The Tripartite Model for Assessing Symptoms of Depression and Anxiety: Psychometric Properties of the Chinese Version of the Mood and Anxiety Symptoms Questionnaire in Patients With Essential Hypertension.

BACKGROUND: In patients with hypertension, psychosocial factors, such as depressive symptoms and anxiety, are associated with reduced quality of life and triple the risk of nonadherence with medical treatment regimens. Thus, screening tests are crucial to identify patients who may require further assessment and treatment. OBJECTIVES: The objective of the current study was to test the psychometric properties of the Chinese version of the Mood and Anxiety Symptoms Questionnaire-Short Form (MASQ-SF-C) in patients with essential hypertension. METHODS: The MASQ-SF-C, the Center for Epidemiologic Studies Depression Scale (CES-D), and the State-Trait Anxiety Inventory (STAI) were administered to a convenience sample of 869 hypertensive patients in 4 hospitals. A confirmatory factor analysis was used to test the tripartite model. We evaluate the internal consistency of the MASQ-SF-C and we used the Bland-Altman approach to evaluate convergent validity between the MASQ-SF-C t score and symptoms of (1) depressive symptoms and (2) anxiety. RESULTS: Cronbach's α coefficient for the total MASQ-SF-C was .95, and Cronbach's α coefficients for the 3 subscales were .83 for anhedonic depression (AD), .91 for anxiety arousal (AA), and .94 for general distress (GD), indicating adequate internal consistency reliability. The mean interitem correlation coefficients were as follows: MASQ-SF-C, 0.29; AD, 0.28; AA, 0.38; and GD, 0.40. The 1-month test-retest reliability for the MASQ-SF-C was 0.72. Confirmatory factor analyses indicated that the 3 first-order factors (GD, AD, and AA) fit the data well (nonnormed fit index = 0.953, comparative fit index = 0.936, incremental fit index = 0.936, root-mean-square error of approximation = 0.038). CONCLUSIONS: This study supported the reliability and validity of the MASQ-SF-C, indicating that it can be used for assessing depressive symptoms and anxiety concurrently in Chinese-speaking patients with hypertension.

Rumination and depression in Chinese university students: The mediating role of overgeneral autobiographical memory.

OBJECTIVE: In this study, we examined the mediator effects of overgeneral autobiographical memory (OGM) on the relationship between rumination and depression in 323 Chinese university students. METHOD: 323 undergraduates completed the questionnaires measuring OGM (Autobiographical Memory Test), rumination (Ruminative Response Scale) and depression (Center for Epidemiologic Studies Depression Scale). RESULTS: Results using structural equation modeling showed that OGM partially-mediated the relationship between rumination and depression (χ2 = 88.61, p < .01; RMSEA = .051; SRMR = .040; and CFI = .91). Bootstrap methods were used to assess the magnitude of the indirect effects. The results of the bootstrap estimation procedure and subsequent analyses indicated that the indirect effects of OGM on the relationship between rumination and depressive symptoms were significant. CONCLUSION: The results indicated that rumination and depression were partially mediated by OGM.

Clinical Outcomes Following Acute Residential Psychiatric Treatment in Transgender and Gender Diverse Adolescents.

Importance: Transgender and gender diverse (TGD) individuals, who have a gender identity that differs from their sex assigned at birth, are at increased risk of mental health problems, including depression, anxiety, self-injurious behavior, and suicidality, relative to cisgender peers. Objective: To examine mental health outcomes among TGD vs cisgender adolescents in residential treatment. Design, Setting, and Participants: This cohort study's longitudinal design was used to compare groups at treatment entry and discharge, and 1-month postdischarge follow-up. The setting was an adolescent acute residential treatment program for psychiatric disorders. Participants were TGD or cisgender adolescents enrolled in the treatment program. Statistical analysis was performed October 2019 to March 2021. Exposure: Adolescents participated in a 2-week acute residential treatment program for psychiatric disorders. Main Outcomes and Measures: Primary outcomes were depressive (the Center for Epidemiologic Studies Depression Scale [CES-D]) and anxiety (the Multidimensional Anxiety Scale for Children [MASC]) symptoms, and emotional dysregulation (the Difficulties in Emotion Regulation Scale [DERS]), measured at treatment entry and discharge, and postdischarge follow-up. Age of depression onset, suicidality, self-injury, and childhood trauma also were assessed at treatment entry. Results: Of 200 adolescent participants who completed treatment entry and discharge assessments, the mean (SD) age was 16.2 (1.5) years; 109 reported being assigned female at birth (54.5%), 35 were TGD (17.5%), and 66 (49.3%) completed 1-month follow-up. TGD participants had an earlier mean (SD) age of depression onset (TGD: 10.8 [2.4] years vs cisgender: 11.9 [2.3] years; difference: 1.07 years; 95% CI, 0.14-2.01 years; P = .02), higher mean (SD) suicidality scores (TGD: 44.4 [23.1] vs cisgender: 28.5 [25.4]; difference: 16.0; 95% CI, 6.4-25.5; P = .001), more self-injurious behavior (mean [SD] RBQ-A score for TGD: 3.1 [2.5] vs cisgender: 1.7 [1.9]; difference: 1.42; 95% CI, 0.69-2.21; P = .001) and more childhood trauma (eg, mean [SD] CTQ-SF score for emotional abuse in TGD: 12.7 [5.4] vs cisgender: 9.8 [4.7]; difference: 2.85; 95% CI, 1.06-4.64; P = .002). The TGD group also had higher symptom scores (CES-D mean difference: 7.69; 95% CI, 3.30 to 12.08; P < .001; MASC mean difference: 7.56; 95% CI, 0.46 to 14.66; P = .04; and DERS mean difference: 18.43; 95% CI, 8.39 to 28.47; P < .001). Symptom scores were significantly higher at entry vs discharge (CES-D mean difference, -12.16; 95% CI, -14.50 to -9.80; P < .001; MASC mean difference: -3.79; 95% CI, -6.16 to -1.42; P = .02; and DERS mean difference: -6.37; 95% CI, -10.80 to -1.94; P = .05) and follow-up (CES-D mean difference: -9.69; 95% CI, -13.0 to -6.42; P < .001; MASC mean difference: -6.92; 95% CI, -10.25 to -3.59; P < .001; and DERS mean difference: -12.47; 95% CI, -18.68 to -6.26; P < .001). Conclusions and Relevance: This cohort study found mental health disparities in TGD youth relative to cisgender youth, with worse scores observed across assessment time points. For all participants, primary clinical outcome measures were significantly lower at treatment discharge than at entry, with no significant differences between discharge and 1-month follow-up. Given the substantial degree of mental health disparities reported in TGD individuals, these findings warrant focused clinical attention to optimize treatment outcomes in gender minority populations.

The cost of materialism in a collectivistic culture: predicting risky behavior engagement in Chinese adolescents.

The goals of the current study were to examine whether (a) negative events mediate the relationship between materialism and risky behavior engagement and (b) materialism moderates the relationship between stress and engagement in risky behaviors in Chinese youth. At Time 1, 406 adolescents (ages 14-19) from Yue Yang, China, completed measures assessing engagement in risky behaviors and the occurrence of negative events. Follow-up assessments occurred once a month for 6 months. In line with our hypotheses, results of hierarchical linear modeling analyses indicated that higher levels of negative events mediated the relationship higher levels of materialism and greater risky behavior engagement. In addition, adolescents who exhibited higher levels of materialism were more likely than adolescents possessing lower levels of materialism to report increased engagement in risky behaviors in response to negative life events. At the same time, the effect was only present in boys. Unexpectedly, girls who reported lower levels of materialism also exhibited increased engagement in risky behaviors in response to negative events.

Coping and involuntary responses to stress in Chinese university students: psychometric properties of the responses to stress questionnaire.

Our objective in this study was to develop a Chinese version of the Responses to Stress Questionnaire (RSQ; Connor-Smith, Compas, Wadsworth, Thomsen, and Saltzman, 2000) and to evaluate its reliability and validity. The Chinese (C) RSQ (RSQ-C) exhibited moderate internal consistency and moderate test-retest reliability. Results of the confirmatory factor analyses indicated that the fit of a 3-factor model of voluntary coping and a separate 2-factor model of involuntary responses to stress were acceptable for the Chinese university sample. With regard to predictive validity, the Primary and Secondary Control Engagement Coping factors were associated with lower levels of depressive and anxious symptoms, whereas the Disengagement, Involuntary Engagement, and Involuntary Disengagement Coping factors were associated with higher levels of such symptoms.

Development and validation of the revised Children's Dysfunctional Attitudes Scale.

OBJECTIVES: The primary goals of the current study were to examine (a) the factor structure and reliability of the Children's Dysfunctional Attitudes Scale (CDAS) in a sample of children and early adolescents and (b) the reliability of the factor structure in two additional independent samples at different developmental stages. DESIGN: In Phase 1, we conducted a factor analysis using maximum likelihood factor extraction and promax rotation to explore the underlying structure of the 40-item CDAS. In Phase 2, we conducted a confirmatory factor analysis on the factors obtained in Phase 1. METHODS: In Phase 1, 140 children (ages 6-14) of affectively ill parents completed the CDAS and measures assessing depressive symptoms, coping strategies, and cognitive-interpersonal vulnerability factors. In Phase 2, 130 third grade children and 184 seventh grade schoolchildren completed similar measures. RESULTS: In Phase 1, a two-factor solution was obtained: (1) Self-critical Perfectionism (SCP) and (2) Personal Standards Perfectionism (PSP). In Phase 2, a two-factor solution provided a significantly better fit than a one-factor solution in both grades. The two factors obtained exhibited high internal consistency in both our high-risk and community samples. Additionally, in both samples, SCP was more strongly associated with depressive symptoms, maladaptive coping strategies, and impaired interpersonal relationships than was PSP. CONCLUSION: The results of the current study suggest that dysfunctional attitudes cluster into SCP and PSP in children as well as early adolescents. Further, SCP may have a more deleterious impact on children's psychosocial functioning as compared to PSP.

Levels of neuroticism differentially predict individual scores in the depression and anxiety dimensions of the tripartite model: A multiwave longitudinal study.

The associations between neuroticism and depression and anxiety symptoms remain unclear possibly due to the lack of specificity and covariation among common symptoms. The current study hypothesized that neuroticism acts as a vulnerability factor for general distress (GD) and specific depression and anxiety symptoms. We investigated this hypothesis using the "tripartite model" (a well-known dimensional model of anxiety and depression). A sample of 644 college students was recruited from Hunan, China. In the initial stage of this investigation, the students completed self-assessment forms to measure their levels of neuroticism and frequency of daily hassles. The students also reported on their levels of GD and specific depression and anxiety symptoms. The same self-assessment procedure was undertaken once a month for the next 6 months. The results of the hierarchical linear model suggest a significant interaction between neuroticism and the level of stress caused by exposure to increased levels of daily hassles, which can be used as a predictor of future levels of GD and specific anxiety symptoms. However, the same interaction was not a significant predictor of specific depression symptoms. The current findings suggest that neuroticism may be a risk factor for specific anxiety but not for specific depression symptoms in face of stress caused by daily hassles.

The "weakest link" as an indicator of cognitive vulnerability differentially predicts symptom dimensions of anxiety in adolescents in China.

This multiwave longitudinal study examined the cognitive vulnerability-stress component of hopelessness theory to differentially predict symptom dimensions of anxiety using a "weakest link" approach in a sample of adolescents from Hunan Province, China. Baseline and 6-month follow-up data were obtained from 553 middle-school students. During an initial assessment, participants completed measures of assessing their weakest links, anxious symptoms, and the occurrence of stress. Participants subsequently completed measures assessing stress, and anxious symptoms one a month for six months. Higher weakest link scores were associated with greater increases in the harm avoidance and separation anxiety/panic dimensions, but not the physical or social anxiety dimension, of anxious symptoms following stress in Chinese adolescents. These results support the applicability of the "weakest link" approach, derived from hopelessness theory, in Chinese adolescents. Weakest link scores as cognitive vulnerability factors may play a role in the development of anxious symptoms, especially in the cognitive dimensions (e.g., harm avoidance and separation anxiety/panic). Our findings also have potential value in explaining the effectiveness of cognitive relevant therapy in treating the cognitive dimensions of anxious symptoms.

'Weakest Link' as a Cognitive Vulnerability Within the Hopelessness Theory of Depression in Chinese University Students.

The current study tested the cognitive vulnerability-stress component of hopelessness theory using a 'weakest link' approach (e.g. an individual is as cognitively vulnerable to depression as his or her most depressogenic attributional style makes him or her) in a sample of Chinese university students. Participants included 520 students in Changsha. During an initial assessment, participants completed measures assessing weakest link, depressive symptoms and occurrence of negative events once a month for 6 months. Results from hierarchical linear modelling analyses showed that higher levels of weakest link scores were associated with greater increases in depressive symptoms following the occurrence of negative events. Higher weakest link level was associated with greater increases in depressive symptoms over time. These results provide support for the applicability of the 'weakest link' approach to the hopelessness theory to Chinese university students.

Altered white matter integrity in individuals with cognitive vulnerability to depression: a tract-based spatial statistics study.

The microstructure of white matter in patients with major depressive disorder (MDD) has been demonstrated to be abnormal. However, it remains unclear whether these changes exist prior to the onset of disease. In this study, diffusion tensor imaging was used to evaluate white matter integrity in individuals who exhibited cognitive vulnerability to depression (CVD), MDD, and healthy controls (HC). Compared with the HC, MDD exhibited a lower fractional anisotropy (FA) in ten brain regions: the cerebral peduncle, the anterior and posterior limbs of the internal capsule (ALIC and PLIC), the external capsule, the retrolenticular part of the internal capsule (RLIC), the body and splenium of the corpus callosum, the superior and posterior corona radiata, and the cingulum. Moreover, CVD had significantly lower FA in the ALIC, the PLIC, the external capsule, the RLIC, the cerebral peduncle, and the superior corona radiata than did the HC. However, the white matter integrity was not significantly different between the CVD and MDD. These preliminary results indicate that alterations in the white matter observed in CVD may be a marker of vulnerability to MDD and that these alterations may exist prior to the onset of depression.

Positive orientation: explorations on what is common to life satisfaction, self-esteem, and optimism.

AIM: Literature documents that the judgments people hold about themselves, their life, and their future are important ingredients of their psychological functioning and well-being, and are commonly related to each other. METHODS: We used confirmatory factor analysis (CFA) under the classical test theory, regression analysis, and a cross national design. RESULTS: This study provides new findings attesting to the hypothesis that evaluations about oneself, one's life, and one's future rest on a common mode of viewing experiences which we named "Positive Orientation". CONCLUSIONS: Results from an Italian and a Canadian study are presented, attesting to a latent dimension that lies at the core of positive evaluations and that corroborates the utility of the new construct as a critical component of individuals' well-functioning.

Measuring adolescent psychopathology: psychometric properties of the self-report strengths and difficulties questionnaire in a sample of Chinese adolescents.

PURPOSE: The Strengths and Difficulties Questionnaire (SDQ) is a brief but comprehensive screening tool for adolescent psychopathology. The current study examined the psychometric properties of the Chinese version of the self-report form of the SDQ (SDQ-C). METHODS: Participants included 1135 adolescents (15.1 +/- 1.8 years, 561 boys and 574 girls) recruited from five schools in mainland China. During a single school-based assessment, participants completed the SDQ-C and the Youth Self Report (YSR). RESULTS: Chinese adolescents scored significantly higher on the peer problems subscale and significantly lower on the emotional symptoms, hyperactivity, and prosocial behavior subscales than did the British normative sample. Girls scored higher on the emotional symptoms subscale and lower on the conduct and peer problems subscales than did boys. Participants between the ages of 15 and 18 years scored higher on the hyperactivity and prosocial behavior subscales and lower on the peer problems subscale than did participants between the ages of 11 and 14. The SDQ-C exhibited strong internal consistency (overall Cronbach's alpha coefficient was .81) and moderate test-retest reliability (Pearson's correlation coefficient was .71 over an 8-week interval). Each SDQ-C subscale score was highly correlated with the corresponding subscale score of the YSR. Confirmatory factor analysis indicated that both the five-factor structure and the higher-order structure of the SDQ-C were suitable and invariant across sex and age. CONCLUSIONS: The SDQ-C exhibited high levels of reliability and validity, indicating that the SDQ-C is appropriate for assessing psychopathology in Chinese adolescents.