Role of Maternal Adverse Childhood Experiences on Infant Neglect: A Multi-Perspective Approach.

We explored the intergenerational transmission effects of maternal adverse childhood experiences (ACEs) and infant neglect from multiple perspectives. The study included a sample of postpartum mothers and infants (N = 550) from the outpatient child health care department of a tertiary hospital in Jinan, Shandong Province, China. Our investigation followed three main lines of inquiry. First, the association of overall maternal ACEs with infant neglect was estimated. Secondly, the cumulative and independent effects of maternal ACEs on infant neglect were explored using the Adverse Childhood Experience Questionnaire-Revised (ACEQ-R) with 14 types of ACEs. Finally, the different patterns of 14 maternal ACEs were identified, and the association between the different patterns and infant neglect was explored. There were three main findings. First, infants born to mothers with ACEs experienced higher levels of neglect compared to those born to mothers without ACEs. Second, infants born to mothers with three or more subtypes of ACEs experienced the greatest levels of neglect, with maternal childhood physical neglect emerging as a particularly influential factor. Third, infants in the "median maternal ACEs" and "high maternal neglect and poor peer relationship" groups experienced more severe neglect than those in the "low maternal ACEs" group. These results suggest that early life experiences substantially shape future parenting behaviors, such as infant neglect.

Associations between parenting burnout and maternal adverse childhood experiences among postnatal women.

This study aims at exploring the relationships between adverse childhood experience (ACEs) and parental burnout. A total of 583 postnatal Chinese mothers were recruited in this cross-sectional study. Maternal ACEs were measured by Adverse Childhood Experience Questionnaire-Revised and parental burnout was measured by Parental Burnout Assessment. Multiple linear and binary logistic regression, and latent class analysis were used to explore the association between each type and cumulative ACEs and parental burnout. We found ACEs were associated with a higher risk of parental burnout. However, the association differed in the type of ACEs. The higher levels of physical abuse (B = 0.971 ~ 0.459, all p < 0.05) and emotional neglect (B = 1.010 ~ 1.407, all p < 0.05) in childhood were correlated with more serious parental burnout. The higher levels of self-threatened (B = 0.429 ~ 0.559, all p < 0.05) and self-deprived experience (B = 0.384 ~ 0.462, all p < 0.05), higher number of ACEs type (B = 2.909 ~ 3.918, all p < 0.05) were associated with more serious parental burnout. Results were consistent after combining four dimensions of parental burnout as a whole in LCA. This study indicated that maternal ACEs were associated with parental burnout. Women with self-deprived, self-threatened and more types of ACEs should be paid special attention.

Relationship Between Sleep Problems and Memory Impairment Among Nurses.

BACKGROUND: Sleep problems are common among nurses and can lead to various health problems. Further, the relationship between multiple sleep problems and memory impairment in clinical nurses remains unknown. Therefore, in this study, we aimed to explore the relationship between sleep problems and memory impairment among nurses. METHODS: Multistage cluster-stratified random sampling was performed from tertiary hospitals in Shandong, China. Overall, a total of 1833 nurses were included in the final analysis. The Chinese version of the Pittsburgh Sleep Quality Index and prospective and retrospective memory questionnaire were administered to the participants. RESULTS: The sleep quality of the nurses decreased during the normal epidemic prevention and control period compared with that before the epidemic in terms of sleep duration, sleep efficiency, and sleep disturbances. Nurses who reported cumulative or specific sleep problems (e.g., high sleep latency, sleep disturbances, and daytime dysfunction) and those in the "daily disturbances" and "poor sleep quality" groups had a higher risk of memory impairment than the others. CONCLUSION: Sleep problems might be important for memory impairment among nurses. These findings may help identify nurses at considerable risk of memory impairment in clinical practice.

Stress begets stress: The moderating role of childhood adversity in the relationship between job stress and sleep quality among nurses.

BACKGROUND: Nurses exhibit considerable variations in sleep quality and experience high job stress levels. Distal factors, such as childhood adversity, and proximal factors, both influence sleep quality. We investigated the moderating role of childhood adversity with job stress and sleep quality, and whether this aligns with the stress-sensitization or stress-amplification models. METHODS: The impact of job stressors' total score and its dimensions on sleep quality was analyzed using traditional linear regression models and the extreme gradient boosting machine learning algorithm. The hierarchical regression examined the moderating role of childhood adversity in the relationship between job stress and sleep quality. An interactive tool was used to visualize the results. RESULTS: Among the dimensions of job stress, "time allocation and workload" strongly correlated with sleep quality, followed by "nursing profession and work problems," "patient care issues," "management and interpersonal problems," and "working environment and equipment problems." The moderating role of childhood adversity in the relationship between different dimensions of job stressors (except working environment and equipment problems) and sleep quality aligns with the stress-sensitization model. LIMITATIONS: This study was susceptible to recall bias and objective sleep data were unavailable. Cross-sectional study design was used, thus limiting causal inferences. Finally, the moderating effect of childhood adversity on subsequent stress among nurses remains unclear. CONCLUSION: Childhood adversity and job stress were integrated into a stress-sensitization model, providing a nuanced and specific examination of sleep quality. Healthcare policymakers should focus on job stress and childhood adversity, improve nurses' sleep quality, and ultimately benefit patient care and outcomes.

Association between transition patterns of sleep problems and suicidal ideation in Chinese female nurses: A prospective study.

OBJECTIVE: Suicidal ideation and sleep problems are both common in nurses. However, few longitudinal studies are available to examine the temporal association between sleep and suicidal ideation in nurses. METHOD: Data from the Health Longitudinal Survey of Nurses in Shandong Province was analyzed, involving 623 female nurses who had completed data of concern in 2018 (T1) and 2019 (T2). Sleep problem was assessed by the Pittsburgh Sleep Quality Index, in which the transition patterns for global and specific sleep component and the cumulative number of sleep component problems were defined. Suicidal ideation was measured by the ninth item of the Patient Health Questionnaire. Binary logistic regression was used to explore the association between sleep and suicidal ideation. RESULTS: Chronic and deteriorated global sleep problems is associated with a greater risk of suicidal ideation. For the specific component of sleep, sleep disturbance and short sleep duration are associated with a higher risk of suicidal ideation. The higher number of cumulative sleep component problems is associated with a higher risk of suicidal ideation. CONCLUSION: Findings indicate sleep disturbance and short sleep duration may be pathways to suicidal ideation. Initiatives that target at sleep problems may be important to reduce suicidal ideation in nurses.

Exploring the relationship between postnatal depressive symptoms and parental burnout from the perspective of the population and individual level.

BACKGROUND: Parental burnout has become increasingly common, which can lead to a range of adverse outcomes. Postnatal mothers are vulnerable and mothers with high postpartum depression scores may be more prone to parental burnout. This study aims to investigate the association between postnatal depressive symptoms and parental burnout at both the population and individual levels. METHODS: This study comprised a cross-sectional study design and participants were recruited using convenience sampling. A total of 560 postnatal mothers answered a questionnaire on their general information, postnatal depressive symptoms and parental burnout. Multiple linear regression and binary logistic regression analysis were used to examine the association between postnatal depressive symptoms and parental burnout. Furthermore, latent class analysis was used to identify subtypes of parental burnout. Finally, binary logistic regression was used to examine the differences in postnatal depressive symptoms between latent classes comprising parental burnout. RESULTS: The prevalence of burnout was approximately 10%. At the population level, postnatal depressive symptoms were positively associated with parental burnout (all P < 0.05). At the individual level, two latent classes were identified (i.e., "low parental burnout class" and "high parental burnout class"). Moreover, mothers with postnatal depressive symptoms were more likely to be associated with high parental burnout (PB) class than the low parental burnout class (OR = 1.12, 95% CI:1.03 to 1.23). CONCLUSION: This study found a positive relationship between postnatal depressive symptoms and parental burnout. It provided evidence for developing depression-targeted programs for parental burnout, which could bring great benefits for both mothers and infants.

Associations of maternal antenatal bonding with neonatal meconium microbiota and the behavior temperament of infants: A prospective longitudinal study.

Exposure to a poor intrauterine environment, such as maternal prenatal stress, has been linked to gut microbiota health in infants. Understanding the link between maternal prenatal bonding, early gut microbiota, and neuropsychological development may promote healthy development in early life. This study included 306 mother-child pairs. Women were assessed for maternal antenatal bonding using the Maternal Antenatal Attachment Scale in all three trimesters of pregnancy. Neonatal meconium samples were collected after birth. The behavioral temperament of infants was measured using the Very Short Form of the Infant Behavior Questionnaire-Revised at 6 months postpartum. Maternal prenatal bonding was negatively associated with the infants' relative abundance of Burkholderia and was positively associated with the relative abundance of Bifidobacterium, infant surgency and effortful control. The infant's relative abundance of Burkholderia mediates the association between maternal prenatal bonding and effortful control of the infant. This study provides new evidence about the long-term behavioral implications of a prenatally positive intrauterine environment in offspring microbiomes. The integration of maternal bonding assessment and intervention into prenatal healthcare and wellness models may modulate the establishment of gut microbiota in early life and long-term neuropsychological development in infants.

Effectiveness of Digital Guided Self-help Mindfulness Training During Pregnancy on Maternal Psychological Distress and Infant Neuropsychological Development: Randomized Controlled Trial.

BACKGROUND: Maternal psychological distress during pregnancy is associated with unfavorable outcomes in infants. Mindfulness-based interventions (MBIs) can effectively alleviate psychological distress, but there are often barriers to the access of face-to-face interventions. OBJECTIVE: This study aimed to investigate the effectiveness of a digital guided self-help (GSH) MBI (GSH-MBI) in reducing maternal psychological distress and improving infant neuropsychological performance. METHODS: This was a randomized controlled trial. We recruited 160 women who were 12 to 20 weeks pregnant and exhibited psychological distress. We randomized them into a digital GSH-MBI group and a control group (usual perinatal care). The digital GSH-MBI consisted of a 6-week intervention through a WeChat mini program, with a daily reminder sent to the participants by a research assistant via WeChat. The primary outcomes consisted of maternal psychological distress, including depression, anxiety, and pregnancy-related anxiety symptoms, which were assessed at 6 time points from baseline to 6 months post partum (only pregnancy-related anxiety symptoms were assessed 3 times during pregnancy). The secondary outcomes were infant neuropsychological outcomes, including temperament and developmental behaviors, which were assessed at 6 weeks and 6 months post partum. RESULTS: Compared with the control group, the digital GSH-MBI group showed a significant reduction in depression, anxiety, and pregnancy-related anxiety symptoms. In addition, the scores of the digital GSH-MBI group were lower than those of the control group for the 3 types of infant temperament at 6 weeks post partum, including quality of mood, distractibility, and adaptability. CONCLUSIONS: Digital GSH-MBIs are effective in alleviating psychological distress among pregnant women and protecting infant outcomes. TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR2000040717; https://www.chictr.org.cn/showproj.aspx?proj=65376.

Maternal Impaired Cognition and Infant Neglect: Exploring the Independent and Combined Effects of Maternal Executive Function and Reflective Function.

Infant neglect is a common type of child maltreatment. According to the Social Information Processing theory, maternal executive function (EF) and reflective function (RF) are assumed to be important contributing factors to infant neglect. However, empirical evidence about this assumption is sparse. This was a cross-sectional study. A total of 1010 eligible women participated. The Behavior Rating Inventory of Executive Function-Adult Version, Parental Reflective Function Questionnaire, and Signs of Neglect in Infants Assessment Scale (SIGN) were used to assess maternal EF, RF, and infant neglect, respectively. Random forest was used to assess the relevant importance of maternal EF and RF. K-means clustering was used to identify the profiles of maternal EF and RF. Multivariable linear regression and generalized additive models were used to examine the independent and combined effects of maternal EF and RF on infant neglect. Each dimension of EF was linearly related to infant neglect. The associations between each dimension of RF and infant neglect were nonlinear. The inflection point for each dimension of RF was indicated. Random forest showed EF was more closely related to infant neglect. EF and RF had accumulative effects on infant neglect. Three profiles were identified. Among them, those with globally impaired EF had the highest level of infant neglect compared with those who had normal cognition or only impaired RF. Maternal EF and RF had independent and combined effects on infant neglect. Interventions with maternal EF and RF as targets are promising for reducing infant neglect.

Internet-delivered mindfulness-based interventions for mental health outcomes among perinatal women: A systematic review.

BACKGROUNDS: Mindfulness-based interventions (MBIs) delivered via the Internet become increasingly popular for improving maternal mental health, but the effectiveness of internet-delivered MBIs (iMBIs) is still unclear. METHODS: PubMed, PsycINFO, Embase, Scopus, CINAHL, and Cochrane Central Register of Controlled Trials were searched. We included studies that were randomized controlled trials (RCTs), quasi-experimental study design, and pre-post test design and contained information on the population of interest (women during pregnancy or within one year after delivery), intervention contents (mindfulness components), and intervention delivery formats (internet-based). ROBINS-I and RoB 2 were used to rate the risk of bias in non-RCTs and RCTs, respectively. RESULTS: Eleven studies composed of six RCTs and five non-RCTs were included. The overall risk of bias was high. IMBIs are effective in improving maternal depression and mindfulness and self-compassion. However, limited by the small number of studies included in the review, effect sizes of iMBIs cannot be estimated. Characteristics of iMBIs (delivery formats, duration, et al.) and studies (study design, measures et al.) were described. CONCLUSION: iMBIs are still in the initial stage. Studies with rigorous study design and larger sample size, and determining the optimal delivery formats and duration and intensity of interventions are necessary.

Effects of a maternal mindfulness intervention targeting prenatal psychological distress on infants' meconium microbiota: A randomized controlled trial.

BACKGROUND: Maternal psychological distress could affect gut microbiota of the infant; however, previous studies to date have been observational. OBJECTIVE: To investigate the effects of mindfulness-based intervention (MBI) during pregnancy on the meconium microbiota of infants by alleviating maternal psychological distress. DESIGN: Randomized controlled trial. METHOD: Pregnant women with symptoms of depression or anxiety were randomized to either the intervention group (n = 80), comprising usual perinatal care and six digitally guided self-help MBI sessions, or the control group (n = 80) who underwent usual perinatal care. Meconium was collected within 48 h of birth to evaluate the infant's gut microbiota. The Kruskal-Wallis rank sum test, analysis of similarities, and DESeq2 were performed to explore the effects of the MBI on alpha and beta diversity indices and specific genera. RESULTS: There were no significant differences between groups regarding the alpha diversity indices, including Chao1 and Simpson (p = 0.83 and p = 0.58). However, there was a significant between-group difference in the beta diversity index (R=0.02, p = 0.03). Bifidobacterium (log2 fold change=-1.90, FDR=0.002) and Blautia (log2 fold change=-1.45, FDR=0.01) were abundant in the intervention group, whereas Staphylococcus (log2 fold change=1.44, FDR=0.01) was abundant in the control group. CONCLUSIONS: MBI aimed at alleviating maternal psychological distress can positively alter the meconium microbiota of infants. However, the mechanisms underlying the effects of maternal mindfulness during pregnancy on infant meconium microbiota require further exploration.

Work-related potential traumatic events and job burnout among operating room nurses: Independent effect, cumulative risk, and latent class approaches.

AIMS: The objective of this study is to explore and compare the strength of associations between work-related potential traumatic events and burnout among operating room nurses based on three different approaches. DESIGN: The study followed a multisite cross-sectional design. METHODS: A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work-related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis-derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis. RESULTS: Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work-related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work-related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization. CONCLUSION: Operating room nurses who reported specific or multiple work-related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support. IMPACT: This study is the first to focus on work-related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health.

Stressors Among Chinese Frontline Health Care Workers Exposed to COVID-19 and Associated Mental Health Outcomes.

The current study aimed to identify the main stressors inherent to caring for patients with coronavirus disease 2019 (COVID-19) and associated mental health outcomes among frontline health care workers. Data were collected via an online questionnaire from 651 frontline health care workers providing direct medical services for patients with suspected or confirmed COVID-19. Participants reported the stressors inherent to caring for patients with COVID-19, including depression, anxiety, and insomnia. Data were analyzed using descriptive statistics and multivariable logistic regression analysis. The most common stressors were "Worry about being negligent and endangering coworkers" (76.2%), "Worry about getting infected" (74.7%), and "Protective gear causing physical discomfort" (73.6%). "Conflict between duty and safety" and "Protective gear causing physical discomfort" were linked to high risk of depression, anxiety, and insomnia. Findings suggest that frontline health care workers may develop adverse mental health outcomes in the face of certain stressors, requiring targeted interventions. [Journal of Psychosocial Nursing and Mental Health Services, 60(1), 17-22.].

Associations of physical activity, sedentary behavior and sleep duration with anxiety symptoms during pregnancy: An isotemporal substitution model.

BACKGROUND: Studies have evidenced the close relationships between movement behavior [physical activity (PA), sedentary behavior (SB), and sleep duration)] and anxiety. Capturing 24 h of these maternal movement behaviors during pregnancy is necessary to understand their relationships. METHODS: In a cross-sectional study design, a total of 946 prenatal women filled Pregnancy Physical Activity Questionnaire-Chinese version, Pregnancy-Related Anxiety Questionnaire, and 7-item Generalised Anxiety Disorders scale between May 2020 and April 2021. An Isotemporal Substitution Model was used to estimate the per-hour effects of replacing one behavior. RESULTS: Replacing moderate-to-vigorous PA(MVPA), light PA (LPA), or SB with sleep could reduce both general and pregnancy-specific anxiety (LPA, B = -0.61∼-0.37, P ≤ 0.01; MVPA, B = -0.35, P = 0.03; SB, B = -0.45∼-0.34, P ≤ 0.01). Replacing SB with MVPA could reduce pregnancy-specific anxiety in the group without adequate sleep duration (SB, B = -0.62,95%CI = -1.13∼-0.17). As for the types of PA, replacing household, occupational or inactivity PA with transportation PA or sleep duration reduced general anxiety (household PA: B = -0.51, 95%CI = -0.73∼-0.29, P < 0.001; occupational PA: B = -0.48, 95%CI = -0.69∼-0.27, P < 0.001; inactivity: B = -0.45, 95%CI = -0.68∼-0.24, P < 0.001). Replacing household PA, occupational PA, or inactivity with transport PA was associated with improved general anxiety (household: B = -0.33, 95%CI = -0.64∼-0.03, P = 0.29; occupational PA: B = -0.31, 95%CI = -0.62∼-0.003, P = 0.35; inactivity: B = -0.28, 95%CI = -0.56∼-0.01, P = 0.33). LIMITATIONS: A cross-sectional study design and self-reported measurement limits the reliability of study. CONCLUSION: Longer time spent in sleep and MVPA may mitigate the negative effects of SB on anxiety.

The Independent and Joint Effects of Different Childhood Abuse Types on Subjective Prospective and Retrospective Memory Impairment During Pregnancy.

Background and Objective: Childhood abuse is considered a risk factor in various health outcomes during pregnancy. However, no study has explored the relationship between childhood abuse and memory impairment during pregnancy. This study is the first to explore the relationship between childhood abuse and subjective memory impairment. Participants, Setting, and Methods: A total of 1,825 pregnant women were recruited from a comprehensive hospital in Shandong province, China, and completed a questionnaire survey. Multivariable linear regression analysis was used to explore the relationship between childhood abuse and subjective prospective and retrospective memory. Results: Pregnant women with high total childhood abuse scores had high prospective and retrospective memory impairment. Among pregnant women reporting only emotional abuse, only physical abuse, or only sexual abuse, women reporting only emotional abuse were found to have high prospective and retrospective memory impairment. Women with all three childhood abuse types also had high prospective and retrospective memory impairment. Conclusion: Women who experienced childhood abuse, especially childhood emotional abuse, had high subjective memory impairment during pregnancy. It is important to ask pregnant women about their experiences of childhood abuse, especially emotional abuse, during early prenatal care, as such abuse is likely to have negative effects on memory during pregnancy.

Sensitivity to change and minimal clinically important difference of Edinburgh postnatal depression scale.

OBJECTIVE: Edinburgh Postnatal Depression Scale (EPDS) was widely used in measuring depression symptoms among pregnant women. However, it is still unclear about the sensitivity to change and minimal clinically important difference (MCID) for EPDS. METHODS: Based on data from an eight-week smartphone-based mindfulness intervention, scores of EPDS, 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder (GAD-7) before and after the intervention were collected. Three self-appraisal questions were collected after the intervention. The sensitivity to change of EPDS was determined by correlations between changes in PHQ-9, GAD-7, and EPDS. MCID for EPDS was determined by distribution-based method (0.5 standard deviation and standard error of the measurement) and anchor-based method (PHQ-9, GAD-7, and participants' self-appraisal served as anchors). The final MCID value for EPDS was calculated by average scores of the two methods. 117 women with pre-post assessments were included in the analysis. RESULTS: EPDS score changes from baseline to post-intervention were correlated with pre-post change in PHQ-9 and GAD-7 (r = 0.540, P < 0.001). The average MCID for EPDS score was found to be 4 points (ranging from -1.45 to -6.5 points) for improvement and 3 points for worsening (ranging from 1.45 to 3.5 points). CONCLUSION: The EPDS is sensitive to detect the changes in maternal depressive symptoms during pregnancy through a mindfulness course of interventions. Four points for improvement and three points for worsening are recommended as MCID for EPDS.

The associations of executive functions with resilience in early adulthood: A prospective longitudinal study.

BACKGROUND: Executive functions and resilience, the key components of an individual's ability to participate meaningfully and effectively in their environment, have become increasingly researched topics in psychology and education. However, little is known about the longitudinal associations of executive functions and resilience among emergent adults. METHODS: We conducted a prospective study with 450 (baseline) participants aged 17-24 years; 420 of these participants also completed a 15-month follow-up. Participants answered questionnaires investigating socio-demographics, executive functions, and resilience, and results were analysed with multivariable logistic regression and cross-lagged analyses. RESULTS: At baseline, the overall prevalence of low executive functions (T-score ≥ 60) among the sample was 18.2%. Relative to persistently low executive functions, newly developed or persistent high executive functions was significantly associated with higher level of resilience at follow-up (bOR = 8.26, 95% CI [2.57, 26.49]; bOR = 8.74, 95% CI [3.69, 20.70], respectively). Further cross-lagged analyses showed bidirectional relationships of executive functions and various executive functions subtypes with resilience. LIMITATIONS: The use of self-report measures may lead to recall bias, and intervention or experimental studies are needed to examine causality. This study recruited participants from one vocational school, which may limit the generalisability of the results. Also, follow-up dropout was a potential bias in this study; the observed results should be interpreted with caution. CONCLUSIONS: Our study proposes that enhancing executive functions may be associated with improved resilience, and vice versa. These findings could influence the development of targeted interventions via mental health professionals to support individuals' development.

Occupational stress, mental health, and self-efficacy among community mental health workers: A cross-sectional study during COVID-19 pandemic.

BACKGROUND: During the COVID-19, community mental health care workers (CMHWs) faced much heavier workloads, which make them vulnerable to mental problems. AIM: This study aims to investigate coronavirus disease-related occupational stress and its single and cumulative effect on mental health and self-efficacy among CMHWs. METHODS: A quick-response online cross-sectional survey WA conducted during the coronavirus disease outbreak. A total of 536 CMHWs were recruited in March 2020, in China. Demographics, occupational stress, depression, anxiety, positive and negative emotions, and self-efficacy were collected. Logistic regression analysis was employed to test the single and cumulative effect of occupational stress on mental health and self-efficacy. RESULTS: CMHWs did not show high level of depression or anxiety in this study. Those who provided service for suspected people who were quarantined reported higher risk of depression and anxiety. Staying out for more than 3 days was a risk factor of depression while cleaning/sterilising streets or communities was a protective factor of depression. Those who received psychiatric training showed higher positive emotion and self-efficacy, and providing psychological assistance online increased the self-efficacy. CMHWs with two different types of work had 0.996 times more risk of depression than those with only one type of work. CONCLUSION: The potential cumulative effect of occupation stress suggested that reasonable job assignment and organisational support are necessary safeguards for CMHWs.