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

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

Assessing the Role of Cortisol in Anxiety, Major Depression, and Neuroticism: A Mendelian Randomization Study Using SERPINA6/SERPINA1 Variants.

Background: Previous evidence informed by the toxic stress model suggests that higher cortisol causes anxiety and major depression, but clinical success is lacking. To clarify the role of cortisol, we used Mendelian randomization to estimate its associations with anxiety, major depression, and neuroticism, leveraging the largest available genome-wide association studies including from the Psychiatric Genomics Consortium, the UK Biobank, and FinnGen. Methods: After meta-analyzing 2 genome-wide association studies on morning plasma cortisol (n = 32,981), we selected single nucleotide polymorphisms (SNPs) at p < 5 × 10-8 and r2 < 0.3 in the SERPINA6/SERPINA1 gene region encoding proteins that influence cortisol bioavailability. We applied these SNPs to summary genetic associations with the outcomes considered (n = 17,310-449,484), and systolic blood pressure as a positive outcome, using inverse-variance weighted meta-analysis accounting for correlation. Sensitivity analyses addressing SNP correlation and confounding by childhood maltreatment and follow-up analyses using only SNPs that colocalized with SERPINA6 expression were conducted. Results: Cortisol was associated with anxiety (pooled odds ratio [OR] 1.16 per cortisol z score; 95% CI, 1.04 to 1.31), but not major depression (pooled OR 1.02, 95% CI, 0.95 to 1.10) or neuroticism (ß -0.025; 95% CI, -0.071 to 0.022). Sensitivity analyses yielded similar estimates. Cortisol was positively associated with systolic blood pressure, as expected. Using rs9989237 and rs2736898, selected using colocalization, cortisol was associated with anxiety in the UK Biobank (OR 1.32; 95% CI, 1.01 to 1.74) but not with major depression in FinnGen (OR 1.14; 95% CI, 0.95 to 1.37). Conclusions: Cortisol was associated with anxiety and may be a potential target for prevention. Other targets may be more relevant to major depression and neuroticism.

Previous observational studies and randomized controlled trials remain inconclusive about whether cortisol causes mental disorders. In this Mendelian randomization study, using genetic variants from the SERPINA6/SERPINA1 gene region as instrumental variables for cortisol to minimize bias from confounding, we found that morning plasma cortisol was positively associated with anxiety but not major depression or neuroticism. From a practical perspective, these findings provide supporting evidence that lowering cortisol may reduce the risk of anxiety but not depression.

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

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

A three-wave longitudinal study on the underlying metacognitive mechanism between depression and Internet gaming disorder.

BACKGROUND AND AIMS: Internet Gaming Disorder (IGD) and depression have negative consequences on individuals' mental health, but their relationships are complex. This three-wave longitudinal study aimed to detect the metacognitive mechanisms underlying the association between IGD tendency and depression based on the self-regulatory executive function model. METHODS: A total of 1,243 Chinese undergraduate student gamers (57% female, M = 19.77, SD = 1.29) were recruited at the baseline survey (Wave 1 [W1]), with 622 and 574 of them taking part in the two follow-up surveys (Wave 2 [W2] at 6 and Wave 3 [W3] at 12 months later), respectively. RESULTS: The three-wave path model demonstrated, after controlling for the autoregressive effect of each variable, that depression consistently predicted IGD tendency but not vice versa, while negative but not positive metacognitions about online gaming (MOG) significantly predicted both depression and IGD tendency. Moreover, two statistically significant mediation paths: (i) negative MOG [W1] → depression [W2] → IGD tendency [W3]; and (ii) depression [W1] → negative MOG [W2] → IGD tendency [W3] were identified. DISCUSSION AND CONCLUSIONS: These findings extend the understanding of the associations among depression, IGD tendency, and MOG, highlighting how negative MOG has a stronger prospective effect than positive MOG on depression and IGD tendency, and also reveal the mutual mediation effects of depression and negative MOG on IGD tendency. Integrated programmes with both emotional regulation training and Metacognitive Therapy are recommended for IGD treatment.

The protective effects of cognitive empathy and emotional empathy on gambling disorder are mediated by risk aversion and responsible gambling attitude.

BACKGROUND: Based on social cognitive theory, this study aimed to examine whether and how social abilities (i.e., cognitive empathy and emotional empathy) are associated with gambling disorder (GD) by incorporating attitudes toward general risk (i.e., risk aversion) and responsible gambling as potential mediators of this link. METHODS: A convenience sample of 580 past-year lottery gamblers (Mage = 34.07, SD = 13.36; 50.4% female), recruited near lottery sales shops, completed an anonymous paper-version questionnaire on site. Data were collected using the DSM-5 diagnostic criteria for GD, Interpersonal Reactivity Index, Risk Aversion Scale, Positive Play Scale, and demographic items. Path analysis and mediation analysis were applied to examine the effects of cognitive empathy and emotional empathy on GD and the mediating roles of risk aversion and responsible gambling attitude. RESULTS: Our results showed that cognitive empathy, but not emotional empathy, was significantly and negatively correlated with GD. Also, the effect of cognitive empathy on GD was fully mediated by risk aversion and responsible gambling attitude, whilst the total indirect effect of emotional empathy on GD was nonsignificant. As hypothesized, the indirect paths from both types of empathy to GD were significantly and serially mediated by risk aversion and responsible gambling attitude. CONCLUSION: Cognitive empathy, distinct from emotional empathy, was a statistically significant correlate of GD. Moreover, the path model results also suggest that responsible gambling attitude was a salient protective factors against GD. Future GD prevention efforts may benefit from paying more attention to the role of responsible gambling attitude.

Understanding Perceived Problematic Pornography Use with the Differential Susceptibility to Media Effects Model.

Problematic pornography use and its adverse consequences are prevalent, but little is known about its psychosocial contributors. Drawing on the Differential Susceptibility to Media Effects Model (DSMM), this study explores whether and how perceived problematic Internet pornography use is associated with psychological factors from three domains: social (i.e., family adaptability), dispositional (i.e., self-acceptance), and development factors (i.e., impulse control difficulties). Analysis of an anonymous survey of 1,483 Chinese emerging adults showed that family adaptability and self-acceptance were negatively correlated with perceived problematic pornography use, whereas impulse control difficulties were positively correlated with perceived problematic pornography use. Self-acceptance mediated the association between family adaptability and perceived problematic pornography use. Impulse control difficulties moderated such mediation effect, in which the protective effect of family adaptability on self-acceptance and that of self-acceptance on perceived problematic pornography use were attenuated by impulse control difficulties. These findings advance understanding of the complex underlying psychosocial mechanisms of perceived problematic pornography use by providing evidence to the applicability of DSMM on such problematic use and clarifying the direct, indirect, and/or moderating role(s) of family adaptability, self-acceptance, and impulse control difficulties in those mechanisms. They also provide insights for targeted approaches in future intervention programs among emerging adults.

Work hard and sleep better: Work autonomy attenuates the longitudinal effect of workaholism on sleep problem among Chinese working adults.

The prevalence of workaholism has negative consequences on human health. Lack of sleep, a well-known problem among adults in modern society, is often attributed to overwork as a result of workaholism. Yet there is a lack of empirical research examining how and when workaholism will lead to sleep problems. To answer this question and to examine the longitudinal effect of workaholism on sleep in China, we investigate the mediating role of perceived evening responsibilities of work and the moderating effect of work autonomy. Two hundred and five Chinese working adults (58.0% female) voluntarily completed the online questionnaires at Time 1 (T1) and Time 2 (T2; 1-month later). Results showed that workaholism at T1 had a significant and positive correlation with sleep problem at T2. Further analysis suggested that perceived evening responsibilities of work fully mediated the relationship between workaholism and sleep problem. Work autonomy was shown to buffer the positive effect of workaholism on perceived evening responsibilities of work and attenuate the indirect effect of workaholism on sleep problem. While workers should be made aware of the negative impact of workaholism on sleep, organizations should also consider interventions to enhance employees' autonomy and control of their work.

Risk factors for Internet Gaming Disorder: Testing the contribution of metacognitions, stress, and coping.

Engaging in online gaming is often considered as an avoidance strategy to cope with stress. This study aimed to test whether metacognitions make a unique contribution and which of them is/are the most salient to explaining Internet Gaming Disorder (IGD) tendency after controlling for age, gender, and stress. We further explored the structure of relationships between these variables by testing a metacognitively mediated stress-IGD model. A convenience sample of 1255 Chinese young adults with gaming experience (age ranged from 18 to 27; 57.0% females) completed an anonymous online questionnaire in June 2021. Each metacognitions subscale was positively correlated with IGD tendency, whilst cognitive confidence and positive beliefs about worry were identified as the most salient dimensions among metacognitions for IGD tendency after controlling for demographics and stress. The mediation path model showed acceptable fit after implementing minor modifications. The bootstrapping results showed that the effect of stress on IGD tendency was fully mediated, with metacognitions and escape motivation as independent mediators. In the model, the paths from both positive metacognitions and uncontrollability/danger metacognitions to escape motivation (and in turn IGD) remained significant, whilst the path between cognitive confidence and IGD also remained significant. The findings suggest revisions to the stress-coping model consistent with self-regulatory executive function theory, and advance our understanding of the potential risk factors linking stress to problematic gaming. Enhancing individuals' capacity for metacognitive regulation may be an effective approach for future IGD preventive interventions among Chinese young gamers.

Investigating the associations of the illness representations of gambling disorder with superstitious and responsible gambling.

Background: As a theoretical framework for understanding illness self-management, the commonsense model of self-regulation (CSM) has been commonly used to promote health behaviors. However, its application to examining gambling disorder (GD) is still in an exploratory stage. Objectives: Based on CSM, the current study aimed to address this knowledge gap and test whether illness representations (i.e., perceived consequences, illness coherence, and emotional representations) of GD are associated with gambling behaviors (i.e., responsible gambling [RG] and superstitious gambling). We also aimed to explore the potential mediating role of positive gambling beliefs (i.e., personal responsibility about gambling and gambling literacy) in such associations. Methods: An online questionnaire survey with snowballing sampling method was administered to Chinese adult past-year gamblers, and 603 valid responses were collected. The structural equation modeling (SEM) analysis with a bootstrapping approach was utilized to test the associations of illness representations with gambling behaviors and the hypothesized mediation effects of positive gambling beliefs. Results: We found that (a) perceived consequences of GD had significant, positive associations with RG and negative associations with superstitious gambling, with positive gambling beliefs acting as full mediators; (b) emotional representations for GD showed significant, negative correlations with RG and positive ones with superstitious gambling, with positive gambling beliefs acting as full and partial mediators, respectively; (c) the direct effect of illness coherence of GD on superstitious gambling behaviors was unexpectedly positive, and its indirect effects via positive gambling beliefs were nonsignificant. Discussion: Under the framework of CSM, the current findings provided new insights in understanding both controlled and at-risk gambling patterns from a perspective of illness self-management. We suggest future GD prevention campaigns may adopt psychoeducational programs to help gamblers form a better understanding about GD as an illness, which may promote RG practices and hence lower the risk of developing GD.

Work addiction in Chinese white-collar workers: the psychometric properties of its measure and its comorbidity with general anxiety in network analysis.

BACKGROUND: Work addiction (WA) threatens occupation-related health in many countries including China. This research aims to evaluate the psychometric properties of the Chinese version of Bergen Work Addiction Scale (BWAS), the most common measure of WA, to facilitate relevant studies in Chinese workers. A network analysis was further conducted to identify central and bridge symptoms within the WA-anxiety network to improve intervention practices. METHODS: A total of 694 Chinese white-collar workers completed an online questionnaire survey in March of 2022, and the responses to BWAS from a subsample of 50 participants one month after this survey were also collected. RESULTS: The unidimensionality of BWAS was supported by results of exploratory factor analysis, exploratory graph analysis, and confirmatory factor analysis and we found satisfactory internal consistency and acceptable test-retest reliability. Multiple-group factor analyses confirmed the measurement invariance of BWAS across genders, districts (i.e., central China, eastern China, western China, and northeastern China), and age groups (i.e., young and middle-aged adults) while the convergent validity of BWAS was demonstrated by its significant correlations with Dutch Work Addiction Scale (r = 0.62, p < 0.001) and its criterion validity was indicated by its significant correlations with general anxiety, weekly work hours, and health status (r = -0.16 to 0.31, p < 0.001-0.01). Network analysis further revealed two central symptoms (WA-tolerance and WA-problems) and three bridge symptoms (WA-problems, WA-mood modification, and mouth dryness of general anxiety) maintaining the WA-anxiety comorbidity. CONCLUSIONS: Our findings suggest that BWAS is a valid measure of WA in Chinese workers and interventions should put special attention to the identified central and bridge symptoms underlying the WA-anxiety network.

Associations of Death Anxiety, Inclusion of Smartphone in the Self, and Affiliation Motivation with Smartphone use and Addiction: A Multiple Mediation Study.

This study is the first to apply terror management theory to understanding smartphone addiction by examining the potential indirect effect of death anxiety on smartphone addiction via inclusion of smartphone in the self (i.e., self-expansion), affiliation motivation (the desire to connect with others) for emotional support, and smartphone use. The sample consisted of 1483 Chinese university students between the ages of 18 and 24 (M = 19.14, SD = 1.03) who voluntarily completed an anonymous questionnaire survey. As hypothesized, death anxiety, inclusion of smartphone in the self, affiliation motivation, and smartphone use were directly, positively correlated with smartphone addiction. In addition, death anxiety exerted significant indirect effects via various pathways, including (i) affiliation motivation for emotional support and smartphone use and (ii) inclusion of smartphone in the self and smartphone use. Findings suggest that effective interventions for smartphone addiction should include targeting death anxiety, self-expansion, and affiliation need frustration.

Metacognitive beliefs and anxiety symptoms could serve as mediators between fear of missing out and gaming disorder in adolescents.

Given the vulnerability to and prevalence of emotional problems and Internet gaming disorder (IGD) in adolescents, this study aimed to test the effects of fear of missing out (FoMO) on IGD and the mediating roles of metacognitive beliefs and anxiety symptoms based on the self-regulatory executive function (S-REF) model. At a Chinese high school, 283 participants (Mage = 16.89 years old; girls = 42.0%) with past-year gaming experience voluntarily completed an anonymous paper-and-pencil questionnaire. FoMO showed significant, positive associations with IGD, anxiety symptoms, and metacognitive beliefs. Results of path analysis showed a significant direct effect of FoMO on IGD, whereas anxiety symptoms mediated the relationship between FoMO and IGD. The indirect effects of FoMO on IGD via serial mediations of three negative metacognitive beliefs (i.e., negative beliefs about worry, low cognitive confidence, and beliefs regarding need for control) and anxiety symptoms were also statistically significant. These findings demonstrated that maladaptive metacognitive beliefs and anxiety are risk-enhancing mediators in the relationship between FoMO and IGD. Therefore, metacognitive therapy, particularly for regulating those three specific significant metacognitive beliefs, is recommended for treating IGD and anxiety, especially for those with higher levels of FoMO.

Altered hierarchical organization between empathy and gambling networks in disordered gamblers.

Background: Despite the demonstrated association between empathy and gambling at the behavioral level, limited neuroimaging research on empathy and gambling disorder (GD) has been conducted. Whether and how the brain network of empathy and that of gambling interact in disordered gamblers has not been investigated. This study aimed to address this research gap by examining the hierarchical organizational patterns, in which the differences of causal interactions of these networks between disordered gamblers and healthy controls were revealed. Methods: Resting-state functional magnetic resonance imaging (fMRI) data of 32 disordered gamblers and 56 healthy controls were included in the formal analysis. Dynamic causal modeling was used to examine the effective connectivity within and between empathy and gambling networks among all participants. Results: All participants showed significant effective connectivity within and between empathy and gambling networks. However, compared with healthy controls, disordered gamblers displayed more excitatory effective connectivity within the gambling network, the tendency to display more excitatory effective connectivity from the empathy network to the gambling network, and reduced inhibitory effective connectivity from the gambling network to the empathy network. Conclusion: The exploratory study was the first to examine the effective connectivity within and between empathy and gambling networks among disordered gamblers and healthy controls. These results provided insights into the causal relationship between empathy and gambling from the neuroscientific perspective and further confirmed that disordered gamblers show altered effective connectivity within and between these two brain networks, which may be considered to be a potential neural index for GD identification. In addition, the altered interactions between empathy and gambling networks may also indicate the potential targets for the neuro-stimulation intervention approach (e.g., transcranial magnetic stimulation).

Childhood environment and adulthood food addiction: Testing the multiple mediations of life history strategies and attitudes toward self.

Food addiction is associated with both physical and mental health conditions, such as obesity and depression, and is considered a public health problem. Based on life history (LH) theory, this study aimed to test the association between unpredictable childhood environment and food addiction in adulthood and to examine LH strategies and attitudes toward self as psychological mediators of this association. A random sample of 1010 adults, aged from 18 to 88 years (44.8% male; Mage = 38.52, SDage = 14.53), voluntarily participated in an anonymous telephone survey conducted in Macao, China. The results of a path analysis showed the significant and positive direct effect of childhood unpredictability on food addiction and its negative association with slow LH strategy, which in turn was negatively correlated with food addiction. In addition, slow LH strategy and self-judgment, rather than self-kindness, acted as serial mediators in the association between childhood unpredictability and food addiction. These findings support the applicability of LH theory to understanding food addiction, as well as pointing to the potential risk effect of self-judgment for food addiction in adulthood. Self-judgment reduction may be a potential supplementary approach for future food addiction intervention.

Is Empathy Associated with Gambling and Its Addiction? A Scoping Review of Empirical Studies.

Considering the low levels of empathy associated with substance-related addictions and the similarities between gambling disorder (GD) and substance-related addiction, understanding the relationship between empathy and GD may clarify the mechanism of addiction development. This scoping review aimed to evaluate the empirical evidence for the potential protective role of emotional and cognitive empathy against GD development via internalizing and/or externalizing pathways. We followed the preferred reporting items for systematic review and meta-analyses extension for scoping reviews and 11 articles met the inclusion criteria. Although most of the reviewed studies used correlational designs and non-gambling-specific samples, this review highlights (1) significant relationships between both types of empathy and the neural activity of gambling behaviors, and (2) reduced cognitive empathy (i.e., fantasy and perspective taking) and increased emotional empathy (i.e., personal distress) among problem gamblers than their gambling counterparts. Despite the lack of studies directly testing the protective role of empathy against GD, the existing studies (n = 8) nevertheless shed light on the potential protective effects of both types of empathy on GD development. This review identified research gaps, which can be addressed in future studies by discovering the underlying mechanisms (e.g., internalizing and externalizing pathways) of these relationships. Experimental or longitudinal studies in gamblers investigating how different types of empathy are associated with GD via these pathways are called for as their findings have implications for prevention and intervention designs for GD and other addictive disorders.

Intention to maintain and willingness to stop: Applying a dual-process model to understanding the maintenance of COVID-19 preventive behaviors.

Preventive behaviors have played an essential role in coping with COVID-19 and may continue to exerting a crucial impact on pandemic control in the future. This study aimed to evaluate the effectiveness of social-cognitive factors on maintenance of COVID-19 preventive behaviors based on a dual-process model, which encompasses a reasoned path via the intention to maintain and a social reaction path via the willingness to stop. We collected a probability sample of 472 community-dwelling adults. Social-cognitive factors, behavioral tendencies, and preventive behaviors of COVID-19 were measured. The results supported that the dual-process framework could account for individual differences in preventive behaviors. Self-efficacy and response cost significantly explained the intention to maintain preventive behaviors, while favorability of risk image and subjective norm significantly explained the willingness to stop preventive behaviors. Our findings proposed strategies for promoting individuals' maintenance of preventive behaviors during a pandemic. The development of prevention policies may focus on two paths: strengthening the intended path by enhancing self-efficacy and decreasing response cost of preventive behaviors and monitoring and improving social influences, such as risk prototype and subjective norm, which can reduce the willingness to stop preventive behaviors.

Validation of the Internet Gaming Disorder Symptoms Checklist Based on the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders in Chinese Adolescents.

This study aims to develop and validate a checklist for IGD symptoms of Chinese adolescents based on the fifth edition of the diagnostic and statistical manual of mental disorders (DISCA). We recruited 2144 secondary school students who reported that they had played Internet games in the past 12 months in two large cities of China. The 9 item of DISCA were all significantly and positively correlated and the scale reliability was satisfactory. The unidimensional structure of the scale was confirmed by Confirmatory Factor Analysis (CFA), χ2/df = 246.18/27, CFI = .95, RMSEA = .06. Measurement invariance across gender and city groups was confirmed by Multiple-group CFA. Criterion validity was demonstrated by the significant positive associations between DISCA score and self-identified IGD, loss of control regarding time spent on Internet gaming, time spent on playing Internet games, depression, and suicidal ideation. DISCA is a brief, reliable, and validated assessment to measure adolescent IGD.

Validation of the Revised Illness Perception Questionnaire of Obstructive Sleep Apnea among Elderly Chinese in the General Population.

PURPOSE: The prevalence of under-diagnosis among individuals with obstructive sleep apnea (OSA) is alarming, and may be associated with perceptions regarding OSA. To facilitate future studies on OSA, this study validated the revised version of the Illness Perception Questionnaire (IPQ-R) for OSA in a general population. METHODS: A random anonymous population-based telephone survey interviewed 580 adults aged ≥ 50 years in Hong Kong, who self-reported not having been told by doctors as having OSA, from February 5 to March 19, 2021. RESULTS: The confirmatory factor analysis identified a modified 7-factor model (i.e., timeline chronic, consequence, personal control, treatment control, illness coherence, timeline cyclical, and emotional representation) that showed satisfactory model fit index and internal consistency. Nine items were removed from the original version because of low factor loadings. No floor and ceiling effects were observed. Convergent validity was supported by the positive associations between the consequence subscale with perceived negative outcomes of OSA and between the illness coherence subscale and perceived understanding of OSA symptoms. The participants tended to endorse the items of timeline chronic, treatment control, and illness coherence but not with those of emotional representations. The mean scores of the IPQ-R subscales differed by age and education level. CONCLUSION: The modified IPQ-R of OSA showed acceptable psychometric properties. It is applicable to assessing illness perceptions of OSA in the Chinese general population aged ≥ 50 years not having received OSA diagnosis. The validated tool would support future studies and health practices related to OSA.

Psychometric Properties of the Abbreviated Version of the Dual School Climate and School Identification Measure-Student (SCASIM-St15) among Adolescents in China.

School climate and school identification are two distinct yet closely interrelated components of school environment; both are associated with adolescents' multiple health behavioral changes. The 15-item Abbreviated version of the Dual School Climate and School Identification Measure-Student (SCASIM-St15) and its 5-factor model simultaneously and separately assess these two constructs. This study validated the Chinese version of SCASIM-St15 among 1108 students from junior middle schools, senior middle schools, and vocational high schools in Taizhou city, Zhejiang, China, via an anonymous, self-administered cross-sectional survey. Confirmatory factor analysis supports the 5-factor model of the original SCASIM-St15 with a satisfactory model fit. Its four factors (i.e., student-student relations, staff-student relations, academic emphasis, and shared values and approach) assess school climate; its fifth factor assesses school identification. The subscales of the SCASIM-St15 demonstrate good psychometric properties, including measurement invariance (across sex and school type), good internal consistency, an absence of floor effect, and good external validity with four external variables (depression, peer victimization, classmate support, and teacher-student relationship). However, some substantial ceiling effects were observed. The five subscales differ significantly across the school types but not between males and females. The validated SCASIM-St15 can be applied to simultaneously understand school climate/school identification among Chinese adolescents, which may greatly facilitate future related observational and intervention research.