Changes in, and factors associated with family functioning: results of four cross-sectional household surveys from 2011 to 2017 in Hong Kong.

BACKGROUND: Previous research has well-documented that family functioning is an important predictor of individuals' physical and mental health. However, relatively little research has explored family functioning at the family and population levels, such as changes in family functioning across years and whether predictors of family functioning differ across different family structures. Understanding of the changes in family functioning across years and factors promoting family functioning will inform the development of preventive measures to enhance family health and resilience. Objectives of the study were: (1) to examine the changes in family functioning across a 6-year study period and (2) to study protective factors associated with family functioning and the extent to which the factors are the same or different across different family structures. METHOD: The study involved secondary data analysis of the biannual Family Survey carried out by the Family Council, an advisory body to the Hong Kong government. A series of ANOVA and regression analyses were conducted using data of four population-based cross-sectional household surveys conducted in Hong Kong in 2011, 2013, 2015, and 2017. RESULTS: There were some fluctuations in overall family functioning scores across the study period, but no significant difference was found between the scores in 2011 and 2017. Different predictors of family functioning were found for different family types, and frequent family communication was a common protective factor for most family types, including never married, married/cohabiting with children, and married/cohabiting with no children. CONCLUSION: The study is among the first to examine changes in family functioning at the population level. Monitoring and addressing family functioning may help tackle various social problems and future public health crises. Interventions to promote family functioning should address both common and different protective factors of different family types.

Bibliometric analysis of functional magnetic resonance imaging studies on chronic pain over the past 20 years.

PURPOSE: The utilization of functional magnetic resonance imaging (fMRI) in studying the mechanisms and treatment of chronic pain has gained significant popularity. However, there is currently a dearth of literature conducting bibliometric analysis on fMRI studies focused on chronic pain. METHODS: All the literature included in this study was obtained from the Science Citation Index Expanded of Web of Science Core Collection. We used CiteSpace and VOSviewer to analyze publications, authors, countries or regions, institutions, journals, references and keywords. Additionally, we evaluated the timeline and burst analysis of keywords, as well as the timeline and burst analysis of references. The search was conducted from 2004 to 2023 and completed within a single day on October 4th, 2023. RESULTS: A total of 1,327 articles were retrieved. The annual publication shows an overall increasing trend. The United States has the highest number of publications and the main contributing institution is Harvard University. The journal PAIN produces the most articles. In recent years, resting-state fMRI, the prefrontal cortex, nucleus accumbens, thalamus, and migraines have been researched hotspots of fMRI studies on chronic pain. CONCLUSIONS: This study provides an in-depth perspective on fMRI for chronic pain research, revealing key points, research hotspots and research trends, which offers valuable ideas for future research activities. It concludes with a summary of advances in clinical practice in this area, pointing out the need for critical evaluation of these findings in the light of guidelines and expert recommendations. It is anticipated that further high-quality research outputs will be generated in the future, which will facilitate the utilization of fMRI in clinical decision-making for chronic pain.

Association between internet use and depressive symptoms among older adults: mediating role of daytime napping and moderating role of productive engagement.

OBJECTIVES: This study investigated the mediating role of daytime napping in the relationship between internet use and depressive symptoms among older adults. Further the moderating effect of productive engagement was assessed on the linkage between internet use and depressive symptoms. METHODS: We surveyed 956 Chinese community-dwelling older adults. Respondents reported their internet use for different purposes (social, informational, and instrumental use), rated their levels of depressive symptoms and of daytime napping, and reported different types of/overall productive engagement. We conducted mediation and moderation analyses to test the potential pathways of associations among those factors. RESULTS: Daytime napping mediated the association between social and informational internet use and depressive symptoms. Family caregiving, sporting activities, and overall productive engagement each moderated the relationship between internet use and depressive symptoms. CONCLUSION: Internet use can increase the risk of depressive symptoms in older adults by increasing daytime napping. However, the benefits of internet use can be particularly salient for those who have a low level of productive engagement. The findings have implications for policies and practices that are designed to help older adults access the internet to enhance well-being.

Long-term effects of childhood adversity on the subjective well-being of older adults in urban China: the mediating effect of elder abuse.

Adverse childhood experiences (ACEs) have negative impacts on individuals' subjective well-being (SWB) in later life. This article investigates the relationships between the ACEs and SWB of Chinese older adults and examines how elder abuse victimization mediates the pathways in these relationships.We used retrospective cross-sectional survey data collected in Beijing, China, in 2019. The study sample consists of 1002 older adults aged 65 years and over. The survey measured individual types, number, and various categories of ACEs of older adults and their elder abuse victimization experiences, along with their SWB (i.e. depression and life satisfaction). We tested the potential mediating role of elder abuse victimization in the relationships between ACEs and SWB.After controlling for socio-demographic factors and self-rated health, the results suggest a full mediating effect of elder abuse on the relationship between both several individual types and multiple categories of ACEs (i.e. childhood victimization, the family's economic difficulties, and a family member's episodes of illness) and depression, in addition to a partial mediating effect of elder abuse between number of ACEs and depression. A full mediating effect of elder abuse was found in regard to the relationship between a family's economic difficulties and life satisfaction.This study provides evidence for a long-term impact of ACEs on the SWB of older adults in China. In analyzing and understanding elder abuse victimization as a pathway linking ACEs and SWB, we stress the importance of the prevention of interpersonal violence across the life course.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2040427 .

Effect of prone trunk-extension on lumbar and lower limb muscle stiffness.

This study investigated the effect of the prone trunk extension test (PTE) on lumbar and lower limb muscle stiffness to explore the optimal angle for lumbar muscle training, understand the peripheral muscle force transmission effect, and determine the modulation strategy and interaction mode of different muscles during PTE. Twenty healthy young females were recruited for this study, and the stiffness of the erector spinae (ES), semitendinosus (ST), biceps femoris (BF), medial head of the gastrocnemius (MG), and lateral head of the gastrocnemius (LG) was measured by MyotonPRO under four angular PTE conditions (0° horizontal position, 10°, 20°, and 30°). With the increasing angle, the stiffness of ES decreased gradually, while ST and BF increased first and then decreased. The stiffness of MG and LG increased first, then decreased, then increased. There was a moderate to strong negative correlation between ES stiffness variation and ST (r = -0.819 to -0.728, p < 0.001), BF (r = -0.620 to -0.527, p < 0.05), MG (r = -788 to -0.611, p < 0.01), and LG (r = -0.616 to -0.450, p < 0.05). Horizontal PTE maximizes the activation of ES. There is a tension transfer between the ES, hamstrings, and gastrocnemius, mainly between the ES, ST, and LG. The study provides data to explore the effect of peripheral muscle force transmission and the modulation strategies of different muscles during trunk extension.

A meta-analysis of the impacts of internal migration on child health outcomes in China.

BACKGROUND: According to China's 2010 population census, 38.81 million children migrated from rural to urban areas in Mainland China, a phenomenon that has attracted much scholarly attention. Due to the lack of quantitative synthesis of migrant children's developmental outcomes, we undertook a meta-analysis to compare their developmental outcomes with those of their urban counterparts. METHODS: We searched Applied Social Sciences Index and Abstracts (ASSIA), Australian Education Index, British Education Index, ERIC, ProQuest Education Journals, PsycINFO, Social Services Abstracts, Family & Society Studies Worldwide, Medline, Women's Studies International databases and the Chinese CNKI database to identify relevant studies. Studies reporting physical and mental health outcomes of migrant children as well as potential protective and risk factors of child developmental outcomes were included. We assessed study quality using a quality assessment checklist. RESULTS: We selected 25 studies from a total of 1592. Our results reveal that migrant children in public schools present significantly greater mental health problems and lower well-being than their urban counterparts, while migrant children in migrant schools do not present significantly different outcomes. In addition, migrant children were found to be more likely to be exposed to physical health risks due to limited utilization of health services. The disadvantageous health outcomes of migrant children were found to be related to a series of individual and social factors, including academic performance, social relationships, and discrimination. CONCLUSIONS: Migrant children are disadvantaged by the sociocultural circumstances in urban areas. Government should target them and provide appropriate support in order to improve their developmental status, which will have a positive impact on the stability and development of society.

Knowledge Mapping Analysis of Research on Pregnancy-Related Pelvic Girdle Pain (PPGP) from 2002 to 2022 Using Bibliometrics.

Background: Pregnancy-related Pelvic Girdle Pain (PPGP) is a prevalent condition characterized by various physiological and pathological processes in the female body. The objective of this study is to offer a comprehensive understanding of the current research landscape, key areas of interest, and potential future directions in the field of PPGP. Methods: Using Web of Science, we explored PPGP literature from 2002 to 2022. VOSviewer and CiteSpace facilitated a quantitative analysis, revealing co-authorship patterns, co-occurring themes, citations, and co-citations. Results: We identified, peaking at 99 publications in 2021. The United States led with 138 publications and the highest citation count (3160). The Karolinska Institute boasted the highest tally of publications (n = 21). Regarding the volume of publications, the esteemed journal of BMC Pregnancy and Childbirth attained the foremost position. Notably, Gutke, Annelie emerged as the most prolific and highly cited author. The analysis of keyword co-occurrence and co-citation clustering unveiled an intricate tapestry of PPGP studies, spanning various domains including risk factors, mechanistic intricacies, diagnostic benchmark, treatment modalities, and far-reaching ramifications on one's quality of life. Conclusion: Research endeavors exploring PPGP have unveiled an enduring trajectory of growth in contemporary times. The existing body of research primarily focuses on delving into the intricate interplay of epidemiological factors and the profound implications of interventions encompassing physical therapy, exercise protocols, and diverse modes of pain management within the domain of PPGP. Multidisciplinary integration encapsulates a prevailing trajectory of progress within this domain, while the focal point of future inquiries into PPGP may revolve around subjects pertaining to standardized outcome reporting.

Bibliometric analysis of stroke and quality of life.

Objective: To perform a bibliometric analysis of stroke and quality of life studies between 2000 and 2022 using VOSviewer and CiteSpace. Methods: The literature data source for this study was the Web of Science Core Collection. CiteSpace and VOSviewer were used to analyze publications in relation to authors, countries, institutions, journals, references, and keywords. Results: A total of 704 publications were obtained for the bibliometric analysis. The number of publications has gradually increased over 23 years, with an annual increase of 728.6%. Kim S is the most prolific author in the field (10 publications), and the United States and Chinese University of Hong Kong have the most publications. Stroke is the most prolific journal with the most citations per paper (91.58) and the highest impact factor (IF 2021, 10.17). The most high-frequency keywords are "stroke," "quality of life," "rehabilitation," and "depression." Conclusion: A bibliometric analysis of stroke and quality of life over the last 23 years provides future research directions.

Bibliometric Analysis of Exercise and Chronic Obstructive Pulmonary Disease.

Background: Chronic Obstructive Pulmonary Disease (COPD) is the leading cause of death in the world. Pulmonary rehabilitation includes, but is not limited to, exercise training and education, which aim to improve the physical and psychological conditions of patients with chronic respiratory diseases through self-management interventions. Objective: The aim of this study was to perform a bibliometric analysis of studies on exercise and COPD published from 2000 to 2021 using VOSviewer and CiteSpace. Methods: All included literature was obtained from the Web of Science core collection. VOSviewer was used to analyze country or region, institution, major co-cited journals, and keywords. CiteSpace was used to analyze centrality, author and co-cited authors, journals, the strongest citation bursts of references, and keywords. Results: A total of 1889 articles meeting the criteria were obtained. The United States has the largest number of publications. The American Journal of Respiratory and Critical Care Medicine is the most influential in this field, and the most published research institution is Queen's University. Denis E. O'Donnell has made significant contributions to exercise and COPD research. Association, impact, and statement are hot spots of research in this field. Conclusion: A bibliometric analysis of exercise interventions for COPD over the past 22 years provides direction for future research.

Effectiveness of Digital Health Interventions in Reducing Bullying and Cyberbullying: A Meta-Analysis.

Bullying and cyberbullying bring adverse physical and psychological impacts on individuals and an economic burden for society. Scholars have developed anti-bullying intervention programs to combat these problems. This meta-analysis aims to examine and compare the effectiveness of digital health interventions (DHIs) in reducing bullying and cyberbullying. A comprehensive search was conducted using databases (PsycINFO, Social Service Abstracts, Sociological Abstracts, MEDLINE, ERIC, and EMBASE). Quasi-experimental and randomized controlled trials (RCTs) published before 31 January 2021 that reported the effects of DHIs in reducing bullying or cyberbullying were included. The 16 studies included in the synthesis reported overall random effect sizes (Cohen's d) for bullying and cyberbullying reduction were 0.41 and 0.19, respectively. The results provide evidence on the effectiveness of DHIs, comparable to that of face-to-face interventions. The subgroup analysis revealed that the critical components of effective DHIs include training on bystander and bully-victim dual roles, coping skills, and interactive serious games. It highlights the promising effects of digital health approaches in bullying and cyberbullying interventions. Our review identifies avenues for future research on the development of more effective DHIs to reduce bullying and cyberbullying.

Who Is at High Risk for Child Abuse and Neglect: Risk Assessment among Battered Women Using Shelter Services.

BACKGROUND: The intersections between intimate partner violence (IPV) and child abuse and neglect (CAN) have received growing attention from the research community. However, there is limited research examining the risk factors for CAN among children of battered women who have experienced severe IPV and seek refuge in shelters. OBJECTIVE: In the current study, we examined the co-occurrence of IPV and CAN and the risk factors for CAN in a sample of battered women. PARTICIPANTS AND SETTING: We recruited 260 battered women who were staying in women's shelters in Hong Kong. METHODS: We analyzed the data collected from the risk assessment reports of battered women and focused on IPV against women, CAN, and risk assessment. RESULTS: Nearly half of the battered women had reported both IPV against themselves and CAN against their children. These women were, in general, younger, unemployed, and had been living in Hong Kong for less than seven years as new immigrants. Other risk factors for CAN in violent families included women's conflicts with their partner and abusers with higher levels of stress and approval of violence. CONCLUSIONS: This exploratory study of risk factors for the co-occurrence of IPV and CAN advances our understanding of the causes of violence against women and children in families with violence. Our findings suggest that additional integrated services should be offered to both battered women and their children during their stay in shelters and after shelter departure. Addressing IPV and CAN and reducing adverse consequences needs greater collaboration among the various stakeholders across the social services, health, educational, and legal sectors.

Social, Community, and Cultural Factors Associated with Parental Stress in Fathers and Mothers.

Parenting stress is a key factor in predicting the quality of parent−child relationships and child development outcomes. Previous research tends to focus on examining individual factors contributing to parental stress, with minimal attention to other important contextual factors that may affect parenting. This study examines the issue from a broader ecological perspective by investigating social, cultural, and community factors associated with parental stress in a community sample of economically active fathers and mothers in Hong Kong. A secondary analysis was conducted using the data from the 2017 Family Survey, a territory-wide household survey conducted in Hong Kong. The data of the current study included a sub-sample of 736 working-class parents (48.4% males and 51.6% females). The mean age of fathers and mothers was 50.99 (SD = 11.2) and 48.68 (SD = 10.34) years, respectively. Mothers reported significantly higher levels of parental stress than fathers, t = −4.241, p < 0.001. Different social, cultural, and community factors were associated with parental stress for fathers and mothers. Strong endorsement of traditional family values (B = −0.23, p = 0.032) and frequent practice of filial piety (B = −0.005, p = 0.019) reduced parental stress in fathers. Additionally, fathers who perceived formal support as effective scored higher levels of parental stress, B = 0.20, p < 0.001. For mothers, informal social support from family members was the only social predictor for reduced parental stress (B = −0.14, p < 0.001) among all the other contextual variables. Community support to reduce parental stress in working parents should address the respective risk factors for fathers and mothers.

Global trends and research hotspots of stroke and magnetic resonance imaging: A bibliometric analysis.

BACKGROUND: In this study, we used CiteSpace and VOSviewer to create a bibliometric visualization of research papers relating to stroke and magnetic resonance imaging (MRI) between 2000 and 2022. To fully understand the trends and hotspots in MRI and stroke research and provide new perspectives for future studies. METHODS: The Web of Science Core Collection was selected as the source of data for this paper. Using CiteSpace and VOSviewer, publications were analyzed for authors, countries, institutions, journals, references, and keywords. RESULTS: We found 1423 papers after searching and removing duplicates, which indicated an upward trend over the previous 23 years. Fiebach J.B. is the most published author (21 publications), Hacke W. is the most cited author (213 citations), and the United States (449 publications) and Harvard University (86 publications) are the most prolific nations and institutions. Stroke is the journal with the most co-citations (1275) and the most papers (171) published. The most representative reference was the 1995 article by Marler et al, which received 115 citations and had the top 3 co-occurring keywords: stroke, magnetic resonance imaging, and MRI. The article by Nogueria et al showed the strongest citation burst at the end of 2022 (strength = 17.32). High-frequency keywords in recent years are time, association, functional connectivity, thrombectomy, and rehabilitation. CONCLUSION: This study provides a scientific perspective on stroke and MRI research, provides valuable information for researchers to understand the current status of research, hotspots, and trends, and guides future research directions.

Aggressive parenting behavior among grandparents providing childcare for grandchildren: A case study of Shenzhen, China.

BACKGROUND: Grandparents play an essential role in childrearing and fill the parenting gap for dual-earner Chinese families. Many Chinese grandparents engage heavily in childcare, which may increase the risk of child abuse. OBJECTIVE: This study aimed to examine grandparental use of psychological and physical aggression toward children and explore its associated risk factors. PARTICIPANTS AND SETTING: This was a cross-sectional study which involved purposive sampling of 278 grandparents (204 females and 74 males) taking care of at least one grandchild below 18 years old in Shenzhen, China. METHODS: Information on childcare was collected, including grandparents' use of psychological and physical aggression and their involvement in childcare in terms of intensity and activity. RESULTS: An alarming percentage (57.1 %) of grandparents had used psychological aggression, while 26.5 % had used corporal punishment, in the past year. The average use of psychological aggression and corporal punishment was 16.10 times and 10.08 times per year, respectively. Grandparents taking care of two or more grandchildren were more likely to use psychological aggression and corporal punishment compared to those taking care of only one grandchild. Higher mental and physical health summary scores were associated with lower likelihood of psychological and physical aggression of grandparents. CONCLUSIONS: This study advances our understanding of negative grandparenting behavior in childcare. As grandparents play a significant role in childcare, we need to improve their grandparenting skills, provide more formal childcare services to ease their childcare burden, and support their physical and mental well-being to reduce the risk of child abuse.

Effect of different isometric trunk extension intensities on the muscle stiffness of the lumbar and lower limbs.

Purpose: To investigate the effect of isometric prone trunk extension (IPTE) contraction intensity on the stiffness of erector spinae (ES), semitendinosus (ST), biceps femoris (BF), and gastrocnemius muscles to understand the overall muscle mechanical behavior during IPTE and to explore the mechanisms of oordinated contraction of the body kinetic chain. Methods: Twenty healthy females were recruited, and participants underwent IPTE at three contraction intensities, i.e., 0% maximum voluntary isometric contraction (MVIC), 30% MVIC, and 60% MVIC, and muscle stiffness was measured using MyotonPRO. Results: Muscle stiffness was moderately to strongly positively correlated with contraction intensity (r = 0.408-0.655, p < 0.001). The percentage increase in stiffness at low intensity was much greater in ES than in lower limb muscles and greater in ST and BF than in gastrocnemius, whereas at moderate intensity, the percentage increase in stiffness decreased in all muscles, and the percentage increase in stiffness in ES was lower than that in ST. There was a moderate to strong positive correlation between ES stiffness variation and ST (r = 0.758-0.902, p < 0.001), BF (r = 0.454-0.515, p < 0.05), MG (r = 0.643-0.652, p < 0.01), LG (r = 0.659-0.897, p < 0.01). Conclusion: IPTE significantly affected the stiffness of lumbar and lower limb muscles, and low-intensity IPTE activated the ES more efficiently. There were significant coordinated muscle contractions between ES, ST, and LG. This provides preliminary evidence for exploring the overall modulation pattern of the lumbar and lower limb muscles' kinetic chains. In future studies, we will combine other stiffness assessment methods (such as Magnetic Resonance Elastography, Shear Wave Elastography, or electromyography) to corroborate our findings.

Associations between perceived material deprivation, social support and violent victimization among Chinese children.

BACKGROUND: Evidence has consistently shown that poverty is associated with the violent victimization of children. Most studies have used family income as a predictor of child poverty. However, it is unclear how multidimensional material deprivation perceived by children is associated with their victimization experiences. OBJECTIVES: This study aimed to examine the association between children's perceived material deprivation and self-reported violent victimization, as well as the role of perceived social support in mediating this relationship. PARTICIPANTS AND SETTING: This cross-sectional school-based study included 445 children aged between 8 and 16 years living in Shenzhen, China. METHODS: The conventional crime module of the Juvenile Victimization Questionnaire (JVQ), the material deprivation index based on the Poverty and Social Exclusion in Hong Kong (PSEHK) project, and the multidimensional scale of perceived social support (MSPSS) were employed to measure children's experiences of violent victimization, material deprivation, and perceived social support. RESULTS: This study discovered that, when income and other factors were controlled for, children's perceived material deprivation was positively associated with self-reported violent victimization (ß = 0.31, p < .01). However, the role played by material deprivation was undermined by high levels of perceived social support, demonstrating the full mediating relationship between perceived material deprivation and violent victimization. CONCLUSION: The findings of this study underline the importance of understanding and reducing children's perceived material deprivation in poverty alleviation and child victimization prevention. Social support is vital for children who perceive themselves as living in deprived circumstances.

Adverse Childhood Experiences: Are They Associated With Greater Risk of Elder Abuse Victimization?

Though a growing number of studies have examined the associations between adverse childhood experiences (ACEs) and negative later-life health outcomes, the effects of these early life-course factors on elder abuse victimization have yet to be fully investigated. Using a life-course perspective, this study examines the associations between ACEs and elder abuse victimization. We used data from a cross-sectional survey conducted in Beijing, China. A total of 1,002 older adults were included in this study. Retrospective self-report items were used to measure ACEs and elder abuse victimization in later life. Univariate and multivariate logistic regressions were performed to examine the associations between ACEs and elder abuse victimization. Five types of ACEs (i.e., socio-economic difficulty of the original family, parental divorce, frequent quarrels between parents, frequent physical punishment by parents, and starvation) were associated with a higher risk of elder abuse victimization. After controlling for participants' socio-demographic characteristics and adding these five types of ACEs simultaneously in the multivariate regression model, the poor socio-economic status of the original family (OR = 1.759, p < .05) and suffering frequent physical punishment inflicted by parents (OR = 2.288, p < .05) were found to be significantly associated with elder abuse victimization. To have multiple (at least 4) ACEs is a risk factor for elder abuse victimization as well (OR = 3.06, p < .001). This study provides evidence for ACEs as risk factors for elder abuse victimization. The findings highlight the importance of strengthening our understanding of the impacts of ACEs in both research and practice.

Elder Abuse and Neglect in China: Prevalence, Co-occurrence, and Intergenerational Risk Factors.

The prevalence and patterns of elder abuse and neglect in China have been understudied. The objectives of this study were to examine the chronicity and prevalence of different patterns of elder abuse, and the influence of individual and contextual risk factors. We used data from a sample of 7,466 adults randomly recruited from six regions in China. The participants responded to a questionnaire about their demographic characteristics, childhood abuse experiences, and instances of abuse and neglect against their elderly parents. Logistic regression analysis was performed to examine the association of elder abuse and neglect with individual and contextual factors. The results showed that one in 10 participants reported that their elderly parents had experienced abuse or neglect in the past year. The elder victims were reported to have suffered different types of abuse and neglect on multiple occasions, ranging from 3.6 to 11.82 times on average. More than 5% of participants reported that their elderly parents had suffered two or more types of abuse and neglect in the past year, accounting for 40% of the elderly victims. The co-occurrence of elder abuse within elderly couples was also high. Reports of abuse and neglect of elderly parents were related to low socioeconomic status, living in rural areas, and the experience of childhood abuse of the participants. This study supports the model of intergenerational transmission of violence in the Chinese population. The high prevalence, chronicity, and co-occurrence of elder abuse and neglect underline the importance of screening for risk factors, and have implications for preventive practice and policy.

Effectiveness of Digital Health Interventions on Unintentional Injury, Violence, and Suicide: Meta-Analysis.

Digital technologies are increasingly used in health-care delivery and are being introduced into work to prevent unintentional injury, violence, and suicide to reduce mortality. To understand the potential of digital health interventions (DHIs) to prevent and reduce these problems, we conduct a meta-analysis and provide an overview of their effectiveness and characteristics related to the effects. We searched electronic databases and reference lists of relevant reviews to identify randomized controlled trials (RCTs) published in or before March 2020 evaluating DHIs on injury, violence, or suicide reduction. Based on the 34 RCT studies included in the meta-analysis, the overall random effect size was 0.21, and the effect sizes for reducing suicidal ideation, interpersonal violence, and unintentional injury were 0.17, 0.24, and 0.31, respectively, which can be regarded as comparable to the effect sizes of traditional face-to-face interventions. However, there was considerable heterogeneity between the studies. In conclusion, DHIs have great potential to reduce unintentional injury, violence, and suicide. Future research should explore DHIs' successful components to facilitate future implementation and wider access.

Adverse childhood experiences, sexual orientation, and depressive symptoms among Chinese college students: An ecological framework analysis.

BACKGROUND: Extensive evidence has demonstrated that adverse childhood experiences (ACEs) predict a high risk of negative health and behavioral outcomes in later life. However, the influence of individuals' psychosocial characteristics and environmental stressors have been mostly omitted in previous research. OBJECTIVE: This study aimed to examine the prevalence of ACEs among LGB (lesbian, gay, and bisexual) and heterosexual emerging adults, and the associations between different patterns of ACE exposure and depressive symptoms after adjusting for factors at different levels. PARTICIPANTS AND SETTING: A representative sample of 928 college students in Xiamen city, China was recruited. METHODS: Latent class analysis was applied to identify the patterns of ACEs. A series of regression analyses were conducted to examine the associations between ACEs and depression and whether ACEs interacted with sexual identity to influence depression, after controlling for individual characteristics, family, school, and society-level factors. RESULTS: Over 35 % of the participants reported they had experienced at least one type of moderate to extreme childhood maltreatment, and those who identified as LGB reported a higher level of ACE exposure. Higher levels of ACE exposure based on score and clustering approaches were associated with higher risks of depression among Chinese emerging adults. However, the associations between ACEs and depression were not significantly moderated by sexual identity. CONCLUSIONS: The findings highlighted the importance of early screening for ACEs particularly among sexual minorities and of delivering tailored interventions based on ecological backgrounds. Both the traditional scoring approach and a data-driven approach can be effective in detecting the cumulative effect of ACEs.