Integrating depression and acute coronary syndrome care in low resource hospitals in China: the I-CARE randomised clinical trial.

Background: Acute coronary syndrome (ACS) often co-occurs with depression, which adversely affects prognosis and increases medical costs, but effective treatment models are lacking, particularly in low-resource settings. This study aims to determine the effectiveness of an ACS and depression integrative care (IC) model compared to usual care (UC) in improving depression symptoms and other health outcomes among patients discharged for ACS in Chinese rural hospitals. Methods: A multicentre, randomised controlled trial was conducted in sixteen rural county hospitals in China, from October 2014 to March 2017, to recruit consecutively all ACS patients aged 21 years and older after the disease stablised and before discharge. Patients were randomly assigned in a 1:1 ratio to receive either the IC or UC, stratified by hospital and depression severity. Patients allocated to IC received an ACS secondary prevention program and depression care including case screening, group counselling, and individual problem-solving therapy. Patients allocated to UC received usual care. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) from baseline to 6 and 12 months. Main secondary outcomes included major adverse events (MAEs) composed of all-cause death, non-fatal myocardial infarction and stroke, and all-cause re-hospitalisation. Participants were followed up till March 2018. All data were collected in person by trained assessors blinded to treatment group and MAEs were adjudicated centrally. This trial is registered with ClinicalTrials.gov, NCT02195193. Findings: Among 4041 eligible patients (IC: 2051; UC: 1990), the mean age was 61 ± 10 years and 63% were men. The mean PHQ-9 score lowered at both 6 and 12 months in both groups but was not lower in IC compared to UC at 6 months (mean difference (MD): -0.04, 95% confidence interval (CI): -0.20, 0.11) or 12 months (MD: -0.06, 95% CI: -0.21, 0.09). There were no treatment group differences for MAEs or other secondary outcomes except for secondary prevention medications at 12 months (45.2% in IC vs 40.8% in UC; relative risk: 1.21, 95% CI: 1.05-1.40). Pre-specified subgroup analyses showed that IC, compared to UC, may be more effective in lowering PHQ-9 scores in women, older patients, and patients with low social support, but less effective in moderately and severely depressed patients (all p for interaction <0.05). Interpretation: The study found that the cardiology nurse-led ACS- and depression-integrated care, compared to usual care, did not improve depression symptoms in all patients discharged with ACS. Greater benefits in certain subgroups warrants further studies. Funding: R01MH100332 National Institute of Mental Health.

Reliability and validity of a novel mobile-based automatic battery of cognitive tests in healthy young Chinese adults.

PURPOSE: To evaluate the reliability and validity of a newly developed computerized Automated Battery of Cognitive Tests in healthy individuals without cognitive impairments or psychiatric disorders. METHODS: From April 20 to July 1, 2023, 142 healthy individuals in Beijing and Tangshan, China were assessed using the Automated Battery of Cognitive Tests. After a 3-week interval, 36 participants were randomly selected for retesting. The assessment also included administration of the Repeatable Battery for the Assessment of Neuropsychological Status and the Automated Battery of Cognitive Tests to 59 participants. RESULTS: The Automated Battery of Cognitive Tests consists of 16 subtests. Internal consistency reliability was 0.75. The test-retest reliability for each factor ranged from 0.337 to 0.850 (p < 0.05). The criterion-related validity, as measured by correlation with the total Repeatable Battery for the Assessment of Neuropsychological Status score, was 0.748 (p < 0.001). The cumulative variance contribution rate is 70.109%. The results of the confirmatory factor analysis indicated a good model fit. CONCLUSIONS: The computerized Automated Battery of Cognitive Tests is a cognitive self-assessment tool with good reliability and validity. It can evaluate multiple aspects of cognitive performance in healthy individuals and is suitable for self-administration through remote access via Internet.

Pain Characteristics of Patients With Fibromyalgia: A Comparison Between Gender and Different Emotional States.

BACKGROUND: Generalized pain is the core symptom of fibromyalgia (FM). Few studies have described FM's different pain characteristics under various conditions. OBJECTIVE: To explore the pain characteristics of patients with FM of different gender and emotional states. STUDY DESIGN: A cross-sectional study. SETTING: A medical center in Beijing, People's Republic of China. METHODS: A total of 197 patients with FM were recruited from an outpatient clinic. Three distinct instruments were used to assess their pain characteristics: the Numeric Rating Scale (NRS-11) to assess pain severity, the Widespread Pain Index (WPI) to assess the number of pain regions, and the Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2) to assess pain qualities. The Zung Self-Rating Anxiety Scale and Zung Self-Rating Depression Scale were used to assess patients' emotional states. An independent 2-sample t test, chi-squared test, and Mann-Whitney U test were used to analyze gender pain characteristics differences and different emotional states (with/without anxiety, with/without depression). RESULTS: Pain severity on the NRS-11 was 7 (5-8), the number of pain regions determined by WPI was 13 (10-16), and the total score of different pain qualities from the SF-MPQ-2 was 2.36 (1.68-3.73) in all patients with FM. The most frequently reported regions of pain were the right shoulder girdle (89.34%), left shoulder girdle (88.32%), upper back (85.28%), and neck (81.73%). The most frequently reported pain qualities were tiredness/exhaustion (97.46%), aching pain (94.42%), numbness (78.68%), cold/freezing pain (75.63%), and tenderness (75.13%). Women patients reported more severe pain and numbness, less frequent chest pain, and shooting pain than men patients did. Patients with FM and anxiety experienced more frequent and more severe feelings of punishing/cruel thoughts, fearfulness, sickening, and tenderness; more frequent jaw pain and cold-freezing pain; more severe pain caused by light touch and tiredness/exhaustion; less frequent lower leg pain than those without anxiety did. Patients with FM and depression reported more frequent and more severe pain caused by light touch; more frequent tenderness; more severe feelings of tiredness/exhaustion, sickening,fearfulness, and punishing/cruel thoughts; and less frequent and less severe piercing pain than those without depression did. LIMITATIONS: The limitations of this study are its single-center design and lack of objective pain indicators. CONCLUSION: Gender significantly affected pain severity, chest pain, numbness, and shooting pain. Jaw pain, lower leg pain, cold/freezing pain, tenderness, pain caused by light touch, piercing pain, and pain-affective descriptors are closely related to emotional states in FM. A comprehensive understanding of pain characteristics in patients with FM would be helpful for disease education, diagnosis, and treatment.

Cross-cultural adaptation and validation of the Chinese version of the short-form of the Central Sensitization Inventory (CSI-9) in patients with chronic pain: A single-center study.

Chronic pain affects more than 30% of the general population. The 9-item Central Sensitization Inventory (CSI-9) is a shortened version of the CSI-25, which is a patient-reported instrument used to screen people at risk of central sensitization (CS). The aim of this study was to cross-culturally adapt and validate a Chinese version of the CSI-9. The Chinese CSI-9 was generated by translation of the original English version, back-translation, cultural adaptation, and revision using the Delphi method. The Chinese CSI-9 was administered to 235 patients with chronic pain and 55 healthy controls. Structural validity (confirmatory factor analysis), construct validity (correlations with other scales), test-retest reliability (intraclass correlation coefficient, ICC), and internal consistency (Cronbach's α) were evaluated. Confirmatory factor analysis was performed using one factor. The Chinese CSI-9 score was positively correlated with the Pain Catastrophic Scale (PCS) total score (r = 0.463), PCS subscale scores (r = 0.347-0.463), Brief Pain Inventory (BPI) mean item score (r = 0.524), BPI total score (r = 0.773), and the number of painful sites (r = 0.451). The Chinese CSI-9 had excellent test-retest reliability (ICC = 0.958) and excellent internal consistency (Cronbach's α = 0.902 in the overall sample and 0.828 in the chronic pain population). The optimal cut-off value for the Chinese CSI-9 was 18 points. The Chinese CSI-9 had excellent test-retest reliability and satisfactory structural validity and construct validity. The CSI-9 could potentially be utilized in China as a self-report questionnaire in both clinical practice and research settings.

Predicting depression and anxiety of Chinese population during COVID-19 in psychological evaluation data by XGBoost.

BACKGROUND: Due to the onset of sudden stress, COVID-19 has greatly impacted the incidence of depression and anxiety. However, challenges still exist in identifying high-risk groups for depression and anxiety during COVID-19. Studies have identified how resilience and social support can be employed as effective predictors of depression and anxiety. This study aims to select the best combination of variables from measures of resilience, social support, and alexithymia for predicting depression and anxiety. METHODS: The eXtreme Gradient Boosting (XGBoost1) model was applied to a dataset including data on 29,841 participants that was collected during the COVID-19 pandemic. Discriminant analyses on groups of participants with depression (DE2), anxiety (AN3), comorbid depression and anxiety (DA4), and healthy controls (HC5), were performed. All variables were selected according to their importance for classification. Further, analyses were performed with selected features to determine the best variable combination. RESULTS: The mean accuracies achieved by three classification tasks, DE vs HC, AN vs HC, and DA vs HC, were 0.78, 0.77, and 0.89. Further, the combination of 19 selected features almost exhibited the same performance as all 56 variables (accuracies = 0.75, 0.75, and 0.86). CONCLUSIONS: Resilience, social support, and some demographic data can accurately distinguish DE, AN, and DA from HC. The results can be used to inform screening practices for depression and anxiety. Additionally, the model performance of a limited scale including only 19 features indicates that using a simplified scale is feasible.

[Analysis of clinical and psychological characteristics in 250 patients with fibromyalgia].

To analyze the clinical and psychological characteristics of fibromyalgia (FM), so as to further understand and improve the capability of identifying FM. The clinical data of 250 FM patients diagnosed in the outpatient clinic of the Department of Rheumatology, the First Medical Center, Chinese PLA General Hospital, from December 2019 to September 2021, were collected and analyzed. The patients aged 40 (31.0, 52.3) years, including 188 female patients (75.2%) and 62 male patients (24.8%). There was a statistically significant difference in age comparison between female [42.5 (33.0,54.0) years] and male patients [32.5 (27.8,43.5) years] (P<0.001). The score of pain degree was 6 (4, 8), and [7 (5, 8)] of female patients was higher than [6 (4, 7)] of the male patients (P=0.040). The widespread pain index (WPI) was 13 (10,15). The regions with high pain incidence were left shoulder girdle (87.2%, 218/250), right shoulder girdle (86.8%, 217/250), upper back (86.4%, 216/250), neck (79.6%, 199/250) and lower back (77.6%, 194/250) and etc. The incidence of chest pain in female patients (55.3%, 104/188) was lower than that in male patients (75.8%, 47/62) (P=0.004). The symptom severity scale (SSS) score was 8 (7-10). 74.6% (185/248) suffered from anxiety and 77.5% (193/249) suffered from depression in 249 patients. Female patients were more common in FM patients than male patients, the median age of female patients was older than that of male patients, and the median score of pain severity of female patients was higher than male patients. Shoulders girdle, upper back, neck and lower back were the most frequently reported pain regions, and the incidence of chest pain in female patients was lower than that in male patients. The incidence of major non-painful symptoms was high and the proportion with anxiety or depression was high. The above clinical features are very helpful for early diagnosis of FM.

Metabolic risk factors of cognitive impairment in young women with major psychiatric disorder.

Background: Cognitive performance improves clinical outcomes of patients with major psychiatric disorder (MPD), but is impaired by hyperglycemia. Psychotropic agents often induce metabolism syndrome (MetS). The identification of modifiable metabolic risk factors of cognitive impairment may enable targeted improvements of patient care. Objective: To investigate the relationship between MetS and cognitive impairment in young women with MPD, and to explore risk factors. Methods: We retrospectively studied women of 18-34 years of age receiving psychotropic medications for first-onset schizophrenia (SCH), bipolar disorder (BP), or major depressive disorder (MDD). Data were obtained at four time points: presentation but before psychotropic medication; 4-8 and 8-12 weeks of psychotropic therapy; and enrollment. MATRICS Consensus Cognitive Battery, (MCCB)-based Global Deficit Scores were used to assess cognitive impairment. Multiple logistic analysis was used to calculate risk factors. Multivariate models were used to investigate factors associated with cognitive impairment. Results: We evaluated 2,864 participants. Cognitive impairment was observed in 61.94% of study participants, and was most prevalent among patients with BP (69.38%). HbA1c within the 8-12 week-treatment interval was the most significant risk factor and highest in BP. Factors in SCH included pre-treatment waist circumference and elevated triglycerides during the 8-12 weeks treatment interval. Cumulative dosages of antipsychotics, antidepressants, and valproate were associated with cognitive impairment in all MPD subgroups, although lithium demonstrated a protect effect (all P < 0.001). Conclusions: Cognitive impairment was associated with elevated HbA1c and cumulative medication dosages. Pre-treatment waist circumference and triglyceride level at 8-12 weeks were risk factors in SCH. Monitoring these indices may inform treatment revisions to improve clinical outcomes.

Differences of medically unexplained symptoms among patients of different ages and sexes in the psychological clinic of a general hospital and the influencing factors of MUS: A cross-sectional study.

Objective: To analyse differences in sex, age, depression, insomnia, psychological stress, resilience, and perceived social support among patients with medically unexplained symptoms (MUS) in a psychological clinic of a general hospital, and to explore the influencing factors of MUS. Methods: This is a cross-sectional study. Seven hundred forty-six first-time patients were assessed with the integrated psychosomatic comprehensive evaluation system (IPS) to evaluate their MUS, depression, insomnia, psychological stress, resilience, and perceived social support. The psychological characteristics were compared with regard to sex and age group (<25 years, low age group; 26-44 years, middle age group; >45 years, high age group). The relationships between age and MUS were explored, and how psychological stress affects MUS was analyzed using the mediator effect model. Results: Different age groups had significant differences in sex, MUS, depression, psychological stress, resilience, and perceived social support. In further pairwise comparison, no significant difference existed in depression, psychological stress, resilience and perceived social support in the middle and low age groups, depression and psychological stress were higher than those in the high age group, resilience and perceived social support were lower than those of the high age group. MUS were higher in the middle age group than in the low age group. No significant difference existed between the two groups and the high age group. Age, severity of MUS, and perceived social support were significantly different between the sexes. Differences in MUS between men and women in different age groups were analyzed using two-factor analysis of variance. It revealed no interaction between sex and different age groups on MUS. The main effect analysis showed that the effects of different age groups on MUS were statistically significant. Based on pairwise comparative analysis, the MUS score in the low age group was lower than that in the middle age group. To clarify a nonlinear relationship between age and MUS, threshold effect analysis was conducted. The results indicated that the piecewise linear regression model could better depict the relationship between age and MUS. The inflection point was at the age of 60 years. Before the age of 60 years, MUS increased with age. No significant correlation existed between age and MUS after the age of 60 years. To understand the influencing factors of MUS, the intermediary effect model was analyzed using MUS as the dependent variable, psychological stress as the independent variable, resilience as mediator variable M1, perceived social support as mediator variable M2, and depression as mediator variable M3. Resilience, perceived social support, and depression had significant mediator effects on the effects of psychological stress on MUS with a total indirect effect of 69.81%. Conclusion: The middle age group had greater MUS than the low age group. Before the age of 60 years, MUS increased with increasing age. Women had more severe MUS than men. Resilience, perceived social support, and depression had significant mediating effects on the effects of perceived stress on MUS. These findings suggest that clinicians should make more comprehensive and detailed evaluations and timely intervention for middle-aged and female patients. Improving psychological resilience and social support can reduce the impact of psychological stress on MUS. Therefore, psychotherapy and multidisciplinary comprehensive treatment are very important for patients is very important for patients.

Why the Victims of Bullying Are More Likely to Avoid Involvement When Witnessing Bullying Situations: The Role of Bullying Sensitivity and Moral Disengagement.

Recent studies have suggested a link between bullying victimization and passive bystander behaviors, such as more outsider behaviors and fewer defender behaviors. However, little is known about the internal mechanism underpinning this relation. The present study aimed to examine the direct and indirect relationships between bullying victimization and two types of bystander behaviors (defender behavior and outsider behavior), considering the possible mediator role of bullying sensitivity and moral disengagement among Chinese adolescents. Participants were 435 primary school students aged from 11 to 13 years (M = 12.27, SD = 0.69) who completed measurements of bullying victimization, bullying sensitivity, moral disengagement, and bystander behaviors. The results of the total effect model indicated that bullying victimization was positively related to outsider behavior and negatively related to defender behavior. The results from the structural equation modelling (SEM) analysis showed that bullying sensitivity mediated the relationship between bullying victimization and defender behavior. The relationship between bullying victimization and outsider behavior was mediated by moral disengagement, as well as the multiple mediation of bullying sensitivity and moral disengagement. These results highlight the roles of bullying sensitivity and moral disengagement in explaining the relation between bullying victimization and bystander behavior among adolescent students. The findings provide important implications for developing intervention programs aiming at school bullying prevention.

Self-help cognitive behavioral therapy application for COVID-19-related mental health problems: A longitudinal trial.

BACKGROUND AND AIM: Recently, the availability and usefulness of mobile self-help mental health applications have increased, but few applications deal with COVID-19-related psychological problems. This study explored the intervention efficacy of a mobile application on addressing psychological problems related to COVID-19. METHODS: A longitudinal control trial involving 129 Chinese participants with depression symptoms was conducted through the mobile application "Care for Your Mental Health and Sleep during COVID-19" (CMSC) based on WeChat. Participants were divided into two groups: mobile internet cognitive behavioral therapy (MiCBT) and wait-list. The primary outcome was improvement in depression symptoms. Secondary outcomes included improvement in anxiety and insomnia. The MiCBT group received three self-help CBT intervention sessions in one week via CMSC. RESULTS: The MiCBT group showed significant improvement in depression and insomnia (allP < 0.05) compared with the wait-list group. Although both groups showed significant improvement in anxiety at the intervention's end, compared with the wait-list group, the MiCBT group had no significant advantage. Correlation analysis showed that improvement in depression and anxiety had a significant positive association with education level. Changes in insomnia were significantly negatively correlated with anxiety of COVID-19 at the baseline. CMSC was considered helpful (n=68, 81.9 %) and enjoyable (n=54, 65.9 %) in relieving depression and insomnia during the COVID-19 outbreak. CONCLUSIONS: CMSC is verified to be effective and convenient for improving COVID-19-related depression and insomnia symptoms. A large study with sufficient evidence is required to determine its continuous effect on reducing mental health problems during the pandemic.

How mathematics anxiety affects students' inflexible perseverance in mathematics problem-solving: Examining the mediating role of cognitive reflection.

BACKGROUND: Too many students persevere in relying upon one (sometimes suboptimal) strategy for solving a wide range of problems, even when they know more efficient strategies. Although many studies have mentioned such phenomena, few studies have examined how emotional factors could affect this type of inflexible perseverance in strategy use. AIMS: To examine whether mathematics anxiety could affect students' inflexible perseverance in strategy use and whether this effect could be mediated by cognitive reflection, which is the ability to engage in deliberate reasoning. SAMPLE AND METHOD: In Study 1, 164 undergraduate students' (18-22 years) mathematics anxiety, cognitive reflection, and performance in overcoming inflexible perseverance were measured by a questionnaire battery. Structural equation models were used to examine the correlations between these variables. In Study 2, 98 undergraduate freshmen (17-18 years) were assigned to two groups, where one group's mathematics anxiety was temporarily induced by task instructions, while the other group served as a control group. Cognitive reflection and inflexible perseverance of the two groups were compared. RESULTS: Study 1 showed that mathematics anxiety was negatively correlated with students' performance on overcoming inflexible perseverance, while cognitive reflection mediated such an effect. Study 2 showed that compared to the control group, the experimental group showed lower cognitive reflection, which led to lower performance in overcoming inflexible perseverance. CONCLUSIONS: Mathematics anxiety was showed to impair students' ability to engage in deliberate reasoning and was associated with inflexible use of strategies. Alleviating students' mathematics anxiety should be considered when promoting students' strategic flexibility.

Implicit Theories and Engagement in Math Among Chinese Adolescent Students: A Moderated Mediation Model of Intrinsic Value and Academic Self-Efficacy.

Recent studies have established associations between students' implicit theories and their academic engagement. However, there is still limited understanding of the potential mechanisms of this relation, and whether it works for students in the context of mathematics as well as in other subjects. The current study aimed to fill this gap by conducting a two-wave survey examining a moderated mediation model concerning the psychological mechanisms that account for the association between students' implicit theories and mathematics engagement. Applying the theoretical framework of implicit theory, we hypothesized that intrinsic value would be a possible mediating variable between students' implicit theories and academic engagement, and that students' academic self-efficacy would moderate the link between implicit theory and intrinsic value. A sample of 710 Chinese adolescent students self-reported their implicit theory, intrinsic value, and academic self-efficacy at Time 1, and engagement in math at Time 2, 12 months apart. After controlling for age and gender, the results revealed positive associations between students' implicit theories and their engagement in math, and intrinsic value partially mediated the relation between implicit theories and engagement in math. Moreover, students' academic self-efficacy moderated the link between implicit theory and intrinsic value. These findings contribute to the understanding of the impact of implicit theory on students' mathematics engagement. Limitations and implications for instructional practices are discussed.

Autonomy Need Dissatisfaction in Daily Life and Problematic Mobile Phone Use: The Mediating Roles of Boredom Proneness and Mobile Phone Gaming.

Psychological needs dissatisfaction has been identified as hindering adaptive development, in which autonomy need dissatisfaction, as one core component, may be associated with adolescents' maladaptive online behaviors. Sporadic research has examined the association between autonomy need dissatisfaction and problematic mobile phone use (PMPU). Boredom proneness and mobile phone gaming were suggested to be linked to this association. This study aimed to examine the mediating effects of boredom proneness and mobile phone gaming in the association between autonomy need dissatisfaction and PMPU. A total of 358 secondary school students completed questionnaires at three waves; autonomy need dissatisfaction was measured in time 1 (T1); boredom proneness and mobile phone gaming were measured one year later (time 2, T2); PMPU was measured two years later (time 3, T3). The structural equation model results showed that T1 autonomy need dissatisfaction not only directly predicted T3 PMPU, but also exerted effects via the mediating role of T2 boredom proneness and the chain mediating role of T2 boredom proneness and T2 mobile phone gaming. These findings reveal the unique role of specific psychological need in engaging PMPU, which provides support to targeted interventions, such that promoting autonomy need satisfaction may be an instrumental procedure to prevent adolescents from addiction-like online behaviors.

Self-Esteem Moderates the Effect of Compromising Thinking on Forgiveness Among Chinese Early Adolescents.

Forgiveness contributes to positive social relationships, which is critical for individual development, particularly for early adolescents. Most previous studies focused on the unique roles of cognitive factors (e.g., compromising thinking) and personality traits (e.g., self-esteem) in the process of developing forgiveness. However, sporadic research has examined their interactive effect on forgiveness from an integrated perspective. Given that forgiveness has been categorized into decisional and emotional forgiveness, this study aimed to examine the effects of compromising thinking on two types of forgiveness, and the moderating effects of self-esteem on the association between compromising thinking and forgiveness among early adolescents. A total of 1,009 Chinese primary and secondary school students (50.4% males; M age = 11.75, SD = 1.27) were recruited to complete three self-reported questionnaires. The results showed that compromising thinking predicted decisional forgiveness but not emotional forgiveness. Furthermore, self-esteem was identified to moderate the conditional effects of compromising thinking on decisional and emotional forgiveness. These findings advance a better understanding of the construct and mechanism of forgiveness, which can provide insights for targeted forgiveness interventions among early adolescents, such as compromising thinking instructions and self-esteem enhancement programs.

Development of the psychosomatic symptom scale (PSSS) and assessment of its reliability and validity in general hospital patients in China.

OBJECTIVES: To develop and verify the Psychosomatic Symptom Scale (PSSS) among psychosomatic patients and the cut-off value of PSSS in distinguishing psychosomatic patients from health controls. METHODS: The PSSS was drafted by an expert workgroup. 996 patients and 366 controls from 14 general hospitals in China were recruited to complete PSSS, Patient Health Questionnaire-15 (PHQ-15) and Symptom Checklist-90 (SCL-90). Student's t-test, Kruskal-Wallis test, Cronbach's α, Spearman's correlation, and confirmatory factor analysis (CFA) were used to verify the PSSS. Receiver operating characteristic (ROC) analyses were used to determine the cut-off value. RESULTS: Cronbach α of PSSS was 0.907. The PSSS was significantly correlated with SCL-90 somatization subscale (r = 0.682, P < 0.001) and PHQ-15 (r = 0.724, P < 0.001). CFA supported the theoretical two-factor structure of the PSSS, with comparative fit index (CFI) = 0.979, Tucker-Lewis index (TLI) = 0.977, root mean square error of approximation (RMSEA) = 0.039 (90% CI: 0.035-0.042), and standardized root mean residual (SRMR) = 0.054. As the sum score of PSSS was significantly higher in female, cut-off values were determined as 11 in females and 10 in males respectively. CONCLUSIONS: The PSSS is a reliable and valid instrument for measuring psychosomatic symptoms.

Trajectory patterns of academic engagement among elementary school students: The implicit theory of intelligence and academic self-efficacy matters.

BACKGROUND: The dropout rate of Chinese elementary school students after 2007 rose again. Little research to date has identified individual differences in pathways of academic engagement to discern those at risk of disengagement and dropout from schools, as well as the longitudinal linkages between cognitive beliefs with academic engagement. AIMS: Examine the developmental trajectories of cognitive, emotional, and behavioural engagement, and assess relations between the implicit theory of intelligence and academic self-efficacy and the development of academic engagement. SAMPLE AND METHODS: We recruited 532, 450, and 415 elementary students to rate on self-report scales in April 2016 (T1), October 2016 (T2), and April 2017 (T3), respectively. Trajectories of academic engagement were analysed by using a multiple-process growth mixture model, and levels of entity theory of intelligence and academic self-efficacy between engagement groups were compared by using analysis of variance. RESULTS: We categorized the students into four groups: persistent (71.24%), climbing (6.01%), descending (16.54%), and struggling engagement (6.20%) groups. Within each group, the levels of academic self-efficacy from T1 to T3 demonstrated a consistent trend with the engagement trajectory; the levels of the implicit theory of intelligence over time showed the reverse trend. CONCLUSIONS: Attention should be given more on the students from the descending and struggling groups. The implicit theory of intelligence and academic self-efficacy showed different longitudinal associations with engagement trajectories.

Does Depressive-Type Schizophrenia Exist? How Do We Prove It?: An Updated Review and Overview.

Depressive symptoms can occur at any point in the duration of schizophrenia. However, we are unable to predict if or when depression will occur in schizophrenic patients. Simultaneously, the standard treatment of depression in schizophrenic patients is the combination of antidepressants and antipsychotics, which has been minimally effective for most patients. Based on several studies, we hypothesized the existence of depressive-type schizophrenia and reviewed the substantial evidence supporting the hypothesis of depressive-type schizophrenia. Simultaneously, we propose technical methods to explore the neuropathology of depressive-type schizophrenia in order to identify the disease during its early stages and to predict how patients will respond to the standard treatment strategies. We believe that the new classification of depressive-type schizophrenia will differentiate it from other forms of depression. In return, this will aid in the discovery of new therapeutic strategies for combatting this disease.

Inhibiting intuitive rules in a geometry comparison task: Do age level and math achievement matter?

Many people apply the "larger area-larger perimeter" rule to solve the perimeter comparison problems, even in situations where this intuitive rule is misleading. To investigate whether inhibitory control is needed in the perimeter comparison reasoning and whether the efficiency of inhibitory control varies with students' ages and achievements, we designed a negative priming paradigm and conducted two experiments. In Experiment 1, a negative priming effect was observed in both Chinese primary school students (n = 123) and college students (n = 42) when they were solving a perimeter comparison task. In Experiment 2 (N = 86), we found that the negative priming effect existed in both high-achieving and low-achieving primary school students, but the magnitude of this effect appeared to be smaller in high-achieving students. These results imply that success in solving geometry quantitative problems requires the ability to inhibit the larger area-larger perimeter intuition in some situations and also that high-achieving students are more capable of doing so.

Effects of Working Memory, Strategy Use, and Single-Step Mental Addition on Multi-Step Mental Addition in Chinese Elementary Students.

The aim of this paper was to examine the roles of working memory, single-step mental addition skills, and strategy use in multi-step mental addition in two independent samples of Chinese elementary students through different approaches to manipulate two dimensions of task characteristics (the primary task). In Study 1, we manipulated strategy types through the dimension of schema automaticity (whether intermediate sums were 10s) and the dimension of working memory load (WML, two steps versus four steps). A hierarchical linear model (HLM) analysis was conducted at case level, strategy level, and individual level. In Study 2, we manipulated task characteristics through schema automaticity (one-time versus two-time regrouping) and the WML (partial versus complete decomposition). A three-level HLM analysis was applied. The general findings of Study 1 and Study 2 suggested that shorter response time on single-step mental addition corresponded to shorter response time on multi-step mental addition. The use of strategies (from easier to more difficult strategies) negatively predicted response time on multi-step mental addition. Easier strategy was associated with shorter response time on multi-step mental addition. Better phonological loop was associated with shorter response time on multi-step mental addition. The findings in both studies highlighted the important role of phonological loop in mental addition in Chinese children, suggesting that the involvement of a specific subcomponent of working memory in mental arithmetic might be subject to linguistic, instructional, and contextual factors.