among adolescents.

Uptake of an App-Based Case Management Service for HIV-Positive Men Who Have Sex With Men in China: Process Evaluation Study.

BACKGROUND: Men who have sex with men (MSM) in China are disproportionately affected by the HIV epidemic, and medication adherence to antiretroviral treatment in this vulnerable population is suboptimal. To address this issue, we developed an app-based case management service with multiple components, informed by the Information Motivation Behavioral skills model. OBJECTIVE: We aimed to conduct a process evaluation for the implementation of an innovative app-based intervention guided by the Linnan and Steckler framework. METHODS: Process evaluation was performed alongside a randomized controlled trial in the largest HIV clinic in Guangzhou, China. Eligible participants were HIV-positive MSM aged ≥18 years planning to initiate treatment on the day of recruitment. The app-based intervention had 4 components: web-based communication with case managers, educational articles, supportive service information (eg, information on mental health care and rehabilitation service), and hospital visit reminders. Process evaluation indicators of the intervention include dose delivered, dose received, fidelity, and satisfaction. The behavioral outcome was adherence to antiretroviral treatment at month 1, and Information Motivation Behavioral skills model scores were the intermediate outcome. Logistic and linear regression was used to investigate the association between intervention uptake and outcomes, controlling for potential confounders. RESULTS: A total of 344 MSM were recruited from March 19, 2019, to January 13, 2020, and 172 were randomized to the intervention group. At month 1 follow-up, there was no significant difference in the proportion of adherent participants between the intervention and control groups (66/144, 45.8% vs 57/134, 42.5%; P=.28). In the intervention group, 120 participants engaged in web-based communication with case managers and 158 accessed at least 1 of the delivered articles. The primary concern captured in the web-based conversation was the side effects of the medication (114/374, 30.5%), which was also one of the most popular educational articles topics. The majority (124/144, 86.1%) of participants that completed the month 1 survey rated the intervention as "very helpful" or "helpful." The number of educational articles accessed was associated with adequate adherence in the intervention group (odds ratio 1.08, 95% CI 1.02-1.15; P=.009). The intervention also improved the motivation score after adjusting for baseline values (ß=2.34, 95% CI 0.77-3.91; P=.004). However, the number of web-based conversations, regardless of conversation features, was associated with lower motivation scores in the intervention group. CONCLUSIONS: The intervention was well-received. Delivering educational resources of interest may enhance medication adherence. The uptake of the web-based communication component could serve as an indicator of real-life difficulties and could be used by case managers to identify potential inadequate adherence. TRIAL REGISTRATION: Clinicaltrial.gov NCT03860116; https://clinicaltrials.gov/ct2/show/NCT03860116. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-020-8171-5.

Reduction in COVID-19 related resource loss and decline in prevalence of probable depression in Chinese adults: an application of the Conservation of Resource Theory.

BACKGROUND: The levels of resource losses due to coronavirus disease 2019 (COVID-19) and mental distress may change during the pandemic period. Based on the Conservation of Resource (COR) Theory, this study investigated such changes and the mediation between survey time (Round 2 versus Round 1) and depression via resource losses. METHODS: Two serial random population-based telephone surveys interviewed 209 and 458 Hong Kong Chinese adults in April 2020 and May 2021, respectively. Probable depression was defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10. The validated Conservation of Resources Scale for COVID-19 (CORS-COVID-19) scale was used to assess resource losses due to COVID-19. Multivariable logistic regression analysis, hierarchical logistic regression analysis, and structural equation modeling (SEM) was conducted to test the association, interaction, and mediation hypotheses, respectively. RESULTS: The prevalence of probable depression declined from 8.6% to 1.0% over time, together with reductions in losses of financial resource (Cohen's d = 0.88), future control (Cohen's d = 0.39), social resource (Cohen's d = 0.60), and family resource (Cohen's d = 0.36) due to COVID-19. All the overall scale/subscales of the CORS-COVID-19 were positively and associated with probable depression [adjusted odds ratio (aOR) ranged from 2.72 to 42.30]. In SEM, the survey time was negatively associated with the latent variable of resource loss (ß = - 0.46), which in turn was positively associated with probable depression (ß = 0.73). In addition, the direct effect of survey time on probable depression was statistically non-significant (ß = - 0.08), indicating a full mediation effect of resource losses. CONCLUSIONS: The lessening of the resource losses might have fully accounted for the significant decline in probable depression from Month 3 to 15 since the first COVID-19 outbreak in Hong Kong, China. The level of depression might have increased during the first phase of the pandemic, but might decline in the later phases if resources losses could be lessened. All stakeholders should hence work together to minimize individuals' COVID-19-related resource losses to prevent depression in the general population, as COVID-19 might be lasting.

Time to Lift up COVID-19 Restrictions? Public Support towards Living with the Virus Policy and Associated Factors among Hong Kong General Public.

The fifth wave of the COVID-19 pandemic has caused an unprecedented toll on Hong Kong. As more countries are starting to lift COVID-19 restrictions, it would be important to understand the public attitudes towards lifting COVID-19 restrictions and to identify its associated factors. The present study examined the level of support towards the living with the virus (LWV) policy for COVID-19 among the public in Hong Kong and to identify the associations between resilient coping, self-efficacy and emotional distress with support towards the LWV policy. A random population-based telephone survey was conducted among 500 Hong Kong Chinese adults from 7 March to 19 April 2022, i.e., during the fifth wave of COVID-19 outbreak. Of the respondents, 39.6% showed a supportive attitude towards the LWV policy. Results from the structural equational modeling showed a positive correlation between resilient coping and self-efficacy. Resilient coping was associated with support towards the LWV policy directly and indirectly through a lower level of emotional distress. Self-efficacy had a direct association with support towards the LWV policy but its indirect association through emotional distress was not significant. Interventions that foster resilient coping and self-efficacy would be effective in reducing public emotional distress and promoting their positive view towards the LWV policy.

Development and validation of the resource loss due to reduction in gaming time scale among adolescent internet gamers in China.

BACKGROUND: Adolescent internet gaming disorder (IGD) is prevalent and positively associated with gaming time, a reduction of which is a common means of IGD prevention/treatment. Personal/interpersonal resource losses due to the reduction in gaming time (RL-RGT) are plausible. According to the Conservation of Resource (COR) theory, RL-RGT may cause mental distress and maladaptive behaviors. No study has investigated such relationships, partially due to the lack of validated tools assessing RL-RGT. This study aimed to develop and validate such a scale (RL-RGTS). METHODS: A cross-sectional survey was conducted in four secondary schools in Guangzhou, China (October to December 2019). Secondary school students who had played internet games in the last 12 months participated in this study (n = 944), irrespective of their IGD status and intention to reduce gaming time. Using a deductive approach, an expert panel generated the 19 scale items. The half-split method was used to conduct exploratory and confirmatory factor analyses. RESULTS: The prevalence of IGD and intention to reduce gaming time were 10.9% and 74.2%, respectively. The exploratory and confirmatory factor analyses identified a 2-factor model (personal loss and interpersonal loss). Psychometric properties (internal consistency, no ceiling effect, and concurrent validity) were satisfactory, but noticeable floor effects were observed. CONCLUSIONS: The RL-RGTS could be applied to understand potential side effects and obstacles regarding interventions reducing IGD through reducing gaming time. The findings support the COR theory and extend its applications to internet gaming research. Validations in other populations are warranted.

The Associations Between Loneliness, Hopelessness, and Self-control and Internet Gaming Disorder Among University Students Who Were Men Who Have Sex With Men: Cross-sectional Mediation Study.

BACKGROUND: The minority stress model postulates that men who have sex with men (MSM) often encounter multiple stressors because of their sexual minority status, which may lead to psychological problems and maladaptive coping such as addictive behaviors (eg, internet gaming disorder [IGD]). It was hypothesized that hopelessness and loneliness would be associated with IGD via self-control among MSM. OBJECTIVE: This study investigated the prevalence of IGD and its associations with variables related to minority stress (loneliness and hopelessness) among MSM who were university students. Mediation involving such associations via self-control was also explored. METHODS: With informed consent, 305 MSM attending universities in Sichuan, China participated in the study. The validated Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) checklist was used to assess IGD. Multivariable logistic regression adjusted for background factors and structural equation modeling were conducted. RESULTS: The prevalence of IGD was 12.8% (n=39). Logistic regression found that IGD was positively associated with hopelessness and loneliness, and negatively associated with self-control. The structural equation modeling identified three significant paths between hopelessness/loneliness and IGD: (1) hopelessness → lower self-control → higher IGD (full mediation), (2) loneliness → lower self-control → higher IGD (partial mediation: effect size of 28%), and (3) a direct effect from loneliness to IGD. CONCLUSIONS: IGD was prevalent among young MSM and warrants interventions that may try to reduce the level of psychosocial problems such as loneliness and hopelessness and improve self-control. According to the socioecological model, the promotion of social acceptance and reduction in stigma toward MSM are important in reducing loneliness and hopefulness among MSM. Self-control links up the relationships between psychosocial problems and IGD and should be given special attention. Longitudinal studies are warranted to confirm the findings and test new mediations between loneliness/hopelessness and MSM with IGD.