Changes in younger stroke survivors' body perception as indicated in body drawings: A comparison between Expressive Arts-based Intervention and control groups.

Stroke-related deficits affect stroke survivors' perception of their bodies and possibly impede their progress in rehabilitation and well-being. This study adopted a pre-and post-test design to compare the changes in body perception among younger stroke survivors after participating in an 8-week Expressive Arts-based Intervention (EABI) (n = 32) with the control group (n = 30). Each participant partook in structured drawing interviews at baseline (T0) and 8-week follow-up/post-intervention (T1). The data were analyzed using content analysis. More EABI (n = 27) than control (n = 14) participants reported positive changes in body perception and applied lighter colours or created a more symmetrical drawing at T1. They shared that EABI promoted these positive changes by facilitating the reconnection with one's body and self. While some control participants experienced positive changes in body perception, others tended to apply darker colours or the same colour to show negative or no changes in body perception. More control (n = 8) than EABI (n = 3) participants reported negative thoughts about their bodies and negative influences from other individuals and the environment. The findings suggested that EABI can change stroke survivors' body perception. EABI can be considered one of the interventions that may help foster positive changes in body perception.

Latent Heterogeneity of Online Sexual Experiences and Associations With Sexual Risk Behaviors and Behavioral Health Outcomes in Chinese Young Adults: Cross-Sectional Study.

BACKGROUND: Online sexual experiences (OSEs) are becoming increasingly common in young adults, but existing papers have reported only on specific types of OSEs and have not shown the heterogeneous nature of the repertoire of OSEs. The use patterns of OSEs remain unclear, and the relationships of OSEs with sexual risk behaviors and behavioral health outcomes have not been evaluated. OBJECTIVE: This study aimed to examine the latent heterogeneity of OSEs in young adults and the associations with sexual risk behaviors and behavioral health outcomes. METHODS: The 2021 Youth Sexuality Study of the Hong Kong Family Planning Association phone interviewed a random sample of 1205 young adults in Hong Kong in 2022 (male sex: 613/1205, 50.9%; mean age 23.0 years, SD 2.86 years) on lifetime OSEs, demographic and family characteristics, Patient Health Questionnaire-4 (PHQ-4) scores, sex-related factors (sexual orientation, sex knowledge, and sexual risk behaviors), and behavioral health outcomes (sexually transmitted infections [STIs], drug use, and suicidal ideation) in the past year. Sample heterogeneity of OSEs was analyzed via latent class analysis with substantive checking of the class profiles. Structural equation modeling was used to examine the direct and indirect associations between the OSE class and behavioral health outcomes via sexual risk behaviors and PHQ-4 scores. RESULTS: The data supported 3 latent classes of OSEs with measurement invariance by sex. In this study, 33.1% (398/1205), 56.0% (675/1205), and 10.9% (132/1205) of the sample were in the abstinent class (minimal OSEs), normative class (occasional OSEs), and active class (substantive OSEs), respectively. Male participants showed a lower prevalence of the abstinent class (131/613, 21.4% versus 263/592, 44.4%) and a higher prevalence of the active class (104/613, 17.0% versus 28/592, 4.7%) than female participants. The normative class showed significantly higher sex knowledge than the other 2 classes. The active class was associated with male sex, nonheterosexual status, higher sex desire and PHQ-4 scores, and more sexual risk behaviors than the other 2 classes. Compared with the nonactive (abstinent and normative) classes, the active class was indirectly associated with higher rates of STIs (absolute difference in percentage points [Δ]=4.8%; P=.03) and drug use (Δ=7.6%; P=.001) via sexual risk behaviors, and with higher rates of suicidal ideation (Δ=2.5%; P=.007) via PHQ-4 scores. CONCLUSIONS: This study provided the first results on the 3 (abstinent, normative, and active) latent classes of OSEs with distinct profiles in OSEs, demographic and family characteristics, PHQ-4 scores, sex-related factors, and behavioral health outcomes. The active class showed indirect associations with higher rates of STIs and drug use via sexual risk behaviors and higher rates of suicidal ideation via PHQ-4 scores than the other 2 classes. These results have implications for the formulation and evaluation of targeted interventions to help young adults.

Start With the Body or the Mind? Differential Benefits of Mindfulness and Qigong Practices for Colorectal Cancer Survivors: A Qualitative Study.

BACKGROUND: Mindfulness and qigong are 2 distinct forms of mind-body practice that have been well-received by cancer survivors. Although there is evidence supporting the effectiveness of mindfulness or qigong in promoting wellness of cancer survivors, little is known about the differential benefits of these common forms of mind-body practices among survivors. OBJECTIVE: To compare the potential biopsychosocial-spiritual impacts of mindfulness and Baduanjin (BDJ) qigong on colorectal cancer survivors. METHODS: Sixty cancer survivors who participated in a mindfulness intervention (n = 38) and BDJ qigong (n = 22) intervention were invited to provide qualitative feedback for their experiences. Content analyses were conducted to identify emerging themes from the data, and χ2 tests were conducted to compare the responses of the mindfulness and BDJ groups in the major categories. RESULTS: Both practices positively influenced psychosocial wellness. The practice of BDJ qigong led to more prominent improvements in physical well-being, whereas mindfulness worked best in enhancing spiritual growth and intrapersonal connectedness. CONCLUSIONS: Survivors of colorectal cancer who are looking for ways to enhance their vitality and rejuvenate their physical body may find the practice of BDJ helpful, whereas survivors who are looking for spiritual comfort or growth may consider practicing mindfulness as an entry point toward mind-body unity. IMPLICATIONS FOR PRACTICE: Mindfulness and BDJ may be helpful for survivors of colorectal cancer to improve their holistic wellness. Oncology nurses can consider prescription of mindfulness and/or BDJ for patients recovering from colorectal cancer.

Associations between COVID-19 mental impact and distress, resilience, burnout and well-being in Hong Kong community adults: A structural equation model.

The COVID-19 pandemic poses substantial risks to individuals' physical and mental health and prolonged psychological responses to the pandemic could lead to emotional exhaustion. The present study aimed to examine the mediating role of COVID-19 related mental impact and distress in the relationship among resilience, burnout, and well-being. The present study recruited 500 community adults (mean age = 38.8 years, SD = 13.9; 76% females) in Hong Kong via an online survey in autumn 2021. The participants completed the Mental Impact and Distress Scale: COVID-19 (MIDc) and validated measures on resilience, burnout, and well-being. Confirmatory factor analysis was conducted to evaluate the psychometric properties of the MIDc. Direct and indirect effects of resilience on burnout and well-being via MIDc were examined via structural equation modeling. Confirmatory factor analysis supported factorial validity for the three factors of MIDc (situational impact, anticipation, and modulation). Resilience showed negative effects on the MIDc (ß = -0.69, SE = 0.04, p < 0.01) and burnout (ß = 0.23, SE = 0.06, p < 0.01). Burnout was positively associated with MIDc (ß = 0.63, SE = 0.06, p < 0.01) and negatively associated with well-being (ß = -0.47, SE = 0.07, p < 0.01). Resilience showed a significant and positive indirect effect (αßγ = 0.203, 95% CI = 0.131 to 0.285) on well-being via MIDc and burnout. The results support a potential mediating role for MIDc as psychological responses in the relationship among resilience and burnout and well-being.

Association between quarantine and sleep disturbance in Hong Kong adults: The mediating role of COVID-19 mental impact and distress.

Background: COVID-19 quarantine has been associated with increased sleep problems and prolonged psychological responses to the pandemic could mediate this relationship. The present study attempted to examine the mediating role of COVID-19 mental impact and distress between quarantine and sleep disturbance. Methods: The present study recruited 438 adults (109 with quarantine experience) in Hong Kong via an online survey between August and October 2021. The respondents completed a self-report questionnaire on quarantine, Mental Impact and Distress Scale: COVID-19 (MIDc), and Pittsburgh Sleep Quality Index (PSQI). The MIDc was treated as a latent mediator and continuous PSQI factor and poor sleep quality (PSQI score > 5) were the study outcomes. We evaluated the direct and indirect effects of quarantine on sleep disturbance via MIDc using structural equation modeling. Analyses were adjusted for gender, age, education level, knowing confirmed COVID-19 cases, COVID-19 frontline work, and primary income source of the family. Results: More than half (62.8%) of the sample reported poor sleep quality. Quarantine was associated with significantly higher levels of MIDc and sleep disturbance (Cohen d = 0.23 - 0.43, p < 0.05). In the structural equation model, the MIDc mediated the relationship between quarantine and sleep disturbance (αß = 0.152, 95% CI = 0.071 to 0.235). Quarantine significantly increased the proportion of poor sleep quality by 10.7% (95% CI = 0.050 to 0.171) indirectly via MIDc. Conclusions: The results provide empirical support to the mediating role of the MIDc as psychological responses in the relationship between quarantine and sleep disturbance.

Psychometric properties of the Patient Health Questionnaire-4 among Hong Kong young adults in 2021: Associations with meaning in life and suicidal ideation.

Background: Young adults in Hong Kong are subject to elevated psychological distress given the societal stressors such as civil unrest and COVID-19 pandemic and suicide is a leading cause of death among them. The present study aimed to evaluate the psychometric properties and measurement invariance of the 4-item Patient Health Questionnaire-4 (PHQ-4) as a brief measure of psychological distress and its associations with meaning in life and suicidal ideation (SI) in young adults. Materials and methods: A mobile survey recruited a large and random sample of 1,472 young adults (Mean age = 26.3 years, 51.8% males) in Hong Kong in 2021. The participants completed the PHQ-4 and Meaning in Life Questionnaire-short form (MLQ-SF) for presence of meaning in life (MIL), SI, COVID-19 impact, and exposure to suicide. Confirmatory factor analysis was conducted to examine the factorial validity, reliability, and measurement invariance of PHQ-4 and MLQ-SF across gender, age, and distress subgroups. Multigroup structural equation model evaluated and compared the direct and indirect effects of latent MIL factor on SI via latent PHQ-4 factor across distress groups. Results: Both MIL and PHQ-4 supported a 1-factor model with good composite reliability (Ω = 0.80-0.86) and strong factor loadings (λ = 0.65-0.88). Both factors showed scalar invariance across gender, age, and distress groups. MIL showed significant and negative indirect effects (αß = -0.196, 95% CI = -0.254 to -0.144) on SI via PHQ-4. PHQ-4 showed a stronger mediating role between MIL and SI in the distress group (Δ = -0.146, 95% CI = -0.252 to -0.049) than the non-distress group. Higher MIL predicted higher likelihoods of help-seeking (Odds ratios = 1.46, 95% CI = 1.14-1.88). Conclusion: The present results support adequate psychometric properties in terms of factorial validity, reliability, convergent validity, and measurement invariance for the PHQ-4 in young adults in Hong Kong. The PHQ-4 demonstrated a substantial mediating role in the relationship between meaning in life and SI in the distress group. These findings support clinical relevance for using the PHQ-4 as a brief and valid measure of psychological distress in the Chinese context.

Psychometric properties of the 12-item Stroke-Specific Quality of Life Scale among stroke survivors in Hong Kong.

The present study examined the psychometric properties of the 12-item Stroke-Specific Quality of Life Scale (SSQOL-12) in 184 stroke survivors in Hong Kong. The participants completed a self-report questionnaire including the SSQOL-12, SF-12 health survey, and validating variables at baseline and 148 stroke survivors completed SSQOL-12 two months later. Confirmatory factor analysis investigated the construct validity, reliability, and measurement invariance of SSQOL-12 across two months. Concurrent, convergent, and divergent validity was examined with respect to SF-12, hope, self-esteem, functional disability, anxiety, and depression. The original 2-factor model did not reveal a superior fit over the 1-factor model and a modified 1-factor model provided an acceptable fit to the data in both waves. The SSQOL-12 factor displayed substantial factor loadings (λ = 0.40-0.87), good internal consistency (Ω = 0.88), temporal stability (r = 0.70), and scalar measurement invariance across time. Stroke-specific quality of life was significantly associated with higher levels of SF-12, hope, and self-esteem and lower levels of functional disability, anxiety, and depression. Most correlations remained significant after controlling for demographic covariates and SF-12. The present findings offered empirical support for the validity and reliability of the unidimensional structure for SSQOL-12 as a measure of stroke-specific quality of life among stroke survivors.

Indirect effects of social support and hope on quality of life via emotional distress among stroke survivors: A three-wave structural equation model.

Objectives: Stroke survivors are prone to functional impairments and reduced quality of life (QoL). This study examined the mediating role of social support and hope in the relationships between functional impairment, emotional distress, and QoL. Methods: A total of 188 stroke survivors in Hong Kong completed assessments on functional impairment, social support, and hope at baseline, with follow-up measurements of emotional distress at 2 months and QoL at 8 months. Structural equation modeling with bootstrapping was used to analyze the direct and indirect effects of functional impairment on emotional distress and QoL via the mediating factors of social support and hope. Results: The partial cascading model provided an adequate fit to the data. Functional impairment had significant negative direct effects on hope and physical QoL and social support had significant positive direct effects on hope and physical QoL. Social support had a significant positive indirect effect on physical QoL via hope and perceived stress and on psychosocial QoL via hope and depression. Functional impairment and hope had a significant negative interaction effect on perceived stress. Conclusion: The findings support a mediating role for hope in the relationship between social support and QoL in stroke survivors. The protective effect of hope on perceived stress was stronger among patients with greater functional impairment.

Comparison of passive drool and cotton-based collection methods for salivary C-reactive protein measurement.

Saliva collection and handling procedures for salivary C-reactive protein (CRP) can be challenging due to a lack of standardized protocols. This study compared two collection methods used to quantify salivary CRP. Twenty-two Chinese adults provided two unstimulated whole saliva samples using passive drool and cotton-based collection devices in two consecutive mornings at baseline and 1 month later. The effects of various factors on CRP levels were analyzed using linear mixed models. Salivary CRP levels were significantly affected by collection time and method, but not day or wave. The CRP peaked upon awakening and declined 45 min later. CRP levels were significantly higher in the passive drool than in the cotton-based method. The Bland-Altman plot revealed relative and proportional biases. The difference in the CRP levels between the methods decreased as the CRP levels increased. Results suggest that passive drool and cotton-based collection methods should not be used interchangeably for measuring low levels of salivary CRP.

Temporal relationships among role stress, staff burnout, and residents' behavioral problems: A 2-year longitudinal study in child care homes in Hong Kong.

Young residents in care homes experience psychological distress arising from their complex family backgrounds. Residential care workers face job demands and are prone to burnout due to the role stress of balancing enormous workloads with residents' emotional needs. This 2-year study examined the changes in role stress, burnout, and residents' behavioral problems, and their temporal relationships in a sample of 381 young residents and 76 workers from residential care homes in Hong Kong. The workers completed the Role Questionnaire and Copenhagen Burnout Inventory and evaluated the residents' behavioral problems using the Child Behavior Checklist every 3 months. Latent growth modeling was used to analyze the temporal changes, and multilevel regression analysis was used to evaluate the associations between role stress and residents' behavioral problems. The workers displayed stable trends in role stress and burnout with significant inter-individual variations in temporal changes. The residents' total behavioral problems displayed piecewise decreasing trajectories with significant declines over the first 9 months. Controlling for baseline levels, changes in role stress showed significant and positive associations with changes in work burnout and total behavioral problems over the first 9 months. The findings provide support for the temporal relationships among role stress, work burnout, and residents' behavioral problems in a residential care setting.

Longitudinal associations between salivary cortisol to C-reactive protein ratios and psychological well-being in Chinese adults.

BACKGROUND: Salivary C-reactive protein (CRP) could be a viable biomarker of inflammation and has been associated with stress outcomes. The hypothalamic-pituitary-adrenal axis can modulate stress-related inflammation. This study aimed to evaluate the interaction effects of immune-endocrine markers on psychological outcomes. METHODS: The study participants were 52 healthy Chinese adults who collected 10 saliva samples over 2 consecutive days at baseline. The participants completed validated measures on anxiety, depression, positive affect, and sleep disturbance at baseline and 1 month later. The stability and diurnal patterns of salivary cortisol and CRP were investigated via paired t-tests and repeated-measures analyses of variance. Regression analysis was used to examine the longitudinal associations between immune-endocrine markers and their interactions (cortisol [Cort]: morning CRP [CRPmorn] and Cort:CRPeven) and psychological measures. RESULTS: Salivary cortisol and CRP displayed satisfactory stability over 2 consecutive days and diurnal patterns of abrupt and gradual decline during the day, respectively. Controlling for baseline psychological measures and confounding variables, Cortmorn and diurnal cortisol slope was significantly and negatively associated with anxiety symptoms and positive affect 1 month later, respectively. Cort:CRPeven and Cort:CRPmorn was significantly and positively associated with depressive symptoms and sleep disturbance 1 month later, respectively. CONCLUSION: These findings offer initial support for the prognostic utility of salivary cortisol and CRP and their balance as determinants of psychological health in healthy adults.

The Satisfaction with Life Scale in Adolescent Samples: Measurement Invariance across 24 Countries and Regions, Age, and Gender.

Measurement of adolescent life satisfaction across cultures has not received much attention in previous empirical research. The present study evaluated measurement invariance of the Satisfaction with Life Scale (SWLS) among adolescents in 24 countries and regions (N = 22,710; age range = 13-19 years; 53% female). A single-factor model with residual covariance between a pair of items tapping past life satisfaction fitted well in 19 countries and regions and showed a partial metric invariance. In a subset of nine countries and regions, partial scalar invariance was supported. Partial metric invariance across all 24 countries and regions was achieved when custom model modifications in five countries and regions were included. Three SWLS items showed evidence of noninvariance across cultures. The measurement model was found to operate similarly across gender and age. Our findings suggest that caution is needed when using the SWLS for measuring life satisfaction among adolescents from different cultures. Supplementary Information: The online version contains supplementary material available at 10.1007/s11482-021-10024-w.

Psychometric validation of the Chinese Health Questionnaire among young people in Hong Kong across 2018 and 2019.

The Chinese Health Questionnaire (CHQ) is a 12-item assessment tool of psychological distress. The present study systematically evaluated the psychometric properties of the CHQ in a large sample of 1968 young people in Hong Kong. The participants completed the CHQ online in 2018 and 869 of them completed a follow-up survey on the CHQ, suicidal ideation, hikikomori, and help-seeking in 2019. Dimensionality of the CHQ was assessed via confirmatory factor analysis using the robust weighted least square estimator in 2018 and 2019. Measurement invariance was investigated across gender, age groups, and time between 2018 and 2019. Convergent validity of the CHQ factors were evaluated with respect to the mental health outcomes in the multiple indicators and multiple causes (MIMIC) approach. Confirmatory factor analyses shortened the CHQ into 10 items and revealed a superior fit for the bifactor model with a general factor and two specific factors on somatic and depressive symptoms in both 2018 and 2019. The general factor demonstrated substantial factor loadings (λ = 0.58-0.91), good reliability (ΩH = 0.85), and temporal stability (r = 0.62), and scalar measurement invariance across gender, age groups, and time. The general factor was significantly and positively associated with suicidal ideation, hikikomori, and help-seeking. The two specific factors displayed lower factor loadings, reliability, temporal stability, and weaker associations with the mental health outcomes. The present findings lend support to a valid and stable bifactor structure with a strong general factor for the CHQ-10 among young people in Hong Kong. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Factor Structure and Measurement Invariance of the Stigma of Suicide Scale-Short Form Among Adolescents and Early Adults in Hong Kong.

Suicide is a global public health concern. The Stigma of Suicide Scale-Short Form (SOSS-SF) is a brief measure on the stigma toward suicide. This study aimed to examine the psychometric properties of the SOSS-SF in a sample of 1,946 adolescents and early adults (M age = 23.3, 69% females) in Hong Kong. The participants completed the SOSS-SF, measures on suicidal ideation and perceived distress, and binary items on lifetime risk behaviors online. Exploratory structural equation modeling evaluated the factor structure and reliability of the SOSS-SF in split samples and its measurement invariance, convergent validity, and discriminant validity in the overall sample. Contrary to a poor fit for the three-factor structure in the original 16-item SOSS-SF, the four-factor model showed a good fit in the revised 12-item version in both subsamples. The four factors (Glorification, Isolation, Disgrace, and Selfishness) loaded significantly on three items each (λ = .52-.93) and had adequate reliability (ω = .78-.88). The SOSS-SF displayed scalar invariance across age group, gender, and suicidal ideation and significant associations with validating variables. These results demonstrate a valid and reliable four-factor structure for the SOSS-SF and support its use for assessment of multifaceted stigma toward suicide.

Longitudinal measurement invariance in urbanization index of Chinese communities across 2000 and 2015: a Bayesian approximate measurement invariance approach.

BACKGROUND: The Urbanicity Scale was developed based on the China Health and Nutrition Survey (CHNS) to measure the urbanization index of communities according to 12 components. The present study was designed to systematically investigate the factorial validity, reliability, and longitudinal measurement invariance (LMI) of the Urbanicity Scale. METHODS: Six waves of CHNS data from 2000 to 2015 were adopted. The factor structure and reliability of the Urbanicity Scale for 301 communities were examined using Bayesian exploratory factor analysis. Metric and scalar LMIs were evaluated using both the conventional exact and a novel approximate LMI approach via Bayesian structural equation modeling across various timeframes. RESULTS: The findings verified the one-factor structure for the Urbanicity Scale, with adequate reliability. LMI was established for the Urbanicity Scale only over a shorter timeframe from 2006 to 2009 but not over a longer timeframe from 2000 to 2015. Partial LMI was found in the factor loadings and item intercepts for the Urbanicity Scale over the 2004 to 2011 period. CONCLUSION: Interpretation of the temporal change in urbanicity was supported only for a shorter (2006 to 2009) but not a longer timeframe (2000 to 2015). Adjustments addressing the partial non-invariance of the measurement parameters are needed for the analysis of temporal changes in urbanicity between 2004 and 2011.

Psychometric properties of the Chinese version of Five Facet Mindfulness Questionnaire-short form in cancer patients: a Bayesian structural equation modeling approach.

BACKGROUND: Mindfulness has emerged as an important correlate of well-being in various clinical populations. The present study evaluated the psychometric properties of the 20-item short form of the Five Facet Mindfulness Questionnaire (FFMQ-SF) in the Chinese context. METHODS: The study sample was 127 Chinese colorectal cancer patients who completed the FFMQ-SF and validated physical and mental health measures. Factorial validity of the FFMQ-SF was assessed using Bayesian structural equation modeling (BSEM) via informative priors on cross-loadings and residual covariances. Linear regression analysis examined its convergent validity with the health measures on imputed datasets. RESULTS: The five-factor BSEM model with approximate zero cross-loadings and one residual covariance provided an adequate model fit (PPP = 0.07, RMSEA = 0.06, CFI = 0.95). Satisfactory reliability (ω = 0.77-0.85) was found in four of the five facets (except nonjudging). Acting with awareness predicted lower levels of perceived stress, negative affect, anxiety, depression, and illness symptoms (ß = - 0.37 to - 0.42) and better quality of life (ß = 0.29-0.32). Observing, nonjudging, and nonreacting did not show any significant associations (p > .05) with health measures. Acting with awareness was not significantly correlated (r < 0.15) with the other four facets. CONCLUSION: The present findings provide partial support for the psychometric properties of the FFMQ-SF in colorectal cancer patients. The nonjudging facet showed questionable validity and reliability in the present sample. Further studies with larger sample sizes are needed to elucidate the viability of FFMQ-SF as a measure of mindfulness facets in cancer patients.

Effects of Expressive Arts-Based Interventions on Adults With Intellectual Disabilities: A Stratified Randomized Controlled Trial.

BACKGROUND: People with intellectual disabilities have difficulties expressing their views and can manifest psychological and behavioral symptoms. The present study aimed to examine the effects of expressive arts-based intervention (EABI) on the behavioral and emotional well-being of adults with intellectual disabilities. METHODS: This study assigned 109 Chinese adults with intellectual disabilities into EABI (N = 55) or control groups (N = 54) using stratified randomization. Pre- and post-intervention quantitative assessments were conducted of aberrant behaviors, personal well-being, mood and color usage in drawings. Focus group interviews were conducted with the EABI participants and their caseworkers at the post-intervention stage. Repeated-measures analysis of covariance evaluated the EABI effects with age, gender and degree of intellectual disability as covariates, and latent profile analysis examined the patterns of color usage in drawings. Qualitative thematic analysis was performed on the interview data. RESULTS: The interview findings suggest that the EABI group was more emotionally expressive and stable after the intervention. Compared to the control group, the EABI group tended to use more diverse colors and leave less empty space in their drawings. No significant overall improvements were found in the EABI group with respect to aberrant behaviors, mood or personal well-being. Among males, the EABI participants showed significantly more anger and less energetic moods than those in the control group. Among females, the EABI participants showed significantly lower levels of aberrant behavior than those in the control group. CONCLUSION: The results of this study suggest that expressive arts-based interventions have different effects on the emotional and behavioral well-being of male and female participants. Moreover, increased color usage may imply a more positive state of emotional well-being.

Effects of a Mindfulness-based Intervention on diurnal cortisol pattern in disadvantaged families: A randomized controlled trial.

OBJECTIVE: The present study examined the psychophysiological effects of Family-based Mindfulness Intervention (FBMI) on children and parents from disadvantaged families. METHODS: This randomized controlled trial recruited parents and their children from 51 disadvantaged families in Hong Kong and randomized them into FBMI (n = 26) and waitlist control (n = 25) groups. The parent intervention included 6 sessions and the child intervention included 8 sessions with 2 half-hour joint programs. Both interventions lasted 9 hours in total each. All participants completed four salivary cortisol measures after wakeup, before lunchtime, late-afternoon, and before sleep at baseline and end of the intervention. The diurnal cortisol pattern was summarized by the morning cortisol, evening cortisol, mean cortisol, and diurnal cortisol slope. RESULTS: Compared to the control group, children in the FBMI group showed significant increases in morning cortisol (d = 0.50, p =  0.03) and significant decreases in diurnal cortisol slopes (d = 0.50, p =  0.04) at the end of intervention. Parents in the FBMI group displayed significant decreases in evening cortisol (d = 0.50, p =  0.04) compared to the control group at the end of intervention. No significant treatment effects were found on the mean cortisol. DISCUSSION: The present findings suggest that FBMI could improve the diurnal cortisol slope and cortisol levels of the children and parents from disadvantaged families, respectively. Future studies should elucidate its potential benefits on neuroendocrine functioning.

Diurnal Cortisol Slope Mediates the Association Between Affect and Memory Retrieval in Older Adults With Mild Cognitive Impairment: A Path-Analytical Study.

BACKGROUND: Memory deficits are linked to dysfunctional HPA axis activity and negative affect in older adults. This study evaluated the mediating effect of the diurnal cortisol pattern on the relationship between affect and memory in older people with mild cognitive impairment (MCI). METHODS: This longitudinal study recruited 189 Chinese older adults with MCI from elderly centers in Hong Kong. The participants completed assessments of affect, salivary cortisol, and digit spans at baseline; neurocognitive assessments on verbal fluency, memory retrieval, and digit spans at 6-month follow-up; and instrumental activities of daily living (IADL) at 1-year follow-up. Structural equation modeling examined the direct and indirect effects of negative affect on memory and IADL via diurnal cortisol pattern. RESULTS: Controlling for covariates, negative affect significantly predicted flattened diurnal cortisol slopes (ß = 0.17, p < 0.05) but not memory or IADL (p = 0.23 - 0.91) directly. Diurnal cortisol slopes negatively predicted memory retrieval (ß = -0.20, p < 0.05), which in turn positively predicted IADL (ß = 0.22, p < 0.01). The indirect effect from negative affect to IADL via cortisol slope and memory retrieval was significant and negative (αßγ = -0.05, 95% bootstrapped CI = -0.248 to -0.001). DISCUSSION: The present study established certain temporal linkages among affect and cortisol slopes at baseline, memory retrieval at 6 months, and functional decline 1 year later in older adults with MCI. Flattened diurnal cortisol slopes might mediate the detrimental effects of negative affect on memory retrieval and functioning across 1 year.

Mindfulness facets predict quality of life and sleep disturbance via physical and emotional distresses in Chinese cancer patients: A moderated mediation analysis.

OBJECTIVE: Colorectal cancer survivors are at risk of symptom burden and emotional distress. Dispositional mindfulness has been linked with better sleep quality and quality of life (QoL) in these patients. This longitudinal study aimed to examine the associations among mindfulness facets, symptom burden, emotional distress, and functional outcomes. METHODS: Study sample of this three-wave, 2-month survey was 127 Chinese colorectal cancer survivors. The participants completed the Five Facet Mindfulness Questionnaire, Memorial Symptom Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and SF-12 health survey. Moderated mediation analyses examined the direct and indirect effects of mindfulness facets on QoLs and sleep quality via symptom burden and emotional distress, using acting with awareness as a moderator. RESULTS: The mindfulness facets had no significant direct effects on functional outcomes 2 months later. Awareness and nonreacting showed significant and positive indirect effects on physical and mental QoL via symptom burden and emotional distress 1 month later, respectively. Awareness, nonjudging, and nonreacting significantly predicted better sleep quality indirectly via emotional distress. Nonreacting showed stronger indirect effects on the functional outcomes among patients with greater awareness. CONCLUSIONS: This study demonstrates longitudinal linkages between dispositional mindfulness and functioning in cancer survivors via symptom burden and emotional distress. Acting with awareness and nonreacting are the two facets that displayed clinical relevance in predicting better sleep quality and QoL.