Li Zhao

Background: Obesity is a well-established risk factor for major depressive disorder (MDD), yet the risk is not uniform, highlighting the need for precise risk stratification. This study aimed to develop a metabolomics-based prediction model to identify high-risk metabolic phenotypes among obese participants and to elucidate the causal metabolic pathways involved. Methods: Forty-one-thousand-four-hundred-fifty-nine obese participants were followed for a median of 14.4 years. We integrated multiple machine learning (ML) algorithms to develop predictive models for 3-, 5-, and 9-year MDD risk, with a temporal validation within the same biobank. Furthermore, we investigated the potential causal relationships within the obesity-metabolite-MDD using mediation Mendelian randomization (MR). Results: During follow-up, 3,642 incident MDD cases were documented. The optimized LightGBM model demonstrated superior predictive performance, achieving AUCs of 0.844 (95% CI: 0.773–0.914), 0.824 (95% CI: 0.771–0.875), and 0.834 (95% CI: 0.796–0.871) for 3-, 5-, and 9-year intervals, respectively, significantly outperforming existing clinical models. Temporal validation confirmed the model’s robustness (AUCs: 0.738–0.776). MR analysis confirmed that key metabolites causally mediate the pathway from obesity to MDD (mediation proportions: −11.5% and −35.3%, all P _ME < 0.05). Conclusions: These findings challenge the notion of a uniform obesity–MDD association, demonstrating that metabolomic signatures can effectively stratify MDD risk. We present a validated ML framework for the early identification of high-risk individuals with obesity, offering a precision medicine approach to guide targeted metabolic and psychiatric interventions.

Background: This study examined the predictive effect of parental marital satisfaction on suicidal behaviors among preadolescents and adolescents in China, with positive youth development (PYD) attributes as a mediator. Methods: A total of 3665 matched pairs of students (aged 9–19, 51.3% boys) and their parents completed questionnaires, with parental marital satisfaction reported by parents and suicidal behaviors (ideation, plan, and attempt) and PYD attributes reported by students. Results: The prevalence of overall suicidal behavior was 15.5% in this sample, with a higher prevalence observed among those with lower parental education levels. Hierarchical regression and structural equation modeling analyses revealed that: (1) after controlling for socio-demographic variables, parental marital satisfaction negatively predicted suicidal behaviors; (2) PYD attributes negatively predicted suicidal behaviors, accounting for the largest proportion of variance (ΔR² range = 0.036–0.102); (3) parental marital satisfaction was positively correlated with PYD attributes; and (4) PYD attributes partially mediated the predictive relationship between parental marital satisfaction and suicidal behavior, with a significant indirect effect (β = −0.06) accounting for 56.6% of the total effect. Conclusions: This study illuminates protective pathways through which a positive family environment cultivates individual competencies, ultimately contributing to reduced suicidal behavior.

Objectives: Previous studies have established links between Internet addiction, life satisfaction, and post-traumatic stress symptoms (PTSS) in individuals exposed to disasters; however, the nature of longitudinal links remains uncertain. This study aimed to determine the potential associations among Internet addiction, life satisfaction and PTSS among disaster-exposed Chinese children and early adolescents. Methods: A three-wave longitudinal design was employed over two years and included 2354 Chinese children and early adolescents aged 6 years to 14 years who directly experienced an earthquake and COVID-19. A complete longitudinal mediation method was applied to analyze data collected in three waves from 2020 to 2022 with a one-year interlude. Results: Life satisfaction at Time 2 (T2) fully mediated the associations between Internet addiction at Time 1 (T1) and PTSS at Time 3 (T3). Internet addiction at T2 was a significant mediator of links between life satisfaction at T1 and PTSS at T3. Conclusions: These findings underscore the pivotal role of life satisfaction in mediating the impact of early Internet addiction on long-term psychological outcomes, highlighting it as a key target for interventions aimed at enhancing mental well-being after disaster exposure. Moreover, Internet addiction mediated the link between earlier life satisfaction and later PTSS, highlighting the importance of reducing problematic Internet use to prevent long-term stress symptoms.

In recent years, with rapid societal changes and increasing educational pressures, the mental health of primary and secondary school students has garnered significant attention. Psychological resilience, as a core capacity for coping with adversity, and emotional competence, as a foundation for emotional regulation in social adaptation, are crucial for student development, with family functioning being a primary environmental factor closely associated with them. Research suggests that healthy family functioning may be associated with higher psychological resilience and emotional competence, while family dysfunction may be linked to increased psychological distress. However, the interconnected mechanisms among family functioning, psychological resilience, and emotional competence, as well as the roles of factors such as gender, urban-rural differences, and grade level, still require further exploration. To explore the associations between family functioning, psychological resilience, and emotional competence among primary and secondary school students in Chengdu, Sichuan Province, and their underlying mechanisms. The study aims to provide a scientific basis for educators and parents to develop targeted mental health interventions. Multicenter cross-sectional study. A cluster sampling method was employed to survey 7,937 students from grades 1 to 9 across five schools in Chengdu. Data were collected using the Chinese Family Assessment Instrument (C-FAI, assessing family mutual support, communication, and conflict harmony), the Resilience Subscale and Emotional Competence Subscale of the Chinese Positive Youth Development Scale (CPYDS, measuring adaptation and recovery under stress, and the ability to perceive, understand, and manage emotions, respectively). Data were double-entered and verified using Epidata 3.1. SPSS 26.0 was used for descriptive statistics, correlation analysis, and difference tests (independent samples t-test, Welch t-test, one-way ANOVA, or Welch ANOVA based on data distribution, with Games-Howell post-hoc tests). Partial correlation analysis controlled for gender, urban/rural residence, and grade. Structural equation modeling was conducted using AMOS 26.0 to analyze the associations and mediating effects among family functioning, psychological resilience, and emotional competence, and to evaluate model fit. Harman’ s single-factor test was applied to detect common method bias. The significance level was set at α=0.05. Family functioning showed significant differences across gender, urban/rural location, and grade level (P<0.05): male students (1.97±0.74), rural students (1.97±0.73), and students in grades 7-9 reported more severe family dysfunction. Psychological resilience was significantly positively correlated with emotional competence (r=0.646,P<0.001), and both were negatively correlated with family dysfunction (r=−0.394 and r=−0.376, respectively, P<0.001). The structural equation model demonstrated a good fit (CMIN/DF=6.988,RMSEA=0.027). Path analysis from the model indicated that psychological resilience may be indirectly associated with emotional competence through family functioning. The mediating effect of this path was 0.089, accounting for 9.2% of the total effect (95% CI: 0.667-0.726, P<0.001). Family dysfunction is significantly negatively correlated with the psychological resilience and emotional competence of primary and secondary school students, with psychological resilience indirectly associated with emotional competence through family functioning. Boys, rural students, and those in grades 7–9 exhibit more severe family dysfunction, warranting focused attention. It is recommended to implement interventions such as “Parent-Child Co-Creation Day,” communication training, and “Father’ s Role Workshop” to optimize family functioning, thereby supporting the mental health of primary and secondary school students.

Background: Medication adherence among pediatric epilepsy patients is frequently suboptimal, and the complex interplay between parental social support, decision‐making participation, treatment satisfaction, and parental anxiety in influencing medication adherence remains underexplored. This study investigates both the direct and indirect pathways linking these factors to medication adherence and examines the mediating role of treatment satisfaction and the moderating role of parental anxiety. Methods: A cross‐sectional study was conducted at three medical institutions between January 2020 and June 2024. Data on patient demographics and standardized scales measuring medication adherence, social support, communication and decision‐making participation, treatment satisfaction, and parental anxiety were collected. Relationships among these variables were analyzed using structural equation modeling (SEM) and moderation analysis. Results: A total of 1056 patients were included in the study, with a mean age of 8.86 ± 3.99 years; 51.7% were male. Path analysis showed that parental social support (STD = 0.344, p < 0.001), communication and decision‐making participation (STD = 0.392, p < 0.001), and treatment satisfaction (STD = 0.090, p < 0.05) had significant positive effects on medication adherence. Parental social support (STD = 0.483, p < 0.001) and communication and decision‐making participation (STD = 0.203, p < 0.001) also strongly influenced treatment satisfaction. The indirect effects of social support and decision‐making participation on medication adherence, mediated through treatment satisfaction, were statistically significant ( p < 0.05). Parental anxiety, as a moderating factor, weakened the positive effects of social support, decision‐making participation, and treatment satisfaction on medication adherence ( p < 0.05). Conclusion: This study systematically develops an integrated model linking parental social support, communication and decision‐making participation, treatment satisfaction, and anxiety to medication adherence in pediatric epilepsy. It highlights the mediating role of treatment satisfaction and the moderating role of parental anxiety. Enhancing parental social support and communication, improving treatment satisfaction, and addressing parental anxiety are key strategies to promote medication adherence.

Dietary patterns influence children and adolescents’ health not only in the present but also in their adulthood. Family characteristics and functioning play a crucial role in food choices and are important modifiable factors for early interventions aimed at preventing unhealthy diets. The study aimed to analyze the dietary patterns of Chinese children and adolescents and explore their associations with family characteristics and functioning. 6276 participants aged 6 to 17 years were recruited for the multicenter cross-sectional study through cluster sampling. Food intake, family characteristics, and family function were assessed. Dietary patterns were identified through factor analysis based on food intake data, and a multiple logistic regression model was used to investigate the associations between dietary patterns, family characteristics, and family functioning. Three distinct dietary patterns were identified: the “Diverse dietary pattern” (characterized by a rich diet and balanced nutrition), the “Fast food concentrated dietary pattern” (primarily consisting of fried foods, sugary drinks, processed meats, and other junk food), and the “Traditional dietary pattern” (mainly vegetables and grains). Girls, those living in rural areas, and those with better family functioning were more likely to adhere to the “Diverse dietary pattern” (p < 0.01). Girls, primary school students, and those with lower educated mothers tended to have higher adherence to the “Traditional dietary pattern” (p < 0.01). High adherence to the “Fast food concentrated dietary pattern” were associated with boys, older age, Han ethnicity, family dysfunction, living with both parents, being an only-child, having a better educated father, lower family income, and higher pocket money (p < 0.01). Children and adolescents from different family backgrounds exhibit distinct dietary patterns, highlighting the importance of early screening and intervention tailored to these varying family characteristics. Among the modifiable family factors, better family functioning stands out as a key area of focus for promoting and sustaining healthy dietary patterns in Chinese children and adolescents.

Background: This study explores the correlation between internet addiction (IA) and deviant behaviors among primary and secondary school students. It analyzes the impact of family functional factors, such as family relationships, parent–child communication, and parental control, on IA. The findings aim to provide a scientific basis for educators and parents to develop targeted preventive and intervention measures.Methods: A cross-sectional survey was conducted using self-administered questionnaires among 8,816 students from five primary and secondary schools in Chengdu. The questionnaire included basic information about students and their families, Young’s Internet Addiction Scale, Shek’s Deviant Behavior Scale, and the Chinese Family Assessment Instrument (C-FAI). Chi-square tests and t-tests were used to compare differences between the at-risk group for internet addiction and the normal population. Statistically significant variables were extracted and included in the hierarchical regression model, with the level of significance set at α = 0.05.Results: The detection rate of IA risk among primary and secondary school students was 14.11%, and the detection rate of deviant behaviors in this group was 85.21%. Deviant behaviors such as deceit (r = 0.201), running away from home (r = 0.215), and damaging others’ property (r = 0.209) showed a weak correlation with the risk of internet addiction, and the differences were statistically significant (p < 0.05). The results of the hierarchical regression analysis showed that all five dimensions of family environment and delinquency scores positively predicted internet addiction. Specifically, the change in R² was 8.7% for mutual concern among family members and 9.7% for student delinquency behavior. Together, family environment and delinquency behavior explained 22.1% of the variance.Conclusion: Primary and secondary school students at risk of IA are more likely to exhibit deviant behaviors, which show a weak correlation with IA. Gender and grade level significantly impact the risk of IA, indicating that male students and those in higher grades require more attention. Strengthening family interventions, especially in areas of mutual communication, family conflict resolution, and parental control, can help prevent IA among primary and secondary school students.

Background: Obesity is a rapidly increasing health problem in China, causing massive economic and health losses annually. Many techniques have emerged to help people with obesity better adhere to intervention programs and achieve their weight loss goals, including food replacement and internet-delivered weight loss consultations. Most studies on weight loss interventions mainly focused on the change in body weight or BMI; however, body fat, especially visceral fat mass, is considered the main pathogenic factor in obesity. In China, more reliable evidence is required on this topic. Moreover, it is unclear whether an integrated weight loss program combining food replacement products, mobile app-based platforms, and daily body composition monitoring using a wireless scale is useful and practical in China. Objective: In this 2-arm, parallel-designed, randomized study, we explored the effectiveness and safety of the Metawell (Weijian Technologies Inc) weight loss program in China, which combines prepackaged biscuits, a wireless scale, and a mobile app. Methods: Participants in the intervention group were guided to use food replacement products and a scale for weight loss and monitoring, whereas participants in the control group received printed material with a sample diet and face-to-face education on weight loss at enrollment. The intervention lasted for 3 months, and follow-up visits were conducted at months 3 and 6 after enrollment. Dual-energy x-ray absorptiometry and quantitative computed tomography were used to assess body fat. A multilevel model for repeated measurements was used to compare differences between the 2 groups. Results: In total, 220 patients were randomly assigned to intervention (n=110) and control (n=110) groups. Participants in the intervention group had significantly greater decreases in BMI, total body fat, visceral adipose area, and subcutaneous adipose area (all P <.001) than those in the control group. However, the rate of change in lean mass was not significantly different between the 2 groups ( P =.62). Further, 35 participants in the intervention group reported adverse events. Constipation was the most frequently reported adverse event (11/110), followed by dizziness (6/110), hypoglycemia (4/110), fatigue (3/110), and gastritis (3/35). Conclusions: The Metawell program was effective for weight loss. After the intervention, participants in the intervention group lost more body weight and body fat while retaining muscle mass than those in the control group.

Objective: To prospectively observe the self-correction of congenital auricular deformity (CAD) and explore the potential factors affecting the self-correction. Methods: This study was a multi-center prospective observational study. Newborns aged 0–3 days from 12 Maternal and Child Health Hospitals or Maternity Hospitals were chosen as the participants and prospectively followed up until week 6 after birth. The primary and secondary outcome was the score of deformity, and the secondary outcome was the improvement rate, respectively. Results: A total of 135 newborns diagnosed with CAD (237 ears) were recruited. Boys and girls accounted for 50.37% (117 ears) and 49.63% (120 ears). The top morphological type was the constricted ear (107 ears, 45.15%). The score of deformity at baseline, week 3, and week 6 after enrollment was 4.00, 3.00, and 2.00, decreasing over time (P < 0.05). The higher the severity of deformity, the worse the self-correcting effect (P < 0.05). The scores of deformity of Stahl’s ear were lower than those of others after follow-up (P < 0.05). No significant differences among the scores of deformity in different genders (P >0.05). The total improvement rate at week 3 and week 6 was 29.96% (71/237 ears) and 37.13% (88/237), respectively. The improvement rate of the Stahl’s ear at week 3 and week 6 after enrollment was higher than that of four other morphological types (P < 0.05). Conclusions: Some CAD tends to self-correction, but for most CADs, there is still a need for early correction. Morphological types and severity of deformity are the main influencing factors on self-correcting effect, whereas sex was not.