Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: A randomized controlled trial.

Rumination and worry are common risk factors of depression and anxiety. Internet-based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three-arm randomized controlled trial compared the efficacy of Internet-based rumination-focused cognitive behavioral therapy (RFCBT), mindfulness-based intervention (MBI), and psychoeducation (EDU) control among 256 at-risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post-intervention (6 weeks), 3-month, and 9-month follow-ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3-month follow-up among participants in RFCBT, and no significant long-term effect among participants in MBI was noted at a 9-month follow-up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow-ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.

Media exposure related to the 2008 Sichuan Earthquake predicted probable PTSD among Chinese adolescents in Kunming, China: A longitudinal study.

OBJECTIVE: This study examined the prevalence and the psychosocial predictors of probable PTSD among Chinese adolescents in Kunming (approximately 444 miles from the epicenter), China, who were indirectly exposed to the Sichuan Earthquake in 2008. METHOD: Using a longitudinal study design, primary and secondary school students (N = 3577) in Kunming completed questionnaires at baseline (June 2008) and 6 months afterward (December 2008) in classroom settings. Participants' exposure to earthquake-related imagery and content, perceptions and emotional reactions related to the earthquake, and posttraumatic stress symptoms were measured. Univariate and forward stepwise multivariable logistic regression models were fit to identify significant predictors of probable PTSD at the 6-month follow-up. RESULTS: Prevalences of probable PTSD (with a Children's Revised Impact of Event Scale score ≥30) among the participants at baseline and 6-month follow-up were 16.9% and 11.1% respectively. In the multivariable analysis, those who were frequently exposed to distressful imagery had experienced at least two types of negative life events, perceived that teachers were distressed due to the earthquake, believed that the earthquake resulted from damages to the ecosystem, and felt apprehensive and emotionally disturbed due to the earthquake reported a higher risk of probable PTSD at 6-month follow-up (all ps < .05). CONCLUSION: Exposure to distressful media images, emotional responses, and disaster-related perceptions at baseline were found to be predictive of probable PTSD several months after indirect exposure to the event. Parents, teachers, and the mass media should be aware of the negative impacts of disaster-related media exposure on adolescents' psychological health. (PsycINFO Database Record

Psychometric properties of the Chinese version of the Revised Posttraumatic Growth Inventory for Children (PTGI-C-R).

We investigated the psychometric properties of the modified 8-item Chinese version of the Revised Posttraumatic Growth Inventory for Children (PTGI-C-R) among 3256 adolescents in Chengdu, China, after the Sichuan Earthquake in 2008. The PTGI-C-R showed good reliability (Cronbach's α = .86; composite reliability = 0.87). A single factor was extracted by exploratory factor analysis and confirmed by confirmatory factor analysis in 2 randomly split half subsamples. Multigroup analyses showed that the single-factor structure was stable across gender groups and age groups (age <15 years and ≥15 years). The PTGI-C-R was negatively correlated with depression (r = -0.21) and positively correlated with resilience, social support, and perceived importance of health, family, and friendship (r ranged from 0.34 to 0.40). Our findings support the idea that the PTGI-C-R is a reliable and valid measure of posttraumatic growth among Chinese adolescents having experienced a natural disaster. Validation of the scale in the context of other traumatic events is warranted.

Validation of the Chinese version of the Children's Revised Impact of Event Scale (CRIES) among Chinese adolescents in the aftermath of the Sichuan Earthquake in 2008.

OBJECTIVE: This study examined the psychometric properties of the 13-item Chinese version of the revised Impact of Event Scale for Children (CRIES) among 3160 high school students in Chengdu, China, 1 month after the Sichuan Earthquake in 2008. METHODS: Participants self-administered a structured questionnaire in classroom settings. Posttraumatic stress symptoms (using the Chinese version of the CRIES) and other psychological variables, including depression, anxiety, thoughts of physical threat, and earthquake-related experiences, were measured. Confirmatory factor analysis and Spearman correlation analyses were conducted to confirm the factor structure and examine the validity of the CRIES. RESULTS: As in previous Western studies, confirmatory factor analysis results indicated that the 3-factor structure of the CRIES (intrusion, avoidance, and hyperarousal) provided a significantly better fit than the single-factor model and the 2-factor model. The CRIES showed good reliability (Cronbach αs for the full scale and subscales ranged from .74 to .85). The CRIES total score was positively correlated with depression, anxiety, automatic thought of physical threat, earthquake-related worries, and postearthquake suicidal ideation. CONCLUSIONS: The CRIES has shown to be reliable and valid in assessing Chinese adolescents' symptoms of potential posttraumatic stress disorder. Our findings also support the 3-factor measurement model of posttraumatic stress symptoms, which is comparable with their Western studies. Further validation studies on other forms of traumatic experience among Chinese adolescents are warranted.

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.

Factor structure and psychometric properties of the Connor-Davidson Resilience Scale among Chinese adolescents.

OBJECTIVES: Resilience refers to psychological characteristics that promote effective coping and positive adaptation in adversity. This study investigated the factor structure and psychometric properties of the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC) among adolescents. METHODS: A total of 2914 Chinese adolescents living in Chengdu, Sichuan, completed the CD-RISC 1 month after the 2008 Sichuan earthquake. They also self-administered the Multidimensional Scale of Perceived Social Support, the Children's Depression Inventory, and the Screen for Child Anxiety Related Emotional Disorders. With confirmatory factor analysis, various factor structures of the CD-RISC reported in previous studies (eg, the 5- and 3-factor models) were examined at the first-order level; and a single factor of resilience was investigated at the second-order level in this sample. The internal consistency and concurrent validity were investigated. Sex and age differences were also examined. RESULTS: Confirmatory factor analysis results showed that the 5-factor model originally derived among US community adults was replicated in our sample, and these 5 factors also loaded on a higher-order "resilience" factor. The Cronbach α coefficient was 0.89. The resilience scores demonstrated expected positive correlation with social support (r = 0.44) and negative correlations with depression (r = -0.38) and anxiety (r = -0.25) (Ps < .001). Male participants reported higher resilience scores than female participants, and younger participants also reported higher resilience scores than older participants. CONCLUSIONS: The Chinese version of the CD-RISC was demonstrated to be a reliable and valid measurement in assessing resilience among Chinese adolescents.

Psychological distress among adolescents in Chengdu, Sichuan at 1 month after the 2008 Sichuan earthquake.

A devastating earthquake occurred on May 12, 2008 in Sichuan, China. This study investigated the prevalence and factors in association with psychological problems among secondary school students living in Chengdu (90 km away from the disaster epicenter) in June 2008. In a cross-sectional survey, 3,324 secondary students self-administered a structured questionnaire in classroom setting. Validated scales were used in this study. Among all respondents, 22.3% reported post-traumatic stress disorder (PTSD); 22.6% were probable depression cases; 10.6% reported suicidal ideation; and 14.1% would like to receive psychological counseling. No gender differences were found. While social/emotional support from teachers or peers (OR from 0.40 to 0.78) and exposure to positive news reports (OR from 0.59 to 0.62) were found protective, prior experience of severe mental distress (OR from 1.60 to 2.68) and corporal punishment (OR from 1.31 to 1.58), worry about future aftershocks (OR from 1.64 to 3.11), absence from school when it was not closed (OR from 1.38 to 1.48), exposures to scary or sorrowful disaster media coverage (OR from 1.39 to 2.07), post-disaster visits to affected sites (OR from 1.51 to 1.59), separation from parents (OR = 1.61), etc., were risk factors predictive of some of the aforementioned psychological problems. Negative mental health impacts were prevalent among the respondents. Teachers, parents, and the mass media are all important in maintaining good mental health among adolescents that are indirectly affected by the severe earthquake. The results have important implications for earthquake preparedness and relief work in the future.

Posttraumatic growth and reduced suicidal ideation among adolescents at month 1 after the Sichuan Earthquake.

BACKGROUND: This study investigated posttraumatic growth (PTG) and reduced suicidal ideation among Chinese adolescents at one month after the occurrence of the Sichuan Earthquake. METHODS: A cross-sectional survey was administered to 3324 high school students in Chengdu, Sichuan. The revised Posttraumatic Growth Inventory for Children and the Children's Revised Impact of Event Scale assessed PTG and posttraumatic stress disorder (PTSD), respectively. RESULTS: Multivariate analysis showed that being in junior high grade 2, having probable PTSD, visiting affected areas, possessing a perceived sense of security from teachers, and being exposed to touching news reports and encouraging news reports were associated with probable PTG; the reverse was true for students in senior high grade 1 or senior high grade 2 who had experienced prior adversities. Among the 623 students (19.3% of all students) who had suicidal ideation prior to the earthquake, 57.4% self-reported reduced suicidal ideation when the pre-earthquake and post-earthquake situations were compared. Among these 623 students, the multivariate results showed that being females, perceived sense of security obtained from teachers and exposure to encouraging news reports were factors associated with reduced suicidal ideation; the reverse was true for experience of pre-earthquake corporal punishment and worry about severe earthquakes in the future. LIMITATIONS: The study population was not directly hit by the earthquake. This study is cross-sectional and no baseline data were collected prior to the occurrence of the earthquake. CONCLUSIONS: The earthquake resulted in PTG and reduced suicidal ideation among adolescents. PTSD was associated with PTG. Special attention should be paid to teachers' support, contents of media reports, and students' experience of prior adversities.