Anxiety and depression are increasingly prevalent among adolescents, and parental parenting practices play a crucial role in the development of these emotional problems. This study aims to develop a mini-program based parenting strategy to prevent anxiety and depression in adolescents, conduct a feasibility analysis, and evaluate its preliminary effects, thereby providing scientific evidence for establishing preventive service systems for adolescent mental health.

Guided by the Persuasive System Design model, a preliminary parenting strategy for preventing adolescent anxiety and depression was developed based on literature review, literature screening and quality appraisal, and qualitative interviews. In October 2023, the Delphi method was used to revise the program through expert consultation. Software engineers collaborated with the research team to develop and refine both the mini-application front end and the web-based management backend using an agile development model, resulting in the final version of the "Smart Growth Assistant" mini-application. For feasibility and preliminary effectiveness evaluation, 30 parents of adolescents were recruited online via convenience sampling between December 2023 and January 2024 to participate in an 8-week intervention delivered entirely through the mini-application. Feasibility outcomes included a researcher-developed satisfaction questionnaire, the System Usability Scale (SUS), and user-experience interviews. Preliminary effectiveness outcomes included the short-form Parental Stress Scale, Parenting Sense of Competence Scale, Parenting Behavior Questionnaire, Center for Epidemiologic Studies Depression Scale (CES-D), and the Self-Rating Anxiety Scale.

A total of 17 experts completed two rounds of Delphi consultation. The judgment coefficient for item evaluation was 0.96, the familiarity coefficient was 0.76, and the authority coefficient was 0.86. The proportion of experts providing comments was 94.1% in the first round and 23.5% in the second. The coefficient of variation for item scores ranged from 0.07 to 0.21 and 0.05 to 0.20 in the 2 rounds, respectively. Kendall's W coefficients were statistically significant (all P<0.05). The final program outline consisted of 8 primary indicators and 34 secondary indicators, and the mini-application included 30 graphic-text units, 4 comic-style case examples, 35 audio clips, and 6 video materials. A total of 23 parents ultimately completed the intervention. The mean satisfaction score was 4.38±0.57, and the total SUS score was 81.74±10.85. Qualitative interviews indicated a generally positive user experience. After the intervention, parental stress scores were significantly reduced, and parental competence and parenting behavior scores significantly improved (P<0.05). Adolescents' depression scores were significantly lower post-intervention (P<0.05), while changes in anxiety scores were not statistically significant (P>0.05).

The mini-program based parenting strategy for preventing adolescent anxiety and depression demonstrated good feasibility. It provides parents with a comprehensive, systematic, and effective individualized guidance program to support the prevention of anxiety and depression among adolescents.

Non-suicidal self-injury (NSSI) often coexists with depressive and anxiety symptoms in adolescents, jointly impairing their mental health. However, the interplay between NSSI and symptoms of depression, anxiety, and sleep problems remain unclear. This study aims to explore the association patterns among insomnia, anxiety, depression, and NSSI behaviors in adolescents.

A total of 4 319 students from three secondary schools in southern Hunan Province were assessed using the Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 items (GAD), Patient Health Questionaire-9 items (PHQ), and the Adolescent Self-Injury Scale (ASIS) to evaluate insomnia symptoms, depressive symptoms, and NSSI behaviors, respectively. Network analysis was then conducted to examine the interrelationships among these symptom domains.

Network analysis indicated that suicidal ideation within depressive symptoms was closely associated with NSSI (edge weight=0.15). Among the symptoms, ISI6 (sleep problems noticed by others, an insomnia symptom), GAD2 (difficulty controlling worries, an anxiety symptom), and PHQ2 (low mood, a depressive symptom) exhibited high strength centrality in the disease network (strength values: 0.88, 0.80, and 0.76, respectively). Additionally, anxiety symptoms including GAD5 (restlessness), GAD6 (irritability), GAD7 (feeling afraid), and depressive symptoms including PHQ2 (low mood), PHQ3 (sleep problems), and PHQ8 (psychomotor retardation/agitation) were identified as bridge symptoms in the network structure (bridge strength values=0.95, 1.32, 1.23, 1.21, 1.32, and 1.27, respectively).

Restlessness, irritability, feeling afraid, feeling down, sleep problems, and psychomotor agitation/retardation may serve as key target symptoms for effective interventions addressing insomnia, anxiety, depression, and NSSI among adolescents.

Non-suicidal self-injury (NSSI) behaviors poses a serious threat to the mental health of adolescents. This study aims to examine how trait anxiety influences NSSI behaviors in adolescents and to explore the potential parallel mediating effects of maladaptive cognitive emotion regulation strategies and impulsivity in this relationship.

Adolescents with NSSI behaviors treated at the Fourth People's Hospital of Huaihua between December 2020 and December 2021 were recruited as participants. A total of 500 questionnaires were distributed, including the Adolescent NSSI Assessment Questionnaire, the Barratt Impulsiveness Scale, the Chinese version of the Cognitive Emotion Regulation Questionnaire (maladaptive strategies subscale), and the Trait Anxiety Inventory. All scales demonstrated good reliability and validity. Statistical analyses such as descriptive statistics, common method bias testing, reliability and validity assessment, correlation analyses, multiple linear regression, path analysis, and mediation analysis were performed using SPSS software, and the SPSSPRO platform.

A total of 376 valid questionnaires were collected. No significant common method bias was detected. Pearson correlation analyses indicated significant positive correlations among all scale scores (all P<0.001). Multiple linear regression analysis showed that, after controlling for demographic factors, trait anxiety, maladaptive cognitive emotion regulation strategies, and impulsivity all significantly and positively predicted adolescent NSSI behavior (R²=0.369). Path analysis revealed 5 significant pathways: Trait anxiety → maladaptive cognitive emotion regulation strategies, trait anxiety → impulsivity, maladaptive cognitive emotion regulation strategies → NSSI behaviors, impulsivity → NSSI behaviors, and trait anxiety → NSSI behaviors (all P<0.001). The model demonstrated good fit (χ²/df=1.651, normed fit index=0.995, comparative fit index=0.998, goodness of fit index=0.995, root mean square error of approximation=0.042). Parallel mediation analysis indicated that, with demographic variables controlled, the total effect of trait anxiety on NSSI behaviors was 0.501. The direct effect was 0.239 (47.7% of the total effect). The mediating effect through maladaptive cognitive emotion regulation strategies was 0.177 (35.3%), and the mediating effect through impulsivity was 0.085 (17.0%). The mediating effect of maladaptive cognitive emotion regulation strategies was significantly greater than that of impulsivity (95% confidence interval 0.012 to 0.176).

Trait anxiety directly predicts NSSI behaviors in adolescents and indirectly affects NSSI through parallel mediating effects of maladaptive cognitive emotion regulation strategies and impulsivity. Among these mediators, maladaptive cognitive emotion regulation strategies play a more prominent mediating role in the relationship between trait anxiety and NSSI behaviors.

Against the backdrop of intensifying educational competition in contemporary society, parents increasingly prioritize their children's development. Parental educational anxiety has become a key factor affecting adolescents' psychological well-being. However, the pathways through which parental educational anxiety influences adolescents' depressive symptoms, particularly the role of adolescents' internal psychological processes, and the moderating function of family supportive factors remain unclear. Situated in the Chinese cultural context, this study aims to construct a moderated mediation model to examine the mediating role of perceived stress in the association between parental educational anxiety and depression among junior middle school students and whether parental educational time investment buffers this pathway.

A cross-sectional survey was conducted, with data collected over one month in June 2023. Using convenience sampling, questionnaires were administered to 736 junior middle school students and their parents from Changsha, Xiangtan, and Shaoyang. Measures included the Chinese Stress Perception Scale (CPSS), the Patient Health Questionnaire-9 (PHQ-9), Parental Educational Anxiety Scale, and the Parental Educational Time Investment Questionnaire. A moderated mediation analysis was performed with the PROCESS macro in SPSS, and network structure estimation was conducted using R software.

Correlation analyses showed that parental educational anxiety was significantly positively associated with junior middle school students' perceived stress and depression (r=0.178 and r=0.155, respectively; both P<0.01). Adolescents' perceived stress was significantly positively correlated with depression (r=0.570, P<0.01) and significantly negatively correlated with parental educational time investment (r=-0.102, P<0.01). Mediation analysis indicated that perceived stress fully mediated the relationship between parental educational anxiety and adolescent depression, with an indirect effect of 0.840, accounting for 64.1% of the total effect. Gender differences were observed: the indirect effect was 1.101 among boys (79.6% of the total effect) and 0.624 among girls (48.6% of the total effect). Moderation analysis further revealed that the interaction between the perceived stress and parental educational time investment significantly and negatively predicted adolescent depression [β=-0.039, t=-2.106, 95% confidence interval (CI) -0.075 to -0.003, P<0.05]. Network analysis showed that among the 4 dimensions of parental educational anxiety, "future development anxiety" had the highest node strength and was the most central and influential node in the network.

Within the Chinese cultural context, parental educational anxiety heightens junior middle school students' perceived stress, which in turn exacerbates their depressive symptoms, highlighting the mediating role of adolescents' cognitive appraisal. Parental educational time investment effectively buffers the negative impact of stress on depression, suggesting its protective significance within the "family stress-individual cognition-emotional health" pathway. Anxiety regarding children's "future development" constitutes the central component of the parental educational anxiety network.

Primary care practices with greater integration of behavioral health care have better patient-reported outcomes. We sought to identify whether there is a threshold effect in the relationship between the degree of Integrated Behavioral Health (IBH) and patient-reported outcomes.

Secondary analysis of survey results from Integrating Behavioral Health and Primary Care, a multistate longitudinal randomized, controlled study of 3,929 adults with multiple chronic medical and behavioral conditions. Patient outcomes included Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) functional status (PROMIS-29), depression (PHQ-9), anxiety (GAD-7), the Duke Activity Status Index, Consultation and Relational Empathy (CARE), patient centeredness, and utilization. IBH was measured by the Practice Integration Profile (PIP) version 1.0. The optimal threshold was identified by examining the relationship of PIP to PROMIS-29. The discriminatory power of the threshold was examined using multilevel linear regression with adjustment for potential confounders.

Fifteen of 44 practices with 1,237 patients were highly integrated (PIP ≥ 65). All outcomes tended to be better in patients from practices with high integration. After adjustment for potential confounders, the relationship remained beneficial for all outcomes, with Pain Intensity (-0.51 [95% CI -0.97, 0.04]), patient centeredness (2.52 [0.88, 4.16]), and CARE (1.62 [0.62, 2.61]) statistically significant.

Patients in high integration practices report better outcomes. A measurable target for IBH, such as a PIP total score ≥ 65, provides a focus for practice leadership and guidance on the time and resources needed to achieve integration associated with positive patient outcomes. The results of this analysis provide further evidence of the broad, beneficial impacts of integrating behavioral health and primary care services.

Cyberchondria, a combination of the words "cyber" and "hypochondriasis," is a condition that is receiving increasing attention from clinicians and researchers globally. Researchers are currently using multiple instruments to quantify it. Furthermore, the instruments have been translated into multiple languages.

This study aimed to examine the extent to which researchers are measuring cyberchondria using the 33-item Cyberchondria Severity Scale (CSS) and its 12-item abbreviated version, the CSS-12. It also examined the relative use of cyberchondria instruments in different languages.

PubMed and PsycInfo were searched for articles published between May 1, 2019, and December 31, 2024, featuring the term "cyberchondria" in the title. Included articles mentioned the CSS, were empirical studies, and were in English. Each article was categorized by the CSS version, publication year, and language of instrument implementation. Fisher exact tests were used to assess associations, and the Spearman rank correlation coefficient was used to evaluate trend monotonicity.

Among the 117 articles included in the analysis, 42 (35.9%) used the CSS, 38 (32.5%) used the CSS-12, and the remaining 37 (31.6%) used unknown or modified versions. Although CSS-12 use began with its introduction in 2019, there was no significant association between publication year and instrument choice (P=.84). Unadjusted analysis found that the relationship between year and the percentage of articles using the CSS-12 showed a statistically significant monotonic trend (ρ=0.89; P=.02). This finding was not significant after applying a Bonferroni correction. However, there was a significant association between the language of the instrument and the CSS version used (P<.001).

From 2019 to 2024, both the CSS and CSS-12 continued to be used. The CSS-12 offers benefits such as brevity and the removal of reverse-keyed items, while the original CSS remains useful for studies that require the mistrust of medical professionals subscale. The significant association between language and instrument choice suggests that cultural and linguistic factors impact selection, and instrument choice should be guided by the study's objectives and the constructs of interest.

Existing evidence on the disease burden of smoking is often outdated and incomprehensive, particularly in Asia, which plays a pivotal role in the global tobacco control community. This study aimed to provide an updated and comprehensive estimate of the mortality and morbidity burden associated with smoking in Hong Kong.

This retrospective cohort study included adults with smoking status information recorded in the Hong Kong Hospital Authority database between 1 January 2008 and 31 December 2012. Subjects were classified into never-smokers, ex-smokers, and current smokers. The primary outcome was all-cause mortality. Cox proportional hazards regression, adjusted with fine stratification weighting and key baseline characteristics, yielded hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome.

Of the 1,571,065 individuals analyzed, there were 14.3% current smokers, 11.9% ex-smokers, and 73.8% never-smokers. After a median follow-up of 11.7 years, 61,198 current smokers, 45,918 ex-smokers, and 220,947 never-smokers died. Significantly higher risks of all-cause mortality were observed among current smokers (HR [95% CI]: 1.53 [1.51-1.56]) and ex-smokers (1.33 [1.31-1.35]) than among never-smokers. Current and ex-smoking were positively associated with the incidences of 76 and 60 out of 115 morbidities, respectively. Strong associations were observed between smoking and increased risks of suicide (intentional self-harm), mental, and behavioral disorders due to psychoactive substance use and alcohol use, particularly among current smokers. Notably, these risks were higher in females than in males for all three outcomes. Additionally, females demonstrated higher risks of all-cause mortality, pneumonia, chronic obstructive pulmonary disease, and asthma compared to males.

Smoking remains a substantial burden on the healthcare system in Hong Kong, which may still be underestimated due to Hong Kong's relatively less advanced stage in the tobacco epidemic compared to some Western countries, where the full hazards of smoking have already manifested more prominently.

Patients with cancer requiring surgery are at increased risk for depressive symptoms. However, prevalence and severity during the perioperative period are poorly characterized. This study systematically reviewed the perioperative prevalence of clinically significant depression and depressive symptom severity in patients with cancer, as measured by self-reported tools.

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, EMBASE, and Scopus databases (searched to 15 December 2023). Clinical studies of patients with cancer undergoing surgery that measured depressive symptoms using a self-reported instrument were included. Study quality and bias were assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and Joanna Briggs Institute Critical Appraisal Checklist. Data extracted included study characteristics, as well as prevalence and severity of depression pre- and postoperatively.

Data from 526 studies involving 103,075 surgical patients were included. The most common cancers were breast (32%), colorectal (10%), and head and neck (8%). The most frequently used tools were the Hamilton Anxiety and Depression Scale Depression Subscale (HADS-D, 52%), Beck's Depression Inventory (BDI, 10%), and the Center for Epidemiological Studies Depression Scale (10%). On average, 24% of patients reported clinically significant depressive symptoms, with higher prevalence preoperatively (P < 0.0001). This perioperative difference shifted to higher prevalence postoperatively for patients with other solid tumors when compared with those with breast or prostate cancer.

A fourth of surgical cancer patients report clinically significant depressive symptoms in their perioperative course, with the preoperative timepoint presenting the greatest risk, extending to the immediately postoperative timepoint. This can inform mental health screening timing while considering cancer type.