A mobile device-based game prototype for ADHD: development and preliminary feasibility testing.

This research aimed to devise and assess a mobile game therapy software for children with Attention-Deficit/Hyperactivity Disorder (ADHD), as well as evaluating its suitability and effectiveness in improving the cognitive ability of typically developing children. The study encompassed 55 children diagnosed with ADHD and 55 neurotypical children. Initial assessments involved ADHD-related scales, computerized tests for information processing, and physiological-psychological evaluations. After a 4-week home-based game intervention, participants underwent re-evaluation using baseline measures and provided feedback on treatment satisfaction. Considering the small proportion of study participants who dropped out, data was analyzed using both the Intention-to-Treat (ITT) analysis and the Per-protocol (PP) analysis. The trial was registered at ClinicalTrials.gov (NCT06181747). In ITT analysis, post-intervention analysis using linear mixed models indicated that the ADHD group improved significantly more than the neurotypical group particularly in Continuous Performance Test (CPT) accuracy (B = -23.92, p < 0.001) and reaction time (B = 86.08, p < 0.01), along with enhancements in anti-saccade (B = -10.65, p < 0.05) and delayed-saccade tasks (B = 0.34, p < 0.05). A reduction in parent-rated SNAP-IV scores was also observed (B = 0.43, p < 0.01). In PP analysis, paired-sample t-tests suggested that the ADHD group had significant changes pre- and post-intervention, in terms of CPT Accuracy (t = -7.62, p < 0.01), Anti-saccade task Correct Rate (t = -3.90, p < 0.01) and SNAP-IV scores (t = -4,64, p < 0.01). However, no significant changes post-intervention were observed in the neurotypical group. Survey feedback highlighted a strong interest in the games across both groups, though ADHD participants found the game more challenging. Parents of ADHD children reported perceived benefits and a willingness to continue the game therapy, unlike the neurotypical group's parents. The findings advocated for the integration of serious video games as a complementary tool in ADHD treatment strategies, demonstrating the potential to augment attentional abilities and alleviate clinical symptoms. However, a randomized controlled trial (RCT) is needed to further verify its efficacy.

Form perception is a cognitive correlate of the relation between subitizing ability and math performance.

"Subitizing" defines a phenomenon whereby approximately four items can be quickly and accurately processed. Studies have shown the close association between subitizing and math performance, however, the mechanism for the association remains unclear. The present study was conducted to investigate whether form perception assessed on a serial figure matching task is a potential non-numerical mechanism between subitizing ability and math performance. Three-hundred and seventy-three Chinese primary school students completed four kinds of dot comparison tasks, serial figure matching task, math performance tasks (including three arithmetic computation tasks and math word problem task), and other cognitive tasks as their general cognitive abilities were observed as covariates. A series of hierarchical regression analyses showed that after controlling for age, gender, nonverbal matrix reasoning, and visual tracking, subitizing comparison (subitizing vs. subitizing, subitizing vs. estimation) still contributed to simple addition or simple subtraction but not to complex subtraction ability or math word problem. After taking form perception as an additional control variable, the predictive power of different dot comparison conditions disappeared. A path model also showed that form perception fully mediates the relation between numerosity comparison (within and beyond the subitizing range) and arithmetic performance. These findings support the claim that form perception is a non-numerical cognitive correlate of the relation between subitizing ability and math performance (especially arithmetic computation).

A Latent Transition Analysis of Aggression Victimization Patterns During the Transition from Primary to Middle School.

School transitions provide contexts for adolescents to reconstruct peer relationships and re-establish social positions. Scarce research has captured the transition of aggressor and victim roles during this period and examined associated factors. To investigate the stability and shifts of aggressor and victim roles following the transition to middle school, this study conducted latent transition analysis with 1261 Chinese adolescents (32.6% female, Mage in Grade 6 = 12.1 years, SD = 0.7). Three subgroups were identified across Grades 5 to 8: aggressive-victims, victims and uninvolved. Adolescents were more likely to transition from aggressive-victim and victim roles to the uninvolved group during the transition to middle school compared to the transitions within the same educational phase. Males and those with insecure parental attachment were at higher risk of being and remaining in the involved groups. The findings underscore the dynamic nature of adolescent aggression and victimization and highlight the transition to middle school as a critical window for interventions aimed at helping adolescents disengage from aggression and victimization.

Loneliness among older Chinese individuals: the status quo and relationships with activity-related factors.

BACKGROUND: With the rapid population aging, healthy aging has become a concern for society as a whole. In this study, loneliness and its relationships with activity-related individual factors were examined among older Chinese individuals from the perspective of mental health and daily leisure activities. METHODS: The data were from the fourth investigation of the Sample Survey of the Aged Population in Urban and Rural China, which had a total of 220,506 participants. Activity ability was assessed by the Barthel Activity of Daily Living Index, a self-designed activity type questionnaire was used to evaluate activity participation, and loneliness was measured with a single-item question. RESULTS: The prevalence of varying degrees of loneliness among Chinese older individuals was 36.6%. The prevalence of loneliness among the older individuals differed significantly by age gender, age, physical health status, annual household income, education level, marital status, living status, ethnic minority status, religious faith and territory of residence. There were differences in activity participation among older Chinese adults in terms of all the demographic factors mentioned above, while there were no significant differences in living status or religious faith, and significant differences in several other demographic factors in terms of activity ability. Self-care ability, as a form of activity ability, and activity participation significantly predicted loneliness among the older participants. CONCLUSION: The topic of loneliness among Chinese older individuals is complex and requires greater attention. The buffering effect of activity-related factors on loneliness suggests that old people should improve their activity ability and participate more in daily activities.

Symptom structure of posttraumatic stress disorder in workplace trauma: A "distraction-avoidance" pattern.

BACKGROUND: Individuals who experience a workplace trauma are at a high risk of developing posttraumatic stress disorder (PTSD). Most of these people return to work soon after the trauma (i.e., experience early-stage natural exposure). This study aims to explore the response pattern of workers who have experienced a workplace trauma and early-stage natural exposure through network analysis and provide insights into the potential impact of early-stage natural exposure. METHODS: Our study included 278 workers directly experiencing the workplace explosion in the Tianjin Economic and Technological Development Zone. A partial correlation network analysis was used to explore the PTSD symptoms relationship and identify central symptoms. RESULTS: The results suggest that emotional numbness, difficulty in concentration, re-experiencing symptoms, and avoidance of thoughts are the most central symptoms, reflecting a "distraction-avoidance" pattern. CONCLUSIONS: The current study found that workers who experienced workplace trauma exhibited a "distraction-avoidance" pattern, which helps deepen our understanding of the PTSD network and leads to some suggestions on intervention measures.

Mediating effect of negative emotions on visual impairment and resilience among middle-aged and elderly populations / 预防医学

Objective @#To investigate the mediating effect of negative emotions on visual impairment and resilience among middle-aged and elderly populations, so as to provide insights into improving psychological health among middle-aged and elderly populations.@*Methods@#Demographic information, visual impairment, negative emotions and resilience in the residents at ages of 45 years and older were collected through the database of the Yushu Physical and Mental Health Survey carried out by Institute of Psychology of Chinese Academy of Sciences. Structural equation model was used to analyze the effects of visual impairment and resilience and the mediating role of negative emotions. @*Results@#Totally 2 997 middle-aged and elderly populations were enrolled, with the median age of 50.00 (interquartile range, 47.00) years. There were 1 320 males (44.04%) and 1 677 females (55.96%), 1 627 illiterate persons (54.29%), and 2 780 married persons (92.76%). The scores of visual impairment, negative emotions and resilience were (6.79±2.59), (6.35±3.05) and (33.38±10.41) points, respectively. The results of structural equation model analysis showed that after adjusting for age, gender, educational level and marital status, visual impairment had a direct negative positive effect on resilience, with a direct effect value of -0.157 (95%CI: -0.177 to -0.137), and visual impairment could also negatively affect residence through negative emotions, with a mediating effect value of -0.112 (95%CI: -0.126 to -0.104), and the mediating effect contributed 41.64% to the total effect.@*Conclusion@#visual impairment could reduce residence directly or indirectly through the mediating effect of negative emotions among middle-aged and elderly populations.

The prevalence of SCT in China, its comorbidity with ADHD and its association with life events and parental-rearing behaviors.

Although sluggish cognitive tempo (SCT) symptoms are often observed in children with attention deficit hyperactivity disorder (ADHD), an increasing number of studies have highlighted its uniqueness. Nevertheless, no national survey on SCT among children and adolescents has been conducted in China. Hence, this research aims to study SCT in China and to evaluate the differences between SCT and ADHD symptoms by comparing their risk factors in terms of life events (LE) and parental rearing behaviors (PRB). This cross-sectional study used data from a survey on 71,929 children and adolescents in 5 province-level regions in China to study the incidence and demographic information of SCT in the Chinese population. Subsequently, the study investigated the comorbidity of ADHD and SCT, and conducted three logistic regressions on the LE and PRB scores to predict whether participants develop symptoms of ADHD or SCT, or neither symptom. 6658 participants were allocated into the SCT group, and the weighted point prevalence of SCT was 9.78%. 36.34% of participants with ADHD (n = 676) were found to demonstrate SCT symptoms, whereas no statistically significant difference was observed in its comorbidity to the three ADHD subtypes (χ2 = 1.668, p > 0.05, Δ = 2). The regression results on the presence or absence of ADHD revealed paternal excessive-interference and rejection, and maternal favoring were associated with ADHD diagnosis, whereas paternal punishment and favoring and maternal emotional warmth was related to the absence of ADHD symptoms. Academic stress and maternal excessive-interference were associated with SCT symptoms, and maternal emotional warmth associated with SCT absence. Concerning the presence of ADHD-only or SCT-only symptoms, LE adaptation was found to relate to SCT-only symptoms, while PRB paternal rejection and maternal favoring were associated with ADHD-only symptoms. While evidencing the high prevalence of SCT in China, our findings supported that although ADHD and SCT were highly comorbid, they may be considered two independent disorders with different risk factors. Specifically, participants with SCT symptoms are more vulnerable to stress from LE and tend to face more maladjustment than ADHD and normally-developing participants, and maternal rearing behaviours are the key factors to SCT symptoms. SCT brings global challenges in its diagnosis and treatment, and the challenge is more severe in a mentally stressful environment. Therefore, stress management and SCT etiology studies are recommended.

Machine learning-based early diagnosis of autism according to eye movements of real and artificial faces scanning.

Background: Studies on eye movements found that children with autism spectrum disorder (ASD) had abnormal gaze behavior to social stimuli. The current study aimed to investigate whether their eye movement patterns in relation to cartoon characters or real people could be useful in identifying ASD children. Methods: Eye-tracking tests based on videos of cartoon characters and real people were performed for ASD and typically developing (TD) children aged between 12 and 60 months. A three-level hierarchical structure including participants, events, and areas of interest was used to arrange the data obtained from eye-tracking tests. Random forest was adopted as the feature selection tool and classifier, and the flattened vectors and diagnostic information were used as features and labels. A logistic regression was used to evaluate the impact of the most important features. Results: A total of 161 children (117 ASD and 44 TD) with a mean age of 39.70 ± 12.27 months were recruited. The overall accuracy, precision, and recall of the model were 0.73, 0.73, and 0.75, respectively. Attention to human-related elements was positively related to the diagnosis of ASD, while fixation time for cartoons was negatively related to the diagnosis. Conclusion: Using eye-tracking techniques with machine learning algorithms might be promising for identifying ASD. The value of artificial faces, such as cartoon characters, in the field of ASD diagnosis and intervention is worth further exploring.

Time course of attentional bias and its relationship with PTSD symptoms in bereaved Chinese parents who have lost their only child.

Background: The death of a child is a highly traumatic event for parents and often leads to posttraumatic stress disorder (PTSD). Attentional bias has been demonstrated in the onset and maintenance of PTSD symptoms.Objective: This study aimed to investigate the time course of attentional bias among bereaved Chinese parents who have lost their only child (Shidu parents), and to examine its relationship with PTSD symptoms and symptom clusters.Methods: Shidu parents (n = 38; 50-72 years of age) completed a dot-probe task with negative (trauma-related), positive, and neutral images at four stimulus presentation times (250, 500, 750, and 1250 ms). PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5).Results: We observed difficulty in disengaging from both negative and positive stimuli at 750 ms and attentional bias away from negative stimuli at 1250 ms. At 1250 ms, attentional avoidance of trauma-related stimuli was positively correlated with PCL-5 total and intrusion scores. Difficulty in disengaging from positive stimuli was negatively correlated with PCL-5 total and intrusion scores as well as negative alterations in cogniti and mood scores.Conclusions: These findings enhance our understanding of attentional bias and cognitive-affective processing in PTSD. This study provides evidence that attentional bias (difficulty in disengaging from positive stimuli and bias away from negative stimuli) are correlated with PTSD symptoms and certain symptom clusters.

The current study examined the time course of attentional bias among bereaved Chinese parents who have lost their only child through a dot-probe task and investigated its relationship with PTSD symptoms and symptom clusters.Participants exhibited difficulty in disengaging from both trauma-related and positive stimuli at 750 ms and exhibited attentional avoidance of trauma-related stimuli at 1250 ms.Attentional avoidance of trauma-related stimuli was positively correlated with PCL-5 total and intrusion scores. Difficulty in disengaging from positive stimuli was negatively correlated with PCL-5 total and intrusion scores as well as negative alterations in cognition and mood scores.

Sex Differences in Patterns of Childhood Traumatic Experiences in Chinese Rural-To-Urban Migrant Children.

BACKGROUND: Children and adolescents are likely to be exposed to various types of childhood traumatic experiences (CTEs) with gender-specific patterns. Rural-to-urban migrant children have been demonstrated a greater risk of CTE exposure than local children. However, no study has investigated sex differences in the patterns of CTEs and predictive factors among Chinese children. METHODS: A large-scale questionnaire survey of rural-to-urban migrant children (N = 16,140) was conducted among primary and junior high schools in Beijing. Childhood trauma history, including interpersonal violence, vicarious trauma, accidents and injuries was measured. Demographic variables and social support were also examined. Latent class analysis (LCA) was utilized to examine patterns of childhood trauma, and logistic regression was used to examine predictors. RESULTS: Four classes of CTEs were found among both boys and girls, labeled low trauma exposure, vicarious trauma exposure, domestic violence exposure, and multiple trauma exposure. The possibility of various CTEs in the four CTE patterns was higher among boys than girls. Sex differences also manifested in predictors of childhood trauma patterns. CONCLUSIONS: Our findings shed light on sex differences in CTE patterns and predictive factors in Chinese rural-to-urban migrant children, suggesting that trauma history should be considered along with sex, and sex-specific prevention and treatment programs should be developed.

Network structure and temporal stability of depressive symptoms after a natural disaster among children and adolescents.

Background: Previous studies have found that the postdisaster developmental course of depression is more stable than that of other mental disorders among children and adolescents. However, the network structure and temporal stability of depressive symptoms after natural disasters among children and adolescents remain unknown.Objective: This study aims to understand the depressive symptom network and evaluate its temporal stability among children and adolescents after natural disasters.Methods: Three-wave measurements were conducted among 1,466 children and adolescents at 3, 15, and 27 months following the Zhouqu debris flow. Depressive symptoms were evaluated by the Child Depression Inventory (CDI), which was dichotomised to signify the presence or absence of depressive symptoms. Depression networks were estimated with the Ising model, and expected influence was used to assess node centrality. A network comparison test was used to test the differences in the depression networks among the three temporal points.Results: Overall, the depressive symptom network was temporally stable regarding symptom centrality and global connectivity over the two-year study period. Self-hate, loneliness, and sleep disturbance were central symptoms and had low variability in the depressive networks at the three temporal points. Crying and self-deprecation had large temporal variability in centrality.Conclusion: The present study provides the first evidence for the temporal stability of the youth depressive symptom network postdisaster. The similar central symptoms and connectivity of depression symptoms at different temporal points after natural disasters may partially explain the stable prevalence and developmental trajectory of depression. Self-hate, loneliness, and sleep disturbance could be central characteristics, and sleep disturbance and reduced appetite, sadness and crying, and misbehaviour and disobedience could be key associations in the endurance of depression among children and adolescents after experiencing a natural disaster.

This study provides the first evidence for the temporal stability of the youth depressive symptom network.The depressive symptom network had temporal stability.Self-hate, loneliness, and sleep disturbance were the central symptoms among youths after a natural disaster.

Long-term anxiety and depression signatures of participants that received esophageal cancer screening: A multicenter population-based cohort study.

BACKGROUND: Current evidence on the psychological impact of screening and diagnosis of esophageal cancer (EC) is limited and unclear. METHODS: This multicenter, population-based, prospective study was conducted in five high-incidence regions in China from 2017 to 2020. The screened participants were diagnosed as healthy, esophagitis, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), or EC based on pathological biopsy. The psychological impact of the screening was assessed by comparing anxiety and depression symptoms at baseline and follow-up. RESULTS: A total of 1973 individuals were ultimately included, with an average follow-up of 22.2 months. The prevalence of anxiety and depression symptoms in screened population at baseline was 14.3% and 18.4%. The prevalence of anxiety and depression symptoms of screeners at follow-up declined (all p < 0.001). The anxiety (RR [95% CI]: 0.37 [0.30-0.46]) and depression (0.29 [0.24-0.36]) of screeners weakened over time, but the anxiety and depression symptoms was continuous for patients with HGIN and patients with EC. Compared with the participants classified as normal, the RRs(95% CI) of anxiety and depression symptoms were 2.20 (1.10-4.30) and 2.03 (1.07-3.86) for the patients with HGIN and 2.30 (0.82-6.20) and 3.79 (01.71-8.43) for the patients with EC. CONCLUSION: The anxiety and depression symptoms of screeners weakened over time, except in patients with HGIN and EC, for whom it remained lasting and high. Psychological assistance and interventions are urgently needed for individuals who are ready for screening and for those diagnosed as having HGIN or EC.

Intergenerational support and depressive symptoms in old age: The difference between urban and rural China.

Objectives: Intergenerational support is associated with fewer depressive symptoms in old age. Uneven development has resulted in huge urban-rural disparities in China, which could lead to different intergenerational relationships. The present study aimed to examine whether intergenerational support was associated with depressive symptoms differently among urban and rural Chinese older participants. Methods: A sample of 3,498 participants from nine pairs of urban subdistricts and rural villages were included in the present study. Depressive symptoms were measured by the 10-item Center for Epidemiological Studies Depression Scale, and the intergenerational support mechanisms (financial, instrumental, and emotional) were assessed with a self-designed questionnaire. Results: Significant areas by support effect for depressive symptoms indicated different associations between intergenerational financial and emotional support and depressive symptoms in urban and rural areas. Specifically, urban older participants receiving emotional support from adult children and rural older participants receiving financial support from adult children showed fewer depressive symptoms. In both areas, participants receiving instrumental support showed fewer depressive symptoms. Conclusion: Our study is the first to compare the urban-rural disparity in association between intergenerational support and depressive symptoms in a developing country, China. The results support modernization theories proposing weakened economic function but intensified emotional ties in societies with higher level of development. Communication-based intergenerational emotional support should be promoted in urban areas, and formal support systems should provide financial and instrumental support to the vulnerable rural older population.

How Maternal Trauma Exposure Contributed to Children's Depressive Symptoms following the Wenchuan Earthquake: A Multiple Mediation Model Study.

Although well-established literature has indicated the burden of mental health among victims after the Wenchuan earthquake, no research has focused on the mental health of mothers and their children who experienced the earthquake and were pregnant during or shortly after it. This study investigates the relationship between maternal trauma exposure (TE) and children's depressive symptoms after the Wenchuan earthquake and explores the risk and protective factors underlying this relationship. A sample of 547 mother-child dyads, in which the mother experienced the Wenchuan earthquake, was used to assess maternal depressive symptoms, maternal TE, children's depressive symptoms, children's perceived impact of the earthquake and maternal posttraumatic growth (PTG). The results showed that maternal TE had two significant one-step indirect associations with children's depressive symptoms (through children's perceived impact of the earthquake and maternal PTG) and one two-step indirect association with children's depressive symptoms (through maternal depressive symptoms via children's perceived impact of the earthquake). The results indicated that maternal depressive symptoms, children's perceived impact of the earthquake and maternal PTG mediated the association between maternal TE and children's depressive symptoms. These findings highlight the importance of mothers in supporting the mental health of these children. Maternal depressive symptoms and PTG, two posttraumatic outcomes, played positive and negative roles in the intergenerational transmission of trauma. Thus, post-disaster interventions should reduce the maternal transmission of trauma-related information and improve maternal PTG to support children's mental health.

The Revision and Application of Aurora in China: Based on Successful Intelligence.

Aurora Battery is a corresponding test of successful intelligence. This study aims to examine the factorial structure of the Chinese version of Aurora Battery and to investigate its internal consistency and validity, as well as to discover the developmental features of Chinese students. A total number of 2007 students were recruited from 13 schools across eastern, central, and western China, ranging from 4th to 8th grade (mean age = 12.29 years) and among them, 43.9% are girls. Confirmatory factor analysis (CFA) was used to examine the factorial structure. Among the tested models, a second-order factor model, in which the three ability factors serve as indicators of a general factor, provided an acceptable model fit to the data. Moreover, measurement invariance across gender and grades were supported, which suggests the mean scores of analytical, creative, and practical abilities are comparable in this research. The criterion-related validity analysis suggests that the battery and its three subscales have good criterion validity. The scale reliability analysis shows that the Cronbach's alpha and the McDonald's omega value of the whole test were .84 and .87, respectively, indicating the scale's internal reliability is good. For ability differences among grades, students' analytical and practical abilities increase across all grades, while creativity presents an upward trend from grade 4 to 6, followed by a downward trend from grade 6 to 7, and an increase from grade 7 to 8. Female students outperform male students on both analytical and creative ability, while with no obvious difference on practical abilities.

A profile analysis of problematic smartphone usage among college students during coronavirus disease 2019: Relations with the impact of news reports.

The coronavirus disease 2019 (COVID-19) outbreak was the first pandemic to occur in a fully globalized society. The aims of the study were to explore the state of problematic smartphone use (PSU) and its risk factors during this incident. A total of 77,211 college students were surveyed online during the COVID-19 pandemic. Conducting latent profile analysis (LPA), we found the most support for a three-class model of subgroups: over-use group (17.3% of the sample), moderate-use group (54.8% of the sample), mild-use group (27.9% of the sample). The results of multinomial logistic regression show that college students who experienced an extreme negative impact from news reports were more likely to be included in the over-use group than in the mild-use group. These results providing insights that may help foster and develop appropriate and effective solutions to prevent PSU among college students during crises, such as reducing the coverage of negative news report. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03896-0.

The psychological impact of esophageal cancer screening on anxiety and depression in China.

Objective: The psychological impact of screening is unclear and has been ignored. This study aimed to evaluate the psychological impact of esophageal cancer (EC) screening on anxiety and depression in China. Materials and methods: A multicenter, population-based study in five high-risk regions of EC was conducted from 2019 to 2020. Residents were recruited and underwent endoscopic screening and then were diagnosed with normal, esophagitis, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and EC. Subjects who did not participate in the screening were referred to as the control group. We surveyed their anxiety and depression levels at baseline and after endoscopy and informed them of different pathological results to evaluate the psychological impact of the screening process. Results: A total of 2,337 subjects completed all surveys in the screening process (normal: 355, esophagitis: 1,713, LGIN: 213, HGIN: 43 and EC: 13), with 63 controls. The levels of anxiety and depression of screeners were significantly higher than those of controls (P < 0.001). The fluctuation of anxiety and depression showed a "V" pattern in the screening process. The prevalence of anxiety symptoms at baseline, after endoscopy and after knowing the pathological results was 5.6, 0.3, and 3.2%, respectively (P < 0.001), and the corresponding prevalence of depression was 3.6, 0.2, and 2.1%, respectively (P < 0.001). With the aggravation of pathological results, the levels of anxiety and depression increased significantly (P < 0.001), especially in patients informed of HGIN (16.3 and 9.3%) and EC (23.1 and 30.8%). Conclusion: Participation in endoscopic screening may bring short-term adverse psychological effects, especially at baseline and knowing the pathological results. More attention should be given to participants waiting for endoscopic screening. The method of informing the screening results of HGIN and EC should be improved. Further precise screening is needed to concentrate on high-risk groups to reduce the psychological impact of screening.

Symptom Structure of Depression in Older Adults on the Qinghai-Tibet Plateau: A Network Analysis.

Previous studies have confirmed that depression among residents in high-altitude areas is more severe, and that depression may be more persistent and disabling in older adults. This study aims to identify the symptom structure of depression among older adults on the Qinghai-Tibet Plateau (the highest plateau in the world) from a network perspective. This cross-sectional study enrolled 507 older adults (ages 60-80 years old) from the Yushu Prefecture, which is on the Qinghai-Tibet Plateau, China. Depressive symptoms were self-reported using the shortened Center for Epidemiological Studies-Depression Scale (CES-D-10). Then, a Gaussian graphical model (GGM) of depression was developed. Poor sleep, fear, and hopelessness about the future exhibited high centrality in the network. The strongest edge connections emerged between unhappiness and hopelessness about the future, followed by hopelessness about the future and fear; hopelessness about the future and poor sleep; fear and unhappiness; and then poor sleep and unhappiness in the network. The findings of this current study add to the small body of literature on the network structure and complex relationships between depressive symptoms in older adults in high-altitude areas.

Analysis of the Difference in College Students' Experience of Family Harmony before and after the COVID-19 Outbreak.

Background: China implemented a home quarantine policy in the early days of the COVID-19 pandemic. At the same time, college students stayed at home for a long time, facing their parents and being directly exposed to family affairs every day. Thus, the effects of the COVID-19 pandemic and home quarantine on college students' experience of family harmony are worth discussing. Objectives: In this study, we aimed to explore whether there was any difference in college students' experience of family harmony before and after the COVID-19 outbreak. Methods: Participants in this study were undergraduates from a university in Tianjin. They completed the college students' experience of family harmony questionnaire (CSEFHQ) before and after the COVID-19 outbreak (December 2019 and March 2020). A total of 215 participants (96 men and 119 women) completed the whole test. Results: The paired sample t-tests showed that the scores on seven dimensions of CSEFHQ: getting along (t = 5.116, p < 0.001), conflict (t = 6.442, p < 0.001), sharing (t = 5.414, p < 0.001), self-isolation (t = 3.014, p < 0.01), help-seeking (t = 5.353, p < 0.001), avoidance (t = 6.010, p < 0.001), support-providing (t = 5.818, p < 0.001), and the total scores of CSEFHQ (t = 6.496, p < 0.001) were all significantly reduced after the COVID-19 outbreak, while the scores on the other two dimensions, undertaking housework (t = 1.379) and indifference (t = 1.765), did not change significantly. Conclusions: The college students' experience of family harmony was significantly worse after the COVID-19 outbreak. These results can be used to improve the level of family harmony of college students during the pandemic and improve their quality of life.