Felt Pressure Research Articles

Demographic, socioeconomic and lifecourse risk-factors for internalized weight stigma

Abstract Background Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with social factors in a large general population birth cohort study for the first time. Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, and sexual orientation using multivariable regression. Using data collected over a 32-year period, we explore the impact of family, peer, and wider social influences in adolescence, and bullying from mid-childhood to adulthood, whilst minimising risk of recall bias. Results In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (0.56 S.D. higher, CI:0.50-0.61), sexual minorities (0.17 S.D. higher, CI:0.09-0.24), and less socioeconomically advantaged individuals (0.16 S.D. higher (CI:0.08-0.24) for those whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (0.13 S.D., CI:0.03-0.23), and the media (S.D. 0.17, CI:0.10-0.25), or had experienced bullying (0.25 S.D., CI:0.17-0.33 for bullying at age 23 years). Conclusions Internalized weight stigma differs substantially between demographic groups, and this is not explained by differences in BMI. The family environment during adolescence, bullying, and pressure to lose weight from the media may have long-lasting impacts on adult IWS. These may be fruitful avenues for intervention to reduce IWS and its consequences. Key messages • Females, sexual minorities, and socioeconomically disadvantaged adults are at greater risk of IWS irrespective of BMI. • To reduce IWS, interventions should improve the family and social environment.

Stability and change in associations between social responsibility goals, achievement, and psychosomatic problems

ABSTRACT Social responsibility goals have shown positive relationships with performance and well-being. However, being too diligent has also been raised as a possible contributing factor to students’ reports of feeling stress and pressure in school, as well as experiencing psychosomatic problems. This study investigates the long-term associations between students’ social responsibility goals, academic achievements, and psychosomatic problems from Grade 9 (n = 4,573) to Grade 12 (n = 3,552), and gender differences in these associations. Descriptive statistics showed that girls reported more psychosomatic problems, higher social responsibility goals, and higher GPAs. Structural equation models showed that psychosomatic problems and achievement were stable over time. Social responsibility goals were associated with less psychosomatic problems and higher achievement in Grade 9. For girls, higher achievement was also associated with psychosomatic problems. Social responsibility goals did not predict later achievement, yet they predicted future psychosomatic problems, although the prediction was significant only for boys.

Factors that influence vaccination communication during pregnancy: provider and patient perspectives using the theoretical domains framework.

Vaccination during pregnancy is recommended but uptake is low and evidence on the topic is limited. This study aimed to identify the drivers of current behavior and barriers to change for health care practitioners (HCPs) and pregnant patients in Canada. This study is an in-depth qualitative investigation of the factors influencing HCPs' vaccination communication during pregnancy, as well as factors influencing pregnant patients' vaccination uptake in Canada using the Theoretical Domains Framework. Three data sources were used: (1) perinatal HCP interviews before COVID-19; (2) perinatal HCP interviews regarding vaccine communication after COVID-19; and (3) survey of pregnant or lactating women after COVID-19. Forty-seven interviews and 169 participant responses were included. Perinatal HCPs reported limited information on vaccine communication or difficulty keeping up-to-date (Environmental context and resources; Knowledge; Beliefs about capabilities). HCPs lacked confidence and struggled with lack of training to address vaccine hesitancy without alienating patients (Beliefs about capabilities; Skills). Pregnant or lactating women struggled with the amount of information they felt was imposed on them, had concerns about the perceived negative consequences of vaccination, and felt pressure to understand what was best for them and their babies (Knowledge; Beliefs about consequences; Social influences). Our study provides a theory-based approach to identify influencing factors that can be mapped to theory-based intervention components, improving the likelihood of intervention effectiveness. The study is the first step in adapting an existing intervention to improve vaccine communication during pregnancy, ultimately, increasing vaccination uptake. http://links.lww.com/IJEBH/A260.

Experiences and beliefs related to sleep paralysis among the general population of the twin cities: A cross-sectional study

BackgroundSleep paralysis (SP) is a rapid eye movement (REM) parasomnia that occurs during the transition between wakefulness and sleep. During this brief state, a person is conscious but unable to move or speak, often experiencing hallucinations. It is ‘isolated’ when it occurs without other symptoms of narcolepsy or sleep disorders. Despite its prevalence, much remains unknown about its clinical features and associated beliefs. ObjectivesThis study examines the frequency of self-reported SP experiences and its associated demographic characteristics, along with participants' beliefs about the condition. MethodsA cross-sectional survey was conducted among visitors at a shopping mall, using the Unusual Sleep Experiences Questionnaire (USEQ) to assess the features of SP episodes and the common beliefs surrounding them. ResultsA total of 350 participants were surveyed (mean age = 25.5 ± 9.30 years; 55.4 % females). Participants who experienced SP at least once in their life time (39.1 %) reported feeling pressure on their chest (67.2 %), an inability to open their eyes (71.5 %), and difficulty speaking (81.0 %) during the episode. The majority of the individuals reported having their first episode at a young age (16–20 years). Most people (24.5 %) were unaware that this condition was known as sleep paralysis, and many (23.5 %) thought that it was just ‘a dream’. ConclusionIsolated sleep paralysis episodes are fairly prevalent, with many people experiencing their first episode at a young age. A typical episode entails a sense of pressure on the chest and difficulty in vocalizing. Misconceptions about the condition are common and wage further exploration.

Contraceptive counseling training experiences and behaviors among obstetrics and gynecology residents in California and Florida

ObjectiveTo describe experiences with contraception counseling training and provision of obstetrics and gynecology residents training in California and Florida. Study designWe conducted a mixed-methods study of obstetrics and gynecology residents training across 19 programs (with approximately 428 residents) in California and Florida from September 2022 through February 2023. We asked participants how often they use tiered-effectiveness counseling, their satisfaction with contraception counseling practices, and experiences with witnessing and recognizing contraception coercion. We asked about personal disappointment when patients decline long-acting reversible contraception (LARC) and pressure from faculty to prescribe LARC. To further explore resident contraception counseling education and behaviors, we conducted semi-structured telephone interviews with a subset of 20 survey volunteers. ResultsWe received survey responses from 155 (36.2%) participants. Most (n = 113 [76.4%]) often or always reported using tiered-effectiveness counseling. While few participants (n = 17 [11.3%]) reported feeling pressure from faculty to convince a patient to keep a LARC, some (n = 34 [22.1%]) reported they often or always feel disappointed when a patient chooses LARC removal, with more Florida participants reporting disappointment (n = 19 [37.3%]) compared to California (n = 15 [14.6%], p = 0.01). We identified two main themes from the telephone interviews. First, residents feel they have limited formal education on how to provide contraceptive counseling and commonly learn these practices by emulating supervising faculty or peer counseling styles. Second, residents are informally taught, through feedback and interactions with supervising faculty and peers, that successful contraception counseling is the ability to convince patients to use highly effective contraception. ConclusionWhen residents lack formalized contraception counseling education, they adopt counseling behaviors that may not be patient centered. ImplicationsWhen obstetrics and gynecology residents lack formalized contraception counseling education, they learn practices that may lead to coercive counseling behaviors during training. Resident education should include recognition and mitigation of contraception coercion and patient-centered counseling both through a formalized curriculum and socialization of trainees during their medical education.

Antecedents and Consequences of Remote Workers’ Felt Pressure to Prove Their Effort

Antecedents and Consequences of Remote Workers’ Felt Pressure to Prove Their Effort

“It creates a divide”: minoritized medical students’ perceptions of professional identity formation

Background: If the task of professional identity formation (PIF) is for the trainee to become acculturated to a specific set of professional values, trainees whose individual identities are already closely aligned with the hegemonic values of medicine might be expected to have an easier PIF process than those trainees who begin their acculturation with individual values that are quite different than the prevailing values in medicine. Method: The present cross-sectional qualitative study examines the PIF experience of 15 medical students who face a range of structural inequalities and cultural constraints in a rural, predominately white medical school setting. Results: Five themes emerged from interviews: 1) participants’ decision to enroll in medical school was substantially influenced by family and broader community; 2) participants' expectations about starting medical school were not met; 3) participants perceived they were different from other medical students and also from the stereotypical physician; 4) participants felt pressure to adjust their personal identity; and 5) participants drew from personal identities to cope with stress. Discussion: These qualitative findings suggest that many participants felt their identity was often an asset in connecting with patients. Concurrently, participants felt a responsibility to return to practice in their home communities, which may represent a uniqueburden. Furthermore, some felt pressure to compromise or change their individual identity to be successful in medical culture. The task for medical schools may be to help students view their identities as a unique advantage, rather than something they need to quell or minimize to be successful.

Beliefs About Cannabis Use Among Male and Female Andalusian Adolescents.

Objectives: This study assessed potential differences between girls and boys in the prevalence rates of cannabis use, sociodemographic factors, and beliefs about cannabis use. Methods: 1,896 Andalusian adolescents aged 14-18 participated in an online survey based on the I-Change model. The survey assessed their beliefs about cannabis use, including attitudes, social influences, self-efficacy, action planning, and intention to use. Multivariate analyses of variance were then conducted to examine potential gender differences in these beliefs, while controlling for last month's cannabis use. Results: Significantly more boys used cannabis in the last month, had boyfriends/girlfriends, and had more pocket money compared to girls. Additionally, girls - in comparison to boys - were more convinced of the disadvantages of cannabis use, but were also more convinced of some of the advantages (such as freedom from boredom, and medicinal use), reported having less favorable social norms for cannabis use, had more female best friends using cannabis, and felt pressure to use cannabis from their female peers. Conclusion: These findings highlight the need for cannabis prevention programs to consider gender differences in beliefs about cannabis use. Programs should not only address general risk factors for cannabis use but also evaluate if their interventions effectively target beliefs that are particularly important for girls and boys.

Global Landscape of the Attack of Predatory Journals in Oncology.

Open-access publishing expanded opportunities to give visibility to research results but was accompanied by the proliferation of predatory journals (PJos) that offer expedited publishing but potentially compromise the integrity of research and peer review. To our knowledge, to date, there is no comprehensive global study on the impact of PJos in the field of oncology. A 29 question-based cross-sectional survey was developed to explore knowledge and practices of predatory publishing and analyzed using descriptive statistics and binary logistic regression. Four hundred and twenty-six complete responses to the survey were reported. Almost half of the responders reported feeling pressure to publish from supervisors, institutions, and funding and regulatory agencies. The majority of authors were contacted by PJos through email solicitations (67.8%), with fewer using social networks (31%). In total, 13.4% of the responders confirmed past publications on PJo, convinced by fast editorial decision time, low article-processing charges, limited peer review, and for the promise of academic boost in short time. Over half of the participants were not aware of PJo detection tools. We developed a multivariable model to understand the determinants to publish in PJos, showing a significant correlation of practicing oncology in low- and middle-income countries (LMICs) and predatory publishing (odds ratio [OR], 2.02 [95% CI, 1.01 to 4.03]; P = .04). Having previous experience in academic publishing was not protective (OR, 3.81 [95% CI, 1.06 to 13.62]; P = .03). Suggestions for interventions included educational workshops, increasing awareness through social networks, enhanced research funding in LMICs, surveillance by supervisors, and implementation of institutional actions against responsible parties. The prevalence of predatory publishing poses an alarming problem in the field of oncology, globally. Our survey identified actionable risk factors that may contribute to vulnerability to PJos and inform guidance to enhance research capacity broadly.

Preservice Teachers’ Assessment Literacy Within Models-Based Practice

Purpose: Using the assessment literacy framework, the purpose of this study was to explore preservice teachers understanding and enactment of the message system during an early field experience. Method: Six PTs employed SE seasons totaling 540 min. Seven qualitative data methods were utilized. Data analysis included deductive and inductive analysis using a thematic approach. Trustworthiness included data triangulation, peer debriefing, negative case analysis, and the maintenance of an audit trail. Results: Three main themes derived from the data included: instructional decisions were driven by the SE model and informal assessment; formal assessment was driven by the structure of SE; and high assessment value but low assessment literacy. Discussion/Conclusion: The SE model drove PTs to use formal assessment, but primarily in an evaluative manner. The PTs lacked assessment literacy, felt pressure to follow the model, did not use assessment to inform teaching, and had concerns for future assessment use.

Patterns of Gender Development Across Intersections of Age, Gender, and Ethnicity-Race.

Two components of gender identity are gender similarity, how one's self-concept relates to the major gender collectives (i.e., female, male), and felt pressure to conform to gender norms. The development of these components across ages and contexts has been understudied. The focus of this study was to examine variations in gender similarity and felt pressure across multiple intersecting contexts: developmental stage, gender, and ethnic-racial group. Six data sets were harmonized and means were compared across 2628 participants (51% girls, 49% boys) from four different developmental cohorts (childhood n = 678, early adolescence n = 1322, adolescence n = 415, and young adulthood n = 213) from diverse ethnic-racial backgrounds (45% White, 23% Latinx/Hispanic, 11% Black/African-American, 7% Asian-American, 5% American Indian, and 5% Multiracial). Results revealed nuanced patterns: Gender intensification was supported in early adolescence, primarily for boys. Young adult men reported lower levels of pressure and gender typicality than younger boys, but young adult women's levels were generally not different than younger girls. Surprisingly, young adult women's levels of own-gender similarity and pressure from parents were higher than adolescent girls. Expectations of gender differences in gender typicality and felt pressure were supported for all ages except young adults, with higher levels for boys. Finally, there were more similarities than differences across ethnic-racial groups, though when there were differences, minoritized participants reported heightened gender typicality and pressure (largely accounted for by higher scores for Black and Latinx participants and lower scores for White and Multiracial participants). These results add to what is understood about contextually dependent gender development.

Analysis of the Mental Health of the Elderly After Retirement

Aging is an inevitable part of all individuals journeys. Many of these elderly people experience problems, especially elderly people who previously spent time working. In fact, there are many cases among the elderly who experience problems, especially for the elderly in the Purbalingga area, there are elderly people who fall ill due to economic problems and social changes that put pressure on the elderly after retirement, making them psychologically weakened. The aim of this research is to identify the mental health of the elderly after retirement. This research uses a qualitative case study approach. The data analysis technique used is triangulation techniques carried out using interviews, observation and documentation using the Miles and Huberman model. The results of this research found that cases of mental health in the elderly after retirement felt pressure due to the absence of strong social relationships between family and retirees and co-workers. So the feeling of loneliness, not being recognized, and the readiness to live a life of economic problems, and the feeling of anxiety during retirement have not been prepared. This has an impact on weakening the welfare and meaning of life of the elderly after retirement.

Divergent veterinarian and cat owner perspectives are barriers to reducing the use of cefovecin in cats.

To understand veterinarian and cat owner perspectives on antimicrobial use in cats, reasons for prescribing cefovecin, and barriers to improving antimicrobial stewardship, including veterinarian and cat owner perspectives of giving oral medication to cats. 21 New York veterinarians and 600 cat owners across the US. Cat owners were surveyed about their preferences for and experiences in giving oral medications to cats and their experiences with antimicrobials specifically. Veterinarians were interviewed about antimicrobial use decisions in cats, benefits and drawbacks of cefovecin, and their perspectives on antimicrobial resistance. Many veterinarians reported feeling pressure to prescribe antimicrobials, while 41% of cat owners reported requesting antimicrobials. Although veterinarians are aware of the downsides of prescribing cefovecin, many prescribed cefovecin in situations where an antimicrobial was not needed or cefovecin may not have been the best choice. Veterinarians thought that 20% of cat owners could not give oral medications, but < 10% of cat owners had a cat that was impossible to medicate. The disconnect between veterinarians' assessment of and cat owners' reported abilities in administering oral medication may contribute to cefovecin use. Demonstrating for cat owners how to give oral medication may help improve compliance and reduce the use of parenteral long-acting formulations. Structural and educational interventions are needed to address other contributors to inappropriate antimicrobial use. This research provides the specific considerations about barriers and motivations for cat owners and veterinarians that are required to guide strategic, tailored interventions for both audiences to advance stewardship.

Perceived research productivity of women in higher education: An investigation of the impact of COVID-19.

This study focuses on the predictors of women academics' perceived research productivity during the pandemic in Türkiye, by taking the changes in paid and unpaid workload alongside the felt pressure concerning productivity into consideration. Predicting the odds to report an above the mean level of decrease in perceived research productivity, unlike expected, increased housework time and administrative workload presented no statistically significant effect. On the other hand, extended care responsibilities (including but not limited to childcare) and felt pressure concerning research performance during the pandemic strongly predicted a high level of reported decrease in research productivity. Findings highlight that institutional care support mechanisms should be among the primary concerns since the pandemic has made the already existing gender inequalities in academia more visible in terms of the challenges women face in balancing paid and unpaid work. In addition, as excess pressure felt by women academics regarding research performance is linked to a decline in reported productivity, creating a compassionate environment in academia not only in unprecedented circumstances but at all times needs to be priority.

“I haven't even taken them to the doctors, because I have that fear of what to expect”: a qualitative description study exploring perceptions and experiences of early childhood healthcare among ethnically diverse caregivers in Aotearoa New Zealand

Equity underpins Aotearoa New Zealand's publicly funded healthcare system; however, ethnic inequality persists. This qualitative study explored the perceptions and experiences of ethnically diverse parents accessing health services for their children. A qualitative description methodology informed interviews and focus groups that were conducted with caregivers of preschool aged children who identified as being of Māori, Pacific, Asian and/or European ethnicity (n=145). Data were analysed following a reflexive thematic analytic approach. Five themes were constructed. Hierarchies of knowledge and trust Caregivers relied on multiple sources of health information and particularly trusted providers or other caregivers who had children. Relational versustransactional health encounters Caregivers were often disappointed that health providers did not build trusting relationships to support positive experiences. Bad mother vibe Mothers often felt judged by providers when accessing care and felt pressure to conform. The 'slow burn' of waiting Caregivers were often frustrated by how slow and fragmented the health system was, which was particularly distressing if their child was unwell or required referral. Navigating complexity Caregivers had to be proactive and assertive to ensure their child received care amidst the numerous barriers they faced, including discrimination and bias. While many commonalities were shared by ethnicity, unique to Indigenous Māori caregivers were the ongoing colonial traumas that impacted their ability to trust the healthcare system. A non-judgemental, competent, and culturally sensitive approach by healthcare professionals and services may help foster trusting relationships and positive health encounters. Strategies to improve trust, ease of access and navigation are needed to mitigate existing complexity, fragmentation, and counter-intuitive nature of the NZ healthcare system. Caregivers require more autonomy over decisions about their child's care and availability of services that reflect their cultural values. Policies are required to alleviate the indirect costs of accessing healthcare, prioritising of whānau/family-centred care, and addressing pervasive racism and bias within the system. Health Research Council of New Zealand (19/263) .

Using refined methods to pick up mice: A survey benchmarking prevalence & beliefs about tunnel and cup handling.

Refined handling improves laboratory mouse welfare and research outcomes when compared to traditional tail handling, yet implementation does not seem to be widespread. Refined handling includes picking up a mouse using a tunnel or cupped hands. The aim of this study was to determine the current prevalence of and beliefs towards refined handling using the theory of planned behavior. It was predicted that refined handling prevalence is low compared to traditional handling methods, and its implementation is determined by individual and institutional beliefs. Research personnel were recruited via online convenience sampling through email listservs and social media. A total of 261 participants in diverse roles (e.g. veterinarians, managers, caretakers, researchers, etc.) responded primarily from the USA (79%) and academic institutions (61%) Participants were surveyed about their current use, knowledge, and beliefs about refined handling. Quantitative data were analyzed via descriptive statistics and generalised regression. Qualitative data were analyzed by theme. Research personnel reported low levels of refined handling implementation, with only 10% of participants using it exclusively and a median estimate of only 10% of institutional mice being handled with refined methods. Individually, participants had positive attitudes, neutral norms, and positive control beliefs about refined handling. Participants' intention to provide refined handling in the future was strongly associated with their attitudes, norms, and control beliefs (p<0.01). Participants believed barriers included jumpy mice, perceived incompatibility with restraint, lack of time, and other personnel. However, participants also believed refined handling was advantageous to mouse welfare, handling ease, personnel, and research. Although results from this survey indicate that current refined handling prevalence is low in this sample, personnel believe it has important benefits, and future use is associated with their beliefs about the practice. People who believed refined handling was good, felt pressure to use it, and were confident in their use reported higher implementation. Increased refined handling could be encouraged through education on misconceptions, highlighting advantages, and addressing important barriers.

Contraceptive preferences and adoption following female genital fistula surgery in Uganda: a mixed-methods study

BackgroundFemale genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes.MethodsWe examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use.ResultsMedian participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods.ConclusionsA high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences.

When the context withholds girls from gender a‐typical conduct: Schools' gender role culture and disruptive school behaviour of boys and girls

AbstractOn average, boys display more disruptive school behaviour than girls. This study looks at this behaviour in the first place as gendered behaviour, investigating whether boys' and girls' disruptive behaviour is associated with their schools' student and teacher gender role culture. Multilevel analyses (HLM7) of representative Flemish data of 2706 male and 2436 female 8th grade students in resp. 57 and 49 secondary schools, and 1247 teachers gathered at the end of school‐year 2013/14, revealed that a more traditional student gender role culture is associated with less disruptive school behaviour in girls. As for boys, the positive association between traditional student gender role culture and disruptive school behaviour disappears when accounting for their individual gender role attitudes, which are significantly more traditional than those of girls. More traditional gender role attitudes coincide with more disruptive behaviour in boys and girls. Moreover, boys displaying less disruptive behaviour report a higher felt pressure for gender conformity. No impact is found of the homogeneity of teachers' gender role attitudes. The findings demonstrate that disruptive school behaviour can be looked at as gendered behaviour and can be tackled, at least partly, by discouraging gender stereotypical beliefs in students.

Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic

The COVID-19 pandemic profoundly affected physical, mental, and economic well-being across the globe and has disproportionately affected certain vulnerable groups. This paper provides a scoping review of literature on the impact of the COVID-19 pandemic on sex workers, published between December 2019 and December 2022. Six databases were systematically searched, identifying 1009 citations; 63 studies were included in the review. Thematic analysis revealed eight main themes: financial issues; exposure to harm; alternate ways of working; COVID-19 knowledge, protective behaviors, fear, and risk; well-being, mental health, and coping; access to support; access to health care; and the impact of COVID-19 on research with sex workers. COVID-associated restrictions led to reduced work and income, leaving many sex workers struggling to cover basic needs; additionally, government protections excluded those working in the informal economy. Fearing the loss of their already reduced number of clients, many felt compelled to compromise both prices and protective measures. Although some engaged in online sex work, this raised concerns about visibility and was impossible for those without technological access or skills. Many feared COVID-19, but felt pressure to continue working, often with clients who refused to wear masks or share exposure history. Other negative impacts on well-being related to the pandemic included reduced access to financial support or health care. Marginalized populations (and especially those in professions which require close contact like sex workers) need further support and capacity-building within the community to recover from the impact of COVID-19.

Factors associated with severe depressive symptoms among Chinese secondary school students in Hong Kong: a large cross-sectional survey.

Many adolescents were reported to have severe depressive symptoms, and a careful assessment of its correlates is essential for prevention and intervention programs. This study aimed to gain insight into the prevalence of severe depressive symptoms and its association with factors at four levels (individual, relationship, school and society) in a large sample of Hong Kong Chinese secondary school students. Secondary school students from Secondary 1 through 7 were selected as participants using a cluster random sampling method. A questionnaire including inventories measuring 24 factors at the four levels (six individual factors, 11 relationship factors, three school factors, and four society factors) was completed by 8,963 participants (56.3% female) with a mean age of 15.1 (SD = 1.8) years. Students with a score of ≥15 on the Patient Health Questionnaire were defined as having severe depressive symptoms. The association between severe depressive symptoms and correlates were examined by t-test and χ2 test. Logistic regression models using a hierarchical approach then examined the individual contribution of these 24 factors to severe depressive symptoms with the control of other factors in the model. 7.4% of the students have severe depressive symptoms. Twenty-two of the 24 factors were significantly associated with severe depressive symptoms in bivariate analyses. In the logistic regression, 11 factors (three individual factors: age, self-esteem and self-mastery; six relationship factors: tobacco use, alcohol drinking, drug use, paternal psychological control, dinner with parents, and perceived social support from friends; one school factor: felt pressure from homework; and one society factor: number of sibling) were statistically significant. Felt pressure from homework, alcohol drinking, and perceived social support from friends were the strongest correlates of severe depressive symptoms. The prevalence of self-reported severe depressive symptoms in Hong Kong Chinese secondary school students was high, and the identification of multiple associated factors at the four levels simultaneously provides a knowledge basis for the development of a comprehensive, multivariate model of factors influencing severe depressive symptoms in Chinese secondary school students. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.