Investigating the reciprocity between cognition and behavior in adaptation to large-scale disasters.

Cognition and behavior could reciprocally impact each other and together determine mental health amid large-scale disasters such as COVID-19. This study reports a six-month cohort study of a population-representative sample of Hong Kong residents (N = 906) from March-August 2021 (T1) to September 2021-February 2022 (T2). Cross-lagged panel analyses reveal that T1 poor behavioral functioning as indicated by high daily routine disruptions is inversely associated with T2 cognitive adaptation as indicated by self-efficacy and meaning-making but not vice versa. T1 routine disruptions but not cognitive adaptation are positively associated with T2 probable depression/anxiety. The positive link between T1 routine disruptions and T2 probable disorders is mediated by poor cognitive adaptation at T2. The present findings suggest that upholding daily behavioral functioning relative to positive states of mind could have a more pivotal role in mental health amid large-scale disasters. Future studies can test interventions that enhance the sustainment of regular daily routines.

Low assets predict persistent depression through living difficulties amid large-scale disasters: A cohort study.

BACKGROUND: In face of large-scale disasters, persons with fewer assets are at greater risk of persistent poorer mental health than persons with more assets. Everyday daily routine disruptions and financial hardship could mediate this association. METHODS: This prospective population-representative study in Hong Kong aimed to investigate the relation between assets during the acute phase of COVID-19 (February-August 2020, T1) and persistent probable depression from T1 to March-August 2021 (T2), as well as the mediating effects of daily routine disruptions and financial hardship on the assets-depression association. RESULTS: Low assets at T1 prospectively related to persistent probable depression from T1 to T2. Primary routine disruptions (i.e., healthy eating and sleep) at T1 and financial hardship at T2 were found to fully mediate the association between T1 assets and persistent probable depression. LIMITATIONS: Persistent probable depression reported on the PHQ-9 should be further verified with clinical diagnoses/interviews. CONCLUSIONS: The COVID-19 pandemic was accompanied by a global economic downturn. Persons who have fewer assets could be at greater risk of depression during this period. Our findings suggest a need to provide behavioral and financial assistance to persons with fewer assets in the short run and a need to ensure that everyone has adequate assets to mitigate the mental health consequences of the COVID-19 pandemic in the long run.

Coping resources mediate the prospective associations between disrupted daily routines and persistent psychiatric symptoms: A population-based cohort study.

This study examined the mediating effects of coping resources in the prospective associations between daily routine disruptions in the acute phase of COVID-19 and persistent probable anxiety and depression. A prospective, population-representative cohort of 1318 Hong Kong Chinese respondents completed a baseline survey between February and July 2020 (T1) and a 1-year follow-up survey between March and August 2021 (T2). Respondents reported demographics and disruptions to primary and secondary daily routines at T1, coping resources (i.e., self-efficacy and meaning making) at T2, and anxiety and depressive symptoms at T1 and T2. We found that 8.1% and 10.0% of respondents reached cutoff scores for probable anxiety and depression respectively at both T1 and T2. Logistic regression showed that T1 daily routine disruptions were positively associated with heightened risk of persistent probable anxiety and depression amid COVID-19. Path analysis showed that 15.3% and 13.1% of the associations of daily routine disruptions with persistent probable anxiety and depression were explained by coping resources, respectively, while the direct routine-outcome associations remained significant. Daily routine disruptions predict higher odds of persistent probable anxiety and depression directly and partially through reducing coping resources. Sustainment of regular daily routines should be advocated and fostered to enhance coping resources and reduce the risk of poorer adjustment among the affected populations amid public health crises.

Testing a New Protocol of Nature-Based Intervention to Enhance Well-Being: A Randomized Control Trial.

This study aims to test the associations of nature contact with multiple dimensions of psychological functioning. A total of 90 university employees were randomly assigned to spend their lunch breaks on (1) a 30-min structured protocol of nature contact and (2) a control group for 10 consecutive weekdays. Psychological distress, psychological well-being, and work-related psychological outcomes were assessed at baseline (T1), the day after the 10-day intervention (T2), and three months after the intervention (T3). Mixed-design analyses of variance (ANOVA) were conducted. Overall, significant intervention effects were found in the structured protocol of nature contact on psychological distress, well-being outcomes, and work engagement (all p < 0.05), whereas the 3-month post-intervention effects were non-significant. Our study showed that nature-based activities during lunch breaks could enhance office workers' mental health in general, but the effects could be short-lived, calling for regular nature-based programs in occupational settings.

DEPDC1B Promotes Melanoma Angiogenesis and Metastasis through Sequestration of Ubiquitin Ligase CDC16 to Stabilize Secreted SCUBE3.

The ability of melanoma to acquire metastasis through the induction of angiogenesis is one of the major causes of skin cancer death. Here, it is found that high transcript levels of DEP domain containing 1B (DEPDC1B) in cutaneous melanomas are significantly associated with a poor prognosis. Tissue microarray analysis indicates that DEPDC1B expression is positively correlated with SOX10 in the different stages of melanoma. Consistently, DEPDC1B is both required and sufficient for melanoma growth, metastasis, angiogenesis, and functions as a direct downstream target of SOX10 to partly mediate its oncogenic activity. In contrast to other tumor types, the DEPDC1B-mediated enhancement of melanoma metastatic potential is not dependent on the activities of RHO GTPase signaling and canonical Wnt signaling, but is acquired through secretion of signal peptide, CUB domain and EGF like domain containing 3 (SCUBE3), which is crucial for promoting angiogenesis in vitro and in vivo. Mechanistically, DEPDC1B regulates SCUBE3 protein stability through the competitive association with ubiquitin ligase cell division cycle 16 (CDC16) to prevent SCUBE3 from undergoing degradation via the ubiquitin-proteasome pathway. Importantly, expression of SOX10, DEPDC1B, and SCUBE3 are positively correlated with microvessel density in the advanced stage of melanomas. In conclusion, it is revealed that a SOX10-DEPDC1B-SCUBE3 regulatory axis promotes melanoma angiogenesis and metastasis, which suggests that targeting secreted SCUBE3 can be a therapeutic strategy against metastatic melanoma.

Disrupted daily routines mediate the socioeconomic gradient of depression amid public health crises: A repeated cross-sectional study.

OBJECTIVE: There is a socioeconomic gradient to depression risks, with more pronounced inequality amid macroenvironmental potential traumatic events. Between mid-2019 and mid-2020, the Hong Kong population experienced drastic societal changes, including the escalating civil unrest and the COVID-19 pandemic. We examined the change of the socioeconomic gradient in depression and the potential intermediary role of daily routine disruptions. METHOD: We conducted repeated territory-wide telephone surveys in July 2019 and July 2020 with 1112 and 2034 population-representative Cantonese-speaking Hong Kong citizens above 15 years old, respectively. Stratified by year, we examined the association between socioeconomic indicators (education attainment, household income, employment status and marital status) and probable depression (nine-item Patient Health Questionnaire [PHQ-9] ⩾ 10) using logistic regression. Differences in the socioeconomic gradient between 2019 and 2020 were tested. Finally, we performed a path analysis to test for the mediating role of daily routine disruptions. RESULTS: Logistic regression showed that higher education attainment in 2019 and being married in 2020 were protective against probable depression. Interaction analysis showed that the inverse association of higher education attainment with probable depression attenuated in 2020 but that of being married increased. Path analysis showed that the mediated effects through daily routine disruptions accounted for 95.9% of the socioeconomic gradient of probable depression in 2020, compared with 13.1% in 2019. CONCLUSION: From July 2019 to July 2020, the mediating role of daily routine disruptions in the socioeconomic gradient of depression in Hong Kong increased. It is thus implied that infection control measures should consider the relevant potential mental health impacts accordingly.

The relation of unrest-related distress with probable depression during and after widespread civil unrest.

Background: This study investigated whether subjective unrest-related distress was associated with probable depression during and after the 2019 anti-ELAB movement in Hong Kong. Methods: Population-representative data were collected from 7157 Hong Kong Chinese in four cross-sectional surveys (July 2019-July 2020). Logistic regression examined the association between subjective unrest-related distress and probable depression (PHQ-9 ⩾ 10), stratified by the number of conflicts/protests across the four timepoints. Results: Unrest-related distress was positively associated with probable depression across different numbers of conflicts/protests. Conclusion: Unrest-related distress is a core indicator of probable depression. Public health interventions should target at resolving the distress during seemingly peaceful period after unrest.

Trends of depression and anxiety during massive civil unrest and COVID-19 in Hong Kong, 2019-2020.

Both COVID-19 and unrest are posing a significant threat to population mental health across the globe. This study examined trends of probable depression and anxiety during a time of civil unrest and concurrent COVID-19 in Hong Kong. Four random digit dialing telephone surveys were conducted in July 2019 (n = 1112), February-March 2020 (n = 2003), April-May 2020 (n = 2008), and July-August 2020 (n = 2034). The prevalence of probable depression increased from 25.7% (95% CI: 23.2-28.3) in July 2019 to 28.2% (95% CI: 26.2-30.1) in February-March 2020, and then decreased to 15.3% (95% CI: 14.0-17.0) in April-May 2020 and 13.7% (95% CI: 12.2-15.2) in July-August 2020. The prevalence of probable anxiety was 19.2% (95% CI: 17.5-20.9) in February-March 2020 and then stabilized in April-May 2020 and July-August 2020 (14.1%, 95% CI: 12.0-15.8). Probable depression and anxiety were more prevalent among persons with high relative to low daily routine disruptions. Combined high unrest-COVID-19 stress was associated with probable depression and anxiety across all persons; high unrest stress alone was associated with probable mental disorders at high daily routine disruptions. Civil unrest and COVID-19 are jointly associated with depression and anxiety among Hong Kong citizens. While population mental health improved, daily routine disruptions is a risk factor of mental disorders at every time-point.

Age-Related Differences of Rumination on the Loneliness-Depression Relationship: Evidence From a Population-Representative Cohort.

BACKGROUND AND OBJECTIVES: This study examined the association of loneliness with depressive symptoms across various age groups. Loneliness is a significant risk factor for precipitating depressive symptoms. Rumination, a mechanism that underpins depression, can become intense when a person feels lonely. In addition, age is a major factor associated with changes in mental and physical health. Thus, the importance of rumination and age in moderating the loneliness-depression link were investigated. RESEARCH DESIGN AND METHODS: This cross-sectional study was conducted during the acute phase of the coronavirus disease 2019 pandemic in Hong Kong (February 27 to March 17, 2020). A population-representative sample of 1,972 people (1,107 females; 18-92 years of age) was recruited and interviewed via telephone through random digit dialing. This sample included 394 younger adults (18-30 years), 1,106 middle-aged adults (31-64 years), and 472 older adults (65 years or above). Respondents reported depressive symptoms, subjective loneliness, state rumination, and sociodemographic factors. RESULTS: Loneliness and rumination were positively associated with depressive symptoms, and they significantly interacted in predicting cognitive-affective symptoms. Further analysis of age showed that the interaction was significant only in middle-aged adults and older adults. Both rumination and age interacted with loneliness, respectively, in predicting cognitive-affective symptoms. DISCUSSION AND IMPLICATIONS: These findings indicate that the strength of the association between loneliness and the cognitive-affective symptoms of depression depends on rumination levels and age. An intervention to regulate rumination offers a feasible direction for health care and social care aimed at improving older adults' mental health.

FSTL1 Secreted by Activated Fibroblasts Promotes Hepatocellular Carcinoma Metastasis and Stemness.

The tumor microenvironment plays a critical role in maintaining the immature phenotype of tumor-initiating cells (TIC) to promote cancer. Hepatocellular carcinoma (HCC) is a unique disease in that it develops in the setting of fibrosis and cirrhosis. This pathologic state commonly shows an enrichment of stromal myofibroblasts, which constitute the bulk of the tumor microenvironment and contribute to disease progression. Follistatin-like 1 (FSTL1) has been widely reported as a proinflammatory mediator in different fibrosis-related and inflammatory diseases. Here we show FSTL1 expression to be closely correlated with activated fibroblasts and to be elevated in regenerative, fibrotic, and disease liver states in various mouse models. Consistently, FSTL1 lineage cells gave rise to myofibroblasts in a CCL4-induced hepatic fibrosis mouse model. Clinically, high FSTL1 in fibroblast activation protein-positive (FAP+) fibroblasts were significantly correlated with more advanced tumors in patients with HCC. Although FSTL1 was expressed in primary fibroblasts derived from patients with HCC, it was barely detectable in HCC cell lines. Functional investigations revealed that treatment of HCC cells and patient-derived 3D organoids with recombinant FSTL1 or with conditioned medium collected from hepatic stellate cells or from cells overexpressing FSTL1 could promote HCC growth and metastasis. FSTL1 bound to TLR4 receptor, resulting in activation of AKT/mTOR/4EBP1 signaling. In a preclinical mouse model, blockade of FSTL1 mitigated HCC malignancy and metastasis, sensitized HCC tumors to sorafenib, prolonged survival, and eradicated the TIC subset. Collectively, these data suggest that FSTL1 may serve as an important novel diagnostic/prognostic biomarker and therapeutic target in HCC. SIGNIFICANCE: This study shows that FSTL1 secreted by activated fibroblasts in the liver microenvironment augments hepatocellular carcinoma malignancy, providing a potential new strategy to improve treatment of this aggressive disease.

Trauma exposure and mental health of prisoners and ex-prisoners: A systematic review and meta-analysis.

The present meta-analytic review examined the associations between different forms of trauma and mental disorders among prisoners and ex-prisoners. Studies published from 1998 to March 31 2021 were identified by searching PsycINFO, PubMed, Medline and Web of Science. Data were meta-analyzed using a random-effect model. Moderator and mediator analyses were conducted. The protocol was registered in PROSPERO (CRD42020181587). We identified 62 studies (50 non-duplicated samples) with 15,115 (97.86%) prisoners and 330 (2.14%) ex-prisoners in 16 countries. A multi-level meta-analysis found that overall trauma was positively associated with more diagnoses or symptoms of mental disorders (Zr = 0.198, 95% CI = [0.167, 0.229], p < 0.001). Stronger effect sizes were found between childhood trauma (Zr = 0.357, 95% CI = [0.147, 0.568], p < 0.01) and sexual trauma (Zr = 0.326, 95% CI = [0.216, 0.435], p < 0.001) and stress-related disorders. Multilevel moderator analysis showed that effect size was stronger in imprisonment trauma (ß = 0.247, 95% CI = [0.177, 0.316], p < 0.01), mixed trauma (ß = 0.234, 95% CI = [0.196, 0.272], p < 0.001), and stress-related disorders (ß = 0.261, 95% CI = [0.214, 0.307], p < 0.01). Associations between trauma and mental disorders were mediated by social support but not coping. Our findings provide an evidence base for future research on the impact of trauma and inform assessments and interventions in correctional settings.

Psychiatric symptoms and behavioral adjustment during the COVID-19 pandemic: evidence from two population-representative cohorts.

This study examined prevalences of anxiety and depression and their correlations with daily routines among Hong Kong Chinese during the COVID-19 pandemic. Random digit dialing recruited two population-representative samples of 6029 residents during a period of low infection and limited intervention (survey 1: n = 4021) and high incidence and intensive measures (survey 2: n = 2008). Prevalence of anxiety for survey 1 and survey 2 were 14.9% and 14% and depression were 19.6% and 15.3%, respectively. Increased odds of anxiety and depression were associated with disrupted routines and lower socioeconomic status in both surveys, whereas depression was inversely related to the novel preventive routine of avoiding going to crowded places in survey 1. The prevalences of anxiety and depression were higher than preceding public health/social crises. A heavier burden of psychiatric conditions was evidenced amongst people experiencing disrupted daily routines across different phases of the pandemic and without novel preventive routines in the early phase.

Civil unrest, COVID-19 stressors, anxiety, and depression in the acute phase of the pandemic: a population-based study in Hong Kong.

PURPOSE: To examine the joint associations of civil unrest and COVID-19 with probable anxiety and depression during the first half of 2020 in Hong Kong. Associations were compared between persons with low or high assets. METHODS: A population-representative sample of 4011 Hong Kong Chinese residents aged 15 years or older were recruited between February and May 2020. Respondents reported current anxiety and depressive symptoms, unrest stress, COVID-19 stress, assets (savings and home ownership), and demographics. RESULTS: Stress due to unrest and COVID-19 was associated with higher prevalence of probable anxiety and depression; persons with both stressors had higher prevalence. This pattern was consistent among persons with low or high assets, but the probabilities of mental disorder were substantially higher among persons with fewer assets. CONCLUSIONS: The effect of stressors on probable anxiety and depression are cumulative: persons with stress due to civil unrest and to COVID-19 reported more mental disorders than persons with stress due to only one, or none of these factors. Overall high assets appear to buffer the consequences of stressors, lowering the risk of mental disorder.

Probable anxiety and components of psychological resilience amid COVID-19: A population-based study.

BACKGROUND: This study examined the associations between components of psychological resilience and mental health at different levels of exposure to COVID-19 stressors. METHODS: A population-representative sample of 4,021 respondents were recruited and assessed between February 25th and March 19th, 2020. Respondents reported current anxiety symptoms (7-item Generalized Anxiety Disorder scale [GAD-7]), cognitive components (perceived ability to adapt to change, tendency to bounce back after adversities) and behavioral components (regularity of primary and secondary daily routines) of resilience, worry about COVID-19 infection, and sociodemographics. RESULTS: Logistic regression revealed that cognitive and behavioral components of resilience were not correlated with probable anxiety (GAD-7≥10) among those reporting no worry. Among respondents who were worried, all resilient components were inversely associated with probable anxiety. Specifically, propensity to bounce back and regular primary routines were more strongly related to lower odds of probable anxiety among those reporting lower levels of worry. LIMITATIONS: The cross-sectional design limits causal inference. Second, other resilient components and some key daily routines that could be related to better mental health were not assessed. Third, generalizability of the findings to other similar major cities is uncertain because cases and deaths due to COVID-19 in Hong Kong have been comparatively lower. CONCLUSIONS: To foster mental health, cultivation of confidence in one's ability to adapt to change and a propensity to bounce back from hardship should be coupled with sustainment of regular daily routines. Such assessment and intervention protocols could be more relevant to those who suffer heightened levels of exposure to COVID-19 stressors.

Probable depression and suicidal ideation in Hong Kong amid massive civil unrest.

PURPOSE: This study examined prevalence and correlates of probable depression and suicidal ideation among Hong Kong Chinese residents amidst the anti-extradition bill protests. METHODS: Random digit dialing recruited a population-representative sample of Hong Kong residents aged 15 years or older during the first three weeks of July, 2019. Respondents reported current depressive symptoms and suicidal ideation, participation in protest activities, attitudes and perceived stress, disruptions to daily routines, and demographics. RESULTS: Among 1112 respondents, 25.7% reported probable depression, and 9.1% reported suicidal ideation. Multivariable logistic regression showed that persons with higher odds of probable depression had primary education and high disruptions to regular routines of eating, sleep, socializing, and leisure activities. Persons who were at higher odds of suicidal ideation had lower household income, used social media to engage in the protests, and had medium or high disruptions to regular eating and sleep. CONCLUSIONS: During the anti-extradition bill protests, the prevalence of probable depression and suicidal ideation were substantially higher than would be expected and higher than during the Umbrella Movement of 2014. Psychiatric morbidity may be a consequence of massive social movements, particularly among persons with limited protective resources whose daily life is disrupted by these events.

Social Capital, Income Loss, and Psychobehavioral Responses amid COVID-19: A Population-Based Analysis.

This study examined the associations of perceived social capital and income change since the outbreak with probable depression and preventive behaviors during the COVID-19 pandemic in Hong Kong. Random digit dialing recruited a population-representative sample of 3011 Hong Kong Chinese aged ≥ 15 years (mean = 44, 55% females) between February 25 and April 29 2020. Respondents reported social capital (perceived interpersonal trust, social harmony, and sense of belonging), income change since the outbreak (loss vs. gain/no change), depressive symptoms, preventive behaviors, and demographics. Controlling for sociodemographics, lack of perceived interpersonal trust was associated with probable depression and avoiding contact with people with respiratory symptoms. Lack of perceived sense of belonging was associated with probable depression and decreased odds of adopting preventive behaviors. Lack of perceived social harmony was associated with probable depression and increased odds of used face masks among respondents with income loss only. Our results suggest that social capital is related to lower risk of depression and to higher chance of used face masks particularly among those experiencing income loss related to COVID-19. Prevention of mental health problems and promotion of effective preventive behaviors could be implemented by focusing on support for those who are socioeconomically disadvantaged.