Abstract Aims The association between a pregnant mother’s vitamin D status and depressive symptoms has yielded inconsistent results. It is possible that other factors play a role in this association, as depression can have multiple causes. Recognizing the significance of the husband’s participation in antenatal care, this study aimed to examine whether the husband’s involvement moderates the link between the mother’s vitamin D status and depressive symptoms during pregnancy. Methods A total of 2983 Chinese married pregnant women, in their 25–35 weeks of pregnancy, completed questionnaires to assess their levels of depressive symptoms and the involvement of their husbands in their antenatal care appointments. Additionally, their serum levels of vitamin D were measured. Results After adjusting for maternal age, parity, and socio-economic status, the husband’s involvement in antenatal care moderated the association between maternal vitamin D status and depressive symptoms during pregnancy (β = 2.03, p = 0.035). Specifically, when their husbands were not regularly present for antenatal care appointments, mothers with suboptimal vitamin D levels experienced more depressive symptoms than those with optimal levels. However, there were no noticeable differences in depressive symptoms between vitamin D groups for mothers whose husbands attended all antenatal care appointments. Conclusions Pregnant women who have suboptimal vitamin D levels and lack support from their spouses are most vulnerable to experiencing depression. It is crucial to holistically assess the social and physiological needs of expectant mothers to reduce their risk of antenatal depression.

IntroductionVaccine-related myocarditis is recognized as a rare but important complication, especially after mass-scale mRNA COVID-19 vaccination. Knowledge regarding how to minimize the risk is limited. As NK cells can mediate acute myocarditis after mRNA COVID-19 vaccination and vitamin D may inhibit NK cells via cytokine modulation, we hypothesize that the myocarditis side effect is related to a hypovitaminosis D – mRNA vaccine – hypercytokinemia – NK cell axis, which is amendable to clinical intervention.MethodsBiochemical, immunophenotypic and genotyping assays were performed to examine vitamin D status and immune profiles in 60 patients who had BNT162b2 vaccine-related acute myocarditis.ResultsA high incidence of hypovitaminosis D (73.3%) was observed in these individuals with vaccine-related myocarditis, particularly in those presented with chest pain or intensive care unit (ICU) admission. Moreover, vitamin D level was negatively associated with peak serum cardiac troponin T level during vaccine-related myocarditis. Genotypically, the GC (vitamin D binding protein) rs4588T allele which encoded the GC2 isoform of vitamin D binding protein was a risk allele, whereas the GC1S isoform was protective. Mechanistically, hypovitaminosis D was associated with higher levels of cytokines pivotal for natural killer (NK) cells (particularly interleukin-1β (IL-1β), IL-12, Interferon-γ (IFN-γ), and IL-8) and higher percentage of CD69+ NK cells in blood, which in turn correlated with chest pain presentation.ConclusionThese data support the hypothesis that vitamin D plays a crucial role in mitigating mRNA vaccine-related myocarditis by modulating proinflammatory cytokine milieu and subsequent unfavorable NK cell activation, laying a groundwork for preventive and treatment strategies.

During the COVID-19 lockdown, with social distancing measures in place and a decrease in social activities, emotional states are more likely to be transferred between family members via increased interactions and communication. However, longitudinal evidence, particularly for early adolescents, is lacking. This study investigated family pre-pandemic influences on parental stress and adolescent psychosocial wellbeing during the COVID-19 pandemic. Data were collected from 233 adolescents and their parents before and during the initial phase of the pandemic. Parents reported their own stress level and perception of adolescent adjustment problems, whereas adolescents reported their own psychological distress level. In addition, adolescents also reported their satisfaction with family life in the pre-pandemic survey. Cross-lagged path models indicated reciprocal associations between parental stress and perception of adolescent adjustment problems. Compared to adolescents low in pre-pandemic family life satisfaction, those adolescents with higher levels of family life satisfaction before the pandemic reported lower levels of anxiety and stress only when parental stress showed no increase during the pandemic. Findings provide support for the mutual influences between parental stress and perceived adolescent adjustment problems during the pandemic. Special attention should be paid to those adolescents who undergo significant family life changes during the pandemic.

Early childbearing is associated with high maternal stress and family violence. However, the long-term effects of rapid repeat pregnancy (RRP) in young motherhood on child outcomes remain largely unknown. This study examined the pathways between maternal RRP at young ages and child psychosocial problems and emergency room visits in later years. A total of 232 Chinese mother-child dyads provided baseline data in 2015 (Time 1; T1) and follow-up data 6 years later in 2021 (Time 2; T2). At T1, mothers completed questionnaires about child physical abuse frequency and family cohesion and reported their own stress levels. At T2, mothers were re-surveyed with the same questionnaires about child physical abuse frequency and family cohesion. Children’s psychosocial problems were assessed through parent proxy-reports and records of emergency room visits were retrieved from hospital databases. After adjusting for demographic information, maternal history of RRP was associated with child physical abuse at T1 (β = .15, p < .05) and in turn linked to child physical abuse recurrence (β = .22, p < .01) and emergency room visits at T2 (β = .22, p < .001). Improved family cohesion over time did not break the link between maternal RRP and child physical abuse recurrence. Poor family dynamics can lead to child physical abuse recurrence and worsen developmental outcomes in children, particularly when coupled with other risk factors such as maternal RRP at young ages. Early interventions to enhance support and reduce vulnerabilities are important for preventing child physical abuse in at-risk families.

Background Growing evidence indicates an association between disordered eating and a range of mental health problems, including anxiety, depression and emotional dysregulation. Aims This study aimed to explore whether reducing risk factors for eating disorders, such as body dissatisfaction and low self-esteem, through school-based programmes can enhance adolescent mental health. Method We searched PubMed, PsycINFO, EMBASE and Web of Science from the date of inception to 15 October 2023. Data were synthesised by using a systematic narrative synthesis framework, and formal assessments were conducted to assess the quality of the included studies. Results After title/abstract screening and full-text assessment, 13 articles met the pre-specified inclusion criteria, comprising a total of 14 studies (n = 5853). Notably, three studies encompassed multiple programmes, leading to the identification of 17 eating disorder prevention programmes. Among these programmes, seven (41%) employed dissonance-based approaches. Topics covered in the programmes included psychoeducation, body acceptance, sociocultural issues, nutrition and physical activities, self-esteem and stress coping. Ten (59%) of the programmes were effective in improving adolescent mental health. Six of the 14 studies (43%) did not specify follow-up time, and quality assessments found the majority to be of either high (five studies, 36%) or fair (eight studies, 57%) quality. Conclusions The findings from the ten effective programmes consistently support the use of body acceptance strategies in improving the mental health of adolescent students. Brief interventions delivered by trained, non-licensed facilitators appear good for the sustainable implementation of in-school psychological services to support well-being among adolescents.

ObjectiveResearch has documented the associations of child maltreatment with a range of physical health problems, but little is known about the physical growth patterns of children who experience maltreatment in early childhood. This study aimed to examine the association between various discipline approaches and physical growth in preschool-aged children.MethodsIn the first year of preschool, parents of 661 Chinese preschool-aged children completed a questionnaire with items pertaining to the frequency of using physical maltreatment, psychological aggression, neglect, and nonviolent discipline toward the child. Children's weight and height were assessed annually using direct assessment in the first and two subsequent years. Longitudinal analyses were performed using multiple regression models.ResultsMore frequent neglect and psychological aggression during the first year of preschool were associated with a higher likelihood of a decreased BMI z score in subsequent years. Conversely, increased experience of physical maltreatment in the first year was associated with an increased likelihood of having overweight or obesity in the third year.ConclusionsResults indicate that early maltreatment experience can impact physical growth. This highlights the importance of preventing abusive parenting and encouraging healthy habits in young children who have experienced maltreatment to decrease their future risk for weight problems.

Objective: Not all women experience the same changes in depression from pregnancy through the years following childbirth, but the patterns of prenatal and postnatal depression are underexplored. This study investigated the trajectories and associated predictors of depressive symptoms in women from pregnancy through the first 3 years postpartum. Method: We followed 340 pregnant women from an antenatal clinic in Hong Kong, first at 20-24 weeks of gestation, then at 4 weeks after childbirth, and again at 3 years after childbirth. Pregnant women reported their depressive symptoms whether they had intimate partner violence, health conditions, adverse childhood experiences, family support, and perceived partner involvement. Latent class growth analysis was applied to identify distinct trajectories of depression, and binary logistic regressions were performed to analyze predictors of trajectories. Results: We found that 26.5% of women showed clinical depressive symptoms at 20-24 weeks of gestation, 9.7% at 4 weeks after childbirth, and 12.6% at 3 years after childbirth. Two classes were identified: a low-stable group (86.2%) and a relapsing/remitting group (13.8%). Women with a history of trauma (i.e., intimate partner violence and adverse childhood experiences) and mental health difficulties were more likely to be classified in the relapsing/remitting group than in the low-stable group. Family support and partner emotional involvement appeared to protect the women from suffering relapsing/remitting depression. Conclusions: The findings highlight the importance of screening for depression throughout pregnancy and extending several years postpartum. Distinguishing the different trajectories of depression and identifying its associated factors are critical to providing targeted interventions to the most vulnerable women (i.e., a relapsing/remitting group in the present study).

Obesity has become a global health concern in recent decades. Utilizing biomarkers presents a promising approach to comprehensively monitor the progress of obesity and its associated health conditions. This review aims to synthesize the available evidence on the correlation between cfDNA level and obesity and to provide insights into the applicability of using cfDNA level as a tool for monitoring progression of obesity. Searches were performed in PubMed and Embase on April 1, 2022. Data and other relevant information were extracted and compiled into a structured table for further analysis. Among 1170 articles screened, 11 articles were included in this review and assessed qualitatively. The results demonstrated that existing evidence mainly focused on three populations, including healthy individuals, cancer patients and pregnant women. Majority of the studies on healthy individuals identified a significant association between cfDNA level and body weight status but not among cancer patients. Varying results were observed among pregnant women at different gestational trimesters. Our review summarized some preliminary evidence on the association between cfDNA level and obesity. More cohort studies in larger scale with comprehensive assessment have to be conducted to examine the applicability of cfDNA as a biomarker for severity and disease progression of obesity.

Limited research has been conducted to examine the factors during early childhood that may contribute to conduct problems in later stages of life. This study aimed to investigate the relationship between family and school environments during early childhood and conduct problems in adolescence. In Wave 1 (W1), the study recruited 502 participants, aged 5-6 years, from Hong Kong local kindergartens, with 51.4% boys. One of their parents provided information about family socioeconomic status (SES), parent-child recreational activities, and child screen time, whereas the class teacher rated their school readiness using the Chinese version of the Early Development Instrument. Data on the number of special facilities were obtained from the kindergartens. In Wave 2 (W2), the same parents of 395 participants were asked about their involvement in their children's education. Finally, in Wave 3 (W3), the parents of 206 participants completed the Conduct Problem scale of the Strength and Difficulties Questionnaire to evaluate the level of conduct problems in the participants. The results of the path analysis revealed that higher W1 family SES was associated with fewer W3 conduct problems through an increase in W1 and W2 parental involvement in children's learning and play activities. Findings have implications for understanding the impact of early-life family and school environments on adolescent conduct problems. Early childhood interventions that promote family resources and positive parent-child interactions have the potential to reduce adolescent conduct problems.

Pregnant women are sensitive to the emotions and cues present in social interactions. They may exhibit heightened stress responses when support is lacking in a harmonious environment. The objective of this study was to examine the interaction of family harmony and social support and its association with stress responses among pregnant women. A total of 556 pregnant women were recruited to participate in this study. Psychological stress was measured using the Perceived Stress Scale - 10 (PSS-10). We assessed their perceived levels of family harmony (Family Harmony Scale-5: FHS-5) and social support (Multidimensional Scale of Perceived Social Support; MSPSS). They also provided blood samples for measurement of interleukin-6 (IL-6) as a marker of inflammation. Moderation analysis was conducted with estimation of regression coefficients and 95 % confidence intervals. After adjusting for covariates, the interaction of family harmony and social support in association with IL-6 levels was significant (β = -0.23, p = .045); however, its association with psychological stress was not significant. Specifically, the lack of support within a harmonious family environment was linked to elevated levels of IL-6 in pregnant women (β = 0.26, p = .023). Social interactions lacking supportive gestures have the potential to exacerbate inflammatory responses in pregnant women. Findings underscore the importance of supportive social interactions in promoting the mental well-being of pregnant women.

Oxytocin receptor gene polymorphism (OXTR rs53576) is associated with human social cognition and behavior. However, results on the contribution of OXTR rs53576 to individual differences in depressive symptoms have been inconsistent. This meta-analysis examined the association between OXTR rs53576 and depressive symptoms and under what conditions this association might hold true. A systematic search of PubMed, PsycInfo, and Web of Science was performed for English articles describing human-based studies from the inception of the databases to February 2023, as well as a manual search of the reference lists of the included articles. The search terms included OXTR rs53576, depressive symptoms, and their synonyms. Standardized mean differences in depressive symptoms between individuals classified by OXTR rs53576 genotypes were evaluated, and random-effects meta-analyses were performed. A total of 10 studies including 2972 subjects from six countries were pooled. Results provided no evidence of an association between OXTR rs53576 and depressive symptoms. The between-study differences in I2 statistics by ethnicity, disease history, and age group suggested the presence of moderating variables. However, the number of eligible studies was small with considerable heterogeneity. Findings underscore the importance of homogeneous sampling for research on depression genetics to affirm the association between OXTR rs35376 and depressive symptoms.

Objective:Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adolescents. Diagnoses of ADHD often rely on subjective ratings from parents and teachers. This study investigated the feasibility of using objective activity monitoring data collected through wearable activity trackers for ADHD diagnosis and monitoring in adolescents. Method:A longitudinal study was conducted involving Chinese adolescents ages 16 to 17 years. Data collected included objective measures (movement acceleration, heart rate, and sleep patterns from passive actigraphy) and subjective measures (parent and self-reported questionnaires). Machine learning models were developed using eXtreme Gradient Boosting (XGBoost) to compare various measures for ADHD classification. Model performance was evaluated using the area under the receiver operating characteristics curve (AUC). The SHapley Additive exPlanations (SHAP) method was used to analyze the importance of different measures on ADHD risk. Results:The study included 30 adolescents (17 with ADHD and 13 without ADHD). Machine learning models using solely objective measures achieved high predictability in classifying ADHD (AUC = 0.844) and ADHD medication status (AUC = 1.000). Models integrating both subjective and objective measures showed enhanced performance (AUC = 0.933). In this sample, key features for ADHD classification included irritability, sex, and quality-of-life indicators; key features for ADHD medication use classification included heart rate and physical activity intensity. Conclusion:Although the sample size was small, actigraphy-based monitoring provides a noninvasive and granular measurement of objective vital signs of adolescents. If validated in larger samples, the incorporation of objective measures is likely to enhance multidimensional assessment and diagnostic accuracy in adolescents with ADHD, supplementing existing diagnostic methods. Study preregistration information:A systematic review of anhedonia and amotivation in depression and cannabis use; https://www.crd.york.ac.uk/prospero/; CRD42023422438.

BackgroundEvidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population. ObjectiveThis study aimed to investigate the potential of a mobile game–based safety education program in improving children’s safety and psychosocial outcomes. MethodsSafe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models. ResultsNo significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3. ConclusionsAnalysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries. Trial RegistrationClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196 International Registered Report Identifier (IRRID)RR2-10.2196/17756

This study aimed to establish sex- and age-specific reference values for motor performance (MP) in Hong Kong preschoolers aged 3–5 years old and examine the relationship between MP and BMI status. A cross-sectional study was conducted among 5,579 preschoolers in Hong Kong. Three MP tests were administered, and height and weight information were collected. GAMLSS was used to compute the normative values of the motor tests. Boys outperformed girls in activities requiring muscle strength and power, while girls outperformed boys in activities requiring balance and coordination. The MP scores increased with age for both overarm beanbag throw and standing long jump for both sexes, while the one-leg balance scores showed larger differences between P 50 and P 95 in older preschoolers. Children with excessive weight performed worse in standing long jump and one-leg balance compared to their healthy weight peers. This study provides valuable information on the MP of preschoolers in Hong Kong, including sex- and age-specific reference values and the association between BMI status and MP scores. These findings can serve as a reference for future studies and clinical practice and highlight the importance of promoting motor skill development in preschoolers, particularly those who are overweight or obese.

COPYRIGHT © 2023 Wong, Tung, Ho and Man. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Editorial: Digital media use and mental health

Although previous research has established a link between the variant rs53576 of the oxytocin receptor gene (OXTR) and social behaviors, our understanding of its long-term impact on mental health from early childhood to adolescence remains limited. This study aimed to explore the potential link between children’s involvement in recreational activities with parents during early childhood, their OXTR rs53576 genotype, and the subsequent development of psychopathology. It involved gathering data during three different stages: early childhood (T1), middle childhood (T2), and adolescence (T3). During T1, the parents of 144 Chinese participants aged 4 to 6 years (48.6

A growing number of studies show an association between attention deficit hyperactivity disorder and physical abuse in childhood. We examined temporal associations of physical abuse risk with methylphenidate treatment in children with attention deficit hyperactivity disorder. Using Hong Kong electronic medical records, we conducted a self-controlled case series study in 1,064 children (5–16 years old) who were treated with methylphenidate and also experienced physical abuse. Compared with non-medicated periods, a higher risk of abuse was observed shortly before treatment initiation (incidence rate ratio = 4.49; 95% confidence interval = 3.76–5.36). After treatment initiation, the risk was comparable to that in non-medicated periods (incidence rate ratio = 0.90; 95% confidence interval = 0.63–1.29), followed by a 37% reduction during subsequent treatment. These findings are consistent with the hypothesis that methylphenidate treatment in children with attention deficit hyperactivity disorder is associated with a reduced risk of becoming a victim of physical abuse. Man, Gao and colleagues find that methylphenidate treatment in children with attention deficit hyperactivity disorder is associated with reduced risk of physical abuse.

Purpose of ReviewPregnant women are vulnerable to mental health problems. Increasing evidence shows that omega-3 polyunsaturated fatty acid (n-3 PUFA) intake during pregnancy is beneficial to maternal perinatal mental health. A systematic review is needed to examine the associations reported in recent studies. The objective of this review was to provide an updated review on the association of antenatal n-3 PUFA intake via different sources (seafood, fish, overall diet, and supplementation) with perinatal mental health problems including depression, anxiety, and psychological distress.Recent FindingsSearches were performed in Web of Science, Embase, PubMed, and APA PsycInfo databases on 21 June 2021. A total of 2133 records were screened. Data including the name of the first author, publication year, study design, sample characteristics, dietary assessment time and tools, mental health outcome measures, and other relevant information were extracted. In total, 13 articles were included in this review and assessed qualitatively. The results demonstrated that dietary intake of n-3 PUFA during pregnancy was associated with perinatal mental health, but the effect of n-3 PUFA supplementation was influenced by pre-existing medical conditions, socio-demographic characteristics, and dietary and lifestyle patterns during pregnancy.Our review found that sources of n-3 PUFA may have differential effects on woman's mental health during and after pregnancy. Further research using large-size cohort or well-controlled trial protocol is needed to determine the effect of n-3 PUFA supplementation during pregnancy on perinatal mental health.

BACKGROUND AND OBJECTIVES:The usual recommended intake of vitamin D for healthy infants is 400 international unit (IU) daily. However, a high dose of vitamin D at 2000-3000 IU daily is needed for those with vitamin D deficiency (VDD). This study aimed to assess the natural history of a group of healthy infants with VDD and the associated factors for persistent VDD.METHODS AND STUDY DESIGN:Healthy infants detected to have VDD (25OHD <25 nmol/L) in a population study were followed, and their demographics and clinical data were collected.RESULTS:One hundred and thirty-one subjects (boys = 66%) were included. Their first serum 25OHD was taken at a median age of 87.5 days. None were treated with high-dose vitamin D supplements, but some have been given vitamin D at 400 IU daily. They were assessed again at the median age of 252.5 days when 15 remained to have VDD and 26 were in the insufficient range (25 - 49.9nmol/L). All persistent VDD children were on exclusive breastfeeding. Exclusive breastfeeding and no vitamin D supplementation were significant risk factors for persistent vitamin D insufficiency (<50nmol/L).CONCLUSIONS:Persistent VDD is common among infants exclusively breastfeeding and those who did not receive vitamin D supplementation.