The Sequelae and Moderators of Influence of Dandruff on Mental Health Among Mainland Chinese Adults.

Introduction: The psychological impact of dandruff has been largely understudied. Methods: In this cross-sectional study (N = 2116), we examined the consequences of self-perception of dandruff severity on mental health, quality of life, and sleep quality among Chinese adults. Additionally, we examined the moderating factors that influence these associations. Results: Bivariate analyses revealed that greater self-perceived dandruff severity was associated with poorer mental health, lower quality of life, and reduced sleep quality. Furthermore, dandruff severity was positively correlated with appearance anxiety, feelings of helplessness, and perceived stigma. Individuals with more severe dandruff experienced increased teasing and ostracism and, subsequently, heightened psychological distress. Moderation analyses demonstrated that females were more adversely affected by dandruff than males, and those with comorbid skin conditions or a history of being teased and ostracized during adolescence due to dandruff experienced exacerbated negative outcomes. Discussion: This study highlights the need for further research on the psychological consequences of self-perceived severity of dandruff and potential interventions to mitigate its impact.

Tracking and Profiling Repeated Users Over Time in Text-Based Counseling: Longitudinal Observational Study With Hierarchical Clustering.

BACKGROUND: Due to their accessibility and anonymity, web-based counseling services are expanding at an unprecedented rate. One of the most prominent challenges such services face is repeated users, who represent a small fraction of total users but consume significant resources by continually returning to the system and reiterating the same narrative and issues. A deeper understanding of repeated users and tailoring interventions may help improve service efficiency and effectiveness. Previous studies on repeated users were mainly on telephone counseling, and the classification of repeated users tended to be arbitrary and failed to capture the heterogeneity in this group of users. OBJECTIVE: In this study, we aimed to develop a systematic method to profile repeated users and to understand what drives their use of the service. By doing so, we aimed to provide insight and practical implications that can inform the provision of service catering to different types of users and improve service effectiveness. METHODS: We extracted session data from 29,400 users from a free 24/7 web-based counseling service from 2018 to 2021. To systematically investigate the heterogeneity of repeated users, hierarchical clustering was used to classify the users based on 3 indicators of service use behaviors, including the duration of their user journey, use frequency, and intensity. We then compared the psychological profile of the identified subgroups including their suicide risks and primary concerns to gain insights into the factors driving their patterns of service use. RESULTS: Three clusters of repeated users with clear psychological profiles were detected: episodic, intermittent, and persistent-intensive users. Generally, compared with one-time users, repeated users showed higher suicide risks and more complicated backgrounds, including more severe presenting issues such as suicide or self-harm, bullying, and addictive behaviors. Higher frequency and intensity of service use were also associated with elevated suicide risk levels and a higher proportion of users citing mental disorders as their primary concerns. CONCLUSIONS: This study presents a systematic method of identifying and classifying repeated users in web-based counseling services. The proposed bottom-up clustering method identified 3 subgroups of repeated users with distinct service behaviors and psychological profiles. The findings can facilitate frontline personnel in delivering more efficient interventions and the proposed method can also be meaningful to a wider range of services in improving service provision, resource allocation, and service effectiveness.

Mirizzi syndrome: The Trojan horse of gallbladder disease.

Background: The incidence of Mirizzi Syndrome ranges from 0.05 to 5.7 % of patients who undergo cholecystectomy. The purpose of this study is to examine the preoperative workup and postoperative outcomes for patients diagnosed with Mirizzi Syndrome. Methods: Retrospective chart review was conducted between January 2018 and January 2022 at a single institution. All adult patients who underwent cholecystectomy were included. Results: 1628 patients underwent cholecystectomy of which 47 were diagnosed with Mirizzi Syndrome. The majority of patients had type 1 Mirizzi Syndrome. Preoperative studies were often nondiagnostic and 81 % of cases were diagnosed intraoperatively. 66 % of cases were performed laparoscopically, an open approach was required for type V Mirizzi Syndrome. The complication rate was 25 %; most commonly a bile leak requiring ERCP. Conclusion: Mirizzi syndrome is more common than previously expected and related to patient's ability to seek timely medical care. Most cases can be completed laparoscopically however there is a high rate of complications. Key message: This study presents an additional cohort of patients found to have Mirizzi syndrome and supports the hypothesis that it is difficult to diagnose preoperatively. Cases should be attempted laparoscopically but there remains a high complication rate.

A group-based transdiagnostic sleep and circadian treatment for major depressive disorder: A randomized controlled trial.

OBJECTIVE: Sleep and circadian disturbance is highly comorbid with a range of psychological disorders, especially major depressive disorder (MDD). In view of the complexity of sleep and circadian problems in MDD, this study aimed to evaluate the efficacy of a group-based transdiagnostic intervention for sleep and circadian dysfunction (TranS-C) for improving depressive symptoms and sleep and circadian functions. METHOD: One hundred fifty-two adults diagnosed with comorbid MDD and sleep and circadian dysfunctions were randomized into TranS-C group treatment (TranS-C; n = 77) or care as usual (CAU; n = 75) control group. The TranS-C group received six weekly 2-hr group sessions of TranS-C, whereas the CAU group continued to receive usual care. Assessments were at baseline, immediate (Week 7), and 12-week (Week 19) posttreatment. Primary and secondary outcomes included depression, anxiety, sleep disturbances, fatigue, quality of life, and functional impairment. RESULTS: The TranS-C group showed significant improvement in depressive symptoms (p < .001, d = 0.84), insomnia severity (p < .001, d = 0.77), sleep disturbances (p < .001, d = 1.15), sleep-related impairment (p < .001, d = 1.22), fatigue (p < .001, d = 1.06), anxiety symptoms (p = .004, d = 0.67), quality of life (p < .001, d = 0.71), and sleep diary-derived parameters (ps < .05, d = 0.12-0.77) relative to the CAU group at immediate posttreatment. These treatment gains remained significant at 12-week follow-up. Significant improvement in functional impairment was also noted at 12-week follow-up. CONCLUSIONS: TranS-C was efficacious and acceptable in alleviating depressive symptoms and sleep and circadian disruptions in adults with MDD. The group format appears to be a low-cost, widely disseminable option to deliver TranS-C. Further research on TranS-C to examine its benefits on other psychiatric disorders is warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Efficacy of ChatGPT in Cantonese Sentiment Analysis: Comparative Study.

BACKGROUND: Sentiment analysis is a significant yet difficult task in natural language processing. The linguistic peculiarities of Cantonese, including its high similarity with Standard Chinese, its grammatical and lexical uniqueness, and its colloquialism and multilingualism, make it different from other languages and pose additional challenges to sentiment analysis. Recent advances in models such as ChatGPT offer potential viable solutions. OBJECTIVE: This study investigated the efficacy of GPT-3.5 and GPT-4 in Cantonese sentiment analysis in the context of web-based counseling and compared their performance with other mainstream methods, including lexicon-based methods and machine learning approaches. METHODS: We analyzed transcripts from a web-based, text-based counseling service in Hong Kong, including a total of 131 individual counseling sessions and 6169 messages between counselors and help-seekers. First, a codebook was developed for human annotation. A simple prompt ("Is the sentiment of this Cantonese text positive, neutral, or negative? Respond with the sentiment label only.") was then given to GPT-3.5 and GPT-4 to label each message's sentiment. GPT-3.5 and GPT-4's performance was compared with a lexicon-based method and 3 state-of-the-art models, including linear regression, support vector machines, and long short-term memory neural networks. RESULTS: Our findings revealed ChatGPT's remarkable accuracy in sentiment classification, with GPT-3.5 and GPT-4, respectively, achieving 92.1% (5682/6169) and 95.3% (5880/6169) accuracy in identifying positive, neutral, and negative sentiment, thereby outperforming the traditional lexicon-based method, which had an accuracy of 37.2% (2295/6169), and the 3 machine learning models, which had accuracies ranging from 66% (4072/6169) to 70.9% (4374/6169). CONCLUSIONS: Among many text analysis techniques, ChatGPT demonstrates superior accuracy and emerges as a promising tool for Cantonese sentiment analysis. This study also highlights ChatGPT's applicability in real-world scenarios, such as monitoring the quality of text-based counseling services and detecting message-level sentiments in vivo. The insights derived from this study pave the way for further exploration into the capabilities of ChatGPT in the context of underresourced languages and specialized domains like psychotherapy and natural language processing.

The Stories We Tell Influence the Support We Receive: Examining the Reception of Support-Seeking Messages on Reddit.

Although social support facilitates coping and recovering from stressful life events, people do not always get the support that they need. Prior research suggests that the way one talks about stressful events to others may influence the support they receive. Given that people are increasingly relying on online communities for social support, this study adopted a person-centered approach (latent profile analysis) to examine how narrative variables related to the motivational themes, emotional content, and organizational structure of randomly sampled support-seeking messages (N = 495) posted on Reddit (r/Anxiety and r/Depression) influenced the quantity (number of comments and post score) and quality (type of support in comments) of support that they received. We identified five distinct narrative profiles of support-seeking posts, which in turn differentially predicted the quality, but not quantity, of social support people received. While commenters provided high levels of emotional support to all forms of posts, we found that coherence was an important determinant of esteem support. A combination of coherence, as well as agency and affective tone, were important determinants of instrumental, informational, and network support. The ways in which one talks about their problems influence the way others support them.

Evaluating the effectiveness of concurrent sessions and counselors' attention allocation in online counseling.

OBJECTIVE: With its anonymity and accessibility, text-based online counseling has shown great potential in reaching people with mental health needs. One strategy adopted to meet the service gap is concurrent counseling, that is, each counselor attending to more than one client at a time. To date, there is no reported evidence supporting its rationality and effectiveness. This study investigated the potential opportunities, effectiveness, and caveats in concurrent service delivery and identified the optimal cutoff number of concurrent sessions while maintaining the quality of service at or above a set threshold. METHOD: We analyzed the transcript of 54,716 online counseling sessions from Open Up, a free, 24/7 text-based counseling service, to develop an attention score that measures the attention allocation of counselors and examined the impact of the counselor's attention allocation on client satisfaction and service outcomes. RESULTS: On average, compared to nonconcurrent sessions, concurrent sessions were longer, more likely to end prematurely, and had lower client satisfaction. We also identified an optimal attention score of approximately 0.4 (out of 1.0, which denotes full attention), which translates to two to three concurrent sessions. CONCLUSIONS: This study provides empirical evidence for the feasibility of conducting multiple text-based sessions concurrently without compromising service quality and client experience. Our method of measuring the counselor attention allocation offers a way to systematically assess and evaluate concurrent sessions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial.

BACKGROUND: Despite its efficacy in treating comorbid insomnia and depression, cognitive behavioral therapy for insomnia (CBT-I) is limited in its accessibility and, in many countries, cultural compatibility. Smartphone-based treatment is a low-cost, convenient alternative modality. This study evaluated a self-help smartphone-based CBT-I in alleviating major depression and insomnia. METHODS: A parallel-group randomized, waitlist-controlled trial was conducted with 320 adults with major depression and insomnia. Participants were randomized to receive either a 6-week CBT-I via a smartphone application, proACT-S, or waitlist condition. The primary outcomes included depression severity, insomnia severity, and sleep quality. The secondary outcomes included anxiety severity, subjective health, and acceptability of treatment. Assessments were administered at baseline, post-intervention (week 6) follow-up, and week 12 follow-up. The waitlist group received treatment after the week 6 follow-up. RESULTS: Intention to treat analysis was conducted with multilevel modeling. In all but one model, the interaction between treatment condition and time at week 6 follow-up was significant. Compared with the waitlist group, the treatment group had lower levels of depression [Center for Epidemiologic Studies Depression Scale (CES-D): Cohen's d = 0.86, 95% CI (-10.11 to -5.37)], insomnia [Insomnia Severity Index (ISI): Cohen's d = 1.00, 95% CI (-5.93 to -3.53)], and anxiety [Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A): Cohen's d = 0.83, 95% CI (-3.75 to -1.96)]. They also had better sleep quality [Pittsburgh Sleep Quality Index (PSQI): Cohen's d = 0.91, 95% CI (-3.34 to -1.83)]. No differences across any measures were found at week 12, after the waitlist control group received the treatment. CONCLUSION: proACT-S is an efficacious sleep-focused self-help treatment for major depression and insomnia. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04228146. Retrospectively registered on 14 January 2020. http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT04228146.

Developing and validating a parser-based suicidality detection model in text-based mental health services.

BACKGROUND: Advances in text-mining can potentially aid online text-based mental health services in detecting suicidality. However, false positive remains a challenge. METHODS: Data of a free 24/7 online text-based counseling service in Hong Kong were used to develop a novel parser-based algorithm (PBSD) to detect suicidal ideation while minimizing false alarms. Sessions containing keywords related to suicidality were extracted (N = 1267). PBSD first applies a sentence parser to work out the grammatical structure of each sentence, including subject, object, dependent and modifier. Then a set of syntax rules were applied to judge if a flagged sentence is a true or false positive. Half of the sessions were randomly selected to train PBSD, the remaining were used as the test set. A standard keywords matching model was adopted as the baseline comparison. Accuracy and recall were reported to demonstrate models' performance. RESULTS: Of the 1267 sessions, 585 (46.2 %) were false alarms. The false alarms were categorized into four types: negation-induced false alarms (NIFA; 14 %), subject-induced false alarms (SIFA; 19 %), tense-induced false alarms (TIFA; 30 %), and other types of false alarms (OTFA; 37 %). PBSD significantly outperforms the baseline keywords matching model on accuracy (0.68 vs 0.53, 28.3 %). It successfully amended 36.8 % (105/297) lexicon matching-caused false alarms. The reduction on recall was marginal (1 vs 0.96, 4 %). CONCLUSIONS: The proposed model significantly improves the use of lexicon-based method by reducing false alarms and improving the accuracy of suicidality detection. It can potentially reduce unnecessary panic and distraction caused by false alarms among frontline service-providers.

The Indirect Effect of Sleep on the Association Between Protracted Social Stressors and Psychological Distress Among Hong Kong Young People.

PURPOSE: Hong Kong youth and young adults experienced unprecedented stress amid social unrest and the COVID-19 pandemic. Few studies have examined how these stressors were related to psychological distress among youth and young adults. This study assessed how psychological distress is associated with stress from social unrest, financial circumstances, and the COVID-19 pandemic, and whether poor sleep quality may explain these associations. METHODS: Participants of a representative phone survey included 1,501 Hong Kong youth and young adults (Mage = 26.1 (4.0); 48.2% female). We examined the associations between psychological distress and three types of stress (social unrest, financial, and COVID-19 stress), and the indirect effect of poor sleep. RESULTS: Eleven point nine percent, 4.1%, and 9.7% of respondents reported feeling very seriously distressed by social unrest, financial circumstances, and the COVID-19 pandemic, respectively. All three forms of stress were associated with poor sleep. The indirect effects of poor sleep on the association between all three forms of stress and psychological distress were identified. Moderated indirect effect analysis indicated that being female intensified the effect of COVID-19-related stress on psychological distress and that younger female youth and older male youth were more vulnerable to financial stress and social unrest stress (vs. older female youth and younger male youth). DISCUSSION: Sleep may be one mechanism that accounts for the association between psychological distress and protracted stressors among Hong Kong youth and young adults. These results suggest the importance of prioritizing sleep improvement in mental health interventions during times of societal change.

Be Still and You Will Know: A Mixed-Method Study on Solitude and Consideration of Future Consequences Among Youth in Rehabilitation.

Although solitude is found to be undesirable to many, systematic practice of it can yield positive psychological outcomes. This mixed-method study explored the process and influence of solitude as a behavioral intervention among youths in a therapeutic community in Hong Kong. Qualitative interviews with 43 youths (67.4% male, mean age = 18.3) revealed that solitude facilitated growth in their sense of personal responsibility, increased perspective-taking, increased respect for rules, change in life attitudes, and growth in consideration of future consequences. A two-wave prospective study (n = 79, 82.3% male, mean age = 17.4) further demonstrated perceived meaningfulness in solitude predicted an increase in consideration of future consequences, but not in other types of behavioral intervention. This study preliminarily demonstrated solitude has beneficial outcomes among high-risk youths, and meaning-making can facilitate this relationship.

Variability in the psychological impact of four waves of COVID-19: a time-series study of 60 000 text-based counseling sessions.

BACKGROUND: Continuous exposure to stressors can lead to vulnerability and, in some cases, resilience. This study examined the variation in its psychological impact across the first four waves of COVID-19 in Hong Kong. METHODS: Transcripts from Open Up, an online text-based counseling service, between January 2019 and January 2021 were analyzed (N = 60 775). We identified COVID-19 mentioned sessions using keywords and further categorized them into those that also mentioned symptoms of common mental disorders (CMDs) and those that did not. Autoregressive integrated moving average models were used to analyze the associations between the severity of the outbreak and the mention of COVID-19 and CMDs. RESULTS: Results revealed that the pandemic led to increased psychological distress. Compared to prior to its advent, more people sought help in the initial months of the outbreak. Furthermore, associations were found between the severity of the outbreak and the number of help-seeker mentioning the pandemic, as well as between the outbreak severity and the number of help-seekers disclosing psychological distress. However, these relationships were not uniform across the four waves of outbreaks; a dissociation between outbreak severity and help-seekers' concern was found in the fourth wave. CONCLUSION: As the pandemic waxes and wanes, people may become habituated to its psychological toll. This may be interpreted as a form of resilience. Instead of worsening with time, the psychological impact of COVID-19 may reduce with repeated exposure.

Whatever will bore, will bore: The mere anticipation of boredom exacerbates its occurrence in lectures.

BACKGROUND: Academic boredom is ubiquitous, and it leads to a range of adverse learning outcomes. Given that students often make estimates of how boring lectures are, does anticipating a lecture to be boring shape their actual experience of boredom? AIMS: The current research investigated whether anticipated boredom intensifies subsequent boredom felt in lectures. SAMPLES: We recruited undergraduate students to participate in three studies. METHODS: Study 1 (N = 121) and study 2 (N = 130) were conducted in natural university lecture environments. We found that students who anticipated a lecture to bore them more subsequently felt more bored by it. In study 3 (N = 92), we experimentally manipulated anticipated boredom before participants watched a lecture video. We found that those who were led to anticipate higher levels of boredom felt more bored by the video. RESULTS AND CONCLUSIONS: Results converged to indicate that the mere expectation that a lecture will be boring may be sufficient to exacerbate its subsequent occurrence. We discuss these findings in the contexts of affective forecasting and education.

Indirect contact with nature, lifestyle, and mental health outcomes during mandatory hotel quarantine in Hong Kong.

BACKGROUND: During the pandemic of COVID-19 Hong Kong lead one of the world's longest and most stringent quarantine measures. AIMS: To examine cross-sectionally (i) the relationship between the duration of mandatory hotel quarantine and mental health outcomes; (ii) whether indirect contact with nature and lifestyle factors (i.e. diet, sleep, exercises, social support, and sense of meaning), mitigated this relationship. METHODS: A group of 248 participants under 14 or 21-d mandatory hotel quarantine in Hong Kong completed an online questionnaire that included quarantine and lifestyle-related questions, as well as mental health outcome measures. RESULTS: For those under a 21-d quarantine, there was a significant effect of the week of quarantine on the level of depressive symptoms (Patient Health Questionnaire-4), which peaked in Week 2. Worse quality of sleep, a lower sense of meaning, and a longer set (but not completed) duration of quarantine were predictors of worse mental health outcomes. The positive relationship between the day of quarantine and the level of perceived stress was moderated by the indirect contact with nature. CONCLUSION: The results shed light on the potential negative impact of prolonged periods of quarantine on mental health outcomes and the possible protective factors.

Revisiting the factor structure of the insomnia severity index among survivors of the 2013 Super Typhoon Haiyan.

OBJECTIVE: The insomnia severity index (ISI) is often used as a screening tool used with its recommended clinical cutoff scores. However, this practice presumes a single-factor structure, which has received little theoretical or empirical support. This study examined the factor structure of the ISI with the aim to validate its clinical application in postdisaster contexts. METHOD: One hundred sixty-eight Filipino adult survivors of the 2013 Super Typhoon Haiyan completed two waves of questionnaires that were 7 months apart. Confirmatory factor analyses were first conducted to compare models with different factor structures, followed by a test of longitudinal measurement invariance. The longitudinal interrelations among factors of the ISI as well as between insomnia and symptoms of psychological distress were then examined with path analysis. RESULTS: Results supported a two-factor model, composed of severity and impact of insomnia, which achieved strong longitudinal invariance. The change in impact of insomnia at T2 was predicted by severity of insomnia at T1. Impact of insomnia was significantly associated with symptoms of stress but not depression and anxiety. CONCLUSION: We preliminarily propose a model in which the impact of insomnia mediates the influence of severity of insomnia on subsequent stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Boredom belief moderates the mental health impact of boredom among young people: Correlational and multi-wave longitudinal evidence gathered during the COVID-19 pandemic.

OBJECTIVES: Young people's experience of boredom and its psychological health sequelae have been exacerbated by the COVID-19 pandemic. The present study examined the moderating role of boredom beliefs-the extent to which one affectively dislikes boredom (boredom dislike) and cognitively accepts it (boredom normalcy)-on the association between boredom experience and mental well-being. We also validated a new measure of boredom beliefs in two different samples of young people. METHOD: We report data from a correlational study with British young people aged 12-25 (Study 1; N = 2495) and a 16-week eight-wave within-subject study with Israeli adolescents aged 12-18 (Study 2; N = 314). RESULTS: Across both studies, disliking boredom was associated with higher frequency and intensity of boredom. Boredom dislike moderated the negative association between boredom and mental well-being, such that the association was more salient among those who strongly disliked boredom. Normalizing boredom was positively associated with mental well-being. The measure of boredom beliefs demonstrated fair validity and reliability. CONCLUSION: Results provide novel insights into the potential buffering effect of boredom beliefs against the mental health impact of boredom, particularly at a time of reduced activity. These findings generalize across two different countries.

Network-based prediction of the disclosure of ideation about self-harm and suicide in online counseling sessions.

BACKGROUND: In psychological services, the transition to the disclosure of ideation about self-harm and suicide (ISS) is a critical point warranting attention. This study developed and tested a succinct descriptor to predict such transitions in an online synchronous text-based counseling service. METHOD: We analyzed two years' worth of counseling sessions (N = 49,770) from Open Up, a 24/7 service in Hong Kong. Sessions from Year 1 (N = 20,618) were used to construct a word affinity network (WAN), which depicts the semantic relationships between words. Sessions from Year 2 (N = 29,152), including 1168 with explicit ISS, were used to train and test the downstream ISS prediction model. We divided and classified these sessions into ISS blocks (ISSBs), blocks prior to ISSBs (PISSBs), and non-ISS blocks (NISSBs). To detect PISSB, we adopted complex network approaches to examine the distance among different types of blocks in WAN. RESULTS: Our analyses find that words within a block tend to form a module in WAN and that network-based distance between modules is a reliable indicator of PISSB. The proposed model yields a c-statistic of 0.79 in identifying PISSB. CONCLUSIONS: This simple yet robust network-based model could accurately predict the transition point of suicidal ideation prior to its explicit disclosure. It can potentially improve the preparedness and efficiency of help-providers in text-based counseling services for mitigating self-harm and suicide.

In online counseling, the help-provider can often be engaging with several service users simultaneously. Therefore, new tools that could help to alert and assist the help-provider and increase their preparedness for getting further help for service users could be useful. In this study, we developed and tested a new tool that is designed to alert help-providers to the disclosure of self-harm and suicidal thoughts, based on the words that the service user has been typing. The tool is developed on the basis that word usage may have a specific pattern when suicidal thoughts are more likely to occur. We tested our tool using two years' worth of online counseling conversations and we show that our approach can help to predict the confession of suicidal thoughts. As such, we are taking a step forward in helping to improve these counseling services.

A Smartphone App for Promoting Mental Well-being and Awareness of Anxious Symptoms in Adolescents: A Pilot Cluster Randomized Controlled Trial.

Objective: To design a smartphone app and evaluate its effect on promoting mental well-being and awareness of anxious symptoms in adolescents. Materials and Methods: A pilot cluster randomized controlled trial was conducted with two secondary schools (390 students, mean age 13.1 years) randomized to the intervention and control groups. An app was designed to encourage "Sharing, Mind, and Enjoyment (SME)" between students and their parents (e.g., express gratitude), including interaction and game elements. The app was used daily over 1 month. The waitlist control group was offered the app after completing all assessments. The primary outcomes were changes in SME behaviors measured at 1 month and 3 months. Secondary outcomes included subjective happiness, well-being, personal health and happiness, family health, happiness and harmony, self-perceived knowledge, and understanding of anxious symptoms. Two focus groups of students and three individual in-depth interviews of community partners were conducted. Results: Seventeen of 152 students (11.2%) in the intervention group used the app together with parents (adherent subgroup) and 69 (45.4%) used it without involving parents. The intervention group did not show significant difference in the change of SME behaviors at 1- or 3-month follow-up compared with the control group. However, the intervention group reported greater increase in the awareness of anxious symptoms at follow-ups than the control group (d = 0.52 at 1 month and d = 0.43 at 3 month, both P < 0.001). Post hoc analysis showed a significantly greater increase in SME-related behaviors in the adherent subgroup than the control group at 3 months (d = 0.46, P = 0.04). The interviews found favorable changes in app users, but motivation to use the app was low in general. Both students and community partners suggested primary school students would be more receptive users. Conclusions: The app did not show effectiveness in increasing SME behaviors of students, but increased awareness of anxious symptoms. Further improvements and tests are warranted. Trial Registration: ClinicalTrials.gov NCT03361475.

Autonomous motivation predicts students' engagement and disaffection in interprofessional education: Scale adaptation and application.

OBJECTIVES: Despite the popularity of interprofessional education, the empirical and theoretical development of its scholarship and science is just emerging. This may be caused in part by the non-availability of measures that can be used by researchers in this field. This study aimed to contribute to the psychological theorizing of interprofessional education by uncovering the psychometric properties of Perceived Locus of Causality adapted to Interprofessional Education (PLOC-IPE) in healthcare education and provide a comprehensive guide on how this can be used to advance the IPE research agenda. METHODS: Confirmatory factor analysis (quantitative design) was used to examine the acceptability of psychometric properties of PLOC-IPE. Data were collected through questionnaires administered at two different time points. The participants consisted of 345 students from Chinese Medicine, Clinical Psychology, Medicine, Nursing, Pharmacy, and Social Work from a university in Hong Kong. RESULTS: Based on confirmatory factor analysis, results of within-network construct validity showed good psychometric properties of PLOC-IPE while between-network validity indicated that the scale can predict IPE-related outcomes. Students' intrinsic motivation in IPE positively predicted emotional engagement and negatively predicted emotional disaffection, demonstrating the applicability of the newly validated PLOC-IPE. Amotivation was a negative predictor of emotional engagement and a positive predictor of emotional disaffection. CONCLUSIONS: Findings support the acceptability of PLOC when adapted to IPE. PLOC-IPE obtained acceptable psychometric properties as a measure of students' academic motivation in IPE. It is an adapted scale that can be used to understand self-determined motivation in the context of IPE in health and social care education. A guide on how PLOC-IPE can be a means by which researchers can contribute to the advancement of scholarship of IPE was provided.

Toward a better understanding of cultural change: Reply to Bao et al. (2022).

Bao et al. (2022) criticize the method, analysis, and conclusion of Hamamura et al. (2021). In this reply, we respond to their three critiques. We trust that this constructive exchange further facilitates our understanding of cultural changes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).