Factor Structure and Longitudinal Invariance of the CES-D across Diverse Residential Backgrounds in Chinese Adolescents

Background:Valid and reliable measures of depressive symptoms are crucial for understanding risk factors,outcomes,and interventions across rural and urban settings.Despite this need,the longitudinal invariance of these measures over time remains understudied.This research explores the structural components of the Center for Epidemiological Studies Depression Scale(CES-D)and examines its consistency across various living environments and temporal stability in a cohort of Chinese teenagers.Method:In the initial phase,1,042 adolescents furnished demographic details and undertook the CES-D assessment.After a three-month interval,967 of these participants repeated the CES-D evaluation.The study employed Confirmatory factor analysis(CFA)to scrutinize the scale’s structural integrity.We investigated factorial invariance by conducting a twopronged CFA:one comparing urban vs.rural backgrounds,and another contrasting the results from the initial assessment with those from the follow-up.Results:The CES-D demonstrated adequate reliability in both rural and urban high school student samples.The preliminary four-factor model applied to the CES-D demonstrated a good fit with the collected data.Invariance tests,including multigroup analyses comparing rural and urban samples and longitudinal assessments,confirmed the scale’s invariance.Conclusions:The results suggest that the CES-D serves as a reliable instrument for evaluating depressive symptoms among Chinese adolescents.Its applicability is consistent across different living environments and remains stable over time.

Screening for depressive symptoms among older adults in Taiwan: Cutoff of a short form of the Center for Epidemiologic Studies Depression Scale

Screening for elders at risk for depression is crucial for promoting mental health in later life. The present study investigates the cutoff score of a short form of the CES-D for screening of depressive symptoms in the elderly population of Taiwan. This particular short form of CES-D is repeatedly used in the Taiwan Longitudinal Study on Aging (TLSA), a national survey of representative older adults in Taiwan, and is therefore referred to as the TLSA form. Data collected from five waves of TLSA were analyzed in this study. Participant responses repeatedly measured in 1989 and 1993 were used to identify a cutoff for the TLSA form of the CES-D with sensitivity and specificity using the cutoff of 4 on the Boston form of the CES-D as the criterion. Longitudinal data from the years 1996, 1999, and 2003 were used to validate the proposed cutoff by comparing the prevalence rates for depressive symptoms among older Taiwan Residents estimated from the identified cutoff and reported in previous studies. The score of 10 on the TLSA form of the CES-D was suggested, yielding a specificity of 0.93 and a sensitivity of approximately 0.96. The estimated prevalence rates for depressive symptoms among Taiwan Residents elders based on the suggested cutoff were between 18.9% and 23.7%, which are similar to previously reported rates. The cutoff score of 10 on the TLSA form of the CES-D is therefore recommended for screening depressive symptoms among older adults in Taiwan.

Repeated measurements of depression and outcomes in patients receiving hemodialysis

Objective:Depression appears to be common among the patients with end-stage renal disease(ESRD).Therefore,how to comprehensively analyze the changes in depression and its impact on patient outcomes is an impor tant research direction.The objectives of this study were to assess changes in depression and whether depression can be used to predict outcomes in patients receiving hemodialysis.Methods:In a longitudinal study,317 patients receiving hemodialysis from two hospitals were investigated.Depression was assessed using the Hamilton Depression Scale(HAMDS)at baseline.Outcomes data(survival and mor tality)were collected from baseline to the end of follow-up 2 years later.Mor tality was assessed using Cox propor tional hazards analysis.Results:The HAMDS score and percentage of high scores increased at three time points.Moreover,the changes were statistically significant.Surviving patients had significantly lower HAMDS scores.Through multivariate Cox regression analysis,age and depression can be used to predict mor tality(P<0.05),and the relative risks(RRs)were 1.032 and 1.069,respectively.Conclusions:Depression in patients receiving hemodialysis is worse.Moreover,baseline depression is an independent predictor of outcomes.Patients receiving hemodialysis should be focused on improving their psychological complications.A systematic and individual psychological health promotion plan must also be incorporated into the health education plan for patients receiving hemodialysis.

慢性心力衰竭患者衰弱变化轨迹及其影响因素

目的探索慢性心力衰竭患者衰弱变化轨迹及其影响因素,为针对性干预提供参考。方法采用方便抽样法选取住院治疗的105例慢性心力衰竭患者,对其入院至出院后6个月期间分为4个时间点进行衰弱评估,了解衰弱变化轨迹,分析影响因素。结果4个时间点患者衰弱评分分别为2(1,3)分、2(0.3)分、1(0,3)分、1(0,3)分;衰弱轨迹分为低水平缓降组(47.6%)、中水平下降组(18.1%)、中水平上升组(34.3%)3个潜类别;多分类logistic回归分析结果显示,年龄、身体质量指数、共病种数、血红蛋白、心功能分级、抑郁和体力活动是患者衰弱轨迹的影响因素(均P<0.05)。结论慢性心力衰竭患者经住院治疗护理,衰弱水平总体呈好转趋势,衰弱轨迹分为3个潜类别,轨迹具有异质性;护理人员可针对不同类别、不同阶段及影响因素制定干预计划,实现精准护理。

大学生焦点解决思维与抑郁症状关系的追踪研究

目的:检验大学生焦点解决思维与抑郁症状的纵向预测关系。方法:选取261名大学生,使用焦点解决问卷(SFI)与抑郁自评量表(SDS)间隔3个月进行2次测量,使用重复测量方差分析和交叉滞后结构方程模型对数据进行分析。结果:2次测量的抑郁症状检出率分别为39.46%和47.89%,SFI跳脱因子得分3月后有所降低(P <0.01)。交叉滞后模型分析显示,基线SFI得分负向预测3个月后的SDS得分(β=-0.19,P<0.05),基线SDS得分对3个月后SFI得分的预测无统计学意义(β=-0.05,P>0.05)。结论:研究提示大学生的焦点解决思维可能有助于减轻抑郁症状。

中国中老年人听力损失与抑郁症状的关联研究

目的:探索中国中老年人听力损失与抑郁症状的纵向关联,为中老年人抑郁的预防提供依据。方法:采用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)2011至2020年中参加2次及以上的受访者数据。听力损失通过自我报告进行评估,抑郁症状通过简版流调用抑郁自评量表(CESD-10)量表进行测量。采用K-M曲线和log-rank检验比较不同分组间发生抑郁症状的风险。采用Cox比例风险回归模型探索听力损失与抑郁症状的纵向关联。结果:研究共纳入12 952例研究对象。基线时1 416(10.9%)例研究对象自报听力损失。在中位随访时间为5.42年的随访中,5 498例研究对象出现抑郁症状。在未调整模型中,基线时的听力损失组发生抑郁症状的风险是无听力损失组的1.34倍(P<0.05),逐步调整社会人口学因素、行为生活方式因素及健康相关因素后,基线时的听力损失仍是抑郁症状的危险因素(HR=1.21,95%CI=1.10~1.34)。结论:听力损失会增加抑郁症状的发生风险,对听力损失进行干预可有效降低抑郁症状的发生。

中国西南地区孕妇妊娠期抑郁发生现状及特征的前瞻性队列研究

目的:探讨中国西南地区孕妇在妊娠期不同阶段抑郁发生的状况及特征。方法:研究为前瞻性多中心研究,研究时间为2018年3月—2019年5月,采用分层抽样和方便抽样相结合的方法选取我国成都市不同层级(部级、省级、市级及区级)的4所妇产医院确诊受孕并进行系统产检的孕妇作为研究对象,使用爱丁堡产后抑郁量表及自行设计的一般状况问卷分别于妊娠早、中、晚期进行调查,分析孕妇妊娠期抑郁发生情况的影响因素。结果:最终纳入1051名孕妇。其中孕早期发生抑郁346人(32.92%),孕中期208人(19.79%),孕晚期215人(20.46%)。连续3期存在抑郁状况者77人(7.33%),任意2期存在抑郁状况者135人(12.84%),任意1期存在抑郁状况者268人(25.50%),无抑郁状况者571人(54.33%)。与无抑郁组比较,与公婆关系、夫妻关系、家中有重大事件发生、担心难产及自己带子女是连续抑郁组的独立影响因素(P<0.05);与任意1期抑郁组比较,夫妻关系、家中有重大事件发生、担心难产及配偶对胎儿有性别期待(男)是连续抑郁组的独立影响因素(P<0.05);与任意2期抑郁组比较,配偶对胎儿有性别期待(男)是连续抑郁组的独立影响因素(P<0.05)。结论:妊娠各期均会有抑郁状况的发生,其中相对于孕中期和孕晚期,孕早期的抑郁发生率最高、程度最重。应重视孕妇早期的心理状况,并从孕早期开始进行心理筛查、干预。对于妊娠期连续抑郁的女性,应帮助其建立良好的夫妻关系、鼓励孕妇树立生育的信心、引导配偶对子女性别持正确的态度,以改善其抑郁状况,促进母婴健康。

Development of health and depressive symptoms among Danish adolescents—Socioeconomic differences and effects of life-style

While the existence of social inequality in health in childhood as well as among adults is well established, research of mechanisms underlying this inequality is still sparse. The study aim was to report on the development of self-rated health and depressive symptoms from age 15 to18 years in a cohort study of Danish adolescents. Methods: The cohort comprised 3,681 individuals born in 1989, 3058 individuals answered the baseline questionnaire in 2004, and 2400 responded to a follow-up questionnaire in 2007, with 2181 individuals participating in both rounds (59% of the original cohort). Social background information of the participants was derived from a national register. For the analysis two variables indicating change in the two health indicators was computed by subtracting the 2007 levels of the variables from the levels experienced in 2004. Results: After 3 years, mean self-rated health (SRH) deteriorated slightly in adolescents (-0.24;95% CI = -0.28 to -0.19) across all socioeconomic status (SES) groups and depressive symptoms increased (0.64;95% CI = 0.52 to 0.75). High household income was protective for decrease in SRH (0.62;0.43 - 0.91). Negative lifestyle changes were associated with poorer SRH and more depressive symptoms. Conclusions: Self-rated health and depressive symptoms changed to the worse among Danish adolescents from age 15 to 18 years. Negative changes in several lifestyle factors were found to accompany the deterioration of health. This result stresses the intrinsic relationship between lifestyle changes and health and the possible positive effect of maintaining and enhancing positive lifestyle factors.

基于交叉滞后分析的脑卒中患者夫妻二元应对与抑郁关系研究

目的探究脑卒中患者夫妻二元应对与抑郁随时间的变化趋势及相互关系,为干预措施的制定提供参考。方法2021年4-12月,便利选取202例脑卒中患者及其配偶照顾者,使用二元应对量表和患者健康问卷抑郁症状群量表在患者病情稳定期(T1)、出院后1个月(T2)和3个月(T3)进行评估,通过交叉滞后分析确定患者夫妻二元应对与抑郁的因果关系。结果脑卒中患者夫妻应对水平随时间发展先上升后下降,而抑郁症状得分随时间发展持续下降,2个变量的变化趋势具有显著的时间效应(均P<0.05),但性别差异不明显。交叉滞后分析显示,患者夫妻的二元应对及抑郁得分存在自回归效应,即自身T1得分可显著影响自身T2得分,自身T2得分可显著影响自身T3得分;患者与配偶二元应对相互预测;患者抑郁正向预测配偶抑郁;配偶抑郁负向预测患者二元应对;患者与配偶二元应对预测自身抑郁(均P<0.05)。结论脑卒中患者夫妻二元应对、抑郁水平和抑郁发生率均呈动态变化。患者夫妻二元应对与抑郁互为因果,相互交织。临床及社区医护人员需实施以家庭为中心的综合性干预方案,以改善患者夫妻的心理状态及应对能力。

Formation and control of the surface defect in hypo-peritectic steel during continuous casting:A review

Hypo-peritectic steels are widely used in various industrial fields because of their high strength,high toughness,high processability,high weldability,and low material cost.However,surface defects are liable to occur during continuous casting,which includes depression,longitudinal cracks,deep oscillation marks,and severe level fluctuation with slag entrapment.The high-efficiency production of hypo-peritectic steels by continuous casting is still a great challenge due to the limited understanding of the mechanism of peritectic solidification.This work reviews the definition and classification of hypo-peritectic steels and introduces the formation tendency of common surface defects related to peritectic solidification.New achievements in the mechanism of peritectic reaction and transformation have been listed.Finally,countermeasures to avoiding surface defects of hypo-peritectic steels duiring continuous casting are summarized.Enlightening certain points in the continuous casting of hypo-peritectic steels and the development of new techniques to overcome the present problems will be a great aid to researchers.

中国高龄老年人抑郁症状状况及影响因素分析

目的 探索中国高龄老年人的抑郁症状状况及影响因素。方法 本研究利用2017—2018年进行的第8轮中国老年健康影响因素跟踪调查(CLHLS)数据,CLHLS采用多阶段分层抽样法,根据纳入和排除标准筛选后,最终纳入6 318名高龄老年人为研究对象。从人口学特征、社会支持、生活方式、健康状况和经济状况5个维度进行研究,采用logistic回归分析中国高龄老年人抑郁症状的影响因素。结果 不同抑郁症状的高龄老年人在性别、体重指数(BMI)、教育水平、吸烟、饮酒、锻炼、婚姻状况、居住状况、年收入、健康状况和居住地分布方面比较,差异有统计学意义(P<0.05)。logistic回归分析显示,BMI<18.5 kg/m^(2)[OR=1.39,95%CI:(1.15,1.69)]、丧偶[OR=1.33,95%CI:(1.06,1.65)]、独居[OR=1.35,95%CI:(1.10,1.66)]是高龄老年人抑郁症状的危险因素(P<0.05);锻炼[OR=0.65,95%CI:(0.53,0.80)]、健康状况好[OR=0.22,95%CI:(0.18,0.27)]、富裕[OR=0.79,95%CI:(0.64,0.98)]是其保护因素(P<0.05)。结论 偏瘦、丧偶、单独居住的高龄老年人出现抑郁症状的可能性高于体重正常、已婚并与配偶一起生活、与家人同住的高龄老年人。锻炼、健康状况好、富裕是高龄老年人出现抑郁症状的可能性低于不锻炼、健康状况差、非常贫穷的高龄老年人。

心理弹性、负性生活事件和抑郁症状的关系:钢化效应和敏化效应

该研究追踪调查汶川地震后1573名青少年,考查心理弹性、生活事件和抑郁症状的关系,以探讨幸存者的心理修复过程。结果表明:(1)心理弹性既能直接预测抑郁症状,也能通过抑郁症状间接影响生活事件;(2)生活事件既能直接预测心理弹性,也能通过抑郁症状间接预测心理弹性;(3)抑郁症状既能直接影响心理弹性,也能通过生活事件间接影响心理弹性。结论:灾后不同特征的青少年心理修复过程不同,存在"钢化效应"和"敏化效应"。

流动儿童压力应对方式与抑郁感、社交焦虑的关系:一项追踪研究

为了探讨流动儿童压力应对方式与抑郁感、社交焦虑的变化特点及其动态关系,本研究通过整群抽样法从5所北京市公立学校和1所打工子弟学校选取1164名流动儿童,采用问卷调查的形式对其进行为期一年的追踪测查,追踪时回收有效数据680份。对前、后测均参加调查的680名被试的数据进行分析,结果发现:(1)经过一年的城市适应,流动儿童整体的积极应对增多,消极应对减少,抑郁感下降,但社交焦虑水平无明显变化;(2)流动儿童个体在压力应对、抑郁感、社交焦虑的发展上均表现出两极分化的现象,年龄越小、来京时间越短、低年级及女生流动儿童群体的发展趋势更为良好;(3)流动儿童压力应对方式与抑郁感、社交焦虑间存在相互作用的动态关系,前测压力应对方式、抑郁感、社交焦虑均能显著预测后测相应变量的水平,前后测压力应对方式对抑郁感、社交焦虑均有即时预测作用,而前测抑郁感和社交焦虑对后测压力应对方式有不同的延时性影响。

影响高速浇铸亚包晶钢表面质量的因素研究

为改善亚包晶钢高速浇铸时的表面质量,从过热度、锰硫比、拉速、铜板温度、平均热流和保护渣几个方面进行讨论。浇铸亚包晶钢时钢水过热度高,在较强的冷却制度下会促进铸坯表面形成凹陷和纵裂。随着拉速的增加,凹陷的发生率呈上升趋势,在同一拉速条件下,铸坯内弧比外弧更易于生成凹陷。结晶器壁热流不均是纵裂纹产生的有利环境,铸坯表面产生裂纹和没有裂纹时,二者的平均热流和铜板温度存在明显的差异。与低碱度保护渣相比,使用高碱度保护渣时,结晶器热流量和铜板温度低,有利于实现弱冷却,均匀形成凝固坯壳,有助于获得良好表面质量的铸坯。

大学生体力活动、心肺耐力与抑郁风险关系的纵向研究

目的:探讨大学生体力活动、心肺耐力、抑郁风险三者之间的关系。方法:采用国际体力活动问卷(IPAQ)、体质健康测试和抑郁筛选量表(CES-D量表)对1 067名在校大学生(其中男生518人,女生549人)体力活动、体质健康水平和抑郁水平进行了评估,研究采用纵向研究设计,追踪测量持续两年时间,每隔1年测量一次,采用潜变量增长模型和Logistic回归对所测得的数据进行分析。结果发现,经过年龄、BMI、独生子女、父母文化程度、自评家庭经济、肺活量等可能的混杂因素校正后,体力活动水平每下降10 MET-min/d可以引起男生抑郁事件的发生风险率增加1.1%(OR=1.011),女生抑郁事件发生风险率增加2.1%(OR=1.021);耐力跑成绩每增加10秒的可以引起男生抑郁事件的发生风险率增加1.5%(OR=1.015),女生抑郁事件发生风险率增加6.3%(OR=1.063)。结论:大学生体力活动水平、心肺耐力与抑郁风险之间的关系密切,提高体力活动水平、心肺耐力水平能有效地降低抑郁风险。

童年中晚期友谊质量与抑郁的关系:一项纵向研究

以友谊质量问卷和儿童抑郁量表为研究工具,对小学3到4年级847名儿童进行了18个月的追踪研究,采用交叉滞后的研究设计,考察了童年中晚期友谊质量与抑郁的关系。结果表明:(1)同一时间点的友谊质量和抑郁之间呈显著的负相关;(2)早期的友谊质量可以显著预测随后的抑郁,早期的抑郁也可以显著预测随后的友谊质量,且相对于友谊质量对抑郁的积极作用,抑郁对儿童友谊质量的瓦解作用更为突出;(3)童年中晚期友谊质量与抑郁的双向作用关系具有跨性别稳定性。

直肠癌患者新辅助放化疗及临时造口术后肠道功能与焦虑抑郁的纵向研究

目的探讨中低位直肠癌患者术前新辅助放化疗及临时性造口后肠道功能及焦虑抑郁的动态变化特征及其相关性,为制定针对性改善措施提供依据。方法采用便利抽样法选择97例中低位直肠癌患者,运用纪念斯隆-凯特林癌症中心(MSKCC)肠道功能问卷及医院焦虑抑郁量表(HADS),分别于确诊时、术前放化疗结束后1个月、造口回纳术后第4天、造口回纳术后3个月及造口回纳术后6个月进行纵向调查。结果 5个时间点患者肠道功能得分分别为69.53±8.89、63.90±8.99、59.95±7.23、63.29±9.31、66.27±7.52,差异有统计学意义(P<0.01);肠道功能总分与焦虑抑郁得分呈负相关(P<0.05,P<0.01)。结论放化疗、手术均影响患者的肠道功能,肠道功能与焦虑抑郁有一定的关系;应关注造口回纳术后早期患者的肠道症状,采取措施改善其肠道功能及心理状况。

急性心肌梗死患者运动恐惧水平及其影响因素的纵向研究

目的调查急性心肌梗死患者运动恐惧水平变化趋势及影响因素,为针对性干预提供参考。方法采用一般资料问卷、心脏病患者运动恐惧量表、医院抑郁量表、运动自我效能量表、锻炼社会支持量表分别于住院期间(T0)、出院后1个月(T1)、出院后3个月(T2)进行问卷调查。结果共147例完成研究。3个时间段运动恐惧水平得分分别为(44.80±6.14)分、(42.26±6.06)分、(38.99±5.26)分,差异有统计学意义(P<0.05)。多元线性逐步回归分析结果显示,年龄、运动自我效能是T0~T2时期急性心肌梗死患者运动恐惧的影响因素(均P<0.05),住院天数在T1、T2时对运动恐惧产生影响(均P<0.05),社会支持仅在T0时对急性心肌梗死患者运动恐惧产生影响(P<0.05),抑郁仅在T1时对运动恐惧产生影响(P<0.05)。结论随着出院时间延长,急性心肌梗死患者运动恐惧水平呈下降趋势。医护人员需关注运动恐惧变化趋势及影响因素,进而制订针对性的干预措施促进患者康复。

童年中晚期抑郁的发展及其与问题行为的并发:一项两年追踪研究

采用儿童抑郁量表和问题行为量表对771名小学3、4年级儿童进行了2年追踪调查,考察了童年中晚期抑郁的发展轨迹及其性别差异,并探讨了童年期中晚期抑郁与问题行为的并发。结果表明:(1)童年中晚期抑郁的发展轨迹为非线性曲线,其随着时间的推移而逐步下降,但在童年晚期阶段,呈现出逐步上升趋势;(2)童年中晚期抑郁的发展轨迹,在初始水平和发展速度上均不存在显著的性别差异;(3)童年中晚期抑郁的发展,常伴随着问题行为的并发。

基于纵向数据线性混合效应模型的老年人抑郁影响因素研究

目的应用线性混合效应(linear mixed effect,LME)模型对老年抑郁量表得分情况进行拟合分析,探讨老年人抑郁情况及其影响因素。方法数据来源于美国国家阿尔茨海默合作中心(National Alzheimer’s Coordinating Center,NACC),采用简版老年人抑郁量表对老年人抑郁情绪进行调查,从2011年进行首次调查的1 345人中筛选出连续随访4年共计230人;根据赤池信息准则(Akaike information criterion,AIC)、贝叶斯信息准则(Bayesian information criterions,BIC)值最小化原则,选择合适的方差-协方差结构(UN)对该数据进行拟合和模型参数估计,利用SAS软件中的MIXED模块对该纵向数据进行建模与分析。结果 LME模型结果显示,受教育年限越长(β=-0. 103,P=0. 016),简版老年抑郁量表(Geriatric Depression Scale,GDS)得分越低;离婚的老年人相比于在婚状态的老年人GDS得分高(β=0. 742,P=0. 025),独居的老年人比在婚状态的GDS得分高(β=1. 495,P=0. 024);复杂活动需要帮助的老年人相比于完全能自理的老年人GDS得分更高(β=0. 420,P=0. 036);近2年经常感到沮丧的老年人GDS得分更高(β=1. 176,P <0. 0001);痴呆状态的老年人比正常认知老年人GDS得分高(β=1. 068,P=0. 003),MCI状态的老年人也比正常状态的老年人GDS得分高(β=1. 020,P=0. 001)。结论线性混合效应模型能有效地处理纵向数据;低文化水平、低自理能力、低认知状态、离婚是造成老年抑郁的重要因素。