Psychological Distress Mediates the Relationship Between HIV-Related Stigma and Prescription Opioid Misuse Among Chinese People Living with HIV.

Prescription opioid misuse (POM) among people living with HIV (PLWH) is a serious concern due to risks related to dependence and overdose, and PLWH may be at higher risk for POM due to psychosocial stressors including psychological distress. However, scant POM research has examined the role of HIV-related stigma (e.g., internalized stigma, enacted stigma) in POM among PLWH. Guided by minority stress theory, this study examined a hypothesized serial mediation among enacted stigma, internalized stigma, psychological distress, and POM within a sample of Chinese PLWH with pain symptoms enrolled in a wave (between November 2017 and February 2018) of a longitudinal cohort study in Guangxi (n = 116). Models were tested individually for six enacted stigma experiences, controlling for key demographic and health-related variables (e.g., CD4 + count). Results showed HIV-related workplace discrimination was the most common stigma experience (12%,) and 10.3% of PLWH reported POM. Indirect effect analyses showed that internalized stigma was indirectly associated with POM through psychological distress. Internalized stigma and psychological distress mediated the association between workplace discrimination and POM. Family discrimination, gossip, and healthcare discrimination were directly associated with POM. This study suggests that Chinese PLWH may engage in POM to cope with psychological distress that is rooted in HIV-related stigma and highlights the important context of workplace discrimination for PLWH. Implications for interventions to reduce POM among PLWH are discussed.

Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States.

This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.

Prescription Opioid Misuse, Pain Interference, Resilience, and Anxiety Among Chinese People Living with HIV: A Moderated Mediation Model.

Prescription opioid misuse (POM) is a concern in people living with HIV (PLWH). Pain interference is a robust factor, and its influences would occur through anxiety and resilience. Limited POM studies attend to Chinese PLWH. This study examined POM and its underlying psychological mechanism using data of PLWH with pain (n = 116) from a cohort study in Guangxi. The PROCESS macro was employed to examine a hypothesized moderated mediation model among pain interference, resilience, anxiety, and POM. Results showed 10.3% PLWH engaged in past-three-month POM. After controlling for demographics, HIV-related clinical outcomes, and pain severity, anxiety mediated the association between pain interference and POM (ß = 0.46, 95% CI = 0.01 to 10.49), and the mediation was moderated by resilience (moderated mediation index = - 0.02, 95% CI = - 0.784 to - 0.001). Chinese PLWH seem to misuse opioids to cope with pain-related anxiety. Resilience appears to offer protection.

Associations Between Internalized and Anticipated HIV Stigma and Depression Symptoms Among People Living with HIV in China: A four-wave Longitudinal Model.

Previous research has documented that HIV-related stigma (e.g., internalized and anticipated stigma) is detrimental to the mental health of people living with HIV (PLWH). However, longitudinal data on the bidirectional relationship between HIV-related stigma and depression symptoms are limited. The purpose of this study was to examine the bidirectional association among internalized and anticipated HIV stigma and depression symptoms among Chinese PLWH. A four-wave longitudinal design (6 months intervals) was employed among 1,111 Chinese PLWH (Mage = 38.58, SD = 9.16, age range: 18-60 years; 64.1% men). The bidirectional model was examined using a random-intercept cross-lagged panel model (RI-CLPM), which evaluated the within- and between-person effects of study variables. At the within-person level, results indicated that depression symptoms at T2 mediated the linkage between internalized HIV stigma at T1 and anticipated HIV stigma at T3, and that anticipated HIV stigma at both T2 and T3 mediated the relationship between depression symptoms at the previous time point and internalized HIV stigma at the subsequent time point. Furthermore, a bidirectional association was found between anticipated HIV stigma and depression symptoms across four waves. At the between-person level, internalized and anticipated HIV stigma were significantly associated with depression symptoms. This study highlights the complex interplay between different forms of HIV-related stigma and mental health problems among PLWH and underscores the importance of considering the bidirectional relationship between the development of psychopathology and stigmatization process in clinical practice.

Artificial Intelligence-Based Chatbots for Promoting Health Behavioral Changes: Systematic Review.

BACKGROUND: Artificial intelligence (AI)-based chatbots can offer personalized, engaging, and on-demand health promotion interventions. OBJECTIVE: The aim of this systematic review was to evaluate the feasibility, efficacy, and intervention characteristics of AI chatbots for promoting health behavior change. METHODS: A comprehensive search was conducted in 7 bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsycINFO, Web of Science, Embase, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated the feasibility or efficacy of AI chatbots for behavior change. The screening, extraction, and analysis of the identified articles were performed by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: Of the 15 included studies, several demonstrated the high efficacy of AI chatbots in promoting healthy lifestyles (n=6, 40%), smoking cessation (n=4, 27%), treatment or medication adherence (n=2, 13%), and reduction in substance misuse (n=1, 7%). However, there were mixed results regarding feasibility, acceptability, and usability. Selected behavior change theories and expert consultation were used to develop the behavior change strategies of AI chatbots, including goal setting, monitoring, real-time reinforcement or feedback, and on-demand support. Real-time user-chatbot interaction data, such as user preferences and behavioral performance, were collected on the chatbot platform to identify ways of providing personalized services. The AI chatbots demonstrated potential for scalability by deployment through accessible devices and platforms (eg, smartphones and Facebook Messenger). The participants also reported that AI chatbots offered a nonjudgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of the moderate to high risk of internal validity, insufficient description of AI techniques, and limitation for generalizability. CONCLUSIONS: AI chatbots have demonstrated the efficacy of health behavior change interventions among large and diverse populations; however, future studies need to adopt robust randomized control trials to establish definitive conclusions.

HIV Service Interruptions During the COVID-19 Pandemic in China: The Role of COVID-19 Challenges and Institutional Response from Healthcare Professional's Perspective.

During the COVID-19 pandemic, HIV-related services have been unavoidably disrupted and impacted. However, the nature and scope of HIV service disruptions due to COVID-19 has rarely been characterized in China. A cross-sectional online survey was conducted among 1029 HIV healthcare providers in Guangxi, China, from April to May 2020. Latent class analysis (LCA) was first used to identify HIV service disruption levels, then hierarchical multilevel logistic regression was conducted to analyze the relationships of COVID-19 challenges, institutional responses, and HIV service disruption levels adjusting for the clustering effect of institutional ownership levels. Four classes of HIV service disruption were identified, with 22.0% complete disruption, 15.4% moderate disruption, 21.9% minor disruption, and 40.7% almost no disruption. COVID-19 challenges were positively associated with the probabilities of service disruption levels. Institutional responses were negatively associated with the probabilities of being classified as "minor disruption" and moderated the association of COVID-19 challenges with complete and moderate disruptions compared with no disruption group. To maintain continuity of core HIV services in face of a pandemic, building a resilient health care system with adequate preparedness is necessary.

Nonmedical use of prescription drugs and biopsychosocial correlates among females who are sex workers in China.

Background: Nonmedical use of prescription drugs (NMPUD) has become a critical public health concern. Chinese literature has paid growing attention to NMUPD, but scarce research has focused on females who are sex workers (FSWs), who have a high risk of substance use. The current study aimed to examine NMUPD and its biopsychosocial correlates in Chinese FSWs. Methods: A total of 410 FSWs (mean age = 33.58 years) from Guangxi, China, completed an anonymous, self-administered survey evaluating NMUPD, somatic symptoms, and psychosocial distress. Results: Overall, 46.6% of FSWs reported lifetime NMUPD and 17.6% reported past-3-month NMUPD. The most commonly reported medications that were used nonmedically were analgesics (46.3%, lifetime; 17.6%, past 3 months). A majority of FSWs (69.1%) reported "relieving pain" as the motive of their NMUPD. FSWs reporting NMUPD were more likely to be younger, be unmarried, have higher income, and work in multiple venues/high-paying venues. Somatic symptoms and psychosocial distress were associated with NMUPD in Chinese FSWs. Conclusions: NMUPD was prevalent in Chinese FSWs and was associated with biopsychosocial factors. Critical attention should be paid to NMUPD in FSWs. Future NMUPD prevention intervention among FSWs may benefit from attending to biopsychosocial factors.

Factors associated with decision making on COVID-19 vaccine acceptance among college students in South Carolina.

COVID-19 vaccination could be a promising approach in controlling the pandemic, but its success relies on the vaccine acceptance among various populations including young adults who are vulnerable to COVID-19 due to active lifestyle and perceived invulnerability. Vaccine acceptance decisions can be influenced by multiple factors and people may weigh these factors differently in decision making. The current study aimed to explore COVID-19 vaccine acceptance among college students in South Carolina and examine how they weigh these factors according to their COVID-19 vaccine acceptance levels (i.e. acceptance, hesitance, refusal). Online survey data were collected from 1062 college students in South Carolina between September and October 2020. Multinomial logistic regresssion was used to compare perceived importance of 12 factors affecting levels of vaccine acceptance, controlling for demographic variables. About 26.1% of participants reported they would definitely take COVID-19 vaccines when available. Compared to acceptance group, refusal and hesitance groups considered side effects and vaccine characteristics (e.g. where the vaccine is produced) as important. Hesitance group considered authoritative advice from school/college as important. Acceptance group considered authoritative advice from government/doctors and local availability of the vaccines and local availability of the vaccines as important. Our findings suggest relatively low vaccine acceptance among college students in South Carolina and different factors were considered in their vaccination decision according to their acceptance levels. Tailored vaccine promotion messages should address specific concerns among the refusal and hesitancy groups. Schools should attend to valid communication strategies in vaccine campaign since the hesitancy group considered school's advice as important. College health educators also need to pay attention to the refusal group who do not value duration of protection or authoritative advice as much as their counterparts in vaccine decision making.

Psychological Distress Among HIV Healthcare Providers During the COVID-19 Pandemic in China: Mediating Roles of Institutional Support and Resilience.

Psychological distress among healthcare providers is concerning during COVID-19 pandemic due to extreme stress at healthcare facilities, including HIV clinics in China. The socioecological model suggests that psychological distress could be influenced by multi-level factors. However, limited COVID-19 research examined the mechanisms of psychological distress among HIV healthcare providers. This study examined organizational and intrapersonal factors contributing to psychological health during COVID-19 pandemic. Data were collected via online anonymous surveys from 1029 HIV healthcare providers in Guangxi, China during April-May 2020. Path analysis was utilized to test a mediation model among COVID-19 stressors, institutional support, resilience, and psychological distress (PHQ-4). Thirty-eight percent of the providers experienced psychological distress (PHQ-4 score > 3). Institutional support and resilience mediated the relationship between COVID-19 stressors and psychological distress. Psychological distress was common among Chinese HIV healthcare providers during COVID-19 pandemic. Psychological health intervention should attend to institutional support and resilience.

Mental Health Problems of HIV Healthcare Providers During the COVID-19 Pandemic: The Interactive Effects of Stressors and Coping.

HIV healthcare providers might be vulnerable to mental health problems during the COVID-19 pandemic. Guided by the stress and coping paradigm, the current study aimed at examining the interactive effects of COVID-19-related stressors and coping on mental health problems. A cross-sectional online survey was conducted among 1029 HIV healthcare providers in Guangxi, China. The prevalence of depression and anxiety in the current study was 13.31% and 6.61%, respectively. Results from path analyses revealed that the main effects of COVID-19-related stressors and coping were significant on both depression and anxiety. The interaction of coping and COVID-19-related stressors had significant effects on depression and anxiety. Simple slope tests revealed that more coping behaviors buffered against the negative effect of COVID-19-related stressors on mental health problems. Coping acted as a protective factor that alleviated the harm of COVID-19-related stressors on mental health. Intervention targeting coping management might benefit the mental health of HIV healthcare providers.

Sexual enhancement expectancy, non-medical use of prescription drugs, and sexual risk behaviors in college students.

Background: American young adults have a high risk of sexually transmitted infections. Sexual risk behaviors may be influenced by psycho-behavioral factors, including substance use and sexual enhancement expectancy. Existing research suggested that substance use may mediate the relationship between sexual enhancement expectancy and sexual risk behaviors. The substance use literature also suggested that non-medical use of prescription drugs (NMUPD) was highly prevalent in college students and was associated with sexual risk. However, limited studies have examined NMUPD-related sexual enhancement expectancy. The current study examined the relationship among sexual enhancement expectancy, NMUPD, and sexual risk behaviors in college students. Methods: Online data were collected in 2016 from 453 US college students with lifetime NMUPD. All participants reported their (1) past-three-month NMUPD, (2) NMUPD sexual enhancement expectancy, and (3) sexual risk behaviors. Structural equation modeling was employed for data analysis. Results: Findings suggested significant associations of NMUPD with sexual enhancement expectancy and sexual risk behaviors. Sexual enhancement expectancy was indirectly associated with sexual risk behaviors through NMUPD. Conclusions: College students' sexual risk behaviors appear to be indirectly influenced by sexual enhancement expectancy through NMUPD. Future sexual risk reduction interventions should attend to sexual enhancement expectancy and NMUPD.

Adherence to preventive behaviors among college students during COVID-19 pandemic in China: The role of health beliefs and COVID-19 stressors.

Before herd immunity is reached, preventive practices still play an important role in controlling the COVID-19 pandemic. Adherence to preventive behaviors could be determined by individuals' health beliefs, which would be influenced by antecedent factors such as previous exposure to pandemic stressors. Applying the health belief model (HBM), this study aims to examine the mediation association among COVID-19 stressors, HBM constructs, and preventive behaviors. Longitudinal data were collected from 1225 Chinese college students using web-based surveys at wave 1 (w1; between January 31 and February 11, 2020) and wave 2 (w2; between March 20 and April 3, 2020). Participants reported their COVID-19 stressors (w1), five HBM constructs (w2), and preventive behaviors (w1 and w2). Paired t-tests suggested that social distancing and self-quarantine behaviors decreased while precautionary behaviors increased from w1 to w2. Path analysis indicated that two HBM constructs (perceived barriers and self-efficacy) mediated the association between COVID-19 stressors and precautionary behaviors. These findings suggested that tailored prevention intervention for college students should attend to perceived barriers and self-efficacy. Individuals who exposed to multiple pandemic stressors merit particular attention and intervention should account for their early pandemic stress experiences.

Information uncertainty: a correlate for acute stress disorder during the COVID-19 outbreak in China.

BACKGROUND: Individuals' stress in responding to the current COVID-19 pandemic may be exacerbated by information uncertainty driven by inconsistent, unverified, and conflicting news from various sources. The current study aims to test if information uncertainty during the COVID-19 outbreak was related to acute stress disorder (ASD) over and above other psychosocial stressors. METHODS: An anonymous online survey was conducted with 7800 college students throughout China from January 31 through February 11, 2020. Existing scales were modified to measure ASD and six potential stressors including information uncertainty during the COVID-19 outbreak. Hierarchical regression analysis was conducted to assess the unique association of information uncertainty with ASD. To minimize the effect of large sample size and also to get a sense of whether the effects of information uncertainty were similar to people at the center of the epidemic, we repeated the hierarchical regression among 10% of the students who were randomly selected from the entire sample ("10% random sample"; n = 780) and 226 students from Hubei Province where the outbreak started. RESULTS: Information uncertainty was highly prevalent among the respondents (64%). It was significantly associated with ASD beyond other key variables and potential stressors across three samples. In the hierarchical regression among the entire sample, demographic variables accounted for 9.4% of the variance in ASD. The other five stressors added 5.1% of the variance. The information uncertainty (ß = .159; p < .001) explained an additional 2.1% of the variance. Likewise, the information uncertainty explained an additional 2.1 and 3.4% of the variance in ASD beyond all other variables among the 10% random sample (ß = .165; p < .001) and the Hubei sample (ß = .196; p < .01), respectively. CONCLUSION: Information uncertainty is a unique correlate of psychological stress during the COVID-19 outbreak. Reducing information uncertainty is essential not only for halting virus transmission but also for mitigating negative impacts of the pandemic on people's psychosocial wellbeing. Transparent, timely, and accurate communication can reduce public confusion, fear, and stress. Capacity building in governments, communities, and media outlets to prevent, reduce and manage information uncertainty should be a critical part of the response to an emerging global health crisis such as the COVID-19 pandemic.

Resilience and psychiatric symptoms as mediators between perceived stress and non-medical use of prescription drugs among college students.

Background: Due to the high prevalence of non-medical use of prescription drugs (NMUPD; i.e., use of these drugs without a doctor's prescription) among college students, it is important to identify psychosocial factors relevant to NMUPD. Prior research shows a link between perceived stress, psychiatric symptoms and NMUPD. Resilience is an essential concept in adaptive coping that emphasizes that resilience protects people against stress. Substantial evidence shows the mediation effect of resilience on the relationship between stress, psychiatric symptoms, and substance use. However, scant literature has examined associations between resilience and NMUPD.Objectives: The current study explored the relationship among perceived stress, psychiatric symptoms, resilience, and NMUPD in college students.Methods: Online data were collected from 1,052 undergraduates (68.7% females) with an average age of 19.8 years in 2016 in Virginia, United States, using anonymous surveys assessing perceived stress, psychiatric symptoms (i.e., depression and social anxiety), resilience (i.e., tenacity, tolerance, acceptance, control, and spirituality), and past-three-month NMUPD (i.e., opioids, sedatives, anxiolytics, and stimulants). Structural equation modeling was employed for data analysis.Results: Resilience together with psychiatric symptoms completely mediated the effects of perceived stress on NMUPD. Resilience completely mediated the relationship between perceived stress and psychiatric symptoms. The goodness-of-fit indicators suggested a good fit of data (RMSEA = .04; CFI = .97; TLI = .96; WRMR = 1.37).Conclusions: Resilience appears to offer protection that can mitigate the effects of perceived stress and psychiatric symptoms on NMUPD. Future interventions related to NMUPD among college students should attend to resilience.

Self-Esteem and Non-Medical Use of Prescription Drugs among College Students: Coping as a Mediator.

Objectives: Non-medical use of prescription drugs (NMUPD) has become a threat to public health. In the United States, NMUPD is especially common in young adults (aged 18-25). Self-esteem is a robust psychosocial factor of substance use. The substance use literature also documents that self-esteem is associated with alcohol use through other cognitive factors, such as coping. Given the important role of coping in substance use intervention, it is important to understand how coping alters mechanisms underlying the effects of self-esteem on NMUPD. However, little research has explored mediational mechanisms among self-esteem, coping, and NMUPD. The current study sought to examine a hypothesized mediation model among self-esteem, coping, and NMUPD in college students. Methods: Data were collected online from 1052 undergraduates (aged 18 to 25; 723 females) in a large public university in Virginia. Participants reported their past-three-month NMUPD (i.e. opioids, sedatives, anxiolytics, and stimulants), self-esteem, and coping (13 domains; e.g. active coping and self-blame). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the factorial structure of coping. Structural equation modeling (SEM) was employed for examining the hypothesized mediation model. Results: EFA and CFA identified a two-factor structure of coping (i.e. adaptive coping and maladaptive coping). SEM suggested that adaptive coping together with maladaptive coping completely mediated the relationship between self-esteem and NMUPD. The goodness-of-fit indicators suggest a good model fit (RMSEA = .04; CFI = .95; TLI = .93; WRMR = 1.11). Conclusion: Self-esteem appears to be a protective factor for NMUPD in college students, and its relationship with NMUPD is mediated by two types of coping. Future interventions targetting NMUPD among college students should attend to self-esteem and coping.

Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China.

Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs - a rapidly increasing, vulnerable population in southwest China. The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14-66) recruited over five years (2010-2014) from 35 National Sentinel Surveillance sites in Guangxi. Analyses included Fisher's exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.

Parenting Mediates the Impact of Caregivers' Distress on Children's Well-Being in Families Affected by HIV/AIDS.

Parental illness imposes great challenges to children's life and mental health. Having a parent infected by HIV may further challenge children's psychological well-being. Existing studies have demonstrated a negative impact of caregiver's distress on children's well-being. Limited studies examined the potential pathways of the link. This study aims to examine whether parenting stress, parenting competence and parental responsiveness can explain the relationship between caregivers' distress and children's well-being. A community sample of children of parents living with HIV and their current caregivers (n = 754 dyads) was recruited in rural central China. Children completed the measures on their psychological well-being and perceived parental responsiveness of their caregivers. Caregivers reported on their psychological well-being, parenting stress, and parenting competence. Structural equation modeling analysis showed that caregivers' distress indirectly affect children's well-being through parenting stress, parenting competence and parental responsiveness. Parenting stress explained the impact of caregiver's distress on parental responsiveness and showed pervasive effects on parenting competence. Our findings lend credence to family-based intervention for children affected by HIV and affirm the importance of incorporating the cognitive, emotional and behavioral components of parenting practices in such intervention.

Mass Media and HIV/AIDS Prevention Among Female Sex Workers in Beijing, China.

The current study aimed to identify the sources of HIV prevention information for female sex workers in Beijing and assess the associations between levels of mass media exposure of HIV/AIDS prevention information and HIV/AIDS knowledge as well as condom use-related attitudes, beliefs, and behaviors. Cross-sectional data were collected from 359 female sex workers in Beijing, China. Chi-square tests and one-way ANOVA tests were employed. Female sex workers sampled in Beijing were more likely to obtain HIV/AIDS prevention information from television and street posters than radio and the Internet. However, a higher level of exposure to and a lasting impression on online information were significantly associated with a higher level of condom use self-efficacy and more consistent condom use among the participants. Exposure to HIV/AIDS prevention information delivered by radio, street posters, and the Internet was found to be associated with sexual communication about HIV or condom use with sexual partners. Overall, this study provides preliminary evidence of the utility of various mass media outlets in delivering HIV/AIDS prevention information among female sex workers in China. Future studies are needed to systematically examine the effectiveness of mass media-based prevention education on HIV/AIDS related attitudes and behaviors among female sex workers and other populations in China.

Collectivistic orientation, acculturative stress, cultural self-efficacy, and depression: a longitudinal study among Chinese internal migrants.

The current study examined the longitudinal relationship of collectivistic orientation and depression and the mediating effects of acculturative stress and cultural self-efficacy between collectivistic orientation and depression. We expect that collectivistic orientation would decrease acculturative stress and increase cultural self-efficacy, and in turn, improve depression. Using data from 641 Chinese internal migrants during a 1-year period, the results supported the hypothesis that collectivistic orientation predicted decreased depression. Moreover, collectivistic orientation alleviated depression through reducing acculturative stress. Although cultural self-efficacy was also a significant mediator, collectivistic orientation relieved depression through decreasing cultural self-efficacy. Implications for future research directions and counseling are discussed.

Extracurricular interest as a resilience building block for children affected by parental HIV/AIDS.

Parental illness and death due to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) impose challenges to children's psychological adjustment. Positive psychology emphasizes individual's resilience in the face of adversity, trauma, and tragedy. Limited data are available regarding the factors that can cultivate resilience of children affected by HIV/AIDS. This study aims to examine the role of extracurricular interest in strengthening resilience among children affected by HIV/AIDS. Participants included 755 children orphaned by parental HIV/AIDS, 466 vulnerable children living with HIV-positive parent(s), and 404 comparison children from HIV-free families in the same community in rural China. The measures include extracurricular interest (i.e., reading, sports, music, painting, science, and playing chess) and indicators of psychological adjustment (i.e., depression, loneliness, and self-esteem). Having extracurricular interest was positively associated with self-esteem and negatively associated with depression and loneliness. Having extracurricular interest attenuated the negative effect of parental HIV/AIDS on children's self-esteem and loneliness, after controlling for children's age, gender, and family socioeconomic status. The findings underscore the importance of nurturing extracurricular interest and make available of such activities to promote resilience for children affected by HIV/AIDS in resource-limited settings.