Specific effects of cumulative childhood trauma on suicidality among youths.

BACKGROUND: Suicidality was very high among individuals who suffered from childhood trauma. The distribution of cumulative childhood trauma among youths remains unclear, as well as the specific effects of cumulative childhood trauma on suicidality. This study attempted to explore the distribution of cumulative childhood trauma and examine the specific effects of cumulative childhood trauma on suicidality. METHODS: A cross-sectional design was employed in this study, with 117,769 college students recruited from 63 universities in Jilin Province, China. All variables were measured by corresponding self-report questionnaires. The Venn diagram was used to represent the distribution of single and cumulative childhood trauma. ANOVA and chi-square tests were conducted to identify the high-risk suicide groups. Multiple linear regression analysis was performed to examine risk factors for suicidality for overlapping subtypes. RESULTS: 27,671 (23.5%) participants reported suffering from childhood trauma, of which 49.5% were male (Mage = 19.59, SD = 1.76). The "physical neglect" group accounted for the largest proportion (31.5%). Suicidality was the highest in the "overlap of childhood neglect, emotional abuse, and physical abuse" group (2.0%). Depression, obsessive-compulsive disorder, and post-traumatic stress disorder were common risk factors for suicidality. LIMITATIONS: This study was limited by cross-sectional studies and self-report bias. CONCLUSIONS: The childhood trauma subtype group with the largest proportion was not necessarily the highest suicidality. Both the largest group and the highest-risk suicide group require special attention to their respective risk factors.

Effect of gender identity on the association between gender dysphoria and suicidality via appearance anxiety among transgender and gender-diverse young people: moderated mediation study.

BACKGROUND: Gender dysphoria is associated with suicidality among transgender and gender-diverse (TGD) people. Gender dysphoria also results in a stress on appearance. AIMS: The objectives of this study were to examine: (a) whether appearance anxiety mediates the effect of gender dysphoria on suicidality; and (b) whether gender identity moderates the mediating effect of appearance anxiety. METHOD: A total of 117 769 college and university students were recruited in this cross-sectional study from Jilin Province, China. After screening based on participants' gender identity, 2352 TGD young people (aged from 15 to 25 years) were divided into three subgroups: female to male (FTM), male to female (MTF) and non-binary. Self-report inventories measured gender dysphoria, suicidality and appearance anxiety. A structural equation model was run to examine the relationships among TGD gender identity, gender dysphoria, appearance anxiety and suicidality. RESULTS: Among TGD young people, gender dysphoria was significantly positively associated with suicidality (ß = 0.15, 95% CI = 0.11-0.18, P < 0.001). Appearance anxiety partially mediated the association between gender dysphoria and suicidality (ß = 0.07, 95% CI = 0.05-0.08, P < 0.001). Gender identity moderated the mediating effects: compared with individuals with FTM identity, among those with MTF and non-binary identities, gender dysphoria showed stronger positive effects on appearance anxiety, and appearance anxiety showed greater effects in mediating the association between gender dysphoria and suicidality. CONCLUSIONS: Among TGD young people, gender dysphoria is significantly associated with suicidality via appearance anxiety, with gender identity moderating the mediating effects. Diverse treatments should consider the heterogeneity of TGD subgroups, with the aim of limiting the tendency of gender dysphoria to trigger appearance anxiety, thus further buffering against the risk of suicide.

Linear and curvilinear association of pain tolerance and social anxiety symptoms among youth with different subgroups of childhood trauma.

BACKGROUND: Social anxiety is a common symptom that occurs after exposure to childhood trauma (CT), and pain tolerance is a protective factor against social anxiety in generic populations with CT. However, few studies have investigated whether and how this association varies across different CT subgroups. Thus, this study aimed to investigate (1) the effects of pain tolerance on social anxiety symptoms among youth with different subgroups of CT; (2) the nonlinear relationship between pain tolerance and social anxiety symptoms among different CT categories. METHODS: In this study, 15,682 college or university students with experiences of CT were identified in a large sample and divided into five CT subgroups. Linear and quadratic regression models were conducted to explore the association between pain tolerance and social anxiety symptoms among youth with different CT subgroups. RESULTS: The results of model revealed a linear relationship between pain tolerance and social anxiety symptoms among youth with most CT subgroups. Notably, an inverted U-shaped curve was found between pain tolerance and social anxiety symptoms in youth with emotional abuse. Social anxiety symptoms increased gradually with pain tolerance scores between 0 and 16, and then sharply decreased when scores reached above 16. LIMITATIONS: Limited by self-report measurements, the results of this study focused only on perceived pain tolerance and ignored behavioral pain tolerance. CONCLUSION: These findings highlight the importance of assessing pain tolerance thresholds in youth with emotional abuse and improving pain tolerance to prevent social anxiety symptoms in youth with different subgroups of CT.

Using decision tree to predict non-suicidal self-injury among young adults: the role of depression, childhood maltreatment and recent bullying victimization.

Importance: Non-suicidal self-injury (NSSI) is a significant mental health issue requiring a deeper understanding of its underlying causes, such as childhood maltreatment, adult bullying victimization, and depression. Previous studies have not adequately addressed the cumulative risks of these factors on NSSI among college students. This population-based study investigates these cumulative risk factors.Design, setting, and participants: The cross-sectional study included 63 university's college students with a mean age of 19.6 years (N = 95,833).Main outcomes and measures: Two Chi-Square Automatic Interaction Detection (CHAID) decision tree models were used to classify subgroups based on childhood maltreatment and adult bullying victimization experiences and to investigate their cumulative risks of NSSI. Recursive partitioning algorithms determined each predictor variable's relative importance.Results: The CHAID model accurately predicted NSSI behaviours with an overall accuracy rate of 77.8% for individuals with clinically relevant depressive symptoms and 97.2% for those without. Among depressed individuals, childhood emotional abuse was the strongest NSSI predictor (Chi-Square, 650.747; adjusted P < .001), followed by sexual and physical abuse. For non-depressed individuals, emotional abuse in childhood was the strongest NSSI predictor (Chi-Square, 2084.171; adjusted P < .001), with sexual and verbal bullying in the past year representing the most significant proximal risks.Conclusions and relevance: Emotional abuse during childhood profoundly impacts individuals, increasing the risk of NSSI in both depressed and non-depressed individuals. Clinically relevant depressive symptoms have a moderating effect on the relationship between childhood maltreatment, adult bullying victimization, and NSSI. Identifying these factors can inform targeted interventions to prevent NSSI development among young adults.

Emotional abuse during childhood has a profound impact on individuals, increasing their risk of non-suicidal self-injury (NSSI), regardless of whether they are depressed or non-depressed.Among depressed individuals, childhood emotional abuse emerges as the strongest predictor of NSSI, followed by sexual and physical abuse.In non-depressed individuals, emotional abuse in childhood assumes a similar role as the strongest NSSI predictor, with sexual abuse and verbal bullying in the past year representing the most significant proximal risks.

Hazardous drinking in young adults with co-occurring PTSD and psychosis symptoms: A network analysis.

BACKGROUND: Existing literature suggests the co-occurrence of post-traumatic stress disorder (PTSD) and psychosis among young adults is related to hazardous drinking. However, the influencing mechanisms among these co-occurrences are inconclusive. Thus, this study aimed to investigate the symptomatic associations between PTSD, psychosis, and hazardous drinking. METHODS: This study included 96,218 young Chinese adults, divided into three groups (PTSD, Psychosis, and co-occurring PTSD-Psychosis). PTSD, psychosis, and hazardous drinking were measured by the ten-item Trauma Screening Questionnaire, the seven-item Psychosis Screener Scale, and the four-item Alcohol Use Disorders Identification Test, respectively. Network analysis was utilized to explore and compare the symptomatic correlation between PTSD, psychosis, and hazardous drinking. RESULTS: In this study, the most crucial symptom (both central and bridge) was "delusion of control" among the three networks. Hazardous drinking was another main bridge symptom. Compared to the Psychosis group and the co-occurring PTSD-Psychosis group, "Delusion of reference or persecution" to "Grandiose delusion" was the strongest edge in "the network structure of the PTSD group". LIMITATIONS: The cross-sectional study cannot determine the causal relationship. Applying self-reporting questionnaires may cause inherent bias. Young adult participants limited the generalization of the results to other groups. CONCLUSIONS: Among the three network structures, delusion of control was the most crucial symptom, and hazardous drinking was another bridge symptom; the edge of delusion of reference or persecution and grandiose delusion was strongest in the PTSD group's network. Efforts should be taken to develop diverse targeted interventions for these core symptoms to relieve PTSD, psychosis, and hazardous drinking in young adults.

Association between sports-related concussions and the risk of self-injury thoughts and behaviors: Who, and under what circumstances?

BACKGROUND: Understanding the association between sport-related concussions and the risk of suicidal and non-suicidal self-injury thoughts and behaviors (SITBs), including non-suicidal self-injury (NSSI), suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA), is crucial for suicide prevention. We aimed to identify the circumstances in which individuals with or without a concussion are vulnerable to SITBs. METHODS: The cross-sectional study included 85,469 students from 63 Chinese university with a mean age of 19.6 years. Firstly, propensity score matching, and inverse probability of treatment weighting (IPTW) were used to match the concussion and non-concussion group based on a range of biological, social, and psychological factors. Subsequently, multivariable logistic regression and a decision tree algorithm were employed to evaluate the interaction and cumulative impact of these risk factors and concussion on the probability of SITBs. RESULTS: In the unmatched sample, concussion exposures were associated with all SITBs, with NSSI (OR, 1.41), SI (OR, 1.10), SP (OR, 1.23), and SA (OR, 1.28). However, the matched and weighted sample only had a significant association with NSSI and SI. The decision tree model revealed that, in the unmatched sample, among individuals without depressive symptoms or childhood emotional abuse, the risk of concussion on SITBs increased from 45.5 % to 65.2 % (χ2, 9.370; adjusted P = .002) after experiencing sexual abuse and verbal bullying. In the matched sample, the risk increased from 46.2 % to 64.6 % (χ2, 6.848; adjusted P = .009). CONCLUSION: Our study revealed that individuals who suffered concussions exhibited a significantly higher risk of SITBs.

The influence of childhood trauma and chronotype on suicide attempts in Chinese emerging adults with severe depressive symptoms.

BACKGROUND: Studies have investigated how adults with severe depressive symptoms are more likely to attempt suicide, and these adults often have traumatic experiences and chaotic sleep/wake rhythms. Thus, this study using Latent class analysis aimed to investigate the relationship between childhood trauma class, chronotype, and suicide attempts among emerging adults with severe depressive symptoms. METHODS: This study was conducted among emerging adults with severe depressive symptoms covering 63 Universities in Jilin Province, China. A total of 1,225 emerging adults (mean age = 19.6 ± 1.78) constructed the final sample. In addition to measuring socio-demographic characteristics, the Childhood Trauma Questionnaire-Short Form, the Single-Item Chronotyping, and a single item for suicide attempts were used to evaluate childhood trauma, chronotype, and suicide attempts, respectively. Latent class analysis was applied to identify the classes of childhood trauma within emerging adults who had severe depressive symptoms. Hierarchical logistic regression models were run to investigate the effects of socio-demographic characteristics, chronotype, and childhood trauma class on suicide attempts. RESULTS: Three latent classes were identified: the Low-risk for childhood trauma class, the Neglect class, and the High-risk for childhood abuse class. Those who suffered sexual, emotional, and physical abuse at the same time were divided into the High-risk for childhood abuse class, and were significantly more likely to experience suicide attempts than those in the Neglect class (OR = 1.97, 95%CI = 1.34-2.89, p < 0.001) and the Low-risk for childhood trauma class (OR = 2.28, 95% CI = 1.50-3.46, p < 0.001). In terms of chronotype, the results showed that the chaotic type was a risk factor for suicide attempts when compared with the evening type (OR = 0.46, 95%CI = 0.27-0.78, p < 0.01), the moderately active type (OR = 0.53, 95%CI = 0.31-0.89, p < 0.05), and the daytime type (OR = 0.42, 95%CI = 0.21-0.86, p < 0.05). Overall, the significant risk factors for suicide attempts included being female, living in an urban area, having experienced sexual, emotional, and physical abuse simultaneously, and having a chaotic chronotype. CONCLUSION: Emerging adults suffering sexual, emotional, and physical abuse at the same time and identifying with chaotic chronotype showed a higher risk of attempting suicide. The findings provided a clinical reference to quickly identify those at high risk of suicide attempts among emerging adults with severe depressive symptoms.

Profile of childhood trauma subtypes associated with self-injurious thoughts and behaviors.

OBJECTIVE: Childhood trauma has been identified as a risk factor for self-injurious thoughts and behaviors (STBs), but the roles of different types of childhood trauma have not been clarified. The current study aimed to explore the association between different childhood trauma experiences and STB profiles. METHOD: The current study utilized data from a cross-sectional survey of 89,281 Chinese university and college students (Mage = 19.6). Participants were classified into one of six STBs groups, including individuals who are not suicidal or having nonsuicidal self-injury (NS) behavior, individuals with suicidal ideation (SI), individuals with nonsuicidal self-injury (NSSI) behavior, individuals with suicide attempt (SA), individuals with both NSSI and SI (NSSI + SI) and individuals with both NSSI and SA (NSSI + SA). Several multinomial logistic regressions were performed. RESULTS: The individuals reporting more emotional abuse experiences are significantly more likely to report higher-risk STB profiles (OR =1.06-1.64). Emotional neglect is also a significant factor predicting higher STB risk compared to NS and SI groups (OR = 1.02-1.08). Mixed findings were found for physical neglect and sexual abuse, as they show different directions of risk-predicting effects in different STB groups. Physical abuse did not significantly predict STBs. CONCLUSIONS: Our results indicate that exposure to childhood emotional abuse increase the risk for all types of STBs, which calls for special attention in future suicide prevention and intervention programs. Our findings further imply possible roles for different subtypes of traumatic experiences to trigger different SBTs, which warrant future exploration. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of Bullying on Anxiety, Depression, and Posttraumatic Stress Disorder Among Sexual Minority Youths: Network Analysis.

BACKGROUND: Bullying victimization is highly prevalent among sexual minority youths, particularly in educational settings, negatively affecting their mental health. However, previous studies have scarcely explored the symptomatic relationships among anxiety, depression, and posttraumatic stress disorder (PTSD) among sexual minority youths who experienced bullying on college campuses. OBJECTIVE: The objectives of our study were to (1) characterize the anxiety-depression-PTSD network structures of gay or lesbian, bisexuals, and other sexual minority youths previously bullied on college campuses; and (2) compare symptomatic associations in the anxiety-depression-PTSD networks among bullied sexual minority youths and heterosexual youths' groups. METHODS: This cross-sectional study recruited college participants from Jilin Province, China. Data were analyzed using a subset of the data extracted after screening for sexual orientation and history of bullying victimization. Sexual minority youths were then divided into 3 subgroups: gay or lesbian (homosexual), bisexual, and other. Mental health symptom severity was assessed using scales: the 7-item Generalized Anxiety Disorder Scale measuring anxiety, the 9-item Patient Health Questionnaire measuring depression, and the 10-item Trauma Screening Questionnaire measuring PTSD symptoms. Combining the undirected and Bayesian network analyses, the anxiety-depression-PTSD networks were compared among sexual minority youths subgroups, and the difference between heterosexual youths and sexual minority youths was investigated. Chi-square tests were used to compare the difference in categorical variables, while independent-sample t tests were run on continuous variables. RESULTS: In this large-scale sample of 89,342 participants, 12,249 identified as sexual minority youths, of which 1603 (13.1%, 95% CI 12.5%-13.7%) reported being bullied on college campuses in the past year. According to the expected influence (EI) and bridge expected influence (bEI) index, in the global network structure of anxiety, depression, and PTSD, sad mood (EI=1.078, bEI=0.635) and irritability (EI=1.077, bEI=0.954) were identified as central and bridge symptoms; emotional cue reactivity (EI=1.015) was a central symptom of PTSD in this global network. In the anxiety-depression-PTSD Bayesian network, anhedonia had the highest prediction priority for activating other symptoms; and feeling afraid linked symptoms from anxiety to the PTSD community. Compared to their heterosexual counterparts, sexual minority youths exhibited a stronger association between difficulty concentrating and appetite. The "sad mood-appetite" edge was strongest in the gay or lesbian network; the "irritability-exaggerated startle response" edge was strongest in the bisexual network. CONCLUSIONS: For the first time, this study identified the most central and bridge symptoms (sad mood and irritability) within the depression-anxiety-PTSD network of sexual minority youths with past bullying-victim experiences on college campuses. Emotional cue reactivity, anhedonia, and feeling afraid were other vital symptoms in the comorbid network. Symptomatic relationships existed showing heterogeneity in bullied heterosexual youths and sexual minority youth networks, which also was present within the sexual minority youth subgroups. Consequently, refined targeted interventions are required to relieve anxiety, depression, and PTSD symptoms.

Anxiety and Depression Symptoms among Youth Survivors of Childhood Sexual Abuse: A Network Analysis.

BACKGROUND: Previous studies have frequently reported a high prevalence of co-occurring anxiety and depression among people who experienced stressful events in childhood. However, few have noted the symptomatic relationship of this comorbidity among childhood sexual abuse (CSA) survivors. Therefore, this study's objectives were as follows: (1) to examine the relationship across symptoms between anxiety and depression among CSA survivors; (2) to compare differences between male and female network structures among CSA survivors. METHODS: A total of 63 Universities and Colleges in Jilin Province, China, covered 96,218 participants in this study, a sub-set data of which met the criteria of CSA was analyzed with the network analysis. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), measured CSA. Anxiety was measured by the seven-item Generalized Anxiety Disorder Scale (GAD-7), and depression was measured by the Patient Health Questionnaire (PHQ-9). The sex difference between anxiety and depression among CSA survivors was compared. RESULTS: 3,479 college students reported the experience of CSA (CTQ-SF total scores ≥ 8), with a prevalence of 3.62% (95% CI: 3.50-3.73%). Among CSA survivors, control worry, sad mood, and energy were central and bridge symptoms of the anxiety and depression network. Meanwhile, male CSA survivors appeared to have a stronger correlation between guilt and suicide, but female CSA survivors seemed to have a stronger correlation between control worry and suicide. Moreover, the edge of control worry-relax-afraid was stronger in the male network, while the edge of restless-relax was stronger in the female network. CONCLUSION: Control worry, sad mood, and energy are crucial to offer targeted treatment and to relieve anxiety and depression symptoms for CSA survivors. Guilt needs more attention for male CSA survivors, while control worry remains more important for female CSA survivors to reduce suicidal ideation and suicide attempts.

Effects of Tobacco Versus Electronic Cigarette Usage on Nonsuicidal Self-Injury and Suicidality Among Chinese Youth: Cross-Sectional Self-Report Survey Study.

BACKGROUND: The increase in tobacco/conventional cigarette (CC) and electronic cigarette (EC) usage among Chinese youth has become a growing public health concern. This is the first large-scale study to compare the impact of CC and EC usage on risk for nonsuicidal self-injury (NSSI) and suicidality in cis-heterosexual and sexual and gender minority (SGM) youth populations in China. OBJECTIVE: This study examines the CC and EC risks for NSSI and suicidality among Chinese youth and compares the extent to which SGM and cis-heterosexual youth's risks for NSSI and suicidality are influenced by their CC and EC usage and dependence. METHODS: A total of 89,342 Chinese participants completed a cross-sectional self-report survey in 2021. Sociodemographic information, sexual orientations, gender identities, CC and EC usage, CC and EC dependence, and risks for suicidality and NSSI were assessed. The Mann-Whitney U test and chi-square test were performed for nonnormally distributed continuous variables and categorical variables, respectively. The multivariable linear regression model was used to examine both the influence of CC and EC usage and CC and EC dependence on NSSI and suicidality as well as the interaction effects of CC and EC usage and CC and EC dependence on NSSI and suicidality by group. RESULTS: The prevalence of CC usage (P<.001) and dependence (P<.001) among SGM participants was lower than that among their cis-heterosexual counterparts. However, the prevalence of EC usage (P=.03) and EC dependence (P<.001) among SGM participants was higher than that among their cis-heterosexual counterparts. The multivariable linear regression model showed that CC dependence and EC dependence had a unique effect on NSSI and suicidality (CCs: B=0.02, P<.001; B=0.09, P<.001; ECs: B=0.05, P<.001; B=0.14, P<.001, respectively). The interaction effects of (1) CC usage and group type on NSSI and suicidality (B=0.34, P<.001; B=0.24, P=.03, respectively) and dual usage and group type on NSSI and suicidality (B=0.54, P<.001; B=0.84, P<.001, respectively) were significant, (2) CC dependence and group type on NSSI were significant (B=0.07, P<.001), and (3) EC dependence and group type on NSSI and suicidality were significant (B=0.04, P<.001; B=0.09, P<.001, respectively). No significant interaction effect was observed between EC usage and group type on NSSI and suicidality (B=0.15, P=.12; B=0.33, P=.32, respectively) and between CC dependence and group type on suicidality (B=-0.01, P=.72). CONCLUSIONS: Our study shows evidence of intergroup differences in NSSI and suicidality risks between SGM and cis-heterosexual youth related to CC and EC usage. These findings contribute to the growing literature on CC and EC in cis-heterosexual and SGM populations. Concerted efforts are necessary at a societal level to curb the aggressive marketing strategies of the EC industry and media coverage and to maximize the impact of educational campaigns on EC prevention and intervention among the youth population.

A network approach to the symptom-level associations between smoking and posttraumatic stress disorder (PTSD) among young adults exposed to childhood sexual abuse.

Background: Previous empirical literature has examined the associations between childhood sexual abuse (CSA) exposure, posttraumatic stress disorder (PTSD), and smoking. However, few studies examined symptom-level associations between smoking and PTSD among CSA victims. Thus, the aims of this study were 1) to explore symptom-level associations between smoking and PTSD among combustible cigarette (CC) and electronic cigarette (EC) users exposed to CSA and 2) to compare the differences manifested in two network structures between EC and CC users with CSA experiences. Methods: This cross-sectional study covers all 63 universities and colleges in Jilin province, China, from October 26 to November 18, 2021. A total of 117 769 students participated in this study, while 3479 young adults were exposed to CSA (3.62%, 95% CI = 3.50%-3.73%). Childhood sexual abuse, PTSD, and smoking symptoms were measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), 10-item Trauma Screening Questionnaire (TSQ-10), and the 6-item Fagerstrom Test for Nicotine Dependence (FTND-6), respectively. In addition, network analysis was applied to analyse psychopathological symptoms between EC and CC users with CSA experiences. Both the edges and centralities were computed, and the network properties were compared among the two groups. Results: Four symptoms of PTSD (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were both central and bridge symptoms between PTSD and smoking among EC and CC users with CSA experiences. Moreover, compared with CC users with CSA, there were significantly stronger associations between "nightmares" - "difficulty with restrictions" and "irritability / anger" - "more during wake up" among young EC users with CSA. Conclusions: The four symptoms (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were keystones for treatments or interventions targeting these CSA victims with PTSD and smoking symptoms. Increasing efforts should be taken to restrict morning smoking among EC users with CSA. In addition, target interventions and strategies founded on these core symptoms and associations should be implemented to relieve the comorbid PTSD and smoking in EC and CC users with CSA experiences.

The role of childhood left-behind experience on childhood trauma exposure and mental health outcomes: a propensity score matching (PSM) analysis.

BACKGROUND: China has a significant number of left-behind families. This study focuses on the long-term effects of childhood left-behind experience on different type of childhood trauma and mental health outcomes in later life development. METHODS: participants were 67 795 Chinese young adults. Psychosocial characteristics were screened by sleep quality, the nine-item Patient Health Questionnaire for depressive symptoms, the generalized anxiety disorder-7 for anxiety symptoms, trauma screening questionnaire for post-traumatic stress, a short form of the Childhood Trauma Questionnaire for childhood trauma. Propensity score matching (PSM) and multivariate linear regression were applied to analyze the data. RESULTS: the results of the post-PSM analysis showed that the distributions of propensity scores for the two groups were approximately equal. And the total sample size in post-analysis dropped to 2358 (Nnuclear family = 1179, Nleft-behind family = 1179), with unmatched cases excluded. Post-matching results showed that the students from left-behind family were significantly associated with severer post-traumatic stress (b = 0.39, 95% CI = [0.15, 0.62]), loneliness (b = 0.29, 95% CI = [0.16, 0.42]), depressive symptoms (b = 0.44, 95% CI = [0.06, 0.82]) and CTQ-physical neglect (b = 0.34, 95% CI = [0.11, 0.58]). CONCLUSION: our study showed that childhood left-behind experiences are tightly related to childhood trauma experience and mental health issues (post-traumatic stress, loneliness and depression) in late adolescents.

Appearance anxiety and social anxiety: A mediated model of self-compassion.

Background: Previous studies have focused on the comorbidity of appearance anxiety and social anxiety, but few studies have focused on the protective role of self-compassion as underlying this mechanism, in young people like University students. With the increase of prevalence of appearance anxiety and social anxiety in this age group, it is necessary to explore factors that can buffer against the symptoms of these disorders. Therefore, the aims of this study were to research the effect of appearance anxiety and social anxiety, then to examine whether self-compassion has a protective effect on social anxiety. Method: The study was cross-sectional and conducted online from October 2021 to November 2021 in Jilin Province, China. A total of 63 Universities in the province participated in this study, totaling 96,218 participants, of which 40,065 were males (41.64%) and 56,153 females (58.36%), the mean age of the sample was 19.59 (±1.74). The Appearance Anxiety Scale-Brief Version was used to measure appearance anxiety. The Social Anxiety subscale of the Self-Consciousness Scale was used to measure social anxiety. The Self-Compassion Scale-Short Form was used to measure self-compassion. A structural equation model (SEM) was run to examine the mediating effect of self-compassion on the relationship between appearance anxiety and social anxiety. Result: Overall, appearance anxiety was positively associated with social anxiety [ß = 0.334, 95% CI = (0.328, 0.341), p < 0.001], and self-compassion could mediate the effect of appearance anxiety on social anxiety [ß = 0.128, 95% CI = (0.124, 0.132), p < 0.001]. Self-compassion played a partial mediating role between appearance anxiety and social anxiety. Conclusion: Individuals with high appearance anxiety are also at higher risk of social anxiety, but self-compassion can buffer against this relationship. These findings begin to explore novel approaches to treat social anxiety and can provide valuable insights for self-compassion training.

Co-occurrence of PTSD and affective symptoms in a large sample with childhood trauma subtypes: A network analysis.

Background: Exposure to childhood trauma (CT) is associated with various deleterious mental health outcomes, increasing the risk of suicidal behaviors. The objective of this study is to investigate the different effects of three forms of CT, including emotional abuse (EA), physical abuse (PA), and sexual abuse (SA), on potential psychopathological symptoms among college students. Methods: A total of 117,769 students from 63 Chinese colleges participated in this study. There were 1,191 participants in the EA group (1.24%; 95% CI: 1.17-1.31%), 1,272 participants in the PA group (1.32%; 95% CI: 1.25-1.40%), and 3,479 participants in the SA group (3.62%; 95% CI: 3.50-3.73%). CT was measured by the Childhood Trauma Questionnaire-Short Form. Psychopathological symptoms (i.e., depression, anxiety, and PTSD) were measured by the PHQ-9, GAD-7, and Trauma Screening Questionnaire, respectively. Network analysis was applied to analyze psychopathological symptoms between three CT subgroups (EA, PA, and SA). The associations and centralities of the networks were calculated, and the network characteristics of the three subgroups were contrasted. Results: The main symptoms across all three groups are uncontrollable worry, sad mood, irritability, and fatigue, which indicates these core symptoms play essential roles in maintaining the whole psychological symptoms network. Furthermore, there are significant differences in symptom associations between the three groups. The comparison of network structures of the three groups shows that the SA group reports more PTSD symptoms, the EA group reports more suicide-related symptoms, and the PA group reports more anxiety symptoms. Conclusion: Specific symptoms were disclosed across each group by the distinctive core psychopathological symptoms found in the CT subgroup networks. The present study's findings show different associations between CT and psychopathology and may help classify potential diagnostic processes. Therefore, local governments and academic institutions are recommended for early intervention to promote the psychological well-being of CT survivors.

Analysis of Psychiatric Symptoms and Suicide Risk Among Younger Adults in China by Gender Identity and Sexual Orientation.

Importance: Younger adults in China who are transgender and gender nonconforming (TGNC) and lesbian, gay, and bisexual (LGB) experience high levels of minority stress (eg, stigma and bullying) and adverse mental health symptoms. However, there is a lack of research documenting mental health disparities compared with their cisgender and heterosexual peers. Studies that disaggregate TGNC and LGB individuals and are conducted in nonmetropolitan regions are also needed. Objectives: To examine whether younger adult students' psychiatric symptoms and suicide risk vary by sexual orientation and gender identity and identify risk factors within LGB younger adults and TGNC younger adults. Design, Setting, and Participants: This cross-sectional study surveyed students at 63 universities in Jilin Province, China, between October 24 and November 18, 2021. Analyses were completed May 6, 2022. Exposures: Gender identity (TGNC vs cisgender) and sexual orientation (LGB vs heterosexual). Main Outcomes and Measures: Psychiatric outcomes included depression, anxiety, traumatic stress, and nonsuicidal self-injury (NSSI), which were measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Trauma Screening Questionnaire, and self-reported NSSI behaviors. The Suicide Behaviors Questionnaire-Revised was used to assess suicide risk. Results: The analytic sample included 89 342 younger adults (mean [SD] age, 19.60 [1.75] years), including 51 438 assigned female at birth and 37 904 assigned male at birth. The sample included 2352 individuals who were TGNC, 6501 who were cisgender LGB, and 80 489 who were cisgender heterosexual. Compared with their cisgender heterosexual peers, TGNC and LGB younger adults were more likely to experience increased psychiatric symptoms across categories and suicide risk, as well as more severe forms of symptoms. In particular, overall suicide risk was 43.03% among TGNC individuals, 36.21% among LGB individuals, and 11.70% among cisgender heterosexual younger adults. Controlling for demographic variables and compared with cisgender heterosexual peers, TGNC young adults had higher odds of suicide risk (adjusted odds ratio, 5.38; 95% CI, 4.94-5.86; P < .001) and of past-year NSSI (adjusted odds ratio, 6.55; 95% CI, 5.87-7.30; P < .001). Separate within-group analyses for LGB and TGNC younger adults highlighted the vulnerability of bisexual women and gender nonbinary groups, as well as the relevance of minority stress-related risk factors, including peer bullying and assault and loneliness. Conclusions and Relevance: This study noted disparities of mental health issues among LGB, transgender, or queer or questioning younger adults in China and suggests a high urgency to address psychological health and prevent suicide in this population. Targeted public health initiatives may be needed to reduce stigma and discrimination, train competent health care professionals, and create affirmative mental health policies and systems of care.

A man-made divide: Investigating the effect of urban-rural household registration and subjective social status on mental health mediated by loneliness among a large sample of university students in China.

Introduction: The urban-rural household registration system in China has been documented with profound social consequences in almost all areas of people's life. This study aims to investigate the underlying mechanism of the rural and urban discrepancies on mental health conditions among a large sample of college students in China. Methods: A survey was distributed among college students in China. A total of 96,218 college students from 63 colleges completed the survey, answering questions on their urban-rural household registration, disposable household income, subjective social status, feelings of loneliness, and anxiety and depression symptoms. Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) analyses were conducted, testing the effect of urban-rural registration on one's mental health, mediated by subjective social status, and loneliness. Results: Structural Equation Modelling (SEM) results revealed that the urban-rural household registration showed a direct effect on anxiety (B = -0.03, 95% CI [-0.038, -0.022], ß = -0.03, p < 0.001) and depression (B = -0.03, 95% CI [-0.035, -0.023], ß = -0.03, p < 0.001), indicating that rural household registration had a negative association with anxiety and depression symptoms, albeit the standardised estimate being very small. The indirect path from the urban-rural registration mediated through subjective social status and loneliness to anxiety and depression was both significant, with B = 0.01, 95% CI [0.010, 0.010], ß = 0.01, p < 0.001, and B = 0.01, 95% CI [0.0090, 0.0090], ß = 0.01, p < 0.001, respectively. The results of the indirect paths demonstrated that students of the rural household registration reported higher anxiety and depression symptoms through a lower subjective social status and higher level of loneliness. Conclusion: This study indicated that decreasing the disparity of social status and tackling loneliness is the key to improve the overall mental health of college students. The urban-rural household registration system may have a very small direct effect on the college students' mental health; but students of urban registration enjoyed higher subjective social status, which had a clear protective effect against anxiety and depression symptoms.

Associations between PTSD symptoms and other psychiatric symptoms among college students exposed to childhood sexual abuse: a network analysis.

Background: Childhood sexual abuse (CSA) is one of the prevalent forms of trauma experienced during childhood and adolescence. Previous research underscores its associations with depression, anxiety, post-traumatic stress disorder (PTSD), and psychosis. Objective: This study examined symptom connections between depression, anxiety, PTSD, and psychosis while simultaneously investigating whether these connections differed by gender among CSA survivors. Methods: A large-scale, cross-sectional study among 96,218 college students was conducted in China. Participants' CSA was measured by the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Participants' PTSD, psychosis, depression, and anxiety were measured by the Trauma Screening Questionnaire (TSQ), the Psychosis Screener (PS), the nine-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Network analysis was used to explore the potential associations between these symptoms and to compare the sex differences in the symptoms model. Results: Among participants who suffered from CSA, females were more likely from left-behind households, while males were more likely from households with a high annual income (P < .001, Cohen's W = 0.07). In addition, compared to male victims, female victims were more likely to report depression, anxiety, and PTSD (P < .001, Cohen's d≈0.2), while male victims were more likely to report psychosis (P < .001, Cohen's d = 0.36). Results from network estimation showed that psychosis, depression, anxiety, and PTSD symptoms were positively correlated. Moreover, psychosis had a stronger connection with PTSD symptoms, including hypervigilance, intrusive thoughts, and physiological and emotional reactivity. Conclusions: The current study explores the associations between PTSD symptoms and psychiatric symptoms among college students exposed to CSA using a network analysis approach. These crucial symptoms of PTSD may have potential connections to psychosis. Target intervention and strategy should be developed to improve mental health and quality of life among these CSA victims. Furthermore, longitudinal studies are warranted to advance our understanding of PTSD and psychosis.

Antecedentes: El abuso sexual infantil (CSA, por sus siglas en inglés) es una de las formas predominantes de trauma experimentado durante la niñez y la adolescencia. Investigaciones anteriores subrayan su asociación con la depresión, la ansiedad, el trastorno de estrés postraumático (TEPT) y la psicosis.Objetivo: Este estudio examinó las conexiones de los síntomas de depresión, ansiedad, TEPT y psicosis mientras investigaba simultáneamente si estas conexiones diferían según el género entre los sobrevivientes de CSA.Métodos: Se realizó un estudio transversal a gran escala entre 96218 estudiantes universitarios en China. El CSA de los participantes se midió mediante el Cuestionario de Trauma Infantil-Versión Corta (CTQ-SF). El TEPT, la psicosis, la depresión y la ansiedad de los participantes se midieron mediante el Cuestionario de detección de trauma (TSQ), el Detección de psicosis (PS), el Cuestionario de salud del paciente de nueve ítems (PHQ-9) y la Escala de trastorno de ansiedad generalizada de 7 ítems. (GAD-7), respectivamente. Se utilizó el análisis de redes para explorar las asociaciones potenciales entre estos síntomas y para comparar las diferencias, según sexo, en el modelo de síntomas.Resultados: Entre los participantes que sufrieron CSA, las mujeres eran más propensas a pertenecer a hogares abandonados*, mientras que los hombres eran más propensos a pertenecer a hogares con un ingreso anual alto (P < .001, W de Cohen = 0.07). Además, en comparación con las víctimas masculinas, las víctimas femeninas tenían más probabilidades de reportar depresión, ansiedad y TEPT (P < .001, d de Cohen ≈0,2), mientras que las víctimas masculinas tenían más probabilidades de informar psicosis (P < .001, d de Cohen = 0.36). Los resultados de la estimación de la red mostraron que psicosis, depresión, ansiedad y síntomas del TEPT estaban correlacionados positivamente. Además, la psicosis tenía una conexión más fuerte con los síntomas del TEPT, incluida la hipervigilancia, los pensamientos intrusivos y la reactividad fisiológica y emocional.Conclusiones: El estudio actual explora las asociaciones entre los síntomas de TEPT y los síntomas psiquiátricos entre estudiantes universitarios expuestos a CSA utilizando un enfoque de análisis de red. Los síntomas del TEPT, que incluyen hipervigilancia, pensamientos intrusivos y reactividad fisiológica y emocional, pueden tener una conexión potencial con la psicosis. Se deben desarrollar intervenciones y estrategias específicas para mejorar la salud mental y la calidad de vida entre estas víctimas de CSA. Además, los estudios longitudinales garantizan un avance en nuestra comprensión del TEPT y la psicosis.

Blind box over-engagement and suicide risk among adolescents and young adults: Results of a large-scale survey.

Background: Gambling appears to be an independent risk factor for suicide among the young population worldwide. Blind boxes are collectable toys packed randomly in the box, which share certain similarities with gambling and are popular among the young population. This is the first study that examined the association between blind box engagement and suicide risk in the young population, the leading consumption group of blind boxes. Methods: This study is part of a large-scale, cross-sectional study using convenience sampling conducted Oct 26 to Nov 18, 2021, which covered all the university and college students in the Jilin province, China. A total of 73,206 participants completed the survey with valid data for the current study (male: N = 28,762; female: N = 44,444; Mean age = 19·59). Participants' blind box engagement, suicide risk, depression, anxiety, alcohol use, smoking habit, and sociodemographic characteristics were assessed. First, we used univariate and multivariable binary logistic regression models to examine the relationship between blind box engagement and suicide risk in all participants. Second, we tested whether depression and anxiety would mediate the association between blind box engagement and suicide risk. Third, we analysed the association between "Frequency (i.e., frequency of blind box engagement)," "Bet (i.e., expenditure on the blind box that exceeds affordability)," "Tolerance (i.e., level of addiction)," "Borrowed (i.e., the amount of money borrowed for blind box engagement)," and suicide risk in the group with blind box engagement history. Findings: 4,195 participants (5·73%) have engaged in blind boxes, with 3,255 females (77·59%) and 940 males (22·41%). In the univariate models, binary logistic regression showed that blind box engagement was associated with suicide risk in both male and female participants (male: OR = 2·21, 95% CI = 1·86-2·63; female: OR = 1·64, 95% CI = 1·50-1·78). In the multivariable models, after controlling age, subjective socioeconomic status, per capita disposable income, alcohol use, and smoking habit, blind box engagement still was associated with suicide risk across genders (male: OR = 2·25, 95% CI = 1·89-2·68; female: OR = 1·58, 95% CI = 1·45-1·73). Depression (male: indirect effect = 0·31, SE = 0·04, p < 0·001; female: indirect effect = 0·20, SE = 0·02, p < 0·001) and anxiety (male: indirect effect = 0·26, SE = 0·03, p < 0·001; female: indirect effect = 0·13, SE = 0·02, p < 0·001) mediate the association between blind box engagement and suicide risk. Within the blind box engagement group, forward binary logistic regression revealed that "Tolerance" was associated with participants' suicide risk in both males (p = 0·001) and females (p < 0·001); "Borrowed" (p = 0·019) alone was associated with the male participants' suicide risk. Interpretation: Our findings showed that blind box over-engagement is positively associated with suicide risk in both young males and females, and this association persisted after adjusting for influencing factors. In spite of the limitations in this study (e.g., cross-sectional, convenience sampling), current findings can assist policymakers in developing regulations for such a prosperous youth-dominant consumption industry while protecting youth's mental health worldwide. Funding: None.

Symptom association between social anxiety disorder, appearance anxiety, and eating disorders among Chinese University students: A network analysis to conceptualize comorbidity.

Background: Incidences of social anxiety disorder (SAD), appearance anxiety, and eating disorders (ED) show an increased prevalence among young people. However, symptoms' associations between these disorders have not been investigated in depth. Network analysis is an approach that can be used to explain the relationship(s) between symptoms of different psychological disorders. Using network analysis, this study aimed to explore the association and potential interacting mechanisms between SAD, appearance anxiety, and ED. Methods: This study included 96,218 University students from Jilin Province, China. SAD, appearance anxiety and ED were assessed using the Social Anxiety Subscale of the Self-Consciousness Scale (SASS), the Appearance Anxiety Scale Brief Version (AASBV), and the Sick, Control, One, Fat, Food questionnaire (SCOFF), Chinese versions. Network analysis was employed to investigate the symptom associations, while the stability of the network model was analyzed using statistical measures. Results: The prevalence of ED among the total sample was 38% (95% CI: 38.1-38.8%), while this figure was 31.2% (95% CI: 30.7-31.6%) in males and 43.6% (95% CI: 43.2-44.0%) in females. Additionally, the total score of SAD was significantly higher in females (11.83 ± 5.37) than it in males (10.02 ± 5.46) (P < 0.001). While the total score of appearance anxiety was also different significantly in gender (39.21 ± 9.49 in females vs. 38 ± 9.42 in males) (P < 0.001). Results showed that ED was associated with all three aspects of appearance anxiety, including "appearance concern," "appearance satisfaction," and "wish for good looks." Appearance anxiety and SAD were also associated; specifically, symptoms of "appearance satisfaction" were significantly associated with the symptoms "easily talk to strangers" and "appearance concern", which was also significantly associated with "embarrassed". Compared with males, females showed significantly stronger associations with appearance anxiety symptoms, while ED symptoms were associated with "troubled by being watched" and "appearance concern". Conclusion: Appearance anxiety was associated with both ED and SAD symptoms. ED may have a potential relationship with SAD, affecting appearance anxiety indirectly. Significant differences were found among males and females in symptom associations between appearance anxiety and SAD. This study therefore clarified that young people should have body-positive interventions and challenge the normative body image discourse, which may help alleviate symptoms of SAD and ED.