Parental Demandingness and Executive Functioning in Predicting Anxiety among Children in a Longitudinal Community Study.

Theoretical models and empirical studies of anxiety have predominately focused on the main effects of various predictors such as executive functioning deficits on anxiety. This study examined the moderating role of parental demandingness in the relationship between executive functioning deficits and anxiety in children. Ninety children (46.67% female) aged from 9 to 14 years completed several executive functioning tasks and a measure of anxiety. Parental demandingness was rated based on an observation of parent-child interactions. The children completed the anxiety measure again at one-year follow-up. The results showed that parental demandingness significantly moderated the prospective relationship between executive functioning deficits and anxiety, such that the association between executive functioning deficits and anxiety in children was weaker when parental demandingness was lower. These findings suggest that low parental demandingness may serve as a protective factor that buffers the detrimental effects of executive functioning deficits on anxiety.

Comparing five depression measures in depressed Chinese patients using item response theory: an examination of item properties, measurement precision and score comparability.

BACKGROUND: Item response theory (IRT) has been increasingly applied to patient-reported outcome (PRO) measures. The purpose of this study is to apply IRT to examine item properties (discrimination and severity of depressive symptoms), measurement precision and score comparability across five depression measures, which is the first study of its kind in the Chinese context. METHODS: A clinical sample of 207 Hong Kong Chinese outpatients was recruited. Data analyses were performed including classical item analysis, IRT concurrent calibration and IRT true score equating. The IRT assumptions of unidimensionality and local independence were tested respectively using confirmatory factor analysis and chi-square statistics. The IRT linking assumptions of construct similarity, equity and subgroup invariance were also tested. The graded response model was applied to concurrently calibrate all five depression measures in a single IRT run, resulting in the item parameter estimates of these measures being placed onto a single common metric. IRT true score equating was implemented to perform the outcome score linking and construct score concordances so as to link scores from one measure to corresponding scores on another measure for direct comparability. RESULTS: Findings suggested that (a) symptoms on depressed mood, suicidality and feeling of worthlessness served as the strongest discriminating indicators, and symptoms concerning suicidality, changes in appetite, depressed mood, feeling of worthlessness and psychomotor agitation or retardation reflected high levels of severity in the clinical sample. (b) The five depression measures contributed to various degrees of measurement precision at varied levels of depression. (c) After outcome score linking was performed across the five measures, the cut-off scores led to either consistent or discrepant diagnoses for depression. CONCLUSIONS: The study provides additional evidence regarding the psychometric properties and clinical utility of the five depression measures, offers methodological contributions to the appropriate use of IRT in PRO measures, and helps elucidate cultural variation in depressive symptomatology. The approach of concurrently calibrating and linking multiple PRO measures can be applied to the assessment of PROs other than the depression context.

Psychometric properties of the Children's Response Styles Questionnaire in a Hong Kong Chinese community sample.

BACKGROUND: The Children's Response Styles Questionnaire (CRSQ) is a widely-adopted inventory that assesses response styles in youths. It is useful in examining how coping styles (particularly rumination) may relate to depressive vulnerability in youths. Despite its utility, little is known about its applicability in non-Western cultures and CRSQ has not been evaluated using current psychometric methods including item response theory (IRT). The present study assessed the properties using IRT methods in a Chinese youth sample. METHODS: Students in Grades 4-6 were recruited from seven public primary schools in Hong Kong, and a total of 581 children (280 boys and 301 girls) between 8 and 14 years of age participated in the study. A Chinese version of CRSQ was administered to them in groups at school after receiving written parental consent as well as students' assent. RESULTS: Confirmatory factor analysis revealed a two-factor structure that was comparable to that identified in Western samples, namely, the rumination and distraction/problem-solving subscales. IRT analysis suggested that items varied in levels of item discrimination and item severity, and in precision/usefulness for assessing the underlying latent trait levels. Test information analysis indicated that rumination subscale was more useful than the distraction and problem-solving subscale in assessing the latent trait over a broader range of levels. For gender-based Differential Item Functioning (DIF) analysis, item 1 "When I am sad, I think about how alone I feel" was found to exhibit higher discriminating power for girls than boys. CONCLUSIONS: The study presents the first attempt to examine CRSQ item properties using IRT analysis and supports its validity beyond the Western cultures. The factor structure of CRSQ was found to be comparable to the West in our Chinese sample. Differential Item Functioning (DIF) evaluation suggested all but one item in the rumination subscale of the CRSQ apply equally well to both boys and girls.

The "self" in pain: the role of psychological inflexibility in chronic pain adjustment.

Self-discrepancy occurs when a person feels the failure to fulfill one's hopes or responsibilities. Although self-discrepancy has been widely examined to elucidate patients' chronic pain adjustment, the underlying mechanism is unclear. The present study proposes that the effect of self-discrepancy on pain outcomes is accounted for by psychological inflexibility, which involves the psychological processes that guide behaviors in the pursuit of goals and values. One-hundred patients with chronic pain were recruited from a public hospital. They were invited to participate in a semi-structured interview regarding their self-discrepancy and complete self-reported questionnaires regarding their psychological inflexibility and pain outcomes. The results confirmed that psychological inflexibility partly accounts for the variance observed between self-discrepancy and pain outcomes. The current study provides additional insight into the mechanism underpinning the impact of self-discrepancy on patients' pain adjustment and offers clinical implications regarding the use of acceptance commitment therapy for chronic pain management.

Affective bias in internal attention shifting among depressed youth.

The present study compared the performance of depressed youths and healthy controls on a modified mental counting task. The mental counting task was designed to capture processes associated with shifting the internal focus of attention by requiring participants to count random runs of words appearing on a computer screen. The words belonged to two different categories, and participants were required to maintain a count of the number of words in each category. Participants' reaction time to successfully update their counts and call for subsequent stimuli was measured. In particular, two versions of the modified counting task were developed: one incorporating neutral words and the other affective words. Overall, our findings in reaction time analysis suggest that depressed patients exhibited greater difficulty switching their internal focus of attention in the affective task when compared to healthy controls, even when controlling for their rate of accuracy. However, there was no significant difference between the groups during the neutral task. Results support the hypothesis that depression is related to impaired internal attention shifting when processing affective material.

Parental Demandingness Predicts Adolescents' Rumination and Depressive Symptoms in a One-year Longitudinal Study.

While past research has linked parental demandingness (parents' rules, regulations, and restrictions for their children) to depression in adolescents, the mechanism underlying this relationship has not been well understood. This study attempts to disentangle the association between parental demandingness and depression by examining the potential mediating role of rumination (a repetitive and passive focus on negative emotions and symptoms) using an objective observational measure of parenting and a two-wave longitudinal design. Participants were 125 students aged 9 to 14 (M = 12.21, SD = 1.39) from local schools in Hong Kong. Participants completed questionnaires and participated in interaction tasks with their primary caregiving parents at T1 and completed the questionnaires again at T2 (one year later). A longitudinal mediation analysis suggested that the relationship between parental demandingness and depression was mediated by rumination. This study advances the existing literature by supporting that parental demandingness influences depression among children through increasing rumination. The present findings provide insights into the future development of parenting interventions (which aim at reducing parents' commands) in prevention programs for depression in children.

Striving to Avoid Inferiority and Procrastination among University Students: The Mediating Roles of Stress and Self-Control.

The current study intended to examine whether the relationship between university students' striving to avoid inferiority (SAI) and procrastination was serially mediated by stress and self-control. The sample consisted of 154 Hong Kong university students. Their levels of striving to avoid inferiority, stress, self-control, and procrastination were measured by the Striving to Avoid Inferiority Scale (SAIS), the stress subscale of the Depression Anxiety Stress Scales (DASS-21), the Short Self-Regulation Questionnaire (SSRQ), and the General Procrastination Scale (GPS), respectively. The results of structural equation modeling revealed that SAI positively predicted stress, stress negatively predicted self-control, and self-control negatively predicted procrastination. SAI did not directly predict procrastination. The results of bootstrapping analyses supported the hypotheses that the effect of stress on procrastination was mediated by self-control, the effect of SAI on self-control was mediated by stress, and more importantly, the effect of SAI on procrastination was serially mediated by stress and self-control. Further research is suggested to investigate the thoughts and feelings pertinent to procrastination and the actual duration of procrastination among university students.

Intimate Partner Violence Victimization, Social Support, and Resilience: Effects on the Anxiety Levels of Young Mothers.

Young mothers face considerable challenges that can affect their mental health, with anxiety being one of the most common mental health problems observed in this population. Furthermore, pregnancy is one of the risk factors for intimate partner violence (IPV). There is thus an urgent need to explore the IPV risk faced by young mothers and its association with their mental health, anxiety in particular. The study aimed to investigate the correlation between IPV victimization and anxiety in young mothers, as well as the protective effects of social support and resilience. A total of 79 young Chinese mothers aged 16 to 25 were recruited from a special service project for young parents in Hong Kong. Just more than half (50.6%) were found to have experienced psychological aggression by their current partner, with 26.6% and 13.9%, respectively, having experienced physical assault and sexual abuse. Roughly a quarter (25.3%) perceived themselves to suffer from moderate or severe generalized anxiety disorder. Logistic regression further showed the young mothers who had experienced physical assault and/or sexual abuse by their current partners to be at least six times likelier to have moderate or severe anxiety disorder (adjusted odds ratio [aOR] = 4.51, p < .05) than those who had experienced no such violence. Young mothers with less perceived social support (aOR = 0.77, p < .01), a lower secondary level of education or below (aOR = 12.99, p < .05), and in receipt of social security assistance (aOR = 5.69, p < .05) were also likelier to have moderate or severe anxiety disorder. The results indicate the importance of social support during the critical period of young motherhood. Health care professionals need to remain alert to the impacts of IPV victimization and the risk of anxiety in young mothers with a low level of education and/or receiving financial support.

Clinical Features of Heterosexual Intimate Partner Violence Victims With Escalating Injury Severity.

Intimate partner violence (IPV) is largely recognized to have a cyclical pattern and violence escalation in terms of frequency and intensity over time. However, there is a lack of systematic investigation of the profiles of victims and quantification of the patterns of injury of the victims associated with the first time versus repeated violence episodes. This study aimed to fill this knowledge gap by medical chart review of 878 victims in a 5-year period from 2010 to 2014 in Accident and Emergency Department (AED) of two public general hospitals in Hong Kong. The differences in injury patterns between the first IPV episode (FE) and recurrent IPV episodes (REs) experienced by male and female victims in heterosexual relationship were evaluated. The results indicated the violence escalation occurred in recurrent IPV in both genders. In female victims, there was significant increase in the number of injury locations (mean [M] = 2.0 vs. 2.2, p < .05), number of causes of injury (M = 1.7 vs. 2.2, p < .001) and police escort (15.2% vs. 22.1%, p < .05) in RE compared to FE. In male victims, however, only the increase in the number of causes of injury was significant (M = 1.6 vs. 2.1, p < .05) in RE compared to FE. In summary, our results highlight the escalation in the severity of harm of IPV victims in heterosexual relationship, and the gender differences in severity aggression and injury and help-seeking behavior change in recurrent IPV. Preventive measures are indicated to intervene the IPV occurrence and recurrence with rising morbidity and a potential of mortality.

Worry and Permissive Parenting in Association with the Development of Internet Addiction in Children.

The Internet has experienced a rapid increase in use globally. Specifically, more than 90% of Hong Kong's citizens use the Internet, and 70% of children in the age group of 6-17 years have daily access to it. However, internet addiction could pose serious social and health issues. Therefore, conducting research to investigate its causes and risk factors is fundamental. The current study examined the relationship between worry and Internet addiction among children in Hong Kong and investigated the moderating effect of the permissive parenting style on such a relationship. The participants consisted of 227 fourth- and fifth-grade students (120 males, 52.9%) with a mean age of 9.55 (standard deviation (SD) = 0.58) in Hong Kong. Each participant was asked to complete the questionnaires, including the Internet Addiction Test for Internet addiction, the Penn State Worry Questionnaire for Children for worry, and the Parental Authority Questionnaire for the permissive parenting style. The results indicated that worry was related to greater Internet addiction among children. Furthermore, there was a moderating effect of the permissive parenting style such that the positive association between worry and Internet addiction was stronger when the permissive parenting style was higher. Our findings imply that parenting styles are influential in the prevention of Internet addiction.

It Is the Family Context That Matters: Concurrent and Predictive Effects of Aspects of Parent-Child Interaction on Video Gaming-Related Problems.

Studies have shown that children frequently experiencing poor parent-child interaction are prone to video gaming-related problems, but it is unclear which specific aspects of such an interaction play a predictive role in the problems. To extend previous research that relies primarily on the self-report method to assess parent-child interaction, we conducted a longitudinal, mixed-methods study. In a laboratory setting, three major aspects of interaction (i.e., affectivity, cohesiveness, and parental behavior) were observed in 241 parent-child dyads (Children: 43 percent female, age range = 8-15, Mage = 12.09, SDage = 1.41; Parents: 78 percent female, age range = 27-63, Mage = 44.44, SDage = 6.09). In addition, both parent and children participants completed questionnaires that measured children's symptoms of Internet gaming disorder (IGD) and exposure to violent video games at baseline (Time 1) and 12 months later (Time 2). The results revealed that at Time 1, positive affectivity and cohesiveness were inversely associated with child-report symptoms of IGD. Also, Time 1 coerciveness (i.e., control dimension of parental behavior) was positively associated with Time 1 child-report exposure to violent video games and Time 2 child-report symptoms of IGD, respectively. Apart from main effects, the results also showed that Time 1 negative affectivity moderated the protective effects of Time 1 positive affectivity on Time 1 parent-report and Time 2 child-report exposure to violent video games, respectively. Overall, this study identifies various key aspects of parent-child interaction that may serve as concurrent or temporal predictors of video gaming-related issues.

Evaluation of the Psychometric Properties of the Asian Adolescent Depression Scale and Construction of a Short Form: An Item Response Theory Analysis.

The present study applied item response theory to examine the psychometric properties of the Asian Adolescent Depression Scale and to construct a short form among 1,084 teenagers recruited from secondary schools in Hong Kong. Findings suggested that some items of the full form reflected higher levels of severity and were more discriminating than others, and the Asian Adolescent Depression Scale was useful in measuring a broad range of depressive severity in community youths. Differential item functioning emerged in several items where females reported higher depressive severity than males. In the short form construction, preliminary validation suggested that, relative to the 20-item full form, our derived short form offered significantly greater diagnostic performance and stronger discriminatory ability in differentiating depressed and nondepressed groups, and simultaneously maintained adequate measurement precision with a reduced response burden in assessing depression in the Asian adolescents. Cultural variance in depressive symptomatology and clinical implications are discussed.