Qiuping Tang

Background: Nonsuicidal self-injury (NSSI) is a severe global health concern, particularly among adolescents, and is closely associated with adverse childhood experiences (ACEs). However, the underlying mechanisms by which ACEs are associated with NSSI remain largely unknown, although peer attachment and alexithymia have been identified as potentially relevant to this relationship. This observational study aimed to test a chain mediation model examining the indirect associations among ACEs, peer attachment, alexithymia, and NSSI in adolescents with mood disorders. Methods: A total of 363 adolescents with mood disorders were recruited from the outpatient clinical psychology department of a general hospital. Clinical interview tools and self-report questionnaires were used to evaluate patients’ history of NSSI, ACEs, peer attachment, and alexithymia. Comparisons were made between groups of patients who did and did not meet the criteria for NSSI diagnosis, and peer attachment and alexithymia were evaluated for potential mediating effects. Results: In total, 203 (55.9%) patients were included in the NSSI group. In the chain mediation model, ACEs were directly associated with NSSI, with a significant effect size of 0.246 (95% confidence interval [CI]: 0.088, 0.404), accounting for 64.2% of the total effect. Peer attachment and alexithymia had a total indirect effect of 0.137 (95% CI: 0.079, 0.221), accounting for 35.8% of the total effect. Conclusions: In addition to reaffirming the direct association between ACEs and NSSI, this study provides novel insight into a chain of indirect associations linking peer attachment and alexithymia to the ACE-NSSI relationship.

Introduction: Insomnia has a remarkably negative effect on the work, quality of life and psychosomatic health of individuals, and imposes a substantial economic burden on society. Mindfulness-based interventions (MBIs) have proven beneficial in the treatment of insomnia. However, the effect of mobile or online-based (mHealth) MBIs requires further verification. This study will evaluate the effectiveness of an mHealth MBI, ‘Mindful Living with Insomnia’ (MLWI), relative to that of mHealth cognitive behavioural therapy for insomnia (CBT-I). Methods and analysis: The study is an mHealth, randomised controlled trial. Two hundred and fifty participants will be allocated randomly and equally to either the MLWI or CBT-I group. The intervention will involve 12 sessions over a 6-week course, with 2, 30 min sessions per week. The primary outcomes are sleep quality, severity of insomnia symptoms and sleep activity, according to the Pittsburgh Sleep Quality Index, Insomnia Severity Index and sleep tracker Mi Smart Band, respectively. The secondary outcomes are perceived stress, anxiety, depression and mindfulness. Outcomes will be evaluated at the baseline, end of the intervention period and at the 3-month follow-up. Data analyses will include covariance, regression analysis, χ ² , t-test and Pearson’s correlations. Participants will be recruited from January to June 2022, or until the recruitment process is complete. The follow-up will be completed in December 2022. All trial results should be available by the end of December 2022. Ethics and dissemination: Full approval for this study has been obtained from the Ethics Committee at The Third Xiangya Hospital, Central South University, Changsha, China (21010). Study results will be disseminated via social media and peer-reviewed publications. Trial registration number: NCT04806009 .

Background: Childhood trauma (CT) is considered as a highly risk factor for depression. Although the pathway of CT to depression, especially the mediating or moderating effects of cognitive emotion regulation strategies (CERS) or neuroticism, have investigated by several studies, the results were inconsistent and there is a paucity of full models among these interactive factors. This study aims to examine the relationships among CT, adaptive / maladaptive CERS, neuroticism, and current depression symptoms in university students. Methods: We recruited 3009 freshman of 2019, aged averagely 18.00 (SD = 0.772) years, from universities in Hunan province in 2019. A moderated mediation model was built to examine the relationships among CT, CERS, neuroticism, and current depression using the SPSS PROCESS 3.5 macro. We conducted bootstrapping of regression estimates with 5000 samples and 95% confidence interval. Results: Results revealed that the significant mediating effects of adaptive CERS (β = 0.012; 95% CI: 0.006 to 0.018) and maladaptive CERS (β = 0.028; 95% CI: 0.016 to 0.040) between CT and depression were observed, accounting for 5.69% and 13.52% of the total effect respectively. Then, moderated mediation analyses results showed that neuroticism simultaneously moderated the direct effect of CT on current depression (β = 0.035; 95% CI: 0.001 to 0.009), and the indirect effects of CT on current depression through adaptive CERS (adaptive CERS – current depression: β = − 0.034; 95% CI: − 0.007 to − 0.001) and maladaptive CERS (maladaptive CERS – current depression: β = 0.157; 95% CI: 0.017 to 0.025). However, the moderating effects of neuroticism in the indirect paths from CT to adaptive CERS (β = 0.037; 95% CI: 0.000 to 0.014) and maladaptive CERS (β = − 0.001; 95% CI: − 0.006 to 0.005) were not significant. Conclusions: This study provides powerful evidences through a large university students sample for the mediating role of adaptive / maladaptive CERS and the moderating role of neuroticism between CT and current depression. This manifests that cognitive emotion regulation may be a vital factor for people who suffered from CT and current depression. Furthermore, the influence of neuroticism in this process cannot be ignored.

Background/Purpose: Nurses engaged in the care of people living with HIV (PLWH) are commonly exposed to workplace stress. This study aimed to explore the stress experiences and coping strategies among nurses taking care of PLWH in China. Methods: Nurses were recruited from the AIDS department of a public, general, third-grade class-A hospital, which has the largest HIV care department in the Hunan Province of China. Thirty-three nurses working in the AIDS Department were recruited in this qualitative study. Eight nurses participated in a focus group and 25 nurses underwent in-depth individual interviews aimed at characterizing the nurse’s feelings and struggles with stress during caregiving for PLWH. The interviews were audio-recorded, transcribed verbatim, anonymized, and imported into NVivo 8.0 software. The data were coded and subjected to thematic analysis. Results: Concerns about occupational exposure, heavy workload, mental health problems and risk behaviors of patients, and discrimination towards nurses caring for PLWH were the four main sources of stress. The negative impact of stress included problems with emotion regulation, somatic health and sleep, and work performance. Some participants also reported a positive impact of work stress on their mental health. Using personality strengths, problem-solving, help-seeking, concealing and avoiding/suppression were common coping strategies employed by nurses caring for PLWH. Conclusion: Our findings help characterize the stress experienced by nurses caring for PLWH in the Chinese cultural context, and may inform specific interventions to help manage stress and promote mental health of nurses.

Background: Committed action is one of the core processes of psychological flexibility derived from acceptance and commitment therapy. It has not been widely investigated in mainland China as appropriate measures are lacking. The current study aimed to validate a Chinese (Mandarin) version of the Committed Action Questionnaire (CAQ-8) in a non-clinical college sample and to explore whether committed action would have a mediating effect in the association between experiential avoidance (EA) and life satisfaction.Methods: We translated the CAQ-8 into Chinese (Mandarin). A total of 913 Chinese undergraduates completed a set of questionnaires measuring committed action, EA, mindful awareness, anxiety, depression, stress, and life satisfaction. For test–retest reliability, 167 respondents completed the CAQ-8 again 4 weeks later.Results: The entire scale of CAQ-8 (Mandarin) and two subscales showed adequate internal consistency and acceptable test–retest reliability. Confirmatory factor analyses confirmed the two-factor structure and the convergent and criterion validity were acceptable. Committed action was correlated with less EA, more mindful awareness, less depressive symptoms, less anxiety, less stress, and more life satisfaction. In bootstrap mediation analyses, committed action partially mediated the association between EA and life satisfaction.Conclusion: The results suggest that the CAQ-8 (Mandarin) is a brief, psychometrically sound instrument to investigate committed action in Chinese populations, and the relationship between EA and life satisfaction was partially explained by committed action. This study provides new information about the usefulness of CAQ-8 and supports the assumption that committed action may be considered a promising factors for improving life satisfaction who have involved in EA among an educated non-clinical population.

Background: Childhood trauma (CT) is considered as a highly risk factor for depression. Although the pathway of CT to depression, especially the mediating or moderating effects of cognitive emotion regulation strategies (CERS) or neuroticism, have investigated by several studies, the results were inconsistent and there is a paucity of full models among these interactive factors. This study aims to examine the relationships among CT, adaptive / maladaptive CERS, neuroticism and current depression symptoms in university students.Methods: We recruited 3009 students, aged averagely 18.00 (SD = 0.772) years, from universities in Hunan province in 2019. A moderated mediation model was built to examine the relationships among CT, CERS, neuroticism and current depression using the SPSS PROCESS 3.5 macro. We conducted bootstrapping of regression estimates with 5,000 samples and 95% confidence interval.Results:Results revealed that the significant mediating effects of adaptive CERS (β = 0.0117; 95% CI: 0.0061 to 0.0181) and maladaptive CERS (β = 0.0278; 95% CI: 0.0161 to 0.0401) between CT and depression were observed, accounting for 5.690% and 13.521% of the total effect respectively. Then, moderated mediation analyses results showed that neuroticism simultaneously moderated the direct effect of CT on current depression (β = 0.035; 95% CI: 0.001 to 0.009), and the indirect effects of CT on current depression through adaptive CERS (adaptive CERS – current depression: β = -0.034; 95% CI: -0.007 to -0.001) and maladaptive CERS (maladaptive CERS – current depression: β = 0.157; 95% CI: 0.017 to 0.025). However, the moderating effects of neuroticism in the indirect paths from CT to adaptive CERS (β = 0.037; 95% CI: 0.000 to 0.014) and maladaptive CERS (β = -0.001; 95% CI: -0.006 to 0.005) were not significant.Conclusions: This study provides powerful evidences through a large university students sample for the mediating role of adaptive / maladaptive CERS and the moderating role of neuroticism between CT and current depression. This manifests that cognitive emotion regulation may be a vital factor for people who suffered from CT and current depression. Furthermore, the influence of neuroticism in this process cannot be ignored.

Background: COVID-19 can lead to increased psychological symptoms such as post-traumatic stress disorder (PTSD), depression, and anxiety among patients with COVID-19. Based on the previous mindfulness-based interventions proved to be effective, this protocol reports a design of a randomized controlled trial aiming to explore the efficacy and possible mechanism of a mindful living with challenge (MLWC) intervention developed for COVID-19 survivors in alleviating their psychological problems caused by both the disease and the pandemic. Methods: In April 2021, more than 1600 eligible participants from Hubei Province of China will be assigned 1:1 to an online MLWC intervention group or a waitlist control group. All participants will be asked to complete online questionnaires at baseline, post-program, and 3-month follow-up. The differences of mental health status (e.g. PTSD) and physical symptoms including fatigue and sleeplessness between the COVID-19 survivors who receiving the online MLWC intervention and the control group will be assessed. In addition, the possible mediators and moderators of the link between the MLWC intervention and target outcomes will be evaluated by related verified scales, such as the Five Facets Mindfulness Questionnaire. Data will be analyzed based on an intention-to-treat approach, and SPSS software will be used to perform statistical analysis. Discussion: The efficacy and potential mechanism of MLWC intervention in improving the quality of life and psychological status of COVID-19 survivors in China are expected to be reported. Findings from this study will shed light on a novel and feasible model in improving the psychological well-being of people during such public health emergencies. Trial registration Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000037524; Registered on August 29, 2020, http://www.chictr.org.cn/showproj.aspx?proj=60034.

Background/purpose: Workplace stress among nurses providing care for people living with human immunodeficiency virus is a serious problem in China that may increase rates of job burnout and affect quality of care. Mindfulness-based intervention has been shown to be effective in relieving stress and burnout in nurses. Therefore, we designed a mixed-method pilot study to evaluate a mindfulness-based intervention for nurses providing care for people living with human immunodeficiency virus. Methods: Twenty nurses caring for people living with human immunodeficiency virus in the First Hospital of Changsha, China participated in a mindfulness-based intervention for 2 hr sessions weekly for 6 weeks. The Perceived Stress Scale, Maslach Burnout Inventory, Five Facets Mindfulness Questionnaire, State-Trait Anxiety Inventory, and the Beck Depression Inventory were used to collect data before and after the mindfulness-based intervention. Participants were invited to attend an in-depth interview 1 week after the end of the mindfulness-based intervention to give feedback. Results: The quantitative analyses revealed a significant change in Five Facets Mindfulness Questionnaire scores. There were no significant differences between pre- and post-intervention measures of any other variables. Qualitative results showed nurses experienced a decrease in work and daily life pressures; improvements in communications with patients, colleagues and families, with better regulation of negative emotions, and acceptance of other people and attention. Conclusion: This study supports the acceptability and potential benefits of the mindfulness-based intervention in helping nurses caring for people living with human immunodeficiency virus to manage stress and emotions, and improve their acceptance of others and attention. A larger study with a randomized controlled trial design is warranted to confirm the effectiveness of this mindfulness-based intervention.

Introduction Insomnia is a prevalent and significant public health concern. Insomnia can lead to increased inflammatory markers associated with chronic diseases such as cardiovascular disease, diabetes and cancer. Studies suggest that mindfulness-based interventions (MBIs) are more easily delivered within the community than cognitive behavioural therapy for insomnia (CBT-I) which was recommended as the preferred non-pharmacological treatment by the American Academy of Sleep Medicine, are effective in insomnia treatment and can reduce inflammatory markers level in older individuals with insomnia. This study aims to compare the effectiveness of an MBI to CBT-I in young and middle-aged individuals with insomnia disorder and explore its effect on nuclear factor kappa B (NF-κB), a transcription factor that controls the expression of genes involved in inflammation. Methods and analysis This report describes a protocol for a randomised controlled trial. Seventy eligible participants will be assigned to mindfulness-based joyful sleep or CBT-I for 2-hour sessions weekly for 8 weeks. The primary outcome is sleep quality assessed by the Pittsburgh Sleep Quality Index, severity of insomnia symptoms assessed by the Insomnia Severity Index and sleep parameters recorded using sleep diary and polysomnography. Secondary outcomes include perceived stress, anxiety and depression. The exploratory outcome is serum level of NF-κB. Outcomes will be evaluated at baseline, the end of the ntervention period and at a 3 month follow-up. Data will be analysed using general linear models, specifically analysis of covariance and analysis of variance will be used. Ethics and dissemination Full ethical approval for this study has been obtained from the Ethics Committee of the Third Xiangya Hospital, Central South University, Changsha, China (2018-S236). If Mindfulness-Based Joyful Sleep is proven effective, its dissemination will help bridge the gap between the unmet need and the demand for insomnia interventions in China. Trial registration number NCT03268629; Pre-results.