Elderly's Homesickness: Development of Elderly Homesickness Questionnaire.

Introduction: Homesickness is a result of migration, and is related to adjustment difficulties and health problems, as well as clinical disorders. The aim of this study was to measure and explore the homesickness of Chinese elderly. Methods: A total of 355 non-local Chinese elderly in Shenzhen were recruited to measure demographic information and homesickness. and tested for reliability and validity. Patterns and influences of homesickness among Chinese elderly were explored through latent profile analysis and One-way ANOVA on the basis of EHQ. Results: A three-factor structure was verified in the 19-item elderly homesickness questionnaire (EHQ), namely "positive contact", "refusal to separate" and "homesickness behavior". The EHQ reports high validity and reliability. Chinese elderly had a high degree of homesickness, and homesickness among Chinese elderly varied significantly across variables such as age, occupation, and education level. Four homesickness patterns were found in Chinese elderly, named low homesick group, moderate homesick group, middle-high homesick group, and high homesick group. Coming from rural/urban areas and living with grandchildren are factors that affect classification. Conclusion: The present study reveals the high validity and reliability of the EHQ among Chinese elderly. The Chinese elderly reported high levels of homesickness, which varied significantly across levels of demographic factors. Four patterns of homesickness were found among the Chinese elderly, coming from rural/urban areas and living with grandchildren are the factors that affect classification. There may be a masking of the male contribution to the main effect due to the larger female sample.

Warm and Harsh Parenting, Self-Kindness and Self-Judgment, and Well-Being: An Examination of Developmental Differences in a Large Sample of Adolescents.

Objectives: This study aimed to examine the associations between warm and harsh parenting and adolescent well-being, and the mediating effects of self-kindness and self-judgment, in relationships. Moreover, this study investigated developmental differences across three adolescence stages (early, middle, and late). Methods: In total, 14,776 Chinese adolescents (mean age = 13.53 ± 2.08, 52.3% males), including individuals in early (10-12 years old, N = 5055), middle (13-15 years old, N = 6714), and late adolescence (16-18 years old, N = 3007) participated in this study. All the adolescents rated their levels of warm and harsh parenting, self-kindness and self-judgment, and well-being. Structural equation modeling (SEM) was adopted to examine the mediation model. Multi-group analysis was conducted to investigate differences in the mediation model across the different developmental stages. Results: Both warm and harsh parenting were related to adolescent well-being through the mediating effects of self-kindness and self-judgment. However, warm parenting exerted a more substantial impact on adolescent well-being. Self-kindness had a more robust mediating effect than self-judgment in relationships. Moreover, harsh parenting had a weaker impact on adolescent well-being in late adolescence than in early and middle adolescence. Warm parenting had a more significant impact on adolescent well-being in early adolescence than in middle and late adolescence. Conclusions: Overall, warm parenting had a more substantial effect than harsh parenting on adolescent well-being. The findings also highlighted the crucial mediating effect of self-kindness in the relationships between parenting and well-being. Moreover, this study also indicated the importance of warm parenting in early adolescence. Intervention programs should focus on enhancing the level of warm parenting to promote self-kindness in adolescents, in order to improve their well-being.

Predictive Models of Life Satisfaction in Older People: A Machine Learning Approach.

Studies of life satisfaction in older adults have been conducted extensively through empirical research, questionnaires, and theoretical analysis, with the majority of these studies basing their analyses on simple linear relationships between variables. However, most real-life relationships are complex and cannot be approximated with simple correlations. Here, we first investigate predictors correlated with life satisfaction in older adults. Then, machine learning is used to generate several predictive models based on a large sample of older adults (age ≥ 50 years; n = 34,630) from the RAND Health and Retirement Study. Results show that subjective social status, positive emotions, and negative emotions are the most critical predictors of life satisfaction. The Support Vector Regression (SVR) model exhibited the highest prediction accuracy for life satisfaction in older individuals among several models, including Multiple Linear Regression (MLR), Ridge Regression (RR), Least Absolute Shrinkage and Selection Operator Regression (LASSO), K Nearest Neighbors (KNN), and Decision Tree Regression (DT) models. Although the KNN and DT models exhibited better model fitting than MLR, RR, and LASSO, their performances were poor in terms of model validation and model generalization. These results indicate that machine learning is superior to simple correlations for understanding life satisfaction among older adults.

Prevalence, correlates, and behavioral outcomes of alcohol gifting in China.

INTRODUCTION: Alcohol gifting is a very common practice in China. However, little is known about the potentially adverse consequences of alcohol gifting. This study aimed to investigate the prevalence of, and factors associated with, alcohol gifting, and explore whether drinking and tobacco use were associated with alcohol gifting. METHODS: Using a cross-sectional multi-stage survey, a sample of 982 household heads from Guangdong Province and 530 household heads from Shaanxi Province was collected online from 30 April to 30 July 2020 in China. Participants completed questionnaires regarding socio-demographic characteristics, social capital, drinking status, and gifting alcohol behavior. Chi-square analysis and multiple logistic regression analysis were used to identify the factors associated with alcohol gifting, and to identify its relationship with alcohol and cigarette use status. RESULTS: Multiple logistic regression analysis showed that age, gender, household annual income, province, drinking status, and social participation were prominent correlates of both offering and receiving alcohol. Participants who were married, had an education level of junior high school, or had a large social network had higher odds of receiving alcohol. When both alcohol gifting behaviors were included in the models, participants who offered alcohol had 2.15 (95% CI: 1.63-2.85) times higher odds of current drinking than those who didn't offer alcohol and participants who received alcohol had 1.87 (95% CI: 1.45-2.41) times higher odds of current drinking than those who did not receive alcohol. Those who received alcohol had significantly higher odds of current smoking (AOR = 1.64; 95% CI: 1.25-2.14), while those who offered alcohol had significantly lower odds of current smoking (AOR = 0.71;95% CI:0.53-0.95). CONCLUSIONS: Social participation is an important correlate of alcohol gifting. Alcohol receiving behaviors were significantly associated with both current alcohol and tobacco use. These associations can be used to inform alcohol gifting interventions in China.

Effectiveness of a 4-Day Mindfulness-Based Intervention in a 2-Month Follow-Up for Chinese Incarcerated People.

Mindfulness-based interventions, an evidence-based stress reduction approach, may help incarcerated people cope with stress-related problems in the challenging environment of prison. However, due to their unique living environment, the duration and instructor guidance required by standard mindfulness-based interventions would be infeasible in most prisons. Therefore, the aims of the current study were to test the effects of two different 4-day interventions (i.e., instructor-guided and audio-based) with content similar to Mindfulness-Based Cognitive Therapy for newly incarcerated males, and to compare the effectiveness of the two interventions relative to a no-intervention control group. Using daily assessments, we explored changes in perceived stress, insomnia, and negative affect in the 56 days following the instructor-guided (N = 25), audio-based (N = 21), and control (N = 44) intervention; length of mindfulness practice during the follow-up was also compared between the two intervention groups. Hierarchical linear model results showed significantly greater linear decreases in perceived stress after both mindfulness interventions during the 56-day follow-up (γ11 = -0.011, p < .001, 95% CI [-0.017, -0.004] for instructor-guided intervention; γ12 = -0.013, p < .001, 95% CI [-0.018, -0.006] for audio-based intervention), as compared to the control group. Compared to the control group, the instructor-guided group reported a significantly greater decrease in insomnia (γ11 = -0.007, p < .001, 95% CI [-0.014, -0.002]), but the audio-based group did not (γ12 = -0.002, p = .160, 95% CI [-.007, .004]). Neither mindfulness-based intervention group reported a significantly greater decrease in negative affect compared to the control group (γ11 = -0.002, p = .170, 95% CI [-0.005, 0.001] for instructor-guided intervention; γ12 = -0.002, p = .150, 95% CI [-0.006, 0.002] for audio-based intervention). No significant difference between the two intervention groups was found in the change of outcomes (γ11 = 0.002, -0.005 and 0.000, p = .350, .130 and .390, 95% CI [-0.008, 0.011], 95% CI [-0.014, 0.004] and 95% CI [-0.004, 0.006] subsequently for perceived stress, insomnia and negative affect). Daily mindfulness practice was significantly longer for the audio-based group on the first day of follow-up (γ02 = -0.758, p < .05, 95% CI [-1.333, -0.129]), but it gradually decreased to the same amount as the instructor-guided group (t (32) = 0.051, p = .959). Short-term mindfulness interventions, either instructor-guided or audio-based, appear to be beneficial for Chinese prisoners in reducing stress. Live instruction may have potential benefit in reducing insomnia and sustaining daily practice.

The Associations of Meteorological and Environmental Factors with Memory Function of the Older Age in Urban Areas.

Individual, meteorological, and environmental factors are associated with cognitive function in older age. However, little is known about how meteorological and environmental factors interact with individual factors in affecting cognitive function in older adults. In the current study, we used mixed effects models to assess the association of individual, meteorological, and environmental factors with cognitive function among older adults in urban areas. Data from 2623 adults aged 60 to 91 years from 25 provinces (or autonomous regions/municipalities) from the China Family Panel Studies (CFPS) were used. We used the memory test in CFPS to measure memory function, while meteorological data from the daily climate data set of China's surface international exchange stations, and the traffic and greening data compiled by the National Bureau of Statistics (NBS) of China, were used to assess meteorological and environmental factors. The ICC of the empty model indicated that 7.7% of the variation in memory test scores for the older adults was caused by provincial characteristics. Results showed that the temperature and relative humidity of provinces moderated the effect of gender on the memory function for the older urban adults. Specifically, in the high temperature areas, memory scores for females were higher than those of males, and in the middle humidity areas, memory scores were also higher for the females than those of males. This study explained how meteorological and environmental factors played roles in influencing demographic factors on memory function among older adults. Further research is needed to better define the role and potential mechanism of this moderation.

The Impact of Early Neighborhood Cohesion, and Its Mechanism, on Cognitive Function in Later Life.

Objectives: This study aimed to explore the impact of early neighborhood cohesion, and its mechanism, on cognitive function in later life. Methods: In total, 10,727 Chinese elderly, aged 60-90, forming two datasets (2014 and 2018) from the China Health and Retirement Longitudinal Study (CHARLS) were used as a sample. Childhood neighborhood cohesion was measured by the extent of how much neighbors were willing to help and how close-knit neighbors were. Mini-Mental State Examination (MMSE) and Center for Epidemiologic Studies Depression Scale (CESD-10) were used to assess the cognitive functions and depression of the elderly. We used a structural equation model to examine the relationship between early neighborhood cohesion and late-life cognitive function and conducted bootstrapping analyses to assess the mechanism. Results: Cognitive function was positively predicted by childhood neighborhood cohesion (ß = 0.06, p < 0.001), and cognitive function of the elderly were also positively predicted through the mediating effects of childhood friendships, which included depression and social activity participation as two chain paths. Conclusion: The findings suggest that childhood neighborhood cohesion positively predicts cognitive function among elderly people through the mediating roles of childhood friendship, depression, and social activity engagement. Childhood neighborhood cohesion is correlated with better childhood friendships, then to fewer depression symptoms and greater elderly social activity participation, and finally to better cognitive functions in the elderly.

Self-compassion and resilience mediate the relationship between childhood exposure to domestic violence and posttraumatic growth/stress disorder during COVID-19 pandemic.

BACKGROUND: Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth (PTG) and posttraumatic stress disorder (PTSD), but it is unclear whether PTG and PTSD share a common/different underlying mechanism. AIM: To explore the common/different underlying mechanism of PTG and PTSD. METHODS: Between February 12 and 17, 2020, a nationwide cross-sectional online survey was conducted in China among 2038 university students, and a self-administered questionnaire was used for the data collection. The data included demographic characteristics, such as age, gender, and subjective social economic status, and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question, Self-compassion Scale, Connor-Davidson Resilience Scale, Posttraumatic Growth Inventory, and the Abbreviated PTSD Checklist-Civilian version. A structural equation model was used to test the hypotheses. RESULTS: Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion (PTG: ß = -0.023, 95%CI: -0.44 to -0.007; PTSD: ß = 0.008, 95%CI: 0.002, 0.014) and via a 2-step indirect path from self-compassion to resilience (PTG: ß = -0.008, 95%CI: -0.018 to -0.002; PTSD: ß = 0.013, 95%CI: 0.004-0.024). However, resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD. CONCLUSION: PTG and PTSD are common results of childhood exposure to domestic violence, which may be influenced by self-compassion and resilience.

Associations of 24-Hour Movement Behavior with Depressive Symptoms and Anxiety in Children: Cross-Sectional Findings from a Chinese Sample.

This study examined the associations between adherence to 24-hour movement behavior guidelines (24-HMB) and the mental-health-related outcomes of depressive symptoms and anxiety in Chinese children. Data on movement behavior from 5357 children (4th and 5th grades), including physical activity, recreational screen time and sleep, were self-reported using the Health Behavior School-Aged Children Survey. Depressive symptoms and anxiety were self-reported using the Chinese version of the nine-item Patient Health Questionnaire and the Generalized Anxiety Disorder Scale, respectively. Depressive symptoms and anxiety were treated as categorical variables. Only 3.2% of the participants met physical activity, screen time, and sleep 24-HMB guidelines. Ordinal logistic regressions showed that, compared with participants who met the 24-HMB guidelines, participants who met none (odds ratio (OR) = 2.62, 95% CI: 1.76-3.90) or any one of the guidelines (OR = 1.88, 95% CI: 1.27-2.77) had higher odds of depressive symptoms. Similarly, there were higher odds of anxiety in participants who met none (OR = 2.32, 95% CI: 1.45-3.70) or any one of the recommendations (OR = 1.62, 95% CI: 1.03-2.57) compared with participants who met all the 24-HMB guidelines. Meeting the 24-HMB guidelines is associated with better mental-health-related outcomes in Chinese children. Because of the low prevalence of Chinese children meeting the 24-HMB recommendations, the present findings highlight the need to encourage children to regularly engage in physical activity, decrease their time spent sitting, and improve their sleep patterns.

Mental health problems among Chinese adolescents during the COVID-19: The importance of nutrition and physical activity / Problemas de salud mental en adolescentes chinos durante el COVID-19: importancia de la nutrición y la actividad física

Mental health problems are common among adolescents and greatly influenced by stressful events. This study sought to assess the prevalence and correlates of insomnia, depressive and anxiety symptoms among Chinese adolescents during the COVID-19. Method: Cross-sectional study (N = 1,794 adolescents, mean age = 15.26) was conducted in May 2020. An online survey was used to collect socio-demographic data, COVID-related fear (COVID-fear), nutrition, physical activity (PA) level and the symptoms of insomnia, depression and anxiety. Results: The prevalence of insomnia, depressive and anxiety symptoms was 37.80%, 48.20% and 36.70%, respectively, among Chinese adolescents during the pandemic. Generalized linear models revealed that female, left behind children, and students with greater COVID-fear tended to report symptoms of insomnia, depression and anxiety concurrently. After adjusting for socio-demographic factors and COVID-fear, better nutritional status and moderately active PA were both associated with lower levels of depressive and anxiety symptoms, while highly active PA was associated with lower levels of insomnia, depressive and anxiety symptoms. Conclusions: These findings suggest that more attention should be paid to psychological health among adolescents while combating COVID-19. To promote adolescents’ mental health, educators should help adolescents develop a healthy lifestyle with balanced diet and regular exercise. (AU)

Los problemas de salud mental son comunes en adolescentes y están influenciados por eventos estresantes. Se evaluó prevalencia y correlatos de síntomas de insomnio, depresión y ansiedad en adolescentes chinos durante el COVID-19. Método: En mayo de 2020 se realizó un estudio transversal (N = 1.794 adolescentes, edad media = 15,26) mediante una encuesta en línea para recopilar datos sociodemográficos, miedo relacionado con COVID-19, nutrición, actividad física (AF) y síntomas de insomnio, depresión y ansiedad. Resultados: La prevalencia de síntomas de insomnio, depresión y ansiedad fue del 37,80%, 48,20% y 36,70%, respectivamente. Modelos lineales generalizados revelaron que mujeres, niños abandonados y estudiantes con más miedo al COVID-19 tendían a informar síntomas de insomnio, depresión y ansiedad simultaneamente. Después de ajustar los factores sociodemográficos y el miedo al COVID-19, mejor estado nutricional y AF moderadamente activa se asociaron con niveles más bajos de síntomas de depresión y ansiedad, mientras que AF muy activa se asoció con niveles más bajos de insomnio, síntomas depresivos y de ansiedad. Conclusiones: Se debe prestar más atención a la salud psicológica de los adolescentes mientras se combate el COVID-19. Para promover su salud mental, los educadores deben ayudarles a desarrollar un estilo de vida saludable con una dieta equilibrada y ejercicio regular. (AU)

Higher Handgrip Strength Is Linked to Better Cognitive Performance in Chinese Adults with Hypertension.

OBJECTIVE: There is growing evidence that in adults, higher levels of handgrip strength (HGS) are linked to better cognitive performance. However, the relationship between HGS and cognitive performance has not been sufficiently investigated in special cohorts, such as individuals with hypertension who have an intrinsically higher risk of cognitive decline. Thus, the purpose of this study was to examine the relationship between HGS and cognitive performance in adults with hypertension using data from the Global Ageing and Adult Health Survey (SAGE). METHODS: A total of 4486 Chinese adults with hypertension from the SAGE were included in this study. Absolute handgrip strength (aHGS in kilograms) was measured using a handheld electronic dynamometer, and cognitive performance was assessed in the domains of short-term memory, delayed memory, and language ability. Multiple linear regression models were fitted to examine the association between relative handgrip strength (rHGS; aHGS divided by body mass index) and measures of cognitive performance. RESULTS: Overall, higher levels of rHGS were associated with higher scores in short-term memory (ß = 0.20) and language (ß = 0.63) compared with the lowest tertiles of rHGS. In male participants, higher HGS was associated with higher scores in short-term memory (ß = 0.31), language (ß = 0.64), and delayed memory (ß = 0.22). There were no associations between rHGS and cognitive performance measures in females. CONCLUSION: We observed that a higher level of rHGS was associated with better cognitive performance among hypertensive male individuals. Further studies are needed to investigate the neurobiological mechanisms, including sex-specific differences driving the relationship between measures of HGS and cognitive performance in individuals with hypertension.

Does More Sedentary Time Associate With Higher Risks for Sleep Disorder Among Adolescents? A Pooled Analysis.

Purpose: To investigate the association between sedentary behavior and anxiety-induced sleep disorder at a global perspective. Methods:A total of 254,924 adolescents (mean age: 14.45 ± 1.42 years; 52.8% girls) who participated in the Global School-Based Student Health Survey were included for analysis. Self-reported questionnaires assessed anxiety-induced sleep disorder and sedentary behavior. Multivariable logistic regression analysis and countrywide meta-analysis were used for investigating the association between sedentary behavior and anxiety-included sleep disorder. Results:The results showed that sedentary time was linearly associated with higher OR of anxiety-related sleep disorder in adolescents across the countries and that 8 h or more per day increased the OR by 2.17 times. Countrywide meta-analysis showed that 8 h or more per day of sedentary behavior yielded an OR = 1.40 (95% CI = 1.34-1.46) of anxiety-induced sleep disorder. Moreover, the association between sedentary behavior and sleep anxiety was significant in adolescents over the age of 11 years regardless of sex. Conclusions:The findings from this study suggest that as sedentary behavior increases, sleep disorders also increase, independently of sex among adolescents. Effective preventive strategies are needed to be taken to decrease sedentary behavior that could be used to improve mental health and sleep quality among adolescents.

The relationship between childhood adversities and complex posttraumatic stress symptoms: a multiple mediation model.

Background: There is a growing research literature on complex posttraumatic stress disorder (CPTSD), yet studies that focused on Chinese populations are still limited. Accumulating evidence showed that adverse childhood experiences (ACEs) are associated with a higher likelihood of CPTSD symptoms, but potential mediating roles of self-kindness and self-judgement on the ACEs-CPTSD relationship remain understudied. Objective: The purpose of this study was to first examine the relationship between ACEs and CPTSD among Chinese college students, and then to test the mediating role of self-kindness and self-judgement on the ACEs-CPTSD relationship. Method: The study included 1361 college students for an online survey in May 2020. Demographic variables (e.g. age, gender, having sibling[s] or not, residence, family structure, and subjective socioeconomic status), ACEs, self-compassion (self-kindness and self-judgement subscales), and CPTSD symptoms were assessed. After controlling for demographic variables, a series of structural equation models tested the mediation hypothesis: indirect effects of self-kindness and self-judgement on the relationship between ACEs and CPTSD symptom. Results: ACEs of College students were positively associated with more severe CPTSD symptoms (posttraumatic stress disorder and disturbances in self-organization symptoms). Furthermore, these direct pathways were mediated by decreased self-kindness and increased self-judgement. Conclusions: Findings have substantial theoretical and treatment implications, including the two critical targets (i.e. lowering self-judgement and raising self-kindness) when treating complex PTSD.

Antecedentes: existe una creciente literatura de investigación sobre el trastorno de estrés postraumático complejo (TEPT-C), sin embargo, los estudios centrados en la población China aún son limitados. La evidencia acumulada mostró que las experiencias adversas de la infancia (ACEs en sus siglas en inglés) están asociadas con una mayor probabilidad de síntomas de TEPT-C, pero los posibles roles mediadores de la bondad hacia uno mismo y auto- juicio propio en la relación ACE-TEPT-C siguen siendo poco estudiados.Objetivo: El propósito de este estudio fue examinar primero la relación entre ACE y TEPT-C entre estudiantes universitarios chinos, y luego probar el papel mediador de la bondad y el auto-juicio en la relación ACE-TEPT-C.Método: El estudio incluyó a 1361 estudiantes universitarios para una encuesta en línea en mayo del 2020. Variables demográficas (por ejemplo, edad, sexo, tener hermanos o no, residencia, estructura familiar y estatus socioeconómico subjetivo), ACE, autocompasión (subescalas de auto-bondad y auto-juicio), y se evaluaron los síntomas de TEPT-C. Después de controlar las variables demográficas, una serie de modelos de ecuaciones estructurales probaron la hipótesis de la mediación: los efectos indirectos de la bondad personal y el auto-juicio sobre la relación entre los ACE y los síntomas de TEPT-C.Resultados: Las ACEs de los estudiantes universitarios se asociaron positivamente con síntomas de TEPT-C más graves (trastorno de estrés postraumático y alteraciones en los síntomas de autoorganización). Además, estas vías directas fueron mediadas por una disminución de la bondad hacia uno mismo y un mayor auto-juicio.Conclusiones: Los hallazgos tienen implicaciones teóricas y de tratamiento sustanciales, incluidos los dos objetivos críticos (es decir, reducir el auto-juicio y aumentar la bondad hacia uno mismo) al tratar el TEPT complejo.

The Association of Meteorological Factors with Cognitive Function in Older Adults.

Individual and meteorological factors are associated with cognitive function in older adults. However, how these two factors interact with each other to affect cognitive function in older adults is still unclear. We used mixed effects models to assess the association of individual and meteorological factors with cognitive function among older adults. Individual data in this study were from the database of China Family Panel Studies. A total of 3448 older adults from 25 provinces were included in our analysis. Cognitive functions were measured using a memory test and a logical sequence test. We used the meteorological data in the daily climate dataset of China's surface international exchange stations, and two meteorological factors (i.e., average temperature and relative humidity) were assessed. The empty model showed significant differences in the cognitive scores of the older adults across different provinces. The results showed a main impact of residence (i.e., urban or rural) and a significant humidity-residence interaction on memory performance in older adults. Specifically, the negative association between humidity and memory performance was more pronounced in urban areas. This study suggested that meteorological factors may, in concert with individual factors, be associated with differences in memory function in older adults.

COVID-19 uncertainty and sleep: the roles of perceived stress and intolerance of uncertainty during the early stage of the COVID-19 outbreak.

BACKGROUND: The COVID-19 pandemic brings unprecedented uncertainty and stress. This study aimed to characterize general sleep status among Chinese residents during the early stage of the outbreak and to explore the network relationship among COVID-19 uncertainty, intolerance of uncertainty, perceived stress, and sleep status. METHODS: A cross-sectional correlational survey was conducted online. A total of 2534 Chinese residents were surveyed from 30 provinces, municipalities, autonomous regions of China and regions abroad during the period from February 7 to 14, 2020, the third week of lockdown. Final valid data from 2215 participants were analyzed. Self-report measures assessed uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and general sleep status. Serial mediation analysis using the bootstrapping method and path analysis were applied to test the mediation role of intolerance of uncertainty and perceived stress in the relationship between uncertainty about COVID-19 and sleep status. RESULTS: The total score of sleep status was 4.82 (SD = 2.72). Age, place of residence, ethnicity, marital status, infection, and quarantine status were all significantly associated with general sleep status. Approximately half of participants (47.1%) reported going to bed after 12:00 am, 23.0% took 30 min or longer to fall asleep, and 30.3% slept a total of 7 h or less. Higher uncertainty about COVID-19 was significantly positively correlated with higher intolerance of uncertainty (r = 0.506, p < 0.001). The mediation analysis found a mediating role of perceived stress in the relationship between COVID-19 uncertainty and general sleep status (ß = 0.015, 95%C.I. = 0.009-0.021). However, IU was not a significant mediator of the relationship between COVID-19 uncertainty and sleep (ß = 0.009, 95%C.I. = - 0.002-0.020). Moreover, results from the path analysis further showed uncertainty about COVID-19 had a weak direct effect on poor sleep (ß = 0.043, p < 0.05); however, there was a robust indirect effect on poor sleep through intolerance of uncertainty and perceived stress. CONCLUSIONS: These findings suggest that intolerance of uncertainty and perceived stress are critical factors in the relationship between COVID-19 uncertainty and sleep outcomes. Results are discussed in the context of the COVID-19 pandemic, and practical policy implications are also provided.

Perceived Beliefs, Uncertainty, and Behavioral Responses During the COVID-19 Outbreak in China: Findings From a Convenience Sample.

PURPOSE: To investigate perceived beliefs, uncertainty, and behavioral responses among Chinese residents toward the COVID-19 outbreak, and explore their relationships amid an incipient pandemic. DESIGN: A cross-sectional correlational survey with a combination of a convenience and snowball sampling design. SETTING: This study was conducted online from February 7 to 14, 2020, the third week after the lockdown of Wuhan city on January 23. PARTICIPANTS: A total of 2,654 residents was contacted, 2,534 agreed to participate, and 2,215 completed valid questionnaires. The sample covered 30 provinces, municipalities, autonomous regions of China, and a broader region. MEASURES: The Uncertainty About COVID-19 Scale was applied to assess perceived public uncertainty. Five dimensions of health beliefs about COVID-19 and 12 health-related response behaviors were measured. ANALYSIS: Univariate analysis and multiple linear regression models were used to identify associations. Mediation was assessed by a bootstrapping technique. RESULTS: Five constructs of health beliefs were found to be significant predictors of multiple response behaviors. Uncertainty about COVID-19 has a direct relationship with general response behaviors (ß=-0.119**) and sanitization practices (ß=-0.068**). Emergency coping behaviors aside, uncertainty also partially mediated associations between perceived susceptibility, perceived effectiveness, and perceived barriers influencing general response behaviors and sanitization practices, respectively. CONCLUSION: Findings provide evidence-based information to government and policymakers for designing effective health communication messages and intervention strategies by targeting the key constructs of the health belief model and reducing perceived uncertainty about COVID-19. They support public health-related response behaviors to prevent COVID-19 spread among the population.

Effects of Basketball and Baduanjin Exercise Interventions on Problematic Smartphone Use and Mental Health among College Students: A Randomized Controlled Trial.

Problematic smartphone use (PSU) has become a prevalent issue worldwide. Previous studies suggest that physical exercising may effectively reduce smartphone users' addiction levels. Comparisons and further evaluations on the long-term effects of different types of exercise-based interventions on treating PSU remain to be investigated. Objective. We investigated if group-based basketball and Baduanjin exercise (a type of Qigong) would reduce PSU and improve the mental health of college students and whether such effects would be sustained. A twelve-week experiment was conducted, where 96 eligible Chinese college students with PSU were randomly assigned to two intervention arms (i.e., basketball and Baduanjin exercises) and a control arm. Outcome measures, including PSU (measured by the Mobile Phone Addiction Index in Chinese (MPAI)) and mental health indices for anxiety (measured by Self-Rating Anxiety Scale (SRAS)), loneliness (measured by the short-form of the UCLA Loneliness Scale (UCLA-LS)), inadequacy (measured by the revised Janis and Field's Feelings of Inadequacy Scale (FIS)), and stress (measured by the Chinese version of Perceived Stress Scale (CPSS)) were collected at the baseline, the end of week 12, and the two-month follow-up. A Generalized Estimating Equations (GEE) model for longitudinal data was utilized in analyses. Results. Both exercise interventions demonstrated significant effects on decreasing PSU (basketball: p < 0.01; Baduanjin: p < 0.01), feelings of anxiety (basketball: p < 0.01; Baduanjin: p=0.04), loneliness (basketball: p < 0.01; Baduanjin: p < 0.01), inadequacy (basketball: p < 0.01; Baduanjin: p < 0.01), and perceived stress (basketball: p < 0.01; Baduanjin: p=0.04), at the end of interventions. At two months after interventions, both exercise interventions demonstrated significant effects on decreasing PSU (basketball: p < 0.05; Baduanjin: p < 0.05), feelings of anxiety (basketball: p < 0.01; Baduanjin: p=0.03), loneliness (basketball: p < 0.01; Baduanjin: p < 0.01), and inadequacy (basketball: p < 0.01; Baduanjin: p=0.01), but not for feeling of stress. Furthermore, group-based basketball demonstrated larger improvements for all these significant results on reducing PSU and meanwhile improving their related mental health parameters among college students.

Mental health problems among Chinese adolescents during the COVID-19: The importance of nutrition and physical activity.

Mental health problems are common among adolescents and greatly influenced by stressful events. This study sought to assess the prevalence and correlates of insomnia, depressive and anxiety symptoms among Chinese adolescents during the COVID-19. METHOD: Cross-sectional study (N = 1,794 adolescents, mean age = 15.26) was conducted in May 2020. An online survey was used to collect socio-demographic data, COVID-related fear (COVID-fear), nutrition, physical activity (PA) level and the symptoms of insomnia, depression and anxiety. RESULTS: The prevalence of insomnia, depressive and anxiety symptoms was 37.80%, 48.20% and 36.70%, respectively, among Chinese adolescents during the pandemic. Generalized linear models revealed that female, left behind children, and students with greater COVID-fear tended to report symptoms of insomnia, depression and anxiety concurrently. After adjusting for socio-demographic factors and COVID-fear, better nutritional status and moderately active PA were both associated with lower levels of depressive and anxiety symptoms, while highly active PA was associated with lower levels of insomnia, depressive and anxiety symptoms. CONCLUSIONS: These findings suggest that more attention should be paid to psychological health among adolescents while combating COVID-19. To promote adolescents' mental health, educators should help adolescents develop a healthy lifestyle with balanced diet and regular exercise.

Los problemas de salud mental son comunes en adolescentes y están influenciados por eventos estresantes. Se evaluó prevalencia y correlatos de síntomas de insomnio, depresión y ansiedad en adolescentes chinos durante el COVID-19. Método: En mayo de 2020 se realizó un estudio transversal (N = 1.794 adolescentes, edad media = 15,26) mediante una encuesta en línea para recopilar datos sociodemográficos, miedo relacionado con COVID-19, nutrición, actividad física (AF) y síntomas de insomnio, depresión y ansiedad. Resultados: La prevalencia de síntomas de insomnio, depresión y ansiedad fue del 37,80%, 48,20% y 36,70%, respectivamente. Modelos lineales generalizados revelaron que mujeres, niños abandonados y estudiantes con más miedo al COVID-19 tendían a informar síntomas de insomnio, depresión y ansiedad simultaneamente. Después de ajustar los factores sociodemográficos y el miedo al COVID-19, mejor estado nutricional y AF moderadamente activa se asociaron con niveles más bajos de síntomas de depresión y ansiedad, mientras que AF muy activa se asoció con niveles más bajos de insomnio, síntomas depresivos y de ansiedad. Conclusiones: Se debe prestar más atención a la salud psicológica de los adolescentes mientras se combate el COVID-19. Para promover su salud mental, los educadores deben ayudarles a desarrollar un estilo de vida saludable con una dieta equilibrada y ejercicio regular.

Mental health problems among Chinese adolescents during the COVID-19: The importance of nutrition and physical activity / Problemas de salud mental en adolescentes chinos durante el COVID-19: importancia de la nutrición y la actividad física

BACKGROUND/OBJECTIVE: Mental health problems are common among adolescents and greatly influenced by stressful events. This study sought to assess the prevalence and correlates of insomnia, depressive and anxiety symptoms among Chinese adolescents during the COVID-19. METHOD: Cross-sectional study (N = 1794 adolescents, mean age = 15.26) was conducted in May 2020. An online survey was used to collect socio-demographic data, COVID-related fear (COVID-fear), nutrition, physical activity (PA) level and the symptoms of insomnia, depression and anxiety. RESULTS: The prevalence of insomnia, depressive and anxiety symptoms was 37.80%, 48.20% and 36.70%, respectively, among Chinese adolescents during the pandemic. Generalized linear models revealed that female, left behind children, and students with greater COVID-fear tended to report symptoms of insomnia, depression and anxiety concurrently. After adjusting for socio-demographic factors and COVID-fear, better nutritional status and moderately active PA were both associated with lower levels of depressive and anxiety symptoms, while highly active PA was associated with lower levels of insomnia, depressive and anxiety symptoms. CONCLUSIONS: These findings suggest that more attention should be paid to psychological health among adolescents while combating COVID-19. To promote adolescents' mental health, educators should help adolescents develop a healthy lifestyle with balanced diet and regular exercise

ANTECEDENTES/OBJETIVO: Los problemas de salud mental son comunes en adolescentes y están influenciados por eventos estresantes. Se evaluó prevalencia y correlatos de síntomas de insomnio, depresión y ansiedad en adolescentes chinos durante el COVID-19. MÉTODO: En mayo de 2020 se realizó un estudio transversal (N = 1.794 adolescentes, edad media = 1526) mediante una encuesta en línea para recopilar datos sociodemográficos, miedo relacionado con COVID-19, nutrición, actividad física (AF) y síntomas de insomnio, depresión y ansiedad. RESULTADOS: La prevalencia de síntomas de insomnio, depresión y ansiedad fue del 3780%, 4820% y 3670%, respectivamente. Modelos lineales generalizados revelaron que mujeres, niños abandonados y estudiantes con más miedo al COVID-19 tendían a informar síntomas de insomnio, depresión y ansiedad simultaneamente. Después de ajustar los factores sociodemográficos y el miedo al COVID-19, mejor estado nutricional y AF moderadamente activa se asociaron con niveles más bajos de síntomas de depresión y ansiedad, mientras que AF muy activa se asoció con niveles más bajos de insomnio, síntomas depresivos y de ansiedad. CONCLUSIONES. Se debe prestar más atención a la salud psicológica de los adolescentes mientras se combate el COVID-19. Para promover su salud mental, los educadores deben ayudarles a desarrollar un estilo de vida saludable con una dieta equilibrada y ejercicio regular

Moving More and Sitting Less as Healthy Lifestyle Behaviors are Protective Factors for Insomnia, Depression, and Anxiety Among Adolescents During the COVID-19 Pandemic.

PURPOSE: This study aimed to investigate associations of physical activity time (PAT) and sitting time (ST) independently and jointly with insomnia, depressive and anxiety symptoms among Chinese adolescents in the context of COVID-19. METHODS: A cross-sectional study including 965 adolescents (mean age = 15.26, SD = 0.46) was conducted in May 2020. PAT, ST and the symptoms of insomnia, depression and anxiety were assessed with the International Physical Activity Questionnaire Short Form, the Youth Self-Rating Insomnia Scales, the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder scale via an online survey platform. Logistic regression was used to analyze the association between COVID-19-related fear, PAT, ST and combinations of PAT and ST with insomnia, depressive and anxiety symptoms. RESULTS: COVID-19-related fear was associated with higher odds of insomnia, depressive and anxiety symptoms. PAT was associated with lower odds of insomnia and depressive symptoms, while ST was associated with higher odds of these three symptoms. After combining PAT and ST, the group with both low PAT and high ST was set as the referent. For insomnia, groups with low ST reported significantly lower odds of symptoms. For depression, groups with high PAT and/or low ST reported lower odds of symptoms. Regarding anxiety, only the group with both high PAT and low ST reported lower odds of symptoms. Generally, group with both high PAT and low ST reported lower odds of the three symptoms than the referent. CONCLUSION: COVID-19-related fear was a risk factor for developing insomnia, depressive and anxiety symptoms among Chinese adolescents. Fortunately, moving more and sitting less were good for sleep and mental health in Chinese adolescents during the pandemic. Educators should help adolescents to be more physically active in their daily life in the primary prevention of adolescent insomnia, depression and anxiety.