ObjectiveTo investigate the impacts of different dimensions of sleep quality on depressive symptoms among adolescents, thus providing evidence for the prevention of depressive symptoms among adolescents. MethodsA baseline survey was conducted from September to November 2023 for 2 373 adolescents selected by stratified cluster sampling from two junior high schools, two senior high schools, and two vocational high schools in Wuhan city. A follow-up survey was conducted from September to November 2024. The Pittsburgh Sleep Quality Index (PSQI) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used for the investigation. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to screen the influencing factors, and the eXtreme Gradient Boosting (XGBoost) algorithm was adopted to construct a prediction model. The prediction performance was evaluated by the area under the curve (AUC). ResultsThe detection rates of depressive symptoms among adolescents in Wuhan were 31.73% at baseline and 32.28% at the one-year follow-up. The median (interquartile range) PSQI total score was 4 (2–6). Adolescents with depressive symptoms at follow-up had higher PSQI total score (5 vs. 3), sleep latency subscale score (1 vs. 0), and daytime dysfunction subscale score (2 vs. 1) than those without depressive symptoms (all P < 0.05). LASSO regression results indicated that baseline depressive symptoms (β = 0.15), daytime dysfunction (β = 0.04), sleep latency (β = 0.02), and sleep disturbances (β = 0.02) were influencing factors for follow-up depressive symptoms. The prediction model achieved an AUC of 0.775 (95%CI: 0.739–0.812). Baseline depressive symptoms and daytime dysfunction had the greatest impacts on follow-up depressive symptoms (with contributions of 0.36 and 0.20, respectively), and their interaction effect value was 0.022 (95%CI: 0.020–0.023). ConclusionsDaytime dysfunction is a key sleep-related risk factor for future depressive symptoms among adolescents. It interacts with baseline depressive symptoms, significantly amplifying the risk of subsequent depression.

BACKGROUND:Social relationship factors have been linked with cardiovascular health in older adulthood, and epidemiological studies indicate that the association may vary for different constructs of social relationships. This study aims to investigate associations between three social relationship measurements including loneliness, social isolation, and social support and psychophysiological stress response among older adults, with a focus on gender differences. METHODS:Ninety older adults (34 males, mean age ± SD = 66.31 ± 5.43) completed measures of social relationships and two stress-inducing tasks including mirror tracing and Stroop-color naming. Heart rate (HR) was monitored throughout the laboratory session. RESULTS:For male participants, social support was significantly associated with a lower stress HR response (β = -0.181, t = -2.44, p = .022), and this association remained significant (β = -0.174, t = -2.33, p = .029) even after all the other covariates including loneliness and social isolation were taken into account. For female participants, no significant association was found between the three social relationship constructs and stress HR response. No significant result was found for psychological stress response for either male or female participants. CONCLUSIONS:These findings suggest gender differences in the association between specific social relationship constructs and physiological stress response in older adults.

To investigate the association between oral microbiome characteristics and suicidal ideation (SI) in vocational high school students. The oral microbiota composition and abundance of the SI group (N = 45) and the matched healthy control group (N = 45) were analyzed using 16S rRNA sequencing. Demographic variables and SI assessments (measured by the Columbia Suicide Severity Rating Scale) were obtained. Bioinformatics analyses (e.g., alpha and beta diversity indices, PCoA, NMDS, and LEfSe) were performed to compare oral microbiota characteristics between the SI group and the control group. The vocational high school students with SI exhibited significantly lower alpha diversity indices in oral microbiota compared to the control group, including PD whole tree (20.56 [19.45, 21.38] vs. 21.37 [20.17, 23.27]), Chao1 (621.82 ± 66.99 vs. 672.24 ± 68.52), and observed species (426.91 ± 54.59 vs. 466.42 ± 69.75) (all p values < 0.01). Beta diversity analysis revealed distinct microbial composition between groups ( p < 0.05), with greater homogeneity in the SI group. LEfSe analysis identified increased abundances of Enterobacter, Escherichia_Shigella, and Parabacteroides in the SI group, while controls showed enrichment of Rikenellaceae and Alistipes. A decrease in oral microbiota diversity and alterations in the abundance of specific bacterial genera (Enterobacter, Escherichia_Shigella, and Parabacteroides) are associated with SI among vocational high school students. Longitudinal studies are needed to elucidate the underlying mechanisms and potential health impacts.

OBJECTIVE:Adolescent suicidal behaviors pose a critical public health challenge. This study examined the co-occurrence patterns of psychological and behavioral risk factors and evaluated their associations with suicidal ideation (SI) and suicide attempts (SA). METHODS:A multicenter adolescent survey conducted in 2023-2024 (n = 19,312) collected sociodemographic, psychological, and behavioral data. Complex survey logistic regression was applied to identify factors associated with SI and SA. Latent class analysis (LCA) was used to derive psychological-behavioral risk profiles, and their discriminative performance was evaluated using logistic regression with 10-fold cross-validation. RESULTS:The prevalence of SI and SA was 25.41% and 8.03%, respectively. Fourteen factors were associated with SI, including resilience, social capital, hostility, depression, anxiety, maladjustment, emotional instability, psychological disequilibrium, virtual world integration, adverse childhood experiences, negative life events, sleep quality, internet addiction and alcohol use. For SA, academic stress and smoking were additionally retained, whereas anxiety, emotional instability, psychological disequilibrium and internet addiction were not retained. Four distinct profiles were identified: Low-risk/High-protection, Moderate distress, Psychological-problem dominant and High-risk/Multi-problem. Compared with the Low-risk group, adolescents in the High-risk group demonstrated substantially higher odds of SI (aOR = 15.87, 95% CI: 13.96-18.03) and SA (aOR = 11.72, 95% CI: 10.11-13.60). The LCA-based model showed good discrimination (AUC = 0.796 for SI; 0.772 for SA), outperforming single-variable models. CONCLUSION:Psychological and behavioral factors among adolescents cluster into distinct risk profiles that are associated with different levels of suicidal behaviors. These findings provide a person-centered, multidimensional perspective for understanding heterogeneity in adolescent suicide-related risk.

Previous research has demonstrated a link between physical activity and loneliness, though the direction of this relationship remains unclear. This study explored daily fluctuations in the temporal relationship between physical activity and loneliness in young adults. A total of 150 participants (83 women; mean age = 21.1 ± 2.19 years) completed daily surveys across 21 consecutive days. Physical activity was measured using ActiGraph accelerometers. Daily loneliness was assessed each evening using the Chinese version of three-item UCLA Loneliness Scale and a single-item measure. Cross-lagged multilevel linear models examined same-day and lagged associations between physical activity and loneliness at within- and between-person levels. On days with higher moderate-to-vigorous physical activity (MVPA) or total energy expenditure (TEE), participants reported lower loneliness; no between-person effects emerged. These results were consistent across both loneliness measures. Gender moderated the MVPA-loneliness association, with stronger effects observed among men than women. Loneliness did not predict next-day physical activity. Engaging in moderate-to-vigorous physical activity may help reduce feelings of loneliness on a daily basis, particularly among men. Future research should explore the mechanisms underlying this relationship and assess causal effects to inform tailored interventions for loneliness reduction.

Background: While long-term exposure to air pollutants may increase the risk of non-alcoholic fatty liver disease (NAFLD), the relative contributions of different air pollutants and the role of particulate matter (PMx) size remain elusive. We investigated independent and joint effects of long-term exposure to PM of different sizes (PM1, PM2.5, PM10, PM1-2.5, and PM2.5-10) and gaseous pollutants (NO2, SO2, and CO) on NAFLD incidence, as well as the impact of different PM2.5 components. Methods: This prospective study included 31,105 participants from the Chinese Cohort of Working Adults (CCWA). Newly diagnosed cases of NAFLD were identified through ultrasound-based diagnosis of hepatic steatosis during physical examination. Logistic regression was employed to estimate associations of individual air pollutants and PM2.5 components with NAFLD. Weighted Quantile Sum (WQS) regression assessed the joint effect of air pollutants and their relative contribution to the joint effect. Stratified analyses by demographic, behavioral, and health factors were also conducted. Results: Each interquartile increase in the exposure to individual air pollutants and PM2.5 components was associated with a higher incidence of NAFLD. PM1-2.5 showed the strongest positive association (OR: 1.21, 95 % CI: 1.15-1.28). Among PM2.5 components, organic matter (OM) had the highest independent effect (OR: 1.19, 95 % CI: 1.12-1.26). Among all included pollutants, PM1-2.5 contributed most (71 %) to the joint effect on the NAFLD incidence at follow-up, followed by PM1 (16 %) and NO2 (13 %); of the PM2.5 components, OM contributed the most (56 %). Effects of air pollutants on the NAFLD incidence were more pronounced in men and smokers. Conclusion: Long-term exposure to PM1-2.5 within the PM2.5 size range most importantly affects new-onset NAFLD, and within PM2.5 components OM appears to be the most relevant contributor. This study may provide valuable insights into implementing preventive strategies for NAFLD.

Background Prenatal depression is highly prevalent and associated with early-life adversities like adverse childhood experiences (ACEs) and school bullying. Machine learning (ML) can effectively capture complex, non-linear predictive patterns for depression. Objective We aimed to identify early-life factors predicting prenatal depression and develop a practical, interpretable ML predictive model. Participants and setting A cross-sectional study recruited 1193 pregnant women via convenience sampling at two hospitals in Hubei, China. Methods Feature selection used a 10-fold cross-validation framework strictly within the training set. Nine ML algorithms were benchmarked using AUROC, AUPRC, F1-score, calibration plots, and Decision Curve Analysis (DCA). SHapley Additive exPlanations (SHAP) evaluated feature dependencies on the independent test set. Results CatBoost emerged as the optimal model. SHAP identified early family economic status, peer victimization, and maltreatment as primary predictive drivers. Crucially, dependence plots revealed prominent non-linear threshold effects: the mere occurrence of relational traumas drove risk more profoundly than their cumulative frequency. Furthermore, complex interactions showed that early material deprivation moderated the associations between peer bullying, abuse, and depression. Conclusion The CatBoost-SHAP framework provides a robust, transparent tool for risk stratification, highlighting non-linear associations between early adversity and prenatal depression. Integrating early-life adversity assessments into first-trimester screening and electronic health records can facilitate precision prenatal interventions.

Loneliness is increasingly recognized as a significant public health concern, yet limited research has examined its prevalence and risk factors among older adults in China. This study investigated the prevalence and risk factors of loneliness among older adults in China using data from the 2018 China Longitudinal Aging Social Survey (CLASS), a nationally representative study. The sample included 9,951 participants aged 60 and older (mean age = 71.3 years, SD = 7.3; 49.94

Emerging evidence suggests indoor air pollution (IAP) from solid fuel use may adversely affect early childhood development (ECD), yet urban-rural disparities in these associations are not well characterized, particularly in high-altitude regions. This study investigated the disparate effects of solid cooking and heating fuel exposure on ECD across urban and rural communities in Tibet, China. We conducted a cross-sectional analysis of 1,085 children from the Tibetan plateau. IAP exposure was determined through validated questionnaires, while ECD was assessed using the Chinese version of the Age and Stage Questionnaires, Third Edition (ASQ-3). Multivariable logistic regression models evaluated associations between IAP exposure and developmental outcomes, with urban-rural effect heterogeneity examined through interaction tests. Solid cooking fuel exposure was significantly associated with developmental delays, particularly in fine motor (OR = 2.25, 95

Background:Fertility desire-based service guided by behavioral theory is a potential strategy to mitigate the HIV transmission risk, while related evidence remains scarce. We examined the long-term effect of theory-guided fertility desire-based services on HIV seroconversion between seropositive and seronegative partners in areas with high HIV prevalence and a cultural emphasis on fertility in China.Methods:We established a retrospective cohort by recruiting 8653 seropositive partners with seronegative partners between January 1, 2009, and December 31, 2020, in Liangshan, China. The differences in HIV seroconversion between partners who received fertility desire-based services guided by the extended Information-Motivation-Behavioral Skills model and those who did not were estimated, based on multivariable and inverse probability weighting adjusted multivariable Cox regression models. Subgroup analysis was conducted based on participants' demographic and HIV-related characteristics.Results:Among the 8653 HIV-seropositive partners, 7958 (92.0%) and their seronegative partners received fertility desire-based services. At the end of the 12-year follow-up, 18 seronegative partners who did not receive fertility desire-based services experienced HIV seroconversion (incidence density: 7.4/1000 person-years), while 98 seronegative partners receiving such services exhibited HIV seroconversion (3.4/1000 person-years). Fertility desire-based services significantly reduced the risk of HIV seroconversion according to multivariable (HR = 0.32, 95% CI: 0.19 to 0.53) and inverse probability weighting-adjusted multivariable Cox regression models (HR = 0.48, 95% CI: 0.27 to 0.84). The effect of fertility desire-based services was more pronounced in men and those older than 40 years.Conclusions:Fertility desire-based services based on the extended Information-Motivation-Behavioral Skills model may help reduce the HIV transmission risk between seropositive and seronegative partners in areas with high HIV prevalence.

Background:Hyperuricemia is a recognized predictor of hypertension. However, the consistent link between elevated serum uric acid (SUA) levels and hypertension risk across different age groups, especially in males, remains a subject of debate. This study aimed to examine the association between SUA trajectories and the risk of new-onset hypertension, focusing on age-group disparities. Methods:We conducted a longitudinal study of 4,221 male employees from Southwestern China, initially free of hypertension, over a 4-year period (2018-2021). All employees underwent annual physical examinations each year. Incident hypertension was defined as newly detected blood pressure ≥140/90 mmHg, or the initiation of anti-hypertensive medication. We employed group-based trajectory modeling to identify the trajectory patterns of SUA levels over the study period. Logistic regression was used to assess the association between these SUA trajectories and the risk of developing hypertension. Additionally, subgroup analyses were conducted by stratifying participants into young (<45 years) and middle-aged (≥45 years) groups, with sensitivity analyses conducted using additional cutoffs of 40 and 50 years. Results:Four distinct SUA trajectories were identified: low (21.18%), moderate-low (45.44%), moderate-high (28.26%), and high (5.12%). The 4-year cumulative incidence of hypertension was 13.2%. Compared to the low SUA trajectory, the high SUA trajectory was independently associated with an increased risk of developing hypertension (OR = 2.22, 95% CI 1.43-3.43). The risk of developing hypertension increased significantly with higher SUA trajectories (P for trend = 0.003), and this dose-response relationship was modified by age (P for interaction = 0.026). In male employees under 45 years, the high SUA trajectory was associated with a higher risk of hypertension (OR = 1.78, 95% CI 1.04-3.07) compared to the low SUA trajectory, while no significant association was found in male employees over 45 years (OR = 2.22, 95% CI 0.89-5.33). Sensitivity analyses showed a significant association in males <40 years (OR = 2.17), a borderline association in those aged 40-49 (OR = 2.07, P = 0.053), but none in those ≥50 (OR = 1.22). Conclusion:Persistently high SUA levels may elevate hypertension risk in males, particularly younger individuals. Age-specific management of SUA may be necessary for hypertension prevention, with early intervention in young men likely yielding greater benefits than in middle-aged men.

The sexual partner’s HIV status trajectory of young men who have sex with men (YMSM) has a significant impact on HIV prevention. There are some potential associations between adverse experiences and HIV status trajectories of sexual partners among YMSM. This study aimed to examine the trajectory of HIV status in sexual partners and to investigate effects of adversity experiences on the sexual partner’s HIV status trajectories. Study data (N = 411) were derived from a 5-year YMSM cohort conducted in Central China from 2017 to 2021. The adversity experiences, including adverse childhood experiences (ACEs), sexual minority discrimination, everyday discrimination, and internalized discrimination, were measured at baseline. Other psychosocial variables including resilience and social support were measured at baseline. The HIV status of YMSM partners was examined at baseline and each follow-up survey. The group-based trajectory modeling (GBTM) was used to derive trajectories of partners’ HIV status, and the multinomial logistic regression was used to examine the association between adversity experiences and the trajectories. The GBTM categorized the HIV status of YMSM sexual partners into four groups, including Group I (low risk), Group II (risk reduction), Group III (increased risk) and Group IV (high risk). The ACEs among YMSM were associated with a higher risk of their sexual partners being categorized into Group III (OR [95

Background: Hearing loss (HL) is one major cause of disability and can lead to social impairments. However, the relationship between loneliness and the risk of incident HL remains unclear. Our study aimed to investigate this association among adults in the UK. Methods: This cohort study was based on data from the UK Biobank study. Loneliness was assessed by asking participants if they often felt lonely. Incident HL was defined as a primary diagnosis, ascertained via linkage to electronic health records. Cox proportional hazard regression models were used to examine the association between loneliness and risk of incident HL. Results: Our analyses included 490,865 participants [mean (SD) age, 56.5 (8.1) years; 54.4% female], among whom 90,893 (18.5%) reported feeling lonely at baseline. Over a median follow-up period of 12.3 years (interquartile range, 11.3 to 13.1), 11,596 participants were diagnosed with incident HL. Compared to non-lonely participants, lonely individuals exhibited an increased risk of HL [hazard ratio (HR), 1.36; 95% confidence interval (CI), 1.30 to 1.43]. This association remained (HR, 1.24; 95% CI, 1.17 to 1.31) after adjusting for potential confounders, including age, sex, socioeconomic status, biological and lifestyle factors, social isolation, depression, chronic diseases, use of ototoxic drugs, and genetic risk of HL. The joint analysis showed that loneliness was significantly associated with an increased risk of incident HL across all levels of genetic risks for HL. Conclusions: Loneliness was associated with the risk of incident HL independent of other prominent risk factors. Social enhancement strategies aimed at alleviating loneliness may prove beneficial in HL prevention.

Gut microbiota affects host health and disease. Large-scale cohorts have explored the interactions between the microbiota, host, and environment to reveal the disease-associated microbiota variation. A population-level gut metagenomic cohort is still rare in China. Here, we performed metagenomic sequencing on fecal samples from the CMEC Microbiome Project in Southwest China. In this study, we identified host socioeconomics, diet, lifestyle, and medical measurements that were significantly associated with microbiome function and composition. We revealed extensive novel associations between the host microbiome and common metabolic disorders. Our results provide new insight into associations of gut microbiota with metabolic disorders so as to support the translation of gut microbiome findings into potential clinical practice.

Objectives: Human behaviors and blood pressure (BP) are closely intertwined, affecting health. However, few studies have demonstrated their complex relationships. Using network analysis, we aimed to untangle the intricate and potential causal relationships between BP and human instinctive behaviors, identifying potential action points for hypertension prevention and control. Study design: Cohort study. Methods: This study is based on two-wave data from 11,277 Chinese adults in the China Multi-Ethnic Cohort (CMEC) and an independent validation cohort of 21,947 adults from the Chinese Cohort of Working Adults (CCWA). We conducted a cross-sectional network analysis to estimate the interrelationships between measured BP and self-reported physical activity (PA), diet, and sleep. The centrality of each variable within the network was estimated using strength centrality index. Additionally, we performed a longitudinal network analysis to infer the potential causal relationships between BP and human instinctive behaviors in participants with normal or above-normal BP. Results: The network models suggested that BP exhibited negative associations with the dietary score (edge weight: -0.09) and sleep duration (-0.05). Non-sedentary behavior and dietary score were the most central variables, strongly connecting BP and other lifestyles. Higher BP predicted a poorer dietary score (beta = -0.21) in participants with above-normal BP. The effect of BP on dietary score was replicated in the validation cohort and validated by linear regression analysis. Conclusions: Non-sedentary behaviors and dietary behaviors may be the potential action points in promoting healthy behaviors and contributing to BP management. It is essential to manage individuals' BP status, nonsedentary behaviors, and dietary behaviors to disrupt malignant cycles.

It remains unclear that trade-off between the benefits of regular physical activity (PA) and the potentially harmful effects of exposure to PM2.5 (particulate matter with aerodynamic diameter < 2.5 μm) in highly polluted regions. Therefore, we aimed to investigate the modification of PM2.5 on the associations of PA volume and intensity with depressive symptoms and glaucoma in individuals with or without depressive symptoms. Data of this study was obtained from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011 to 2020. PA volume and intensity were measured by a standardized questionnaire; a machine learning prediction model was applied to ascertain the PM2.5 concentrations. Cox proportional hazards regression models were employed to explore associations. A total of 20,930 participants were finally included, with 11,214 analyzed for PA and depressive symptom risk and 16,965 analyzed for PA and glaucoma risk. PA volume or intensity was independent protective factor for incident depressive symptoms, while PM2.5 was independent risk factor for depressive symptoms and glaucoma in participants with or without depressive symptoms. Among participants with low PM2.5 exposure (< 35 micrograms per cubic meter [µg/m3]), PA volume or intensity showed an inverse association with the risk of incident depressive symptoms, but insignificant associations between PA volume or intensity and glaucoma risk were observed in either participants with or without depressive symptoms. Among participants with high PM2.5 exposure (≥ 35 µg/m3), higher PA volume or intensity increased the risks of depressive symptoms and glaucoma. Higher PA level was associated with a reduced risk of depressive symptoms only among participants with low PM2.5 exposure, and higher PA did not decrease the risk of glaucoma regardless of PM2.5 level. Our findings recommend regular PA to prevent depressive symptoms in less polluted regions and reinforce the importance of air quality improvement.

Suicide has become a significant issue globally and in China in recent years. Research has shown that stigma toward young men who have sex with men (YMSM) and depressive symptoms are associated with suicidal ideation among YMSM after coming out. However, the potential mechanisms are not fully understood. This study used cohort data from three cities in central China, including a total of 372 participants. The study analyzed the relationship between coming out type and suicidal ideation, with sexual minority stigma and depressive symptoms as mediating factors. The data was analyzed using a chain mediation model. The relationship between total out of the coming out score and suicidal ideation was mediated by sexual minority stigma, while depressive symptoms did not have a significant mediating effect. Depressive symptoms mediated the relationship between coming out to family or other intimates and suicidal ideation. Additionally, we observed a chain mediation mechanism, which continuously mediated the relationship between suicidal ideation and coming out through sexual minority stigma and depressive symptoms The study concludes that coming out affects YMSM suicidal ideation through sexual minority stigma and depressive symptoms. The impact of different coming out types on YMSM suicidal ideation varies.

This study assessed whether higher levels of fine particulate matter (PM2.5) reduce the protective effects of leisure-time physical activity (LTPA) on all-cause, cardiovascular, and cancer mortality, and explored the PM2.5 threshold beyond which attenuation occurs. We conducted two complementary investigations. First, a systematic review and meta-analysis (per PRISMA guidelines) identified eligible cohort studies from PubMed, Web of Science, Embase, and SPORTDiscus (from inception to 6 January 2025) that examined the independent or joint associations of LTPA and PM₂.₅ with mortality among adults (≥ 18 years). Second, an individual-level pooled analysis using harmonized data from three cohorts was performed using Cox regression modeling to assess the associations observed in the meta-analysis. In Study One, a total of seven cohort studies (n = 1,515,094; deaths = 115,196) were included in the meta-analysis, revealing that the reduction in all-cause mortality risk diminished with higher PM2.5 exposure. Meeting the recommended LTPA level (7.5–15 MET-h/week) reduced all-cause mortality risk by approximately 30

Loneliness is linked to cardiovascular health, with atypical stress reactivity serving as an underlying mediator. This study aimed to investigate the association between loneliness and heart rate variability (HRV) reactivity to acute social stress in younger adults. A total of 92 participants (52 women; mean age = 22.05 +/- 2.25 years; range: 17-29 years) completed the Trier Social Stress Test (TSST), during which their electrocardiogram (ECG) signals were recorded. HRV was assessed using several measures, including the root mean square of successive differences in inter-beat intervals (RMSSD), the percentage of successive inter-beat intervals differing by more than 50 ms (pNN50), and the high-frequency component of HRV (HF-HRV). Loneliness was measured using the revised UCLA Loneliness Scale. Multiple linear regression models were fitted to examine the associations between loneliness and HRV reactivity, controlling for other covariates including age, sex, BMI, neuroticism, social network size, respiration rate and baseline HRV. In the total sample, loneliness was associated with decreased HRV reactivity, indicating a reduced ability of the autonomic nervous system to regulate cardiovascular function under stress. Sex differences were found in the association between loneliness and HRV reactivity, with women exhibiting more significant correlations. These findings suggest that diminished HRV reactivity to social stress may be a physiological mechanism through which loneliness impacts cardiovascular health.