What Could Highly Engaged Workers Gain From Mental Health Promotion Programs?: An Exploratory Analysis of Secondary Outcomes of Brief Daily Workplace Well-being Programs.

OBJECTIVE: The current study aims to examine the effects of mental health programs on well-being among highly engaged workers. METHODS: Participants were randomly allocated to body-mind-spiritual or peer support program. Of the whole sample, we examined participants' work engagement and positive affect from the highest quarter and the lowest quarter of work engagement at baseline. Measures were taken at baseline and 1-month intervals during 3-month programs and 3-month follow-up. RESULTS: The programs had decreasing effects on work engagement in the HWE subgroup. There is an increasing trend of positive affect on the HWE group only in the body-mind-spiritual program. The trajectories of work engagement in the HWE group moved toward a moderate level. CONCLUSION: Our results suggest that the work engagement's decrease in the HWE group could be a sign of recovery and relaxation.

Minor Forms of Parental Maltreatment and Educational Achievement of Immigrant Youths in Young Adulthood: A Longitudinal Study.

Parental hostility and emotional rejection-or aggregated as general harsh family interactions with parents-have received little research attention due to such parent-child interactions being counted as minor forms of parental maltreatment and regarded as being less harmful. However, recent research showed that these minor forms of parental maltreatment on youth development are far from negligibility on account of their frequency, chronicity, and incessancy. In this longitudinal study, we investigated how parental hostility, emotional rejection, and harsh family interactions with parents of in early adolescence of immigrant youths (wave-1 Mage = 14) adversely impact successful college graduation of immigrant youths in young adulthood (wave-3 Mage = 24) through the mediation of their development of academic aspirations in late adolescence (wave-2 Mage = 17). Using data from a representative sample of the Children of Immigrants Longitudinal Study (N = 3344), the current study revealed that parental hostility, emotional rejection, and harsh family interactions with parents significantly impaired successful college graduation of immigrant youths in young adulthood, with the decreased odds of 20.1% to 30.22%. Furthermore, academic aspirations of immigrant youths in late adolescence not only significantly mediated the abovementioned relationships but also contributed to the higher odds of immigrant youths' college graduation by 2.226 to 2.257 times. Findings of this study related to educational innovations, family services, and policy implications are discussed herein.

Where There's a Will, There's a Way? Social and Mental Forces of Successful Adaptation of Immigrant Children in Young Adulthood.

Although the twenty-first century is deemed as a new era of globalization, waves of immigration continue, due to disparities between politically and economically unstable regions and Western democratized and developed countries. Immigration research has therefore reignited its attention on the successful adaptation of immigrants' offspring, which has profound implications for Western immigrant-receiving countries, as well as worldwide stability. Although immigration research mainly informed by the conventional assimilation theory and/or segmented assimilation perspective accentuates the importance of structural factors, termed as social forces here, in relation to immigrant children's successful adaptation in adolescence, an argument of determinism and tenability keeps on and the contribution of human mental resources and determination, termed as mental forces here, in shaping life trajectories of immigrant children should be not ignored. For this, with a representative sample of 3344 immigrant children from the Children of Immigrants Longitudinal Study (CILS), we examined and compared both the effects of social and mental forces measured in adolescence of immigrant children on their multiple adaptation outcomes in terms of college graduation, engagement in postgraduate study, and first and current job attainments in young adulthood with a Bayesian multilevel modeling framework. The results found that both social forces of segmented assimilation theory and mental forces of immigrant children in adolescence were significantly predictive of immigrant children's successful adaptation in young adulthood (OR = 1.088-2.959 and ß = 0.050-0.639 for social forces; OR = 11.290-18.119 and ß = 0.293-0.297 for mental forces), in which, although the latter showed stronger effects than the former, the effects of mental forces on adaptation of immigrant children were conditionally shaped by the contexts of the social forces informed by segmented assimilation theory. The findings of the current study highlight the significance of the organism-environment interaction perspective on immigration research and provide an insight to consider a context-driven response thesis proposed.

Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol.

Studies have consistently showed that informal caregivers have worse health, more medical consultations, anxiety and depression, and lower quality of life than those who do not provide such care. Positive outcomes of psychoeducation interventions have been found, but many of them are relatively long in duration, making them less cost-effective in implementation. The proposed study is a multi-site, three-arm randomized controlled trial of a mindfulness-based intervention for Chinese family caregivers. Effects of the intervention will be compared with those of an evidence-based psychoeducation program and treatment-as-usual. Two hundred forty cross-generational caregivers of frail older adults with moderate to severe levels of frailty will be recruited and randomly assigned to mindfulness-based intervention, psychoeducation, and treatment-as-usual experimental conditions. Program effectiveness will be analyzed on measures of caregiver burden, depression, anxiety, positive caregiving experience, spirituality, family conflict, and the biomarker of heart rate variability. Measures on coping styles, experiential avoidance, and self-efficacy will be explored to see if they mediate the changes to participant improvements in outcomes. Six-month follow-up will be included to investigate the maintenance effects. This study will provide evidence on mindfulness-based interventions on caregivers of frail older adults and expand the existing models of intergenerational caregiving in Chinese culture.

Intimate Partner Sexual Violence and Mental Health Indicators Among Chinese Emerging Adults.

Intimate partner sexual violence (IPSV) among emerging adults, including heterosexuals and sexual minorities in the Chinese population, is poorly understood. Focusing on college students, the objectives of the present study were to estimate the prevalence of IPSV among Chinese emerging adults, examine the association between sexual orientation and IPSV, and evaluate the mental health and quality of life of survivors of IPSV. Data were collected from four university campuses in Hong Kong. A total of 1,015 participants were included in the data analysis. The prevalence of IPSV as identified by Conflict Tactics Scale (CTS)-2 was 12.1%. There was no gender difference in the prevalence of IPSV. Multiple logistic regression found that being older; having experienced childhood sexual abuse and having a smoking habit; and belonging to a sexual minority were factors associated with IPSV. Multiple linear regression found that IPSV survivors were more likely to have higher levels of anxiety and depression, more severe psychosomatic symptoms, and poorer quality of life in three domains: psychological, social relationships, and environment when compared with those without IPSV experience. The documented factors underscored the importance of awareness that men and sexual minorities might incur IPSV, which should receive more attention in IPSV prevention programs. Also, interventions for IPSV survivors should be targeted at improving their mental health and quality of life and sex education should place more emphasis on sexual consent and sexual health in dating relationships.

Study Protocol of Brief Daily Body-Mind-Spirit Practice for Sustainable Emotional Capacity and Work Engagement for Community Mental Health Workers: A Multi-Site Randomized Controlled Trial.

BACKGROUND: Given the emotional demanding nature of social services, we developed a brief daily body-mind-spirit (BMS) program and successfully piloted it with workers at elderly services. The proposed study focuses on community mental health workers who are often under chronic stress and vulnerable to burnout. METHODS: The study aims to evaluate the program for fostering sustainable emotional capacity and work engagement for community mental health workers. A multi-site randomized controlled trial design is adopted. All the 24 the Integrated Community Centre for Mental Wellness (ICCMW of Hong Kong will be approached to join this program. Assuming conservatively, 60% ICCWM (14 centers) will respond and participate. At each site, a pair of intervention and control groups will be run. The targeted total sample size is 224. To investigate the course of changes in burnout and engagement, each group will last 6 months, including 3-month intervention and 3-month follow-up. Measures will be taken at monthly intervals. DISCUSSION: In light of literature and the pilot trial's findings, participants in the Brief Daily BMS intervention group are expected to have a reduced burnout level and a narrowing of range in work engagement during the 3 months intervention. And within the 3 months post-intervention period, a rebound of burnout level and a widening of range in work engagement are expected to be observed in the same group of participants. Hopefully, this study will contribute to the deeper understanding of burnout and work engagement, and shed light on sustainable intervention for emotionally demanding workplaces. CLINICAL TRIAL REGISTRATION: The trial has been registered in the Clinical Trials Centre of the University of Hong Kong. HKUCTR-2763 Registered 27 December 2019 - Retrospectively registered, http://www.hkuctr.com/Study/Show/eb930d24e2c647afb7a922055163f24b.

Effects of a Mindfulness-based Intervention on diurnal cortisol pattern in disadvantaged families: A randomized controlled trial.

OBJECTIVE: The present study examined the psychophysiological effects of Family-based Mindfulness Intervention (FBMI) on children and parents from disadvantaged families. METHODS: This randomized controlled trial recruited parents and their children from 51 disadvantaged families in Hong Kong and randomized them into FBMI (n = 26) and waitlist control (n = 25) groups. The parent intervention included 6 sessions and the child intervention included 8 sessions with 2 half-hour joint programs. Both interventions lasted 9 hours in total each. All participants completed four salivary cortisol measures after wakeup, before lunchtime, late-afternoon, and before sleep at baseline and end of the intervention. The diurnal cortisol pattern was summarized by the morning cortisol, evening cortisol, mean cortisol, and diurnal cortisol slope. RESULTS: Compared to the control group, children in the FBMI group showed significant increases in morning cortisol (d = 0.50, p =  0.03) and significant decreases in diurnal cortisol slopes (d = 0.50, p =  0.04) at the end of intervention. Parents in the FBMI group displayed significant decreases in evening cortisol (d = 0.50, p =  0.04) compared to the control group at the end of intervention. No significant treatment effects were found on the mean cortisol. DISCUSSION: The present findings suggest that FBMI could improve the diurnal cortisol slope and cortisol levels of the children and parents from disadvantaged families, respectively. Future studies should elucidate its potential benefits on neuroendocrine functioning.

The Effects of Family-Based Mindfulness Intervention on ADHD Symptomology in Young Children and Their Parents: A Randomized Control Trial.

Objective: The aim of the study is to investigate the feasibility of a family-based mindfulness intervention in improving children with inattention and hyperactivity symptoms. Method: A total of 100 children aged 5 to 7 years with ADHD symptoms and their parents were randomly assigned to a family-based mindfulness intervention (n = 50) or a wait-list control group (n = 50). Results: Families from intervention group had greater improvements in children's ADHD symptoms, with medium effect sizes of -0.60 for inattention and -0.59 for hyperactivity; overall behaviors; and parenting stress and well-being than those in wait-list control group. Conclusion: The positive results on the child primary outcome measures have provided initial evidence of the family-based mindfulness intervention as a treatment option to ADHD. The reduction of parental stress and increase in psychological well-being has demonstrated the value of mindfulness in enhancing parent's self-management.

The effect of a brief mindfulness-based intervention on personal recovery in people with bipolar disorder: a randomized controlled trial (study protocol).

BACKGROUND: With the advent of the recovery movement in mental health, a humanistic paradigm shift has occurred, placing the focus on personal recovery (i.e., hope, identity, and life meaning) instead of functional or clinical recovery only (i.e., symptom reduction or increases in physical function). Along the journey of recovery, people with bipolar disorder (BD) struggle to cope with recurring mood fluctuations between depression and mania. Mindfulness-based interventions (MBIs) have the potential to result in improvements in personal recovery outcomes. Thus, this protocol will evaluate the efficacy and mechanisms of a brief MBI for helping individuals with BD with their personal recovery. It is hypothesized that adults with BD randomly assigned to a brief MBI intervention will report greater improvements in personal recovery than those in a waiting list control condition. In addition, it is hypothesized that such benefits will be mediated by improvements in emotion awareness, emotion regulation, and illness acceptance. Moreover, the specific stage of BD is hypothesized to moderate the beneficial effects of the brief MBI, such that those in the early stage of BD will report more benefits regarding emotion awareness and emotion regulation, whereas those in the late stage of BD will report more advantages concerning illness acceptance. METHOD: One hundred and fifty-four adults with BD will be recruited from hospitals and community settings for this research project. This study will use a mixed methods design. A randomized-controlled trial will be conducted to compare a brief MBI (four sessions in total) group and a waiting list control group. Assessments will be made at baseline, after intervention, and at six-month follow-up. In addition, a qualitative and participatory research method called Photovoice will be employed to further understand the experiences of the participants who receive the brief MBI along their personal recovery journey. DISCUSSION: If the study hypotheses are supported, the findings from this research project will provide empirical support for an alternative treatment. Moreover, by identifying the mechanisms of the beneficial effects of the brief MBI, the findings will highlight process variables that could be specifically targeted to make MBI treatment even more effective in this population. TRIAL REGISTRATION: This study is registered with the Chinese Clinical Trial Registry ( ChiCTR- 1900024658 ). Registered 20th July 2019.

Corrigendum: A Multidimensional PERMA-H Positive Education Model, General Satisfaction of School Life, and Character Strengths Use in Hong Kong Senior Primary School Students: Confirmatory Factor Analysis and Path Analysis Using the APASO-II.

[This corrects the article DOI: 10.3389/fpsyg.2018.01090.].

A Multidimensional PERMA-H Positive Education Model, General Satisfaction of School Life, and Character Strengths Use in Hong Kong Senior Primary School Students: Confirmatory Factor Analysis and Path Analysis Using the APASO-II.

The multidimensional PERMA-H positive education model provided evaluation and education framework for the theoretical and practice development of positive psychology in schools. Character strengths use mediates the association of strength knowledge and well-being. Using the Assessment Program for Affective and Social Outcomes (2nd Version) (APASO-II), the Subjective Happiness Scale, and the Physical Health Subscale of the PERMA-profiler, a multidimensional measure of PERMA-H was validated using confirmatory factor analysis in the context of a positive education program evaluation in senior primary school students. The association of PERMA-H measurements with school well-being as measured by general satisfaction of school life, and levels of depression and anxiety, and the mediation mechanism of character strengths use in such association were studied using path analysis. A cross-sectional sample of 726 senior primary school students (i.e., grade 4-6) aged 8-13 from the two primary schools completed a baseline evaluation questionnaire of a positive education program. Satisfactory internal reliability of the scales was obtained with Cronbach's alpha coefficients < 0.70. The scales were generally positively and moderately inter-correlated, except for level of anxiety and depression symptoms which was negative. Good psychometric properties of APASO-II were evidenced from the factor structure of sub-scale scores conforming to six factors of the PERMA-H model by confirmatory factor analysis. Path analyses showed that the APASO-II factors together with measures of subject happiness and positive health as the multidimensional PERMA-H model of positive education differentially predicted general satisfaction of school life, level of anxiety and depression, and character strengths use. Character strengths use mediated the relationship of Positive Engagement with general satisfaction of school life. Positive education utilizes knowledge and research findings from positive psychology in schools to produce intended positive outcomes like enhanced well-being and reduced level of depression in students. This study provided a solid foundation for related scientific research and the understanding of the multidimensional framework of positive psychology concepts. Systematic promotion and longitudinal evaluation of positive education at the institutional level in Hong Kong can be achieved with the use of APASO-II and the positive education scales of subjective happiness and physical health.

Association Between Using Smartphone Dating Applications and Alcohol and Recreational Drug Use in Conjunction With Sexual Activities in College Students.

BACKGROUND: The association between using smartphone dating applications (apps) and substance use in conjunction with sexual activities was only examined in homosexual men. This association was poorly understood in heterosexual samples. OBJECTIVE: To explore the association between using dating apps and alcohol, and use of recreational drug in conjunction with sexual activities in college students. DESIGN: 666 students from four universities in Hong Kong were recruited in this cross-sectional study in the year 2015. Outcome measures included the use of dating apps, sexual history, and drug and alcohol use. Multivariable logistic regressions were employed. RESULTS: The use of dating apps for more than 1 year was found to be associated with recreational drug use in conjunction with sexual activities (adjusted odds ratio: 7.23). Other risk factors of recreational drug use in conjunction with sexual activities included being bisexual/homosexual male, a smoker, and having one's first sexual intercourse at the age of less than 16 years. The use of dating apps was not a risk factor for alcohol consumption in conjunction with sexual activities. Risk factors for alcohol consumption in conjunction with sexual activities included being older, having monthly income more than HKD5,000, and a smoker. Furthermore, risk factors for alcohol consumption in conjunction with the last sexual activity included currently being in a dating relationship, a smoker, and having sex with a casual partner. CONCLUSIONS: Using dating apps is an emerging risk factor of drug misuse. Interventions for practising safe sex and preventing drug use should be targeted at dating app users.

The association between smartphone dating applications and college students' casual sex encounters and condom use.

OBJECTIVE: This study aims to explore the association between using smartphone dating applications (apps) and having unprotected sex with a casual sex partner. STUDY DESIGN: This is a cross-sectional study. Students were recruited from four university campuses in Hong Kong by convenience sampling. MAIN OUTCOME MEASURES: Subjects completed a structured questionnaire asking about the use of dating apps, sexual history and socio-demographic information. Multiple logistic regressions were used to explore the association between using dating apps and having unprotected sex with a casual sex partner. RESULTS: Six hundred and sixty-six subjects were included in the analysis. Users of dating apps were more likely to have had unprotected sex with a casual sex partner the last time they engaged in sexual intercourse (aOR: 10.06). Using dating apps for more than 12 months was associated with having a casual sex partner in the last sexual intercourse (aOR: 3.21), as well as having unprotected sex with that casual partner (aOR: 13.56). CONCLUSION: We found a robust association between using dating apps and having unprotected sex with a casual sex partner, implying that using dating apps is an emerging sexual risk factor. We recommend that interventions promoting the safe use of dating apps should be implemented.

The effect of a family-based mindfulness intervention on children with attention deficit and hyperactivity symptoms and their parents: design and rationale for a randomized, controlled clinical trial (Study protocol).

BACKGROUND: About 4 % of children in Hong Kong have attention deficit hyperactivity disorder (ADHD). The parents of children with ADHD report higher levels of stress and show more negative parenting behavior. Medication and behavior training are evidence-based treatments, but both show significant limitations. In short, medical treatment is not suitable for preschool children and would suppress growth, whereas parents under stress may not be capable of consistently applying behavior management skills. Mindfulness training can improve attention and facilitate cognitive development and overall functioning. It has been widely adopted as a treatment option in health care, but its application in a family context is limited. In this context, a family-based mindfulness intervention (FBMI) has been developed to promote the attention and mental health of children with attention symptoms and to reduce the stress experienced by their parents. This article describes the design and conduct of the trial. METHODS/DESIGN: A multicenter, 8-week, waitlist, randomized controlled trial of FBMI is currently being conducted in Hong Kong (from mid-2015 to mid-2016). Its effectiveness will be examined by comparing the participants who receive treatment to those in a waitlist control group. The study population consists of one hundred twenty children with ADHD, or with symptoms of inattention and hyperactivity, between 5 and 7 years of age and their parents. To be included in the study, the children are required to meet or exceed the borderline cutoff score of the Chinese version of the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors Rating Scale (SWAN-C). The primary outcome measures are the children's ADHD symptoms and behavior and the parents' stress. The secondary outcome measures include the children's overall behavioral problems and performance on the Attention Network Test, the parents' ADHD symptoms, the parents' mindful parenting scores, and heart rate variability of parents. DISCUSSION: This study is probably the first randomized controlled trial of FBMI for young children and their caregivers. A rigorous design and multiple outcome measures are used to examine the effectiveness of FBMI. If the hypotheses are confirmed, FBMI may serve as an additional treatment option for children with ADHD. TRIAL REGISTRATION: This study is registered with the Chinese Clinical Trial Registry (reference number: ChiCTR-IOR-15007292 ). Registered 28 October 2015.

The roles of emotional competence and social problem-solving in the relationship between physical abuse and adolescent suicidal ideation in China.

The study investigated the relationship among physical abuse, positive psychological factors including emotional competence and social problem-solving, and suicidal ideation among adolescents in China. The possible moderating effects of emotional competence and social problem-solving in the association between physical abuse and adolescent suicidal ideation were also studied. A cross-sectional survey employing convenience sampling was conducted and self-administered questionnaires were collected from 527 adolescents with mean age of 14 years from the schools in Shanghai. Results showed that physical abuse was significantly and positively related to suicidal ideation in both male and female adolescents. Emotional competence was not found to be significantly associated with adolescent suicidal ideation, but rational problem-solving, a sub-scale of social problem-solving, was shown to be significantly and negatively associated with suicidal ideation for males, but not for females. However, emotional competence and rational problem-solving were shown to be a significant and a marginally significant moderator in the relationship between physical abuse and suicidal ideation in females respectively, but not in males. High rational problem-solving buffered the negative impact of physical abuse on suicidal ideation for females. Interestingly, females with higher empathy and who reported being physically abused by their parents have higher suicidal ideation. Findings are discussed and implications are stated. It is suggested to change the attitudes of parents on the concept of physical abuse, guide them on appropriate attitudes, knowledge and skills in parenting, and enhance adolescents' skills in rational problem-solving.

The Chinese medicine construct "stagnation" in mind-body connection mediates the effects of mindfulness training on depression and anxiety.

OBJECTIVES: Previous studies have identified different, but highly correlated variables explaining the effects of mindfulness training. Many of them are limited by tautological explanation. Under the framework of the mind-body connection, mindfulness training cultivates body awareness and promotes self-management of illness. Stagnation, a concept from Chinese medicine, may help explain the mechanism of change in mindfulness training. METHODS: Individuals with depressive and anxiety symptoms (n=82) were randomized to either a Compassion-Mindfulness Therapy (C-MT) program or a waitlist control condition. The effect of stagnation as a mediator was investigated for dependent variables including depression, anxiety, and other physical and mental health variables. MAJOR OUTCOME MEASURES: Depression, anxiety, stagnation, physical distress, daily functioning, positive affect, negative affect. RESULTS: Compared with the participants in the control group, those who completed C-MT demonstrated significant decreases in depression, F(1, 78)=15.67, p<.001, anxiety, F(1, 78)=7.72, p<.001, stagnation, F(1, 78)=4.96, p<.001, and other body-mind-spirit well-being measures. After entering the change in stagnation as the mediator, the effect of treatment reduced: depression (.35-.22), anxiety (.33-.05), and same patterns in other three secondary measures. The Sobel test was administered and significant reductions between group and depression (z=2.18, p=.029), anxiety (z=2.21, p=.027), and three secondary other measures (p<.05) were indicated. CONCLUSION: The study provides initial support for the role of stagnation in mediating changes in mindfulness training. It adds evidence to body-mind nondualism and offers new possibilities in studying treatment process and change mechanism.

A randomized, controlled clinical trial: the effect of mindfulness-based cognitive therapy on generalized anxiety disorder among Chinese community patients: protocol for a randomized trial.

BACKGROUND: Research suggests that an eight-week Mindfulness-Based Cognitive Therapy (MBCT) program may be effective in the treatment of generalized anxiety disorders. Our objective is to compare the clinical effectiveness of the MBCT program with a psycho-education programme and usual care in reducing anxiety symptoms in people suffering from generalized anxiety disorder. METHODS: A three armed randomized, controlled clinical trial including 9-month post-treatment follow-up is proposed. Participants screened positive using the Structure Clinical Interview for DSM-IV (SCID) for general anxiety disorder will be recruited from community-based clinics. 228 participants will be randomly allocated to the MBCT program plus usual care, psycho-education program plus usual care or the usual care group. Validated Chinese version of instruments measuring anxiety and worry symptoms, depression, quality of life and health service utilization will be used. Our primary end point is the change of anxiety and worry score (Beck Anxiety Inventory and Penn State Worry Scale) from baseline to the end of intervention. For primary analyses, treatment outcomes will be assessed by ANCOVA, with change in anxiety score as the baseline variable, while the baseline anxiety score and other baseline characteristics that significantly differ between groups will serve as covariates. CONCLUSIONS: This is a first randomized controlled trial that compare the effectiveness of MBCT with an active control, findings will advance current knowledge in the management of GAD and the way that group intervention can be delivered and inform future research. Unique Trail Number (assigned by Centre for Clinical Trails, Clinical Trials registry, The Chinese University of Hong Kong): CUHK_CCT00267.