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Background: Chronic insomnia (CI) is the most common subtype of insomnia. Auricular acupoint therapy (auricular acupoint bloodletting plus auricular acupressure) is a common treatment for CI, but its efficacy is uncertain due to the poor quality of previous studies. The purpose of this study is to evaluate the efficacy and safety of auricular acupoints in the treatment of CI by comparing with sham auricular acupoint therapy. Methods: This is a multicenter, randomized, two-arm interventional clinical trial. Participants will participate in the study for a total of 18 weeks, consisting of three phases: 2 weeks of screening, 4 weeks of treatment, and 12 weeks of follow-up. Based on the response rate of the primary outcome in our previous study, 156 randomly allocated participants are planned. Eligible participants will be randomly assigned to the auricular acupoint therapy group and sham auricular acupoint therapy group according to a ratio of 1:1. A total of 8 sessions in 4-week treatment period will be carried out. The primary outcome is a response rate at week 4, and the responder is defined as the percentage of those having at least 3 points reduction in insomnia symptoms from baseline as measured via the Pittsburgh Sleep Quality Index (PSQI). Furthermore, response rates at other weeks, PSQI, Insomnia Severity Index (ISI), Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), World Health Organization Quality of Life Scale-Abbreviated Form (WHOQOL-BREF), as well as sleep efficiency (SE), sleep arousal frequency (SA) and total sleep time (TST) recorded by actigraphy are chosen as secondary outcomes. Trial registration: www.chictr.org.cnIdentifer: ChiCTR2200065187, Registered 31 Oct 2022.

Background Suicide is a major public health safety concern among youth. Childhood emotional abuse is one of the most widely recognized risk factors for suicidal behaviors. However, little is known about the role of sleep problems and emotion dysregulation in this relationship. Methods This study is part of a large-scale health-related cohort among Chinese college students. A total of 7434 participants who completed the first three waves of data collection were used for data analysis. All participants completed questionnaires regarding childhood emotional abuse (Wave 1), sleep problems and emotional dysregulation (Wave 2), and suicidal behaviors (Wave 3). Mediation analyses with bootstrapping were conducted to investigate the mediating role of sleep problems and emotional dysregulation in the relationship between childhood emotional abuse and suicidal behaviors. Results The results showed that the prevalence of childhood emotional abuse and suicidal behaviors were 8.7% and 5.9%, respectively. Findings from mediation analysis showed that sleep problems and emotional dysregulation served both parallel and sequential mediating roles in the relationship between childhood emotional abuse and suicidal behaviors. Limitations All measures were based on self-report instead of objective assessments or clinical diagnostic evaluations. Conclusions Psychological interventions aimed at developing healthy sleep habits and emotion regulation skills may be helpful in decreasing the risk of suicidal behaviors, especially for suicide ideators with childhood emotional abuse.

A growing number of studies have documented that sleep problems were associated with suicidal ideation. However, little is known about the mediating and moderating mechanisms underlying this relation. The present study examined whether mental distress mediated the relationship between poor sleep quality and suicidal ideation, and whether this mediating process was moderated by family functioning. A sample of 1520 community adults (49.6% males, 18–35 years old) recruited from the community through social media completed an online survey regarding sleep quality, mental distress, family functioning and suicidal ideation. The current study found that the prevalence of suicidal ideation among community adults was 30.0%, and females had a higher prevalence than males. After controlling for demographic variables, poor sleep quality was positively associated with suicidal ideation. Mediation analysis indicated that mental distress partially mediated the association between poor sleep quality and suicidal ideation. Tests of moderated mediation further revealed that family functioning moderated the second part of the mediation process. Specifically, mental distress was a significant risk factor for suicidal ideation in community adults with low family functioning, but not for those with high family functioning. This study helps to elucidate the mechanism that underlined the pathway between sleep problems and suicidal ideation among community adults. Psychological interventions aimed at reducing sleep problems and mental distress may be helpful for decreasing the risk of suicidal ideation, especially for suicide ideators with poor family functioning.

Background Sleep disturbance can be an important predictor associated with suicide behaviors. However, to date, few studies have examined the prospective relationships between different types of sleep disturbance and suicidal behaviors. The current study examined which sleep disturbance types were independent risk factors for subsequent suicidal behaviors in a large sample of Chinese college students. Methods Data came from a large-scale health-related cohort study in Guangdong, China. Participants were 11,740 college students initially assessed in March and April in 2019 and reassessed six month later. Self-administered structured questionnaires were used to assess suicidal behaviors, insomnia, nightmares, sleep disordered breathing (SDB) symptoms, restless legs syndrome (RLS) symptoms, depression, substance abuse and demographic characteristics. A series of logistic regression analyses were conducted to examine the associations between different types of sleep disturbance and suicidal behaviors. Results Overall, 12.2% and 1.2% of college students reported suicidal ideation and attempts at baseline, and 8.6% and 2.4% reported similar behavior at follow-up. After adjustment for key covariates and prior suicidal behaviors, frequent nightmares (AORs = 1.35–1.69) and RLS symptoms (AOR = 1.37) at baseline predicted subsequent suicidal ideation, and only frequent nightmares (AOR = 2.40) at baseline predicted subsequent suicidal attempts. Limitations All measures were based on self-report instead of objective assessments or clinical diagnostic evaluations. Conclusions Frequent nightmares and RLS symptoms were independently associated subsequent suicidal ideation or attempts. Screening and managing sleep disturbance may be helpful for reducing the risk of suicidal behaviors among college students.

Internalizing and externalizing problems are the most prevalent health problems among adolescents. However, few studies have examined co-occurring internalizing and externalizing problems from a longitudinal perspective.A total of 1051 seventh-grade students from two junior high schools were recruited at baseline. Among them, 932 valid participants were reassessed 1 year and 2 years later. Data were analyzed using parallel-process latent class growth analysis and multinominal logistic regression.Four joint trajectories of internalizing and externalizing problems were identified. Compared with the low-risk group, adolescents in the moderate and chronic co-occurring group had lower resilience, higher levels of insecure attachment, family conflicts, and academic pressure. Adolescents in the pure internalizing group had higher levels of family conflicts and academic pressure compared with the low-risk group.Co-occurrence of symptoms is very high in adolescents. More individualized intervention programs should be provided to these specific groups.

This 10-year cohort study explored whether individual differences in resilience during early stages post-earthquake could have diverse impacts on future PTG and whether the impacts varied by sex. 1357 Chinese adolescent survivors of the Wenchuan earthquake were assessed on their resilience at 6-, 12-, 18-, and 24-months post-earthquake. 799 participants responded to an online survey 10 years later, and 744 of which provided useable data for subsequent analysis. Resilience trajectories were modeled using the latent class growth analysis. Linear regressions were used to test the predictive effects of different resilience trajectories on subsequent PTG. Of 744 samples (M

Objective Depression is highly prevalent among 1st-year college students, and evening chronotype is an important risk factor associated with depression. This study investigates the mediating role of sleep quality and the moderating role of resilience between chronotype and depressive symptoms. Methods A total of 4531 students were included in this cross-sectional study. Mediation and moderated mediation models were applied. Results The association between chronotype and depressive symptoms was partially mediated by sleep quality, and the direct and indirect effects were moderated by resilience. The negative correlation between chronotype and depressive symptoms was significant in students with low levels of resilience compared with moderate/high levels. The positive correlation between sleep quality and depressive symptoms was strongest in low-level resilience students. Conclusion This study reveals that greater eveningness is associated with poorer sleep quality among 1st-year college students, which may lead to severer depression, and highlights the importance of resilience training in reducing depressive symptoms.

Background : Maternal psychopathology can be an important factor associated with psychological adjustment of children. However, there is limited research on long-term impacts of maternal posttraumatic stress disorder (PTSD) on children's mental health. This study examined how PTSD trajectories of women exposed to the 2008 Wenchuan earthquake in China predicted their children's mental health symptoms 10 years after the earthquake. Methods : 410 dyads of mothers and their adolescent children who exposed to the Wenchuan earthquake were investigated at 12 and 18 months post-earthquake. While the mothers completed measures of earthquake exposure and PTSD symptoms, the children completed measures of earthquake exposure, PTSD, depression and anxiety symptoms. In the 10-year follow up, 257 out of the 410 children completed measures of PTSD, depression and anxiety symptoms. Data were analyzed using linear regression. Results : Four trajectories of maternal PTSD symptoms were identified: (a) chronic (9.5%); (b) resilient (66.3%); (c) delayed (7.6%); and (d) recovery (16.6%); More importantly, the findings demonstrated that children whose mothers experienced chronic PTSD reported higher level of PTSD and anxiety symptoms 10 years after the earthquake. Limitations : Only two waves of maternal PTSD were collected, self-reported tools other than clinical reviews were used to collect data, and a significant proportion of participants did not respond at the 10-year follow-up. Conclusions : This study identified maternal PTSD trajectories following the Wenchuan earthquake. Chronic PTSD symptoms in mothers were associated with increased risk of children's PTSD and anxiety 10 years after the earthquake.

Aim Individual vulnerability to shift work disorder (SWD) varies. The aim of the present study was to verify the individual characteristics that predicted SWD onset by following Chinese intern nurses who at baseline had not worked rotating or night shifts. Methods A total of 706 Chinese first-year intern female nurses aged 16–24 years were recruited. At baseline (T0), they reported demographic characteristics, insomnia symptoms and excessive sleepiness, trait neuroticism, sleep reactivity, morningness, and circadian flexibility and languidity. At the three-month (T1) and six-month (T2) follow-up, the SWD status was determined based on significant sleep disturbance and/or excessive sleepiness in the context of working a rotating shift schedule. Results and conclusions The prevalence rates of SWD were 35.2% at T1 and 37.7% at T2. Two bivariate logistics regressions revealed that morningness (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 1.09–1.58, T1; OR = 1.36, 95% CI = 1.12–1.65, T2), languidity (OR = 1.56, 95% CI = 1.28–1.90, T1), and sleep reactivity (OR = 1.29, 95% CI = 1.07–1.57, T1; OR = 1.31, 95% CI = 1.07–1.61, T2) predicted the onset of SWD, while flexibility (OR = 0.75, 95% CI = 0.62–0.90, T1) decreased the odds of SWD onset. By comparing nurses with SWD and nurses without SWD across all six months, morningness (OR = 1.58, 95% CI = 1.20–2.07), sleep reactivity (OR = 1.54, 95% CI = 1.16–2.04), languidity (OR = 1.70, 95% CI = 1.30–2.22), and flexibility (OR = 0.70, 95% CI = 0.54–0.90) showed significant effects on persistent SWD.

Suicide is a major public health concern, especially among adolescents and young adults. Although research has begun to explore the developmental trajectories of suicide-related outcomes, most have thus far focused on children and adolescents. The current study extends existing literature by identifying subgroup trajectories and related factors of college students over a two-year period.The data used in this study was obtained from an ongoing longitudinal study in Guangdong, China. A total of 3871 students participated in assessments performed at three time points at one-year assessment intervals. Growth mixture modeling (GMM) was used to estimate trajectory classes for suicidal behaviors, followed by multivariable logistic regression to explore the association between predictive factors and classes.GMM analyses extracted two distinct trajectories of suicidal behaviors: a low-decreasing group (n = 3669, 94.8 %) and a high-increasing group (n = 202, 5.2 %). Multivariate logistic regression analyses revealed that depressive symptoms, non-suicidal self-injury, hopelessness, and childhood emotional abuse served as risk factors for the high-increasing group, while reasons for living served as protective factors.Psychological interventions aimed at reducing the influence of risk factors and bolstering reasons to live may help to decrease the risk of suicide behaviors in college students.

The aim of this study was to translate and validate the Screen for Adult Anxiety Related Emotional Disorders (SCAARED). The original SCAARED was translated into Chinese and administered 6371 Chinese college students (45.4% females, mean age 18.64 ± 0.89) aged 17-28. The factor structure of SCAARED in Chinese was examined by confirmatory factor analysis and exploratory structural equation modeling (ESEM). Internal consistency and criterion-related validity were also evaluated. The four-factor structure of the SCAARED (generalizing anxiety disorder, separation anxiety disorder, social anxiety disorder and panic disorder) fit the sample well. The SCAARED and its each dimension demonstrated good internal consistency, split-half reliability and criterion-related validity. Similar to other versions of SCAARED, Chinese version of the SCAARED showed that excellent psychometric properties. These findings support that the SCAARED is a reliable and valid anxiety disorder screening instrument in Chinese college students. Future replication studies are warranted in diverse samples and clinical populations.

Sleep problems and mental health problems are of great concern after the disasters. Although some studies have established that sleep problems and internalizing and externalizing problems are associated in children and adolescents who have not experienced trauma, the directionality of this association and whether sleep problems are differentially associated with different types of internalizing and externalizing problems after disasters are largely unknow. Data came from a cohort study of Chinese adolescents after earthquake. A total of 1275 adolescents (Mage = 15.96, SD = 1.30; 56.2% female) were surveyed at 18 months (T18m) and 30 months (T30m) post-earthquake. Self-administered structured questionnaires were used to assess sleep problems, and internalizing and externalizing problems. Cross-lagged models were used to investigate reciprocal relations between two variables over time after adjusting for some confounders. Significant bidirectional associations were detected between sleep problems and emotional symptoms (sleep to emotion: β = 0.15; emotion to sleep: β = 0.17), peer problems (sleep to peer: β = 0.07; peer to sleep: β = 0.06), and ADHD symptoms (sleep to ADHD: β = 0.14; ADHD to sleep: β = 0.13). Although sleep was a significant driver of later conduct problems (β = 0.14), the reverse association was not significant. Given that sleep problems may precipitate internalizing and externalizing problems in disaster-exposed adolescents, early intervention programs aimed at improving sleep quality may be helpful in promoting and preventing mental health after disasters.

Previous cross-sectional studies have documented that sleep reactivity was associated with depressive symptoms, but the potential mechanisms underlying this relationship were understudied. Therefore, the present study with a longitudinal prospective design was to reveal the mediating roles of sleep disturbance and emotion regulation difficulties (ERD) between sleep reactivity and depressive symptoms. This study included 725 student nurses who were followed up periodically for 9 months, with an interval of three months. All participants completed questionnaires regarding sleep reactivity, sleep disturbance, ERD, and depressive symptoms. Adjusted analyses suggested that the direct effect of sleep reactivity on depressive symptoms was non-significant. The bootstrap procedure revealed two significant indirect effects: from sleep reactivity to depressive symptoms with sleep disturbance as a mediator and from sleep reactivity to depressive symptoms with sleep disturbance and ERD as sequential mediators. Therefore, sleep reactivity might be considered as an indicator of shiftwork adaptability in the evaluation of recruitment. Psychological interventions aimed at developing healthy sleep habits and emotion regulation skills may be helpful in decreasing the risk of depression.

Considerable studies have explored the potential mechanisms between trauma exposure and PTSD, but little is known about the role of sleep problems and resilience in this relationship. To address this research gap, the present study examined whether sleep problems mediated the relationship between earthquake exposure and PTSD symptoms, and whether this mediating process was moderated by resilience. A sample of 1,342 adolescents (Mage = 15.54 years, SD = 1.26) completed questionnaires regarding earthquake exposure, sleep problems, resilience, and PTSD symptoms 12 months after a devastating earthquake in China. After controlling for demographic variables, earthquake exposure was significantly, and positively associated with PTSD symptoms, and sleep problems partially mediated this relationship. Tests of moderated mediation further revealed that resilience moderated the relationship between earthquake exposure and PTSD symptoms as well as sleep problems and PTSD symptoms. Specifically, the relationship between earthquake exposure and PTSD symptoms was only significant for adolescents with a lower level of resilience; meanwhile, the positive relationship between sleep problems and PTSD symptoms was stronger among low-resilient adolescents. Therefore, sleep-targeted and resilience-based interventions may be effective in alleviating PTSD symptoms resulted from the earthquake.

Background In this study, we examined psychometric properties of the Chinese version of the Resilience Scale (RS) and parenting-related factors associated with resilience among disaster-exposed adolescents. Methods Eighteen months after the earthquake, a total of 1266 adolescents (43.4% male, mean age = 15.98; SD = 1.28) were assessed using the RS, the Post-traumatic Stress Disorder Self-Rating Scale, the Depression Self-rating Scale for Children, the Screen for Child Anxiety Related Emotional Disorders, and Parental Bonding Instrument. Results Through exploratory factor analyses (EFAs) and parallel analysis, responses were characterized into a 3-factor structure: personal competence, meaningfulness, and acceptance of self and life. Cronbach’s alpha coefficient for the RS was 0.89 and the test-retest reliability coefficient was 0.72. In terms of predictive validity, resilience was found to be a significant predictor for PTSD, depression, and anxiety. Multiple regression analysis showed that maternal parenting styles were significant predictors of resilience after adjusting for gender, age, sibling number, and earthquake experiences. Conclusions The Chinese version of RS is a reliable and valid tool for assessing resilience among adolescent survivors after disasters. The implications for research and resilience-oriented interventions were also discussed.

Background The predictive effects of change patterns of sleep problems on mental health after a long-term disaster remain poorly known. We examined the change patterns of sleep problems after the Wenchuan earthquake, and tested whether specific sleep-related change patterns could predict mental health problems (posttraumatic stress disorder [PTSD], anxiety, and depression) in the 10 years after Wenchuan earthquake. Methods 1357 adolescents exposed to the Wenchuan earthquake were surveyed on potential sleep problems at 18 months (T18m) and 30 months (T30m) post-earthquake. Among them, 799 participants completed the followed-up survey online 10 years after the earthquake (T10y). Since some participants did not provide sleep problems data at both T18m and T30m, 707 samples were included in final analyses. Linear regression analysis was performed. Results Four different patterns of sleep problems were identified: stable-low pattern (61.1%), stable-high pattern (15.3%), decreasing pattern (13.2%), and increasing pattern (10.5%). Additionally, we found that individuals in stable-high and increasing patterns were more likely to experience PTSD, anxiety, and depression at T10y in the crude model. After controlling for confounders (e.g., earthquake exposure), these patterns were strongly predictive of depression at T10y. Limitations Only two waves of sleep problems were collected and subjective sleep outcomes methods were used to collect data instead of objective methods. Conclusions Sleep problems had heterogeneity after a deadly earthquake. Individuals in stable-high and increasing patterns should be given more attention. Timely assessment and targeted interventions on specific sleep problems are necessary for preventing an escalation of adverse mental health outcomes.

Aims Previous studies regarding associations between depressive symptoms and suicidality (suicidal ideation, plans and attempts) have usually employed a variable-centred approach, without considering the individual variance in time-varying changes of depressive symptoms. Through 10-year follow-up of a large cohort of Chinese adolescents exposed to the 2008 Wenchuan earthquake, this study examined whether individual variance in depressive symptoms during the early phases post-earthquake could generate different suicidality outcomes in young adulthood. Methods A total of 1357 Chinese adolescents exposed to the Wenchuan earthquake were surveyed on depressive symptoms and other variables at 6, 18 and 30 months post-earthquake. In total, 799 participants responded to the 10-year follow-up and completed an online survey covering suicidality and other variables. The analytic sample was 744 participants who had valid data on depressive symptoms and suicidality. Data were analysed using logistic regressions. Results Prevalence estimates of past-year suicidal ideation, suicide plans and suicide attempts measured at 10 years post-earthquake were found to be 10.8%, 7.3% and 3.0%, respectively. Five trajectories of depressive symptoms were classified: resistance (54.4%), chronicity (13.3%), recovery (10.4%), delayed dysfunction (12.0%) and relapsing/remitting (10.0%). After controlling for covariates, whole-sample regressions revealed only the relapsing/remitting depressive trajectory remained significantly predictive of suicidality. Moreover, males not females in the chronic group were more likely to have suicide plans. Conclusions The findings highlight the importance of detecting disaster survivors with different trajectories of mental status and providing with them individualised and effective mental health services, to decrease their risk of suicidality in the future.

Objective To examine the prevalence of sleep disturbances 10 years after Wenchuan earthquake, and to explore whether comorbid post-traumatic stress disorder (PTSD) and depressive symptoms could predict sleep disturbances and whether such effects were modified by gender. Methods Participants were 1357 adolescents in the Wenchuan Earthquake Adolescent Health Cohort Study (WEAHC). 799 of the participants completed the followed-up survey 10 years after the earthquake. At 12-month post-earthquake (T12m), a battery of standardized measures were used to assess individual earthquake exposure, sleep disturbances (insomnia symptoms and poor sleep quality), PTSD, and depressive symptoms. At 10 years post-earthquake (T10y), those survivors reported their sleep disturbances via an online survey. Data were analyzed using binary logistic regression. Results The prevalence of insomnia (14.3%) and of poor sleep quality (19.8%) at T10y decreased when compared with it at T12m. After controlling for covariates, it is revealed that depression-only and comorbidity groups at T12m predicted sleep disturbances at T10y among the whole sample and males. As for females, who have depression-only and comorbidity were more likely to develop insomnia symptoms but not poor sleep quality. Conclusions Sleep disturbances remained highly prevalent among survivors even 10 years after the earthquake. Depression-only and comorbidity groups were related to higher risks of sleep disturbances, especially for males. Assessments and interventions targeting both depressive symptoms and comorbid PTSD to reduce sleep disturbances after a deadly disaster are warranted.

Natural disaster exposure is associated with increased risk of mental health problems. This study aimed to investigate the prevalence, course, and risk factors of probable psychiatric disorders among 1,573 adolescents following the May 2008 Wenchuan earthquake in China. Symptoms of posttraumatic stress disorder (PTSD), depression, panic disorder (PD), generalized anxiety disorder (GAD), separation anxiety disorder (SAD), social phobia (SP), conduct disorder (CD), and attention deficit hyperactivity disorder (ADHD) were assessed at 6 and 18 months postearthquake using a battery of standardized measures. Approximately 62.9% and 56.1% of the sample, respectively, had at least one probable psychiatric disorder at 6 and 18 months postearthquake. The most common disorders were PTSD, depression, PD, GAD, and ADHD. With regard to the course of disorders, PTSD, GAD, PD, SAD. and ADHD decreased; SP and CD remained stable; and depression increased. Generalized estimating equations models showed that female sex, older age, having experienced the death or injury of family members, being a direct witness of tragic scenes, low social support, and a high level of negative life events were risk factors for most disorders, odds ratios (ORs) = 1.3-20.8. However, logistic regressions indicated that earthquake exposure variables were specifically related to persistent PTSD, ORs = 2.0-2.5, and negative life events were associated with persistent depression, ORs = 2.4-5.3. Various psychiatric symptoms are pervasive, intense, and persistent among adolescent survivors. Systematic and periodic screening are needed to closely monitor the onset, course, and risk factors of mental health problems after disasters.

The distinct molecular subtypes of lung cancer are defined by monogenic biomarkers, such as EGFR, KRAS, and ALK rearrangement. Tumor mutation burden (TMB) is a potential biomarker for response to immunotherapy, which is one of the measures for genomic instability. The molecular subtyping based on TMB has not been well characterized in lung adenocarcinomas in the Chinese population. Here we performed molecular subtyping based on TMB with the published whole exome sequencing data of 101 lung adenocarcinomas and compared the different features of the classified subtypes, including clinical features, somatic driver genes, and mutational signatures. We found that patients with lower TMB have a longer disease-free survival, and higher TMB is associated with smoking and aging. Analysis of somatic driver genes and mutational signatures demonstrates a significant association between somatic RYR2 mutations and the subtype with higher TMB. Molecular subtyping based on TMB is a potential prognostic marker for lung adenocarcinoma. Signature 4 and the mutation of RYR2 are highlighted in the TMB-High group. The mutation of RYR2 is a significant biomarker associated with high TMB in lung adenocarcinoma.

Background : The association between parent-child depression following disasters has been well documented. However, longitudinal studies of posttraumatic depression using parent-child dyadic are scarce. This study aimed to investigate inter-related effects between parent and child depression, as well as predictors of depressive symptoms, in a large sample of Wenchuan earthquake survivors. Methods : Data are from the Wenchuan Earthquake Adolescent Health Cohort (WEAHC) Study that included 685 parent-child dyads exposed to the earthquake. Depression was assessed with the Self-Rating Depression Scale (for parents) and Depression Self-Rating Scale for Children, at 12 (T12m) and 18 months (T18m) post-earthquake. Longitudinal actor-partner interdependence models (APIMs) were employed to examine depression within dyads. Predictors of depressive symptoms were assessed by the cart algorithm throughout the 6-month follow-up. Results : Adjusting for earthquake exposure and previous depressive symptoms, parents’ depression at 12 months predicted children's depressive symptoms at 18 months, and vice versa (β = 0.14 for parents and β = 0.12 for children). Psychomotor retardation in parents, and dysphoria/social isolation and positive affect in children were identified as crucial screening indicators identifying parents and children at increased risk for depression. Conclusion : A bidirectional association was found between parent and child depression following a mass disaster. Both parent and child depression status should be examined when implementing interventions to identify and treat depression in earthquake survivors.

Objective The multi-wave longitudinal study was to explore the underlying mechanisms between sleep disturbance and depressive symptoms for up to 9.5 months among student nurses and to examine whether emotional exhaustion and sleep-related worry could be the mediators. Methods 856 student nurses aged 15–24 years (mean age = 17.8 years; all female) were recruited from a nursing school. Participants reported demographic variables (age, sibling, location, health condition, family monthly income and parents' marital quality) at baseline (Time1), Body Mass Index, weekly exercise, sleep disturbance and depressive symptoms at 3-month into internship (Time2), emotional exhaustion and sleep-related worry at 6-month into internship (Time3), and depressive symptoms at 9.5-month follow-up (Time4). Mediation analyses with bootstrapping were conducted to investigate the mediating role of emotional exhaustion and sleep-related worry in the relationship between sleep disturbance and depressive symptoms. Results Adjusted analyses suggested that the direct effect of sleep disturbance on depressive symptoms was not significant (β = 0.026, SE = 0.069, p = .71). Mediation analyses revealed two significant indirect effects between Time2 sleep disturbance and Time4 depressive symptoms with the mediating effect of emotional exhaustion (β = 0.019, SE = 0.009, BC95%CI [0.0036,0.0405]) and sleep-related worry (β = 0.016, SE = 0.008, BC95%CI [0.0026,0.0337]) respectively. When testing serial multiple mediation, the specific indirect effect of sleep disturbance on depressive symptoms through both emotional exhaustion and sleep-related worry was significant (β = 0.005, SE = 0.003, BC95%CI [0.0004,0.0123]). Conclusions Emotional exhaustion and sleep-related worry were positively associated with sleep disturbance and depressive symptoms.

Total glucosides of paeony are the active constituents of Paeoniae Radix Alba. In this study, a novel strategy was proposed to find more metabolites and the differences between paeoniflorin, albiflorin and total glucosides of paeony (TGP). This strategy was characterized as follows: firstly, the animals were divided into three groups (paeoniflorin, albiflorin and TGP) to identify the source of TGP metabolites from paeoniflorin or albiflorin; secondly, a generic information-dependent acquisition scan for the low-level metabolites was triggered by the multiple mass defect filter and dynamic background subtraction; thirdly, the metabolites were identified with a combination of data-processing methods including mass defect filtering, neutral loss filtering and product ion filtering; finally, a comparative study was used in the metabolism of paeoniflorin, albiflorin and TGP. Based on the strategy, 18 metabolites of TGP, 10 metabolites of paeoniflorin and 13 metabolites of albiflorin were identified respectively. The results indicated that the hydrolysis, conjugation reaction and oxidization were the major metabolic pathways, and the metabolic sites were the glycosidic linkage, the ester bond and the benzene ring. This study is first to explore the metabolism of TGP, and these findings enhance our understanding of the metabolism and the interactions of paeoniflrin and albiflorin in TGP. Copyright © 2015 John Wiley & Sons, Ltd.

Objective This study aimed to investigate longitudinal relationships between sleep problems and subtypes of anxiety symptoms among adolescent earthquake survivors. Methods Participants were 1573 adolescents (male, 45.8%; mean age at baseline 15.01 years, standard deviation (SD) = 1.26) in the Wenchuan Earthquake Adolescent Health Cohort. The Pittsburgh Sleep Quality Index and the Screen for Child Anxiety Related Emotional Disorders were used to assess participants’ sleep problems and anxiety symptoms four times during 2.5 years after the earthquake. Anxiety symptoms included subtypes of panic disorder (PD), generalized anxiety disorder (GAD), separation anxiety disorder (SeAD), social phobia (SP), school phobia (ScP). Longitudinal lagged generalized estimating equations (GEE) models were used to determine the prospective associations. Results Overall, there was a bidirectional relationship between sleep problems and anxiety symptoms. For the specific sleep problems and anxiety subtypes, short sleep duration predicted symptoms of PD, GAD, and ScP, and was predicted by GAD; difficulty falling asleep predicted GAD symptoms, whereas PD symptoms increased difficulty falling asleep; poor sleep quality predicted ScP symptoms and was predicted by symptoms of GAD and ScP; difficulty maintaining sleep was not associated with any subtype of anxiety symptoms in any direction; SeAD and SP were not associated with any specific sleep problems in any direction. Conclusion While sleep problems and anxiety symptoms are bidirectional, the associations vary by subtypes of sleep problems and anxiety symptoms. The potential biological mechanisms for the specific associations between dimensional sleep and anxiety symptoms and their clinical implications should be further investigated.

Natural disaster exposure is associated with increased risk of mental health problems. This study aimed to investigate the prevalence, course, and risk factors of probable psychiatric disorders among 1,573 adolescents following the May 2008 Wenchuan earthquake in China. Symptoms of posttraumatic stress disorder (PTSD), depression, panic disorder (PD), generalized anxiety disorder (GAD), separation anxiety disorder (SAD), social phobia (SP), conduct disorder (CD), and attention deficit hyperactivity disorder (ADHD) were assessed at 6 and 18 months postearthquake using a battery of standardized measures. Approximately 62.9% and 56.1% of the sample, respectively, had at least one probable psychiatric disorder at 6 and 18 months postearthquake. The most common disorders were PTSD, depression, PD, GAD, and ADHD. With regard to the course of disorders, PTSD, GAD, PD, SAD. and ADHD decreased; SP and CD remained stable; and depression increased. Generalized estimating equations models showed that female sex, older age, having experienced the death or injury of family members, being a direct witness of tragic scenes, low social support, and a high level of negative life events were risk factors for most disorders, odds ratios (ORs) = 1.3-20.8. However, logistic regressions indicated that earthquake exposure variables were specifically related to persistent PTSD, ORs = 2.0-2.5, and negative life events were associated with persistent depression, ORs = 2.4-5.3. Various psychiatric symptoms are pervasive, intense, and persistent among adolescent survivors. Systematic and periodic screening are needed to closely monitor the onset, course, and risk factors of mental health problems after disasters.

Background Previous research has examined the association between parents’ and children’s posttraumatic stress disorder symptoms (PTSS) after a variety of traumatic events. However, longitudinal parent-child dyadic studies are scarce. Methods Independent self-reports were collected from parent-adolescent dyads (n = 688) after the 2008 Wenchuan earthquake. Adolescents (Mean = 15.22 years; 61.63% female) and one of their parents (Mean = 41.04 years; 58.14% female) each reported on their PTSS at 12 (T12m) and 18 months (T18m) following the earthquake. Longitudinal actor-partner interdependence models (APIMs) were used to examine PTSS within dyads. Results The prevalence rates of probable PTSD at T12m and T18m were 18.90% and 11.92% in adolescents; as well as 22.09% and 15.12% in parents, showing a significant decline over time. After adjusted for earthquake exposure, both maternal and paternal PTSS at T12m prospectively predicted adolescent girls’ and boys’ PTSS at T18m (mother to daughter: β = 0.13; mother to son: β = 0.17; father to daughter: β = 0.17; father to son: β = 0.33), while adolescent girls’ and boys’ PTSS at T12m only predicted maternal PTSS at T18m (daughter to mother: β = 0.20; son to mother: β = 0.20), but not paternal PTSS at T18m. Limitations Self-reported measures other than clinical reviews were used to collect data. Conclusions This study highlights the mutual impacts of adolescent and parental (especially maternal) PTSS after a disaster. Psychological prevention and intervention for adolescent disaster survivors should adopt a whole family approach.

Interpersonal self-support is an indigenous Chinese personality concept. It represents the idealized notion of the kind of personality traits that help individuals deal with interpersonal problems and develop and maintain the harmonic and appropriate social relationships required in China's collectivistic and interdependent culture. It also was assumed to be a protective personality factor with regard to mental health and was found to be negatively related to psychosomatic symptoms. In the current study, cognitive processing of interpersonal information is assumed to be an underlying mechanism that connects interpersonal self-support with interpersonal relationships and mental health. To test this hypothesis, we conducted two experiments to investigate whether attentional bias on positive and negative interpersonal information was related to high and low interpersonal self-support. A spatial cueing task and the emotional Stroop task were administered to two samples of high and low interpersonal self-support Chinese undergraduate students to measure attentional bias. The results from both experiments suggested that high interpersonal self-support students had an attentional bias toward positive interpersonal information, while low interpersonal self-support students preferentially attended to negative interpersonal information. Study 1 indicated that attentional bias toward positive interpersonal information was easily engaged in the high interpersonal self-support group, while attentional bias toward negative interpersonal information was both easy to engage and difficult to disengage in the low interpersonal self-support students. These results support our hypotheses that high interpersonal self-support people engage in positive processing of interpersonal information, whereas low interpersonal self-support people engage in negative processing of interpersonal information. The differential balance between positive and negative processing on interpersonal information may explain why interpersonal self-support predicts both mental health and interpersonal relationships. In addition, the relational schema may explain why interpersonal self-support is associated with an attentional bias toward interpersonal information.

This study aimed to investigate the developmental trajectories and associated predictors of anxiety symptoms among Chinese adolescents exposed to Wenchuan earthquake. 1573 adolescent survivors were followed up at 6, 12, 18, and 24 months post-earthquake. Self-report measures were used to evaluate earthquake exposure, anxiety symptoms, negative life events, social support, and trait resilience. Growth mixture modeling (GMM) and multi-nominal logistic regression were used to analyze data. The results showed that 45.6%, 50.9%, 39.2%, and 39.9% of participants showed clinical levels of anxiety symptoms at 6, 12, 18, and 24 months post-earthquake, respectively. Four developmental trajectories were identified: resistance, recovery, delayed-onset anxiety, and chronic anxiety. Gender, injury of family members, negative life events, social support, and trait resilience were significant predictors for distinct anxiety trajectories. Individualized and appropriate psychosocial interventions should be provided for adolescents affected by natural disasters, especially those at higher risk for chronic or delayed mental problem symptoms.

Purpose: This study longitudinally investigated the changes of depressive symptoms among adolescent survivors over 2 years and a half after the 2008 Wenchuan earthquake in China, as well as the predictive effects of demographic characteristics, earthquake exposure, negative life events, social support, and dispositional resilience on the risk of depressive symptoms at two time points after the earthquake. Methods: Participants were 1573 adolescent survivors (720 males and 853 females, mean age at initial survey = 15.00 ± 1.26 years), whose depressive symptoms were assessed at 6 months (T6m) and 30 months (T30m) post-earthquake. Data on demographics, earthquake exposure, and dispositional resilience were collected at T6m. Negative life events and social support were measured at T6m and 24 months (T24m) post-earthquake. Results: The prevalence rates of probable depression, 27.5 at T6m and 27.2% at T30m, maintained relatively stable over time. Female gender was related with higher risk of depressive symptoms at both T6m and T30m, while being only child could only predict higher risk of depressive symptoms at T30m. Negative life events and social support at T6m, as well as earthquake exposure, were concurrently associated with increased risk of depressive symptoms at T6m, but not associated with the risk of depressive symptoms at T30m, while negative life events and social support at T24m could predict depressive symptoms at T30m, all of which suggested that these variables may have strong but short-term effect on adolescents’ depressive symptoms post-earthquake. Besides, dispositional resilience was evidenced as a relatively stable negative predictor for depressive symptoms. Conclusions: These findings could inform mental health professionals regarding how to screen adolescent survivors at high risk for depression, so as to provide them with timely and appropriate mental health services based on the identified risk and protective factors for depressive symptoms.

Prior studies have shown that interpersonal self-support is related to emotional symptoms. The present study explored the relationship between interpersonal self-support and attentional disengagement from emotional faces. A spatial cueing task was administrated to 21 high and 24 low interpersonal self-support Chinese undergraduate students to assess difficulty in shifting away from emotional faces. The Sidak corrected multiple pairwise tests revealed that the low interpersonal self-support group had greater response latencies on negative faces than neutral faces or positive faces in the invalid cues condition,F(2, 41) = 5.68,p< .01, η2= .22. In addition, in the invalid cues condition, the low interpersonal self-support group responded more slowly than the high interpersonal self-support group to negative faces,F(1, 42) = 7.63,p< .01, η2= .15, the 95% confidence interval for difference of reaction time from 16.30 to 104.70. The results support our hypotheses that low interpersonal self-support is related to difficulty disengaging from negative emotional information and suggest that interpersonal self-support may refer to emotional dispositions, especially negative emotional dispositions.

Total glucosides of paeony are the active constituents of Paeoniae Radix Alba. In this study, a novel strategy was proposed to find more metabolites and the differences between paeoniflorin, albiflorin and total glucosides of paeony (TGP). This strategy was characterized as follows: firstly, the animals were divided into three groups (paeoniflorin, albiflorin and TGP) to identify the source of TGP metabolites from paeoniflorin or albiflorin; secondly, a generic information-dependent acquisition scan for the low-level metabolites was triggered by the multiple mass defect filter and dynamic background subtraction; thirdly, the metabolites were identified with a combination of data-processing methods including mass defect filtering, neutral loss filtering and product ion filtering; finally, a comparative study was used in the metabolism of paeoniflorin, albiflorin and TGP. Based on the strategy, 18 metabolites of TGP, 10 metabolites of paeoniflorin and 13 metabolites of albiflorin were identified respectively. The results indicated that the hydrolysis, conjugation reaction and oxidization were the major metabolic pathways, and the metabolic sites were the glycosidic linkage, the ester bond and the benzene ring. This study is first to explore the metabolism of TGP, and these findings enhance our understanding of the metabolism and the interactions of paeoniflrin and albiflorin in TGP.