Internet addiction and depressive and anxious symptoms among Chinese rural left-behind adolescents: Mediating roles of resilience and friendship quality.

BACKGROUND: Rural left-behind adolescents are more vulnerable to Internet addiction and depressive and anxious symptoms due to the lack of family support and parental supervision. This study was the first to investigate the longitudinal relationships between Internet addiction and depressive and anxious symptoms and to examine the mediating roles of resilience and friendship quality in rural left-behind adolescents. METHODS: Included in this study, which was from a longitudinal study conducted five times over 2 years, were 1001 rural left-behind adolescents. The internationally used scales for depressive and anxious symptoms, Internet addiction, resilience and friendship quality were administered. A structural equation model was used for analysis. RESULTS: The prevalence of Internet addiction, depressive and anxious symptoms among rural left-behind adolescents were 17.7%, 35.8% and 27.6%, respectively. Internet addiction predicted the later depressive and anxious symptoms (ß = 0.200, 95% confidence interval [CI]: 0.116-0.274 and ß = 0.263, 95% CI: 0.188-0.330). Resilience acted as an independent mediator in the relationships between Internet addiction and depressive and anxious symptoms (ß = 0.037 and 0.034, P < 0.01). Resilience and friendship quality played a chain-mediating role on the longitudinal relationships between Internet addiction and depressive and anxious symptoms (ß = 0.011 and 0.010, P < 0.001). The mediating effects accounted for 24.0% and 16.7% of the total effects, respectively. CONCLUSION: Resilience and friendship quality play an independent or chain-mediating role in longitudinal relationships between Internet addiction and depressive and anxious symptoms. The findings inform targeted intervention strategies to improve the mental health of left-behind adolescents.

The association between physical activity and subjective well-being among adolescents in southwest China by parental absence: a moderated mediation model.

OBJECTIVES: Built on the Positive Youth Development (PYD) framework, this study examined how physical activity affected the subjective well-being of adolescents in the multi-ethnic area of southwest China. The mediating role of school connectedness as an external development asset and the moderating role of resilience as an internal development asset were specified and tested within the framework of sport-based PYD. METHODS: A cross-sectional survey of 3143 adolescents (47.2% boys with mean age = 12.88 and SD = 1.68) was conducted in 2020. A structural equation model (SEM) was developed to estimate the direct effect of physical activity, the mediating effect of school connectedness, and the moderating effect of resilience on adolescents' subjective well-being. Multi-group comparison was made to investigate differences and similarities across three parental absence subgroups: (1) both parents present, (2) one parent absent, and (3) both parents absent. RESULTS: As surmised, physical activity, school connectedness, and resilience all positively and significantly affected adolescents' subjective well-being. SEM analyses revealed that school connectedness mediated the effect of physical activity on subjective well-being. Moreover, resilience moderated both the direct and indirect effects of physical activity (through school connectedness) on subjective well-being. Finally, the multi-group comparison revealed a moderating effect of parental absence on the moderated mediation model. LIMITATIONS: This study is a cross-sectional survey, so inference of causal associations among the study variables is impossible. CONCLUSIONS: Healthy lifestyle behaviors, school-supportive settings, and positive individual development assets can enhance the subjective well-being of adolescents in southwest China, especially those whose parents were absent. Physical activity interventions informed by the PYD framework should be incorporated into public health programs designed to foster the physical and mental health of left-behind adolescents in southwest China.

Subjective well-being among AIDS orphans in southwest China: the role of school connectedness, peer support, and resilience.

BACKGROUND: Few studies have explored the health and development of AIDS orphans using the positive youth development (PYD) framework. Grounded in this framework, the main objective of this study is to examine how internal assets (i.e., resilience) and external assets (i.e., school connectedness, peer support) affect subjective well-being among Yi AIDS orphans in the Liangshan Yi Autonomous Prefecture, Sichuan province, China. METHODS: A cross-sectional survey was conducted by interviewing 571 AIDS orphans and 979 non-orphans of Yi ethnic minority from 5th-10th grades. Structural equation models (SEM) were utilized to identify and estimate the direct and indirect effects of internal and external assets on subjective well-being. RESULTS: The average score of subjective well-being was significantly lower for AIDS orphans than for in non-orphans (P < 0.05). Resilience, school connectedness, peer support (number of friends, caring friends), and self-rated physical health had significant and positive direct effects on subjective well-being. In addition, the effects of school connectedness, and peer support on subjective well-being were mediated by resilience. CONCLUSIONS: Positive individual and school-related contextual assets can bolster subjective well-being among AIDS orphans. The design of health intervention programs for AIDS orphans should incorporate these positive development assets.

Predicting physical exercise changes in Chinese rural adolescents: the application of the health action process approach model.

The purposes of the current study were to explore the applicability of the Health Action Process Approach (HAPA) model for interpreting changes in physical exercise behavior and to examine the key determinants of changes in physical exercise. The participants were 639 rural middle school students in Sichuan province, China, who did not perform physical exercise. Three surveys and two interventions were completed in the same participants within 1.5 years. The HAPA model elements and physical exercise were estimated by a self-reported questionnaire. The results showed that 158 students (24.7%) formed a habit of physical exercise. The structural equation model for the pre-intention stage and behavior stage showed acceptable goodness of fit. Outcome expectancies (ß=0.136, P=0.014) and action self-efficacy (ß=0.314, P=0.001) directly predicted intention of physical exercise, the latter directly predicted physical exerciseplanning (ß=0.537, P<0.001), andplanning subsequently predicted physical exercise (ß=0.324, P<0.001). Maintenance self-efficacy indirectly predicted physical exercise through planning (95%CI: 0.014, 0.053). The findings suggested that the HAPA model was a very useful tool for predicting changes in physical exercise behavior, as this model explains the process of changing physical exercise habits and reveals the weak link in such behavioral changes among Chinese rural adolescents.

[Analysis of reciprocity between mental health status and academic achievement under the protective effect of psychological resilience in junior school students in earthquake-hit area].

OBJECTIVE: To verify the reciprocity between mental health status and academic achievement and the protection of psychological resilience. METHODS: An approximate sampling method was adopted in October, 2010. Two junior high schools were selected from the severely earthquake-hit area( Mianzhu City, Sichuan Province) andthe slight earthquake-hit area( a suburban county of Chengdu City, Sichuan Province), respectively, and conducted the survey by using a self-report questionnaire( including general demographic characteristics, middle school students ' mental health scale and resilience scale). Then, the follow-up surveys were conducted every half year. The data were analyzed by repeated measurement variance analysis, Pearson product moment correlation analysis and non-recursive structural equation model. RESULTS: 1015 participants were included in this study who participated 5 surveys, of whom 49. 3% were male and 57. 9% in the slight disaster areas. The average age in the baseline survey was( 12. 72 ± 0. 50) years old, with a range of 11-15 years old. In the non-recursive structural equation model, the better the mental health status was, the higher academic achievement was( ß =-0. 037, P < 0. 001), vice versa( ß =-0. 199, P < 0. 001). The psychological resilience was protective factor for academic achievement( ß = 0. 199, P <0. 001) and mental health( ß =-0. 282, P < 0. 001). The 95% CI of the two intermediate effects( " psychological resilience→ mental health→academic achievement" and " psychological resilience→ academic achievement→mental health") were( 0. 008-0. 017) and(-0. 062--0. 025), with 5. 7% and 13. 0% of total effect, respectively. CONCLUSION: Mental health status and academic achievement are mutual influence. The effect of academic performance on mental health status is greater than that of mental health status on academic performance. Psychological resilience is an important protective factor of mental health and academic performance.

[Physical exercise impact on the life satisfaction among rural adolescents in Zizhong County].

OBJECTIVE: To explore the direct effect of physical exercise impacting on life satisfaction and the mediating role of mental health status and resilience between the relationship of physical exercise and life satisfaction in rural adolescents. METHODS: A total of 2282 of grade 7 and grade 10 of two rural middle school students( 15. 21± 0. 74 years, range 11-18 years) were surveyed in Zizhong County, Sichuan Province, chosen by typical sampling and cluster sampling using a self-report structured questionnaire, including demographic characteristics, physical exercise, Resilience Scale( CD-RISC) and mental health scale( MMHI-60), life satisfaction scale. A structural equation model was used for statistical analysis. RESULTS: The fitting indices of multiple mediating role of structural equation model showed good fitting: χ~2/DF = 4. 528, GFI = 0. 935, AGFI = 0. 906, RMSEA = 0. 039. Physicalexercise was a direct protective determination for life satisfaction, the standardized coefficient was 0. 056( P < 0. 05). Physical exercise indirectly impacted on life satisfaction through the mediating variables of resilience and mental health status, and the 90 % CI of the mediating effect were( 0. 331-0. 557) and( 0. 051-0. 178), respectively. The mediating effect accounted for 67. 1 % of total effect. CONCLUSION: Physical exercise exerts a direct and indirect positive effect on life satisfaction. Resilience and mental health status have mediating effects on the relationship between physical exercise and life satisfaction.

[The associations between the peer relation, social support and mental health of adolescents in Wenchuan Earthquake-hit areas].

OBJECTIVE: To identify trajectory and its correlates of mental health among adolescents in Wenchuan earthquake-hit areas. METHODS: The students of grade seven were selected in two junior high schools from slightly and severely earthquake-hit areas respectively. Longitudinal design was used to address 5-time follow-up surveys among the same participants every 6 months since October, 2010. The main contents of thequestionnaire included demographic information, adolescent mental health, self-esteem, social support, peer relationship and so on. The number of cases in this study sample included 970 students who attended five surveys. 415 students were in the severely earthquake-hit area( boys 48. 2%, girls 51. 8%) and 555 students were in the slightly earthquake-hit area( boys 49. 2%, girls 50. 8%). The average age of the subjects was11. 6 ± 0. 5 years at the first survey. Repeated measure analysis of variance and latent variable growth curve model were used to analyze data. RESULTS: The mental health of adolescents presented a worse trend in the whole stage of junior high school( F = 9. 1, P <0. 05), and the mental health of the adolescents from slightly earthquake-hit area areas was always better than that from the severely earthquake-hit area( F = 135. 9, P < 0. 05). The self-esteem, peer relation of the slightly earthquake-hit areas were significantly higher than corresponding measurements of the heavily earthquake-hit areas( F = 17. 7 and 3. 8, P <0. 05), but the social support had a reverse result( F = 7. 8, P < 0. 05). Directly positive influencing factors for mental health were self-esteem, peer relation. The better peer relationships and higher self-esteem, the better mental health of adolescent were( ß =- 0. 119 and- 0. 526, P < 0. 05). Peer relations could not only directly affect the mental health of adolescents, but also improve the level of self-esteem( ß = 0. 334, P < 0. 001)by increasing the level of social support( ß = 0. 565, P < 0. 001) to indirectly affect act on mental health. CONCLUSION: The status and trajectory of mental health of adolescents from the earthquake-hit areas were influenced by the type of disaster areas, peer relation, self-esteem and social support.

Factors associated with medication interruption among outpatients with severe mental illness exposed to COVID-19.

Many patients with severe mental illness (SMI) relapsed and deteriorated during the COVID-19 pandemic, as they experienced medication interruption. This study aimed to investigate factors affecting medication interruption in patients with SMI during the COVID-19 pandemic. A total of 2,077 patients with SMI participated in an online survey on medication interruption during the COVID-19 outbreak. The questionnaire comprised six parts: basic demographic information, COVID-19 exposure, state of disease, medication compliance before COVID-19, medication interruption during COVID-19, and the specific impact and needs. A total of 2,017 valid questionnaires were collected. Nearly 50% of patients with SMI have been affected to varying degrees of life expectancy and treatment. Among them, 74 patients stopped taking medicines for more than 14 days without a prescription. Logistic regression analysis showed that cohabitant exposure [OR = 26.629; 95% CI (3.293-215.323), p = 0.002], medication partial compliance and non-compliance pre-COVID-19 [OR = 11.109; 95% CI (6.093-20.251), p < 0.001; OR = 20.115; 95% CI (10.490-38.571), p < 0.001], and disease status [OR = 0.326; 95% CI (0.188-0.564), p < 0.001] were related to medication interruption. More than 50% of the patients wanted help in taking medications, follow-up, and receiving more financial support and protective materials. We found that the daily lives of patients with SMI were much more susceptible to impact during the pandemic. Patients with a history of partial or non-medication compliance before COVID-19 and an unstable disease state are more easily affected by pandemics and epidemics and need extra attention should similar large-scale outbreaks occur in the future.

Investigation of the occupational exposure to blood-borne pathogens of staff at a third-class specialist hospital in 2015-2018: a retrospective study.

To understand the current situation of occupational exposure to blood-borne pathogens in a women's and children's hospital and analyze the causes to provide a scientific basis for improving occupational exposure prevention and control measures. We analyzed occupational exposure to blood-borne pathogens in a third-class women's and children's hospital from 2015 to 2018, considering the workers' occupational categories and length of service; the sites, types, and causes of exposure; and the pathogens of the source patients. From 2015 to 2018, there were 146 cases of occupational exposure to blood-borne pathogens, mainly from sharp-instrument injuries (81.5%; 119/146). Trainees represented the highest proportion of occupational exposure (30.1%; 44/146), followed by nurses (29.5%; 43/146). Occupational exposure among staff with less than one year of service accounted for 43.2% (63/146) of cases. Fisher's exact test showed that different occupational groups had different types of occupational exposure, and among the occupationally exposed populations, the proportion of sharp injuries is higher than that of blood and body fluid exposure, and the difference is statistically significant (χ2 = 12.937, P = 0.008). Different occupational groups faced exposure to different types of pathogens: medical staff were more likely than workmen to be exposed to hepatitis B, while workmen were more likely than medical staff to be exposed to unknown pathogens; these differences were statistically significant (χ2 = 55.344, P < 0.001). Health records were established for all cases of occupational exposure to blood-borne pathogens, and no staff members contracted a blood-borne disease due to occupational exposure. In order to reduce occupational exposure, regular training in occupational protection for junior medical staff and workers should be strengthened, the monitoring and protection system of occupational exposure to blood-borne pathogens improved, standard prevention measures strengthened, operations standardized, safe injection equipment provided, and comprehensive measures taken.

Prevalence of Posttraumatic Stress Disorder (PTSD) and Its Correlates Among Junior High School Students at 53 Months After Experiencing an Earthquake.

OBJECTIVE: To identify the prevalence of posttraumatic stress disorder (PTSD) and its determinants among adolescents more than 4 years after the 2008 Wenchuan earthquake. METHOD: Adolescents (1,125 total) from 2 junior high schools in areas affected by the catastrophic earthquake were followed up for 3 years. The self-rating PTSD scale based on the Manual of Mental Disorders, 4th Edition (DSM-IV) and the Chinese Classification and Diagnostic Criteria of Mental Disorders, 2nd Edition, Revised (CCMD-2-R) was collected at 53 months, and determinant data were collected repeatedly. Logistic regression was used for a determinants analysis. RESULTS: The prevalence of overall PTSD was 23.4% among the sample. The risk factors for PTSD were older age (OR=1.52, 95% CI: 1.20~1.92), and death or injury of a family member in the earthquake (OR=1.61, 95% CI: 1.09~2.37). Adolescents who had moderate-to-severe common mental health problems were more likely to have PTSD symptoms, with ORs from 3.98 to 17.67 (All P<0.05). Self-esteem remained a protective factor for PTSD regardless of age, whereas positive coping was a protective factor for PTSD when adolescents were older. CONCLUSION: PTSD symptoms among adolescent survivors of a catastrophic earthquake seemed to persist over time. Long-term interventions are needed to alleviate PTSD symptoms among adolescent survivors. (Disaster Med Public Health Preparedness. 2019;13:414-418).

Heterogeneity of adolescent health risk behaviors in rural western China: A latent class analysis.

BACKGROUND: Adolescent health risk behaviors are a public health priority given their prevalence and their associations with chronic diseases and life quality in adulthood. This study examined the heterogeneity of adolescent health risk behaviors and the associations between demographic characteristics and subgroup membership in rural western China. METHODS: In fall 2015, 2805 students from rural middle schools in Sichuan Province were surveyed using the Health-Related Behavior Questionnaire for Adolescents. Latent class analysis (LCA) was used to identify subgroups of adolescents with distinct patterns of health risk behaviors. Differences in class membership related to selected demographic characteristics were examined using multinomial logistic regression analysis. RESULTS: A four-class model emerged: (1) high-risk group (n = 108, 4.0%), (2) high-physical-inactivity and suicide-risk group (n = 340, 12.1%), (3) moderate-risk group (n = 897, 32.0%), and (4) low-risk group (n = 1460, 52.1%). The multinomial logistic regression analysis revealed that boys and adolescents with poor parental relationships and high allowances (spending money) were significantly more likely to be in the high-risk group than the low-risk group. CONCLUSIONS: Adolescents in rural western China are a heterogeneous population requiring different tailored and effective interventions.