Internalized Homonegativity and Psychological Distress Among Chinese Gay Men: The Mediating Role of Loneliness and the Moderating Role of Authoritarian Filial Piety.

Purpose: Previous research has consistently found that internalized homonegativity is a salient predictor of psychological distress, but how and when this relationship occurs is unclear, especially among Chinese sexual minority individuals, who are less frequently studied in the literature. This study explored whether the cultural norm of filial piety moderates the indirect association between internalized homonegativity and psychological problems (i.e., symptoms of anxiety and depression) through a sense of loneliness. Methods: To study this question, data were collected from 426 self-identified gay men in China, from February to July 2021, using an online platform. Demographic data, loneliness, authoritarian filial piety (AFP), and internalized homonegativity were measured in this cross-sectional study. Results: In the direct and mediation models, internalized homonegativity had a significant association with psychological distress. In the moderated mediation model, AFP strengthened the effect of internalized homonegativity on loneliness. The indirect positive effect of internalized homonegativity on psychological distress through loneliness was stronger for participants with higher AFP. Conclusions: Loneliness appears to play a role in the relationship between internalized homonegativity and psychological distress. Intervention programs for reducing psychological distress among sexual minority individuals should especially target gay men who endorse high levels of AFP because as a group, their internalized homonegativity is more likely to have a stronger impact on psychological health through loneliness compared with those with low levels of AFP.

A protocol of Chinese expert consensuses for the management of health risk in the general public.

Introduction: Non-communicable diseases (NCDs) represent the leading cause of mortality and disability worldwide. Robust evidence has demonstrated that modifiable lifestyle factors such as unhealthy diet, smoking, alcohol consumption and physical inactivity are the primary causes of NCDs. Although a series of guidelines for the management of NCDs have been published in China, these guidelines mainly focus on clinical practice targeting clinicians rather than the general population, and the evidence for NCD prevention based on modifiable lifestyle factors has been disorganized. Therefore, comprehensive and evidence-based guidance for the risk management of major NCDs for the general Chinese population is urgently needed. To achieve this overarching aim, we plan to develop a series of expert consensuses covering 15 major NCDs on health risk management for the general Chinese population. The objectives of these consensuses are (1) to identify and recommend suitable risk assessment methods for the Chinese population; and (2) to make recommendations for the prevention of major NCDs by integrating the current best evidence and experts' opinions. Methods and analysis: For each expert consensus, we will establish a consensus working group comprising 40-50 members. Consensus questions will be formulated by integrating literature reviews, expert opinions, and an online survey. Systematic reviews will be considered as the primary evidence sources. We will conduct new systematic reviews if there are no eligible systematic reviews, the methodological quality is low, or the existing systematic reviews have been published for more than 3 years. We will evaluate the quality of evidence and make recommendations according to the GRADE approach. The consensuses will be reported according to the Reporting Items for Practice Guidelines in Healthcare (RIGHT).

Call for Faith: Religiousness, Religious Coping and Psychological Disturbance of Chinese Christians During COVID-19.

OBJECTIVES: This study is aimed at investigating the relationships between religious practice, religious coping strategies, and mental health among Chinese Christians in the context of the COVID-19 outbreak. METHODS: A total of 915 participants from several cities in China completed online questionnaires, including sociodemographic data, mental disorder history, and years as a Christian, as well as frequency of weekly religious practice, Religious Coping Scale, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder scale (GAD-7). RESULTS: The result of multivariate analysis indicated that during the COVID-19 pandemic, among Chinese Christians without a history of mental disorder, negative religious coping were associated with depression, and anxiety symptoms. Among Chinese Christians with a history of mental disorders, comorbidity with 1 mental disorder, comorbidity with 2 or more mental disorders, negative religious coping, and positive religious coping were associated with depression symptoms. Comorbidity with 2 or more mental disorders, negative religious coping, and positive religious coping were associated with anxiety symptoms. CONCLUSION: Christians with a previous history of mental illness are more likely to experience anxiety during the epidemic. In the future, mental health services during disasters may put more attention on certain religious groups and provide more spiritual care to maintain their well-being accordingly.

On the Link Between Reciprocal/Authoritarian Filial Piety and Internalized Homonegativity: Perceived Pressure to Get Married in a Heterosexual Marriage as a Mediator.

Previous research has revealed that filial piety belief plays a critical role in self-acceptance of sexual orientation, but studies have rarely examined whether and how reciprocal (i.e., providing care and support based on affective bonding) and authoritarian (i.e., showing unconditional obedience to parents because of parental authority) filial piety contribute to internalized homonegativity. A total of 477 Chinese lesbian, gay, bisexual, questioning/queer, or other non-heterosexual (LGBQ +) adults participated in this study. These participants completed a battery of measures for reciprocal and authoritarian filial piety, perceived internalized, social, and parental pressure to get married in a heterosexual marriage, internalized heteronormativity, socially oriented identity (i.e., negative beliefs about how others in society would negatively treat them because of their sexual orientation), and family-oriented identity (e.g., guilt related to filial piety and worries about present and future life). The results indicated that higher reciprocal filial piety was directly associated with higher internalized heteronormativity. Higher authoritarian filial piety had a direct link with higher family-oriented identity. In addition, authoritarian filial piety was positively associated with internalized heteronormativity through internalized pressure to get married; authoritarian filial piety had a positive link with socially oriented identity through perceived social pressure to get married; authoritarian filial piety was positively related to family-oriented identity through perceived parental pressure to get married. Conclusions: Authoritarian filial piety is a risk factor for internalized homonegativity, and perceived pressure to get married in a heterosexual marriage might be the underlying mechanism for the relationship between authoritarian filial piety and internalized homonegativity.

Cognitive deficiency, parental relationship, and coping strategies are related with anxiety and depression among parents of children with epilepsy.

Background: The diagnosis of epilepsy in a child often and understandably causes psychological adjustment difficulties in the parents. To help parents of children with epilepsy cope with stress, it is important to understand how parents cope with the sickness of their child. The objective of this study was to assess factors related to the state of anxiety and depression among parents of children with epilepsy. Methods: The present study was a cross-sectional study, and the data were collected through an anonymous, Internet-based survey platform between October 2018 and October 2019 from 250 participants aged 22-65 years. Participants were invited to fill questionnaires include socioeconomic questionnaire, anxiety, depression, and coping strategies scale. Result: Among the parents of children with epilepsy, 48.8% (122/250) had depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score >4) and 46.4% (116/250) had anxiety symptoms (7-item Generalized Anxiety Disorder [GAD-7] score >5). Depression among parents of children with epilepsy was significantly associated with comorbidity (odds ratio [OR] = 0.392, 95% CI = 0.182-0.846), a poor parental relationship (OR = 0.283, 95% CI = 0.130-0.614), positive coping (OR = 0.947, 95% CI = 0.903-0.992), and negative coping (OR = 1.287, 95% CI = 1.179-1.405). Anxiety among parents of children with epilepsy was significantly associated with a poor parental relationship (OR = 0.416, 95% CI = 0.207-0.835) and negative coping (OR = 1.155, 95% CI = 1.087-1.228). Conclusions: The present study indicates the importance of couple support and providing effective coping to make parents of children with epilepsy more resilient in the presence of negative life events, especially for parents of children with comorbidity with cognitive deficiency.

The Journey of Individuation: Experiences of Chinese Patients Treated by Western Psychoanalysts in Online Psychodynamic Psychotherapy.

This qualitative study focuses on the process of treatment over the internet from a psychodynamic perspective based on the experiences of seventeen patients in China who underwent online treatment by psychoanalysts based in the United States or other Western nations. The data were collected and analyzed using psychodynamic themes. Seventeen participants involved in online cross-national and cross-cultural psychodynamic treatment were recruited in China. Various themes in regard to the process of online treatment in a cross-national and cross-cultural context emerged. Findings indicate the following: (1) in contrast to traditional relational patterns, psychodynamic treatment provides a new relationship model; (2) psychodynamic treatment creates a space of self-reflection for Chinese patients in terms of their relationships; (3) the therapeutic setting emphasizes clear boundaries, free space, equal relationships, and emotional expression for patients. The results provide new insights into self-examination, which frees patients from the inflexible aspects of traditional relationships, family hierarchies, and rigid cultural values. In addition, psychodynamic treatment in a cross-national and cross-cultural setting not only enables patients to work through their trauma but also empowers them to explore their unique journey of individuation.

Development and Validation of the Chinese Version of The Masturbation Beliefs Scale.

BACKGROUND: Negative experiences of and beliefs regarding masturbation frequently affect people's psychological well-being and health behaviors, but there is currently no specific assessment tool to measure Chinese people's beliefs about masturbation. AIM: The goal of the present study was to develop a brief scale (the Masturbation Beliefs Scale, BMS) for Chinese university students. METHODS: The BMS was developed and administered online to 2 different samples, with a total sample of 3,231 respondents (1,527 males and 1,704 females). The items were formulated based on previous qualitative research data. Exploratory and confirmatory factor analyses were performed. OUTCOMES: The BMS scale contains 3 dimensions with good internal consistency and construct validity, which can well measure Chinese people's belief about masturbation. RESULTS: The results of the two samples showed that the 17-item culturally based BMS demonstrated good internal consistency and construct validity. Three factors capturing university students' beliefs regarding masturbation emerged. The 3 factors were labeled beliefs about male masturbation (BAMM), beliefs about female masturbation (BAFM), and negative affect toward masturbation (NATM). The participants' culturally based masturbation beliefs were negatively related to independent self-construal and sexual compulsivity. In addition, their culturally based masturbation beliefs consistently predicted their likelihood of premarital sexual behavior. CLINICAL TRANSLATION: Clinicians and researchers could utilize this culturally sensitive instrument to evaluate individuals' experiences of masturbation, which could help clinicians deliver efficacious sex therapy and sexual education to individuals who have misconceptions or phobias regarding masturbation. STRENGTHS AND LIMITATIONS: The scale is an innovative tool that measures culturally relevant beliefs regarding masturbation among Chinese students. A limitation of this study is that several constructs were measured by single questions. This may attenuate the estimated correlation since single items are less reliable than multiple-item scales. CONCLUSION: The present research demonstrates that a culturally sensitive scale is necessary to understand the culturally based values that influence university students' beliefs regarding masturbation and sexual behavior. Ren Z, Liu Y, Deng J. Development and Validation of the Chinese Version of The Masturbation Beliefs Scale. Sex Med 2022;10:100501.

Understanding Suffering and Emotion in Chinese Earthquake Survivors: Environment, Society, Body-Mind, and Spirituality.

Research on posttraumatic experiences has focused heavily on emotional experiences based on predetermined psychopathological standards. In contrast, victims' subjective experiences-especially of indigenous populations-are scarcely discussed. This study used a narrative approach to examine the experiences of 22 Sichuan earthquake survivors who were diagnosed with posttraumatic stress disorder. Victims completed semistructured interviews regarding their overall experiences, and analysis of narrative was employed to analyze the data. The current study found that the earthquake brought significant changes to participant lives regarding their (i) environment, (ii) society, (iii) body-mind, and (iv) spiritual dynamics. Each of these key themes and its practical and theoretical implications are discussed along with suggestions for further development and practices of culturally sensitive mental health services for earthquake survivors in China.

Predictors of Anxiety and Depression in Medical Professionals During the Time of COVID-19 Outbreak.

OBJECTIVES: The aim of this study was to investigate the influences of sociodemographic data, mental disorder history, confusion and somatic discomfort triggered by social media on anxiety and depression symptoms among medical professionals during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: A total of 460 participants completed online questionnaires that included sociodemographic data, mental health disorder history, an assessment of confusion and somatic discomfort triggered by social media, and psychological disturbance. Hierarchical linear regression model was adopted to analysis the data. RESULTS: The hierarchical linear regression model was able to explain 41.7% of variance in depression symptoms, including comorbidity with 1 mental disorder (B = 0.296; P < 0.001), confusion (B = 0.174; P < 0.001), and somatic discomfort (B = 0.358; P < 0.001) triggered by social media. The hierarchical linear regression model was able to explain 41.7% of variance in anxiety symptoms, including sex (B = -0.08; P < 0.005), comorbidity with 1 mental health disorder (B = 0.242; P < 0.001), confusion (B = 0.228; P < 0.001), and somatic discomfort (B = 0.436; P < 0.001) triggered by social media. CONCLUSIONS: These results suggest that it is important to provide adequate psychological assistance for medical professionals with mental health problems in COVID-19 to buffer the negative impact of social media.

Factors associated with unsafe sexual behavior among sexually active Chinese University students, Hebei Province, 2019.

BACKGROUND: Healthy sexual behavior is critical for controlling the HIV/AIDS epidemic among university students, particularly in regions with increasing infection rates among university students in China. METHODS: This study investigated the prevalence of unhealthy sexual behavior in the past 6 months and the associated demographic and psychosocial factors among sexually active Chinese university students. Self-identified sexually active Chinese university students were recruited for the study. RESULTS: The study found that most students used condoms inconsistently during sexual intercourse (54.8%), and logistic regression showed that condomless sex was associated with being raised by a single parent (AOR = 1.934, 95% CI 1.234-3.031) or by grandparents or others (AOR = 1.583, 95% CI 1.003-2.50) and with sometimes using dating apps (AOR = 1.496, 95% CI 1.106-2.024). The independent protective factors for condomless sex were HIV knowledge scores between 15 and 18 compared to scores of 0 to 4 (AOR = 0.434, 95% CI 0.244-0.771). Among sexually active university students, 15.5% reported that they had multiple sexual partners; having multiple sexual partners was associated with sometimes (AOR = 2.543, 95% CI 1.553-4.167) or always (AOR =4.048, 95% CI 2.177-7.527) using dating apps. Being female (AOR = 0.402, 95% CI 0.231-0.699) and in a relationship (AOR = 0.236, 95% CI 0.154-0.363) were protective factors against having multiple sexual partners. CONCLUSIONS: There is an urgent need to promote HIV prevention and to implement psychosocial interventions by providing comprehensive sex education and access to condoms and health care on campuses to decrease the potential factors related to unhealthy sexual behaviors among university students.

A Grounded Theory Exploration of the Stages of Relationship Development in Marriages of Convenience in China.

A marriage of convenience has been defined as a reciprocal relationship between a gay man and a lesbian that provides a way to cope with social, cultural, family, and political stress, but this definition may be oversimplified in explaining this type of reciprocal relationship in a guanxi (the system of social networks and influential relationships that facilitate business and other dealings) society such as China. Such relationships are undergoing a process of development and change rather than remaining stable in Chinese guanxi society. This paper explores the nature and process of the development of marriages of convenience between gay men and lesbians in China. The data were collected and analyzed according to the grounded theory method. A theoretical sampling strategy was employed, and a sample of 15 people involved in so-called marriages of convenience was recruited from gay and lesbian communities in China. In our research, we found that the marriage relationships documented in this study included four stages: (1) men dang hu dui (being matched for marriage), (2) partnership, (3) friendship, and (4) kinship. Building a suitable relationship in a marriage of convenience can help gay men and lesbians meet social expectations while simultaneously retaining a degree of autonomy for their own homosexual identities. Maintaining and developing guanxi is a basic method of conflict resolution in Chinese society. Meanwhile, the ambiguity of the relationship within a marriage of convenience may cause conflict in these marriages. Treatment modalities are recommended to reorganize the system structuring these marriages and clarify ambiguous family boundaries by redefining who is in the family unit and his and her associated roles and responsibilities in the marriage of convenience. We conclude that more research is warranted to investigate how family therapy can be adapted for Chinese gay and lesbian individuals.

Un matrimonio de conveniencia se ha definido como una relación recíproca entre un hombre homosexual y una lesbiana que ofrece una manera de afrontar el estrés social, cultural, familiar y político. Sin embargo, esta definición puede ser demasiado simple para explicar este tipo de relación recíproca en una sociedad guanxi (el sistema de redes de contactos y de relaciones influyentes que facilitan los negocios y otros acuerdos), como la de China. Dichas relaciones están sufriendo un proceso de desarrollo y cambio en lugar de mantenerse estables en la sociedad guanxi de China. Este artículo analiza la índole y el proceso de desarrollo de los matrimonios de conveniencia entre gais y lesbianas en China. Los datos se recopilaron y se analizaron de acuerdo con el método de la teoría fundamentada. Se empleó una estrategia de muestreo teórico y se reunió una muestra de 15 personas implicadas en matrimonios denominados de conveniencia pertenecientes a comunidades gais y lesbianas de China. En nuestra investigación descubrimos que las relaciones conyugales documentadas en este estudio constaban de cuatro etapas: 1) men dang hu dui (búsqueda de pareja para casarse), 2) sociedad, 3) amistad, y 4) parentesco. La construcción de una relación adecuada en un matrimonio de conveniencia puede ayudar a los gais y a las lesbianas a satisfacer expectativas sociales y, a su vez, a conservar un grado de autonomía para sus propias identidades homosexuales. El mantenimiento y el desarrollo del sistema guanxi es una manera básica de resolver conflictos en la sociedad china. Mientras tanto, la ambigüedad de la relación dentro de un matrimonio de conveniencia puede causar conflicto en estos matrimonios. Se recomiendan modalidades de tratamiento para reorganizar el sistema que estructura estos matrimonios y para aclarar los límites familiares ambiguos mediante la redefinición de quiénes integran el grupo familiar y de los roles y las responsabilidades asociados a cada uno en el matrimonio de conveniencia. Llegamos a la conclusión de que se requiere más investigación con el fin de investigar cómo la terapia familiar puede adaptarse para las personas gais y lesbianas de China.

The resting-state functional connectivity of amygdala subregions associated with post-traumatic stress symptom and sleep quality in trauma survivors.

Neuroimaging findings suggest that the amygdala plays a primary role in both the psychopathology of posttraumatic stress disorder (PTSD) and poor sleep quality, which are common in trauma survivors. However, the neural mechanisms of these two problems in trauma survivors associated with amygdala remain unclear. In the current study, we aimed to explore the role of functional connectivity of amygdala subregions in both PTSD symptoms and poor sleep quality. A total of 94 trauma-exposed subjects were scanned on a 3T MR system using resting-state functional magnetic resonance imaging. Both Pittsburgh Sleep Quality Index and Clinician-Administered PTSD Scale scores were negatively correlated with the resting-state functional connectivity between the left basolateral amygdala-left medial prefrontal cortex and the right basolateral amygdala-right medial prefrontal cortex. Our findings suggest a shared amygdala subregional neural circuitry underlying the neuropathological mechanisms of PTSD symptoms and poor sleep quality in trauma survivors.

The psychological burden experienced by Chinese citizens during the COVID-19 outbreak: prevalence and determinants.

BACKGROUND: The present study is aims to investigate the prevalence and determinants of depression and anxiety among the general population in the context of coronavirus disease 2019 (COVID-19) outbreak in China. METHODS: A cross-sectional self-report survey methodology was used to gather the following data from Chinese citizens: sociodemographic information, physical and mental health disorder history, daily online time, social media exposure, feeling toward social media exposure, perception of the disease, infection cases in the local area, and previous experiences with stressful life incidents. Levels of anxiety and depression were self-reported employing the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire 9-item scale, respectively. RESULTS: Among the 6130 participants, the prevalence of anxiety and depression was 7.1 and 12%, respectively. Multiple logistic regression analysis revealed that psychological disturbances were associated with gender, people with religious background, being a medical professional, having physical or mental health disease, difficulty accessing medical aids, experience with traumatic incidents, the perceived possibility of sequelae after being cured of COVID-19, daily online time, the source of the information relevant to COVID-19, frequency of receiving information regarding COVID-19, and negative feelings triggered by social media. CONCLUSIONS: There needs to be a consistent message from authorities to reduce the panic and confusion of the public, and to decrease public exposure to persistently negative information. It is necessary to help people transform their negative experiences into positive changes especially for individuals with physical illness, individuals with mental health disorders, and medical professionals.

Loss of homeland: a qualitative study of the changes in perception of relocated Sichuan earthquake survivors with posttraumatic stress disorder.

BACKGROUND: This research aims to explore the life experiences of relocated earthquake survivors with PTSD and develop a conceptual framework for understanding their life experiences. METHOD: Interviews were conducted with twenty-three participants. The participant selection, data collection and analysis were based on grounded theory methodology. A theoretical model called "loss of homeland" was developed. RESULTS: Loss of homeland was the most important condition that influenced the relocated participants' self-identity, social connections, and meaning system. These aspects were categorized into existential changes, lost connections, and changes in identity. Post-disaster relocation threatens individuals' sense of meaning, integrity of self, and sense of belonging, affects every aspect of everyday life and shatters their inner and outer harmony. CONCLUSIONS: Further research guided by this theoretical model is needed to inform post-disaster mental health services and relocation policy. Mental health professionals and policy makers can make more informed decisions in terms of disaster relocation policy and manage post-disaster psychological disturbances by focusing on both places and people.

Exploring memory function in earthquake trauma survivors with resting-state fMRI and machine learning.

BACKGROUND: Traumatized earthquake survivors may develop poor memory function. Resting-state functional magnetic resonance imaging (rs-fMRI) and machine learning techniques may one day aid the clinical assessment of individual psychiatric patients. This study aims to use machine learning with Rs-fMRI from the perspectives of neurophysiology and neuroimaging to explore the association between it and the individual memory function of trauma survivors. METHODS: Rs-fMRI data was acquired for eighty-nine survivors (male (33%), average age (SD):45.18(6.31) years) of Wenchuan earthquakes in 2008 each of whom was screened by experienced psychiatrists based on the clinician-administered post-traumatic stress disorder (PTSD) scale (CAPS), and their memory function scores were determined by the Wechsler Memory Scale-IV (WMS-IV). We explored which memory function scores were significantly associated with CAPS scores. Using simple multiple kernel learning (MKL), Rs-fMRI was used to predict the memory function scores that were associated with CAPS scores. A support vector machine (SVM) was also used to make classifications in trauma survivors with or without PTSD. RESULTS: Spatial addition (SA), which is defined by spatial working memory function, was negatively correlated with the total CAPS score (r = - 0.22, P = 0.04). The use of simple MKL allowed quantitative association of SA scores with statistically significant accuracy (correlation = 0.28, P = 0.03; mean squared error = 8.36; P = 0.04). The left middle frontal gyrus and the left precuneus contributed the largest proportion to the simple MKL association frame. The SVM could not make a quantitative classification of diagnosis with statistically significant accuracy. LIMITATIONS: The use of the cross-sectional study design after exposure to an earthquake and the leave-one-out cross-validation (LOOCV) increases the risk of overfitting. CONCLUSION: Spontaneous brain activity of the left middle frontal gyrus and the left precuneus acquired by rs-fMRI may be a brain mechanism of visual working memory that is related to PTSD symptoms. Machine learning may be a useful tool in the identification of brain mechanisms of memory impairment in trauma survivors.

Traditionality, Spirituality and Somatoform Dissociation Symptoms in Chinese Buddhists.

To evaluate the relationship between spiritual experience and hysterical experiences in Buddhist participants in ethnic groups in China, this cross-sectional study recruited 39 participants aged 16-57 years old, and self-administered surveys were administered in two villages, one city and one town by four research assistants in the Inner Mongolia and Qinhai areas. Binary logistic regression analyses were used to evaluate the factors associated with somatoform dissociation symptoms. Surveys were completed by 639 participants (mean age 31 years; 54.6% females) in 2017. Binary regression models showed that diverging from tradition and having a college education or above were associated with suffering from somatoform dissociation symptoms. By contrast, participants with higher experiences and older people were less likely to experience somatoform dissociation symptoms. Our current research highlights the contribution of spiritual experiences and traditional values to reducing somatization dissociation symptoms, and the findings could help to promote a new relationship between psychiatry and spiritual experiences that will benefit both mental health professionals and those who seek their assistance.

The influence of environmental pressure on Internet Use Disorder in adolescents: The potential mediating role of cognitive function.

PURPOSE: The current study attempts to clarify the mediating role of cognitive function on the relationship between environmental pressure (pressure caused by negative parenting styles and dysfunctional school environments) and Internet Use Disorder (IUD); this study explores the effects of sex and left-behind children (LBC). METHODS: A cross-sectional sample of adolescents aged 12-15 years was recruited in 2018. A total of 3048 junior high school adolescents in rural areas of the Sichuan province in western China completed a series of psychological inventories, including the Adolescent Pathological Internet Use Scale (APIUS), the Junior High School Students' Perceived School Climate Inventory (PSCI-M), the Egna Minnen av. Barndoms Uppfostran (EMBU), and the Mental Health Screening Inventory for Children and Adolescents (MHS-C), for an analysis of IUD, school climate, parenting styles and cognition, respectively. RESULTS: Among the participants, 18.5% (N = 565) exhibited significant symptoms of IUD. The correlation analysis showed that IUD was positively correlated with parents' punishment, rejection and over-interference and academic pressure, whereas IUD was negatively associated with good teacher-student relationships, good schoolmate relationships and cognitive function scores. Structural equation modelling (SEM) showed that cognitive function partially contributed to the association between family and school pressures and IUD. DISCUSSION: Cognitive function is one of the mediating pathways through which environmental pressures may predict IUD among junior high school students. Interventions may target the mediating pathway of cognitive function to alleviate the negative impact of environmental pressure on IUD.

Altered amygdala subregion-related circuits in treatment-naïve post-traumatic stress disorder comorbid with major depressive disorder.

Individuals with both post-traumatic stress disorder and major depressive disorder (PTSD+MDD) often show greater social and occupational impairment and poorer treatment response than individuals with PTSD alone. Increasing evidence reveals that the amygdala, a brain region implicated in the pathophysiology of both of these conditions, is a complex of structurally and functionally heterogeneous nuclei. Quantifying the functional connectivity of two key amygdala subregions, the basolateral (BLA) and centromedial (CMA), in PTSD+MDD and PTSD-alone could advance our understanding of the neurocircuitry of these conditions. 18 patients with PTSD+MDD, 28 with PTSD-alone, and 50 trauma exposed healthy controls (TEHC), all from a cohort who survived the same large earthquake in China, underwent resting-state functional magnetic resonance imaging. Bilateral BLA and CMA functional connectivity (FC) maps were created using a seed-based approach for each participant. The analysis of covariance of FC was used to determine between-group differences. A significant interaction between amygdala subregion and diagnostic group suggested that differences in connectivity patterns between the two seeds were mediated by diagnosis. Post-hoc analyses revealed that PTSD+MDD patients showed weaker connectivity between right BLA and (a) left anterior cingulate cortex/supplementary motor area, and (b) bilateral putamen/pallidum, compared with PTSD-alone patients. Higher CMA connectivities left ACC/SMA were also observed in PTSD+MDD compared with PTSD-alone. An inverse relationship between the connectivity of right BLA with right putamen/pallidum and MDD symptoms was found in PTSD+MDD. These findings indicate a relationship between the neural pathophysiology of PTSD+MDD compared with PTSD-alone and TEHC and may inform future clinical interventions.

Increased functional segregation of brain network associated with symptomatology and sustained attention in chronic post-traumatic stress disorder.

BACKGROUND: Traditional regional or voxel-based analyses only focus on specific brain regions or connectivity rather than the whole brain's functional organization. Using resting state functional magnetic resonance imaging (rs-fMRI), we aimed to explore the altered topological metrics, clinical symptoms and cognitive function in chronic post-traumatic stress disorder (PTSD) in order to identify the brain network mechanisms underlying these clinical and cognitive symptoms. METHODS: Forty patients with unmedicated chronic PTSD and forty-two matched trauma-exposed healthy controls (TEHCs) underwent rs-fMRI, and the topological organization of the whole-brain network was calculated using graph theory. The Rapid Visual Information Processing (RVP) task and Wechsler Memory Scale-IV (WMS-IV) were used to evaluate the subjects' sustained attention and memory capacity. All clinical and cognitive measures and topological parameters of the PTSD patients and TEHCs were compared, and the relationships between altered network metrics and symptom severity were explored. RESULTS: Compared with the TEHCs, the patients showed increases in the normalized clustering coefficient, small-worldness, normalized local efficiency and efficiency-based small-worldness. The left middle occipital gyrus showed increases in nodal global efficiency and nodal degree that were negatively correlated with the severity of PTSD symptoms. The altered connections in PTSD only involved the default mode network (DMN) and the occipital network. LIMITATIONS: Comorbid conditions were included, and current cross-sectional study cannot conclude on causality. CONCLUSIONS: Patients with chronic PTSD showed increased functional brain network segregation, mainly in the occipital cortex, which could be a protective or compensatory mechanism to alleviate clinical symptoms.

Maintaining "mianzi" and "lizi": Understanding the reasons for formality marriages between gay men and lesbians in China.

As a result of societal expectations and to avoid societal homophobia, many lesbians and gay men in China marry heterosexual partners and do not disclose their own sexual orientation. This study used qualitative methods to explore why gay men enter into such marriages of convenience. A total of 17 in-depth interviews were conducted with lesbians and gay men who had entered "formality marriages." All interviews were digitally recorded for transcription; transcripts were analyzed using grounded theory to determine themes. The reasons for engaging in formality marriage can be grouped into broad categories, including: maintaining mianzi (reputation) and lizi (inner reality), avoiding moral distress, social discrimination, working in tizhi (social systems), accounting for their social relationships, and fulfilling filial piety. From our model we can see growing up as a member of a minority sexual orientation group means being discriminated against and marginalized in the family, work place, community, and society at large. Formality marriages not only offer a way to maintain one's personal and family reputation ( mianzi) in different contexts, but also avoid moral distress and maintain a personal private sexual orientation ( lizi) with their own homosexual partner. Formality marriage serves as a compromise to ensure cultural continuity, and it harmonizes individuals' interpersonal relationships and traditional Chinese family values. Understanding the reasons for formality marriage practices can help health professionals to create public health campaigns to dispel stereotypes and stigma about homosexuality, and to develop culturally sensitive services for homosexual populations.