The chain mediating roles of anxiety and depression in the relationship between the effects of the COVID-19 pandemic and procrastination in adolescents: a longitudinal study.

BACKGROUND: The relationship between the Coronavirus Disease 2019 (COVID-19) pandemic, which is a traumatic event for adolescents, and procrastination is not clear. Mental health may play an important role in this relationship; however, the underlying mechanisms remain unknown. This study aimed to construct chain mediation models to examine whether anxiety and depression symptoms mediate the effects of the COVID-19 pandemic on procrastination in adolescents. METHODS: A convenience sample of 12 middle and high schools in Harbin, China, with four follow-up online surveys was conducted during the COVID-19 pandemic. A total of 4,156 Chinese adolescents were enrolled in this study, of whom ages 11-18 (Mean = 13.55; SD = 1.18), 50.75% were male, and 93.24% were middle school students. Descriptive demographic analysis and Pearson's correlation analysis of the effects of the COVID-19 pandemic (T1), anxiety(T2), depression (T3), and procrastination (T4) were performed in SPSS 22.0. Chain mediation analysis performed with Mplus 8.3. RESULTS: The effects of the COVID-19 pandemic, anxiety symptoms, depression symptoms, and procrastination were positively correlated (P < 0.01). The effects of the COVID-19 pandemic have a direct link on adolescent procrastination (effect = 0.156; SE = 0.031; 95%CI: 0.092, 0.214), and have three indirect paths on procrastination: the independent mediating role of anxiety symptoms was 29.01% (effect = 0.047; SE = 0.012; 95%CI: 0.024, 0.072), the independent mediating role of depression symptoms was 29.01% (effect = 0.047; SE = 0.010; 95%CI: 0.030, 0.068), as well as the completely chain mediating role of anxiety and depression symptoms was 15.43% (effect = 0.025; SE = 0.005; 95%CI: 0.017, 0.036). CONCLUSIONS: Our results suggest that anxiety and depressive symptoms are part of a causal chain between the effects of the COVID-19 pandemic and procrastination among Chinese adolescents. To effectively reduce their procrastination, attention should be paid to the emotional distress caused to adolescents by major events such as the COVID-19 epidemic. All data were taken from self-reported measures and one city in China, which may bias the results and limit their generalizability.

Trajectories and influencing factors in adolescent procrastination behavior throughout the COVID-19 pandemic: a four-wave prospective longitudinal study.

Background: Despite the growing attention given to adolescent behavior problems, little is known about the trajectories and factors that have influenced adolescent procrastination during the COVID-19 pandemic. This study monitors changes in procrastination behavior among Chinese adolescents during the pandemic and identifies vulnerable groups. Methods: A four-wave study using a representative sample of 11-to 18-year-olds in China was conducted, with baseline data collected in June 2020 (n = 4,156; 49% girls) and follow-ups in December 2020 (n = 3,392; 50% girls), August 2021 (n = 2,380; 48% girls), and October 2021 (n = 1,485; 49% girls). Procrastination behavior was assessed using the General Procrastination Scale. Latent growth curve models, latent growth mixture modes, and multivariate logistic regression models were used to describe the trajectory of procrastination and identify predictors of deterioration. Results: The proportion and overall trends of adolescent procrastination increased with the pandemic. Higher parental over-protection was a contributing factor to the higher baseline levels leading to the faster growth of adolescent procrastination. The model identified three distinct trajectories of low-increasing [including 2,057 participants (49.5%)], moderate-stable [including 1,879 participants (45.2%)], and high-decreasing procrastination [including 220 participants (5.3%)]. More daily leisure screen-time, lower frequency of exercise weekly, and dissatisfaction with distance learning were the top three risk factors for moderate-stable and high-decreasing procrastination compared to low-increasing procrastination. Adolescents with mothers with a higher level of education were more liable to be high-decreasing procrastination than moderate-stable procrastination. Conclusion: The proportion and overall trends of adolescent procrastination increased with the pandemic. The categories of procrastination among adolescents during that time period were probed. Also, the study further clarified the risk factors for severe and moderate procrastination relative to no procrastination. Thus, effective procrastination prevention and intervention strategies need to be implemented to support adolescents, particularly those at risk.

Relationship between psychological capital and depression in Chinese physicians: The mediating role of organizational commitment and coping style.

Background: It is well known that the medical profession is a high-risk practice, with intense work and complex situations. The physicians are prone to suffer from depression due to occupational stress under high workloads for long periods of time. Depression not only impairs physicians' mental health, but also affects the quality of health services, so it is important to explore the factors and mechanisms affecting depression among physicians. Methods: In this cross-sectional study, 1,139 physicians from Heilongjiang Province were surveyed by cluster sampling procedures. The questionnaires included Psychological Capital Questionnaire, Chinese Employee Organizational Commitment Questionnaire, Trait Coping Style Questionnaire and Self-rating Depression Scale. Pearson correlation analysis and Bootstrap were used for statistical analysis. Results: This study found that 41.6% of physicians suffering from depression. Among them, 17.0% of physicians showed moderate depression, and 2.6% of physicians exhibited severe depression. The serial-multiple mediation of organizational commitment and positive coping styles in the relationship between psychological capital and depression was significant. Conclusion: The results showed that the psychological capital was sequentially associated with increased organizational commitment, and then increased positive coping styles, which resulted in reduced depression among physicians.

Sleep quality and creativity in Chinese college student during the COVID-19 pandemic: The mediating role of executive function.

Background: COVID-19 has impacted adolescents' interpersonal relationships, life attitudes, and mental health during the past 3 years. However, previous studies predominantly focused on negative problems, while few studies assessed the situation of teenagers from the perspective of positive psychology. Therefore, this study explores the creativity level of Chinese college students during the COVID-19 pandemic, the relationship between sleep quality and creativity, and the mediating role of executive function. Method: A cross-sectional study was conducted across six colleges in Heilongjiang in China, with a sample of 4,258 college students recruited via stratified cluster sampling. Data were collected through an online survey. A mediation model was constructed, and SPSS PROCESS macro was used to analyze the data. Results: The creativity score of Chinese college students during the COVID-19 pandemic was 106.48 ± 13.61. Correlation analysis demonstrated that sleep quality correlated negatively with creativity (r = -0.08, P < 0.01) but positively with executive function (r=0.45, P < 0.01), whilst executive function correlated negatively with creativity (r = -0.10, P < 0.01). Moreover, the mediation model revealed that executive function partially mediated the relationship between sleep quality and creativity in college students (indirect effect = -0.017, SE = 0.004, 95% CI = [-0.025, -0.008]). Executive function accounted for 48.6% of the variance in college students' creativity. Conclusion: School administrators should implement measures such as sleep education to enhance students' sleep quality. Concurrently, curriculum and assessment implementation should enhance executive function. Such measures can contribute to improved student creativity, thus helping students overcome the negative emotional impact of the COVID-19 pandemic.

Factors Influencing Post-traumatic Stress Symptoms in Chinese Adolescents During the COVID-19 Pandemic.

To investigate the prevalence of post-traumatic stress symptoms (PTSSs) and analyze the influencing factors of PTSS among adolescents in a large sample study during the COVID-19 pandemic, we did a cross-sectional study by collecting demographic data and mental health measurements from a large group of 175,318 adolescents in 32 Chinese provinces and autonomous regions, using the Impact of Event Scale-Revised (IES-R) that was used to measure the PTSS of the participants. The results showed that the prevalence of PTSS was 35.7% in Chinese adolescents during the COVID-19 pandemic. Binary logistic regression analysis showed that, for the personal risk factors, the older age, female gender, the personality domains of extroversion, the irregular sleep schedule, the lack of aerobic exercise, and the lack of peer support were associated with the higher levels of PTSS. The family subjective and objective factors were associated with higher levels of PTSS. Our findings suggested that family factors are the most important factors that affect Chinese adolescents' PTSS due to the longtime home quarantine.

Association of the Combined Effects between Insulin-Like Growth Factor-1 Gene Polymorphisms and Negative Life Events with Major Depressive Disorder among Chinese population in the Context of Oxidative Stress.

Background: Oxidative stress may be increased in a number of psychiatric disorders, including major depressive disorder (MDD). MDD has been shown to be related to insulin-like growth factor-1 (IGF-1) as well as to negative life events; exploring the interaction of IGF-1 polymorphisms and negative life events on the risk of MDD is needed. The aim of this study was to analyze the single and combined effects of IGF-1 polymorphisms (rs972936 and rs978458) and negative life events with MDD among Chinese population. Methods: 420 MDD patients (according to DSM-V) and 420 age- and gender-matched control subjects were recruited in a case-control study. Negative life events were assessed using standard rating scales. IGF-1 rs972936 and rs978458 were identified by sequencing. The chi-square (χ 2) tests were performed to explore the association of negative life events and IGF-1 polymorphisms with MDD. Results: Our results found that the negative life events were associated with the risk of MDD (P < 0.001; OR = 3.28, 95% CI: 2.19-4.85). The genotypes of IGF-1 were associated with the risk of MDD (P < 0.001); carrying the IGF-1 rs972936 C allele (OR = 1.53, 95% CI: 1.26-1.85) and rs978458 T allele (OR = 1.92, 95% CI: 1.58-2.34) had a higher risk of MDD. The combined effects between IGF-1 rs978458 and negative life events were associated with the risk of MDD (P < 0.05; OR = 2.94, 95% CI: 1.23-7.03), but IGF-1 rs972936 was not associated (P > 0.05). Conclusions: Based on the oxidative stress hypothesis, we confirm that carrying IGF-1 rs972936 C allele and rs978458 T allele have a higher risk of MDD and the combined effects between IGF-1 rs978458 and negative life events were associated with the risk of MDD among Chinese population.

The Gender-Specific Interaction of DVL3 and GSK3ß Polymorphisms on Major Depressive Disorder Susceptibility in a Chinese Han Population: A Case-Control Study.

Based on the "oxidative stress hypothesis" of major depressive disorder (MDD), cells regulate their structure through the Wnt pathway. Little is known regarding the interactions of dishevelled 3 (DVL3) and glycogen synthase kinase 3 beta (GSK3ß) polymorphisms with MDD. The aim of the current study was to verify the relationship between DVL3 and GSK3ß genetic variants in a Chinese Han population and further to evaluate whether these interactions exhibit gender-specificity. A total of 1136 participants, consisting of 541 MDD patients and 595 healthy subjects, were recruited. Five single-nucleotide polymorphisms (SNPs) of DVL3/GSK3ß were selected to assess their interaction by use of a generalized multifactor dimensionality reduction method. The genotype and haplotype frequencies of DVL3/GSK3ß polymorphisms were significantly different between patients and controls for DVL3 rs1709642 (P < 0.01) and GSK3ß rs334558, rs6438552, and rs2199503 (P < 0.01). In addition, our results also showed that there were significant interaction effects between DVL3 and GSK3ß polymorphisms and the risk of developing MDD, particularly in women. The interaction between DVL3 (rs1709642) and GSK3ß (rs334558, rs6438552) showed a cross-validation (CV) consistency of 10/10, a P value of 0.001, and a testing accuracy of 59.22%, which was considered as the best generalized multifactor dimensionality reduction (GMDR) model. This study reveals the interaction between DVL3 and GSK3ß polymorphisms on MDD susceptibility in a female Chinese Han population. The effect of gender should be taken into account in future studies that seek to explore the genetic predisposition to MDD relative to the DVL3 and GSK3ß genes.

Psychological Impact of COVID-19 Epidemic on Adolescents: A Large Sample Study in China.

Background: The COVID-19 pandemic is a major public health emergency. However, little is known about the psychological impact of this pandemic on adolescents. We aim to assess the prevalence and influencing factors of depression, anxiety, and posttraumatic growth (PTG) among adolescents in a large sample study. Methods: This cross-sectional study collected demographic data and mental health measurements from 175,416 adolescents covering 31 provinces, centrally administered municipalities, and autonomous regions in mainland China from February 23 to March 8, 2020. The status of depression, anxiety, and PTG was assessed by the nine-item Patient Health Questionnaire, seven-item generalized anxiety disorder questionnaire, and post-traumatic growth inventory. Results: The prevalence of depression, anxiety, and PTG in adolescents was 35.9, 28.0, and 45.6%, respectively. The prevalence of depression and anxiety in the slight or severe epidemic areas was similar. Regression analysis showed that female sex and older age were associated with higher levels of depression, anxiety, and lower levels of PTG. Symptoms related to COVID-19, excessive attention to epidemic information, living in urban or severe epidemic areas, and conflicts with parents during home quarantine were risk factors for depression, anxiety, and PTG. Frequent communication with peers, exercise, and receiving public welfare psychological assistance were protective factors. Poor family economic status was a significant risk factor for depression and PTG. Conclusion: Our findings suggested that positive and negative psychological reactions coexist in adolescents faced with the pandemic. The factors associated with psychological problems and PTG provide strategic guidance for maintaining adolescents' mental health in China and worldwide during any pandemic such as COVID-19.

Exploration of Psychological Mechanism of Smartphone Addiction Among International Students of China by Selecting the Framework of the I-PACE Model.

The I-PACE (interaction of person-affect-cognition-execution) model explains that the causes of addiction are the result of individual susceptibility (genetic and personality), psychopathological factors (negative emotions), and cognitive and affective factor interaction. The issue of smartphone addiction and its emerging effects are now becoming an essential social enigma. This study is aimed at exploring how personal, affective, cognitive, and execution factors accelerate the mechanism of smartphone addiction among international students. Randomly selected, six hundred international students have constituted the population for our study. All participants were asked to complete self-administered questionnaires. The questionnaire included demographics (gender, place of stay, educational level, and reason for smartphone usage), Mobile Phone Addiction Index, Loneliness Scale (UCLA), Rosenberg Self-Esteem Scale, Beck Depression Inventory, Perceived Stress Scale, Eysenck Personality Questionnaire, and Simplified Coping Style Questionnaire. Statistical analysis was performed using SPSS. 20.3% (n = 122) of international students are agonized with smartphone addiction, while 79.7% (n = 478) use smartphones at an average level. Students' place of stay, neuroticism personality, social desirability, self-esteem, loneliness, depression, perceived stress, and passive coping are associated with smartphone addiction. Loneliness and depression show a strong positive significant correlation, among other variables while loneliness, neurotic personality, depression, low self-esteem, stress, and passive coping are risk factors for smartphone addiction. This study reveals that international students are a high-risk group for smartphone addiction. It has a great deal of impact on students' behavior and psyche. Multiple social, psychological, affective, and cognitive factors affect smartphone addiction. It would be beneficial to direct the students to limit their phone usage and indulge in other healthy physical activities to complete academic goals.

Perceived Stress and Smartphone Addiction in Medical College Students: The Mediating Role of Negative Emotions and the Moderating Role of Psychological Capital.

Background: Many studies have confirmed the existence of an extremely close relationship between smartphone addiction and perceived stress. However, the mediating and moderating mechanisms underlying the association between perceived stress and smartphone addiction in medical college students remain largely unexplored. Methods: A questionnaire was distributed among a total of 769 medical college students in Heilongjiang Province, China. Participants completed measures of perceived stress, smartphone addiction, negative emotions, and psychological capital. Pearson's correlation analysis was used to test the correlations between variables. The analysis of a moderated mediation model was performed using Hayes's PROCESS macro. Results: Pearson's correlation analysis indicated that perceived stress (r = 0.18, p < 0.01) and negative emotions (r = 0.31, p < 0.01) were positively correlated with smartphone addiction, and psychological capital was negatively correlated with smartphone addiction (r = -0.29, p < 0.01). The moderated mediation analysis indicated that negative emotions partially mediated the association between perceived stress and smartphone addiction [mediation effect accounted for 33.3%, SE = 0.10, 95% CI = (0.10, 0.24)], and the first stage of the mediation process was significantly moderated by psychological capital [moderated mediation = -0.01, SE = 0.01, 95% CI = (-0.01, -0.00)]. Conclusion: Negative emotions play a mediating role between perceived stress and smartphone addiction, and psychological capital plays an important moderating role in the first stage of the mediation process.

Diagnostic Biomarker Hsa_circ_0126218 and Functioning Prediction in Peripheral Blood Monocular Cells of Female Patients With Major Depressive Disorder.

INTRODUCTION: Although major depressive diroder (MDD) has brought huge burden and challenges to society globally, effective and accurate diagnoses and treatments remain inadequate. The pathogenesis that for women are more likely to suffer from depression than men needs to be excavated as well. The function of circRNAs in pathological process of depression has not been widely investigated. This study aims to explore potential diagnostic biomarker circRNA of female patients with MDD and to investigate its role in pathogenesis. METHODS: First, an expression profile of circRNAs in the peripheral blood monocular cells of MDD patients and healthy peripherals were established based on high-throughput sequencing analysis. In addition, the top 10 differentially expressed circRNAs were quantified by quantitative real-time PCR to explore diagnostic biomarkers. To further investigate the function of biomarkers in the pathogenesis of MDD, bioinformatics analysis on downstream target genes of the biomarkers was carried out. RESULTS: There is a mass of dysregulated circRNAs in PBMCs between female MDD patients and healthy controls. Among the top 10 differentially expressed circRNAs, hsa_circ_0126218 is more feasible as a diagnostic biomarker. The expression level of hsa_circ_0126218 displayed upregulation in patients with MDD and the area under the operating characteristic curve of hsa_circ_0126218 was 0.801 (95% CI 0.7226-0.8791, p < 0.0001). To explain the competing endogenous RNA role of hsa_circ_0126218 in the pathogenesis of female MDD, a hsa_circ_0126218-miRNA-mRNA network was established. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses stated that some of the enriched pathways downstream of hsa_circ_0126218 are closely related to MDD. Moreover, we established a protein-protein network to further screen out the hub genes (PIK3CA, PTEN, MAPK1, CDC42, Lyn, YES1, EPHB2, SMAD2, STAT1, and ILK). The function of hsa_circ_0126218 was refined by constructing a verified circRNA-predicted miRNA-hub gene subnetwork. CONCLUSION: hsa_circ_0126218 can be considered as a new female MDD biomarker, and the pathogenesis of female MDD by the downstream regulation of hsa_circ_0126218 has been predicted. These findings may help further improve the early detection, effective diagnosis, convenient monitoring of complications, precise treatment, and timely recurrence prevention of depression.

Roles of Anxiety and Depression in Predicting Cardiovascular Disease Among Patients With Type 2 Diabetes Mellitus: A Machine Learning Approach.

Cardiovascular disease (CVD) is a major complication of type 2 diabetes mellitus (T2DM). In addition to traditional risk factors, psychological determinants play an important role in CVD risk. This study applied Deep Neural Network (DNN) to develop a CVD risk prediction model and explored the bio-psycho-social contributors to the CVD risk among patients with T2DM. From 2017 to 2020, 834 patients with T2DM were recruited from the Department of Endocrinology, Affiliated Hospital of Harbin Medical University, China. In this cross-sectional study, the patients' bio-psycho-social information was collected through clinical examinations and questionnaires. The dataset was randomly split into a 75% train set and a 25% test set. DNN was implemented at the best performance on the train set and applied on the test set. The receiver operating characteristic curve (ROC) analysis was used to evaluate the model performance. Of participants, 272 (32.6%) were diagnosed with CVD. The developed ensemble model for CVD risk achieved an area under curve score of 0.91, accuracy of 87.50%, sensitivity of 88.06%, and specificity of 87.23%. Among patients with T2DM, the top five predictors in the CVD risk model were body mass index, anxiety, depression, total cholesterol, and systolic blood pressure. In summary, machine learning models can provide an automated identification mechanism for patients at CVD risk. Integrated treatment measures should be taken in health management, including clinical care, mental health improvement, and health behavior promotion.

The Relationship between Achievement Motivation and Job Performance among Chinese Physicians: A Conditional Process Analysis.

BACKGROUND: To explore the relationship between achievement motivation and job performance among physicians, this study investigated the impacts of different personality traits on job performance among the physicians. METHODS: This cross-sectional study was conducted in 2017 and 1,523 physicians from eight tertiary grade A hospitals in Harbin, China. The type of data collected included the achievement motivation of the physicians, job performance, organizational commitment, personality traits, and other demographic variables. To assess and compare the demographic data, independent t-test and ANOVA were applied. Further, Pearson correlation coefficients were used to evaluate the correlation among the variables. Moderated mediation analysis was performed to test the correlation among the job performance, achievement motivation, organizational commitment, neuroticism, extraversion, openness, agreeableness, and conscientiousness. RESULTS: Achievement motivation directly influences job performance and organizational commitment partially mediates the direct effects of achievement motivation on job performance. Additionally, our findings demonstrated that agreeableness and conscientiousness moderate the strength of the relationships between achievement motivation and job performance mediated by organizational commitment. CONCLUSION: We propose that hospital managers should pay attention to the personal growth of the physicians and improve their organizational commitment via creating a positive working climate and training for career planning and education. Moreover, managers should identify conscientiousness and agreeableness individuals and increase their responsibilities geared towards improving the performance of the organization.

The Impact of Transformational Leadership on Physicians' Performance in China: A Cross-Level Mediation Model.

Transformational leadership has been becoming increasingly vital to the provision of high-quality health care, particularly during major public health emergencies. The present study aims to investigate the impact of transformational leadership on physicians' performance and explore the cross-level underlying mechanisms with achievement motivations and coping styles among Chinese physicians. During 2017-2019, 1,527 physicians of 101 departments were recruited from six hospitals in China with a cluster random sampling method. Participants completed several questionnaires regarding their job performance, achievement motivations, coping styles, and transformational leadership. Multilevel mediation effects were tested using cross-level path analysis. The result of this study indicated that transformational leadership was applied well in Chinese medical settings with a score of 101.56 ± 6.42. The hierarchical linear model showed that transformational leadership had a cross-level direct positive effect on physicians' performance (ß = 1.524, p < 0.05). Furthermore, results of cross-level path analyses revealed that transformational leadership contributed to physicians' performance by sequentially influencing achievement motivations first and then coping styles. In addition, the path "transformational leadership → positive coping (PC) style → physicians' performance" showed the strongest cross-level indirect effect. In summary, public health leaders should enhance physicians' performance by promoting individual development, especially achievement motivation and PC style.

Social Support and Suicide Risk Among Chinese University Students: A Mental Health Perspective.

Background: World Health Organization recognizes suicide as a public health priority. This study aimed to investigate the risk life events which led university students to consider suicide and explore the protective mechanism of social support (including subjective support, objective support, and support utilization) on suicide risk. Methods: Three thousand nine hundred and seventy-two university students were recruited in Harbin, China. Social Support Rating Scale, Self-Rating Anxiety Scale, the Beck Depression Inventory, and the 25-item scale of suicide acceptability were used to collect participants' information. Descriptive statistics, Pearson's correlation, and mediation analysis were employed for statistical analysis. Results: "Drug addict," "infected with HIV," and "incurable illness" were the top three events that led university students to consider suicide. Social support played an important protective role against suicide risk. Subjective support and support utilization had total effects on suicide acceptability, including direct and indirect effects. Anxiety (indirect effect = -0.022, 95% CI = -0.037 ~ -0.009) and depressive symptoms (indirect effect = -0.197, 95% CI = -0.228 ~ -0.163) mediated the relationship between subjective support and suicide acceptability; meanwhile, the association between support utilization and suicide acceptability was mediated by anxiety (indirect effect = -0.054, 95% CI = -0.088 ~ -0.024) and depressive symptoms (indirect effect = -0.486, 95% CI = -0.558 ~ -0.422). However, the protective impact of objective support worked totally through decreasing anxiety (indirect effect = -0.018, 95% CI = -0.035 ~ -0.006) and depressive symptoms (indirect effect = -0.196, 95% CI = -0.246 ~ -0.143). Moreover, the mediation effects of depressive symptoms had stronger power than anxiety in the impact of social support on suicide risk. Conclusions: Among Chinese university students, suicide acceptability was elevated when there was a health scare. Social support effectively reduced suicide risk via decreasing anxiety and depressive symptoms. From the mental health perspective, families, peers, teachers, and communities should work together to establish a better social support system for university students, if necessary, help them to seek professional psychological services.

Negative emotions, self-care activities on glycemic control in adults with type 2 diabetes: a cross-sectional study.

Glycemic control has become a focus of concern among diabetic patients. However, only 26.71% of patients achieved better glycemic control in China. Given the complexity of glycemic control, it is worth investigating the potential mechanisms between negative emotions and glycemic control. A total of 428 participants were recruited from a tertiary hospital (the number of hospital beds>500). They completed questionnaires consisting of demographics, Zung Self-Assessed Anxiety Scale(SAS), Zung Self-Assessed Depression Scale(SDS), and the Summary of Diabetes Self-Care Activities (SDSCA). HbA1 c was used to measure glycemic control. Descriptive analysis, Pearson correlation analysis, and Bootstrap analysis were conducted to analyze data. A total of 428 questionnaires were distributed, with 28 invalid questionnaires (93.46% were valid). Depression and self-care activities (exercise, medication) were associated with glycemic control. At the same time, the Bootstrap analysis revealed that self-care activities (exercise: standardized coefficient ß = 0.0181, p < 0.05, medication: standardized coefficient ß = 0.0211, p < 0.05) mediated the relationship between depression and glycemic control.

Association between type D personality and in-stent restenosis in patients treated with percutaneous coronary intervention: A mediation analysis of dietary patterns.

OBJECTIVE: Type D personality is a psychosocial risk factor for cardiovascular events and in-stent restenosis (ISR), but the mechanisms involved are not well understood. This study aimed to evaluate the effects of dietary patterns on the association between Type D personality and ISR in patients with coronary artery disease treated with percutaneous coronary intervention (PCI). METHODS: This cross-sectional study comprised a total of 230 post-PCI patients who were assessed for Type D personality, depression, dietary patterns, physical activity and medication adherence via self-administered questionnaires. ISR was assessed by coronary angiography. RESULTS: Type D personality (odds ratio [OR], 3.35; 95% confidence interval [CI], 1.05-10.71, p=0.042), low fruit intake (OR, 0.30; 95% CI, 0.12-0.68, p=0.008) and low vegetable intake (OR, 0.48, 95% CI, 0.27-0.91, p=0.021) were independent risk factors for ISR after adjustment for psychosocial, lifestyle and cardiovascular risk factors. Mediation analyses revealed that Type D personality had a significant direct effect on the development of ISR (p<0.05). In addition, nutrients in fruits and vegetables, including vitamin C, vitamin E and fiber, were important mediators of the relationship between Type D personality and ISR (p<0.05), the percentage of total indirect effect was 24.65%. CONCLUSIONS: These findings suggested that the low intake of fruit and vegetables in Type D patients can predict ISR. The healthy dietary interventions to supply vitamin C, vitamin E and fiber may help to improve the prognosis in post-PCI patients with Type D personality.

Relationship between Illness Perception and Depressive Symptoms among Type 2 Diabetes Mellitus Patients in China: A Mediating Role of Coping Style.

OBJECTIVE: The aims of the present study were to investigate the prevalence of depressive symptoms among type 2 diabetes mellitus (T2DM) patients in China and to explore how coping style influences the relationship between illness perception and depressive symptoms. METHODS: Nine hundred and thirty-nine T2DM patients were recruited from a grade 3 Class A hospital in Harbin, China, and asked to complete a demographic questionnaire as well as the Self-rating Depression Scale (SDS), Brief Illness Perception Questionnaire-Revised (IPQ-R), and Medical Coping Modes Questionnaire (MCMQ). Hierarchical linear regression analysis and the bootstrap method were preformed to examine if coping style influenced the relationship between illness perception and depression. RESULTS: The majority of patients (73.59%) exhibited depressive symptoms, including 37.27% with moderate and 6.71% with severe depressive symptoms. Depressive symptoms were more frequent in patients with complications (P < 0.05). A resignation coping style partially mediated the influence of illness perception on depressive symptoms. CONCLUSIONS: Interventions to improve coping style may reduce the prevalence or severity of depressive symptoms among T2DM patients, potentially enhancing treatment adherence and clinical outcome.

Association Between FoxO1, A2M, and TGF-ß1, Environmental Factors, and Major Depressive Disorder.

INTRODUCTION: Investigations of gene-environment (G×E) interactions in major depressive disorder (MDD) have been limited to hypothesis testing of candidate genes while poly-gene-environmental causation has not been adequately address. To this end, the present study analyzed the association between three candidate genes, two environmental factors, and MDD using a hypothesis-free testing approach. METHODS: A logistic regression model was used to analyze interaction effects; a hierarchical regression model was used to evaluate the effects of different genotypes and the dose-response effects of the environment; genetic risk score (GRS) was used to estimate the cumulative contribution of genetic factors to MDD; and protein-protein interaction (PPI) analyses were carried out to evaluate the relationship between candidate genes and top MDD susceptibility genes. RESULTS: Allelic association analyses revealed significant effects of the interaction between the candidate genes Forkhead box (Fox)O1, α2-macroglobulin (A2M), and transforming growth factor (TGF)-ß1 genes and the environment on MDD. Gene-gene (G×G) and gene-gene-environment (G×G×E) interactions in MDD were also included in the model. Hierarchical regression analysis showed that the effect of environmental factors on MDD was greater in homozygous than in heterozygous mutant genotypes of the FoxO1 and TGF-ß1 genes; a dose-response effect between environment and MDD on genotypes was also included in this model. Haplotype analyses revealed significant global and individual effects of haplotypes on MDD in the whole sample as well as in subgroups. There was a significant association between GRS and MDD (P = 0.029) and a GRS and environment interaction effect on MDD (P = 0.009). Candidate and top susceptibility genes were connected in PPI networks. CONCLUSIONS: FoxO1, A2M, and TGF-ß1 interact with environmental factors and with each other in MDD. Multi-factorial G×E interactions may be responsible for a higher explained variance and may be associated with causal factors and mechanisms that could inform new diagnosis and therapeutic strategies, which can contribute to the personalized medicine of MDD.

Factors influencing self-concept among adolescents infected with HIV: a cross-sectional survey in China.

OVERVIEW: The mental health problems of adolescents with human immunodeficiency virus (HIV) are important. It is of great significance to explore which factors can affect the self-evaluation and understanding of adolescents with HIV. OBJECTIVE: We found that adolescents with HIV have a lower level of self-concept than healthy adolescents. This study aimed to determine the factors influencing self-concept among adolescents with HIV in China. SETTING: A questionnaire was distributed among a total of 290 adolescents in Henan Province, China. One hundred and forty questionnaires were distributed in the case group (adolescents with HIV) and the control group (healthy adolescents) was issued 150 questionnaires.The Piers-Harris Children's Self-concept Scale, the Perceived Stress Scale, the Perceived Social Support Scale and the Simplified Coping Style Questionnaire were adapted for a Chinese population. Differences between the groups were tested for significance using Student's t-test, and analysis of variance was used to test continuous variables. The relationship between environmental personality factors and adolescent self-concept was examined by Pearson correlation analysis. Hierarchical linear regression analysis was used to model the effects of environmental personality factors on self-concept. RESULTS: The self-concept total score among adolescents with HIV was significantly lower than healthy adolescents (p<0.05). Hierarchical regression analysis indicated that age (ß=-0.19, t=-2.16, p=0.03), perceived stress (ß=-0.19, t=-2.22, p=0.03), perceived social support (ß=0.26, t=3.25, p=0.00), positive coping style (ß=0.50, t=5.75, p=0.00) and negative coping style (ß=-0.45, t=-5.33, p=0.00) were significantly associated with self-concept total scores. CONCLUSIONS: The self-concept of adolescents with HIV is related to perceived stress, perceived social support and coping style. These findings underline the significance of self-concept among adolescents infected with HIV.