PurposeUncertainty in income, working hours and platform governance is widely documented in platform work, yet workers' capacity to tolerate future uncertainty may vary substantially. Understanding how intolerance of uncertainty relates to mental health outcomes may provide deeper insight into psychological vulnerability under structurally uncertain work conditions. This study examines levels of intolerance of uncertainty (IU), work anxiety and depressive symptoms among Chinese platform workers, and assesses whether support from family, co-workers, platforms and government/society shows distinct direct and buffering associations with these outcomes. Design/methodology/approachUsing longitudinal survey data collected from 566 platform workers across 18 cities in Henan Province, China, the study describes the distribution of IU and mental health indicators and tests longitudinal associations via hierarchical OLS regressions with interaction terms. Simple-slope analyses are used to illustrate significant moderation effects. FindingsPlatform workers reported relatively high levels of IU, work anxiety and depressive symptoms, with vulnerability varying across socio-demographic and job groups. IU was positively associated with both work anxiety and depressive symptoms. Social support showed differentiated roles: government/society support was directly associated with lower work anxiety, whereas co-worker support and platform support attenuated the positive association between IU and depressive symptoms. Family support showed no robust associations in this sample. Practical implicationsInterventions should prioritise strengthening work-proximal and institutional supports, including peer networks, platform-provided assistance, and broader regulatory and societal protections, as these forms of support may be particularly consequential for reducing anxiety and uncertainty-related distress. In addition, taking into account platform workers' levels of intolerance of uncertainty may help to better understand potential vulnerability to psychological distress and inform supportive health-promotion initiatives. Originality/valueThe study advances understanding of platform workers' well-being by highlighting that social support is not uniform in function: support sources closer to the work process and platform governance are more likely to buffer intolerance of uncertainty and its mental health consequences, whereas more distal forms of support may be less effective in contexts of chronic uncertainty.

Adolescents' healthy, holistic development is shaped by family processes. The arrival of a newborn sibling is a brief, intense transition to siblinghood (TTS) that reorganizes roles and attention; yet short-term adolescent outcomes in this window are seldom examined, and findings remain inconsistent. Using two-wave national data on Chinese junior secondary students (N = 8,896), we estimated lagged models adjusting baseline outcomes and tested maternal and paternal support as indirect pathways. Relative to no TTS, both first-time and additional TTS were associated with higher depressive symptoms and lower academic performance, while the cognitive association appeared primarily for first-time TTS. Pooled interaction tests showed no slope difference for depression or academics, and indirect paths via maternal but not paternal support partially accounted for several links. Findings highlight short-term challenges around sibling birth and suggest that strengthening everyday parental support may help adolescents navigate TTS.

Introduction Materialistic value orientation, defined as the long-term endorsement of values, goals, and beliefs centered on the importance of acquiring money and possessions that convey status, has been associated with various negative developmental outcomes among adolescents. However, the formation of materialistic values remains insufficiently understood, and research examining the association between adverse childhood experiences (ACEs) and materialistic value orientation is limited, particularly among Chinese adolescents. This study examined the relationships among ACEs, parent-child attachment, and adolescent materialistic value orientation, and explored gender differences in these associations.Methods Data were drawn from a 2022-2023 survey of 11,386 Chinese high school students (mean age = 16.41; 51% boys) using multi-stage stratified sampling across eastern, central, and western China. Participants completed self-report measures of ACEs, parent-child attachment, and materialistic value orientation. Correlation analyses and one-way ANOVAs were used to examine associations among key variables, and regression-based moderated mediation analyses with follow-up simple slope tests were conducted to test the role of parent-child attachment and gender differences.Results Higher ACE exposure was associated with stronger materialistic value orientation among adolescents. ACEs were associated with greater attachment insecurity and poorer parent-child attachment was also related to higher materialistic value orientation. Gender differences were observed: boys reported higher overall levels of materialistic value orientation, whereas ACEs showed stronger associations with parent-child attachment and materialistic value orientation among girls.Conclusions These findings suggest that adverse childhood experiences are linked to adolescents' materialistic value orientation and highlight the importance of family relationships in value development. Gender-sensitive approaches may be beneficial, with attention to higher baseline materialistic value orientation among boys and greater sensitivity to family adversity among girls.

Positive Youth Development (PYD) is crucial for adolescent well-being, yet the interrelationships of its components, especially during early adolescence, remain underexplored. This study employed network analysis to investigate the central components of PYD and their sex and grade differences among 2,837 Chinese junior high school students (grades 7-9). The 5Cs Positive Youth Development Scale-Very Short Form (PYD-VSF) was used to measure the 5Cs: Competence, Confidence, Caring, Connection, and Character. Results revealed that "self-worth", "connection to family", and "bullied empathy" play a central role in the overall PYD network among adolescents. These nodes were also central in both sex-specific networks. However, their patterns of association with other nodes differed between boys and girls. Across grade levels, "self-worth" and attributes related to Connection and Caring consistently showed high centrality. Nevertheless, the degree of centrality, relative ranking, and specific patterns of association for these nodes differed across grades. These findings underscore the interconnected and complex systemic nature of PYD, calling for sex- and grade-sensitive interventions to effectively promote positive outcomes among youth.

School-based mental health services are widely available in China. However, current services focus more on universal services and lack specificity, which may weaken the possibility of students exposed to adverse childhood experiences (ACEs) benefiting from them. Yet large-scale empirical evidence on this gap remains scarce, limiting understanding of how these services are associated with mental health outcomes in this vulnerable population. This study aimed to examine the association between the quality of multi-level school mental health services, as perceived by students, and their mental health, with particular attention to the moderating role of ACE exposure. This cross-sectional study analyzed data from a national school-based survey of 84,866 students (mean age = 15.90, SD = 1.62) across 374 Chinese secondary schools. ACEs, including abuse, household dysfunction and neglect, were measured. Satisfaction with school-based universal mental health services and students’ perceived effectiveness of school-based targeted psychological support were measured. Depression, self-injury behaviors, subjective well-being and self-esteem were measured as mental health outcomes. Analyses used generalized linear mixed models with interaction effects between ACE exposure and satisfaction or perceived effectiveness. All ACE domains and cumulative ACEs were associated with poorer mental health, whereas satisfaction of universal services and perceived effectiveness of targeted support were associated with better mental health. However, these associations were significantly weakened among adolescents exposed to abuse or household dysfunction—but not among those exposed to neglect—with largely similar patterns across the two adversity types for both positive and negative mental health outcomes. In addition to these shared attenuations, the perceived effectiveness showed weaker associations between depression and self-esteem in the abuse-exposed group (depression: AOR: 1.06, 95

Improved internet access has exposed rural adolescents in China to a greater risk of internet addiction. However, existing studies seldom examine the relationship between dynamic changes in internet addiction and psychosocial maladjustment. This study aims to explore the transition patterns of internet addiction and its associations with emotional and interpersonal problems over time. A one-year longitudinal survey was conducted among 782 middle school students in rural China. Latent Profile Analysis (LPA) was conducted to identify internet addiction profiles at two time points. Latent Profile Transition Analysis (LPTA) was then used to examine the transition patterns between profiles over time. Subsequently, statistical analyses were conducted to explore how these transitions were associated with emotional and interpersonal problems. Three profiles of internet addiction were identified: minimal-internet addiction, low-internet addiction, and high-internet addiction. Based on LPTA, most adolescents with higher internet addiction at T1 shifted to lower-severity profiles over time (high → minimal: 35.3

This study aimed to investigate the relationship between premenstrual symptoms and the 5Cs model of positive youth development (PYD), as well as the mediating effect of body satisfaction and the moderating effect of physical exercise. Using the two-stage cluster sampling method, 2,837 students from Grade 7 to 9 in rural China participated in this cross-sectional study, including 1378 girls who had experienced menarche. Results showed that premenstrual symptoms were significantly negatively associated with Competence, Confidence, Connection and body satisfaction, and negatively related to each dimension of the 5Cs via an indirect effect on body satisfaction. Physical exercise buffered the negative direct effect of premenstrual symptoms on Character and Connection. Girls who had experienced menarche had higher levels of Caring. Interestingly, body satisfaction might mask the positive effect of mild symptoms on Character and Caring. This study confirms the adverse impact of premenstrual symptoms on the positive developmental potential of adolescents.

[This corrects the article DOI: 10.3389/fpubh.2025.1658120.].

Objective This study aims to explore how parent-child attachment is associated with sibling relationship quality among rural Chinese adolescents in families with two children, considering adolescents' perceived parental favoritism and gender combination as moderators. Background Sibling relationship quality are crucial for adolescents' development and well-being. Although previous research has noted the positive impact of parent-child attachment on sibling relationship quality, the role of parental favoritism and gender combination remains largely unexplored. Method Using a sample of 1,805 rural Chinese adolescents from families with two children, this study employed scales to measure adolescents' perceived parental favoritism, sibling relationship quality, and parent-child attachment. Statistical analyses, including t tests, one-way analysis of variance, and moderation analysis were conducted. Results Both mother-child and father-child attachment were positively correlated with sibling relationship quality. Adolescents' perceived parental favoritism moderated the strength of the relationship between parent-child attachment and sibling relationship quality, with gender combination playing a dual moderating role. High levels of parental favoritism weakened the association between parent-child attachment and sibling relationship quality, particularly in combinations of two boys. Conclusion This study, focused on two-child families, emphasizes the significance of parent-child attachment in shaping sibling relationships among rural Chinese adolescents and highlights the need for fair parenting practices to mitigate the detrimental effects of adolescents' perceived parental favoritism. Implications These findings suggest interventions to enhance positive family relationships and adolescent well-being by promoting equitable parent-child relationships and addressing parental favoritism in families with two children.

Background The evidence for an association between early menarche and depression is inconsistent. We therefore performed a meta-analysis to examine this association. Methods The protocol for the current study was registered at the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42023483591. We searched several databases up to 17 June 2024. Random effects models were used to calculate pooled effect sizes. Results A total of 22 studies involving 87,798 participants were included. The Newcastle–Ottawa Scale (NOS) scores of the 22 studies ranged from 4 to 8, with a median score of 6. Depression scores and depression incidence were significantly higher in the early menarche group than in the non-early menarche group (Standardized Mean Difference: 0.13, 95 % CI: 0.04, 0.21; OR: 1.37, 95 % CI: 1.23, 1.52). However, moderate heterogeneity was observed (depression scores: I2 = 54 %, p = 0.03; depression incidence: I2 = 61 %, p = 0.001). Subgroup analyses revealed that depression scores were significantly associated with study type (cohort studies: I2 = 57 %, p = 0.071; case–control studies: I2 = 61 %, p = 0.051) and study quality (≥ 6: I2 = 58 %, p = 0.065; < 6: I2 = 62 %, p = 0.052). Conclusions This meta-analysis revealed that early menarche was associated with depression. Parents, schools and health care providers should monitor the emotions of girls who experience menarche at an earlier age.

BackgroundThe escalating out-of-pocket medical expenses pose a significant threat to the financial stability of households worldwide. Identifying persistent catastrophic health expenditure (CHE) is imperative for alleviating medical-related economic difficulties. This study comprehensively investigated the spatio-temporal dynamics and key determinants of persistent CHE in China across the 2012–2020 period.MethodsThis longitudinal quantitative study leveraged data from five waves of the China Family Panel Studies (CFPS), conducted biennially from 2012 to 2020. Variables pertaining to the incidence, depth, and duration of CHE were scrutinized, with covariates informed by the Andersen health service utilization model, including predisposing, enabling, and need factors. Spatio-temporal patterns were analyzed through spatial autocorrelation analysis. Tobit regression was employed to analyze CHE depth, whereas a Generalized Estimating Equation model was used to investigate factors influencing the duration of CHE.ResultsThe analytical sample comprised a balanced panel of 2,544 households, yielding a total of 12,720 observations. Although the incidence of CHE decreased from 16.27 to 13.88%, there was a persistent upward trajectory in the intensity of CHE, which rose from 0.026 in 2012 to 0.069 in 2020. The proportion of households experiencing persistent CHE saw a marked increase, escalating from 0% in 2012 to 14.32% in 2020. Rural households demonstrated a higher incidence of CHE compared to urban households, and significant regional variations in persistent CHE were evident. The spatial clustering of persistent CHE experienced a dynamic transition from aggregation to dispersion and then to a partial recovery during 2012–2020. Factors such as poor self-assessed health status (OR = 1.015, 95% CI 0.011 to 0.194; p < 0.05), a greater number of family dependents (OR = 1.047, 0.040 to 0.053; p < 0.05), the presence of chronic diseases (OR = 1.013, 0.006 to 0.021; p < 0.05), and hospitalization (OR = 1.069, 0.053 to 0.081; p < 0.05) were significantly associated with an elevated risk of persistent CHE.ConclusionFinancial protection against persistent CHE remains a challenge in China, particularly for rural households, low-income groups, families with chronic diseases, and regions with underdeveloped economies. Policy must prioritize enhancing insurance benefit packages, establishing persistent CHE-linked targeted assistance, and implementing region-specific strategies to address the root causes of health-induced poverty.

Background: Vision problems are still widespread among children and adolescents in rural areas of China. Previous studies on the effects of vision problems on adolescent development have mostly focused on the effects of vision problems from a negative and problematic perspective, but the associations of vision problems with adolescent development potential and resources and potential mediating and moderating mechanisms are unclear. In this study, we investigated the potential mediating effects of vision-related quality of life (VR-QoL) and the potential moderating effects of self-control in the relationship between vision problems and positive youth development (PYD). Methods: Using a two-stage sampling method, 2,837 students in grades 7-9 at five middle schools in four townships in Zhenping County, Henan Province, completed self-report questionnaires that included measurements of vision problems, PYD, VR-QoL and self-control as well as covariates such as sex. The relationships among variables were analysed with a moderated mediation model using the PROCESS macro of SPSS. Results: The total effect and direct effect of vision problems on PYD were not significant, but PYD was predicted negatively by the emotional dimension of VR-QoL. VR-QoL may fully mediate the association between visual problems and PYD. The moderated mediation analysis results showed that self-control enhanced the positive effect of the emotional dimension on PYD. Simple slope analyses indicated that the emotional dimension positively predicted PYD at a high level of self-control, while the emotional dimension did not significantly predict PYD at a low level of self-control. Conclusion: The present study revealed the relationship between vision problems and PYD and related mechanisms. Vision problems affected PYD through VR-QoL, and the mediating effect was greater in adolescents with high levels of self-control.

It has been suggested that the intergenerational transmission of anxiety may be an important contributor to the high prevalence of anxiety in adolescents. The objectives of this study are to examine whether and how parental anxiety is related to adolescent’s anxiety and to explore the associations of parental anxiety and parent-child communication with adolescents’ anxiety across different grades. The current survey was conducted online from February 8th to February 27th, 2020.The questionnaires were distributed and retrieved through a web-based platform. A total of 6196 Chinese rural adolescents from grade seven to twelve (age ranging from 11 to 18 years old) were included. In this study, parental anxiety was significantly associated with higher adolescent anxiety (β = 0.14, p < 0.001) and this association was statically strongest at grade twelve. Besides, children with problematic parent-child communication related to COVID-19 reported elevated anxiety (β = 0.05, p < 0.01). In contrast, effective parent-child communication about COVID-19 mitigated the level of anxiety transmitted from parent to child (β = -0.04, p < 0.05). During the COVID-19 epidemic, parents’ anxiety was related to adolescents’ anxiety. In addition, parent-child communication plays a moderating role in the above relationship. These findings emphasize the importance of implementing more psycho-education programs that specifically target parents’ emotion regulation and effective communication abilities to ameliorate the psychopathological symptoms of parents and their children.

Although numerous studies have analyzed the ways in which migration influences the life chances of adult immigrants and social inequalities, the association of parental migration with the equality of life chances of left-behind children is unclear. These explorations are important for understanding how opportunity inequalities may evolve into health inequalities and how to promote the equal development of children. This study examined the association between the left-behind experience and the equality of life chances in emerging adulthood among a rural Chinese population. A total of 849 rural Chinese young adults completed questionnaires about the migration of their parents and their living conditions and were assigned to several groups according to gender and type of parents’ migration. With non-left-behind children as a reference group, the chance of first marriage was significantly higher for women in the absence of their fathers (HR = 2.56, 95

Background The incidence of stroke is a challenge in China, as stroke imposes a heavy burden on families, national health services, social services, and the economy. The length of hospital stay (LOS) is an essential indicator of utilization of medical services and is usually used to assess the efficiency of hospital management and patient quality of care. This study established a prediction model based on a machine learning algorithm to predict ischemic stroke patients’ LOS. Methods A total of 18,195 ischemic stroke patients’ electronic medical records and 28 attributes were extracted from electronic medical records in a large comprehensive hospital in China. The prediction of LOS was regarded as a multi classification problem, and LOS was divided into three categories: 1–7 days, 8–14 days and more than 14 days. After preprocessing the data and feature selection, the XGBoost algorithm was used to build a machine learning model. Ten fold cross-validation was used for model validation. The accuracy (ACC), recall rate (RE) and F1 measure were used to evaluate the performance of the prediction model of LOS of ischemic stroke patients. Finally, the XGBoost algorithm was used to identify and remove irrelevant features by ranking all attributes based on feature importance. Results Compared with the naive Bayesian algorithm, logistic region algorithm, decision tree classifier algorithm and ADaBoost classifier algorithm, the XGBoot algorithm has higher ACC, RE and F1 measure. The average ACC, RE and F1 measure were 0.89, 0.89 and 0.89 under the 10-fold cross-validation. According to the analysis of the importance of features, the LOS of ischemic stroke patients was affected by demographic characteristics, past medical history, admission examination features, and operation characteristics. Finally, the features in terms of hemiplegia aphasia, MRS, NIHSS, TIA, Operation or not, coma index etc. were found to be the top features in importance in predicting the LOS of ischemic stroke patients. Conclusions The XGBoost algorithm was an appropriate machine learning method for predicting the LOS of patients with ischemic stroke. Based on the prediction model, an intelligent medical management prediction system could be developed to predict the LOS based on ischemic stroke patients’ electronic medical records.

Background: ACEs hurt subsequent physical and mental health outcomes. However, still little has been known about the rate of ACEs among rural Chinese emerging adults and the different buffering effects of the three types of social support on different kinds of ACEs. This study described the rate of ACEs among Chinese rural emerging adults, examined the relationship between ACEs and deviant behaviors, and tested the moderating effect of three different sources of perceived social support on this relationship. We hope these results will be helpful in further interventions.Methods: We used the second wave of a longitudinal survey that included ACEs variables in 2018. A total of 1031 emerging adults aged 18 to 25 participated in the current study.Results: we found that (1) the rate of abuse, neglect, and household dysfunction was 10.0, 30.0, and 24.9%, respectively among Chinese rural emerging adults; (2) abuse and household dysfunction experience were significantly and positively associated with deviant behaviors; (3) friend support moderated the relationship between three types of ACEs and deviant behaviors. Other support moderated the relationship between abuse/household dysfunction and deviant behaviors.Conclusions: ACEs could increase the risk of deviant behaviors. Perceived friend support could reduce the negative effect of three types of ACEs. Other support could reduce the negative impact of abuse and household dysfunction. These results suggest that reducing ACEs to make children's family environments safer and enhancing social support for emerging adults from rural areas are beneficial, which could prevent or reduce their deviant behaviors.

The Coronavirus Disease 2019 (COVID-19) pandemic has caused numerous unexpected changes for families and societies, which have likely contributed to higher amounts of stress for most parents. This study aimed to examine the relationship between burnout and mental health among parents during the COVID-19. Pandemic exposure and household factors (e.g., family structure, family function) were examined as moderators. An online cross-sectional survey recruiting 1,209 adults was conducted from April 21st to April 28th, 2020 during the COVID-19 lockdown in China. The multivariable linear regression analysis was employed to test the association between burnout, household factors, and mental health among parents. Findings suggested that for parents with a young child, poorer mental health was related to a higher level of burnout (β = 0.220, P < 0.001) and greater exposure to the pandemic. Mothers of a single and/or young child had considerably poorer mental health. Moreover, the relationship between mental health and burnout among parents was significantly moderated by epidemic exposure (β = 2.561, P < 0.001), family structure (number of children: β = −1.257, P < 0.001; first child age: β=-1.116, P < 0.001) and family function (β = −0.574, P < 0.05). This study indicated that burnout symptoms were significantly associated with worse mental health among parents in China. Besides, exposure to the pandemic, family structure, and family function was found to moderate the association between burnout and mental health among parents. Therefore, the present study stressed enhanced access to mental health resources and emotional supports for parents during a public crisis to reduce the deleterious effects of burnout.

Children are more likely to experience maltreatment and parental conflict in a pandemic context, which can exacerbate their vulnerability to psychological disorders. The purpose of the present study was to examine mental health symptoms in children aged 0 to 10 years and consider related factors from the perspectives of maltreatment and parental conflict during the COVID-19 lockdown. Participants were 1286 parents aged 18 years and over with children aged 0 to 10 years were included. Several multivariable linear regressions were used to analyze the data. The largest variance in child mental health was explained by child maltreatment, as more maltreatment predicted higher reported psychological problems (standardized beta = 0.49, P < 0.001). Comparatively, parental conflict predicted less variance in mental health problems than maltreatment (standardized beta = 0.18, P < 0.001). Children who experienced more maltreatment experience and exposure to COVID-19 showed elevated levels of mental health symptoms (standardized beta = 0.06, p < 0.05), as did those who experienced parental conflict and pandemic exposure (standardized beta = 0.06, p < 0.05). The findings highlight that tailored programs that focus on a healthy family environment and strategic parental support services may be particularly effective in reducing children’s mental health problems due to COVID-19 exposure.

The objective of this study was to examine the risk factor of addictive Internet use from a cumulative risk perspective among rural Chinese adolescents. This was a cross-sectional study. A total of 1489 adolescents from three high schools in Henan Province participated in this study. The results showed that (1) the prevalence of addictive Internet use among rural Chinese adolescents was 11.8