Symptoms of depression and anxiety in Chinese adolescents: heterogeneity and associations with executive function.

BACKGROUND: Depression and anxiety are common symptoms associated with significant morbidity in adolescents. Few studies have explored the relationship between latent profiles of adolescent depression-anxiety symptoms and executive function (EF), which is also a major pediatric public health concern. METHODS: The sample included 1,306 participants who were recruited from two schools in Ningxia. The Depression Self-Rating Scale for Children (DSRSC) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) were used to assess the level of depression-anxiety symptoms in adolescents, and their executive function state was assessed using the Behavior Rating Inventory of Executive Function-Self-Report version (BRIEF-SR). Latent profile analysis (LPA) was carried out using Mplus 7.0 to explore the most likely number of profiles based on the subscales of DSRSC and SCARED. The relationship between adolescents' executive function and depression-anxiety symptoms were analyzed by multivariable logistic regression, and the odds ratio were used to test the impact of this relationship. RESULTS: The LPA results show that the three-profile model was the best-fitting model for adolescent depression and anxiety symptoms. The proportions of Profile-1 ("Healthy Group"), Profile-2 ("Anxiety Disorder Group"), and Profile-3 ("Depression-Anxiety Disorder Group") were 61.4%, 23.9%, and 14.7%, respectively. Additional analyses using multivariable logistic regression suggested that poor shifting capacity and emotional control were significantly more likely to be classified into the depression and/or anxiety groups, and worse working memory, task completion, and better inhibition were significantly more likely to be classified into the anxiety group. CONCLUSIONS: The findings contribute to our understanding of the heterogeneity of adolescents' depression-anxiety symptoms and highlight the important role of executive function in influencing mental health outcomes. These findings will guide the improvement and delivery of interventions for the treatment of anxiety and depression in adolescents, mitigating functional impairments in patients and reducing disease risk.

Relationship between chronotypes and aggression in adolescents: a cross-sectional study.

BACKGROUND: This study aimed to investigate the relationship between chronotypes and aggression in adolescents. METHODS: A cross-sectional study was conducted on 755 primary and secondary school students aged 11-16 years in rural areas of Ningxia Province, China. The Chinese version of the Buss-Perry Aggression Questionnaire (AQ-CV) and the Chinese version Morningness-Eveningness Questionnaire (MEQ-CV) were used to assess the aggressive behavior and chronotypes of the study subjects. The Kruskal-Wallis test was then used to compare the differences in aggression among adolescents with different chronotypes, and Spearman correlation analysis to determine the relationship between chronotypes and aggression. Further linear regression analysis was used to investigate the effects of chronotype, personality traits, family environment, and class environment on adolescent aggression. RESULTS: There were significant differences in chronotypes between different age groups and different sexes. Spearman correlation analysis showed that the MEQ-CV total score was negatively correlated with the AQ-CV total score (r = -0.263) and score of each AQ-CV subscale. In Model 1, chronotypes were negatively associated with aggression when controlling for age and sex, and evening-type adolescents might be more likely to exhibit aggressive behavior (b = -0.513, 95% CI: [-0.712, -0.315], P < 0.001); in Model 2, the negative association remained after controlling for family and class environment on the basis of Model 1 (b = -0.404, 95% CI: [-0.601, -0.208], P < 0.001); and in Model 3, the negative association still existed after controlling for personality traits on the basis of Model 2 (b = -0.383, 95% CI: [-0.577, -0.190], P < 0.001). CONCLUSION: Compared to morning-type adolescents, evening-type adolescents were more likely to exhibit aggressive behavior. Given social expectations for MT adolescents, adolescents should be actively guided to develop a good circadian rhythm that may be more conducive to their physical and mental development.

Correlational research on facial and clinical characteristics of adolescents with obsessive-compulsive disorder.

BACKGROUND: The neurodevelopmental model of obsessive-compulsive disorder (OCD) suggests that the neurodevelopmental changes in the ventral striatal circuit of the prefrontal lobe are associated with the initial symptoms of OCD. Facial morphology is one of the most consistent anatomical phenotypes of neurodevelopmental disorders, which can reflect brain structure and function. Facial deformity, an easily measured index of brain malformation, can reflect abnormal brain structure and function. Therefore, this study aims to explore the relationship between clinical features and neurodevelopment of adolescents with OCD through facial morphology. METHODS: The enrolled study sample comprised 40 adolescents diagnosed with OCD using the Obsessive Compulsive Inventory-Child Version (OCI-CV) and 38 healthy controls (HCs). Facial photos, 21 facial diameters, and 9 facial angles were collected using image software. RESULTS: In males, lower lip red height was significantly lower in OCD patients than in HCs (P < 0.025); no significant differences were observed in other facial indicators (all P > 0.025). In females, the nasolabial angle was smaller in OCD patients than in HCs (P < 0.025); no significant differences were observed in other facial indicators (all P > 0.025). The difference in lower lip red height between the OCD group and HC group was positively correlated with neutralizing symptoms (r = 0.401, P < 0.05). CONCLUSIONS: Male OCD patients had a thinner lower lip and female OCD patients had smaller nasolabial angles. The facial features of adolescents with OCD were positively correlated with lower lip redness and neutralizing symptoms.

Migrant adolescents' behavioral problems compared to host adolescents and adolescents in their region of origin: a longitudinal study.

BACKGROUND: Since the 1990s, families from the ecologically hostile mountainous southern areas of Ningxia Province, China, have been migrating to the northern areas of the province. This study compared the prevalence of behavioral problems among migrant adolescents to those among host adolescents (adolescents from the northern areas) and adolescents in the region of origin (adolescents from the southern areas), to determine whether ecological migration is related to adolescent behavioral problems, and possible changes in such problems over time. METHODS: We used the Children and Adolescents Ecological Migration Survey on Mental Health, administered to 4805 students aged 12-16 years and their parents between 2012 and 2014 (W1), of whom 1753 students and their parents completed the follow-up between 2014 and 2017 (W2). Parents answered questions related to adolescent behavioral problems, main source of family income, parents' desire to reverse migrate, improved standard of living, and parents' educational attainment, while children completed the Eysenck Personality Questionnaire and a classroom environment questionnaire. RESULTS: The prevalence of behavioral problems among the migrant adolescents (28.04%) was significantly higher than among host adolescents (21.59%) or adolescents in the region of origin (24.37%; p < 0.001) at W1. After adjusting for gender and age, parents' work outside the home was the main source of family income (OR = 1.42, 95% CI = 1.13-1.78), and adolescents' learning burden (OR = 1.04, 95% CI = 1.01-1.06) in school negatively influenced behavioral problems. Strong student-teacher relationships (OR = 0.97,95% CI = 0.94-0.99) and parents who had no intention to move back to the original residence (OR = 0.70, 95% CI = 0.52-0.94) exerted a protective effect at W1; at W2, a protective effect was associated with improved living conditions (OR = 0.39-0.55, 95% CI = 0.25-0.84). The extent of behavioral problems among migrant adolescents significantly decreased after two years. CONCLUSION: Ecological migration will increase children's behavioral problems in the early stage, with various factors influencing the extent of these problems.

Informational Analysis and Prediction of Obsessive-Compulsive Disorder Pathogenesis.

OBJECTIVE: We aimed to predict the possible mechanism of obsessive-compulsive disorder (OCD) by integrating and analyzing mRNA sequencing results from two datasets and to provide direction for future studies into the pathogenesis of OCD. METHODS: Two OCD datasets, GSE78104 and GSE60190, were obtained, and the intersection of the two gene sets with differential expression in OCD samples was selected. Kyoto Encyclopedia of Genes and Genomes (KEGG) signal pathway enrichment and Gene Ontology (GO) analyses were performed using the Database for Annotation, Visualization, and Integrated Discovery (DAVID) online analysis website for the genes at the intersection, and the data were mapped using http://www.bioinformatics.com.cn. After genes with p≤0.05 had been screened out, protein-protein interaction (PPI) interaction analysis was conducted using Metascape to screen the key Molecular Complex Detection (MCODE) genes. MCODE genes were then enriched using the KEGG signaling pathway and GO classification. RESULTS: A total of 3,449 differentially expressed genes (DEGs) were obtained from the GSE78104 and GSE60190 datasets. KEGG, GO, and Gene Set Enrichment Analysis analyses of DEGs showed that the onset of OCD was related to oxidative phosphorylation and other metabolic processes, which may have a similar pathogenesis to other neurodegenerative diseases. Single-gene PPI analysis of SAPAP3 revealed that the mechanism by which SAPAP3 knockout induces OCD may also be caused by affecting oxidative phosphorylation. CONCLUSION: The mechanism of SAPAP3 knockout-induced OCD in mice may be due to the oxidative phosphorylation process in the body. Future studies on the neural circuit mechanism of OCD should be conducted.

Alerting network, cognitive flexibility in children with attention deficit hyperactivity disorder and the moderating effect of neuroticism.

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, and cognitive flexibility is a sub-component of executive functioning. Studies have shown impairments in cognitive flexibility in ADHD, which is affected by attentional processes. Personality, as a long-standing trait, has a profound effect on ADHD. However, previous studies have not assessed the relationship between attentional function, personality traits, and cognitive flexibility in children with ADHD. This study explored the association between attention networks, personality, and cognitive flexibility in ADHD, filling a gap in the related field. We expect our findings will provide insights into and clues for the prevention and interventional treatment of ADHD. This study primarily aimed to analyze differences in cognitive flexibility between individuals with ADHD and those without and further examine associations between attention networks, personality, and cognitive flexibility in children with ADHD. Overall, 55 children aged 7 to 11 years diagnosed with ADHD and 40 children without ADHD participated in this study. Cognitive flexibility, personality traits, and attentional networks were assessed using the Wisconsin Card Sorting Test, Eysenck Personality Questionnaire, and Attention Network Test, respectively. Additionally, the association between personality traits and strong attentional functioning and cognitive flexibility was investigated using multiple regression analysis. Children with ADHD had significant deficits in cognitive flexibility. A multiple regression analysis revealed that the alerting effect was highly associated with cognitive flexibility at high levels of neuroticism. This association was not salient in individuals with low levels of neuroticism. This study demonstrated that the ADHD group experienced lower cognitive flexibility than the control group. In addition, we showed the effect of neuroticism and alerting networks on cognitive flexibility. These findings may help psychiatrists provide intervention strategies to mitigate the impairment of social functioning in ADHD with cognitive spirituality deficits.

Red Raspberry Extract Decreases Depression-Like Behavior in Rats by Modulating Neuroinflammation and Oxidative Stress.

Objective: Red raspberry serves as a proven natural product to produce anti-inflammatory, antioxidant, and anticancer functions, but limited findings are available on its effects on depression. This study, by using a chronic unpredictable mild stress- (CUMS-) induced depression model, thus investigated the effects and underlying mechanism of red raspberry extract (RRE) on depressive behavior, inflammation, and oxidative stress. Methods: Different treatments were given after random grouping of Sprague-Dawley rats, including no intervention (control), CUMS induction, and CUMS+different concentrations of RRE, and subsequently, depression-like behavior tests were performed. HE staining was designed to observe the pathological damage of the hippocampal tissue in rats. The levels of oxidative stress, endocrine hormones, and inflammatory factors were determined by biochemical assay and ELISA, and gene expression (mRNA and protein) in the hippocampal tissue by qRT-PCR and Western blot. Results: On completion of CUMS treatment, the rats showed severe depression-like behavior, with obvious hippocampal tissue damage, oxidative inflammatory response, and endocrine imbalance. Importantly, RRE treatment significantly improved such depression-like behavior and attenuated histopathological damage in CUMS rats when reducing inflammation and oxidative stress and endocrine imbalance with upregulation of glutathione (GSH), superoxide dismutase (SOD), and interleukin- (IL-) 10 and downregulation of adrenocorticotropic hormone (ACTH), corticosterone (CORT), malondialdehyde (MDA), IL-1ß, cyclooxygenase- (COX-) 2, and human macrophage chemoattractant protein- (MCP-) 1. In addition, for CUMS rats, RRE was a contributor to increasingly expressed brain-derived neurotrophic factor (BDNF), neurotrophic tyrosine receptor kinase 2 (TrkB), and p-mTOR but inhibited p-GSK-3ß expression in the hippocampal tissue. All the above antidepressant effects of RRE were concentration-dependent. Conclusion: By regulating neuroinflammation, oxidative stress response, endocrine level, and BDNF/TrkB level, RRE showed potential efficacy in alleviating depression-like behavior and histopathological damage of hippocampal tissue in CUMS rats by regulating the GSK3ß and mTOR signaling pathways.

Protocol for a Pragmatic Trial of Pharmacotherapy Options Following Unsatisfactory Initial Treatment in OCD (PROCEED).

Background: Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), but a large proportion of patients do not achieve remission after an adequate SSRI trial. To the best of our knowledge, there have been no well-powered randomized controlled trials (RCTs) of sequenced pharmacotherapy using pragmatic research designs. China provides a unique context for undertaking such a trial that will recruit the largest treatment-naïve participants and systematically compare the efficacy of different sequenced pharmacotherapy. Methods: A pragmatic research design will be adopted, with n = 1,600 treatment-naïve OCD patients initially treated for sertraline for 12 weeks, and with non-remitters then randomized to 5 different augmentation or switching pharmacotherapy options for another 12 weeks. The 5 arms will include: (1) treatment with higher than usual doses of sertraline, (2) switch to fluvoxamine, (3) switch to venlafaxine, (4) augmentation with memantine, and (5) augmentation with aripiprazole. Discussion: China is uniquely positioned to recruit sufficiently large sample sizes of treatment-naïve OCD patients to compare different pharmacotherapy options; data from the proposed trial promises to help inform current clinical practice guidelines by providing important information about optimal pharmacotherapy choice for those who demonstrate no response or response but no remission to first line pharmacotherapy. Trial Registration: The trail was registered on 27 August 2020 in ClinicalTrials.gov (https://register.clinicaltrials.gov/) (NCT04539951).

Parental autonomy-support, intrinsic life goals, and well-being among adolescents in China and North America.

Self-determination theory proposes that prioritizing intrinsic life goals, such as community involvement, is related to well-being, whereas focusing on extrinsic life goals, such as financial success, is associated with lower well-being and that parenting influences the type of life goals that youth adopt. In a sample of 515 Chinese (56% female, mean age = 15.50) and 567 North American (52% male, mean age = 14.17) adolescents, a model of the relationships between parenting, life goals, and well-being was investigated and confirmed for intrinsic life goals. Across societies, autonomy-supportive parenting was associated with the endorsement of intrinsic life goals, which in turn was associated with well-being. Intrinsic life goals partially mediated the relationship between parental autonomy-support and well-being. These findings suggest that, cross-culturally, prioritizing intrinsic life goals is related to increased well-being among adolescents and that parents could encourage intrinsic life goals by being supportive of their children's autonomy.

Development of the psychosomatic symptom scale (PSSS) and assessment of its reliability and validity in general hospital patients in China.

OBJECTIVES: To develop and verify the Psychosomatic Symptom Scale (PSSS) among psychosomatic patients and the cut-off value of PSSS in distinguishing psychosomatic patients from health controls. METHODS: The PSSS was drafted by an expert workgroup. 996 patients and 366 controls from 14 general hospitals in China were recruited to complete PSSS, Patient Health Questionnaire-15 (PHQ-15) and Symptom Checklist-90 (SCL-90). Student's t-test, Kruskal-Wallis test, Cronbach's α, Spearman's correlation, and confirmatory factor analysis (CFA) were used to verify the PSSS. Receiver operating characteristic (ROC) analyses were used to determine the cut-off value. RESULTS: Cronbach α of PSSS was 0.907. The PSSS was significantly correlated with SCL-90 somatization subscale (r = 0.682, P < 0.001) and PHQ-15 (r = 0.724, P < 0.001). CFA supported the theoretical two-factor structure of the PSSS, with comparative fit index (CFI) = 0.979, Tucker-Lewis index (TLI) = 0.977, root mean square error of approximation (RMSEA) = 0.039 (90% CI: 0.035-0.042), and standardized root mean residual (SRMR) = 0.054. As the sum score of PSSS was significantly higher in female, cut-off values were determined as 11 in females and 10 in males respectively. CONCLUSIONS: The PSSS is a reliable and valid instrument for measuring psychosomatic symptoms.

The Depressive Experiences Questionnaire: construct validity and prediction of depressive symptoms in a sample of Chinese undergraduates.

BACKGROUND: The Depressive Experiences Questionnaire (DEQ) was developed to measure two dimensions of depression-prone personality, Dependency and Self-criticism. We investigated the construct validity and prediction of DEQ in a Chinese sample, and explored whether Blatt's conceptualizations of depression-prone personality variables are appropriate for the Chinese context. METHODS: The original version of the DEQ was translated into Chinese (DEQ-C). During the initial assessment, 640 Chinese university students completed the DEQ-C and the Center for Epidemiologic Studies Depression Scale (CES-D). Six months later, the CES-D was re-administered. RESULTS: A principal components analysis yielded a three-factor model that was consistent with Blatt's theory. However, these three factors emerged in a different order in comparison to the original sample. Factorial validity was also acceptable with low correlations between each DEQ-C factor in males (r=.01 approximately -0.14), and females (r=0.19 approximately 0.28). Convergent validity was supported by significant positive correlations between the CES-D and both Dependency and Self-criticism. Predictive validity was demonstrated by hierarchical multiple regression analyses showing that Self-criticism predicted increased depressive symptoms both in males (beta=0.27, p<0.01) and in females (beta=0.16, p<0.05); Dependency predicted levels of depressive symptoms only in females (beta=0.11, p<0.05). CONCLUSIONS: The Chinese version of the DEQ demonstrated satisfactory validity, including construct validity and predictive validity, the DEQ-C can be considered as an appropriate tool for assessing personality vulnerability to depression in Chinese college students.

Balance across contexts: importance of balanced need satisfaction across various life domains.

Self-determination theory posits that satisfaction of three basic psychological needs-autonomy, competence, and relatedness-are required for psychological well-being, and a recent study showed that the balance in the satisfaction of these three needs independently affects well-being. The present investigation builds on these findings by examining the balance of adolescents' need satisfaction across distinct life contexts. The results of three studies show that adolescents who experience a balance of need satisfaction across important life contexts, including at school, at home, with friends, and in part-time jobs, reported higher well-being and better school adjustment. This finding emerged consistently across four countries and across multiple measures of school adjustment, including teacher reports. Together, these results support previous research that highlights the importance of consistency for psychological functioning.

Prevalence and Correlates of Direct Self-Injurious Behavior among Chinese Adolescents: Findings from a Multicenter and Multistage Survey.

Direct self-injurious behavior (DSIB) has become an important focus due to its perniciousness and perplexity. Little is known about its prevalence and correlative factors in Chinese adolescents, including how data may differ according to gender. A multicenter, multistage stratified cluster random sampling was used to examine the previous 12-month prevalence of DSIB, as well as the possible correlates of demographics, risky behaviors, suicidality, and psychosocial factors associated with DSIB in a school-based sample of 11,880 students (49.5 % boys and 50.5 % girls). Approximately 30 % of the adolescents in the sample reported at least one incident of DSIB in the past 12-month period. After controlling for demographic variables, analyses of the independent relationships of DSIB with risky behaviors, suicidality, and psychosocial factors were conducted for each gender. Smoking, binge drinking, running away from home, suicide ideation, suicide plans, positive affect, and physical symptoms were identified as common factors associated with DSIB for both genders in the final model. In addition, truancy, fighting, physical inactivity, motor impulsiveness, and depressed affect were found to be related to DSIB in boys, whereas suicide attempts and somatic complaints were found to be related to DSIB in girls. Separation anxiety and social anxiety associated negatively with DSIB in boys and girls, respectively. DSIB was not found to independently relate to attention impulsiveness, non-planned impulsiveness, self-esteem, or harm avoidance in either genders. DSIB was prevalent in Chinese adolescents. Programs intended to promote physical and mental health in adolescents should take into account gender differences in DSIB-associated factors, including risky behaviors, suicidality, and psychosocial factors.

[A cross-sectional survey on behavior problems among eco-migrant children of Hui and Han in Ningxia, China].

OBJECTIVE: To investigate the detection rate and correlates of behavioral problems among eco-migrant children in Hui and Han ethnicities. METHODS: Using multistage randomized sampling method, 2 653 eco-migrant teenagers, 3 174 indigenous and 2 334 homeland peers were selected. Their parents were asked to finish the Achenbach's Child Behavior Checklist (CBCL) and a self-developed correlates questionnaire. RESULTS: 765 eco-migrant children with behavioral problems were detected, with detection rate as 28.8%, higher than that of homeland group (24.2%) and native group (19.3%) (χ(2) = 73.547, P < 0.012 5). Ecological migration mainly influenced factors as bad contacts, depression, obsessive-compulsive, discipline, attack for boys aged 6-11, bad contacts for boys aged 12-16 and extraversion behavioral problems for girls aged 12-16, in Hui. These factors both associated to eco-migrant children's behavioral problems in Hui and Han:cesarean section (OR = 1.863, 95% CI:1.144-3.035, for Han) and (OR = 2.979, 95% CI:2.067-4.293, for Hui), physical defects (OR = 1.730, 95%CI:1.087-2.751, for Han) and (OR = 2.552, 95%CI:1.649-3.950, for Hui), arable as a main income way(OR = 1.272, 95%CI:1.066-1.518, for Han) and (OR = 1.212, 95%CI: 1.033-1.422, for Hui), parents' education level above middle school (OR = 0.709, 95% CI: 0.539-0.932, for Han) and (OR = 0.698, 95%CI: 0.542-0.898, for Hui), parents' frequently in good mood (OR = 0.710, 95%CI:0.613-0.821, for Han) and (OR = 0.826, 95%CI:0.718-0.949, for Hui). However, major diseases in the process of growth (OR = 1.794, 95% CI:1.163-2.767), and parents with chronic illness or disability (OR = 1.463, 95% CI:1.061-2.016) only associated with that in Han;single-parent or remarried families(OR = 1.583, 95% CI:1.078-2.325), parents often drinking (OR = 1.557, 95%CI:1.019- 2.379), the time of parents' work longer than half a year (OR = 1.494, 95% CI:1.197-1.864), parents' more content to life now(OR = 0.813, 95% CI:0.700-0.945), and children in older age (OR = 0.939, 95%CI:0.889-0.991) only related to that in Hui. CONCLUSION: The eco-migrant children showed a low state in mental health, especially among Hui peers, and the correlated factors were different in Han and Hui, which was supposed to get great importance when taking effective intervention.