Eight-Year Trajectories of Late-Life Loneliness and Incident Dementia: A Nationally Representative Cohort Study.

OBJECTIVE: Some older adults with loneliness might have transient loneliness, followed by full remission, while others might have persistent loneliness. Such different courses might differ in predicting the risk of dementia, but most previous studies assessed short-term loneliness at a single time point, ignoring the long-term changes of loneliness. This study aimed to explore the association between 8-year trajectories of late-life loneliness and incident dementia. METHODS: Data were from the English Longitudinal Study of Ageing (waves 2-9). This study included 6,722 older adults measured for loneliness greater than or equal to three times from wave 2 (2004-2005) to wave 6 (2012-2013) and free from dementia in wave 6. Loneliness was assessed using the short 1980 version of the University of California, Los Angeles Loneliness Scale. Group-based trajectory modeling was used to explore loneliness trajectories during waves 2-6. Cox proportional hazard models were used to investigate the association of loneliness trajectories with incident dementia during waves 6-9. RESULTS: Five distinct loneliness trajectories were identified: long-term low, persistently decreasing, persistently increasing, long-term moderate, and long-term high. Compared with long-term low loneliness, the HRs (95% confidence intervals) for persistently decreasing, persistently increasing, long-term moderate, and long-term high loneliness were 1.29 (0.83-2.00), 1.55 (1.04-2.31), 1.56 (1.03-2.38), and 3.35 (1.89-5.91), respectively. CONCLUSION: The elderly show distinct patterns of loneliness over time, which cannot be captured by a single assessment of loneliness. The elderly with long-term loneliness and persistently increasing loneliness might be the high-risk group for dementia. Further studies are needed to determine whether reducing loneliness can prevent dementia.

Childhood maltreatment and subsequent depressive symptoms: a prospective study of the sequential mediating role of self-esteem and internalizing/externalizing problems.

BACKGROUND: Depression among adolescents is a seriously disabling public health problem with an extremely high prevalence. Identifying risk factors of depression at an early stage is important to reduce the disease burden. Childhood maltreatment (CM) is one of the major risk factors for depression. The key mediating processes that how CM affects the development of depression, however, still need further clarification. The present study tested the mediating effect of self-esteem, internalizing problems, and externalizing problems between CM and depressive symptoms. Potential sex differences in the foregoing associations were also explored. METHODS: A three-wave longitudinal study was carried out among 1,957 middle and high school students from 69 classes in 10 public schools in the Guangdong province of China. Data collection started when students were in grades 7 and 10 (median age: 13.0, range: 11-18) between January and April 2019, and the students were followed up once a year thereafter. Self-reported CM, depressive symptoms, self-esteem, internalizing and externalizing problems, and other demographics were collected. The multiple serial mediation analysis was conducted. RESULTS: We found that CM was positively related to subsequent internalizing and externalizing problems, as well as depressive symptoms, while self-esteem was negatively related to depressive symptoms. Serial mediation analysis indicated that self-esteem (mediator 1) and internalizing problems (mediator 2) sequentially mediated the path from CM to depressive symptoms in the overall and male population. Moreover, with externalizing problems as mediator 2, self-esteem (mediator 1) acted as a partial mediator in the association between CM and depressive symptoms in males, whereas externalizing problems played a complete mediating role in females. CONCLUSION: Findings revealed that self-esteem and internalizing problems sequentially mediated the influence of CM on depressive symptoms whereas externalizing problems played an independent mediating role. In addition, sex differences need to be taken into consideration when designing prevention and intervention strategies, given the different psychosocial processes between boys and girls.

The Effect of Internet-Based Cognitive Behavioral Therapy on Major Depressive Disorder: Randomized Controlled Trial.

BACKGROUND: Many people living with major depressive disorder (MDD) in China do not receive treatment owing to a lack of mental health services, along with significant stigma toward mental illness. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase access to mental health care for people with MDD. OBJECTIVE: The aims of this study were to (1) evaluate the efficacy of ICBT for depressive symptoms in patients with MDD; (2) evaluate the effect of ICBT on anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social function, and health-related quality of life (HRQoL); and (3) explore the acceptability of and satisfaction with the ICBT program among participants. METHODS: Patients with MDD were enrolled and randomized to the ICBT group or the waiting-list control (WLC) group. The ICBT group received ICBT delivered through a WeChat mini-program with general support by nonspecialists. Participants in the 2 groups were self-evaluated online at baseline and posttreatment for changes in the primary outcome (ie, depressive symptoms) and secondary outcomes (ie, anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social functional impairment, and HRQoL). Changes in outcomes were measured by changes in overall scores on respective scales, and response and remission rates were calculated based on depressive symptoms. The acceptability of and satisfaction with the ICBT program were measured by treatment adherence and participants' feelings (ie, modules seriously completed, perceived benefit, and satisfaction). RESULTS: We included 40 patients who were randomly assigned to the ICBT group and 44 who were assigned to the WLC group. Compared with the WLC group, the ICBT group had fewer depressive symptoms, fewer anxiety symptoms, less nonspecific psychological distress, and greater general self-efficacy. Moreover, the ICBT group had higher response (18/31, 58%) and remission rates (17/31, 55%). The adherence rate in the ICBT group was 78% (31/40), and the majority of participants who completed all ICBT modules were satisfied with the ICBT program. CONCLUSIONS: ICBT demonstrated greater improvements in depressive symptoms, anxiety symptoms, nonspecific psychological distress, and general self-efficacy among selected patients with MDD in comparison with the findings in waiting-list controls. The ICBT program in this study had good acceptability and satisfaction among participants. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2100046425); https://tinyurl.com/bdcrj4zv.

Global, regional, and national burden of ambient and household PM2.5-related neonatal disorders, 1990-2019.

Previous studies have shown a relationship between fine particulate matter (PM2.5) exposure and an increased risk of neonatal disorders. Considering the huge burden of neonatal disorders, we assessed spatiotemporal trends of neonatal disorders burden caused by ambient and household PM2.5 at the global, regional, and national levels from 1990 to 2019. The number, rate, and population attributable fraction (PAF) of ambient and household PM2.5-related neonatal disorders disability-adjusted life years (DALYs) in 204 countries and territories from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019 to measure the related neonatal disorders burden by age, sex, subtype, and region. Estimated annual percentage change (EAPC) was estimated to quantify temporal trends. In 2019, approximately a fifth of the global neonatal disorders burden was attributable to PM2.5 exposure, with 7.54% for ambient PM2.5 and 13.23% for household PM2.5. Although the global neonatal disorders burden attributable to household PM2.5 has decreased substantially in the past 30 years, that attributable to ambient PM2.5 has increased, especially in lower sociodemographic index (SDI) regions. The highest rate and PAF of ambient PM2.5-related neonatal disorders DALYs in 2019 were in South Asia and East Asia, respectively, and the fastest increases were in Eastern Sub-Saharan Africa (for rate: EAPC = 2.55, 95% CI: 2.37-2.73) and South Asia (for PAF: EAPC = 3.88, 95% CI: 3.68-4.08). In addition, we found an inverted V-shaped between rates and PAFs of ambient PM2.5-related neonatal disorders DALYs in 2019, as well as corresponding EAPCs, and SDI, while rates and PAFs of household PM2.5-related neonatal disorders DALYs in 2019 were highly negatively correlated with SDI. In the past three decades, the global ambient PM2.5-related neonatal disorders burden largely increased, especially in lower SDI regions. Comparatively, the household PM2.5-related neonatal disorders burden decreased but still accounted for about two-thirds of the PM2.5-related neonatal disease burden.

The association of FKBP5 gene methylation, adolescents' sex, and depressive symptoms among Chinese adolescents: a nested case-control study.

BACKGROUND: Depressive symptoms among adolescents are a serious health concern around the world. Altered DNA methylation in the FK506 binding protein 5 (FKBP5) gene has been reported to regulate stress response, which has been reported to be closely associated with depressive symptoms. However, most of the contributing studies have been conducted among adults and relatively few studies have considered the effect of disparate social influences and sex differences on the DNA methylation of FKBP5 in persons with depressive symptoms. The present study aimed to test the associations of FKBP5 DNA methylation and depressive symptoms among adolescents and explore possible sex differences in the foregoing associations. METHODS: This study was conducted using a nested case-control design within a longitudinal cohort study from January 2019 to December 2019. Adolescents aged 12 to 17 years from 69 classes in 10 public high schools located in Guangdong province of China participated in this research. Students with persistent depressive symptoms that reported having depressive symptoms at both baseline and follow-up were treated as the case group, and those without depressive symptoms were randomly selected as the control group. Our study finally included 87 cases and 151 controls. Quantitative methylation analyses of the selected gene were carried out by MassARRAY platform System. RESULTS: The overall DNA methylation trend of FKBP5 CpG sites in the case group was lower in comparison to the control group. Compared to healthy controls, lower methylation percentage of FKBP5-12 CpG 1 was observed in adolescents with persistent depressive symptoms after adjusting for covariates (case: 0.94 ± 2.00, control: 0.47 ± 0.92; F = 5.41, P = 0.021), although the statistical significance of the difference was lost after false discovery rate correction (q > 0.05). In addition, the hypomethylation of FKBP5-12 CpG 1 was approaching significance after adjustment for social-environmental factors (aOR = 0.77; P = 0.055), which indicated that no independent association was detected between hypomethylation of FKBP5 CpG sites and persistent depressive symptoms. Furthermore, in the present study, we were unable to identify sex differences in the association of FKBP5 gene methylation with depressive symptoms. CONCLUSION: The decreased methylation level of FKBP5 was observed in adolescents with persistent depressive symptoms, albeit non-significant after correction for multiple testing. Our results presented here are preliminary and underscore the complex gene-environment interactions relevant to the risk for depressive symptoms.

Global, regional, and national burden of depressive disorders among young people aged 10-24 years, 2010-2019.

OBJECTIVE: To describe the latest disease burden, temporal trends, and risk factors of depressive disorders among young people. METHODS: Data from the Global Burden of Disease Study 2019 was utilized to analyze depressive disorders among individuals aged 10-24 years. The study focused on describing the incidence, prevalence, disability-adjusted life years (DALYs), and their attributable risk factors across 204 countries and territories from 2010 to 2019. The estimated annual percentage change (EAPC) was calculated to quantify the temporal trends. RESULTS: Globally, the incidence, prevalence, and DALYs rate of depressive disorders per 100 000 young people increased from 3003.01, 2445.69, and 448.61 in 2010 to 3035.26, 2470.67, and 452.58 in 2019, indicating a slight upward trend (EAPC = 0.11 for incidence and prevalence; EAPC = 0.09 for DALYs rate). Notably, the percentage of DALYs of depressive disorders among young people increased substantially from 3.24% in 2010 to 3.66% in 2019, an increase of 13.06% (EAPC = 1.26, 95%CI: 1.08-1.44), and the burden of depressive disorders among young people rose from fouth to second in females, and from tenth to fifth in males. Social demographic index (SDI) and other indicators were positively correlated with the percentage of DALYs of depressive disorder and negatively correlated with the EAPC of DALYs. CONCLUSION: The global burden of depressive disorders among young people is on the rise. The regional differences in depressive disorders among young people suggest the need for enhanced screening efforts in low-SDI areas, along with the adoption of more effective prevention and control measures.

Stigma and its associations with medication adherence in major depressive disorder.

This study sought to evaluate internalized stigma (IS) and perceived stigma (PS), in persons (n = 522) living with major depressive disorder (MDD), with a view to analyzing the association of IS and PS with medication adherence in a cohort of participants with MDD in China. Perceived stigma is the awareness of societal negative views and attitudes towards depression, and IS is applying others' attitudes to oneself, both measured by the Depression Stigma Scale (DSS). Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). We observed that 76.0 % of participants reported IS and 84.5 % reported PS. Factors associated with increased IS included older age, marital status, disease history, and a higher baseline Patient Health Questionnaire-9 (PHQ-9). Higher education level, family income, and scores on the Connor-Davidson Resilience Scale (CD-RISC) were associated with lower levels of IS. Higher education levels, Childhood Trauma Questionnaire (CTQ) scores, and living with others were also associated with higher PS, while engagement in exercise and higher number of prior episodes were associated with lower PS. IS had a negative association with medication adherence, whereas PS did not significantly associate with adherence. In conclusion, a testable hypothesis is derived from our data that strategies targeting IS amongst persons with MDD may improve overall rates of adherence to antidepressant treatment, a necessary prelude to improving recovery.

Impact of painful physical symptoms on first-episode major depressive disorder in adults with subthreshold depressive symptoms: A prospective cohort study.

OBJECTIVE: To investigate the impact of baseline painful physical symptoms (PPS) on subsequent first-episode major depressive disorder (MDD) in adults with subthreshold depressive symptoms, including subgroup analyses to assess whether the associations differ in individuals with and without physical diseases. METHODS: A total of 2343 adults with subthreshold depressive symptoms were recruited at 34 primary health care centers. PPS were measured at baseline. First-episode MDD during follow-up was diagnosed by professional psychiatrists using the Mini-International Neuropsychiatric Interview. RESULTS: Baseline PPS showed independent impacts on first-episode MDD in adults with subthreshold depressive symptoms without physical diseases, but not in those with physical diseases. A non-linear association (P < 0.001) was observed between PPS burden and the risk of first-episode MDD. The HRs for first-episode MDD exhibited a rapidly increasing trend between PPS burden scores of 10-16, and maintained consistently high when scores exceeded 16. The analyses for specific PPS revealed that headache, neck pain, and heart or chest pain were independently associated with first-episode MDD in participants without physical diseases, the HRs were 1.57 (1.15-2.36), 1.53 (1.02-2.30), and 1.69 (1.14-2.50), respectively. Further network analysis demonstrated that heart or chest pain serves as a bridge symptom among the seven specific PPS and first-episode MDD in those without physical diseases. CONCLUSION: PPS burden and heart or chest pain may be significant indicators for first-episode MDD in adults with subthreshold depressive symptoms without physical diseases. Future studies should investigate whether interventions targeting PPS can prevent episode MDD in this subthreshold population.

Evaluation of Social Isolation Trajectories and Incident Cardiovascular Disease Among Middle-Aged and Older Adults in China: National Cohort Study.

BACKGROUND: Although the association between social isolation and the risk of subsequent cardiovascular disease (CVD) is well documented, most studies have only assessed social isolation at a single time point, and few studies have considered the association using repeatedly measured social isolation. OBJECTIVE: This study aimed to examine the association between social isolation trajectories and incident CVD in a large cohort of middle-aged and older adults. METHODS: This study used data from 4 waves (wave 1, wave 2, wave 3, and wave 4) of the China Health and Retirement Longitudinal Study. We defined the exposure period as from June 2011 to September 2015 (from wave 1 to wave 3) and the follow-up period as from September 2015 to March 2019 (wave 4). On the basis of the inclusion and exclusion criteria, our final analytic sample included 8422 individuals who had no CVD in the China Health and Retirement Longitudinal Study in waves 1 to 3 and were fully followed up in wave 4. Social isolation was ascertained using an extensively used questionnaire at 3 consecutive, biennial time points from waves 1 to 3, and individuals were assigned to 3 predefined social isolation trajectories based on their scores at each wave (consistently low, fluctuating, and consistently high). Incident CVD included self-reported physician-diagnosed heart disease and stroke combined. Cox proportional hazard models estimated the associations of social isolation trajectories with risks of incident CVD, adjusting for demographics, health behaviors, and health conditions. RESULTS: Of the 8422 participants (mean age 59.76, SD 10.33 years at baseline), 4219 (50.09%) were male. Most of the participants (5267/8422, 62.54%) had consistently low social isolation over time and 16.62% (1400/8422) of the participants had consistently high social isolation over the exposure period. During the 4-year follow-up, 746 incident CVDs occurred (heart disease: 450 cases and stroke: 336 cases). Compared with individuals with consistently low social isolation, those with fluctuating social isolation (adjusted hazard ratio 1.27, 95% CI 1.01-1.59) and consistently high social isolation (adjusted hazard ratio 1.45, 95% CI 1.13-1.85) had higher risks for incident CVD after adjusting for demographics (ie, age, sex, residence, and educational level), health behaviors (ie, smoking status and drinking status), and health conditions (ie, BMI; history of diabetes, hypertension, dyslipidemia, chronic kidney disease; use of diabetes medications, hypertension medications, and lipid-lowering therapy; and depressive symptoms scores). CONCLUSIONS: In this cohort study, middle-aged and older adults with fluctuating and consistently high social isolation exposure had higher risks of the onset of CVD than those without the exposure. The findings suggest that routine social isolation screenings and efforts to improve social connectedness merit increased attention for preventing CVD among middle-aged and older adults.

Reciprocal relationships between self-esteem, coping styles and anxiety symptoms among adolescents: between-person and within-person effects.

BACKGROUND: Previous researches have not distinguished the between-person effects from the within-person effects when exploring the relationship between self-esteem, coping styles, and anxiety symptoms among adolescents. To address this gap, this study investigated reciprocal associations among self-esteem, coping styles, and anxiety symptoms in a three-wave longitudinal panel survey, using an analytical strategy that disaggregates the within-person and the between-person variance. METHODS: Data was drawn from the Longitudinal Study of Adolescents' Mental and Behavioral Well-being Research study conducted in 10 public schools in the Guangdong province of China. All participants had a baseline visit (N = 1957, mean age 13.6, grades 7 and 10) and follow-up interviews at 1-year intervals for 3 years. A random intercept cross-lagged panel model combined with mediation analysis was performed. RESULTS: At the within-person level, the following results were observed. (1) Low self-esteem and anxiety symptoms bidirectionally predicted each other. (2) Low self-esteem and negative coping style bidirectionally predicted each other. (3) Anxiety symptoms predicted subsequent negative coping style but not vice versa. At the between-person level, we obtained the following main results. (1) Significant predictive effects on the random intercept were found among all three study constructs. (2) There were sex differences regarding the association between self-esteem and anxiety symptoms and the correlation of females was stronger than that of males. (3) Self-esteem mediated the reciprocal relations between coping styles and anxiety symptoms. CONCLUSIONS: Overall, findings revealed a reciprocal relationship between low self-esteem and anxiety symptoms for both females and males. Besides, anxiety symptoms predict subsequent negative coping style but not vice versa. We also highlighted the mediating role of self-esteem in the reciprocal relations between coping styles and anxiety symptoms. Thus, interventions targeted at promoting self-esteem and cultivating positive coping style may help reduce adolescent anxiety.

Association of emotional and behavioral problems with sleep disturbance among Chinese adolescents: The moderation effect of academic performance.

BACKGROUND: This study aimed to explore the association of emotional and behavioral problems with sleep disturbance among Chinese adolescents, and to test whether these associations vary with adolescents' academic performance. METHODS: Data were from the 2021 School-based Chinese Adolescents Health Survey using a multistage, stratified-cluster, and random-sampling method to collect information from 22,684 middle school students in Guangdong Province, China. RESULTS: Emotional problems (aOR = 1.34, 95 % CI = 1.32-1.36), conduct problems (aOR = 1.19, 95 % CI = 1.16-1.21), hyperactivity (aOR = 1.35, 95 % CI = 1.33-1.37), and peer problems (aOR = 1.06, 95 % CI = 1.04-1.09) were significantly associated with the increased risk of sleep disturbance among middle school students in Guangdong Province. The prevalence of sleep disturbance among adolescents was 29.4 %. There were significant interactions of emotional problems/conduct problems/peer problems/prosocial behavior with academic performance on sleep disturbance. Further stratification analyses by academic performance showed that adolescents with self-reported good academic performance had a higher risk of sleep disturbance than those students with self-reported average or poor academic performance. LIMITATIONS: This study only included school students and used the cross-sectional design to preclude causality determination. CONCLUSIONS: Our findings suggest that emotional and behavioral problems elevate the risk of sleep disturbance in adolescents. Adolescent academic performance plays a modulating role in these above-mentioned significant associations for sleep disturbance.

Association between bullying victimization, coping style, and mental health problems among Chinese adolescents.

BACKGROUND: This study aimed to examine the association of bullying victimization with anxiety and depressive symptoms among Chinese adolescents and explored the role of coping styles in the foregoing associations. METHOD: Data were drawn from the 2019 School-based Chinses Adolescents Health Survey (n = 19,809). Information about bullying victimization, coping styles, anxiety symptoms, and depressive symptoms were measured. Linear mixed-effects models were performed. RESULTS: After adjusting for covariates, verbal victimization (ß = 1.94 for anxiety symptoms; ß = 4.62 for depressive symptoms), relational victimization (ß = 3.40 for anxiety symptoms; ß = 8.37 for depressive symptoms), physical victimization (ß = 2.63 for anxiety symptoms; ß = 6.07 for depressive symptoms) and cyber victimization (ß = 4.68 for anxiety symptoms; ß = 10.72 for depressive symptoms) were associated with anxiety and depressive symptoms. Moreover, the severity of anxiety and depressive symptoms tended to increase with the number of victimization types. The interaction effects between bullying victimization and coping style on anxiety and depressive symptoms were significant. Further stratified analyses by coping styles indicated that the association of relational and cyber victimization on anxiety and depressive symptoms were significantly stronger in adolescents with negative coping style than in those with positive coping style. LIMITATIONS: Causal inference is limited due to the cross-sectional design. CONCLUSION: Bullying victimization is associated with anxiety and depressive symptoms, and coping styles may play a moderate role in these associations. Interventions to promote mental health could focus on developing positive coping styles, particularly among adolescents with bullying victimization.

Predictive potential of somatic symptoms for the identification of subthreshold depression and major depressive disorder in primary care settings.

Background: The presence of heterogenous somatic symptoms frequently obscures the recognition of depression in primary care. We aimed to explore the association between somatic symptoms and subthreshold depression (SD) and Major Depressive Disorder (MDD), as well as to determine the predictive potential of somatic symptoms in identifying SD and MDD in primary care. Methods: Data were derived from the Depression Cohort in China study (ChiCTR registry number: 1900022145). The Patient Health Questionnaire-9 (PHQ-9) was used to assess SD by trained general practitioners (GPs), and the Mini International Neuropsychiatric Interview depression module was used to diagnose MDD by professional psychiatrists. Somatic symptoms were assessed using the 28-item Somatic Symptoms Inventory (SSI). Results: In total of 4,139 participants aged 18-64 years recruited from 34 primary health care settings were included. The prevalence of all 28 somatic symptoms increased in a dose-dependent manner from non-depressed controls to SD, and to MDD (P for trend <0.001). Hierarchical clustering analysis grouped the 28 heterogeneous somatic symptoms into three clusters (Cluster 1: energy-related symptoms, Cluster 2: vegetative symptoms, and Cluster 3: muscle, joint, and central nervous symptoms). Following adjustment for potential confounders and the other two clusters of symptoms, per 1 increase of energy-related symptoms exhibited significant association with SD (OR = 1.24, 95% CI, 1.18-1.31) and MDD (OR = 1.50, 95% CI, 1.41-1.60) The predictive performance of energy-related symptoms in identifying individuals with SD (AUC = 0.715, 95% CI, 0.697-0.732) and MDD (AUC = 0.941, 95% CI, 0.926-0.963) was superior to the performance of total SSI and the other two clusters (P < 0.05). Conclusions: Somatic symptoms were associated with the presence of SD and MDD. In addition, somatic symptoms, notably those related to energy, showed good predictive potential in identifying SD and MDD in primary care. The clinical implication of the present study is that GPs should consider the closely related somatic symptoms for early recognition for depression in practice.

Associations of stressful life events with subthreshold depressive symptoms and major depressive disorder: The moderating role of gender.

BACKGROUND: Stressful life events (SLEs) are high-risk factors for subthreshold depressive symptoms (SDS) and major depressive disorder (MDD). This study sought to assess the association of SLEs with SDS and MDD, with a focus on gender effects. METHODS: A total of 4132 participants were recruited from 34 primary health care settings. The Stressful Life Events Screening Questionnaire (SLESQ) was used to measure SLEs that participants had experienced in the past time. The Patient Health Questionnaire 9 (PHQ-9) was used to assess SDS, and the Mini-International Neuropsychiatry Interview (MINI) depression module was used to assess the diagnosis of MDD by trained psychiatrists. RESULTS: In our sample (N = 4132), exposure to any SLEs was more common in individuals with SDS and MDD than in non-depressed population, and the proportion of emotional abuse was relatively high (SDS: 10.6 %; MDD: 33.9 %). After adjusting for control variables, people who experienced SLEs were at a higher risk of SDS and MDD. For males, those experiencing only one event were not at a higher risk of SDS (P = 0.061). For individuals who had experienced multiple SLEs, the association between SLEs and SDS was stronger in females than males. However, the association between SLEs and MDD was stronger in males than females. LIMITATIONS: The cross-sectional study design and self-reported SLEs. CONCLUSIONS: SLEs were associated with the increased risks of SDS and MDD. The associations of SLEs with SDS were more robust for females than males. In contrast, the association between SLEs and MDD was stronger in males than females.

Gender differences in the association of sexual orientation with depressive symptoms: A national cross-sectional study among Chinese college students.

BACKGROUND: Depressive symptoms among the lesbian, gay, bisexual (LGB) in college students have generated worldwide concern in recent decades. This study aimed to estimate the associations between sexual orientation and depressive symptoms among Chinese college students, with a focus on gender differences. METHODS: A total of 30,733 college students were recruited from 10 Chinese province-level regions with a multistage, stratified cluster, random sampling method between March and June 2019. The 20-item Center for Epidemiologic Studies Depression Scale (CESD-20) was used to measure the depressive symptoms. Sexual orientation was assessed by asking the question, "Which of the following options best describes you?" The responses were categorized as heterosexual, gay/lesbian, bisexual, and unsure. RESULTS: In our sample (N = 30,733), the prevalence of depressive symptoms was 6.1%. Among the surveyed Chinese college students, 3.7% self-reported as LGB, and 7.2% were unsure. LGB (gay/lesbian: 14.9% for males and 6.8% for females; bisexual: 9.3% for males and 16.4% for females) had a higher risk of depressive symptoms than heterosexuals. After adjusting for control variables, LGB and unsure college students were more likely to have depressive symptoms than their heterosexual peers. For males, unsure college students reported the highest risk of depressive symptoms; for females, lesbian and bisexual college students reported the highest risk of depressive symptoms. LIMITATIONS: The cross-sectional study design and self-reported depressive symptoms and sexual orientation. CONCLUSION: LGB was associated with increased depressive symptoms among Chinese college students. Furthermore, the associations of LGB sexual orientation with depressive symptoms were more robust for females than males.

Associations Between Child Maltreatment and Depressive Symptoms Among Chinese College Students: An Analysis of Sex Differences.

Background: Depressive symptoms and child maltreatment are both global public health problems among young adults. This study aimed to investigate the associations between five types of child maltreatment and depressive symptoms among Chinese college students, with a focus on potential sex differences. Methods: A cross-sectional study of a nationally representative sample of Chinese college students was conducted from March to June 2019 with a multistage, stratified cluster, random sampling method. In total, 30,179 college students from 60 colleges of 10 Chinese province-level regions completed standard questionnaires, including a history of child maltreatment and current depressive symptoms. Results: The prevalence of depressive symptoms among college students in China was 7.3%. After adjusting for control variables, physical abuse (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI] = 1.17-1.23), emotional abuse (aOR = 1.21, 95% CI = 1.19-1.23), sexual abuse (aOR = 1.19, 95% CI = 1.16-1.22), physical neglect (aOR = 1.14, 95% CI = 1.12-1.16) and emotional neglect (aOR = 1.08, 95% CI = 1.07-1.09) were all positively associated with depressive symptoms. Notably, a cumulative effect of child maltreatment on depressive symptoms among Chinese college students was observed. Moreover, sex differences in the associations of emotional abuse, emotional neglect, and the number of maltreatment types with depressive symptoms were statistically significant (P < 0.05). Further stratification analyses showed that female students who experienced emotional abuse and emotional neglect had a higher risk of depressive symptoms than male students, and the cumulative effect of maltreatment types was stronger for females than males. Conclusion: Five types of child maltreatment and their co-occurrence were associated with an increased risk of depressive symptoms among college students. Furthermore, the effects of emotional abuse, emotional neglect and the number of maltreatment types on depressive symptoms were stronger for females than for males. These findings can promote understanding of the effects of child maltreatment on depressive symptoms, and prevention and intervention strategies for depressive symptoms should consider the type of child maltreatment and sex differences.

The associations between sleep situations and mental health among Chinese adolescents: A longitudinal study.

OBJECTIVE: Few studies are conducted to explore the longitudinal relationships between sleep situations and mental health among adolecents. This study aimed to explore the sleep situations (ie, sleep habits and sleep problems) among Chinese adolescents and the longitudinal associations between sleep situations and mental disorder symptoms (ie, depressive and anxiety symptoms). METHODS: This longitudinal study included 1957 high school students from ten schools in Guangzhou in January 2019, with 1836 students contributing valid data at a one-year follow-up (retention rate: 93.9%). Data of depressive and anxiety symptoms, sleep habits, and sleep problems were collected using a self-reported questionnaire. RESULTS: The current study found that over half of the adolescents did not reach the recommended 8-h sleep-time on weekdays (63.3%). Short sleep duration, especially on weekdays, was significantly associated with subsequent depressive (AOR = 0.86, 95%CI: 0.80-0.92) and anxiety symptoms (AOR = 0.86, 95%CI: 0.77-0.96). In addition, longer weekday-weekend catch-up sleep and more sleep problems were risk factors of depressive and anxiety symptoms. CONCLUSIONS: The health effects of insufficient sleep and suboptimal sleep quality on adolescents should not be neglected. Our longitudinal research showed that adolescents would demonstrate severer depressive and anxiety symptoms if lacking of a healthy sleeping practice. A regular sleep schedule and close attention to adolescents' mental disorders are highly recommended.

The relationship between childhood emotional abuse and depressive symptoms among Chinese college students: The multiple mediating effects of emotional and behavioral problems.

BACKGROUND: This study aims to explore the mediational effects of emotional and behavioral problems on the association between childhood emotional abuse and depressive symptoms among college students. METHODS: Data were drawn from 60 universities from 10 provinces in China (n=30,374). Information about childhood maltreatment, depressive symptoms, emotional and behavioral problems were gathered through the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Univariable and multivariable logistic regression models and mediating models were used. RESULTS: After controlling for demographic factors, childhood emotional abuse was the strongest risk factor for depressive symptoms (adjusted odds ratio (aOR)=2.54, 95%CI=2.27-2.85). The relationship between childhood emotional abuse and depressive symptoms was partially mediated by emotional and behavioral problems with 68.7% total indirect effect. Among the 5 identified subtypes of emotional and behavioral problems, the mediating effects of emotional problems (57.3%) and hyperactivity (28.6%) were higher than peer problems (7.8%) and prosocial behavior (3.6%). Conduct problems did not show a significant mediating effect (p>0.05). LIMITATIONS: The cross-sectional design is limited to make inferences about causality. CONCLUSIONS: Childhood emotional abuse was strongly associated with depressive symptoms in college students. Of the five identified subtypes of emotional and behavioral problems, four subtypes mediated the relationship between childhood emotional abuse and depressive symptoms, including emotional problems, hyperactivity, peer problems and prosocial behavior.