Growth Mixture Modeling Analysis Research Articles

Joint developmental trajectories of depression and post-traumatic stress disorder symptoms among Chinese children during COVID-19

BackgroundIn early 2020, Chinese children started to demonstrate severe depression and post-traumatic stress disorder symptoms (PTSS) caused by lockdown and self-isolation (measures taken at the beginning of the COVID-19 pandemic). ObjectivesConcerning the significant impact of the pandemic on children's physical and mental development, the study aimed to explore children's depression and PTSS during the COVID-19 pandemic and the protective effects of family resilience on the trajectories. Methods883 children participated and completed three waves of online follow-up questionnaires. The latent growth mixture modeling (LGMM) analysis was used to explore the trajectories of children's depression and PTSS based on the individual approach. ResultsTwo types of depression trajectories were identified and defined as the resilient group (83.01 %) and the recovery group (16.99 %); Two types of PTSS trajectories were identified and defined as the resilient group (71.12 %) and the recovery group (28.88 %); Two types of the joint trajectories of depression and PTSS were identified and defined as the resilient group (83.47 %) and the chronic group (16.53 %). The results indicated that maintaining a positive outlook (a dimension of family resilience) was the potential predictor of PTSS trajectories. ConclusionThe trajectories of depression and PTSS among Chinese children during the COVID-19 pandemic were heterogeneous, and there were similar evolving subtypes. Family resilience could be a critical protective factor for children and families.

Patterns of physical and mental co-occurring developmental health among Chinese elderly: A multidimensional growth mixture model analysis

BackgroundThis study focuses on the heterogeneity, interaction, and imbalance in the concurrent development of physical and mental health trajectories among Chinese elderly. MethodsThe data used in this study are from four waves of the China Health and Retirement Longitudinal Study (CHRLS) conducted between 2011 and 2018. A multidimensional growth mixture model (MGMM) was employed to analyze the patterns and characteristics of co-occurring physical and mental health development. Additionally, multinomial logistic regression analysis was conducted to systematically investigate the factors that predict the conjoint trajectories of physical and mental health. ResultsThe study findings reveal the presence of four distinct latent classes of conjoint trajectories for physical and mental health. These classes are categorized as follows: ‘physical and mental health deteriorating’, ‘physical disease increasing & low mental vulnerability maintaining’, ‘low physical & mental vulnerability maintaining’, and ‘high physical disease increased & mental health moderate-stable’. Furthermore, demographic characteristics, socioeconomic status, family-society relations, health behaviors, and institutional factors were found to significantly predict these latent classes. ConclusionThe study emphasizes the diversity and complexity of physical and mental co-occurring developmental health issues in the elderly population in China. These findings have significant implications for the development of targeted intervention strategies that take into account the unique health changes experienced by older adults. Additionally, they can serve as evidence for the establishment of a comprehensive long-term care system.

Meaning in life following service among post-9/11 military veterans: A latent growth mixture model analysis.

Meaning in life refers to the "sense made of, and significance felt regarding, the nature of one's being and existence." Meaningful living promotes well-being, resilience, and personal growth. Yet, much remains unknown about how meaning changes over time and determinants of meaning, particularly during major life transitions. We identified distinct trajectories of meaning using latent growth mixture models and examined prospective predictors of class membership in a military veteran cohort assessed at multiple time points throughout the first 3 years after leaving service. Three trajectories were identified: consistently high meaning (89.5%; n = 7025), diminishing meaning (6.1%; n = 479), and strengthening meaning (4.4%; n = 348). Veterans with greater posttraumatic stress symptoms, depression symptoms, and moral injury experienced increased odds of a less adaptive trajectory (i.e. diminishing and/or strengthening vs. consistently high meaning), whereas veterans who reported greater psychological resilience, community relationship satisfaction, and intimate relationship satisfaction experienced lower odds of a less adaptive trajectory. Several gender differences were also observed. Results provide insight into veteran subgroups that are more likely to experience lower meaning after leaving military service and thus may benefit from additional support to reduce their risk for poor longer-term health and well-being outcomes.

Developmental trajectories of depression, anxiety, and stress among college students: a piecewise growth mixture model analysis

Mental health issues are becoming increasingly common among college students, but not all students follow the same developmental trends of mental health. This study aims to identify the developmental trajectories of depression, anxiety, and stress among college students and the related factors for different trajectory classes. The data were collected from a longitudinal survey of college students over four consecutive years, and 2473 students were included in the analysis. The study used a piecewise growth mixture model to determine the subtrajectories, and a multinomial logistic regression model was constructed to investigate the related factors affecting students in subtrajectories. The results revealed that subtrajectories include the low and stable class, increasing class, decreasing then stable class, increasing then decreasing class, and decreasing and high class. The decreasing and high class only presents in the trajectories of anxiety and stress. Regarding related factors, high BMI and high sleep hours were identified as related factors for the increasing class of depression; gender and high sleep hours were associated with the increasing class of anxiety; and hometown location was related to the increasing class of stress. Extroversion personality, relationship with classmates, siblings, and father’s education level are related factors for other subtrajectories. Considering that college students experience multiple trajectories of depression, anxiety, and stress, mental health education and psychological intervention should be carried out for students in each class.

성장혼합모형(GMM)을 적용한 장애인의 직업능력 유형과 영향요인

In this study, using data from the 1st year (2015) to the 6th year (2021) of the 2nd wave of the Korea Employment Agency for the Disabled's Panel Survey of Employment for the Disabled (PSED), In order to identify the categorization of the vocational ability of the disabled according to the classification and the influence of ecological factors that affect these categorization, a growth mixture model analysis was conducted. Analysis results, First, it was confirmed that individual differences were significant in the change trajectory of the disabled's vocational ability. Second, as a result of analyzing the growth mixture model for the trajectory of change in the vocational ability of the disabled, it was confirmed that there are three potential classes. The largest proportion of the disabled people's vocational ability was likely to belong to the 'high level maintenance type', followed by the 'low level continued type' and the 'high level reduced type'. Third, among the personal background factors of the disabled, the lower the 'age' and 'spouse', the higher the probability of belonging to the 'high level maintenance type' rather than the 'high level reduction type group' or 'low level continuing type' of vocational ability. . Among the disability characteristics factors, the more 'persons with physical disabilities' and 'mild disabilities', the higher the probability of belonging to the 'high level maintenance type' rather than the 'high level reduction type group' or 'low level continued type' of vocational ability. Among the occupational characteristics factors, the more 'jobs', the higher the 'education level', and the 'health status', the higher the 'high level maintenance type' rather than the 'high level reduction type group' or 'low level continuous type' of vocational ability. I'd say it's more likely to belong.

Career Decision Trajectories and Antecedents Among University Students: A Five-wave Growth Mixture Model Analysis

Career Decision Trajectories and Antecedents Among University Students: A Five-wave Growth Mixture Model Analysis

Heterogeneity in resilience patterns and its prediction of 1-year quality of life outcomes among patients with newly diagnosed cancer: An exploratory piecewise growth mixture model analysis

PurposeThis study was designed to explore the impact of a new cancer diagnosis on resilience of patients and whether the resilience patterns could predict Quality of Life (QoL) in the first year. MethodsAn exploratory linear piecewise growth mixture modeling (PGMM) with one hypothetical dot (3 months since diagnosis, T1) was employed to identify different resilience patterns and growth in 289 patients with different cancer diagnoses at five assessment occasions (T0-T4). Logistic regression analysis was performed to select potential predictors and receiver operating characteristic (ROC) curve analysis was utilized to test PGMM’s discriminative ability against 1-year QoL. ResultsFive discrete resilience trajectories with two growing trends were identified, including “Transcendence” (7.3%), “Resilient” (47.4%), “Recovery” (18.7%), “Damaged” (14.9%) and “Maladaption” (11.8%). Advanced stage, colorectal cancer, and receiving surgery therapy were significant predictors of negative resilience trajectories (“Damaged” or “Maladaption”). Discriminative ability was good for PGMM (AUC = 0.81, 95%CI, 0.76–0.85, P < 0.0001). ConclusionHeterogeneity is identified in resilience growth before and after 3 months since diagnosis. 26.7% newly diagnosed patients need additional attention especially for those with advanced colorectal cancer and receiving surgery therapy.

Study Protocol Using Cohort Data and Latent Variable Modeling to Guide Sampling Women With Type 2 Diabetes and Depressive Symptoms.

Depression affects one in three women with Type 2 diabetes, and this concurrence significantly increases the risks of diabetes complications, disability, and early mortality. Depression is underrecognized because of wide variation in presentation and the lack of diagnostic biomarkers. Converging evidence suggests inflammation is a shared biological pathway in diabetes and depression. Overlapping epigenetic associations and social determinants of diabetes and depression implicate inflammatory pathways as a common thread. This article describes the protocol and methods for a pilot study aimed to examine associations between depressive symptoms, inflammation, and social determinants of health among women with Type 2 diabetes. This is an observational correlational study that leverages existing longitudinal data from the Women's Interagency HIV Study (WIHS), a multicenter cohort of HIV seropositive (66%) and HIV seronegative (33%) women, to inform purposive sampling of members from latent subgroups emergent from a prior retrospective cohort-wide analysis. Local active cohort participants from the Bronx study site are then selected for the study. The WIHS recently merged with the Multicenter Aids Cohort Study (MACS) to form the MACS/WIHS Combined Cohort Study. Latent subgroups represent distinct symptom trajectories resultant from a growth mixture model analysis of biannually collected depressive symptom data. Participants complete surveys (symptom and social determinants) and provide blood samples to analyze plasma levels and DNA methylation of genes that encode for inflammatory markers (CRP, IL-6, TNF-α). Correlation and regression analysis will be used to estimate the effect sizes between depressive symptoms and inflammatory markers, clinical indices (body mass index, hemoglobin A1C, comorbidities), and social determinants of health. The study began in January 2022, and completed data collection is estimated by early 2023. We hypothesize that depressive symptom severity will associate with higher levels of inflammation, clinical indices (e.g., higher hemoglobin A1C), and exposure to specific social determinants of health (e.g., lower income, nutritional insecurity). Study findings will provide the basis for future studies aimed at improving outcomes for women with Type 2 diabetes by informing the development and testing of precision health strategies to address and prevent depression in populations most at risk.

Early and Persistent Dysphagia Relief Predicts Tumor Response in Esophageal Squamous Cell Carcinoma Patients Treated with Immunochemotherapy.

In this prospective study, we aimed to investigate the role of patient-reported dysphagia relief in predicting pathological tumor responses to neoadjuvant immunochemotherapy (NAIC) in locally advanced esophageal squamous cell carcinoma (ESCC) patients. This study was designed as a multi-center, prospective study including ESCC patients who received NAIC in the discovery and validation cohorts. The patients' responses to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-OES 18 and QLQ-C30 were collected at multiple time points. Subsequent time point-intensive esophageal cancer-specific dysphagia trajectories were depicted using growth mixture modeling (GMM) analysis. Furthermore, univariate and multivariate binary logistic regression was used to assess the independent predictors for pathological tumor responses. A total of 120 patients from the discovery cohort and 42 patients from the validation cohort were included in the analysis. In the discovery cohort, 19 (22.9%) of the 83 patients achieved pCR status. In the independent validation cohort, 24 patients underwent surgery, and 9 (37.5%) patients achieved pCR status. Trajectory analysis showed that, in the pCR group, the beginning of rapid declines in the slope occurred on days 3, 6, and 9. Further multivariate analysis showed that the degree of dysphagia relief (△dysphagia%) was the only significant independent predictor for pCR status (OR = 3.267, 95% CI 1.66-6.428, P < 0.001). The AUC value for △dysphagia% was 0.961 (95% CI: 0.922-0.999, P < 0.001). The current study demonstrated that a longitudinal patient-reported outcome (PRO) was an easily obtained, cost-effective, and noninvasive tool for predicting tumor responses to neoadjuvant immunochemotherapy.

Language development trajectories in young children with developmental disabilities in Taiwan

BackgroundLanguage development is critical to various outcomes in young children with developmental disabilities (DD), including autism spectrum disorder (ASD) and non-ASD delays. However, language development trajectories in young children with DD in non-Western populations remain unclear. AimsTo investigate the language development trajectories of young children with DD in Taiwan. We investigated the relationship between trajectory class assignment and diagnostic outcomes (ASD or non-ASD delays) at 3 years after enrollment in the study and the differences in early abilities among children in different trajectory classes. Methods and ProceduresThe participants were 101 young children with DD (mean age: 21.88 months; follow-up: 1.5 and 3 years after enrollment). Growth mixture modeling analyses were conducted to receptive language developmental quotients (RLDQ) and expressive language developmental quotients (ELDQ) on the basis of the Mullen Scales of Early Learning. Outcomes and ResultsThree RLDQ trajectories were identified, namely age expected, delayed catch-up, and delayed, and two ELDQ trajectories were identified, namely delayed improve and delayed. Trajectory class assignment was related to diagnostic outcomes. Children who demonstrated more proficient skills at the early time point, demonstrated improved language outcomes 3 years later. However, adaptive functioning did not differ between the two ELDQ trajectory classes. Conclusions and ImplicationsLanguage development in young children with DD in Taiwan is heterogeneous. Delayed receptive and expressive language development trajectories relate to later ASD diagnoses.

The association between trajectories of change in social functioning and psychological treatment outcome in university students: a growth mixture model analysis.

The transition to university and resultant social support network disruption can be detrimental to the mental health of university students. As the need for mental health support is becoming increasingly prevalent in students, identification of factors associated with poorer outcomes is a priority. Changes in social functioning have a bi-directional relationship with mental health, however it is not clear how such measures may be related to effectiveness of psychological treatments. Growth mixture models were estimated on a sample of 5221 students treated in routine mental health services to identify different trajectories of change in self-rated impairment in social leisure activities and close relationships during the course of treatment. Multinomial regression explored associations between trajectory classes and treatment outcomes. Five trajectory classes were identified for social leisure activity impairment while three classes were identified for close relationship impairment. In both measures most students remained mildly impaired. Other trajectories included severe impairment with limited improvement, severe impairment with delayed improvement, and, in social leisure activities only, rapid improvement, and deterioration. Trajectories of improvement were associated with positive treatment outcomes while trajectories of worsening or stable severe impairment were associated with negative treatment outcomes. Changes in social functioning impairment are associated with psychological treatment outcomes in students, suggesting that these changes may be associated with treatment effectiveness as well as recovery experiences. Future research should seek to establish whether a causal link exists to understand whether integrating social support within psychological treatment may bring additional benefit for students.

Trajectories of alcohol consumption in U.S. military veterans: Results from a 10-year population-based longitudinal study

BackgroundAlcohol use disorder is a public health problem, especially among US veterans. This study examined the nature and predictors of 10-year trajectories of alcohol consumption in US veterans. MethodsData were analyzed from the 2011–2021 National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 2309 US veterans. ResultsLatent growth mixture modeling analyses revealed four trajectories of alcohol consumption (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C]) over a 10-year period: excessive (4.1%; mean [standard deviation] AUDIT-C baseline=8.6 [2.0], slope= −0.33 [0.07]); at-risk (22.1%; baseline=4.1 [1.6], slope=0.02 [0.07]); rare (71.7%; baseline=1.2 [1.3], slope= −0.01 [0.03]); and recovering alcohol consumption (2.1%; baseline=8.4 [1.9], slope= −0.70 [0.14]). The strongest predictors of excessive vs. rare alcohol consumption group were younger age (relative variance explained [RVE]=27.8%), and lower agreeableness (RVE=27.0%); at-risk vs. rare alcohol consumption group were fewer medical comorbidities (RVE=82.3%); recovering vs. rare alcohol consumption group were greater dysphoric arousal symptoms (RVE=46.1%) and current mental health treatment (RVE=26.5%); excessive vs. at-risk alcohol consumption group were younger age (RVE=25.9%), greater dysphoric arousal symptoms of posttraumatic stress disorder (RVE=22.0%), and lower conscientiousness (RVE=19.1%); and excessive vs. recovering alcohol consumption group were current mental health treatment (RVE=61.1%) and secure attachment style (RVE=12.4%). ConclusionsOver the past decade, more than 1 in 4 US veterans consumed alcohol at the at-risk-to-excessive level. Veterans who are younger, score lower on agreeableness and conscientiousness, endorse greater dysphoric arousal symptoms, and currently not engaged in mental health treatment may require close monitoring and prevention efforts to mitigate the risk of a chronic course of at-risk-to-excessive alcohol consumption.

Developmental Trajectories and Predictors of Self-Esteem in Childhood: Growth Mixture Modeling Approach

Objectives: The four-wave longitudinal study explored developmental trajectories of self-esteem of elementary school children and examined the predictive factors such as the mother’s parenting behavior, children’s happiness and school adjustment associated with these trajectories.Methods: Trajectories of self-esteem from grades 1 to 4 were modeled using 1,659 children drawn from the Panel Study on Korean Children (PSKC) 2015~2018. Growth Mixture Modeling (GMM) analysis was used to estimate trajectories of self-esteem in grades 1~4. Using multiple logistic regression, the identified trajectories were then used to analyze whether the mother’s parenting, children’s happiness, and school adjustment affected the latent class classification.Results: First, the self-esteem of grades 1 to 4 revealed a linear growth pattern over time. Second, GMM identified four developmental trajectories in childhood self-esteem, of which the low-increasing, low-decreasing, high-increasing, or moderate-decreasing group reflected the normative trajectories. Third, the mother’s warm parenting, the academic performance of school adjustment, and the happiness of the children were significant in predicting the classification of latent class in the change trajectories of self-esteem.Conclusion: The results showed individual differences and heterogeneity in the development of selfesteem. Groups’ initial different developmental levels at first grade continue until grade 4. Developmental trajectories provide the direction for interventions by the level of self-esteem for elementary children. Especially, educational programs and interventions in mothers’ warm parenting, children’s happiness, and academic performance, which affect self-esteem trajectories, would be needed. These findings provide a meaningful foundation for designing programs and practical suggestions to encourage the self-esteem of elementary children.

The interrelations between psychological outcome trajectories and resource changes amid large-scale disasters: A growth mixture modeling analysis

Currently little is known about the interrelations between changes in psychiatric symptoms and changes in resources (personal, social, financial) amid large-scale disasters. This study investigated trajectories of psychiatric symptoms and their relationships with different patterns of changes in personal, social, and financial resources between 2020 and 2022 amid the COVID-19 pandemic. A population-representative sample (N = 1333) was recruited to complete self-report instruments at the pandemic’s acute phase (February–July 2020, T1), and again at 1-year (March–August 2021, T2) and 1.5-year (September 2021–February 2022, T3) follow-ups. Respondents reported depressive and anxiety symptoms, self-efficacy, perceived social support, and financial capacity. Growth mixture modeling (GMM) identified four trajectories of depressive and anxiety symptoms: resilience (72.39–74.19%), recovery (8.40–11.93%), delayed distress (7.20–7.35%), and chronic distress (8.33–10.20%). Four patterns were demonstrated in resource changes: persistent high resources (40.89–47.64%), resource gain (12.08–15.60%), resource loss (6.30–10.43%), and persistent low resources (28.73–36.61%). Loss and gain in financial resources characterized chronic distress and resilience, respectively. Loss in personal resources characterized delayed distress, whereas loss or no gain in social resources was related to chronic/delayed distress. Respondents in resilience were also more likely to have persistent high resources while those with delayed/chronic distress were more likely to have persistent low resources. These results provide an initial evidence base for advancing current understanding on trajectories of resilience and psychopathology in the context of resource changes during and after large-scale disasters.

Does a change in moral neutralization from early to mid-adolescence predict a change in delinquency?

ABSTRACT A growth mixture modeling (GMM) analysis of neutralization scores in 1,830 youth across six waves of data revealed evidence of a three-class model in which moral neutralization either increased (low accelerating), decreased (high decelerating), or remained the same (moderate stable) over time. Controlling for age, sex, race, group assignment, and Wave 1 delinquency, an analysis of covariance revealed a significantly greater increase in Wave 6 delinquency in the moderate stable group than in the low accelerating group. When the average neutralization score was added as a control variable, the low accelerating group was highest, the moderate stable group next highest, and the high decelerating group lowest on Wave 6 delinquency. These results indicate that change in the pattern of neutralization scores (accelerating, stable, decelerating) may be as important as the level of moral neutralization at any particular point in time in determining the effect of neutralization on future delinquency.

Trajectories of Learned Helplessness in Maintenance Haemodialysis Patients and Their Predictive Effects on Self-Management: A Latent Growth Mixture Modeling Approach.

Learned helplessness (LH) is an essential psychological factor influencing maintenance haemodialysis (MHD) patients' health behaviour and is closely related to prognosis of the disease. This study aimed to identify potential trajectories of LH in MHD patients and assess their predictive role in self-management. This study was conducted in strict compliance with national laws, the Declaration of Istanbul, and the Declaration of Helsinki. A total of 347 MHD patients at a blood purification centre in Hunan Province, China, were selected as the study population. Four longitudinal surveys (baseline and second/fourth/sixth month after baseline) were conducted using the General Information Questionnaire for MHD patients, the Chinese version of the Learned Helplessness Scale for MHD patients, and the Self-Management Scale for Haemodialysis. Latent growth mixture model (LGMM) analysis was used to identify LH trajectories, and their predictors were analysed using multinomial logistic regression. The predictive role of LH trajectory on self-management was analysed using linear regression. This study identified three LH trajectories in MHD patients, named the "high-decreasing group" (57.9%), "low-increasing group" (21.3%), and "low-stability group" (20.7%). The results of the univariate analysis showed that sex (χ2=33.777, P < 0.001), age (χ2=10.605, P<0.05), and subjective social status (SSS) (χ2=12.43, P<0.01) were associated with LH trajectory classes. Multinomial logistic regression further demonstrated that gender, age, and SSS were predictors of different LH trajectories. The intercept and slope of the overall LH trajectory were negatively correlated with self-management (β=-0.273, P<0.001; β=-0.234, P<0.01). MHD patients show three different LH trajectories. The initial level and developmental rate of LH can negatively predict future self-management. It is necessary to screen MHD patients' LH and develop targeted interventions for them with different LH trajectories at specific stages.

PrEP risk perception and adherence among men who have sex with men: a prospective cohort study based on growth mixture model

BackgroundIt can be considered that pre-exposure prophylaxis (PrEP) risk perception is the negative experiences or concerns about taking PrEP. The aim of this study is to explore the longitudinal trajectory of PrEP risk perception among men who have sex with men (MSM) and its impact on adherence.MethodsData related to PrEP risk perception and adherence were derived from a prospective cohort study in Western China from 2013 to 2015. Subjects were categorized into the time-driven, event-driven and blank control groups. Tenofovir disoproxil fumarate (TDF) was administered to subjects in the time-driven and event-driven groups, and all subjects were followed up every 12 weeks. The PrEP risk perception scale was constructed, and the growth mixture model (GMM) was used to classify longitudinal PrEP risk perception. The effect of different levels of PrEP risk perception on drug adherence was explored using generalized estimating equations (GEE) with relative risk (RR) and 95% confidence interval (CI).ResultsThe PrEP risk perception scale consists of 4 dimensions and 16 items with Cronbach's alpha = 0.828 and a good model fit. According to the GMM analysis, the subjects' PrEP risk perceptions were separated into two groups: a "high-risk perception group" (n = 133) and a "low-risk perception group" (n = 493), where the proportion of high levels of drug adherence were 57.89% and 68.35%, respectively (p = 0.024). High levels of PrEP risk perception in the MSM population hinder drug adherence (RR = 0.71, 95% CI 0.50 to 0.99, p = 0.046). The results of this study were validated in the subsequent PrEP projects conducted in 2019 to 2021.ConclusionThis study demonstrates that high levels of PrEP risk perception in the MSM population are an obstacle to drug adherence, emphasizing the necessity of focusing on PrEP risk perception in this population and the value of its application in the current context.

Trajectories of Job Burnout among Bus Drivers in China: A Three-Year Follow-Up Study

This study aimed to characterize job burnout in longitudinal trajectories among bus drivers and examine the impact of variables related to job burnout for trajectories. A longitudinal study was conducted in 12,793 bus drivers in Guangdong province, China, at 3-year follow-up assessments. Growth mixture modeling (GMM) was used to estimate latent classes of burnout trajectories and multinomial logistic regression models were applied to predict membership in the trajectory classes. In general, there was a decrease in job burnout in 3 years [slope = -0.29, 95%CI = (-0.32, -0.27)]. Among those sub-dimensions, reduced personal accomplishment accounted for the largest proportion. GMM analysis identified five trajectory groups: (1) moderate-decreased (n = 2870, 23%), (2) low-stable (n = 5062, 39%), (3) rapid-decreased (n = 141, 1%), (4) moderate-increased (n = 1504, 12%), and (5) high-stable (n = 3216, 25%). Multinomial logistic regression estimates showed that depression symptoms, anxiety symptoms, and insomnia were significant negative predictors, while daily physical exercise was a significantly positive predictor. We found an overall downward trend in bus drivers' burnout, particularly in the sub-dimension of personal accomplishment. Mentally healthier drivers and those who were usually exercising were more resilient to occupational stress and less likely to suffer burnout.

Recovery from open osteocapsular débridement for primary elbow osteoarthritis is rapid and does not depend on preoperative motion.

Osteocapsular débridement is a surgical treatment for functionally limiting primary elbow osteoarthritis (PEOA). We hypothesized that postoperative improvement in range of motion (ROM) following elbow osteocapsular débridement could be grouped into predictable patterns. We also hypothesized that significant improvements in ROM frequently take place for up to 6 months after surgery. A retrospective chart review of patients who underwent open elbow débridement for PEOA was performed. Demographic information and surgical approach were recorded. ROM data were also collected at preoperative, intraoperative, and postoperative intervals of 2 weeks, 6 weeks, 3 months, and 6 months. Growth mixture modeling and latent class growth analysis were performed to identify groups of motion recovery trajectories, while Student's t-tests were performed to compare ROM data between intervals. Our study included 76 patients who underwent open elbow débridement (9 with a lateral approach, 55 medial, and 12 both) for PEOA. The mean preoperative arc of motion was 95°±22°. This improved to a mean final motion arc of 127°±11 at final follow-up, which was 92% of the mean intraoperative arc. The mean time to achieve final motion was 3 months, with 79% of patients achieving their final ROM arc by this point. Patients achieved an average of 85% of their final arc of motion by the 2-week postoperative visit (92% of final flexion and 61% of final extension). Growth mixture modeling and latent class growth analysis did not identify any statistically significant groupings for postoperative ROM progression trajectories. Arc of motion preoperatively, intraoperatively, and at 2 weeks postoperatively did not correlate with the final arc of motion. There were no characteristics or thresholds of motion which conferred a higher likelihood of achieving a better result postoperatively. ROM recovery after osteocapsular débridement for PEOA is not dependent on preoperative, intraoperative, or 2-week postoperative arcs of motion. Most of the ROM recovery occurs in the early postoperative period, with flexion restored preferentially faster than extension. The final arc of motion can be expected by 3 months postoperatively. This knowledge has potential benefit in affecting patients' personal time commitment to rehabilitation and the overall cost for therapy and splinting beyond the 3-month time point.

Trajectories and predictors of child abuse in Chinese children aged 4–7 years: A growth mixture model analysis

Trajectories of child abuse and associated predictors have not been fully elucidated to date, particularly under the Chinese cultural context. The current study attempted to explore trajectories of child abuse and predictors in a Chinese community sample based on a longitudinal study. Three waves of data were collected from 521 caregivers who had children aged 4–7 years with caregiver-reported questionnaires. An unconditional growth mixture model analysis was used to examine developmental trajectories, and a conditional growth mixture model analysis was conducted to examine predictors for trajectories. The results showed that changes in child abuse, physical abuse, and emotional abuse over time were heterogeneous, including in the None to Low class (93.8 %, 93.6 %, and 92.4 %) and the Sustained Abuse class (6.2 %, 6.4 %, and 7.6 %). The children’s sex, caregivers’ education levels, family income, and caregivers’ childhood trauma predicted the classification of child abuse, physical abuse, and emotional abuse (β = −0.72 to 1.32, S.E. = 0.18–0.39, p <.01), e.g., girls and caregivers’ low childhood trauma predicted individuals belonging to the sustained abuse class of physical abuse, and these factors also predicted child abuse within this class (β = −1.28 to 2.85, p <.05). These findings suggest that different subtypes of child abuse may have different trajectories, and prevention strategies should be implemented based on specific subtypes. Additionally, the findings highlight that many more longitudinal studies should be conducted on child abuse and examine changes in abuse over time.