Family socioeconomic status and mental health in Chinese adolescents: the multiple mediating role of social relationships.

BACKGROUND: The purpose of this study is to explore whether social relationships of family and school contexts mediate the influence of socioeconomic status (SES) on Chinese adolescents' mental health. METHODS: A school-based study was conducted among a sample aged 13-18 in East China (n = 6902). We used scales for measuring social relationships and self-rated mental health. Family SES was computed from subjective socioeconomic status, education and occupation of parents.The mediation model was tested by using Path Analysis in IBM SPSS-Amos. RESULTS: The results showed that SES can significantly influence adolescent mental health through parent-child relationship, student-teacher relationship and student-student relationship. The total effect, direct effect and total indirect effect were -0.209 (95% CI = -0.299, -0.136), -0.090 (95% CI = -0.174, -0.007), -0.119 (95% CI = -0.187, -0.078) for boys, and -0.337 (95% CI = -0.478, -0.230), -0.132 (95% CI = -0.283, 0.010), -0.205 (95% CI = -0.351, -0.085) for girls. CONCLUSION: The link between SES and adolescent mental health can be explained by social relationships. Focusing on the parent-child, student-student and student-teacher relationship interventions may contribute to improving the mental health of Chinese adolescents, especially in low socioeconomic groups, as well as female students.

Meaning of socioeconomic status for mental health of adolescents in East China.

There is limited evidence on the association between different dimensions of socioeconomic status and mental health on adolescents in developing nations. The aim of this study was to examine this association among adolescents in East China. A school-based study that recruited 6902 adolescents aged 13 to 18 years was conducted in Suzhou, Hefei and Hangzhou. Multiple of indicators of socioeconomic status and mental health in adolescents were examined. Results revealed that girls showed significantly higher score of the global severity index, obsessive-compulsive, depression, anxiety, hostility, and phobic anxiety symptoms than boys. As expected, there was a slightly negative correlation between different dimensions of socioeconomic status to different domains of mental health problems (r ranged from -0.044 to 0.124). Furthermore, we found that maternal education and occupation were significantly associated with mental health for both boys and girls, while subjective socioeconomic status only was significantly associated with girls. In conclusion, adolescents in families with socioeconomic disadvantage, in the form of lower educational level and occupational prestige of mothers, had greater risk of mental health problem. Meanwhile, higher subjective socioeconomic status positively affects the mental health of female adolescents.

Effectiveness comparisons of various psychosocial therapies for children and adolescents with depression: a Bayesian network meta-analysis.

The existence of depression among children or adolescents can trigger a sequence of burdens on themselves, their families and even the whole society, which cause both physical and economic impacts. Our network meta-analysis (NMA) was aimed at comparing them with each other for evaluating the optimal psychosocial therapy to help children and adolescents with depression to improve their mental health. Based on several biomedical databases, a system of search strategies was conducted for searching randomized controlled trials (RCTs) which published from their inception on October, 1st 2018 without language restriction. We carried out an expression analysis for comparing the efficacy of various psychosocial therapies using Bayesian NMA. A battery of analyses and assessments, such as conventional meta-analysis and risk of bias, were performed concurrently. Only 32 of RCTs which involved 2677 participants were eventually included in our analyses from the 19,176 of initial citation screening. In addition, in terms of various valid assessment instruments, interpersonal psychotherapy [standard mean difference (SMD) = -1.38, Credible interval (CrI) - 2.5, - 0.20)], computer cognitive-behavioral therapy (SMD = -1.36, CrI - 2.59, - 0.14), cognitive-behavioral therapy (SMD = -1.16, CrI - 2.15, - 0.18), had significantly better effects than the named control group. All together, these results suggest that interpersonal psychotherapy might be the best approach to improve the depressive state among children and adolescents. This study may provide an excellent resource for future endeavors to utilize psychosocial interventions and may also serve as a springboard for creative undertakings as yet unknown.

Optimal approaches for preventing depressive symptoms in children and adolescents based on the psychosocial interventions: A Bayesian Network Meta-Analysis.

BACKGROUND: It is necessary to develop effective preventive interventions before depression established to alleviate depressive symptoms or delay the onset of depression. In this study, we employed Bayesian network meta-analysis to identify the optimal psychosocial intervention approach for preventing depressive symptoms in children and adolescents. METHODS: We searched publication databases and conference abstracts, from time of their inception through April 2019 without language restriction, for randomized controlled trials that compared the efficacy of various psychosocial intervention approaches. We extracted the mean and standard deviation values between baseline and the last observation, and calculated the change score in depression. We also assessed ranking probability by surface under the cumulative ranking curve using a 95% credible interval. RESULTS: A total of 27 randomized controlled trials, involving 5,976 participants aged between 7 to 18 years, were included in our analyses. Analysis of various valid assessment instruments indicated that computer cognitive-behavioral therapy [standard mean difference (SMD = -1.82)], cognitive-behavioral therapy (SMD = -1.54) and interpersonal psychotherapy (SMD = -1.29) were statistically superior to wait-list group. Among the approaches, computer cognitive-behavioral therapy had the highest probability of being the best intervention, based on improvement from baseline to the end of the intervention (SUCRA = 90.47%, CrI: 0.55, 1.00). LIMITATIONS: The results herein may not apply to other cultures and ethnic minorities because about half of the studies included in our analysis were conducted in the United States. CONCLUSIONS: Computer cognitive-behavioral therapy was the most recommended intervention to accompany the depression among children and adolescents according to our Bayesian network meta-analysis results.

Risk factors for depressive symptoms among older Chinese adults: A meta-analysis.

BACKGROUND: The study aims to explore the risk factors for depressive symptoms among older Chinese adults. METHODS: PubMed, PsycINFO, Cochrane Library, EMbase, Google Scholar, Chinese National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database, and Wanfang data were searched for potentially relevant articles published before September 1st, 2019. Stata/IC 15 was used to perform a meta-analysis and subgroup analysis to compute the pooled odds ratio. RESULTS: The retrieve strategy yielded 11 studies that met the inclusion criteria. The total sample size was 31528 across seven districts, including Mainland China, Hong Kong, and Taiwan. Patients with depression were included in the sample size. Fourteen risk factors were extracted for at least having two or more relative studies. The combined odds ratio ranged from 0.70 to 4.75. Female, poor self-perceived financial condition, single, average and poor self-perceived health status, diabetes, adverse life events, poor social support, two or more numbers of cardiovascular diseases, and functional disability are risk factors of depressive symptoms among older Chinese adults. Fair or good social support is a protective factor. LIMITATIONS: These findings may be somewhat limited by (i) quality of studies included, (ii) a finite number of studies met inclusion criteria. CONCLUSIONS: Despite the methodological limitations of the studies and this meta-analysis, average or poor self-perceived health status, functional disability, poor social support, poor self-perceived financial condition, negative life events, and diabetes appear to be significant risk factors for depressive symptoms among the aged population in China. Social support can mitigate depressive symptoms.

How do socioeconomic status relate to social relationships among adolescents: a school-based study in East China.

BACKGROUND: A great number of studies have concentrated on the influence of socioeconomic status with health outcomes, but little on how socioeconomic status affects social relationship in adolescents' families, peers and schools. This study aimed to clarify more detailed information on the connection between social relationships and different dimensions of socioeconomic status. METHODS: A school-based cross-sectional study was performed by 13-18 adolescents enrolled in East China from September, 2018 to May, 2019, which recruited 6902 students from junior and senior high schools and used the stratified random sampling method. Parent-child relationship (cohesion, expressiveness, conflict), peer relationship (interpersonal relationship, communication and interaction, social emotion) and student-teacher relationship (intimacy, support, satisfaction, conflict) were investigated. Besides, objective socioeconomic status (parental education and occupation, assessed by the adolescent) and subjective socioeconomic status (self-evaluation of family social class) were measured. More detailed information was used to clarify the link between social relationships and different dimensions of socioeconomic status. RESULTS: All five indicators of socioeconomic status were slightly positively correlated with the quality of social relationships (r ranged from 0.036 to 0.189, all p < 0.001), except that maternal education was not correlated with the conflict dimension of parent-child relationship. Standardized regression coefficients indicated that paternal education (ß = 0.08) and occupation (ß = 0.07) were the predictors of parent-child relationship. And peer relationship model revealed that the corresponding effect size was slightly stronger for subjective socioeconomic status (ß = 0.10), whereas the maternal education had a slightly stronger correlation with student-teacher relationship (ß = 0.07) relative to other indicators. CONCLUSIONS: Adolescents with lower socioeconomic status had poorer social relationships compared to those with higher socioeconomic status. These findings have important public health implications for health policy makers to make sound decisions on resources allocation and services planning in improving adolescents' social relationships and promoting health outcomes.

Contributions of Modifiable Risk Factors to Dementia Incidence: A Bayesian Network Analysis.

OBJECTIVE: To determine and compare the contributions of modifiable risk factors (RFs) with the prevention of dementia in older adults. DESIGN: A systematic review and Bayesian network meta-analysis (NMA). The observational group was set as a reference to collect all existing RFs and compare them with each other. SETTING AND PARTICIPANTS: An exhaustive and comprehensive literature search strategy was used to identify relevant prospective cohort studies from several online databases from their inception to May 1, 2019. Participants without dementia were adults aged greater than 50 years. MEASURES: The required data were extracted from the eligible studies to facilitate the Bayesian NMA. RESULTS: Forty-three cohort studies with 277,294 participants were included in this NMA. Using the observation group as the reference, all defined RFs, except for antioxidants, were associated with lower risks of all-cause dementia [no sleep disturbances (odds ratio, OR 0.43, 95% credible interval, CrI 0.24-0.62), a high level of education (OR 0.50, 95% CrI 0.34-0.66), no history of diabetes (OR 0.57, 95% CrI 0.36-0.78), nonobese patients (OR 0.61, 95% CrI 0.39-0.83), no smoking history (OR 0.62, 95% CrI 0.45-0.79), living with family members (OR 0.67, 95% CrI 0.45-0.89), participation in physical exercise (OR 0.73, 95% CrI 0.46-0.94), abstinence from drinking (OR 0.78, 95% CrI 0.56-0.99), and no history of hypertension (OR 0.80, 95% CrI 0.65-0.96)]. CONCLUSIONS/RELEVANCE: The findings provide reliable support for the hypothesis that modifiable somatic and lifestyle factors are strong predictors of all-cause dementia.

Effects of non-pharmacological therapies for people with mild cognitive impairment. A Bayesian network meta-analysis.

OBJECTIVE: To compare the effects of non-pharmacological therapies (NPTs) on improving the cognition of people with mild cognitive impairment (MCI) by performing a Bayesian network meta-analysis (NMA). METHODS: We searched eight databases for potentially eligible studies. Physical exercise (PE), cognitive stimulation (CS), cognitive training (CT), cognitive rehabilitation (CR), musical therapy (MT) and multi-domain interventions (MI). Pairwise meta-analyses were performed by estimating the weighted mean differences with 95% confidence interval (CI) for mini-mental state examination. The NMA was undertaken to compare different interventions. RESULTS: CS, PE, MI, MT and CT may all be effective in improving the cognition of patients with MCI. CR was unable to show a significant efficacy. Our NMA ranking results suggest the effectiveness of the six NPTs to be ranked from best to worst as follows: CS, PE, MI, MT, CT and CR. CONCLUSIONS: NPT has great potential to improve the cognition of the elderly with MCI. CS has the highest probability of being the optimal NPT. However, the result should be interpreted with cautions given the limited number and small samples of included randomized controlled trials (RCTs) in this field, large diversity existing in different study designs and potential risk of bias. Future RCTs with high quality and large sample sizes are required to confirm our results. SUMMARY: NPT, as a whole definition, has great potential to improve the cognition of the elderly with MCI. Our NMA ranking results suggest the effectiveness of the six NPTs to be ranked from best to worst as follows: CS, PE, MI, MT, CT and CR.

Non-pharmacological therapeutic strategy options for patients with dementia based on cognitive function-A Bayesian network meta-analysis of randomized controlled trials.

Dementia represents one of the most common neurodegenerative disorders in older adults. However, it is still unclear whether non-pharmacological therapies (NPTs) are effective or not and which treatment should be preferred. We applied a series of search strategies to identify eligible randomized controlled trials on 1st October, 2018, investigating the effects of NPTs of dementia in the older persons. Pairwise and network meta-analyses were sequentially performed. A total of 31 trials were included, which enrolled 1895 participants and 7 NPTs. Compared with control group, all the NPTs included were statistically beneficial to cognitive function, and our study indicated Comprehensive Therapy(CT) [the surface under the cumulative ranking curve (SUCRA = 92.42%)] might be the best choice for dementia patients. Our study suggests CT might be the optimal NPT for improving the cognitive function of dementia patients. However, the above conclusions need to be further analyzed.

Depressive Symptoms Among Children and Adolescents in China: A Systematic Review and Meta-Analysis.

BACKGROUND Depressive symptoms are a pervasive mental health problem in Chinese adolescents. The aim of this article was to systematically assess the trend of depressive symptoms in China among adolescents (1988 to 2018). MATERIAL AND METHODS A systematic and comprehensive literature search was conducted in both English and Chinese databases, including PubMed, EMBASE, Cochrane CENTRAL, CNKI, and Wan Fang Database, to identify relevant studies published between 1988 and 2018. Batteries of analyses in this meta-analysis were undertaken using Stata version 12.0 statistical software. RESULTS Sixty-two related reports involving 232 586 participants finally met our inclusion and exclusion criteria. The results suggest the prevalence of depressive symptoms has generally increased over time. The prevalence estimates before 2000 were 18.4% (95% CI, 14.5-22.3%), and were 26.3% (95% CI, 21.9-30.8%) after 2016. The pooled prevalence of depressive symptoms among children and adolescents was 22.2% (95% CI: 19.9-24.6%, I²=99.6%, p<0.001). More subgroup analyses classified by screening instrument, gender, and region were carried out in this meta-analysis. CONCLUSIONS Results of our meta-analysis suggest that depressive symptoms have become more prevalent among Chinese adolescents. This trend emphasizes the need for effective prevention strategies and greater availability of screening tools for this vulnerable population.

Dementia in China (2015-2050) estimated using the 1% population sampling survey in 2015.

AIM: To determine the prevalence of dementia in the past two decades and provide updated estimates about older people (aged ≥60 years) with dementia in China from 2015 to 2050. METHODS: The English and Chinese databases were retrieved. Published epidemiology surveys of dementia from 1990-2018 were screened. Meta-analysis was used to calculate their pooled prevalence. The age-moving method was used to estimate the population aged ≥60 years in 2020, 2030, 2040 and 2050 based on the data of the sampling survey of 1% of the population in 2015 released by the National Bureau of Statistics. The pooled prevalence of three age groups (60-69, 70-79, ≥80 years) from 2015 to 2018 was used as the basis to estimate the number of older people with dementia. RESULTS: The pooled prevalence rate of dementia in Mainland China from 1985 to 2018 was 4.9% (95% CI 4.3-5.4), and the prevalence rate from 2015 to 2018 among them was 7.4% (95% CI 5.3-9.5). In 2020, 2030, 2040 and 2050, the number of people with dementia will be 16.93 million, 24.25 million, 31.98 million and 35.98 million, respectively. Furthermore, people with dementia aged ≥60 years in 2050 will be 2.13-fold than that of 2015. CONCLUSION: The number of dementia patients in China will increase dramatically in the next 30 years without preventive measures. Geriatr Gerontol Int 2019; 19: 1096-1100.

Effects of physical activity and exercise on the cognitive function of patients with Alzheimer disease: a meta-analysis.

BACKGROUND: Alzheimer's disease (AD), as the most common cause of dementia, brings huge economic burden for patients and social health care systems, which motivates researchers to study multiple protective factors, among which physical activity and exercise have been proven to be both effective and economically feasible. METHODS: A systematic literature search was performed for eligible studies published up to November 1st 2018 on three international databases (PubMed, Cochrane Library, and Embase) and two Chinese databases (Wanfang Data, China National Knowledge Infrastructure). All analyses were conducted using Stata 14.0. Due to heterogeneity between studies, a random-effects model was used for this meta-analysis. Meta-analysis was used to explore if physical activity and exercise can exert positive effects on cognition of elderly with AD and subgroup analyses were conducted to find out if there are dose-response effects. RESULTS: A total of 13 randomized controlled trials were included with a sample size of 673 subjects diagnosed with AD. Intervention groups showed a statistically significant improvement in cognition of included subjects measured by the MMSE score (SMD = 1.12 CI:0.66~1.59) compared to the control groups. Subgroup analyses showed different amounts of physical activity and exercise can generate different effects. CONCLUSIONS: As one of few meta-analyses comparing different quantities of physical activity and exercise interventions for AD in details, our study suggests that physical activity and exercise can improve cognition of older adults with AD. While the concomitant effects on cognition functions of high frequency interventions was not greater than that of low frequency interventions, the threshold remains to be settled. However, more RCTs with rigorous study design are needed to support our findings.

The optimal treatment for improving cognitive function in elder people with mild cognitive impairment incorporating Bayesian network meta-analysis and systematic review.

It's widely acknowledged that, as a neurodegenerative aging disease representing an intermediate stage between cognitive intactness and Alzheimer's disease (AD), Mild cognitive impairment (MCI) poses an excessive burden on patients' well-being, family members, health-care providers as well as the whole society. This study focuses on three cognitive interventions proposed by Clare and Woods, which are, Cognitive stimulation (CS), Cognitive training (CT) and Cognitive rehabilitation (CR). Our Network meta-analysis (NMA) aims to compar them with one another to determine the optimal cognitive intervention for elderly adults with MCI in improving their cognitive function. We applied extensive strategies to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs) which scrupulously compared any two of the three cognitive interventions with one another or any one of the three with a control group as the placebo or non-active group in treating elder patients with MCI in accordance with Petersen's criteria. Our NMA of cognitive interventions for patients diagnosed with MCI appraised the relative effectiveness of cognitive interventions across trials simultaneously. Our study attempts to summarize available data to suggest that CS (Mean difference [MD] = 0.95, 95% confidence interval [CI]:0.27, 1.70) and CT (MD = 0.70, [CI]:0.11,1.30) were significantly beneficial to MCI patients for improving their cognition status while CR (MD = 0.59, [CI]:-0.30,1.50) scored lowest. Our study suggested CS was most likely to be the best intervention for improving the cognitive function of MCI patients.

Comparison of Cognitive Intervention Strategies for Older Adults With Mild to Moderate Alzheimer's Disease: A Bayesian Meta-analytic Review.

OBJECTIVES: We aimed to identify the best form of cognitive therapy among 3 main cognitive interventions of Alzheimer's disease (AD) including cognitive training (CT), cognitive stimulation (CS), and cognitive rehabilitation (CR). DESIGN: Systematic review and Bayesian network meta-analysis. SETTING AND PARTICIPANTS: An exhaustive literature search was conducted based on PubMed, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, the China National Knowledge Infrastructure database, the Chinese Biomedical Literature database, the Wan Fang database, and Web of Science and other database and randomized controlled trials were identified from their inception to May 1, 2018. Older adult participants diagnosed with AD were recruited. MEASURES: We conducted a Bayesian network meta-analysis (NMA) to rank the included treatments. Cognitive functions were measured based on the Mini-Mental State Examination (MMSE). A series of analyses and assessments, such as the Pairwise meta-analysis and the risk of bias, were performed concurrently. RESULTS: Only 22 studies were included in our analysis based on a series of rigorous screenings, which comprised 1368 participants. No obvious heterogeneities were found in NMA (I2 = 32.7%, P = .07) after the data were pooled. The mean difference (MD) of CT [MD = 2.1, confidence interval [CI]: 1.0, 3.2), CS (MD = 0.92, CI: -0.20, 2.0), and CR (MD = 2.0, CI: 0.73, 3.4) showed that CT and CR could significantly improve cognitive function as measured by MMSE in the treatment group whereas the CS was less effective. CT had the highest probability among the 3 cognitive interventions [the surface under the cumulative ranking curve (SUCRA) = 84.7%], followed by CR (SUCRA = 50.0%) and CS (SUCRA = 47.4%). CONCLUSIONS/RELEVANCE: Our study indicated that the CT might be the best method for improving the cognitive function of AD patients. The findings from our study may be useful for policy makers and service commissioners when they make choices among different alternatives.

Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis.

BACKGROUND: The increasing prevalence of Alzheimer disease (AD) emphasizes the need for effective treatments. Both pharmacological therapies such as nutrition therapy (NT) and nonpharmacologic therapies including traditional treatment or personalized treatment (e.g., physical exercise, music therapy, computerized cognitive training) have been approved for the treatment of AD or mild cognitive impairment (MCI) in numerous areas. METHODS: The aim of this study was to compare 4 types of interventions, physical exercise (PE), music therapy (MT), computerized cognitive training (CCT), and NT, in older adults with mild to moderate AD or MCI and identify the most effective intervention for their cognitive function. We used a system of search strategies to identify relevant studies and include randomized controlled trials (RCTs), placebo-controlled trials evaluating the efficacy and safety of 4 interventions in patients with AD or MCI. We updated the relevant studies which were published before March 2017 as a full-text article. Using Bayesian network meta-analysis (NMA), we ranked cognitive ability based objectively on Mini-Mental State Examination (MMSE), and assessed neuropsychiatric symptoms based on Neuropsychiatric Inventory (NPI). Pairwise and network meta-analyses were sequentially performed for efficacy and safety of intervention compared to control group through RCTs included. RESULTS: We included 17 RCTs. Fifteen trials (n = 1747) were pooled for cognition and no obvious heterogeneity was found (I = 21.7%, P = .212) in NMA, the mean difference (MD) of PE (MD = 2.1, confidence interval [CI]: 0.44-3.8) revealed that PE was significantly efficacious in the treatment group in terms of MMSE. Five trials (n = 660) assessed neuropsychiatric symptoms with an obvious heterogeneity (I = 61.6%, P = .034), the MD of CCT (MD = -7.7, CI: -14 to -2.4), revealing that CCT was significantly efficacious in NPI. CONCLUSIONS: As the first NMA comparing different interventions for AD and MCI, our study suggests that PE and CCT might have a significant improvement in cognition and neuropsychiatric symptoms respectively. Moreover, nonpharmacological therapies might be better than pharmacological therapies.