What factors preventing the older adults in China from living longer: a machine learning study.

BACKGROUND: The fact that most older people do not live long means that they do not have more time to pursue self-actualization and contribute value to society. Although there are many studies on the longevity of the elderly, the limitations of traditional statistics lack the good ability to study together the important influencing factors and build a simple and effective prediction model. METHODS: Based on the the data of Chinese Longitudinal Healthy Longevity Survey (CLHLS), 2008-2018 cohort and 2014-2018 cohort were selected and 16 features were filtered and integrated. Five machine learning algorithms, Elastic-Net Regression (ENR), Decision Tree (DT), Random Forest (RF), K-Nearest Neighbor (KNN), and eXtreme Gradient Boosting (XGBoost), were used to develop models and assessed by internal validation with CLHLS 2008-2018 cohort and temporal validation with CLHLS 2014-2018 cohort. Besides, the best performing model was explained and according to the variable importance results, simpler models would be developed. RESULTS: The results showed that the model developed by XGBoost algorithm had the best performance with AUC of 0.788 in internal validation and 0.806 in temporal validation. Instrumental activity of daily living (IADL), leisure activity, marital status, sex, activity of daily living (ADL), cognitive function, overall plant-based diet index (PDI) and psychological resilience, 8 features were more important in the model. Finally, with these 8 features simpler models were developed, it was found that the model performance did not decrease in both internal and temporal validation. CONCLUSIONS: The study indicated that the importance of these 8 factors for predicting the death of elderly people in China and built a simple machine learning model with good predictive performance. It can inspire future key research directions to promote longevity of the elderly, as well as in practical life to make the elderly healthy longevity, or timely end-of-life care for the elderly, and can use predictive model to aid decision-making.

Complex posttraumatic stress disorder and dissociation in trauma-exposed Chinese adolescents: a latent class analysis.

Background: Preliminary evidence provides support for the proposition that there is a dissociative subtype of Complex posttraumatic stress disorder (CPTSD). Research on this proposition would extend our knowledge on the association between CPTSD and dissociation, guide contemporary thinking regarding placement of dissociation in the nosology of CPTSD, and inform clinically useful assessment and intervention.Objectives: The present study aimed to investigate the co-occurring patterns of CPTSD and dissociative symptoms in a large sample of trauma exposed adolescents from China, and specify clinical features covariates of such patterns including childhood trauma, comorbidities with major depressive disorder (MDD) and generalized anxiety disorder (GAD), and functional impairment.Methods: Participants included 57,984 high school students exposed to the coronavirus disease 2019 (COVID-19) pandemic. CPTSD and dissociative symptoms, childhood traumatic experience, and functional impairment were measured with the Global Psychotrauma Screen for Teenagers (GPS-T). Major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Latent class analysis (LCA) was employed to test the co-occurring patterns of CPTSD and dissociative symptoms. Analysis of covariance (ANCOVA) and chi-square tests were respectively used to examine between-class differences in continuous and categorical clinical covariates.Results: A 5-class model emerged as the best-fitting model, including resilience, predominantly PTSD symptoms, predominantly disturbances in self-organization (DSO)symptoms, predominantly CPTSD symptoms, and CPTSD dissociative subtype classes. The CPTSD dissociative subtype class showed the lowest level of functioning and the highest rates of MDD, GAD and childhood trauma.Conclusions: Our findings provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD, and inform for further research and clinical practice on traumatized individuals.

The present study identified a dissociative subtype of ICD-11 CPTSD among trauma exposed youth.The dissociative subtype of ICD-11 CPTSD was associated with poorer mental health outcomes.Findings of this study provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD.

A latent class analysis of dissociative PTSD subtype among Chinese adolescents following the COVID-19 pandemic and lockdown.

BACKGROUND: The COVID-19 pandemic and related policies have amplified the vulnerability of adolescents to the development of posttraumatic stress disorder (PTSD) and dissociation symptoms. This study sought to explore the profile patterns and psychopathological characteristics of co-occurring PTSD and dissociation symptoms in Chinese adolescents. METHODS: A total of 57,984 junior and senior high school students in Deyang City, China were recruited between July 13 and July 19, 2020. PTSD and dissociation symptoms, risk factors, and functional impairment variables were assessed using the Global Psychotrauma Screen for Teenagers (GPS-T) instrument. Latent class analysis (LCA) was employed to examine the phenomenology and risk factors of co-occurring PTSD and dissociation symptoms. Analysis of Variance (ANOVA) was utilized to investigate differences in COVID-19 pandemic-related exposure and functional impairment across distinct symptom profiles. RESULTS: A 4-class model was selected as the optimal solution, comprising subgroups of low symptom, predominant PTSD symptom, predominant dissociation symptom, and PTSD-dissociation symptom. Class membership could be significantly predicted by other stressful experiences, social support, childhood maltreatment and psychiatric histories. The PTSD-dissociation symptom class exhibited the most severe COVID-19 pandemic-related exposure and functional impairment among all classes. LIMITATIONS: The cross-sectional design, Chinese cultural background, online survey method and oversimple measurements were the limitations. CONCLUSIONS: Our findings extend existing knowledge about the coexisting patterns of PTSD and dissociation symptoms in adolescents, which could assist in identifying high-risk youths. Furthermore, our findings offer recommendations for shaping public health policies and formulating effective clinical interventions for adolescents following the COVID-19 pandemic and lockdown.

Anxiety, depression, and PTSD symptoms among high school students in china in response to the COVID-19 pandemic and lockdown.

AIMS: This study aimed to investigate the prevalence of anxiety, depression and PTSD symptoms, and associated risk factors among a large-scale sample of adolescents from China after the pandemic and lockdown. METHOD: A total of 57,948 high school students took part in an online survey from July 13 to 29, 2020. The mental health outcomes included anxiety, depression and PTSD symptoms. Risk factors included negative family relationships, COVID-19 related exposure, and a lack of social support. RESULTS: The prevalence of anxiety, depression and PTSD symptoms was 7.1%, 12.8%, and 16.9%, respectively. COVID-19 related exposure significantly linked to the mental health outcomes (all p < .001). The most important predictors for the mental health outcomes were family relationship and social support (all p < .001). CONCLUSION: The pandemic may have long-term adverse mental health consequences among adolescents. Adverse family relationships and lack of social support could be the major risk factors for the post-pandemic mental health outcomes of adolescents.

The factor structure of major depressive symptoms in a sample of Chinese earthquake survivors.

BACKGROUND: Experiencing natural disasters is associated with common mental disorders including major depressive disorder (MDD). However, the latent structure of MDD is widely debated, and few studies tested the MDD factor structure in Chinese natural disaster survivors. Therefore, the aim of the current study was to evaluate the factorial validity of the Patient Health Questionnaire-9 (PHQ-9) for DSM-5 major depressive disorder (MDD) symptoms in Chinese earthquake survivors. METHOD: Participants were 1058 Chinese earthquake survivors. Self-reported measures included the PHQ-9 and the Short-Form Health Survey (SF-36). Confirmatory factor analysis (CFA) and structural equation modelling (SEM) was used to examine the latent structure of MDD and the associations between latent factors of MDD and different domains of health-related quality of life (HRQoL), respectively. RESULTS: In the current sample, the model consisted of somatic and cognitive/affective (non-somatic) factors demonstrated significantly better fit than the other competing MDD models (χ2 = 173.89, df = 26, CFI = 0.986, TLI = 0.981, RMSEA = 0.073, BIC = 18,091.13). Further SEM analyses indicated that the non-somatic factor was significantly related to both physical (ß = - 0.362, p < .01) and psychosocial HRQoL (ß = - 0.773, p < .01), while the somatic factor was a uniquely predictor of physical HRQoL (ß = - 0.336, p < .01). Furthermore, we found the somatic factor partially mediated the relationship between the cognitive/affective factor and physical HRQoL (all ps < .05). CONCLUSIONS: The MDD symptoms was best captured by a two-factor model comprised of somatic and cognitive/affective factors in Chinese natural disaster survivors. The two MDD factors were differentially associated with physical and psychosocial HRQoL, and the cognitive/affective factor associated physical HRQoL partially through the somatic factor. The current findings increase our understanding of latent structure of MDD symptoms, and carry implications for assessment and intervention of post-disaster mental health problems.

An exploration of the DSM-5 posttraumatic stress disorder symptom latent variable network.

BACKGROUND: Both the latent variable model and the network model have been widely used to conceptualize mental disorders. However, it has been pointed out that there is no clear dichotomy between the two models, and a combination of these two model could enable a better understanding of psychopathology. The recently proposed latent network model (LNM) has provided a statistical framework to enable this combination. Evidence has shown that posttraumatic stress disorder (PTSD) could be a suitable candidate disorder to study the combined model. In the current study, we initiated the first investigation of the latent network of PTSD symptoms. METHODS: The latent network of DSM-5 PTSD symptoms was estimated in 1196 adult survivors of China's 2008 Wenchuan earthquake. Validation testing of the latent network was conducted in a replication sample of children and adolescent who experienced various trauma types. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). The latent network was estimated using the seven-factor hybrid model of DSM-5 PTSD symptoms, analysed using the R package lvnet. RESULTS: The latent network model demonstrated good fit in both samples. A strong weighted edge between the intrusion and avoidance dimensions was identified (regularized partial correlation = 0.75). The externalizing behaviour dimension demonstrated the highest centrality in the latent network. CONCLUSIONS: This study is the first to investigate the latent network of DSM-5 PTSD symptoms. Results suggest that both latent symptom dimension and associations between the dimensions should be considered in future PTSD studies and clinical practices.

Antecedentes: tanto el modelo de variable latente como el modelo de red se han utilizado ampliamente para conceptualizar los trastornos mentales. Sin embargo, se ha señalado que no existe una dicotomía clara entre los dos modelos, y una combinación de estos dos modelos podría permitir una mejor comprensión de la psicopatología. El modelo de red latente (LNM) recientemente propuesto ha proporcionado un marco estadístico para permitir esta combinación. La evidencia ha demostrado que el trastorno de estrés postraumático (TEPT) podría ser un trastorno candidato adecuado para estudiar el modelo combinado. En el presente estudio, iniciamos la primera investigación de la red latente de síntomas de TEPT.Métodos: La red latente de síntomas del TEPT DSM-5 se estimó en 1196 adultos sobrevivientes del terremoto de Wenchuan en China en 2008. Las pruebas de validación de la red latente se realizaron en una muestra de replicación de niños y adolescentes que experimentaron varios tipos de trauma. Los síntomas de TEPT se midieron mediante la Lista de verificación de TEPT para DSM-5 (PCL-5). La red latente se estimó utilizando el modelo híbrido de siete factores de síntomas del TEPT DSM-5, analizados utilizando el paquete R lvnet.Resultados: El modelo de red latente demostró un buen ajuste en ambas muestras. Se identificó un margen ponderado fuerte entre las dimensiones de intrusión y evitación (correlación parcial regularizada = 0,75). La dimensión del comportamiento de externalización demostró la centralidad más alta en la red latente.Conclusiones: este estudio es el primero en investigar la red latente de síntomas de TEPT DSM-5. Los resultados sugieren que tanto la dimensión de los síntomas latentes como las asociaciones entre las dimensiones deben considerarse en futuros estudios de TEPT y prácticas clínicas.

A comparison of ICD- 11 and DSM-5 criteria for PTSD among a representative sample of Chinese earthquake survivors.

BACKGROUND: Striking differences regarding the diagnosis of PTSD exist between the ICD-11 and DSM-5. This study compared the prevalence and comorbidity of PTSD between the ICD-11 and DSM-5. METHODS: An epidemiological sample of 1160 Chinese adult earthquake survivors collected nine and a half years following the Wenchuan earthquake, in Sichuan province. The PTSD Checklist for DSM-5 (PCL-5), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were used to measure PTSD, depression, and anxiety symptoms. RESULTS: The ICD-11 PTSD criteria yielded higher prevalence estimates than the DSM-5 criteria. There were no significant differences in PTSD's comorbidity with major depressive disorder (MDD) or generalized anxiety disorder (GAD) between the ICD-11 and DSM-5 criteria. CONCLUSIONS: Results found that the ICD-11 and DSM-5 performed differently in assessing PTSD prevalence, but showed similar co-occurrence with MDD and GAD. This study adds to knowledge about the similarities and differences of using different PTSD criteria and carries implications for clinical and research utilization of the two widely used PTSD diagnostic criteria.

Antecedentes: Existen notables diferencias en relación al diagnóstico de TEPT entre la CIE-11 y el DSM-5. Este estudio comparó la prevalencia y la comorbilidad de TEPT según la CIE-11 y el DSM-5.Métodos: Una muestra epidemiológica de 1160 chinos adultos supervivientes a un terremoto fue seguida por nueve años y medio posterior al terremoto de Wenchuan, en la provincia Sichuan. Se utilizaron la lista de chequeo de TEPT para el DSM-5 (PCL-5 por sus siglas en inglés), el Cuestionario de Salud del Paciente (PHQ-9 por sus siglas en inglés) y la Ansiedad Generalizada-7 (GAD-7 por sus siglas en inglés) fueron usados para medir TEPT, depresión y síntomas ansiosos.Resultados: Los criterios de la CIE-11 produjeron mayor prevalencia de TEPT que los criterios del DSM-5. No hubo diferencia significativa en la comorbilidad del TEPT con episodio depresivo mayor (MDD por sus siglas en inglés) o Trastorno de Ansiedad Generalizada (GAD por sus siglas en inglés) entre los criterios de la CIE-10 y el DSM-5.Conclusiones: Los resultados concluyen que la CIE-11 y el DSM-5 se desempeñaron en forma diferente al evaluar la prevalencia de TEPT, pero mostraron similar co-ocurrencia de MDD y GAD. Este estudio aporta al conocimiento acerca de las similitudes y diferencias al usar diferentes criterios de TEPT, y conlleva implicaciones para el uso clínico y de investigación de dos criterios de TEPT ampliamente utilizados.