Suicidal ideation and suicide attempts among students aged 12 to 24 after the lifting of COVID-19 restrictions in China: prevalence and associated factors.

Objective: To investigate the prevalence and associated factors of suicidal ideation and suicide attempts among adolescent and young adults in China from December 14, 2022 to February 28, 2023, when COVID-19 restrictions were lifted. Methods: Students in middle and high schools and colleges and universities in the province of Sichuan, China were asked to complete on-line cross-sectional surveys. Information was collected about sociodemographics, experiences related to the COVID-19 pandemic, suicidal ideation and suicide attempts. Participants also filled out the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 and the Social Support Rate Scale surveys. Factors associated with suicidal ideation or suicide attempts were explored using logistic regression. Results: Of the 82,873 respondents (aged 12 to 24 years), 21,292 (25.7%) reported having thought of suicide at least once in their lifetime, 10,382 (12.5%) reported having thought about suicide within the previous 12 months, and 1,123 (1.4%) reported having attempted it within the previous 12 months. Risk of lifetime suicidal ideation was higher among middle school students than among older students. Risk of suicidal ideation and risk of suicide attempts correlated directly with severity of symptoms of depression and anxiety, and inversely with level of social support. Greater risk of suicidal ideation and suicidal attempts was associated with: being female, living in an urban environment, attending a boarding school, currently being in love, having parents who divorced or remarried, having parents who exhibit non-authoritative parenting behavior, having higher family income, having been COVID-19 infected, having been quarantined for a long time, and being dissatisfied with one's education. Conclusions: Suicidal ideation and suicide attempts remain prevalent among young people in China. The potential associated factors identified in our study may be useful for targeting appropriate psychosocial interventions and developing mental health policies.

A national survey of pandemic fear and cyberchondria after ending zero-COVID policy: The chain mediating role of alexithymia and psychological distress.

BACKGROUND: More than half the domestic population in China were infected with COVID-19 in two months after ending "zero-infection policy", which severely overwhelmed frontline healthcare providers with stress and fear. However, there is no study to date investigating the associations between nurses' fear of pandemic and cyberchondria. This study aimed to 1) investigate the correlations between fear pandemic and cyberchondria among frontline nurses, and 2) discover its potential mechanism. METHODS: A cross-sectional sample of frontline nurses (N = 8161) was recruited from 98 hospitals across China in February 2023. Participants were invited to complete an online, self-rated standardized questionnaire focused on pandemic fear, alexithymia, psychological distress, and cyberchondria. Environmental, clinical and socioeconomic information were collected for adjustment while conducting chain mediation analysis. RESULTS: When other covariates were controlled, it was found that fear of the pandemic significantly contributed to cyberchondria (b = 0.58, 95%CI [0.56, 0.60], p < .001). The chain mediation model suggested that both alexithymia and psychological distress were mediating factors between pandemic fear and cyberchondria. CONCLUSIONS: The higher the perceived fear, the greater the cyberchondria, which suggests that reducing fear about the pandemic and providing adequate support could reduce the incidence of cyberchondria. As alexithymia and psychological distress may be transdiagnostic mechanisms between fear and cyberchondria, targeted interventions focused on expression dysregulation and emotional identification could be useful.

Predictive effects of organizational justice on job satisfaction in bus drivers: the moderating effects of role overload and proactive personality.

BACKGROUND: There have been few longitudinal studies on Chinese bus drivers and the individual differences in the relationships between organizational justice and job satisfaction. This study examined the organizational justice and job satisfaction in bus drivers and the individual differences in this relationship. METHODS: A two-wave longitudinal study design was employed. A first survey was conducted on 513 Chinese bus drivers in October 2021 that collected socio-demographic information and asked about their perceptions of organizational fairness. A second survey was conducted six months later that asked about role overload and job satisfaction and assessed their proactive personality type. An effect model was then used to explore the moderating effects of role overload and proactive personality type on the relationships between organizational justice and job satisfaction. RESULTS: Both procedural and interactive justice predicted the bus drivers' job satisfaction. Proactive personalities and role overload were found to enhance this relationship. CONCLUSIONS: Organizations could benefit from screening at the recruitment stage for drivers with highly proactive personalities. Relevant training for drivers with low proactive personalities could partially improve employee job satisfaction. When viewed from a Chinese collectivist cultural frame, role overload could reflect trust and a sense of belonging, which could enhance job satisfaction. Finally, to improve employee job satisfaction, organizations need to ensure procedural and interactive justice.

Reducing the risk of suicidal behaviors in medical graduate students: exploration of student-supervisor relationship and subjective family socioeconomic status.

Objective: This study aimed to investigate the association between the risk of suicidal behaviors and student-supervisor relationships and subjective family socioeconomic status (SFSS) in medical graduate students, and to propose preventive strategies to reduce the suicidal risk among medical graduate students. Materials and methods: A total of 1,310 validated questionnaires were collected from medical graduate students, which included demographic information, study programs, the Suicidal Behaviors Questionnaire-Revised (SBQ-R) questionnaire, the Leader-Member Exchange 7 (LMX-7) questionnaire, and SFSS by MacArthur Scale. Multiple regression analysis was employed to examine the associations between variables and adjust for confounders. A moderation analysis, containing simple slope analysis and Johnson-Neyman interval plots were used to analyze the moderating effect of the SFSS in the association of SBQ-R and LMX-7 scores. Results: A total of 88 participants (6.7%) were at risk of suicidal behaviors. In the high-quality student-supervisor relationship group (LMX-7 score ≥ 25), SFSS was significantly higher than in the low- and moderate-quality relationship group (p=0.002). The median SBQ-R score and proportion of suicide risk was significantly lower (p<0.001) in the high-quality student-supervisor relationship group. Multiple regression analysis indicated LMX-7 scores (ß=-0.098, 95% CI [-0.118, -0.077], p<0.001) and SFSS (ß=-0.073, 95% CI [-0.127, -0.019], p=0.008) were significantly negatively associated with SBQ-R, whereas the interaction term of SFSS with LMX-7 (ß=0.018, 95% CI [0.007, 0.029], p=0.001) showed a significant positive association with SBQ-R. The Johnson-Neyman interval showed a significant association between LMX-7 and SBQ-R scores only when SFSS was less than 7.82 (p<0.05). Conclusion: The risk of suicidal behaviors was associated with student-supervisor relationships and SFSS among medical graduate students. Poor relationships with supervisor were associated with an elevated risk of suicidality, and SFSS moderated this association. Educators should pay increased attention to the suicidal risk of medical graduate students with poor supervisor relationships, especially those from families with low SFSS, and provide timely preventive strategies.

The association of childhood trauma with suicidality in adult psychiatric patients: The mediating role of NSSI and the moderating role of self-esteem.

BACKGROUND: The contribution of specific childhood trauma subtypes to suicidal thoughts and the associated mechanisms remains unclear, particularly in psychiatric patients. METHODS: Face-to-face interviews were conducted with 449 psychiatric patients aged 18-73. Childhood trauma, self-esteem, nonsuicidal self-injury (NSSI), and suicidality were assessed retrospectively. Regression and moderated mediation model were employed to examine these relationships. RESULTS: Emotional and sexual abuse were independently associated with suicidality. Female patients reported higher levels of emotional and sexual abuse, lower self-esteem, and a heightened risk of suicide. Self-esteem moderated the links between childhood trauma and NSSI, as well as between NSSI and suicidality. NSSI served as a mediator between childhood trauma and suicidality. CONCLUSIONS: Suicide prevention in mentally ill patients should involve targeted programs addressing specific childhood trauma. Additionally, psychological interventions to enhance self-esteem and assist individuals engaging in NSSI behavior are crucial.

Clinical and cognitive effects of external trigeminal nerve stimulation (eTNS) in neurological and psychiatric disorders: a systematic review and meta-analysis.

This pre-registered (CRD42022322038) systematic review and meta-analysis investigated clinical and cognitive outcomes of external trigeminal nerve stimulation (eTNS) in neurological and psychiatric disorders. PubMed, OVID, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP database for Chinese technical periodicals were searched (until 16/03/2022) to identify trials investigating cognitive and clinical outcomes of eTNS in neurological or psychiatric disorders. The Cochrane Risk of Bias 2.0 tool assessed randomized controlled trials (RCTs), while the Risk of Bias of Non-Randomized Studies (ROBINS-I) assessed single-arm trials. Fifty-five peer-reviewed articles based on 48 (27 RCTs; 21 single-arm) trials were included, of which 12 trials were meta-analyzed (N participants = 1048; of which ~3% ADHD, ~3% Epilepsy, ~94% Migraine; age range: 10-49 years). The meta-analyses showed that migraine pain intensity (K trials = 4, N = 485; SMD = 1.03, 95% CI[0.84-1.23]) and quality of life (K = 2, N = 304; SMD = 1.88, 95% CI[1.22-2.53]) significantly improved with eTNS combined with anti-migraine medication. Dimensional measures of depression improved with eTNS across 3 different disorders (K = 3, N = 111; SMD = 0.45, 95% CI[0.01-0.88]). eTNS was well-tolerated, with a good adverse event profile across disorders. eTNS is potentially clinically relevant in other disorders, but well-blinded, adequately powered RCTs must replicate findings and support optimal dosage guidance.

Differences among fathers, mothers, and teachers in symptom assessment of ADHD patients.

Background: The Swanson Nolan, and Pelham scale version IV (SNAP-IV) is the most critical tool for ADHD screening and diagnosis, which has two scoring methods. ADHD requires symptom assessment in multiple scenarios, and parent and teacher reports are indispensable for diagnosing ADHD. But the differences of assessment results from fathers, mothers and teachers, and the consistency of results from different scoring methods are unknown. Therefore, we carried out this study to understand the differences in the scores of fathers, mothers and teachers using SNAP-IV for children with ADHD and to explore the differences in scoring results under different scoring methods. Methods: The SNAP-IV scale and Demographics Questionnaire and Familiarity Index were used to survey fathers, mothers and head teachers. Measurement data are expressed as the mean ± standard deviation (x ± s). The enumeration data were described by frequency and percentage. ANOVA was used to compare group differences in mothers', fathers', and teachers' mean SNAP-IV scores. The Bonferroni method was used for post hoc multiple comparison tests. Cochran's Q test was used to compare the differences in the abnormal rate of SNAP-IV score results of mothers, fathers and teachers. Dunn's test was used for post hoc multiple comparison tests. Results: There were differences in scores among the three groups, and the differences showed inconsistent trends across the different subscales. Differences between groups were calculated again with familiarity as a control variable. The results showed the familiarity of parents and teachers with the patients did not affect the differences in their scores. The evaluation results were different under two assessment methods. Conclusion: Results concluded that fathers did not appear to be an appropriate candidate for evaluation. When using the SNAP-V for assessment, it should be comprehensively considered from both the scorer and symptom dimensions.

Association between alexithymia and non-suicidal self-injury in psychiatric patients: the mediating role of self-esteem and the moderating role of emotional intelligence.

BACKGROUND: Raffagnato's theory claims that if people have no words to express their emotions (alexithymia), they express themselves by venting or through non-suicidal self-injury (NSSI). However, these associations have not been confirmed in psychiatric patients. This study explored the relationship between alexithymia and NSSI in psychiatric patients and the potential underlying psychological mechanisms. METHODS: This retrospective study involved face-to-face interviews with 449 outpatients consecutively recruited from West China Hospital. Alexithymia, self-esteem, NSSI, and emotional intelligence (EI) were measured. The moderating role of EI and the mediating role of self-esteem between alexithymia and NSSI were also explored. Logistic regressions were used to examine whether sociodemographic, clinical variables and alexithymia were independently associated with NSSI. RESULTS: The DSM-5 NSSI disorder and alexithymia prevalences were found to be 32.5% and 45.2%. When the other covariables were controlled for, the alexithymic patients were found to be at increased odds (OR 2.76) of engaging in NSSI behaviors. These results confirmed the strong associations between alexithymia, low self-esteem, and NSSI risk. Lower EI was found to be related to the connections between alexithymia and NSSI. Except for the lower risk in anxiety patients, the risk of NSSI was similar for patients with other mental disorders, CONCLUSION: This study revealed the psychological mechanisms through which alexithymia increases the risk of NSSI. Therefore, to reduce NSSI risk, screening for alexithymia should be emphasized. Self-esteem as a targeted psychological intervention could also assist in mitigating the process from alexithymia to NSSI behaviors, and EI training for psychiatric patients could weaken the relationship between alexithymia and NSSI.

Bullying victimization and internalizing and externalizing problems in school-aged children: The mediating role of sleep disturbance and the moderating role of parental attachment.

BACKGROUND: Studies have shown that bullying victimization may be related to internalizing and externalizing problems; however, the mechanism underlying this relationship remains unknown. This study explored the mediating role of sleep disturbance and the moderating role of parental attachment. METHODS: A total of 1543 Chinese primary school students (M age = 8.92 years, SD1.7 years; range, 6-12) completed bullying victimization, sleep disturbance, and parental attachment measures, and provided information on their parents' occupations. The parents or guardians (n = 1995) also completed ratings on their children's internalizing and externalizing problems. RESULTS: It was found that bullying victimization directly affected internalizing and externalizing problems and also influenced sleep disturbance. Regardless of the parent's socioeconomic status, parental attachment was found to moderate the relationship between bullying victimization and internalizing problems. CONCLUSIONS: These findings contribute to understanding the partial mediating mechanism of sleep disturbance in the association between bullying victimization and internalizing and externalizing problems. The protective role of parental attachment proved central to preventing internalizing problems in bullied children. Intervention programs that enhance parental attachment and improve sleep quality could assist in mitigating the impact of bullying victimization on internalizing or externalizing problems.

Longitudinal associations between pandemic post-traumatic stress symptoms and subsequent non-suicidal self-injury in adolescents: A multiple mediation model.

BACKGROUNDS: PTSD is one of the most common conditions after people have experienced trauma. While previous studies have found a link between PTSD and non-suicidal self-injury, (NSSI), few studies have longitudinally explored this relationship and the underlying mechanisms. AIMS: This study explored adolescent NSSI frequency after COVID-19 lockdown experiences, the relationship with early PTSD symptoms, and the mediating role of depression and sleep problems. METHODS: A cohort of 1609 adolescents completed two surveys during and after the national lockdown in China; one month into the lockdown and six months later; which assessed demographic and pandemic-related exposure variables; PTSD, depression, sleep, and NSSI. Mediation analyses and hierarchical regression were employed to examine the relationships and the paths between these variables. RESULTS: The NSSI rate was found to be 31.9 % after the three-month lockdown, with 20.6 % of adolescent participants reporting sleeping disorders, and 33.9 % indicating probable depression. Adolescents who had earlier PTSD symptoms, often smoked and/or drank, and had current depression and sleep disorders reported greater NSSI. Early PTSD symptoms were found to predict later NSSI and were mediated by sleep problems and depressive symptoms. Specifically, PTSD avoidance and numbing symptoms were significantly associated with NSSI above and beyond the depressive symptoms, sleeping problems, and the other covariables. CONCLUSION: It is necessary to be vigilant about the increased risk of NSSI in adolescents who have experienced extended pandemic lockdowns. Preventing early adolescent PTSD symptoms, especially avoidance and numbness, and helping teenagers quit smoking and drinking could reduce the risk of sleep disorders, depression, and NSSI.

The association between the deviation from balanced time perspective on adolescent pandemic mobile phone addiction: the moderating role of self-control and the mediating role of psychological distress.

Background: Few studies have examined the impact that the deviation from balanced time perspective (DBTP) had on mobile phone addiction during the COVID-19 normalization prevention and control phase. Therefore, this study sought to determine the associations between DBTP, depression and anxiety, self-control, and adolescent mobile phone addiction. Methods: The moderated mediating model was tested using the SPSS PROCESS model. The sample was 1,164 adolescents from different regional areas of Sichuan, China. From February to March 2020, participants completed the Zimbardo time perspective inventory (ZTPI), the brief symptom inventory for physical and mental health (BSI-18), the self-control scale (SCS), and the Chinese version of the mobile phone addiction index (MPAI). Results: The DBTP was significantly and positively correlated with mobile phone addiction, depressive and anxiety symptoms mediated the relationship between DBTP and mobile phone addiction, self-control moderated the indirect effect of DBTP on mobile phone addiction, and as the level of self-control increased, the effect of DBTP on anxiety and depression and the effect of depression and anxiety on mobile phone addiction weakened. Conclusion: During the COVID-19 pandemic, DBTP and lower self-control were risk factors for higher mobile phone addiction in adolescents. Therefore, guiding adolescents to balance their time perspective and enhance their self-control could strengthen their psychological well-being and reduce addictive mobile phone behaviors. This research was supported by "Youth Fund of the Ministry of Education" (18YJCZH233): "Research on the plastic mechanism of decision-making impulsiveness of anxious groups in the context of risk society."

Optimism and friendship quality as mediators between trait emotional intelligence and life satisfaction in Chinese adolescents: A two-wave longitudinal study.

Using a convenience sample of adolescents (N = 1609; 63.5% female; M age = 16.54), this study explored whether EI predicted adolescent life satisfaction and whether friendship quality and optimism mediated this relationship during the COVID-19 pandemic. The structural equation modeling revealed that EI predicted adolescent life satisfaction, friendship quality, and optimism, friendship quality partially mediated the relationship between EI and life satisfaction, and optimism partially mediated the relationship between EI and friendship quality. These findings prove that psychological or educative approaches focused on EI could increase life satisfaction in adolescents during difficult times such as COVID-19, but EI may be linked with life satisfaction via friendship quality only. Training in optimism approaches and friendship quality enhancement programs could also effectively promote life satisfaction.

Childhood abuse, left-behind status and mental health among lesbian, gay, and bisexual young adults in China.

BACKGROUND: Lesbian, gay, and bisexual (LGB) young adults are at increased risk of mental distress in China. To better carry out psychological intervention, it is essential to understand unique patterns of mental distress and their association with childhood abuse/neglect, including experiencing being left behind by migrating parents. OBJECTIVE: In a sample of Chinese LGB young adults, we examined: (1) associations between childhood abuse and left-behind status and mental distress; (2) latent profiles of mental distress; and (3) associations between childhood abuse and left-behind status and latent profiles of mental distress. PARTICIPANTS AND SETTING: A sample of 630 Chinese LGB young adults aged 18-30 years was recruited to complete an online survey. METHODS: Participants provided demographic information and completed validated measures of childhood abuse experience and mental distress. Latent profile analysis (LPA) was used to identify patterns of mental distress, and logistic regression analysis was used to examine the relationships among these variables. RESULTS: Results showed that all forms of childhood abuse and left-behind status were associated with all dimensions of adulthood mental distress. The LPA suggested a 3-group solution as optimal (no mental distress, mild mental distress, and moderate/severe mental distress). Participants who experienced any forms of childhood abuse were more likely to be members of both the mild mental distress and moderate/severe mental distress groups (all p's < 0.001). Also, participants who had left-behind status were more likely to be in the moderate/severe mental distress group (AOR = 1.61, p < .05). CONCLUSIONS: Our findings highlight the need for interventions aimed at addressing childhood abuse/neglect among Chinese LGB young adults, as these experiences increase the risk for mental health issues in adulthood.

Alexithymia and post-traumatic stress disorder symptoms in Chinese undergraduate students during the COVID-19 national lockdown: The mediating role of sleep problems and the moderating role of self-esteem.

Objective: This study examined whether sleep disturbance was a mediator between alexithymic traits and post-traumatic stress disorder (PTSD) COVID-19 pandemic-related stress symptoms, and explored whether self-esteem moderated the alexithymic contribution to poor sleep and PTSD symptoms. Method: A representative sample of young adults (N = 2,485) from six universities in Southwest China completed online self-report surveys on alexithymia, sleep, PTSD, self-esteem, sociodemographic information, and health-related behaviors. Results: High alexithymic young adults were found to be more likely to have higher sleep problems and higher PTSD symptoms. The moderated mediation model showed that sleep problems mediated the associations between alexithymia and PTSD symptoms. Alexithymic people with lower self-esteem were more likely to have elevated PTSD symptoms and sleep problems than those with higher self-esteem. Conclusion: Targeted psychological interventions for young people who have difficulty expressing and identifying emotions are recommended as these could assist in reducing their post-traumatic psychophysical and psychological problems. Improving self-esteem could also offer some protection for trauma-exposed individuals.

A single-ion magnet building block strategy toward Dy2 single-molecule magnets with enhanced magnetic performance.

A molecular dysprosium(III) complex [Dy(DClQ)3(H2O)2] (1) was used as a building unit for the construction of lanthanide SMMs, leading to the isolation of two dinuclear Dy(III) complexes, namely [Dy2(DClQ)6(MeOH)2] (2) and [Dy2(DClQ)6(bpmo)2]·6MeCN (3) (DClQ = 5,7-dichloro-8-hydroxyquinoline, bpmo = 4,4'-dipyridine-oxide). Structural analyses revealed the same N3O5 coordination environment of the Dy(III) centers with a distorted biaugmented trigonal prism (C2V symmetry) and triangular dodecahedron (D2d symmetry) for 2 and 3, respectively. Magnetic studies revealed the presence of ferromagnetic and weak antiferromagnetic exchange interactions between the Dy3+ centers in 2 and 3, respectively. Interestingly, slow relaxation of magnetization at zero fields was evidenced with an Ueff of 51.4 K and 159.0 K for complexes 2 and 3, respectively. The detailed analysis of relaxation dynamics discloses that the Orbach process is dominant for 2 whereas Raman and QTM play an important role in 3. Theoretical calculations were carried out to provide insight into the magnetic exchange interactions and relaxation dynamics for the complexes. Due to a single-ion magnet (SIM) of 1, the foregoing results demonstrate a SIM modular synthetic route for the preparation of dinuclear lanthanide SMMs.

Fear of COVID-19, prolonged smartphone use, sleep disturbances, and depression in the time of COVID-19: A nation-wide survey.

Background: The COVID-19 pandemic has had a wide range of behavioral and psychological effects on the general population. This study examined the relationship between fear of COVID-19, daily smartphone use, sleep disturbance, and depression in the general population during the early stage of COVID-19. Methods: An online nation-wide survey was conducted from March 20 to April 10, 2020. Sociodemographic information, including age, gender, educational attainment, vocation, and duration of self-isolation, was collected; fear of COVID-19 and other objective exposures, daily hours of smartphone use, night sleep duration, sleep disturbance, and depressive symptoms were measured with structured questions and PHQ-9. There were 1,280 questionnaires in total, and 1,250 valid questionnaires remained. Results: The prevalence of sleep disturbance and depression were found to be 13.1 and 10.7%, respectively. Feelings of extreme fear, longer smartphone use, difficulty initiating sleep, and early morning awakening were significant risk factors for depression. Daily hours of smartphone use, difficulty initiating sleep, and early morning awakening partially mediated the association between feeling extremely scared of the pandemic and depression. Conclusion: Psychological interventions in a major public health crisis should focus more on the subjective perception of pandemic fear. At the same time, daily smartphone use and sleep disturbances could serve as targets for monitoring and intervention for depression during a pandemic.

Adolescent mobile phone addiction during the COVID-19 pandemic predicts subsequent suicide risk: a two-wave longitudinal study.

Both the rate of mobile phone addiction and suicidality among adolescents have increased during the pandemic lockdown. However, the relationship between mobile phone addiction and suicide risk and the underlying psychological mechanisms remains unknown. This study examined the associations between mobile phone addiction in adolescents during the first month of lockdown and the suicide risk in the subsequent five months. A two-wave short-term longitudinal web-based survey was conducted on 1609 senior high school students (mean age = 16.53 years, SD = 0.97 years; 63.5% female). At Time 1 (T1), the severity of mobile phone addiction and basic demographic information was collected from Feb 24 to 28, 2020 in Sichuan Province, China (at the pandemic's peak). Five months later, between July 11 and July 23 (Time 2, T2), mobile phone addiction, daytime sleepiness, depression, and suicidality were measured within the past five months. The regression analysis revealed that mobile phone addiction during quarantine directly predicted suicidality within the next five months, even after controlling for the effect of depression and daytime sleepiness. Meanwhile, mobile phone addiction at T1 also indirectly predicted suicidality at T2, with depression and daytime sleepiness mediating this association. Programs targeting improvement of daytime sleepiness and depressive symptoms may be particularly effective in reducing suicide risk among adolescents with mobile phone addiction.

Heterosexual Marital Intention: The Influences of Confucianism and Stigma Among Chinese Sexual Minority Women and Men.

In traditional Confucianist culture in China, marriage and offspring are highly valued, placing sexual minority adults under tremendous pressure to marry an opposite sex partner. This study explored how Confucianism and stigma were associated with the intention to pursue a heterosexual marriage among Chinese sexual minority individuals as well as the moderating mechanisms of gender and age. Cross-sectional data were collected from 747 participants via online social networks from March to June 2020. Items assessed Confucianism values (communalism, filial piety, traditional gender roles); stigma (rejection sensitivity, social discrimination); and heterosexual marital intention (HMI). A total of 1.7% (n = 12) participants had ever been married, 11.6% (n = 87) planned to marry a different-sex partner, 60.4% (n = 451) had no intention to pursue a heterosexual marriage, and 26.4% (n = 197) had no specific marital plan. Bisexual participants scored significantly higher than homosexual individuals in HMI. Sexual minority adults with high levels of Confucianism and stigma were more likely to intend to marry. Importantly, both individual stigma (rejection sensitivity) and interpersonal stigma (social discrimination) partially mediated the relationship between Confucianism and HMI. Confucianism had a stronger impact on HMI for men than women, and age moderated the influence of Confucianism (including communalism and filial piety) on HMI, with a stronger impact for younger than older generations. This study contributes to a better understanding of how Confucianism and stigma may be connected to the intention to pursue a heterosexual marriage, suggesting culture-modified theories of stigma and sexual minority stress are needed to explain the experiences of sexual minority people in contemporary China.

Effects of Stress in Adaptation to Undergraduate Life on Psychiatric Morbidity: Mediating Effects of Early Trauma and Adverse Family Factors.

Purpose: University students experience high levels of stress, and the prevalence of depression is higher than in the general population. The reason is not clear. More effective interventions and better prevention are needed. Methods: We did annual cross-sectional surveys of Chinese undergraduates 2014-2018 (mean age 18.7 [SD 2.1], N = 39,573). We measured adaptation to university life using the Adolescent Self-rating Life Events Checklist (ASLEC) and common mental disorders using standardized self-report instruments. Regression analyses identified associations between childhood maltreatment, current family problems, stress in adaptation to undergraduate life, and psychiatric morbidity. Mediation analyses further tested relationships between these factors. Results: Childhood maltreatment, current family problems, stress in adaptation, and psychiatric morbidity were all significantly associated with each other. The strongest association between childhood experiences and psychiatric morbidity was for sexual abuse and depression (OR = 3.39, 95%CI: 2.38-4.83, p < 0.001) and between stress from adaptation and somatic disorder (OR = 4.54, 95%CI: 3.62-5.68, p < 0.001). Associations between childhood maltreatment and stress from university life were partly mediated by psychiatric morbidity. Associations between family problems and psychiatric morbidity were mediated by stress from university life. Conclusions: Stress from adaptation to university life and pressures from academic study exert stronger effects on psychiatric morbidity among students than childhood traumatic experiences and current family problems, although these factors are closely interrelated. Mental health services for students should focus on adaptation to university life and pressures from academic study as well as external factors of childhood trauma and family problems.