Active and avoidant coping profiles in children and their relationship with anxiety and depression during the COVID-19 pandemic.

Active and avoidant coping styles are important dispositional factors in the development of anxiety and depression symptoms. Children use both active and avoidant coping strategies together in daily life. No studies have investigated the relationship between active-avoidant coping profiles and internalizing symptoms in children. The present study aimed to investigate children's active-avoidant coping profiles and assess the relationship that active-avoidant coping profiles have with anxiety and depression symptoms. A two-wave longitudinal study was conducted among 322 Chinese children in the People's Republic of China during the COVID-19 pandemic. Participants completed the Children's Coping Strategies Checklist-Revised 1 at Time 1 and the Revised Child Anxiety and Depression Scale at Time 1 and 6 months later (Time 2). Four active-avoidant coping profiles were revealed: low active copers, high active copers, balanced copers, and avoidant copers. Low and high active copers had lower levels of anxiety and depression symptoms than balanced copers and avoidant copers. Avoidant copers showed a larger decrease in depression symptoms than balanced copers and high active copers during the COVID-19 pandemic. It is important to improve children's active-avoidant coping profiles to relieve anxiety and depression symptoms.

The Chinese version of Posttraumatic Growth and Depreciation Inventory-Expanded version (PTGDI-X) for cancer survivors.

Many patients with cancer report positive changes often referred to as posttraumatic growth (PTG). Some of these self-reported PTG may represent maladaptive illusions created by individuals to cope with the illness. A recently established Posttraumatic Growth and Depreciation Inventory - Expanded version (PTGDI-X) includes both PTG and posttraumatic depreciation (PTD) items. This inventory may provide a more balanced picture of the phenomenological world of cancer survivors. We examined the Chinese version of the PTGDI-X's applicability to cancer patients, and how PTG and PTD were related to posttraumatic stress symptoms. Two hundred sixty-five cancer survivors in Taiwan completed the Chinese version of the PTGDI-X, along with the PTSD Checklist for the DSM-5 to measure posttraumatic stress disorder (PTSD) symptoms. Confirmatory factor analysis showed that the factor structure of the PTGDI-X established in a multi-national study fit our data from cancer patients modestly well. The PTD score had a significant and positive correlation with PTSD symptoms, whereas the PTG and PTSD showed a significant curvilinear relationship in the form of an inverted U-shape. This study's results indicate that PTG and PTD are separated constructs with differential relationships with cancer outcomes. The Chinese version of the PTGDI-X is a viable instrument for psycho-oncological research. The PTD scores can provide useful information to guide cognitive interventions to reduce distorted cognitions. In contrast, the PTG scores can provide further information on the phenomenological world of cancer survivors. In this study, clinical implications and future studies were considered.

Motivational interviewing for caries prevention in adolescents: a randomized controlled trial.

OBJECTIVE: The objective of this study is to investigate the effectiveness of motivational interviewing (MI) in changing health behaviors (snack and toothbrushing) and preventing dental caries among adolescents. METHODS: Five hundred and twelve adolescents with unfavorable caries-related behaviors ("snacking three times or more a day" and/or "toothbrushing less often than twice a day") were randomly assigned to three groups. Group I received prevailing health education (oral health talks and pamphlets). Participants in group II joined a one-on-one face-to-face MI session. In group III, a patient communication tool (Cariogram) was incorporated to facilitate the MI process. At baseline and 24 months post-intervention, a self-administered questionnaire gathered information of participants' sociodemographic characteristics and oral health self-efficacy and behaviors. Their oral hygiene and tooth status were assessed by a blinded examiner. RESULTS: After 24 months, 460 (89.8%) participants were followed up. Compared with group I, (i) restriction of frequent snacking was more likely in group II [OR (95% CI): 3.91 (1.48-10.33)] and group III [OR (95% CI): 6.33 (2.46-16.27)], whereas group III tended to adopt the behavior of toothbrushing twice a day [OR (95% CI): 4.80 (1.79-12.85)]; (ii) no significant between-group difference in plaque score reduction was found (p > 0.05); and (iii) groups II and III developed fewer cavitated teeth (△DICDASII 3-6MFT) [ß (95% CI): - 0.19 (- 0.37, - 0.01) and - 0.20 (- 0.38, - 0.02), respectively], whereas increment of total carious lesions (△DICDASII 1-6MFT) was lower in group III [ß (95% CI): - 0.63 (- 1.24, - 0.02)]. CONCLUSION: MI outperformed prevailing health education in improving oral health behaviors and preventing dental caries among adolescents. CLINICAL RELEVANCE: Incorporating MI into dental care for caries-prone adolescents contributes to optimal health outcomes. TRIAL REGISTRATION: HKUCTR-1852 ( http://www.hkuctr.com/ ) (Hong Kong, 2013).

Hope in the context of chronic musculoskeletal pain: relationships of hope to pain and psychological distress.

INTRODUCTION: The cognitive model of hope suggests that people with high levels of hope are able to think about the ways to goals (pathways) and motivated to pursue those pathways to reach their goals (agency). We hypothesized that higher levels of hope would be related to lower levels of pain and less psychological distress (ie, anxiety and depression) and better adjustment. OBJECTIVES: This study aims to examine the relationship, if any, between cognition of hope and chronic musculoskeletal pain. METHODS: One hundred and six patients with chronic musculoskeletal pain were recruited by convenient sampling from 2 public hospitals in Hong Kong. We assessed the hope level, psychological distress, and health outcomes by psychometric inventories. RESULTS: Zero-order correlation results showed that hope was inversely associated with psychological distress (ie, anxiety and depression) and positively related to subjective self-efficacy. There was no significant relationship with severity of pain. Patients presented with longer duration of chronic musculoskeletal pain have higher hope level while pain developed after injury on duty have lower hope level. CONCLUSION: The findings of this cross-sectional study highlight the potential importance of hope in understanding adjustment to chronic musculoskeletal pain. Future longitudinal research could help reveal how hope and adjustment interact over the treatment of chronic pain cases.

Fear and anxiety about COVID-19 among local and overseas Chinese university students.

This study aimed to establish a new COVID-19 Fear (Higher Education) scale to investigate the relationship between fear and generalised anxiety symptoms among Chinese students in mainland China, Hong Kong, and other countries. 219 Chinese university students studying in universities in mainland China (n = 76, 34.7%), Hong Kong (n = 66, 30.1%), and overseas (i.e., outside of China as international students, n = 77, 35.2%) participated in an online study from March 31, 2020 to April 4. Participants completed a newly developed COVID-19 Fear (Higher Education) scale to measure three domains of fear including fear of infection, fear of instability and fear of insecurity related to the COVID-19 pandemic. They also completed the Generalized Anxiety Disorder 7-item scale (GAD-7) on the severity of anxiety symptoms. About 9.6% of the participants could be classified as exhibiting high anxiety level according to the GAD-7. More students studying overseas (about 15%) were classified into the high GAD group when compared to students studying in both mainland China (6.6%) and Hong Kong (6.1%). MANOVA results showed that students studying in Hong Kong and overseas had more concerns related to preventive measures related to COVID-19 than their mainland counterparts did. We concluded that international students studying away from their home country would have higher risk to develop anxiety problems during a collective trauma such as the COVID-19 pandemic. Education institutions should provide support services including online support groups, social media groups for mutual support to alleviate the fear and anxiety of international students.

Coping profiles predict long-term anxiety trajectory in breast cancer survivors.

This study examined the long-term trajectory patterns of anxiety in breast cancer survivors and identified its predicting variables, especially the type of coping profile. Eighty-one patients who completed all four questionnaires from the 10-year study were included in the analysis. Anxiety scores from the Hospital Anxiety and Depression Scale were used in latent class growth analysis to chart the anxiety trajectory of cancer survivors. Demographic variables, clinical variables, depression level, and coping profiles (adaptive versus maladaptive) were used as predictors. Our study identified a two-class model of long-term anxiety trajectory among breast cancer survivors, with a resistant group (85.2%) and a distress group (14.8%). Demographic and clinical variables were not associated with anxiety trajectory paths. On the other hand, maladaptive coping characterized by higher scores in helplessness/hopelessness, cognitive avoidance, and anxious preoccupation, and lower scores in fighting spirit and fatalism in the Mini-MAC was a significant predictor of distressed anxiety. Coping profiles identified using the Mini-MAC were predictive of long-term anxiety trajectory among breast cancer survivors in our survey. Early interventions on coping with cancer could reduce long-term anxiety problems.

Change in death metaphors among university students in Hong Kong from 2004 to 2016.

Death metaphors are a meaningful way to understand personal perceptions of death, an important construct affecting how people live. This study collected death metaphor data among 100 university students in Hong Kong in 2016 and compared the findings with another study reported in 2004. Interpersonally oriented death metaphors were still popular among students a decade later. There was a general decrease in positive perception of death and an increase in negative perception of death from 2004 to 2016. Death metaphors are useful tools in death education programs, especially in cultures where death is a taboo topic.

Cancer-coping profile predicts long-term psychological functions and quality of life in cancer survivors.

PURPOSE: Cancer survivors experience significant psychosocial distress even after completion of cancer treatment. The association between cancer coping and cancer recovery is not well established. The present study investigated the cancer-coping profile and cancer outcomes in breast cancer survivors. METHODS: A three-wave longitudinal study was conducted. In 2009 (wave 1), 248 breast cancer survivors completed a package of psychological inventories to evaluate cancer copying style, psychological distress, anxiety and depression, and quality of life. They received follow-up survey in 2012 (wave 2) and 2016 (wave 3). A latent profile analysis (LPA) was conducted among participants in wave 1 to identify cancer-coping class. Identified cancer-coping class was used to predict psychological and survival outcomes in waves 2 and 3. RESULTS: Two cancer-coping classes were identified through LPA, namely adaptive cancer coping (class I; 52%) and maladaptive cancer coping (class II; 47.8%). Demographic and clinical factors did not differ significantly between the two classes. Subsequent analyses demonstrated that the cancer-coping style in wave 1 predicted the psychological symptoms and quality of life outcomes at the two follow-ups (waves 2 and 3). Survivors in the adaptive group (class I) exhibited lower cancer distress, anxiety and depression scores, and higher quality of life scores than those in the maladaptive group did. Cancer coping were not found to be significantly associated with cancer survival or recurrence. CONCLUSIONS: The identified cancer-coping styles were predictive of the survivors' psychological symptoms, psychological well-being, and health-related quality of life but not cancer survival or recurrence.

Cognitive factors associated with depression and anxiety in adolescents: A two-year longitudinal study.

Background/Objective: To examine the roles of anxiety sensitivity and attentional bias in the development of anxiety and depression symptoms among adolescents. Method: 214 grade 7 to grade 10 Hong Kong Chinese students completed a package of psychometric inventories to measure levels of anxiety sensitivity, selective attentional processing, and anxiety and depressive symptoms in 2016 and then again in 2017. Results: Girls, when compared with boys, exhibited more anxiety symptoms and anxiety sensitivity in 2016. They also reported a significant increase in mean depression level from 2016 to 2017. Regression analyses revealed that the physical-concerns dimension of anxiety sensitivity, positive attentional bias, and to a lesser extent negative attentional bias were related to the development of both anxiety and depression symptoms one year later. Fear of mental incapacity could predict depression one year later but not anxiety symptoms. Conclusions: Intervention through anxiety sensitivity training to reduce somatic concerns and attentional bias modification to increase habitual attention to positive stimuli and to disengage from negative stimuli can reduce anxiety and depression symptoms among high school students.

Antecedentes/Objetivo: Examinar el rol de la sensibilidad a la ansiedad y del sesgo atencional en el desarrollo de los síntomas ansiosos y depresivos en adolescentes. Método: Doscientos quatorce estudiantes que cursaban entre séptimo y décimo Grado completaron pruebas para medir niveles de sensibilidad a la ansiedad, procesamiento selectivo atencional y síntomas de ansiedad y depresivos en 2016 y 2017. Resultados: Las chicas mostraron más síntomas de ansiedad y de sensibilidad a la ansiedad en 2016, en comparación con los chicos, así como un aumento significativo en el nivel promedio de depresión entre 2016 y 2017. Los análisis de regresión revelaron que la dimensión relacionada con las preocupaciones físicas de la sensibilidad a la ansiedad, el sesgo atencional positivo y, en menor medida, el sesgo atencional negativo se asociaban al desarrollo de síntomas ansiosos y depresivos después de un año. El temor a la incapacidad mental predecía la depresión después de un año, pero no los síntomas de ansiedad. Conclusiones: El entrenamiento de la sensibilidad a la ansiedad para reducir problemas somáticos y la modificación del sesgo atencional para aumentar la atención habitual a estímulos positivos y desasirse de los negativos puede reducir la ansiedad y síntomas depresivos en estudiantes de Secundaria.

A longitudinal evaluation of psychosocial changes throughout orthognathic surgery.

BACKGROUND: Jaw correction surgery can cause significant psychosocial impacts on patients. This prospective study investigated the longitudinal changes of psychosocial characteristics of patients with dentofacial deformities after jaw correction surgery and the factors that predict the psychological resilience in Hong Kong Chinese undergoing jaw correction surgery. METHODS: A longitudinal cohort study was conducted on 92 Hong Kong Chinese patients (32 males, 60 females; mean age = 24.75 ± 5.65 years), who had jaw correction surgery as treatment for their dentofacial deformities, from 1st June 2011 to 30th June 2015. Self-completed psychological inventories including Brief Symptom Inventory, Life Orientation Test, and the Adult Trait Hope Scale were used to measure distress, optimism, and hope levels respectively. Patients completed the inventories in five time points: the surgical consent signing day (usually two to three months before the surgery) (T1); one day before operation (T2), first to second post-operative week (T3), third post-operative month (T4) and sixth post-operative month (T5). RESULTS: Latent class growth analysis revealed two outcome trajectory classes: a resilience trajectory (n = 45, 48.9%) and a chronic dysfunction trajectory (n = 14, 15.2%). Another 33 (35.9%) showed erratic trajectory patterns that would not be classified into any categories. The psychological distress levels of patients in the resilience trajectory group, on average, were below the clinical threshold of the Brief Symptom Inventory at all time points. However, the opposite result was obtained for patients in the chronic dysfunctional group. Patients exhibiting a resilience trajectory pattern, when compared to those showing a chronic dysfunction pattern, had higher optimism (t(57) = 3.69, p < .0001) and hope (t(57) = 2.46, p < .05) levels at T1. Logistic regression analyses were conducted to compare the relative power of optimism and hope levels at T1 to predict resilience or chronic dysfunctional group membership. A test of the full model against a constant only model was statistically significant (χ2(2) = 24.096, p < .01). Preoperative baseline optimism (B = -.276, p < .05) but not hope (B = -.25, ns) was a significant variable to classify the outcome trajectories for psychological distress. CONCLUSIONS: Most patients were resilient to dentofacial deformities jaw correction surgery. About 15% exhibited a chronic distress pattern. An optimistic view about the surgery may enhance resilience. Pre-surgical counselling or educational sessions to facilitate a realistic positive outlook about the operation would be beneficial.

The effect of positive and negative memory bias on anxiety and depression symptoms among adolescents.

OBJECTIVE: To examine the interaction effect of anxiety and depression on the intentional forgetting of positive and negative valence words. METHODS: One hundred fifty-five grade 7 to grade 10 students participated in the study. The item-method directed forgetting paradigm was used to examine the intentional forgetting of positive-valence, negative-valence, and neutral-valence words. RESULTS: Negative-valence words were recognized better than either positive-valence or neutral-valence words. The results revealed an anxiety main effect (p = .01, LLCI = -.09, and ULCI = -.01) and a depression main effect (p = .04, LLCI = .00, and ULCI = .24). The anxiety score was negative, whereas the depression score was positively related to the directed forgetting of negative-valence words. Regression-based moderation analysis revealed a significant anxiety × depression interaction effect on the directed forgetting of positive-valence words (p = .02, LLCI = .00, and ULCI = .01). Greater anxiety was associated with more directed forgetting of positive-valance words only among participants with high depression scores. With negative-valence words, the anxiety × depression interaction effect was not significant (p = .15, LLCI = - .00, and ULCI = .01). CONCLUSION: Therapeutic strategies to increase positive memory bias may reduce anxiety symptoms only among those with high depression scores. Interventions to reduce negative memory bias may reduce anxiety symptoms irrespective of levels of depression.

A Gender-Responsive Treatment Facility in Correctional Services: The Development of Psychological Gymnasium for Women Offenders.

With increasing evidence suggesting a disparity in female and male offenders in terms of rehabilitative needs, growing concern has been placed on the development of gender-specific services for female offenders. As such, a prison-based psychological gymnasium (PSY GYM), with distinctive features in integrating cognitive-behavioral and positive-psychology concepts to address female offenders' needs, was set up in 2011. The present study aims to introduce the concept as well as present findings to evaluate the overall effectiveness of PSY GYM. Nineteen Chinese female offenders participated in a 6- to 8-month intensive training program at the Lo Wu Correctional Institution (LWCI) of the Hong Kong Correctional Services Department in Hong Kong. Psychometric inventories were used to assess their psychological distress and positive growth following the program. Participants showed significant reduction in their depression, anxiety, and stress symptoms, and in their tendency to pay attention to negative information. Furthermore, their sense of hope, gratitude, and tendency to pay attention to positive information had remarkably increased. This indicated the effectiveness of PSY GYM in facilitating successful rehabilitation for female offenders.

Motivational Interviewing to Promote Oral Health in Adolescents.

PURPOSE: Motivational interviewing (MI) is a counseling strategy to help people change their behaviors. This single-blinded randomized controlled trial evaluated the effectiveness of MI in improving adolescents' oral health. METHODS: Fifteen secondary schools were randomly assigned to three groups: (I) prevailing health education, (II) MI, and (III) MI coupled with interactive dental caries risk assessment (MI + RA). Adolescents (n = 512) with unfavorable oral health behaviors (infrequent toothbrushing and/or frequent snacking) were recruited; 161, 163, and 188 in groups I-III, respectively. Participants in the three groups received their respective interventions. At baseline and after 6 and 12 months, participants completed a questionnaire on their oral health self-efficacy and behaviors. Their oral hygiene (dental plaque score) and dental caries (number of decayed surfaces/teeth status) were recorded. RESULTS: Compared with group I, subjects in groups II and III were more likely to reduce their snacking frequency (odds ratios [95% confidence intervals {CIs}]: 7.12 [1.80-28.16] and 11.17 [2.90-42.98], respectively) and increase their toothbrushing frequency (odds ratios [95% CIs]: 5.26 [2.28-12.16] and 11.45 [4.99-26.26], respectively) after 12 months. Taking group I as a reference, groups II and III had lower number of new carious teeth △D ICDAS II 1-6MFT (ß [95% CI]: -.24 [-.44 to -.04] and -.31 [-.51 to -.11], respectively). CONCLUSIONS: MI was more effective than prevailing health education strategy in eliciting positive changes in adolescents' oral health behaviors and preventing dental caries.

The interaction effect of attentional bias and attentional control on dispositional anxiety among adolescents.

Research has shown that children and adolescents with attentional control deficits tend to have high anxiety and exhibit threat-related selective attentional bias. This study aimed to investigate how positive and negative attentional biases would interact with attentional control on dispositional anxiety. One hundred and twenty participants aged 18 years of age or younger participated in a visual dot-probe task to measure their attentional bias and completed psychological questionnaires to measure their trait anxiety, and attentional control. Mean reaction times to the probe in milliseconds were used to measure attentional bias. Overall, our participants showed a bigger tendency towards attending to positive emotional stimuli than to negative emotional stimuli. Adolescents with high dispositional anxiety showed poorer attentional control. Regression analyses showed that attentional control interact with negative attentional bias to affect anxiety. For participants with high attentional control, higher negative attentional bias was associated with lower trait anxiety. Trait anxiety was not related to negative attentional bias for participants with low attentional control. Positive attentional bias showed no significant relationship with dispositional anxiety, either alone or in interaction with attentional control. Theoretical and clinical implications of the findings are also discussed.

Randomized controlled trial of supportive-expressive group therapy and body-mind-spirit intervention for Chinese non-metastatic breast cancer patients.

PURPOSE: This study aimed to evaluate the efficacy of supportive-expressive group (SEG) therapy and body-mind-spirit (BMS) intervention on emotional suppression and psychological distress in Chinese breast cancer patients. METHODS: This three-arm randomized controlled trial assigned 157 non-metastatic breast cancer patients to BMS, SEG, or social support control group. SEG focused on emotional expression and group support, whereas BMS emphasized relaxation and self-care. All groups received 2-h weekly sessions for 8 weeks. The participants completed measurements on emotional suppression, perceived stress, anxiety, and depression at baseline and three follow-up assessments in 1 year. RESULTS: Using latent growth modeling, overall group difference was found for emotional suppression (χ 2(2) = 8.88, p = 0.012), marginally for perceived stress (χ 2(2) = 5.70, p = 0.058), but not for anxiety and depression (χ 2(2) = 0.19-0.94, p > 0.05). Post-hoc analyses revealed a significant and moderate reduction (Cohen d = 0.55, p = 0.007) in emotional suppression in SEG compared to control group, whereas BMS resulted in a marginally significant and moderate fall (d = 0.46, p = 0.024) in perceived stress. Neither SEG nor BMS significantly improved anxiety and depression (d < 0.20, p > 0.05). CONCLUSIONS: The present results did not demonstrate overall effectiveness for either BMS or SEG therapy in the present sample of Chinese non-metastatic breast cancer patients. The participants appear to derive only modest benefits in terms of their psychological well-being from either intervention.

A Brief Strengths Scale for individuals with mental health issues.

Using their strengths and virtues enables individuals to build resilience and alleviate mental health issues. However, most existing instruments for measuring strengths are too lengthy to provide effective assessment for clinical screening. A brief instrument with good factorial and ecological validity is needed to measure strengths, especially among individuals with mental health issues. In this study, the authors developed a brief inventory, the Brief Strengths Scale-12 (BSS-12), to assess 3 strengths: Temperance Strength, Intellectual Strength, and Interpersonal Strength. Two studies were conducted. Study 1 was conducted in Hong Kong. Service recipients (n = 149) from a psychiatric rehabilitation organization were recruited to establish the factor structure and construct validity of the BSS-12. In Study 2, 203 university undergraduates from mainland China were recruited to examine the factorial invariance of the BSS-12 in a different culture and population. Each factor demonstrated satisfactory internal consistency, content validity, and discriminant validity. The BSS-12 may be a useful tool for assessing strengths in clinical and nonclinical settings for service planning and the evaluation of intervention effectiveness. (PsycINFO Database Record

Emotional Valence, Arousal, and Threat Ratings of 160 Chinese Words among Adolescents.

This study was conducted to provide ratings of valence/pleasantness, arousal/excitement, and threat/potential harm for 160 Chinese words. The emotional valence classification (positive, negative, or neutral) of all of the words corresponded to that of the equivalent English language words. More than 90% of the participants, junior high school students aged between 12 and 17 years, understood the words. The participants were from both mainland China and Hong Kong, thus the words can be applied to adolescents familiar with either simplified (e.g. in mainland China) or traditional Chinese (e.g. in Hong Kong) with a junior secondary school education or higher. We also established eight words with negative valence, high threat, and high arousal ratings to facilitate future research, especially on attentional and memory biases among individuals prone to anxiety. Thus, the new emotional word list provides a useful source of information for affective research in the Chinese language.