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Background Although both peer victimization and bullying perpetration negatively impact preadolescents’ development, the underlying neurobiological mechanism of this adverse relationship remains unclear. Besides, the specific psycho-cognitive patterns of different bullying subtypes also need further exploration, warranting large-scale studies on both general bullying and specific bullying subtypes. Methods We adopted a retrospective methodology by utilizing the data from the Adolescent Brain and Cognitive Development SM Study (ABCD Study®) cohort collected between July 2018 and January 2021. Participants were preadolescents aged from 10 to 13 years. The main purpose of our study is to examine the associations of general and specific peer victimization/bullying perpetration with preadolescents’ (1) suicidality and non-suicidal self-injury; (2) executive function and memory, including attention inhibition, processing speed, emotion working memory, and episodic memory; (3) brain structure abnormalities; and (4) brain network disturbances. Age, sex, race/ethnicity, body mass index (BMI), socioeconomic status (SES), and data acquisition site were included as covariates. Results A total of 5819 participants aged from 10 to 13 years were included in this study. Higher risks of suicide ideation, suicide attempt, and non-suicidal self-injury were found to be associated with both bullying perpetration/peer victimization and their subtypes (i.e., overt, relational, and reputational). Meanwhile, poor episodic memory was shown to be associated with general victimization. As for perpetration, across all four tasks, significant positive associations of relational perpetration with executive function and episodic memory consistently manifested, yet opposite patterns were shown in overt perpetration. Notably, distinct psycho-cognitive patterns were shown among different subtypes. Additionally, victimization was associated with structural brain abnormalities in the bilateral paracentral and posterior cingulate cortex. Furthermore, victimization was associated with brain network disturbances between default mode network and dorsal attention network, between default mode network and fronto-parietal network, and ventral attention network related connectivities, including default mode network, dorsal attention network, cingulo-opercular network, cingulo-parietal network, and sensorimotor hand network. Perpetration was also associated with brain network disturbances between the attention network and the sensorimotor hand network. Conclusions Our findings offered new evidence for the literature landscape by emphasizing the associations of bullying experiences with preadolescents’ clinical characteristics and cognitive functions, while distinctive psycho-cognitive patterns were shown among different subtypes. Additionally, there is evidence that these associations are related to neurocognitive brain networks involved in attention control and episodic retrieval. Given our findings, future interventions targeting ameliorating the deleterious effect of bullying experiences on preadolescents should consider their subtypes and utilize an ecosystemic approach involving all responsible parties.

Hong Kong adolescents are at increased risk for poor psychological well-being. A higher quality relationship between adolescents and their mothers may promote positive adjustment, given the strong family-oriented culture in Hong Kong. Potential pathways by which the mother–adolescent relationship may facilitate better adolescent subjective well-being, however, remains unclear. Current resilience theories underscore the importance of examining the role of external resources for individual’s resilience capacity, and cascading effects of family functioning on adolescent subjective well-being outcomes by promoting their resilience resources. Therefore, we tested the hypothesis that a higher quality mother–adolescent relationship will be associated with better adolescent subjective well-being via improved resilience resources. Adolescents from Hong Kong ( N  = 133; M age = 11 years, SD  = 0.21, 51.8% female) reported on their relationship with their mothers, resilience resources, and subjective well-being at Time 1 and one year later at Time 2. We used the half-longitudinal mediation model for testing mediation with two time points. Both resilience resources and mother–adolescent relationship quality were positively associated with adolescent subjective well-being, concurrently and one year later. Further, adolescents’ resilience resources mediated the association between mother–adolescent relationship quality and their subjective well-being one-year later. Our findings provide support for the cascading effect of external resources (i.e., mother–adolescent relationship quality) on adolescents’ resilience resources and their later subjective well-being. The findings can inform the improvement of existing resilience enhancement programs by adding components that strengthen family relationships. Highlights We used a half-longitudinal mediation model to test the pathway by which mother–adolescent relationship quality is associated with Hong Kong adolescents’ subjective well-being over time. Findings support that adolescents’ resilience resources mediated the longitudinal link between mother–adolescent relationship quality and adolescents’ subjective well-being. Findings have practical implications for improving existing resilience-based intervention programs among Hong Kong adolescents, by integrating intervention components to improve mother–adolescent relationship quality.

BackgroundThe early prediction of adolescent depression recurrence poses a significant challenge in the field. This study aims to investigate and compare the abilities of the general psychopathology factor (p) and the specific internalizing factor, in predicting depression recurrence over a 2-year course, as well as identifying remitted depressed adolescents from healthy adolescents. Longitudinal changes of these two factors in different trajectory groups were also tracked to examine their sensitivity to sustained remission and relapse.MethodsWe included 255 baseline-remitted depressed adolescents and a healthy control group (n = 255) matched in age, sex, and race, sourced from the Adolescent Brain Cognitive Development Study. The linear mixed model was employed for the statistical analysis.ResultsThe p factor not only effectively discriminated between remitted depressed adolescents and healthy controls but also robustly predicted the depression recurrence over a subsequent 2-year course. The specific internalizing factor could only differentiate remitted depressed adolescents from healthy controls. Additionally, a noteworthy longitudinal decline of the p factor in the sustained-remission group was observed.ConclusionsPsychopathology factors serve as the inherent and enduring measurement of long-term mental health aberrations. Longitudinal results indicate that the p factor is more sensitive to respond to sustained remission than the internalizing factor. The ability of the overall p factor to anticipate depression relapse, unlike the specific internalizing factor, suggests the clinical interventions should monitor and mitigate the coincident symptoms across all dimensions to preempt relapse of adolescent depression, rather than an exclusive focus on internalizing symptoms.

Background With suicide as a leading cause of death, the issue of children and adolescent suicide risks is in the spotlight today. To empower teachers in primary and secondary schools to serve as gatekeepers and to ensure the safety of children and adolescents, the systematically tailored and localized Life Gatekeeper suicide prevention program was designed for Chinese schools. Objective With the ultimate goal of preventing child and adolescent suicide, we aim to outline a research protocol for examining outcomes of the recently created standardized school-based Life Gatekeeper program in reducing teachers’ stigma, increasing their knowledge, willingness to intervene, and perceived competence. Methods Participants will be recruited from eligible primary and secondary schools. Cluster sampling will be used to randomly assign each school to either the intervention group or the control group. The primary outcomes are stigma against suicide, suicide literacy, perceived competence, and willingness to intervene with suicidal individuals, which will be measured using the Stigma of Suicide Scale, the Literacy of Suicide Scale, and the Willingness to Intervene Against Suicide Questionnaire, respectively. Measurements will be taken at four time points, including pre-intervention, immediately after the intervention, 6-month follow-up, and 1-year follow-up. Conclusions The current study features innovative implementation in the real world, by using a randomized controlled trial design to examine the effectiveness of a school-based gatekeeper program among primary and secondary school teachers, following a sequence of defined and refined steps. The research will also investigate the viability of a school-based gatekeeper program for primary and secondary school teachers that could be quickly and inexpensively implemented in a large number of schools.

Background To address the lack of mental health practitioners in developing countries, the current study explored the feasibility of a newly developed self-guided digital intervention program TEA (training for emotional adaptation) in alleviating depressive and anxiety symptoms, as one of a few studies which adapted from theoretical models with effective intervention techniques. Methods The first part of this study involved 11 professional mental health practitioners giving feedback on the feasibility of the TEA; while the second part involved a mixed-method single-arm study with 32 participants recruited online, who went through the seven intervention sessions within 14 days. The questionnaires were collected before, after, 14 days after, and 30 days after intervention. Additionally, 10 participants were invited to semi-structured interviews regarding their suggestions. Results Practitioners thought that the TEA showed high professionalism (8.91/10) and is suitable for treating emotional symptoms (8.09/10). The generalized estimating equation model showed that the TEA significantly reduced participants' depressive and anxiety symptoms, while the effects of the intervention remained 30 days post intervention (Cohen's d > 1). Thematic analysis revealed three main themes about future improvement, including content improvement, interaction improvement, and bug-fixing. Conclusions To address the current needs for digital mental health intervention programs to account for the insufficient availability of mental health services in China, the current study provides preliminary evidence of the effectiveness of TEA, with the potential to address the urgent need for remote mental health services. Trial registration The study was registered at the Chinese Clinical Trial Register (ChiCTR), with number [ChiCTR2200065944].

The impact of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) traits on suicidal thoughts and behaviors (STBs) remains inadequately explored. Hence, the present study aims to delve deeper into these intricate issues, contributing to a better understanding of these complex challenges among Chinese youth. The data of 90,882 participants was collected from 63 Chinese universities and colleges in Jilin, China. We aim to explore the risks of STBs on ASD, ADHD, and co-occurrence of ASD + ADHD by using the Autism Spectrum Quotient-10 items (AQ-10) and Adult ADHD Self Report Scale (ASRS). Propensity score matching (PSM) was implemented to balance demographical variables across the four groups. Binary logistic regression was then conducted to further analyze and compare suicide risk across the four groups, also accounting for sex differences. Suicide risks were significantly higher in the ADHD (OR = 1.24, p < 0.001) and ASD + ADHD(OR = 1.49, p < 0.001) traits group. However, there was no significant difference in suicide risk between the ASD traits group (OR = 1.00, p = 1.00) and the control group. The risk of suicide was significantly higher for females than for males across all four groups (p < 0.001). These results indicate the importance of screening for ASD + ADHD traits in young adults, especially females due to its higher risk of STBs. Further studies are warranted to delve deeper into this issue, emphasizing the necessity of formal diagnostic tests and directing focused attention toward addressing these complexities.

BackgroundPain sensitivity is critical for preventing non-suicidal self-injury (NSSI) behaviours; however, individuals engaging in such behaviours often exhibit decreased pain sensitivity, which may undermine this natural safeguard. The dorsolateral prefrontal cortex (DLPFC) is a key region involved in pain regulation, and recent approaches using transcranial direct current stimulation (tDCS) to target the DLPFC have shown potential for modulating pain processing and restoring normal pain perception for individuals engaging in NSSI behaviours.AimsThis study aimed to explore the immediate and short-term effects of a single session of tDCS on pain sensitivity in individuals with NSSI, as well as its secondary effects on mood and NSSI-related factors.MethodsIn this randomised, double-blind, parallel, sham-controlled clinical trial, participants with a history of NSSI were randomly assigned to receive either active or sham tDCS. The intervention consisted of a single 20 min tDCS session targeting the left DLPFC. The primary outcome was pain sensitivity, measured by the pressure pain threshold (PPT) and heat pain score (HPS). Secondary and additional outcomes included NSSI urges, NSSI resistance, self-efficacy in resisting NSSI, mood-related variables and exploratory cognitive-affective processes such as rumination, self-criticism and self-perceived pain sensitivity, assessed at baseline, immediately post-intervention, and at 24 hours, 1 week and 2 weeks follow-ups.ResultsFor the primary outcomes, no significant differences between groups were observed for pain sensitivity (PPT, padj=0.812; HPS, padj=0.608). However, an exploratory sensitivity analysis treating each trial as an individual observation revealed a significant effect on HPS (padj=0.036). For the secondary and additional outcomes, although there were initial improvements in joyful feelings and reductions in negative affect at 2 weeks post-intervention, these effects did not remain significant after multiple comparison corrections. Notably, reductions in rumination were statistically significant at both 1-week and 2-week follow-ups (1 week, padj=0.040; 2 weeks, padj=0.042). There were no significant effects on NSSI urges, NSSI resistance, self-efficacy in resisting NSSI or self-criticism.ConclusionsA single session of tDCS over the left DLPFC did not produce significant changes in pain sensitivity in individuals with NSSI. A sensitivity analysis indicated an effect on heat pain sensitivity, possibly reflecting changes in brain activity, warranting confirmation through neuroimaging. These findings suggest that tDCS warrants further investigation for its potential to influence pain-related cognitive-affective processes in individuals with NSSI.

BackgroundYouth suicide has been a pressing public mental health concern in China, yet there is a lack of gatekeeper intervention programmes developed locally to prevent suicide among Chinese adolescents.AimsThe current Delphi study was the first step in the systematic development of the Life Gatekeeper programme, the first gatekeeper programme to be developed locally in China that aims to equip teachers and parents with the knowledge, skills and ability to identify and intervene with students at high risk of suicide.MethodsThe Delphi method was used to elicit a consensus of experts who were invited to evaluate the importance of training content, the feasibility of the training delivery method, the possibility of achieving the training goals and, finally, the appropriateness of the training materials. Two Delphi rounds were conducted among local experts with diversified professional backgrounds in suicide research and practice. Statements were accepted for inclusion in the adjusted training programme if they were endorsed by at least 80% of the panel.ResultsConsensus was achieved on 201 out of 207 statements for inclusion into the adapted guidelines for the gatekeeper programme, with 151 from the original questionnaire and 50 generated from comments of the panel members. These endorsed statements were synthesised to develop the content of the Life Gatekeeper training programme.ConclusionsThis Delphi study provided an evidence base for developing the first gatekeeper training programme systematically and locally in China. We hope that the current study can pave the way for more evidence-based suicide prevention programmes in China. Further study is warranted to evaluate the effectiveness of the Life Gatekeeper training programme.

Flourishing, an indicator which reflects one’s emotional status and ability to function, is an important antecedent for adolescents’ later psychological and physical development. This study aimed to shift the research focus on rural adolescents from a deficit-based orientation to a strength-based orientation by integrating the effects of individual and social factors. Altogether, 995 Chinese rural adolescents (569 boys and 426 girls, Mage = 12.56 years) completed a self-report questionnaire which included the Ego Identity Scale, Intrinsic Motivation Scale, Social Capital Scale and Flourishing Scale. The results indicate that: (1) ego identity exploration has a positive effect on rural adolescents’ flourishing; (2) intrinsic motivation has an indirect effect on the relationship between ego identity exploration and flourishing; and (3) social capital may moderate the indirect effect by attenuating the relationship between ego identity exploration and intrinsic motivation. The findings highlight the importance of constructing a more comprehensive framework by integrating individual and social perspectives to understand and foster the flourishing of rural adolescents. Meanwhile, it is necessary to incorporate the strengths of family, school and social organizations in order to enhance rural adolescents’ flourishing.