The prevalence and correlates of peripartum depression in different stages of pregnancy during COVID-19 pandemic in China.

BACKGROUND: Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China. METHODS: Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup. RESULTS: Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P < 0.001, 2.92, P = 0.003, 1.58, P = 0.150 in the three trimesters, respectively; Severe vs. No, aORs were 13.00, 20.45, 5.38 in the three trimesters, respectively, all P < 0.05), and worries and fears about childbirth (aORs were 2.46, 2.96, 2.50 in the three trimesters, respectively, all P < 0.05) were associated with depression throughout pregnancy. CONCLUSIONS: The prevalence rate of peripartum depression during the COVID-19 outbreak in China was not higher than usual. The influence of current pregnancy status on movement, as well as worries and fears about childbirth were independent risk factors for peripartum depression throughout pregnancy during COVID-19. The stage of pregnancy should be considered when implementing interventions.

Mixed methods to explore factors associated with the decline of patients in the methadone maintenance treatment program in Shanghai, China.

BACKGROUND: This study was to characterize the Methadone Maintenance Treatment (MMT) in Shanghai, China, and to explore factors associated with the decline of patients in MMT during 2005-2016. METHODS: Both qualitative and quantitative methods were used in this study. Based on the data from Shanghai Centers for Disease Control (CDC), we described the changes in the number of patients who received MMT, and new enrollment each year from 2005 to 2016. Focus groups were conducted with 22 patients, and in-depth interviews were conducted with 9 service providers. RESULTS: Quantitative data demonstrate that the number of new enrollment began to decline in 2009, and the number of patients receiving MMT began to decline in 2012. The main reasons for dropout include (1) discontinuing medication due to unknown reasons (25%), (2) criminal activities other than drug-related crimes (20%), (3) relapse to heroin use (16%), and (4) physical disease (10%). Qualitative assessment results indicate that the major reasons for the decline of patients in MMT are as follows: (1) the increase of Amphetamine-type stimulants (ATS) use in recent years, (2) limited knowledge about MMT in both patients and MMT staff, (3) complicated enrollment criteria, and (4) discrimination against drug use. CONCLUSION: Various reasons to explain the decline of patients in MMT in Shanghai, China, were identified. Government agencies, service providers, and other stakeholders need to work together and overcome identified barriers to support MMT programs in China.

Association Between Family Atmosphere and Internet Addiction Among Adolescents: The Mediating Role of Self-Esteem and Negative Emotions.

Objectives: Family atmosphere is a significant predictor of internet addiction in adolescents. Based on the vulnerability model of emotion and the compensatory internet use theory, this study examined whether self-esteem and negative emotions (anxiety, depression) mediated the relationship between family atmosphere and internet addiction in parallel and sequence. Methods: A total of 3,065 Chinese middle school and high school students (1,524 females, mean age = 13.63 years, SD = 4.24) participated. They provided self-reported data on demographic variables, family atmosphere, self-esteem, anxiety, depression, and internet addiction through the Scale of Systemic Family Dynamic, Self-Esteem Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Internet Addiction Test, respectively. We employed Hayes PROCESS macro for the SPSS program to scrutinize the suggested mediation model. Results: It revealed that self-esteem, anxiety, and depression mediated the relationship between family atmosphere and internet addiction in parallel and sequence. The pathway of family atmosphere-self-esteem-internet addiction played a more important role than others. Conclusion: The present study confirmed the mediating role of self-esteem and negative emotions between family atmosphere and internet addiction, providing intervention studies with important targeting factors.

Family Dynamics and Functioning of Adolescents from Two-Child and One-Child Families in China.

Background: To promote the balanced development with the population, China has phased out a one-child policy in 2016, and a two-child policy was launched, which has led to dramatic changes in family structure. The transition could be a huge challenge for adolescents who are in a period of psychological vulnerability. Purpose: This study explored the differences and predictors of family dynamics and functioning between two-child and one-child families in the context of China's two-child policy. Methods: We used the Self-rating scale of Systemic Family Dynamics (SSFD) and Family Assessment Device-General Functioning (FAD-GF) to investigate the family dynamics, family functioning, and family structure and status of 3289 adolescents under the background of China's two-child policy. Results: Results revealed that the mean scores for family atmosphere, personalization, disease concept, overall family dynamics, and family functioning health rate of the one-child families were higher than those of the two-child families. Parental marital status, mother's education, annual household income, and family economic satisfaction in two-child and one-child families was positively correlated with family dynamics and functioning, but not significantly associated with living style, parental age and employment. Family financial satisfaction, parental marital status, and distress in the family were predictors of family dynamics and functioning, and parental preference was also an important factor in two-child families. Conclusion: The findings suggest family atmosphere, personality, disease concept, family dynamics, and family functioning of the one-child families were better than those of the two-child families. Unlike one-child families, parental preference is an important predictor of family dynamics and functioning in two child families. This study increases our understanding of adolescents psychological problems during family structure transitions under the background of fertility policy, providing psychologists with more evidence-based evidence and intervention directions.

Prevalence and Contributing Factors of Childhood Trauma, Anxiety, and Depression Among Adolescents From Two-Child Families in China.

The two-child policy has been implemented in China since 2016 and has attracted the attention of the world. Adolescents may face huge psychological challenges in the process of changing family structures and relationships. To date, no mental health survey of adolescents from two-child families has been conducted. We investigated the prevalence and risk factors for childhood trauma, anxiety, and depression in two-child families in a statistically representative sample of Chinese senior high school students from Shanghai. A total of 426 participants were randomly selected from 1,059 students of four senior high schools in different districts of Shanghai. The childhood trauma questionnaire-short form (CTQ-SF), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used as the screening tools. We found that the overall prevalence of childhood trauma, anxiety, and depression among senior high school students in two-child families was 46.70% (95% CI, 39.93-53.47%), 22.17% (95% CI, 16.53-27.81%), and 35.85% (95% CI, 29.34-42.36%), respectively. The two-child families was an important factor associated childhood trauma, emotional neglect, and physical neglect (χ2 = 5.984, p = 0.014; χ2 = 4.071, p = 0.044; χ2 = 4.202, p = 0.040). Ranking in two-child families was a risk factor for childhood trauma (ß = -0.135, p = 0.048). Parental preference was a significantly correlated with physical abuse, physical neglect, anxiety, and depression (ß = -1.581 to 0.088, p < 0.05). Meanwhile, emotional abuse, physical abuse, emotional neglect, and physical neglect of participants in the two groups were positively correlated with anxiety and depression (r = 0.195-0.478, p < 0.05). There was a significant relationship between sexual abuse and anxiety symptoms in the one-child family group (r = 0.161, p < 0.05). The findings suggest that the overall prevalence of childhood trauma, anxiety and depression among adolescents from two-child families in China was high. The two-child families and family ranking are important factors associated childhood trauma, while parental preference is related to anxiety and depression. These results highlight an urgent need to be addressed by adolescents' mental health service providers and policy-makers.

The Influence of Childhood Trauma and Family Functioning on Internet Addiction in Adolescents: A Chain-Mediated Model Analysis.

OBJECTIVE: This study aimed to examine the prevalence of Internet addiction in adolescents, analyze the associations of childhood trauma, systematic family dynamics, and family functioning with Internet addiction, and investigate the mediating chain role of anxiety and depression in the relationship of childhood trauma and family functioning with adolescent Internet addiction. METHODS: This was a cross-sectional study in which general sociodemographic data were obtained from 3357 adolescents in grades 6-12 who were assessed using psychometric instruments such as the Childhood Trauma Questionnaire, Young Internet Addiction Test, Systematic Family Dynamics Self-Rating Scale (SSFD), Family Functioning Assessment (FAD), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). RESULTS: (1) The prevalence of Internet addiction among adolescents was 26.09% (876/3357). The prevalence of childhood trauma was 54.96% (1845/3357), and the prevalence of Internet addiction was significantly different between adolescents who suffered childhood trauma and those who did not (χ2 = 96.801, ν = 1, p = 0.000). (2) Childhood trauma and various dimensions of systematic family dynamics had a significant negative and positive relationship with poor family functioning and anxiety or depression, respectively. (3) Childhood trauma was a positive predictor of Internet addiction through the chain-mediated effect of anxiety and depression, but there were no direct effects. Poor family functioning was a positive predictor of adolescent Internet addiction, and this positive prediction was augmented by the chain-mediated effect of anxiety and depression. CONCLUSIONS: Childhood trauma and poor family functioning or support predicted Internet addiction in adolescents, with anxiety and depression as mediators.

A study on the correlation between family dynamic factors and depression in adolescents.

Objectives: To evaluate the relationship between systemic family dynamics and adolescent depression. Methods: An offline survey was distributed to 4,109 students in grades 6-12, with the final analysis including 3,014 students (1,524 boys and 1,490 girls) aged 10-18 years. The questionnaire included the Self-Rating Scale of Systemic Family Dynamics (SSFD), the Self-Rating Depression Scale (SDS), and demographic characteristics. Results: Family dynamics were negatively correlated with depressive symptoms, with better family dynamics (high scores) associated with lower levels of depression based on the SDS score. After adjusting for sociodemographic characteristics, an ordinal multiclass logistic regression analysis identified family atmosphere (OR = 0.952, 95% CI: 0.948-0.956, p < 0.001) as the most important protective family dynamic against depression, followed by individuality (OR = 0.964, 95% CI: 0.960-0.968, p < 0.001). Latent class analysis (LCA) created the low family dynamic and high family dynamic groups. There were significant differences in the mean SDS scores between the two groups (45.52 ± 10.57 vs. 53.78 ± 11.88; p < 0.001) that persisted after propensity matching. Family atmosphere and individuation had a favorable diagnostic value for depression, with AUCs of 0.778 (95% CI: 0.760-0.796) and 0.710 (95% CI: 0.690-0.730), respectively. The diagnostic models for depression performed well. Conclusion: Poor family dynamics may be responsible for adolescent depression. A variety of early intervention strategies focused on the family may potentially avoid adolescent depression.

Promoter Hypomethylation of miR-124 Gene Is Associated With Major Depressive Disorder.

Based on our previous studies and other evidence, miR-124 is an important biomarker and therapeutic target for major depressive disorder (MDD). The aim of this study was to clarify the role of miR-124 methylation in MDD and antidepressant effects from the perspective of epigenetics. MethylTarget™ was used to detect methylation levels of the three miR-124 precursor genes (MIR124-1, MIR124-2, and MIR124-3) in 33 pre- and post-treatment MDD patients and 33 healthy controls. A total of 11 cytosine-phosphate-guanine (CpG) islands in the three miR-124 precursor genes, including 222 CpG sites, were detected. All CpG islands were hypomethylated in MDD patients when compared to healthy controls and seven CpG regions were still identified with a statistically significant difference after Bonferroni correction. In addition, 137 of 222 CpG sites were found a statistical difference between MDD patients and controls, and 40 CpG sites were still statistically significant after Bonferroni correction. After performing the LASSO regression model, seven biomarkers with differential methylation among 40 CpG sites were identified. Mean methylation score was lower in MDD patients (z = -5.84, p = 5.16E-9). The AUC value reached 0.917 (95% CI: 0.854-0.981) to discriminate MDD and controls. No changes in methylation of the three miR-124 precursor genes were found in MDD patients following antidepressant treatment. The methylation of miR-124 could be a promising diagnostic biomarker for MDD.

The effect of prohibiting outside food during COVID-19 pandemic on the body weight of schizophrenic patients taking olanzapine or clozapine: a retrospective self-controlled study.

BACKGROUND: Olanzapine and clozapine are atypical antipsychotics (AAPs) with the greatest risk of weight gain, and changes in feeding behavior are among the most important underlying mechanisms. However, few studies have investigated the role of diet-alone interventions in improving individuals' weight gain by taking AAPs. In closed management mental hospitals of China, family members are allowed to bring food to patients regularly, causing patients to have caloric intake added to their 3 daily meals. However, during the global pandemic of coronavirus disease 2019 (COVID-19), bringing food to the hospital was temporarily prohibited in mental health institutions in China to prevent the spread of the virus. This study sought to compare the body weight and body mass index (BMI) changes of patients taking olanzapine or clozapine undergoing diet-alone interventions caused by this prohibition. METHODS: A retrospective self-controlled study was conducted on 90 patients with schizophrenia from a single-center treated with olanzapine or clozapine monotherapy, or combined with aripiprazole or ziprasidone which has a small metabolic impact. A paired-samples t-test was used to compare the changes in body weight and BMI before and after the 3-month prohibition, and general linear regression was used to analyze the effects of gender, age, disease course, duration of drug exposure, and equivalent dose on the BMI improvement. Also, the percentage of people who lost weight and that of individuals who lost 5% of their pre-prohibition body weight were calculated. RESULTS: Paired-samples t-test showed that after 3-month prohibition, the patients' body weight (71.68±6.83 vs. 66.91±7.03, P<0.001) and BMI (26.43±2.11 vs. 24.63±1.81, P<0.001) decreased significantly. Weight loss rate accounted for 99.1%, and weight loss of 5% from the pre-prohibition body weight accounted for 71.8%. General linear regression showed that the duration of drug exposure (ß =-0.678, P<0.001) was significantly and negatively correlated with the BMI changes. No significant correlation of gender, age, disease course, or equivalent dose with BMI changes was found. CONCLUSIONS: Diet-alone interventions facilitate weight loss in chronically hospitalized schizophrenia patients taking AAPs. Conduction of dietary intervention in the early stages of medication may yield greater benefits.

The prevalence and related factors of metabolic syndrome in outpatients with first-episode drug-naive major depression comorbid with anxiety.

Metabolic syndrome (MetS) is associated with depression, but its role in major depressive disorder comorbid with anxiety (AMD) is unclear. This study aimed to investigate the prevalence and clinical correlates of MetS in first-episode drug-naive (FEDN) patients with AMD in a Chinese Han population. In total, 1380 FEDN outpatients with AMD were recruited in this cross-sectional study. The sociodemographic features, clinical characteristics, history of suicide attempts, thyroid-stimulating hormone (TSH) levels, and MetS parameters of each subject were evaluated. All subjects were rated on the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and the Positive and Negative Syndrome Scale positive symptom subscale. The prevalence of MetS among AMD patients was 8.04%. Compared to the non-MetS group, age, age of onset, TSH level, HAM-A and HAM-D scores, history of attempted suicide, and comorbid psychiatric symptoms were higher in the MetS group. Those in this group were also more likely to be married, and they had a lower educational level. Furthermore, age, psychiatric symptoms, suicide attempts, and higher TSH levels were independently associated with MetS in AMD patients. This study suggests a lower prevalence of MetS in FEDN patients with AMD in a Chinese Han population. Older age, comorbid psychiatric symptoms, history of attempted suicide, and higher TSH levels are related factors for MetS in AMD patients.