Exposure to Violence in Social Unrest, Resilience, and Mental Health of Older People in Hong Kong.

OBJECTIVE: Older adults are prone to the negative effects of exposure to violence on their mental health. This study aimed to examine the impact of exposure to violence during social unrest and the role of resilience in the mental health of older people. DESIGN: A total of 1,203 people aged 65 years or older were randomly selected for a telephone survey using the random digit dialing numbering method in Hong Kong. MEASUREMENTS: A 13-item scale was developed to measure exposure to violence. The Chinese versions of the Connor-Davidson Resilience Scale and the Startle, Physiological Arousal, Anger, and Numbness scales for measuring mental health status were adopted in the survey. RESULTS: The results showed that the more frequently older people were exposed to information, the more negative mental health status they had. However, exposure to witnessing and experiencing violence was not significantly associated with mental health status. Older adults' level of resilience had a moderating effect between exposure to information and mental health, whereas the effect of exposure to information on mental health was stronger for respondents with lower resilience. CONCLUSION: This study showed that emotional problems caused by exposure to related information among older people should be properly addressed during massive social unrest and conflict. Their resilience capacity is an important moderating factor. Future interventions and support services should focus on enhancing the resilience of older people to better equip them with overcoming problems related to macro-social issues.

Exposure to socio-political unrest and wellbeing of older people in Hong Kong.

BACKGROUND: The social unrest in the second half of 2019 in Hong Kong came with conflicts, confrontations, and violence which affected almost everyone in the city. The destruction and disruption of the urban facilities have undoubtedly had a significant impact on the lives and mental well-being of the public, and the older people are even more vulnerable. This study examined the impacts of the social unrest on the wellbeing of older people, an area that was seldomly addressed in the public discourse and literature. METHODS: Narrative interviews were conducted to capture older people's lived experiences and ways of making sense of the unrest in Hong Kong. A total of 63 participants aged 60 and above was recruited through personal networks of the research team, and referrals by participants who took part in the interviews. Qualitative semi-structure interviews was conducted one on one via telephone. RESULTS: Thirty-three male and 30 female participants took part in the interview. The number of participants from different risk zones affected by political unrest was comparable. Three themes were generated. Participants experienced challenges during the social unrest, including disturbance to family and social life, reduced incomes which affect quality of life, and difficulties in socializing with friends and accessing medical services. The social unrest caused emotional disturbance, giving rise to feelings of panic, fear, insomnia, depression, annoyance, and anger. Participants reported different coping strategies, ranging from moving to other places, to avoiding going to risky areas and watching news. CONCLUSION: Social unrest brings emotional distress to older people. In many cases, older people cope with challenges in different ways, whether active or passive. Social workers and other professionals should give more support to older people to encourage them to overcome their difficulties. The stakeholders' awareness of the problem and mental health promotion is required to alleviate the multiple layers of negative impacts.

The impact of social unrest and pandemic on mental health of young people in Hong Kong: The transdiagnostic role of event-based rumination.

OBJECTIVE: Co-occurring population-level events, such as social unrest and coronavirus disease 2019, are observed in many societies today. Few studies have explored their combined mental health effects on young people. While self-focused rumination has been suggested to be a key mechanism underlying depression, the role of event-based rumination in mediating the impact of population stressors has yet to be elucidated. METHODS: Data were collected from 6988 young people in a large-scale community online survey in Hong Kong. The survey assessed symptoms of post-traumatic stress disorder and depression, direct exposure to social unrest-related traumatic events, coronavirus disease 2019 pandemic-related events, personal stressful life events, event-based rumination and other individual risk factors. RESULTS: High levels of comorbid post-traumatic stress disorder and depressive symptoms were observed. Logistic regression analysis revealed that probable post-traumatic stress disorder was associated with traumatic events (odds ratio = 1.73, 95% confidence interval = [1.64, 1.82]), pandemic-related events (odds ratio = 1.08, confidence interval = [1.01, 1.16]), stressful life events (odds ratio = 1.20, confidence interval = [1.21, 1.37]), high event-based rumination (odds ratio = 3.00, confidence interval = [2.58, 3.48]), lower resilience (odds ratio = 1.18, confidence interval = [1.15, 1.21]), higher smartphone reliance (odds ratio = 1.09, confidence interval = [1.05, 1.13]) and financial concerns (odds ratio = 1.25, confidence interval = [1.18, 1.33]). The odds for probable post-traumatic stress disorder was also significantly higher when two or more traumatic events were experienced (odds ratio = 4.03, confidence interval = [3.52, 4.62]). Factors associated with moderate-to-severe level depressive symptoms were similar. Event-based rumination significantly mediated between different types of external events (traumatic events, pandemic-related events, stressful life events) and both post-traumatic stress disorder and depressive symptoms. CONCLUSION: These findings suggest that diverse types of stressful events during population-level crises could add to personal stressors to affect mental health outcomes in young people. Among other protective and risk factors, event-based rumination presented as a prominent transdiagnostic mediator for different symptom dimensions which may be a potentially important target for early risk detection and intervention.

Mental Health Risks after Repeated Exposure to Multiple Stressful Events during Ongoing Social Unrest and Pandemic in Hong Kong: The Role of Rumination: Risques pour la santé mentale après une exposition répétée à de multiples événements stressants d'agitation sociale durable et de pandémie à Hong Kong: le rôle de la rumination.

OBJECTIVES: The co-occurrence of different classes of population-level stressors, such as social unrest and public health crises, is common in contemporary societies. Yet, few studies explored their combined mental health impact. The aim of this study was to examine the impact of repeated exposure to social unrest-related traumatic events (TEs), coronavirus disease 2019 (COVID-19) pandemic-related events (PEs), and stressful life events (SLEs) on post-traumatic stress disorder (PTSD) and depressive symptoms, and the potential mediating role of event-based rumination (rumination of TEs-related anger, injustice, guilt, and insecurity) between TEs and PTSD symptoms. METHODS: Community members in Hong Kong who had utilized a screening tool for PTSD and depressive symptoms were invited to complete a survey on exposure to stressful events and event-based rumination. RESULTS: A total of 10,110 individuals completed the survey. Hierarchical regression analysis showed that rumination, TEs, and SLEs were among the significant predictors for PTSD symptoms (all P < 0.001), accounting for 32% of the variance. For depression, rumination, SLEs, and PEs were among the significant predictors (all P < 0.001), explaining 24.9% of the variance. Two-way analysis of variance of different recent and prior TEs showed significant dose-effect relationships. The effect of recent TEs on PTSD symptoms was potentiated by prior TEs (P = 0.005). COVID-19 PEs and prior TEs additively contributed to PTSD symptoms, with no significant interaction (P = 0.94). Meanwhile, recent TEs were also potentiated by SLEs (P = 0.002). The effects of TEs on PTSD symptoms were mediated by rumination (ß = 0.38, standard error = 0.01, 95% confidence interval: 0.36 to 0.41), with 40.4% of the total effect explained. All 4 rumination subtypes were significant mediators. CONCLUSIONS: Prior and ongoing TEs, PEs, and SLEs cumulatively exacerbated PTSD and depressive symptoms. The role of event-based rumination and their interventions should be prioritized for future research.

Terror Management Theory and the COVID-19 Pandemic.

Terror management theory is focused on the role that awareness of death plays in diverse aspects of life. Here, we discuss the theory's implications for understanding the widely varying ways in which people have responded to the COVID-19 pandemic. We argue that regardless of whether one consciously believes that the virus is a major threat to life or only a minor inconvenience, fear of death plays an important role in driving one's attitudes and behavior related to the virus. We focus on the terror management theory distinction between proximal defenses, which are activated when thoughts of death are in current focal attention and are logically related to the threat at hand, and distal defenses, which are activated when thoughts of death are on the fringes of one's consciousness and entail the pursuit of meaning, personal value, and close relationships. We use this framework to discuss the many ways in which COVID-19 undermines psychological equanimity, the diverse ways people have responded to this threat, and the role of ineffective terror management in psychological distress and disorder that may emerge in response to the virus.

Mentoring as a Buffer for the Impact of Social Unrest due to Systemic Racism and Ambient Discrimination.

Mentoring may act as a buffer for the negative impacts of racial trauma. Building Up (conducted 2020-2024) is a cluster-randomized trial at 25 institutions of postdoctoral fellows and early-career faculty from underrepresented backgrounds. Generalized linear mixed models were used to identify mentoring competencies associated with the impact of social unrest due to systemic racism. Eighty-two percent of participants (n=143) identified as female, 33% as non-Hispanic Black, and 36% as Hispanic. Mentoring that aligns expectations and mentoring that assesses understanding were significantly associated with social unrest due to systemic racism impacting ability to work (OR=2.84 and OR=0.52, respectively) and conduct research (OR=4.21 and OR=0.41, respectively). Future research should elucidate specific aspects of mentoring relationships that serve as a buffer during times of social unrest.

From Mourning and Melancholia to Neurobiology in an Era of Global Warming, Pandemic Disease, and Social Chasms: Grief as a Requisite for Change.

We find ourselves in a unique time in history with the confluence of a pandemic, global warming, and social chasms felt throughout the world. In this article, it is suggested that the grieving process is necessary for progress. The article addresses grief from a psychodynamic lens and progresses through the neurobiological changes that occur in the grieving process. The article discusses grief as both a result of and a necessary response to COVID-19, global warming, and social unrest. It is argued that grief is a vital process in order to fully change as a society and move forward. The role of psychiatry, and specifically psychodynamic psychiatry, is integral in paving the way to this new understanding and a new future.

The Indirect Effect of Sleep on the Association Between Protracted Social Stressors and Psychological Distress Among Hong Kong Young People.

PURPOSE: Hong Kong youth and young adults experienced unprecedented stress amid social unrest and the COVID-19 pandemic. Few studies have examined how these stressors were related to psychological distress among youth and young adults. This study assessed how psychological distress is associated with stress from social unrest, financial circumstances, and the COVID-19 pandemic, and whether poor sleep quality may explain these associations. METHODS: Participants of a representative phone survey included 1,501 Hong Kong youth and young adults (Mage = 26.1 (4.0); 48.2% female). We examined the associations between psychological distress and three types of stress (social unrest, financial, and COVID-19 stress), and the indirect effect of poor sleep. RESULTS: Eleven point nine percent, 4.1%, and 9.7% of respondents reported feeling very seriously distressed by social unrest, financial circumstances, and the COVID-19 pandemic, respectively. All three forms of stress were associated with poor sleep. The indirect effects of poor sleep on the association between all three forms of stress and psychological distress were identified. Moderated indirect effect analysis indicated that being female intensified the effect of COVID-19-related stress on psychological distress and that younger female youth and older male youth were more vulnerable to financial stress and social unrest stress (vs. older female youth and younger male youth). DISCUSSION: Sleep may be one mechanism that accounts for the association between psychological distress and protracted stressors among Hong Kong youth and young adults. These results suggest the importance of prioritizing sleep improvement in mental health interventions during times of societal change.

Differences in mental indicators and state-hope related to the level of engagement in social unrest: Israel 2023.

Background: This study examined the interplay between engagement in social unrest, mental indicators, state-hope and demographic variables. In addition, mental indicators and state-hope were compared in line with levels of engagement in social unrest. Methods: In a cross-sectional study, conducted from March 23 to April 10, 2023, 2031 Israelis were recruited via a survey company. Participants completed self-report questionnaires to assess engagement in social unrest, anxiety, social unrest related distress, state-hope and demographic variables. Results: Participants with higher engagement in social unrest, who opposed the law reform, were prone to higher levels of social unrest related distress, anxiety, and lower levels of state-hope compared to those not engaged in social unrest activities or those who supported the law reform. Conclusions: Concerns regarding unmet mental health needs, during and following social unrest, regardless of the engagement level, should be actively addressed by mental health professionals and health policy makers.

Prevalence, time trends, and correlates of major depressive episode and other psychiatric conditions among young people amid major social unrest and COVID-19 in Hong Kong: a representative epidemiological study from 2019 to 2022.

Background: Hong Kong is among the many populations that has experienced the combined impacts of social unrest and the COVID-19 pandemic. Despite concerns about further deteriorations in youth mental health globally, few epidemiological studies have been conducted to examine the prevalence and correlates of major depressive episode (MDE) and other major psychiatric disorders across periods of population-level changes using diagnostic interviews. Methods: We conducted a territory-wide household-based epidemiological study from 2019 to 2022 targeting young people aged 15-24 years. MDE, generalised anxiety disorder (GAD), panic disorder (PD), and bipolar disorder (BD) were assessed using the Composite International Diagnostic Interview-Screening Scales in 3340 young people. Psychotic disorders were assessed by experienced psychiatrists according to the DSM. Help-seeking patterns were also explored. Findings: 16.6% had any mental disorder (13.7% 12-month MDE, 2.3% BD, 2.1% GAD, 1.0% PD, 0.6% psychotic disorder). The prevalence of MDE increased from 13.2% during period 1 (May 2019-June 2020) to 18.1% during period 2 (July-December 2020), followed by 14.0% during period 3 (January-June 2021) and 13.2% during period 4 (July 2021-June 2022). Different stressors uniquely contributed to MDE across periods: social unrest-related stressors during period 1, COVID-19 stressors during period 2, and personal stressors during periods 3-4. Lower resilience, loneliness, frequent nightmares, and childhood adversity were consistently associated with MDE. Compared to other conditions, those with MDE showed the lowest service utilisation rate (16.7%). Perceiving services to "cost too much" and "talked to friends or relatives instead" were among the major reasons for not seeking help. MDE was also significantly associated with poorer functioning and health-related quality of life. Interpretation: MDE can be sensitive to population-level changes, although its persistently elevated prevalence across the study period is of concern. Efforts to mitigate their impacts on youth mental health alongside personal risk factors are needed. Further work is required to increase the availability and acceptability of youth-targeted mental health services. Funding: Food and Health Bureau (HKSAR Government).

Building and Testing of a Conceptual Model to Describe and Measure the Health of People as Affected by Post-traumatic Stress Disorder During Social Unrest: A Confirmatory Factor Analysis and Structural Equation Modeling.

Background: Social unrest affects people's health and well-being. People's health-related needs during social unrest are concerns in both research and clinical practice. This study aimed to build and test a framework to describe and understand the health status and needs of people with post-traumatic stress disorder (PTSD) during social unrest. Methods: This study was a cross-sectional survey. A total of 460 people who had experienced post-traumatic distress as a result of the social unrest in 2019 and 2020 were included. A conceptual model comprised four essential areas, namely posttraumatic distress symptoms, participation restrictions, perceived stigma and functional disability, was built from literature. Part 1 validated four instruments that evaluate and define the factor structure of these four areas, In Part II, structural equation modeling was used to test and validate a combined model. Results: Factors underlying the four areas were defined. Analysis using structural equation modeling confirmed a best fit of the model. PTSD symptoms, perceived stigma and participation restriction during social unrest contributed significantly to functional disability; PTSD symptoms exerted a direct effect on participation restriction and perceived stigma; and the effect of PTSD symptoms on functional disability was mediated through its influence on perceived stigma during social unrest. Conclusions: A community-based inclusive approach is essential to understand the holistic needs of people with PTSD during social unrest. To improve health and well-being in addition to evaluating mental health impacts, considering interactions with the rapid change and stressful social environment is essential.

Effects of a Mindful Parenting Workshop for Parents of Adolescents and Young Adults Following Social Unrest in Hong Kong.

OBJECTIVES: The social unrest that began in Hong Kong in 2019 became a threat to public mental health, such as for depression and post-traumatic stress disorders. A supportive family environment is the most effective protective factor for mental health problems for young people who are exposed to conflict and violence. This study investigated the outcomes of a brief mindful parenting workshop on parent mental health and family functioning. METHODS: Using a randomized controlled trial design, 54 parents of adolescents and young adults were randomized into intervention group and waitlist control group. Depression, anxiety, post-traumatic stress symptoms, negative emotions, family functioning, and family conflicts were measured at baseline (pretest), following training, and at 3-month follow-up. RESULTS: We found a significant improvement in family functioning among parents in the intervention group when compared to those parents in the control group (F [1, 51] = 4.41, p = .04). When we further controlled the child-initiated physical conflict as covariate, a significant reduction of self-rated levels of depressive symptoms was found in the parents from the intervention group when compared to the parents in the control group (F [1, 49] = 5.14, p = .03). CONCLUSIONS: We found preliminary evidence that a brief mindful parenting workshop can strengthen parent and family mental health at times of social unrest. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04427683).

The impact of social unrest due to systemic racism on underrepresented post-doctoral fellows and early-career faculty.

Introduction: Social unrest tied to racism negatively impacted half of NIH-funded extramural researchers underrepresented (UR) in science. UR early-career scientists encounter more challenges in their research careers, but the impact of social unrest due to systemic racism in this group is unclear. We used mixed methods to describe the impact of social unrest due to systemic racism on mentoring relationships, research, and psychological well-being in UR post-doctoral fellows and early-career faculty. Methods: This is a cross-sectional analysis of data collected in September 2021-January 2022 from 144 UR early-career researchers from 25 academic medical centers in the Building Up Trial. The primary outcomes were agreement on five-point Likert scales with social unrest impact statements (e.g., "I experienced psychological distress due to events of social unrest regarding systemic racism"). Thematic analysis was conducted on responses to one open-ended question assessing how social unrest regarding systemic racism affected participants. Results: Most participants were female (80%), non-Hispanic Black (35%), or Hispanic (40%). Over half of participants (57%) experienced psychological distress as a result of social unrest due to systemic racism. Participants described direct and indirect discrimination and isolation from other persons of color at their institutions. Twice as many participants felt their mentoring relationships were positively (21%) versus negatively (11%) impacted by social unrest due to systemic racism. Conclusions: Experiences with racial bias and discrimination impact the career and well-being of UR early-career researchers. Mentoring relationships and institutional support play an important role in buffering the negative impact of racial injustice for this population.

Stressful events as correlates of depressive and PTSD symptoms in Hong Kong women during social unrest and COVID-19 pandemic.

BACKGROUND: Stressors at the population level affect women more than men. The influence of prolonged stressors on mental disorders in women is yet unknown, especially when social movements and pandemics coexist. METHODS: This study analysed data from an online mental health self-help service for women in Hong Kong between May and September 2020. We collected demographic data, PTSD symptoms, and exposure to social unrest-related traumatic events (TEs), pandemic-related traumatic events (PEs), and personal stressful life experiences (SLEs). Multiple logistic regression was performed to examine the links between TEs, PEs, and SLEs and PTSD. RESULTS: The study found that 38.4% of 751 women had moderate-to-severe depressive symptoms and 23.8% had probable PTSD. The most common TEs, PEs, and SLEs were violence via media, major physical health concerns, and plans thwarted due to COVID-19, respectively. Younger age, less education, unemployment, and more stressors (individually or collectively, except for high TEs and PEs) were linked to increased odds of moderate-to-severe depressive symptoms. TEs and PEs increased the risk of probable PTSD only when SLEs were present. LIMITATION: The non-random samplinging procedure reduced the generalisability to the entire women population. CONCLUSIONS: Exposure to social conflicts and pandemics may increase depressive and PTSD symptoms in women. Developing mental health services for women should consider the impact of concurrent major events.

Identifying geopolitical event precursors using attention-based LSTMs.

Forecasting societal events such as civil unrest, mass protests, and violent conflicts is a challenging problem with several important real-world applications in planning and policy making. While traditional forecasting approaches have typically relied on historical time series for generating such forecasts, recent research has focused on using open source surrogate data for more accurate and timely forecasts. Furthermore, leveraging such data can also help to identify precursors of those events that can be used to gain insights into the generated forecasts. The key challenge is to develop a unified framework for forecasting and precursor identification that can deal with missing historical data. Other challenges include sufficient flexibility in handling different types of events and providing interpretable representations of identified precursors. Although existing methods exhibit promising performance for predictive modeling in event detection, these models do not adequately address the above challenges. Here, we propose a unified framework based on an attention-based long short-term memory (LSTM) model to simultaneously forecast events with sequential text datasets as well as identify precursors at different granularity such as documents and document excerpts. The key idea is to leverage word context in sequential and time-stamped documents such as news articles and blogs for learning a rich set of precursors. We validate the proposed framework by conducting extensive experiments with two real-world datasets-military action and violent conflicts in the Middle East and mass protests in Latin America. Our results show that overall, the proposed approach generates more accurate forecasts compared to the existing state-of-the-art methods, while at the same time producing a rich set of precursors for the forecasted events.

The squeaky wheel gets the grease: Violent civil unrest and global social assistance provision.

What are the contemporary determinates of social assistance provision? What is the role of contentious politics? Social assistance literature is dominated by economic and demographic accounts, which under-examine the possibility that governments extend social assistance to contain social unrest. We test factors associated with these "structuralist" and "political" theories on a new panel dataset which includes 54 OECD and emerging market countries between 2002 and 2015. The results indicate social assistance coverage has a significant positive relationship with riots. We explain this outcome as policymakers expanding social assistance as a means of containing violent civil unrest. This effect is more significant in emerging markets, suggesting that the domination of structural explanations is a result of sample bias toward the OECD. Finally, we find that governments consider World Bank social policy recommendations only insofar as there is violent unrest.

The HIV and SARS-CoV-2 Parallel in Dentistry from the Perspectives of the Oral Health Care Team.

OBJECTIVES: The aim of this study was to unravel the professional and social consequences of COVID-19 as compared with the AIDS pandemic according to oral health care providers, staff, and administrators. METHODS: An exploratory qualitative inquiry via at-a-distance, semistructured interviews engaged a purposefully recruited sample of oral health care team workers in British Columbia. Interviews took place between April 20 and May 15, 2020; they were audio recorded, transcribed verbatim, and deidentified for interactive thematic analysis. An inductive process of coding was used to identify themes, subthemes, and categories of information. RESULTS: Forty-five interviews were conducted with 18 dentists, 12 dental hygienists, 6 certified dental assistants, and 9 administrators; 22 were females. Interviews each lasted an average of 48 min. After the transcripts were coded, 3 subthemes emerged: 1) personal protective equipment and universal precautions as commonsense approaches to care during both pandemics; 2) an (un)collapsed world in terms of global lockdowns; and 3) social unrest in terms of the potential for stigma and discrimination caused by both pandemics. These subthemes made up the COVID-19-AIDS parallel theme. CONCLUSION: This study explored the extent to which the current COVID-19 pandemic is leading to professional and social consequences when a parallel is drawn with the AIDS pandemic. This is the first qualitative study that identifies the potential social unrest of the pandemic from the perspective of oral health care providers and administrators. Future studies should include other providers across Canada, as well the patients receiving oral health care during this pandemic. KNOWLEDGE TRANSFER STATEMENT: The COVID-19 pandemic has unraveled potential societal implications in a parallel to the HIV/AIDS era from the perspectives of oral health care providers and their staff. Such implications are changing the way that oral health care is delivered; it may also be leading to social unrest in the form of stigma and discrimination. This study discusses some of these implications from the perspective of oral health care providers and administrators.

Time-dependent association between mass protests and psychological distress on social media: A text mining study during the 2019 anti-government social unrest in Hong Kong.

BACKGROUND & AIMS: Social media are increasingly pivotal as the platform where activists and observers plan, promote, and respond to collective actions. To examine how mass protests influence psychological wellbeing and distress, this study analyzed their time-dependent association during the 2019 anti-government social unrest in Hong Kong. METHODS: Consecutive day-by-day users-generated content on online forums and social network sites (SNS) from June to November 2019 was obtained. A Cantonese term-list was created to identify terms related to mass protests and psychological distress. The frequency of comments containing such terms was analyzed using time series models. RESULTS: There were 3,572,665 social media comments in the investigation period. As hypothesized, the frequency of comments with mass protest terms was higher on days with mass protests than on days without. Frequency of comments with both mass protest- and psychological distress-terms was also higher on days with protests than days without. Time-lagged effect (responses on the following day) of protest-terms was found on online forums but not on SNS. Our results suggest a positive association between offline protest activities and online psychological reactions. CONCLUSIONS: Social media content reveals discussions of psychological distress stemming from, or exacerbated by, social unrest. The potential mutual influences between mass protests and online reactions, as well as the functional differences between online forums and SNS in this regard are discussed. Street protests and their associated psychological distress can be readily detected on popular online forums. Mental health services should consider, and even make use of, such dynamic relationship between on- and offline activities.

Nursing student experiences in turmoil: A year of the pandemic and social strife during final clinical rotations.

BACKGROUND: The duration and magnitude of the coronavirus (COVID-19) posed unique challenges for nursing students, whose education was altered because of the pandemic. PURPOSE: To explore the perceptions and experiences of nursing students whose clinical rotations were abruptly interrupted by COVID-19's initial surge in the United States. METHODS: This qualitative study was conducted at a midwestern, academic medical center to elicit senior nursing students' experiences. An online survey was administered with eight open-ended questions asking about: initial impressions of the pandemic; experiences of being a senior nursing student; sources of stress and coping mechanisms; preparing to work as a registered nurse; and views on the nursing profession. RESULTS: Among the 26 students who completed the survey, the majority were female (92%), aged 28 ∓ 4.1 years. A total of 18 subcategories emerged with four main themes identified as: a) breakdown of normal systems, b) feeling alone and the inability to escape, c) protective factors/adaptability, and d) role identify and formation. CONCLUSIONS: Findings indicate students implemented a variety of strategies while adapting to the abrupt interruption of in-person clinical rotations, mandated restrictions, and social unrest. The cascading themes illustrate the enormity of sudden changes and their significant impact on daily life.

Subjective Well-Being among Parents of Children with Special Educational Needs in Hong Kong: Impacts of Stigmatized Identity and Discrimination under Social Unrest and COVID-19.

The COVID-19 pandemic and social unrest have posed a unique set of challenges to Hong Kong. During these two social events, parents of children with special educational needs (SEN) who were already experiencing caregiving pressure, likely coped with additional stressors; they were at a higher risk of mental health problems. A pre-registered, cross-sectional survey study was carried out among 234 Hong Kong parents of children with SEN, investigating the associations of stigmatized identity, perceived discrimination, and subjective well-being under the impact of these social events. Utilizing the Bayesian modelling, we found that highly self-stigmatized parents not only perceived more daily-life discriminating behaviors against them, but also reported having higher distress, more negative emotions, and lower life satisfaction. A higher perceived impact of social events and more discrimination were also associated with lower well-being. Additionally, stigmatized identity, perceived discrimination, and perceived impact of social events demonstrated unique associations with well-being variables, indicating they were substantial stressors. The study called out for public attention to the mental health conditions among parents of children with SEN and other disadvantaged groups in society.