Effects of Mindfulness and Life-Skills Training on Emotion Regulation and Anxiety Symptoms in Chinese Migrant Children: A Randomized Controlled Trial.

PURPOSE: China's rapid urbanization has been associated with increased mental health challenges, especially in rural-to-urban migrant children. This study evaluates the effects of mindfulness and life-skills (LS) training on emotional regulation and anxiety symptoms from a randomized controlled trial aimed at improving the mental health of Chinese migrant children. METHODS: Two intervention arms-mindfulness training (MT) and MT plus LS mentorship (MT + LS)-were compared to a waitlist control group of 368 migrant children aged 9-17 years. Volunteers were trained to deliver interventions to 285 migrant children in small groups of 15 for eight weeks weekly. Social integration varied: migrant children mixed with local children at public schools were considered highly integrated, those in migrant-only classrooms at public schools had intermediate levels of integration, and children in private migrant schools had low integration. Emotion regulation and anxiety symptoms were assessed preintervention, postintervention, and three months postintervention. RESULTS: Postintervention and compared to the control group, children with high social integration in the MT arm showed increased cognitive reappraisal ability (p < .05) but higher physical anxiety (p < .01). Children with high social integration in the MT + LS arm had lower anxiety symptoms of harm avoidance (p < .01) and physical anxiety (p < .05). Children with low social integration in the MT + LS arm showed lower cognitive reappraisal (p < .01) and poorer overall emotion regulation abilities (p < .01). Three months later, children with intermediate integration in the MT + LS arm had lower separation anxiety (p < .05) and harm avoidance anxiety (p < .05). No other groups showed significant improvements in emotion regulation or reducing in anxiety symptoms three months postintervention. DISCUSSION: Mindfulness and LS training may benefit Chinese migrant children who have higher levels of social integration but increase anxiety in those with lower social integration. Future research should consider the sociocultural context in which a treatment is implemented.

Association between anxiety, depression symptoms, and academic burnout among Chinese students: the mediating role of resilience and self-efficacy.

BACKGROUND: To explore the associations between anxiety and depression symptoms and academic burnout among children and adolescents in China, and to examine the role of resilience and self-efficacy in addressing academic burnout. METHODS: A total of 2,070 students in grades 4-8 were recruited from two primary and three middle schools in Shanghai, completed the Elementary School Student Burnout Scale (ESSBS), the Multidimensional Anxiety Scale for Children-Chinese (MASC-C), the Center for Epidemiological Studies Depression Scale (CES-D), the Connor-Davidson Resilience Scale (CD-RISC), and the General Self-Efficacy Scale (GSES), with 95.04% effective response rate. Multivariable regression analyses examining the associations between anxiety / depression symptoms and academic burnout (as well as the associations between resilience / self-efficacy and academic burnout) were performed using STATA 16.0 and SmartPLS 3.0. RESULTS: Anxiety symptoms (ß = 0.124, p < 0.01) and depression symptoms (ß = 0.477, p < 0.01) were positively correlated with academic burnout. Resilience partially mediated the association between depression symptoms and academic burnout (ß = 0.059, p < 0.01), with a mediation rate of 12.37%. Self-efficacy partially mediated the associations between anxiety symptoms and academic burnout (ß = 0.022, p < 0.01) and between depression symptoms and academic burnout (ß = 0.017, p < 0.01), with mediation rates of 17.74% and 3.56%, respectively. Resilience and self-efficacy together (ß = 0.041, p < 0.01) formed a mediating chain between depression symptoms and academic burnout, with a mediation rate of 8.6%. CONCLUSIONS: Anxiety and depression symptoms were positively associated with academic burnout. Resilience and self-efficacy were found to mediate the associations partially.

general psychopathology factor in Chinese adolescents and its correlation with trans-diagnostic protective psycho-social factors.

BACKGROUND: Comorbidity in mental disorders is prevalent among adolescents, with evidence suggesting a general psychopathology factor ("p" factor) that reflects shared mechanisms across different disorders. However, the association between the "p" factor and protective factors remains understudied. The current study aimed to explore the "p" factor, and its associations with psycho-social functioning, in Chinese adolescents. METHODS: 2052 students, aged 9-17, were recruited from primary and secondary schools in Shanghai, China. Multiple rating scales were used to assess psychological symptoms and psycho-social functioning. Confirmatory factor analysis was conducted to verify the fit of models involving different psychopathology domains such as externalizing, internalizing, and the "p" factor. Subsequently, structural equation models were used to explore associations between the extracted factors and psycho-social functioning, including emotion regulation, mindful attention awareness, self-esteem, self-efficacy, resilience, and perceived support. RESULTS: The bi-factor model demonstrated a good fit, with a "p" factor accounting for 46 % of symptom variation, indicating that the psychological symptoms of Chinese adolescents could be explained by internalizing, externalizing, and the "p" factor. Psychologically, a higher "p" was positively correlated with emotion suppression and negatively correlated with mindful attention awareness, emotion reappraisal, self-esteem, and resilience. Socially, a higher "p" was associated with decreased perceived support. LIMITATIONS: Only common symptoms were included as this study was conducted at school. Furthermore, the cross-sectional design limited our ability to investigate causal relationships. CONCLUSIONS: A "p" factor exists among Chinese adolescents. Individuals with higher "p" factor levels were prone to experience lower levels of psycho-social functions.

Measurement of flourishing: a scoping review.

Introduction: Flourishing is an evolving wellbeing construct and outcome of interest across the social and biological sciences. Despite some conceptual advancements, there remains limited consensus on how to measure flourishing, as well as how to distinguish it from closely related wellbeing constructs, such as thriving and life satisfaction. This paper aims to provide an overview and comparison of the diverse scales that have been developed to measure flourishing among adolescent and adult populations to provide recommendations for future studies seeking to use flourishing as an outcome in social and biological research. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we conducted a scoping review across PubMed and EMBASE of studies introducing original flourishing scales (defined as a previously unpublished measure of mental health or wellbeing that used "flourishing" in its definition). Studies focusing on adult populations that were published before April 28, 2023 were considered eligible for inclusion. Results: Out of 781 studies retrieved, we identified seven eligible studies covering seven unique flourishing scales. We find that all seven scales are multidimensional and assess features over monthly or yearly intervals. While most of the scales (six out of seven) include indicators of both hedonic and eudaimonic wellbeing, the operationalization of these dimensions of wellbeing varies considerably between scales. Several of the scales have been translated and validated across multiple geographical contexts, including higher- and lower-income countries. Discussion: Complementing self-report measures with other social, economic, regional, and biological indicators of flourishing may be useful to provide holistic and widely applicable measures of wellbeing. This review contributes to concept validation efforts that can guide strategies to sustain flourishing societies.

The Association Between Screen Time and Outdoor Time on Adolescent Mental Health and Academic Performance: Evidence from Rural China.

Purpose: We examine how adolescent free time allocation-namely, screen time and outdoor time-is associated with mental health and academic performance in rural China. Methods: This paper used a large random sample of rural junior high school students in Ningxia (n = 20,375; age=13.22), with data collected from self-reported demographic questionnaires (to assess free time allocation), the Strengths and Difficulties Questionnaire (to assess mental health), and a standardized math test (to measure academic performance). We utilized a multivariate OLS regression model to examine associations between free time allocation and adolescent outcomes, controlling for individual and family characteristics. Results: Our sample's screen time and outdoor time both averaged around 1 hour. About 10% of the sample adolescents reported behavioral difficulties, while a similar percentage (11%) reported abnormal prosocial behaviors. Adolescents with higher levels of screen time (>2 hours) were 3 percentage points more likely to have higher levels of behavioral difficulties (p<0.001), indicating that excessive screen time was associated with worse mental health. Meanwhile, outdoor time was associated with better mental health, and positive correlations were observed at all levels of outdoor time (compared to no outdoor time, decreasing the likelihood of higher levels of behavioral difficulties by between 3 and 4 percentage points and of lower prosocial scores by between 6 and 8 percentage points; all p's<0.001). For academic performance, average daily screen times of up to 1 hour and 1-2 hours were both positively associated with standardized math scores (0.08 SD, p<0.001; 0.07 SD, p<0.01, respectively), whereas there were no significant associations between outdoor time and academic performance. Conclusion: Using a large sample size, this study was the first to examine the association between adolescent free time allocation with mental health and academic performance, providing initial insights into how rural Chinese adolescents can optimize their free time.

The Association between Video Game Time and Adolescent Mental Health: Evidence from Rural China.

As digital devices like computers become more widely available in developing countries, there is a growing need to understand how the time that adolescents spend using these devices for recreational purposes such as playing video games is linked with their mental health outcomes. We measured the amount of time that adolescents in rural China spent playing video games and the association of video game time with their mental health. We collected data from primary and junior high schools in a poor, rural province in northwest China (n = 1603 students) and used the Depression, Anxiety, and Stress Scales (DASS-21) to measure mental health symptoms. The results indicated that the average video game time was about 0.69 h per week. There was a significant association between adolescent video game time and poorer mental health. Each additional hour of playing video games also increased the chance of having moderate or above symptoms. Moreover, boys and non-left-behind children had worse mental health if they played more video games. Our study contributes to literature on the links between recreational screen time and mental health, and it sheds light on an issue addressed by recent government legislation to limit the video game time of minors in China.

The Role of Self-Esteem in the Academic Performance of Rural Students in China.

The self-esteem of students may be significantly associated with their academic performance. However, past research in developing contexts on this issue is limited, particularly among early adolescents. Using a sample of 3101 students from rural primary and junior high schools in China, this study measured their self-esteem by the Rosenberg Self-Esteem Scale (RSES) and explored its association with academic performance. Our findings indicate that students in rural China had both significantly lower self-esteem and a higher prevalence of low self-esteem when compared to past studies of similarly aged students both from urban China and internationally. Furthermore, there was a strong positive correlation between a student's self-esteem and academic performance. A one-SD increase in RSES score (indicating better self-esteem) was associated with an increase of 0.12 SD in standardized math scores (p < 0.001), and students with low self-esteem (RSES score < 25) scored lower on math tests by 0.14 SD (p < 0.001), which were robust and consistent when employing the propensity score matching method. Our study expands the growing body of empirical evidence on the link between self-esteem and academic performance among rural youth in developing countries and emphasizes the need to improve their self-esteem with the aim of helping them achieve academically.

Behavioral Strengths and Difficulties and Their Associations with Academic Performance in Math among Rural Youth in China.

Behavioral strengths and difficulties among children and adolescents may be significantly associated with their academic performance; however, the evidence on this issue for rural youth in developing contexts is limited. This study explored the prevalence and correlates of mental health from three specific dimensions-internalizing problems, externalizing problems, and prosocial behavior-measured by the Strengths and Difficulties Questionnaire (SDQ), and the association of these dimensions with academic performance in math among a sample of 1500 students in rural China. Our findings indicated that students in rural China had worse behavioral difficulties and poorer prosocial skills when compared to most past studies conducted inside and outside of China. In addition, total difficulties and prosocial scores on the SDQ were significantly associated with student math test scores, as students whose externalizing, internalizing, and prosocial scores were in the abnormal range scored lower in math by 0.35 SD, 0.23 SD, and 0.33 SD, respectively. The results add to the growing body of empirical evidence related to the links between social environment, mental health, and academic performance in developing countries, highlighting the importance of students' mental health for their academic performance, and of understanding risk factors in the social environment among rural youth in developing countries.

Association between mental health and executive dysfunction and the moderating effect of urban-rural subpopulation in general adolescents from Shangrao, China: a population-based cross-sectional study.

OBJECTIVES: To examine the association between mental health and executive dysfunction in general adolescents, and to identify whether home residence and school location would moderate that association. DESIGN: A population-based cross-sectional study. SETTING: A subsample of the Shanghai Children's Health, Education, and Lifestyle Evaluation-Adolescents project. 16 sampled schools in Shangrao city located in downstream Yangtze River in southeast China (December 2018). PARTICIPANTS: 1895 adolescents (48.8% male) which were divided into three subpopulations: (A) adolescents who have urban hukou (ie, household registration in China) and attend urban schools (UU, n=292); (B) adolescents who have rural hukou and attend urban schools (RU, n=819) and (C) adolescents who have rural hukou and attend rural schools (RR, n=784). MEASURES: The Depression Anxiety and Stress Scale-21 was used to assess adolescent mental health symptoms, and the Behaviour Rating Inventory of Executive Function (parent form) was applied to measure adolescent executive dysfunction in nature setting. RESULTS: Mental health symptoms were common (depression: 25.2%, anxiety: 53.0%, stress: 19.7%) in our sample, and the prevalence rates were lower among UU adolescents than those among the RR and RU, with intersubgroup differences in screen exposure time explaining most of the variance. We found the three types of symptoms were strongly associated with executive dysfunction in general adolescents. We also observed a marginal moderating effect of urban-rural subgroup on the associations: UU adolescents with depression (OR 6.74, 95% CI 3.75 to 12.12) and anxiety (OR 5.56, 95% CI 1.86 to 16.66) had a higher executive dysfunction risk when compared with RR youths with depression (OR 1.93, 95% CI 0.91 to 4.12) and anxiety (OR 1.80, 95% CI 1.39 to 2.33), respectively. CONCLUSIONS: Rural adolescents experienced more mental health symptoms, whereas urban individuals with mental health problems had a higher executive dysfunction risk.

Association of Child Mental Health with Child and Family Characteristics in Rural China: A Cross-Sectional Analysis.

Assessing the mental health problems encountered by school children and understanding the contributing factors are crucial to inform strategies aimed at improving mental health in low-resource contexts. However, few studies have investigated the mental health problems among disadvantaged children in poorer countries. This study examines the prevalence of mental health problems in rural China and their association with child and family characteristics. The study uses survey data from 9696 children in 120 rural primary schools and measures child mental health using the Strengths and Difficulties Questionnaire (SDQ). Overall, 17.9% of the sample children were found to be in the abnormal range of the SDQ total difficulties scores. The mean score was 12.93 (SD = 4.94). Abnormal scores were associated with child and family characteristics, including older child age (Odds Ratio, OR = 0.704, 95% CI: 0.611, 0.810; p < 0.001), gender (OR = 1.235, 95% CI: 1.112, 1.371; p < 0.001), and academic performance (OR = 0.421, 95% CI: 0.369, 0.480; p < 0.001). Reading time was found to be protective for mental health. Risk factors include excessive screen time (OR = 1.685, 95% CI: 1.409, 2.016; p < 0.001) and being bullied (OR = 3.695, 95% CI: 3.301, 4.136; p < 0.001). Our study suggests that future mental health illness prevention programs in rural China should consider targeting different aspects of children's social contexts.

Depressive Symptoms and the Link with Academic Performance among Rural Taiwanese Children.

Previous studies reflect a high prevalence of depressive symptoms among Taiwanese adolescents (ages 13-18), but there is an absence of literature related to the risk of depression of children in Taiwan (ages 6-12), particularly among potentially vulnerable subgroups. To provide insight into the distribution of depressive symptoms among children in rural Taiwan and measure the correlation between academic performance, we conducted a survey of 1655 randomly selected fourth and fifth-grade students at 92 sample schools in four relatively low-income counties or municipalities. Using the Center for Epidemiological Studies-Depression Scale (CES-D) we assessed the prevalence of depressive symptoms in this sample, in addition to collecting other data, such as performance on a standardized math test as well as information on a number of individual and household characteristics. We demonstrate that the share of children with clinically significant symptoms is high: 38% of the students were at risk of general depression (depression score ≥ 16) and 8% of the students were at risk of major depression (depression score > 28). The results of the multivariate regression and heterogeneous analysis suggest that poor academic performance is closely associated with a high prevalence of depressive symptoms. Among low-performing students, certain groups were disproportionately affected, including girls and students whose parents have migrated away for work. Results also suggest that, overall, students who had a parent who was an immigrant from another country were at greater risk of depression. These findings highlight the need for greater resource allocation toward mental health services for elementary school students in rural Taiwan, particularly for at-risk groups.

Concurrent validity of the Ages and Stages Questionnaire and the Bayley Scales of Infant Development III in China.

Choosing a valid and feasible method to measure child developmental outcomes is key to addressing developmental delays, which have been shown to be associated with high levels of unemployment, participation in crime, and teen pregnancies. However, measuring early childhood development (ECD) with multi-dimensional diagnostic tests such as the Bayley Scales of Infant and Toddler Development III (Bayley-III) can be time-consuming and expensive; therefore, parental screening tools such as the Ages and Stages Questionnaire (ASQ-3) are frequently an alternative measure of early childhood development in large-scale research. The ASQ is also becoming more frequently used as the first step to identify children at risk for developmental delays before conducting a diagnostic test to confirm. However, the effectiveness of the ASQ-3 is uncertain. In this study, we evaluate the accuracy of the ASQ-3 as a screening measure for children at risk of developmental delay in rural China by age group. To do so, we administered the Bayley-III, widely considered to be the "gold standard" of ECD diagnostic tests, to a sample of 1,831 five to twenty-four month-old children and also administered the ASQ-3 to their caregivers. We then compared the outcomes of the ASQ-3 test to those of the Bayley-III. We find that the ASQ-3 was significantly though weakly correlated with the Bayley-III and that the strength of this correlation increased with child age and was stronger when the mother was the primary caregiver (as compared to the grandmother). We also find that the sensitivity and specificity of ASQ-3 ranged widely. The overall findings suggest that the ASQ-3 may not be a very accurate screening tool for identifying developmentally delayed children, especially for children under 13 months of age or children whose primary caregiver is not the mother.

Breastfeeding and the Risk of Illness among Young Children in Rural China.

Poor rural areas in China exhibit the country's highest rates of child mortality, often stemming from preventable health conditions such as diarrhea and respiratory infection. In this study, we investigate the association between breastfeeding and disease among children aged 6⁻24 months in poor rural counties in China. To do this, we conducted a longitudinal, quantitative analysis of socioeconomic demographics, health outcomes, and breastfeeding practices for 1802 child⁻caregiver dyads across 11 nationally designated poverty counties in southern Shaanxi Province in 2013⁻2014. We found low rates of continued breastfeeding that decreased as children developed: from 58.2% at 6⁻12 months, to 21.6% at 12⁻18 months, and finally to 5.2% at 18⁻24 months. These suboptimal rates are lower than all but one other country in the Asia-Pacific region. We further found that only 18.3% of children 6⁻12 months old met the World Health Organization (WHO)-recommended threshold for minimum dietary diversity, defined as consuming four or more of seven specific food groups. Breastfeeding was strongly associated with lower rates of both diarrhea and cough in bivariate and multivariate analyses. As the first analysis to use longitudinal data to examine the relationship between continued breastfeeding and child illness in China, our study confirms the need for programmatic interventions that promote continued breastfeeding in order to improve toddler health in the region.

Effect of Caregiver's Mental Health on Early Childhood Development across Different Rural Communities in China.

Previous research has found that there are high rates of developmental delays among infants and toddlers in rural areas of China. Caregiver mental health problems might be one significant predictor of developmental delays among infants and toddlers, as has been found in other areas of the world. One way that the mental health of caregivers could affect early childhood development is through its effect on parenting practices. In this study, we used data from four major subpopulations of rural China to measure the correlation of caregiver mental health problems with the developmental outcomes of infants and toddlers. To do so, the study used the Bayley Scales of Infant Development III (BSID III) to examine the rates of developmental delays among 2514 rural infants/toddlers aged 6⁻30 months old. The results of the testing demonstrate that 48% of the sample's infants/toddlers have cognitive delays; 52% have language delays; 53% have social-emotional delays; and 30% have motor delays. The data collection team also assessed caregiver mental health by using the Depression Anxiety Stress Scales (DASS-21) questionnaire. According to the findings, 39% of caregivers in the sample have symptoms of at least one kind of mental health problem (depression, anxiety, or stress). We also found that most caregivers do not engage in positive parenting practices, while a significant share of caregivers engage in negative parenting practices. The statistical analysis found that showing signs of mental health problems is significantly and negatively associated with infant/toddler developmental outcomes. The study also found that caregivers who show signs of mental health problems are significantly less likely to engage in interactive parenting practices. The study confirms that society needs to pay more attention to caregiver mental health problems in order to improve infant/toddler developmental outcomes in rural China and increase human capital accumulation in China as a whole.