Family APGAR Index Research Articles

Mediating Effect of Illness Perception on the Relationship Between Perceived Family Function and Sleep Quality Among Patients With Atrial Fibrillation.

To evaluate the sleep quality of patients with atrial fibrillation and its influencing factors, and explore whether illness perception mediates the relationship between family function and sleep quality. Cross-sectional survey conducted from November 2020 to November 2021. A total of 191 participants validly completed the Pittsburgh Sleep Quality Index, the Family APGAR Index and the Brief Illness Perception Questionnaire. Data were analysed using descriptive statistics, independent samples t-tests, one-way ANOVA, Pearson correlation analysis and multiple linear regression analysis. Bootstrapping was used to detect the mediating role of illness perception. Patients with atrial fibrillation reported poor sleep quality, good family function and a moderate level of illness perception. The better the family function, the lower the level of illness perception and the better sleep quality in patients with atrial fibrillation. Patients with commercial medical insurance had lower levels of sleep quality relative to self-financed patients. EHRA III and EHRA IV patients had worse sleep quality than EHRA II patients. Illness perception played a significant mediating role in the relationship between family function and sleep quality. Patients with atrial fibrillation have poorer sleep quality, and the type of medical insurance and EHRA score are independent indicators related to their sleep quality. Future health education and interventions need to focus on strengthening and improving the emotional support of family members in order to improve family function and reduce illness perception, thereby improving sleep quality of patients with atrial fibrillation. This study provides further evidence that nurses need to enhance their awareness and provide ongoing education to better identify patients with AF who have family dysfunction and perceived high levels of illness threat perceptions, as these factors negatively impact sleep quality. This study was reported in strict compliance with the strengthening the reporting of observational studies in epidemiology (STROBE) guideline. No patient or public contribution.

Correlation Between Family Dysfunction and Nonsuicidal Self-Injury in a Sample of Chinese Adolescents: The Mediating Effect of Alexithymia and circRNA_103636.

Adolescent group may be prone to a variety of behavioral disorders, one of which is nonsuicidal self-injury (NSSI), NSSI intervention is limited for its unknown mechanism, so this study aimed to explore the factors associated with and pathological mechanism underlying NSSI from the perspective of family dysfunction, alexithymia, circRNA_103636 in a sample of Chinese adolescents. A total of 200 MDD adolescents with NSSI and 200healthy controls were enrolled via a convenient sampling method in clinical settings. The Family APGAR Index (APGAR), Toronto Alexithymia Scale (TAS-20), and Adolescent Nonsuicidal Self-injury Assessment Questionnaire (ANSSIAQ) were used for mental assessment of the study group and control group participants. Real-time quantitative reverse transcription PCR (qRT-PCR) was utilized to detect circRNA_103636 expression in peripheral blood mononuclear cells (PBMCs). There were significant between-group differences of 134 patients (67%) in the study group and 42 patients in the control group (21%) with moderate or severe family dysfunction (P<0.01). The APGAR score was lower, and the difficulty identifying feeling (DIF), difficulty describing feeling (DDF) and externally oriented thinking (EOT) scores of the TAS-20 and ΔCt value of circRNA_103636 were greater in the study group than in the control group. NSSI behavior and NSSI function were negatively correlated with the APGAR score and positively correlated with DIF, DDF, and the EOT of TAS-20 and the ΔCt value of circRNA_103636. Multiple regression analysis confirmed that EOT, circRNA_103636 expression, and APGAR were predictors of ANSSIAQ, which could explain 40.5% of the variance. Similarly, the alexithymia and circRNA_103636 expression mediated the correlation between family dysfunction and NSSI in the study group, and these mediating effects accounted for 27.25% and 23.33%, respectively, of the total effect. Taken together, family dysfunction, alexithymia, and circRNA_103636 expression have predictive effects on NSSI and alexithymia, circRNA_103636 expressions are mediators between family dysfunction and NSSI in Chinese adolescent. Here, we established a new model for NSSI in which exposure to family dysfunction could induce pathological process by modulating personality traits and epigenetic regulators.

The relationships among family function, psychological resilience, and social network of patients with chronic disease in the community

This study aimed to examine the relationships among family function, psychological resilience, and social network of patients with chronic disease in the community and to further identify whether psychological resilience played a mediating role in the relationship between family function and social network. A cross-sectional survey including 460 convenient samples of patients with chronic disease in four Chinese communities was conducted using a general characteristics questionnaire, the Family APGAR Index, the Connor-Davidson Resilience Scale, and the Lubben Social Network Scale 6. Data were analyzed using descriptive analysis, Student's t-test, one-way ANOVA, Pearson/Spearman correlation, hierarchical multiple regression analysis, and mediation analysis using the PROCESS macro. Family function, psychological resilience, and social network were significantly related. Psychological resilience partially mediated the relationship between family function and social network. Interventions designed to enhance family function and psychological resilience may improve social network among patients with chronic disease in the community.

The association between caregiver burden, social capital, and family functioning among caregivers of older adults with PSD - A cross-sectional study.

This study aimed to explore the relationships between social capital, family functioning, and caregiver burden in caregivers of older adults with post-stroke dementia (PSD). A cross-sectional correlational study was conducted between November 2017 and April 2018 among 105 caregivers of older adults with PSD using a demographic questionnaire, the Social Capital Scale, Family APGAR Index (APGAR), and Caregiver Burden Inventory (CBI).An independent samples t-test was also utilized to compare caregiver burden based on demographic characteristics. Statistical analysis comprised Pearson correlation analysis and multiple regression analysis using SPSS version 22.0 to identify influencing factors. Significant negative correlations were found between caregiver burden and variables such as social capital (p < .001) and family functioning (p < .01). The results of the multivariate analysis revealed that social capital, physical condition, and duration of caregiving were the main influencing factors (β = 58.162, ΔR2 = 0.289, p < .001). These findings suggest that nurses should continue to prioritize the well-being of patients' families, and collaborative efforts should be made to establish care facilities that cater to both medical and social needs.

Construction and verification of a risk prediction model for cognitive frailty in older patients with chronic obstructive pulmonary disease and diabetes mellitus.

We explored risk factors for cognitive frailty in older patients with chronic obstructive pulmonary disease (COPD) and diabetes mellitus to develop and verify a risk prediction model for cognitive frailty. This was a cross-sectional study. Convenience sampling was used to randomly select 378 patients hospitalized between February 2022 and December 2023. We allocated 265 patients who visited between February 2022 and February 2023 to a modeling group to analyze risk factors for cognitive frailty and create a logistic regression model for risk prediction. Another 113 patients who visited between March 2023 and December 2023 were included in a validation group for model verification. The cognitive frailty incidence in the 265 patients was 35.09% (93/265). Regression analysis showed that age >80 years (odds ratio [OR] = 4.576), regular exercise (OR = 0.390, polypharmacy (OR = 3.074), depression (OR = 2.395) duration of COPD combined with diabetes (OR = 1.902), Family APGAR index score (OR = 0.428), and chronic pain (OR = 2.156) were factors influencing the occurrence of cognitive frailty in older patients with COPD accompanied by diabetes. The constructed risk prediction model for cognitive frailty in older patients with COPD and diabetes showed good predictive value, aiding in the clinical identification of high-risk patients and facilitating timely intervention and guidance.

Anxiety and sleep quality in patients receiving maintenance hemodialysis: multiple mediating roles of hope and family function

The objective of this cross-sectional study was to examine the extent of sleep quality among individuals undergoing maintenance hemodialysis (MHD) and to scrutinize whether hope and family function serve as mediators in the association between anxiety and sleep quality in this cohort. A convenience sampling method was used to recruit 227 patients receiving maintenance hemodialysis from two tertiary hospitals in Wuhan. Participants completed several self-report questionnaires, including the Sociodemographic questionnaire, Hospital Anxiety and Depression Scale, Athens Insomnia Scale, Herth Hope Index, and Family APGAR Index. As per the findings of the chain mediation analysis, it was observed that the sleep quality scores were directly predicted by anxiety. Moreover, anxiety positively predicted sleep quality scores through hope and family function as mediators. The observed types of mediation were partial mediation. The total indirect effect value was 0.354, indicating the mediating effect of hope and family function, while the total effect value was 0.481, representing the overall effect of anxiety on sleep quality. The total effect size was 73.60% (0.354/0.481), indicating that the mediation accounted for a significant portion of the relationship. This study established the chain mediating effect of hope and family function between anxiety and sleep quality in patients receiving maintenance hemodialysis. The findings highlight the importance of addressing anxiety and promoting hope and family function to improve sleep quality in this population. The findings suggest that healthcare professionals should be attentive to the anxiety levels of these patients and implement targeted interventions to help alleviate anxiety, enhance hope, and improve family functioning, with the ultimate goal of improving sleep quality in this population.

Suicide risks among caregivers of patients with depressive disorders.

To investigate the suicide risk factors among caregivers of individuals with depression who may develop suicidal ideation due to the ongoing challenges of managing the patient's mood fluctuations. This cross-sectional study enrolled dyads of patients with depression and their caregivers from a medical centre. The assessment included a psychiatric diagnostic interview, the Hospital Anxiety and Depression Scale, the List of Threatening Experiences, Benefit Finding Scale, Numerical Pain Rating Scale, Stigma Subscale of the Explanatory Model Interview Catalogue, Big Five Inventory-10, the Family APGAR Index and the Suicide Assessment Scale. Univariate and multivariate regression analysis were used to explore the interrelationship between the mental health of patients and caregivers. Among the 125 caregivers, 60.0% (n = 75) were females. The most common psychiatric diagnoses were depressive disorders (33 of 125; 26.4%), followed by anxiety disorders (21 of 125; 16.8%) and insomnia disorder (19 of 125; 15.2%). There was a significant association between the stressful life events of depressive patients and the suicide risk of their caregivers. The severity of anxiety and depression in caregivers was significantly associated with the suicide risk among the caregivers. A relationship may exist between the psychological well-being of patients with depression and their caregivers.

Gender differences in attitudes towards psychological help-seeking among chinese medical students: a comparative analysis

BackgroundMedical students are known to be at a greater risk of psychological disorders compared to the general population. However, their rate of help-seeking behavior is low. The purpose of this study was to explore the influencing factors of attitudes towards psychological help-seeking among Chinese medical students and to examine its gender differences.MethodsA total of 3,453 medical students from three medical colleges in Hainan Province, China, completed anonymous questionnaires that included socio-demographic attributes, the Family APGAR Index, the General Health Questionnaire (GHQ-20), and the Attitudes Towards Seeking Professional Psychological Help Short Form (ATSPPH-SF). Associations between predictor variables and attitudes towards help-seeking were explored using multivariate linear regression, and regression models with interaction terms were employed to test gender difference.ResultsThe mean score on ATSPPH-SF Scale was 15.04 ± 3.45, with males scoring significantly lower than females (14.34 vs. 15.64, P < 0.0001). For both male and female groups, psych knowledge, mental health status, family function and help-seeking utility perception significantly influenced attitudes toward psychological help-seeking. Furthermore, having more than once psycho-help experiences was positively correlated with women’s attitudes. Significant interactions were found between gender and mental health status.ConclusionAttitude towards seeking psychological help was relatively negative among Chinese medical students. The implementation of interventions should take into account the at-risk population, especially the males and individuals with poor mental health.

Sleep quality as a mediator between family function and life satisfaction among Chinese older adults in nursing home

BackgroundThe life satisfaction of the elderly in nursing home is the focus of social concern.The purpose of this study was to evaluate the effects of family function and sleep quality on life satisfaction among elderly individuals in nursing homes and examine the mediating effect of sleep quality between family function and life satisfaction.MethodsA cross-sectional observational study was conducted .A total of 127 older adults who completed the Life Satisfaction Index A (LSI-A), the Family APGAR Index and the Pittsburgh Sleep Quality Index (PSQI) were recruited from four nursing homes in Chongqing, China.ResultsLife satisfaction was positively correlated with family function (r=0.434, p<0.01) and negatively correlated with PSQI (r = -0.514, p<0.01). PSQI was found to be negatively associated with family function (r=-0.387, p<0.01).Family function had a significant effect on PSQI (path a: β=-0.8459, 95% CI=-1.2029, -0.4889), and PSQI had a significant effect on life satisfaction (path b: β=-0.3916, 95% CI=-0.5407, -0.2425). The total effect (path c) and direct effect (path c') of family function on life satisfaction were significant (β=0.8931, 95% CI=0.5626, 1.2235 and β=0.56181, 95% CI=0.2358, 0.8879, respectively). The coefficient for the indirect effect of family function on life satisfaction through PSQI was statistically significant (β=0.3312, 95% CI=0.1628, 0.5588). PSQI played a partial mediating role between family function and life satisfaction, and PSQI mediated 32.58% of the total effect of family function on life satisfaction.ConclusionsFamily function and sleep quality were significant predictors of elderly people's life satisfaction in nursing homes. Sleep quality partially mediated the relationship between family function and life satisfaction.The interventions focused on promoting family function and improving sleep quality may be more helpful in improving elderly people's life satisfaction in nursing homes.

Chinese college students' mental health during the first three months of the COVID-19 pandemic: the protective role of family functioning.

Various psychological theories suggest that a supportive family environment protects the mental health of young adults during stressful life events. However, evidence is limited regarding the protective role of family support during a major public health crisis. To examine the role of family functioning on mental health among Chinese college students during first stage of the COVID-19 pandemic. Between January-March 2020, 1,555 college students (44% female, on average 19 years old) from five Chinese universities participated. Participants rated their family functioning on the Family APGAR Index and their mental health on the Psychological Questionnaires for Emergent Events of Public Health, measuring depression, neurasthenia, fear, obsessive-anxiety and hypochondriasis. Better family functioning was associated with having fewer psychological symptoms. In addition, we identified three mental health profiles related to the severity across the psychological symptoms: Low-level, medium-level and high-level symptom clusters. Latent profile analysis showed that as family function improved, students were, respectively, 16 to 24% more likely to be in the low-level symptom group, compared to being in the medium symptom group or the high-level symptom group. These results support the notion that family support may act as a psychological buffer for young adults during a large-scale public health crisis like the COVID-19 pandemic.

Personality Traits and Internet Addiction among Adolescent Students: The Moderating Role of Family Functioning.

Objectives: Internet addiction is a behavioral addiction characterized by excessive and compulsive use of the internet. The risk of internet addiction among adolescents has risen recently due to an increase in technological advancement and globalization. However, previous studies have focused on the precipitating factors triggering the internet addiction without looking at the exogenous factors and boundary conditions, such as family functioning, that can either sustain or weaken such behavior. Thus, the present study aimed to examine the moderating role of family functioning in the relationship between personality traits and internet addiction among adolescents. Methods: This study is a cross-sectional study consisting of 3150 adolescent students in the grade/class level of JSS1-SS3 who were assessed with standardized measures of the Big-Five Personality Inventory, Internet Addictive Test, and Family APGAR Index. Pearson correlation was used to explore the bivariate relationships between the demographic variable and other variables of interest, while Hayes regression-based PROCESS macro for SPSS was used to test the Hypotheses. Results: (1) Openness to experience, conscientiousness, extraversion, and neuroticism positively correlated with internet addiction, whereas agreeableness was negatively associated with internet addiction. (2) Positive family functioning correlated negatively with internet addiction. (3) Positive family functioning moderated the relationships of extraversion and agreeableness with internet addiction but not on openness to experience, conscientiousness, and neuroticism with internet addiction. Conclusions: Positive family functioning correlated negatively with internet addiction among adolescents, suggesting that improving family functioning would be a valuable tactic for reducing adolescents' susceptibility to personality-related internet addiction.

Digital boundaries: A study on WeChat parent-child relationships among Chinese college students and their association with family factors.

This study aims to investigate the current state of WeChat parent-child relationships among college students and their association with family factors. Using convenient sampling, 6159 students,age from 18 to 25,the participants were selected from colleges of Chengdu to complete a questionnaire survey on response and attitudes towards parents' WeChat friend requests, Family APGAR Index,Parental Management Scale,Family Conflict Scale,were used as measurement tools. Responses to parental WeChat friend requests showed significant positive correlations with higher levels of family function satisfaction (r = 0.10, P<0.01) and parental management (r = 0.11, P<0.01), and a significant negative correlation with family conflict (r = -0.03, P<0.05). This study reveals that Chinese college students generally accept their parents' WeChat friend requests, influenced by family dynamics and traditional values. Positive parental management, family harmony, and good marital relationships enhance students' willingness to connect with their parents on WeChat, indicating the complex interplay between digital interactions and traditional family concepts.This underscores the importance for parents to adopt modern and scientific parenting approaches, fostering a harmonious and nurturing family atmosphere rooted in trust and mutual respect for their children.

Associations Between Family Functioning and Social Avoidance and Distress in Patients with Strabismus: A Chain Mediation Model.

Exploring the mechanisms of fear of negative evaluation (FNE) and self-esteem between family functioning and social avoidance and distress (SAD) to inform the promotion of social functioning in people with strabismus. Convenience sampling was used to select 249 strabismus patients attending a tertiary-level ophthalmology hospital in Wenzhou City from July 2023 to February 2024. The Social Avoidance and Distress Scale, Rosenberg Self-Esteem Scale, Brief Fear of Negative Evaluation Scale, and Family APGAR Index Questionnaire were utilized to assess levels of social avoidance and distress, self-esteem, fear of negative evaluation, and family functioning. Structural equation modeling (SEM) was employed to explore the sequential mediating role of FNE and self-esteem in the relationship between family functioning and SAD. Family functioning negatively predicted SAD directly (β=-0.14, P<0.01). Additionally, family functioning predicted FNE (β=-0.19, P<0.01) and self-esteem (β=0.41, P<0.01). FNE positively predicted SAD (β=-0.38, P<0.01) and negatively predicted self-esteem (β=-0.22, P<0.01). Moreover, self-esteem negatively predicted SAD (β=-0.33, P<0.01). FNE and self-esteem mediated the relationship between family functioning and SAD, with a combined mediating effect of -0.249, explaining 63.52% of the total variance. This study examined how FNE and self-esteem affect the link between family functioning and SAD in patients with strabismus. These findings complement our understanding of SAD mechanisms in strabismus patients, encompassing familial, cognitive, and emotional perspectives, and offer theoretical insights for enhancing social functioning in this population.

Association between Medical Coping Modes and Family Function among Older Adults with Hypertension

Background: Coping, an essential intermediary variable of psychological stress, may affect the process of disease, and alongside family function, has also been linked to patient quality of life. However, these have not yet been investigated in older adults with hypertension. Objective: To investigate the correlation between medical coping modes and family function, and the associated factors among older adults with hypertension in China. Methods: This cross-sectional study included 341 patients (135 men, 206 women) with a mean age of 75.16. Participants were recruited from three hospitals in China, the Medical Coping Modes Questionnaire and the Family APGAR Index Scale were used to collect dada. Data were analyzed using Pearson correlation and multiple linear regression analysis in SPSS 26.0. Results: Medical coping ability included three dimensions: Confrontation (19.42±3.83), avoidance (14.37±3.02), acceptance– resignation (9.19±2.09), and family function (7.47±1.47) were insufficient in older adults with hypertension; further, family function was positively correlated with the confrontation dimension (p&lt;0.05), and negatively correlated with the acceptance– resignation dimension (p&lt;0.05). Conclusion: Improving family function among older adults with hypertension could enhance confrontation and reduce acceptance–resignation. Family-centered intervention measures may assist in promoting coping ability and healthy behaviors among older adults with hypertension.

Family function, anxiety and depression in adults with disabilities: a network analysis.

The prevalence of family dysfunction, anxiety and depression is high in people with disabilities due to long-term activity constraints and social difficulties. Recently, although studies have attempted to provide guidance for family therapy by focusing on the relationship between family function and negative emotions, the specific effects of improved family function during family therapy on alleviation of anxiety and depressive symptoms have been obscured. Thus, this study attempted to elucidate the impact of specific family functioning on specific symptoms of anxiety and depression through network analysis. Family APGAR Index Questionnaire (APGAR), Generalized Anxiety Scale (GAD-7), and Patient Health Questionnaire Depression Scale (PHQ-9) were used to survey 897 adults with disabilities in Sichuan Province. Meanwhile, network analysis for studying the relationship between anxiety, depression and family functioning among the disabled via R software. The network analysis showed that (1) Nodes PHQ4 ("Energy"), APGAR3 ("Growth"), GAD1 ("Nervousness") and GAD4 ("Relaxing Trouble") were central nodes in the network model; (2) Bridge nodes linking family function, anxiety and depressive symptoms in the sample were PHQ9 ("Suicide ideation"), PHQ6 ("Worthlessness"), GAD1 ("Nervousness") and GAD5 ("Restlessness"); (3) The node APGAR5 ("Resolve") directly connects the bridge symptoms PHQ9 ("Suicide ideation") and PHQ8 ("Motor"). This study suggests that therapists could target the resolve of family members during family therapy to reduce suicidal ideation and enhance the level of activity of people with disabilities, thereby improving the network of anxiety and depression symptoms and alleviating negative emotions of people with disabilities.

Family characteristics in adolescents with overweight or obesity: a network analysis.

Rates of overweight and obesity continue to grow in adolescents. Overweight and obesity in adolescence are associated with numerous immediate and long-term adverse health conditions. Throughout adolescence, parents and the family have an important and central influence on adolescents' health and lifestyle. The home environment may be a major factor in shaping children's weight. However, our current understanding of the interplay between family-related variables in adolescents with overweight or obesity is limited and fragmented. This study aimed to assess the relationship between family-related variables in adolescents who are overweight or obese using network analysis and inform future health promotion for family-based intervention. Participants (n = 488) were recruited from middle schools in Nanjing from October 2022 to March 2023. Participants, together with their parents, completed a questionnaire at school about the family food environment, family size, family APGAR index, family physical activity facilities, parental mental health, rearing behavior, parental weight status, drinking history, marital satisfaction, and sociodemographic characteristics. The network split into three distinct communities of items. Network analysis showed that parental mental health and paternal rearing styles-rejection were the most central nodes in the network. In contrast, maternal weight status was the most peripheral and least connected nodes. Family-related variables constituted a connected network in adolescents with overweight or obesity. The pattern of network node connections supports that interventions could prioritize targeting changing parental mental health and paternal rearing styles in adolescents with overweight or obesity.

Influencing factors of two-way social support for the old adults in China: A cross-sectional study

This study aims to investigate the status and influencing factors of two-way social support among old adults. A cross-sectional study of 408 convenient samples of old adults was conducted using socio-demographic questionnaire, Brief 2-Way Social Support Scale, Modified Barthel index, General Well-being Schedule, Family APGAR Index, and Lubben Social Network Scale 6. The two-way social support score for old adults in China was (43.74±7.86), with the receiving and giving social support scoring (22.80±4.06) and (20.94±4.52), respectively. The multiple linear regression analysis revealed that family care, residence place, socioeconomic status, and social network were associated with both receiving and giving social support. Chronic diseases and religious beliefs were related to receiving social support, while gender, general well-being, and residence form were related to giving social support. Tailored interventions based on the distinct influencing factors are needed to enhance old adults’ social support both as recipients and providers.

Effect of stressors on family adaptation in stroke patients: A parallel multivariable mediation model

AimsThe mechanisms underlying how stressors affect family adaptation are unclear. This study determined the relationship between stressors and family adaptation among stroke patients, particularly the parallel mediating role of family function and family resilience. Methods and resultsThe study was conducted in the neurology ward of a tertiary hospital in China. A total of 335 stroke inpatients were interviewed face-to-face from August 2020 to March 2021. A questionnaire was administered that included demographic characteristics, the Family Inventory of Life Events and Changes, Family Apgar Index Scale, Family Hardiness Index Scale, and Family Adaptation Scale. The demographic data and correlations among the research variables were analyzed. A bootstrap method using the SPSS PROCESS macro was employed to test a mediation model. Family adaptation was negatively related to stressors (r = -0.291, p < 0.01) and positively related to family function (r = 0.531, p < 0.01) and family resilience (r = 0.393, p < 0.01). Furthermore, family function and family resilience played parallel mediating roles between stressors and family adaptation. ConclusionsThis study elaborated how stressors interacted with family adaptation through the mediation of family function and family resilience. The findings suggest that enhancement of family function and family resilience may help to improve family adaptation among stroke patients.

The Morbidity and Associated Factors of Depression in Caregivers of Patients with Depressive Disorder.

Depressive disorder significantly impacts patients' daily living activities and quality of life. Caregivers of patients with depression may also suffer from psychological distress related to the chronic burden of caring for the patient's mood changes. The purpose of this study was to evaluate the morbidity and associated factors of depression in caregivers of patients with depressive disorder. In this study, we used a cross-sectional design with consecutive sampling. Study subjects were recruited from the psychiatric outpatient clinic of a medical center from August 2021 to June 2022. Caregivers of depressive disorder patients were enrolled and assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale (HADS), Suicide Assessment Scale (SAS), Stigma Scale of the Explanatory Model Interview Catalogue (EMIC), and Family APGAR Index. Of the 120 caregivers that completed the study, 59.2% (n=71) were females. The most common psychiatric diagnosis was depressive disorders (25.8%), followed by anxiety disorders (17.5%) and insomnia disorder (15.8%); 54.2% of the caregivers had a psychiatric diagnosis. Using logistic regression analysis, we found that anxiolytics/hypnotics use (OR=5.58; 95% CI, 1.84-16.96; p<0.01), higher suicide risk (SAS) (OR=1.10; 95% CI, 1.05-1.16; p<0.001), and lower family support (APGAR scores) (OR=0.82; 95% CI, 0.71-0.94; p<0.01) were three significant associated factors. Depression was the most prevalent psychiatric diagnosis in caregivers of patients with depressive disorder. Early psychiatric diagnosis for caregivers of patients with depression is crucial to offering suitable support and treatment and may improve caregivers' quality of life.

Association of adverse childhood experiences and depression among medical students: the role of family functioning and insomnia.

Few studies have explored the mechanisms linking adverse childhood experiences (ACEs) to depression in medical students. This study aimed to investigate the relationship between ACEs and depression through the serial mediation effect of family functioning and insomnia. A cross-sectional survey was conducted with 368 medical students from university in Chengdu in 2021. The participants were asked to complete four self-report questionnaires, including ACEs scale, the family APGAR index, the ISI and PHQ-9. Singe and serial mediation analyses were conducted using structural equation modeling by Mplus 8.3. ACEs had a significant direct effect on depression (β = 0.438, p < 0.001) and through three significantly indirect pathways: (1) through family functioning (β = 0.026, 95% CI: 0.007-0.060), accounting for 5.9% of the total effect; (2) through insomnia (β = 0.103, 95% CI: 0.011-0.187), accounting for 23.5% of the total effect; and (3) through the serial mediators involving in family functioning and insomnia (β = 0.038, 95% CI: 0.015-0.078), accounting for 8.7% of the total effect. The total indirect effect was 38.1%. This cross-sectional study prevented us from establishing causality. This study highlights the role of family functioning and insomnia as serial mediators of the relationship between ACEs and depression. Findings help to elucidate the mechanism that underlines the pathway between ACEs and depression in medical students. These findings may indicate developing measures to strengthen family functioning and improve insomnia aiming to reduce depression in medical students with ACEs.