The mutual overlapping impact of stress and infection on mental health problems in adolescents and youths during and after COVID-19 pandemic in China.

BACKGROUND: It is unclear about the mutual impact of COVID-19 related psychological stress and infection on mental health of adolescent and youth students. This study aimed to explore the mutual impact of COVID-19 related psychological stress and infection on mental health problems among students. METHODS: This study was conducted from December 14, 2022 to February 28, 2023 in Sichuan, China. Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, Insomnia Severity Index, and Internet Addiction Test were used. Participants were grouped by COVID-19 infection and psychological stress level. The differences among groups were compared, and logistic regression analysis was used to investigate risk factors for depression, anxiety, PTSD and insomnia among groups. RESULTS: Of 90,118 participants, 82,873 (92.0 %) finished the questionnaires and were included in the study. Of 82,873 participants, 33,314 (40.2 %) reported to be infected with COVID-19. Participants had depression symptoms (38.1 %), anxiety symptoms (31.8 %), PTSD (33.9 %), insomnia (34.0 %), and internet addiction (60.3 %). Compared with participants uninfected with low psychological stress level, the risk for symptoms of depression, anxiety, PTSD and insomnia increased by 9.6 %, 12.3 %, 6.6 %, and 12.0 % in participants infected with low psychological stress level (p < 0.001), 106.8 %, 125.9 %, 125.2 %, and 95.7 % in participants uninfected with high psychological stress level (p < 0.001), and 147.3 %, 161.1 %, 158.7 %, and 141.0 % in participants infected with high psychological stress level (p < 0.001). LIMITATION: This study is a cross-sectional design, and no causal associations should be inferred. Infection status was based on self-report of participants with infectious symptoms. CONCLUSION: COVID-19 related psychological stress and infection per se have mutually overlapping impacts on mental health problems among students. Further health policies and psychosocial interventions should be developed to reduce mutually overlapping impact and improve the long-term mental health among students.

Psychometric Properties of the Chinese Version of the Occupational Fatigue Exhaustion/Recovery Scale: A Test in a Nursing Population.

BACKGROUND: The Occupational Fatigue Exhaustion/Recovery Scale (OFER) was designed to assess occupational fatigue in nurses. Although the original English version of this instrument has shown high degrees of reliability and validity, a Chinese version of this scale has yet to be verified. PURPOSE: The aim of this study was to evaluate the psychometric properties of the OFER in a population of Chinese nurses. METHODS: The scale was translated using translation and back-translation. The validities and reliabilities were evaluated on 923 qualified participants using content validity index, concurrent validity, factorial validity, internal consistency reliability, and test-retest reliability. RESULTS: The content validity index for the OFER was .92. The correlation coefficients between the scores of the OFER subscales and the criteria in this study (varying from -.498 to .705) verified that the OFER has acceptable concurrent validity. Principal component analysis and confirmatory factor analysis revealed that three factors correspond to the structure of the original instrument and that recovery mediates the relationship between acute and chronic fatigue. The Cronbach's alpha for the chronic fatigue, acute fatigue, and intershift recovery subscales were .83, .85, and .86, respectively. Test-retest reliabilities with correlation coefficients from .61 to .78 were found in the three subscales. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: OFER is a reliable and valid instrument for assessing work-related fatigue in Chinese nurses. However, further improvement of the acute fatigue subscale is recommended. The OFER has the potential to elicit information that is useful for assessing fatigue in nurses in China. Furthermore, as it differentiates between acute and chronic fatigue, OFER may be an effective tool for guiding the development and implementation of various, related intervention measures.

[Effects of Group Cognitive Behavioral Therapy on Social Anxiety Disorders].

OBJECTIVE: To evaluate the effect of group cognitive behavioral therapy (GCBT) on social anxiety disorders (SAD). METHODS: A total of 50 patients with SAD were recruited in this study. A survey containing the Liebowitz social anxiety scale (LSAS),the automatic thoughts questionnaire (ATQ),the fear of negative evaluation questionnaire (FNE),the social support rating scale (SSRS),the tridimensional personality questionnaire (TPQ),and the egna minnen barndoms uppfostran (EMBU) was administered before and (one week) after the GCBT,including in the 50 healthy controls. About 21 patients completed the eight-week GCBT (once a week,2 h a session). Follow-up surveys were conducted on 40 patients (22 patients treated with GCBT and 18 untreated) over a 1-5 year period. RESULTS: Significant differences were found between the SAD patients and healthy controls in thinking mode,personality characteristics,social support,parental rearing styles,and social anxiety symptoms. Significant decrease in social anxiety symptom ( t=4.06, P=0.000) , negative automatic thoughts ( t=4.58, P=0.000) and fear for rejection ( t=3.85, P=0.000) were observed after the GCBT therapy. Such improvement was positively correlated with subjective social support (r=0.361, P=0.022) ,and negatively correlated with rejection of father (r=-0.431, P=0.005) . There was also statistical difference between the patients with and without the GCBT therapy ( P=0.033) . CONCLUSION: GCBT treatment can relieve SAD symptoms by changing the negative cognitive of SAD patients. Social support and rejection of father affects the prognosis of SAD.

[The value of 5-HTT gene polymorphism for the assessment and prediction of male adolescence violence].

OBJECTIVE: To establish an adolescent violence crime prediction model, and to assess the value of serotonin transporter (5-HTT) gene polymorphism for the assessment and prediction of violent crime. METHODS: Investigative tools were used to analyze the difference in personality dimensions, social support, coping styles, aggressiveness, impulsivity, and family condition scale between 223 adolescents with violence behavior and 148 adolescents without violence behavior. The distribution of 5-HTT gene polymorphisms (5-HTTLPR and 5-HTTVNTR) was compared between the two groups. The role of 5-HTT gene polymorphism on adolescent personality, impulsion and aggression scale also was also analyzed. Stepwise logistic regression was used to establish a predictive model for adolescent violent crime. RESULTS: Significant difference was found between the violence group and the control group on multiple dimensions of psychology and environment scales. However, no statistical difference was found with regard to the 5-HTT genotypes and alleles between adolescents with violent behaviors and normal controls. The rate of prediction accuracy was not significantly improved when 5-HTT gene polymorphism was taken into the model. CONCLUSION: The violent crime of adolescents was closely related with social and environmental factors. No association was found between 5-HTT polymorphisms and adolescent violence criminal behavior.

[Study on resting-state default mode network in patients with posttraumatic stress disorder after the earthquake].

OBJECTIVE: To explore the pathogenesis of posttraumatic stress disorder (PTSD) by studying default mode network during the resting state in patients with PTSD after homologous traumatic experience. METHODS: Seventeen PTSD patients and 20 matched normal controls received the examnation of resting-state fMRI scanning. Left and right posterior cingulate cortex was regarded as seed region respectively, and the functional connectivity about whole brain was assessed by using resting-state functional connectivity analysis. RESULTS: Compared with control group, the patients with PTSD showed that the brain area with decreased functional connectivity included left superior frontal gyrus and right fusiform gyrus, while the brain area with increased functional connectivity included right precuneus, right superior temporal gyrus and right middle temporal gyrus. CONCLUSION: The brain default mode network of PTSD patients is abnormal in resting state. These abnormalities might be the neuropathological mechanisms of PTSD.

[Brain evoked potentials in patients with depression or anxiety].

OBJECTIVE: To investigate the features and clinical implications of event related potential (ERP) and cognitive-processing in patients with depression, anxiety or both anxiety and depression METHODS: A total of 34 patients with anxiety (HAMA>14, HAMD<17), 33 patients with depression (HAMD>17, HAMA<14), 54 patients with both anxiety and depression (HAMA>14, HAMD>17), and 37 health volunteers were recruited in the study. The event related potential were recorded by Nihon Kohden instruments. RESULTS: Compared with the healthy volunteers, the latency of P3a and P3b was longer (P<0.05) and the amplitude of N2-P3b was lower in the patients with anxiety (P<0.05); the Amplitude of N2-P3b was lower (P<0.05) in the patients with depression; the latency of P3a was longer and the amplitude of N2-P3b was lower (P<0.05) in the patients with both anxiety and depression. The latencies of P3a and P3b in the patients with anxiety and both anxiety and depression were longer than in the patients with depression(P<0.05). The latency of N2 in the patients with anxiety and depression was longer than in the patients with anxiety or depression (P<0.05). CONCLUSION: The features of ERP in patients with depression are different from those with anxiety, which provides an electroneurophysiology basis for the clinical diagnosis and differential diagnosis for anxiety and depression.

[The mental health of children and adolescents from earthquake affected areas].

OBJECTIVE: To examine the mental health status of 11-16 years old children exposed to the 5.12 WenChuan earthquake and to help develop post-traumatic psychological interventions. METHODS: The self-reported Strengths and Difficulties Questionnaire (SDQ) was administered to 540 children (mean age: 13.82+/-0.98, male/female ratio 1.06:1) from the earthquake affected areas one month after the earthquake. RESULTS: (1) The children had an average difficulty score (T score) of 13.41+/-5.71, with 74.6% reporting at least minor perceived difficulties. (2) The children with higher levels of exposure had higher emotional subscale scores (z=-2.323, P=0.020). The female students had higher emotional subscale scores than the male students (z=-4.985, P=0.000). (4) The impact of the difficulties on the children's learning increased with age (z=9.106, P=0.011). (5) The longer the children lived in the transferred safe places, the more likely the children got an abnormal (OR=1.233, P=0.003). CONCLUSION: The mental health status of the children from the earthquake affected areas are influenced by their exposure levels, gender, age and the length of living in transferred safe places. These factors should be taken into considerations when post-traumatic psychological interventions are planned.

[Diagnosis of "unspecified psychotic disorder" in identifying criminal responsibility].

OBJECTIVE: To explore diagnosis and management of "unspecified psychotic disorder" in determination of criminal responsibility. METHODS: Analysis of 12 cases of "unspecified psychotic disorder" during determination of criminal responsibility in Sichuan Forensic Expertise Center in Southwest China from January 2006 to July 2007. RESULTS: The main reason to diagnose unspecified psychotic disorder was there were insufficient information and findings . Descriptions of mental abnormalities were not complete and were atypical (83.3%). Even if "unspecified psychotic disorder" was diagnosed, it was still possible to determine criminal responsibility by its motivation and intention to escape. 75% suspects were determined to bear limited criminal responsibility and 25% were not criminally responsible. CONCLUSION: The unspecified psychotic disorder is a provisional diagnosis. It should be used cautiously in the course of jurisdictional identification of mental diseases.

[The influence of self-improving based group psychotherapy in defense mechanisms for the clients with social anxiety disorder].

OBJECTIVE: To evaluate the influence and therapeutic effect of self-improving based group psychotherapy which bases on pathopsychology mechanism of social anxiety disorder (SAD) in denfense mechanisms for the client with SAD. METHODS: 70 psychotherapy clients and inpatients with SAD were involved in this group psychotherapy voluntarily. Every group had six to eight clients with SAD and two psychotherapists. Psychotherapy was conducted once a week with 2 to 2. 5 hours for a period of 8 weeks. The evaluation of the therapeutic effect contains the subjective perception of the clients with SAD, Liebowitz Social Anxiety Scale (LSAS), and Defense Style Questionnaire (DSQ). RESULTS: 65 clients with SAD completed the therapy. The clients reported self and social functions were improved after 8 weeks therapy. The total score of LSAS after the therapy was significantly lower than that of before the therapy (Z = -5.673, P=0.000). A significant decrease in immature defense machanism and in neurotic defense machanism were observed (Z = -4.866, -2.973; P=0.000, 0.003 respectively). And a trend of increasing the use of mature defense machanism was also observed (Z = -2.780, P=0.005). CONCLUSION: Self-improving based group psychotherapy can encourage the clients with SAD accept themselves and cure the social anxiety symptoms. And there was a increasing use of mature defense machanism. These imply the clinic application value of the studied group psychotherapy.

[Prevalence and risk factors of social anxiety disorder in high schools and universities in Chengdu].

OBJECTIVE: To explore the prevalence and risk factors of social anxiety disorder (SAD) in high schools and universities in Chengdu. METHODS: 2279 students in Chengdu sampled by optimum distributing delaminating grouping method were interviewed one-to-one by the trained psychiatrists according to SCID. Both the cooperated SAD patients (n=156) and the normal counterparts (NC, n=156) in the 2279 students completed Egma Minnen av Bardndosnauppforstran (EMBU), State-Trait Anxiety Inventory (STAI-Form Y), Fear of Negative Evaluation Scale (FNE) and Defense Style Questionnaire (DSQ). RESULTS: There were 179 SAD patients, 88 female ones and 91 male ones, in the 2279 students of the high schools and universities in Chengdu. Statistical analysis reveals that the SAD patients differ from the NC in seven aspects, i.e. growing circumstances (P = 0.049), family economical status(P = 0.000), family history of psychiatric disorder, scales of EMBU,STAI, FNE and DSQ. CONCLUSION: The total prevalence of SAD in the students of high schools and universities in Chengdu was 8.15%, the female prevalence 8.35%, and the male prevalence 7.62%. The possible risk factors were: growing up in the countryside, low family economic state, parental rearing pattern being deficient in emotional warmth, understanding, trust and encouragement but excessive in refuse, denial and overprotection, having anxiety trait, feeling fear of negative evaluation, more likely to use neurotic and immature defense mechanism while less likely to use mature defense mechanism, having positive family mental disorder history.

Hyperglycemia inhibits the uptake of dehydroascorbate in tubular epithelial cell.

BACKGROUND/AIMS: Oxidative stress has been considered to be a common pathogenetic factor of diabetic nephropathy. But the reason why renal cells are susceptible to oxidative injury in diabetes is not clear. Vitamin C plays a central role in the antioxidant defense system and exists in two major forms. The charged form, ascorbate, is taken up into cells via sodium-dependent facilitated transport. The uncharged form, dehydroascorbate, enters cells via glucose transporter and is then converted back to ascorbate within these cells. Because dehydroascorbate and glucose compete for glucose transporters, hyperglycemia will exclude vitamin C from the cell and resulted in a decreased antioxidant capacity in some cell type that is dehydroascorbate dependent. As such, we hypothesized that some renal cells were dehydroascorbate dependent and the susceptibility of renal cells to glucose-induced injury was mediated by hyperglycemic exclusion of dehydroascorbate uptake through competing for glucose transporter. The aims of the present study were to determine whether tubular epithelial cell was dehydroascorbate dependent and the effect of dehydroascorbate on the production of reactive oxygen species in cells incubated by high glucose. METHODS: Tubular epithelial cell was cultured in RPMI-1640 medium containing 10% newborn calf serum. Intracellular ascorbate and dehydroascorbate contents were measured with vitamin C assay system. The intracellular formation of reactive oxygen species was detected with the fluorescent probe CM-H(2)DCFDA by using confocal microscopy. RESULTS: Ascorbate entry into the cells was not significantly different from background noise. In contrast, we observed a significant increase in the uptake of dehydroascorbate in tubular cell. At a dehydroascorbate concentration of 1 mM, increasing concentrations of glucose competitively inhibited dehydroascorbate entry into the cells such that the accumulation of dehydroascorbate was smaller than half maximal at about 22 mM glucose. Cytochalasin B, a kind of hexose transporter inhibitor, inhibited dehydroascorbate entry into the cells. At a glucose concentration of 25 mM, increasing concentrations of dehydroascorbate reduced reactive oxygen species generation in a dose-dependent manner when dehydroascorbate concentration was smaller than 4 mM. However, the inhibitory effect was not observed at 8 mM of dehydroascorbate. CONCLUSIONS: Tubular epithelial cells are dehydroascorbate dependent. Vitamin C exclusion from tubular epithelial cells through competition of glucose and dehydroascorbate for common transport mechanism in diabetes will deprive the cells of antioxidant ability and could lead to reactive oxygen species accumulation.

[The prevalence of mild cognitive impairment among residents aged 55 or over in Chengdu area].

OBJECTIVE: To study the prevalence of mild cognitive impairment (MCI) in the urban and the rural areas in Chengdu, Southwest China. METHODS: Residents aged 55 or over were selected by stratified random cluster sampling from 19 districts, cities, and counties of Chengdu area in Sichuan province. A two-stage survey was carried out. In the first stage, CMMSE, CES-D were used as screening instruments. In the second stage, Diagnostic questionnaires of dementia and CDR were used as diagnostic instruments. The diagnostic criteria of mild cognitive impairment adopted from Petersen's were: (1) memory complaint; (2) normal activities of daily living; (3) normal general cognitive function; (4) memory impairment incompatible with age; (5) not demented; (6) CDR = 0.5 and (7) exclusion of the reversible cognitive impairment caused by other factors (i.e. depression). RESULTS: Three thousand, nine hundred and ten subjects were examined. The prevalence rates of MCI was 2.4%. The MCI prevalence rates in the urban and the rural areas were 1.5%, 2.5% respectively, without significant difference. The MCI prevalence in males and females were 1.8%, 2.9% respectively. Prevalence rate in female was higher than in males with significant difference. Prevalence of illiteracy (4.0%) was the highest among different educational levels. The accumulated prevalence increased with age. CONCLUSION: The prevalence of MCI (2.4%) was slightly higher than the prevalence of AD (2.05%) in the same areas of Chengdu. MCI seemed to be a high risk factor for AD which should to be followed up. Early intervention in MCI might be helpful in the prevention of AD.