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Background High prevalence and strong relationships among suicidal ideation, Internet gaming disorder (IGD), insomnia, and depression have been reported for adolescents worldwide, but the mechanism underlying these psychological problems remains unclear. This cross-sectional study explored the mediating effect of insomnia and depression on the association between IGD and suicidal ideation. Methods Participants were 1066 adolescents (median age = 13.0 years) with Internet games exposure in the previous 12 months from junior high schools in Shanghai, China. Questionnaire measures of suicidal ideation, IGD, insomnia, depressive symptoms, and background characteristics were obtained. Path analysis was conducted to test the multiple mediating roles of insomnia and depression. Results Suicidal ideation, IGD, insomnia, and depression prevalence was 27.2, 13.6, 9.2, and 17.0%, respectively. A serial multiple mediation model was generated. The mediation effect of insomnia and depression on the pathway from IGD to suicidal ideation was 45.5% (direct effect: standardized estimate [Std. estimate] = 0.186; total indirect effect: Std. estimate = 0.155). The association between IGD and depression was partially mediated by insomnia (direct effect: Std. estimate = 0.211; indirect effect: Std. estimate = 0.135). The proposed model fit the data well. Conclusions Insomnia and depression may serially mediate the association between IGD and suicidal ideation. IGD was positively associated with insomnia, then with depression, which in turn positively contributed to suicidal ideation. We suggest greater monitoring of Internet use and prevention of insomnia and depression to mitigate the risk of suicidal ideation among Chinese adolescents.

Background It is imperative to promote behavior/intention of taking up booster COVID-19 vaccination (BI-BV) among people who have ever contracted COVID-19 (PECC). The aims were to investigate the prevalence of BI-BV and its associations with perceived social support. Guided by the stress coping theory, we tested mediators between perceived social support and BI-BV via self-stigma, active coping, and maladaptive emotion regulation (rumination and catastrophizing). Methods A random population-based telephone survey was conducted among adult PECC having completed the primary series of COVID-19 vaccination prior to the diagnosis; 230 participants were interviewed from June to August 2022 during the fifth (last) major outbreak in Hong Kong. The associations between the independent variables and BI-BV were tested by logistic regression analysis. A structural equation model (SEM) tested the indirect effects of the latent variables of self-stigma, active coping, and maladaptive emotion regulation between the latent variable of perceived social support and BI-BV. Results The prevalence of BI-BV was 62.2%. It was associated with age, marital status, full-time employment, and chronic disease status. The logistic regression analysis found that BI-BV was positively associated with perceived social support (ORc = 1.31, 95% CI: 1.12– 1.54), active coping (ORc = 1.40, 95% CI: 1.10– 1.79), rumination (ORc = 1.75, 95% CI: 1.13– 2.70), and catastrophizing (ORc = 3.12, 95% CI: 1.49– 6.51) and negatively associated with self-stigma (ORc = 0.80, 95% CI: 0.72– 0.88). In the SEM analysis, the positive association between perceived social support and BI-BV was fully mediated: 1) via self-stigma (β = 0.07, 95% CI: 0.03– 0.14), 2) via active coping (β = 0.06, 95% CI: 0.02– 0.12), and 3) via self-stigma and then active coping (β = 0.01, 95% CI: 0.002– 0.04). Two of these indirect paths involved active coping. The indirect paths involving maladaptive emotion regulation were all non-significant. Conclusions Perceived social support was associated with BI-BV, and was mediated via self-stigma, active coping, and serially self-stigma then active coping but not emotion maladaptation. The data supported the stress cognitive coping model in explaining the association between perceived social support and BI-BV. Interventions promoting BI-BV may consider modifying the observed significant factors. Future longitudinal studies are warranted to confirm the findings.

Background Gaming time reduction has been effective in reducing internet gaming disorder (IGD). This study investigated the prevalence of behavioral intention of gaming time reduction (BI-GTR) among middle school students who self-perceived having IGD. Based on the Conservation of Resource (COR) theory, the mediations between personal/interpersonal resource losses due to gaming time reduction and BI-GTR via perceived stress due to gaming time reduction were investigated. Methods A cross-sectional, anonymous survey was conducted among Chinese adolescent internet gamers with self-perception of IGD in Chengdu, China, from December 2019 to January 2020 ( n  = 485). Self-perception of IGD was assessed by a screening question “Do you perceive yourself having IGD? (yes/no response options)”, while probable IGD was assessed by the 9-item DSM-5 Checklist. Results Among all participants with self-perception of IGD, the prevalence of BI-GTR was 67.4%; it was significantly lower in the probable IGD group than the non-probable IGD group (56.2% versus 73.4%, OR = 1.63, 95% CI: 1.27, 2.08). Multivariate logistic regression analyses showed that, with the adjustment of background factors, personal resource losses (ORa = 0.93, 95% CI: 0.91, 0.95), interpersonal resource losses (ORa = 0.92, 95% CI: 0.90, 0.95), and perceived stress (ORa = 0.60, 95% CI: 0.49, 0.72) were significantly and negatively associated with BI-GTR. Path analysis, adjusting for background factors as well, revealed that the negative association between personal resource losses and BI-GTR was significantly and partially mediated via perceived stress ( β = − 0.07; p  = 0.023; mediation effect size = 15.6%); The similar indirect effects of perceived stress between interpersonal resource losses and BI-RGT were, however, statistically non-significant ( β = − 0.01; p  = 0.874). Multigroup path analysis further showed that the mediation mechanisms were invariant between the probable IGD and non-probable IGD groups. Conclusions The novel findings about the prevalence of BI-GTR, its associated factors, and mediations among Chinese adolescents with self-perception of IGD have implications for future research/interventions. It has extended the application of COR theory to studying health-seeking behaviors. Future confirmation and interventional studies are required. Clinical trial number Not applicable.

PurposeThis study investigated the associations between some factors related to working from home status (WFHS) and positive/negative experiences due to social distancing and their interactions effects on depressive symptoms during the COVID-19 pandemic.MethodsA random population-based telephone survey interviewed income-earning adults in the Hong Kong general population during April 21–28, 2020 (n = 200).ResultsMild to severe depression (according to PHQ-9) was reported by 12% of the participants. The prevalence of WFHS categories was 14% for 3–7 days and 13% for ≥ 8 days (past 2 weeks). The multivariable regression analysis showed that, social isolation (β = 0.36; p < 0.001), relaxation feeling in daily life (β = − 0.22; p = 0.002), and WFHS ≥ 8 days (β = 0.15; p = 0.027), but not perceived huge inconvenience and improved family relationship, were associated with depressive symptoms. Statistically significant interaction effects were found. Some positive experiences buffered the potential harms of some negative experiences of social distancing on depressive symptoms; WFHS ≥ 8 days significantly moderated the risk/protective effects of social isolation, improved family relationship, and relaxation feeling on depressive symptoms.ConclusionsSocial distancing is double-edged. Positive experiences should be maximized while negative experiences be minimized, as both were directly and interactively associated with depression. Intensive but not mild to moderate (< 80%) WFHS may impact depressive symptoms negatively via its direct association with depression; it also moderated the associations between positive/negative experiences due to social distancing and depression. Further research is required to discern the inter-relationships among WFHS, positive/negative experiences of social distancing, and depression to better cope with the stressful pandemic.

Background Obstructive sleep apnea (OSA) is highly prevalent, under-detected, but preventable among older adults. The Common Sense Model of Illness postulates that illness representations are associated with coping and behavioural outcomes. This study investigated the associations between illness representations of OSA and behavioral intention of clinical diagnostic examination for OSA (BICDE-OSA) under two conditional/unconditional situations, stratified by high-risk versus low-risk OSA. Methods A random population-based telephone survey interviewed 945 Chinese people aged ≥ 50 years without OSA diagnosis in the Hong Kong general population from February to November 2021. Results The prevalence of unconditional BICDE-OSA based on the participants’ current sleep situation was only 5.3%; that of conditional BICDE-OSA based on the hypothetical situation of having OSA was 54.3%. Significantly higher prevalence of conditional BICDE-OSA was found in the high-risk than the low-risk of OSA groups (64.4% versus 52.9%; p  < 0.05); no significant between-group difference in unconditional BICDE-OSA was found. Illness representations of timeline chronic, timeline cyclical, consequences, and emotional representation were significantly associated with both conditional/unconditional BICDE-OSA (adjusted for background factors); illness coherence was significantly associated with conditional BICDE-OSA but not with unconditional BICDE-OSA. Conclusions High proportions of older people did not indicate conditional/unconditional BICDE-OSA, possibly resulting in low detection and treatment rates. As OSA was prevalent in the study population and the unconditional group showed a much higher prevalence of BICDE-OSA than the conditional group, the prevalence of BICID-OSA might increase if the high-risk people are made aware of their risk. Interventions modifying illness representations may be considered.

•From 1200 telephone interviews, the COVID-19 vaccine acceptance rate was 37.2%.•Acceptance rate was the highest in adults aged 18–24 years then increased with age.•Government recommendation was the strongest predictive factor of vaccine acceptance.•A key obstacle of acceptance included lack of confidence on vaccine manufacturers.•These predictors provide evidence-based formulation of vaccination strategies. Vaccines for COVID-19 are anticipated to be available by 2021. Vaccine uptake rate is a crucial determinant for herd immunity. We examined factors associated with acceptance of vaccine based on (1). constructs of the Health Belief Model (HBM), (2). trust in the healthcare system, new vaccine platforms and manufacturers, and (3). self-reported health outcomes. A population-based, random telephone survey was performed during the peak of the third wave of COVID-19 outbreak (27/07/2020 to 27/08/2020) in Hong Kong. All adults aged ≥ 18 years were eligible. The survey included sociodemographic details; self-report health conditions; trust scales; and self-reported health outcomes. Multivariable regression analyses were applied to examine independent associations. The primary outcome is the acceptance of the COVID-19 vaccine. We conducted 1200 successful telephone interviews (response rate 55%). The overall vaccine acceptance rate after adjustment for population distribution was 37.2% (95% C.I. 34.5–39.9%). The projected acceptance rates exhibited a “J-shaped” pattern with age, with higher rates among young adults (18–24 years), then increased linearly with age. Multivariable regression analyses revealed that perceived severity, perceived benefits of the vaccine, cues to action, self-reported health outcomes, and trust in healthcare system or vaccine manufacturers were positive correlates of acceptance; whilst perceived access barriers and harm were negative correlates. Remarkably, perceived susceptibility to infection carried no significant association, whereas recommendation from Government (aOR = 10.2, 95% C.I. 6.54 to 15.9, p < 0.001) was as the strongest driving factor for acceptance. Other key obstacles of acceptance included lack of confidence on newer vaccine platforms (43.4%) and manufacturers without track record (52.2%), which are of particular relevance to the current context. Governmental recommendation is an important driver, whereas perceived susceptibility is not associated with acceptance of COVID-19 vaccine. These HBM constructs and independent predictors inform evidence-based formulation and implementation of vaccination strategies.

This study was to investigate the prevalence of actual uptake of pre-exposure prophylaxis (PrEP), willingness to use daily oral PrEP under two cost scenarios, and potential issues related to PrEP use among men who have sex with men (MSM) with HIV negative/unknown sero-status in Hong Kong, China. Factors associated with the two measures of willingness were also investigated. 403 eligible MSM completed the anonymous venue-based face-to-face interview/telephone interview. Only 1% had ever used PrEP. After being briefed about some facts of PrEP, the prevalence of willingness to use daily oral PrEP was 7.7% if they could purchase PrEP at private hospitals/clinics at HK$8,000 (US$1,032)/month (market rate) and 45.2% if free PrEP was provided by public hospitals/clinics in Hong Kong (free PrEP). After adjusted for significant background variables, significant factors of these two measures of willingness included: (1) number of correct responses to knowledge on PrEP, (2) perceived risk of HIV infection in the next six months, and (3) constructs of the Theory of Planned Behavior: positive and negative attitudes toward PrEP, perceived their significant others would support them take PrEP (perceived subjective norm), perceived number of local MSM who were willing to take PrEP (perceived descriptive norm), and confidence in using PrEP under the two scenarios (perceived behavioral control). Among all participants, 9.7% and 25.1% would start and discontinue using PrEP without consulting doctors; 26.0% would not take PrEP daily if it was provided for free, and 42.4% would not take up HIV testing every 3 months after using PrEP. Different strategies should be considered for promoting PrEP at market rate and if free PrEP is made available. Future promotion should increase their knowledge about PrEP, modify their perceptions related to HIV and PrEP, and address some potential issues related to PrEP use.

Poor mental health was prevalent among HIV positive men who have sex with men (HIVMSM), and a tremendous burden extents on their families and society. The present study investigated the prevalence of depression and its relationship with social support, HIV self-stigma, positive affect and negative affect among 321 HIVMSM in Chengdu, China. The study was conducted during July 2013 through October 2013. Findings showed that 55.8 % of the participants had mild to severe depression. The results of structural equation modeling showed that social support and positive affect were negatively associated with depression, while HIV self-stigma and negative affect were positively associated with depression. Social support, positive affect, and negative affect mediated the association between HIV self-stigma and depression. The hypothesized model had a satisfactory fit. Interventions improving mental health among this population are warranted.

Background. Little is known about the community psychological and behavioral responses to influenza pandemics. Methods. Using random digit dialing, we sampled 12,965 Hong Kong residents in 13 cross-sectional telephone surveys between April and November 2009, covering the entire first wave of the 2009 influenza A(H1N1) pandemic. We examined trends in anxiety, risk perception, knowledge on modes of transmission, and preventive behaviors. Results. Respondents reported low anxiety levels throughout the epidemic. Perceived susceptibility to infection and perceived severity of H1N1 were initially high but declined early in the epidemic and remained stable thereafter. As the epidemic grew, knowledge on modes of transmission did not improve, the adoption of hygiene measures and use of face masks did not change, and social distancing declined. Greater anxiety was associated with lower reported use of hygiene measures but greater social distancing. Knowledge that H1N1 could be spread by indirect contact was associated with greater use of hygiene measures and social distancing. Conclusion. The lack of substantial change in preventive measures or knowledge about the modes of H1N1 transmission in the general population suggests that community mitigation measures played little role in mitigating the impact of the first wave of 2009 influenza A(H1N1) pandemic in Hong Kong.