Serial Multiple Mediation Model Research Articles

How well does nature contact promote academic achievement in geography? The serial multiple mediating effects of sense of place and geospatial thinking

ABSTRACT Current studies emphasise that nature plays a key role in geography education. However, little research has been devoted to elucidating the underlying mechanisms by which nature contact (NC) influences academic achievement. With the aim of filling this gap, this study provides a serial multiple mediator model that examines how contact with nature promotes academic achievement in geography (AAG) and is further associated with the serial multiple mediating effect of students’ sense of place (SOP) and geospatial thinking (GT). A self-report questionnaire was administered to 885 senior high-school students in China. The results indicated that the positive association between NC and students’ AAG was not only mediated by an SOP and GT but also serially mediated by an SOP and GT. The findings and details are valuable for educational researchers and practising teachers, as they extend our understanding of the factors influencing AAG and how they correlate with geography learning processes.

The impact of loneliness on depression during the COVID-19 pandemic in China: a two-wave follow-up study

AbstractDuring the COVID-19 pandemic, many regions and countries implemented lockdowns and isolation to curb the virus’s spread, which might increase loneliness and lead to a series of psychological distress. This study aims to investigate the association between loneliness and depression during the COVID-19 pandemic and examine whether perceived social support and perceived internal control mediate the loneliness-depression relationship in China. Self-report questionnaires were distributed online in two waves during the pandemic in 2020. At Wave 1, demographics and loneliness were reported when the lockdown was initially implemented in China, and at Wave 2, as the pandemic came under control and the epicenter lifted its lockdown. Depression, perceived social support, and perceived internal control were measured at both two waves. Higher levels of loneliness at Wave 1 were associated with more depression at Wave 2 after controlling for baseline depression and demographic variables. Simple mediation models showed that both perceived social support and internal control at two waves independently mediated the relationship between Wave 1 loneliness and Wave 2 depression. Additionally, the serial multiple mediation model indicated that perceived social support and perceived internal control sequentially mediated the path from loneliness to subsequent depression. A higher level of loneliness during the initial lockdown was linked with more severe depression with the development of the COVID-19 pandemic. Both perceived social support and perceived internal control acted as essential protective factors against depression from loneliness. Meanwhile, social support might protect mental health by enhancing the sense of self-control when facing loneliness.

Instrumental activities of daily living function and cognitive status among Chinese older adults: a serial multiple mediation model.

This study aimed to develop and validate a serial multiple mediation model to investigate the association between instrumental activities of daily living (IADL) function and cognitive status among older adults while exploring the underlying mechanisms. This cross-sectional study involved 3,665 individuals aged 60 years and older who participated in the China Health and Retirement Longitudinal Survey (CHARLS). A serial multiple mediation model was utilized to explore the direct and indirect relationship between IADL function and cognitive status and whether sleep duration, social engagement, and depressive symptoms mediated this relationship. Decreased IADL function was associated with worse cognitive status [effect = -0.620, 95% CI: (-0.692, -0.540)]. Sleep duration, social participation (SP), and depressive symptoms all acted as mediators in the relationship between IADL function and cognitive status. This study found both direct and indirect associations between IADL function and cognitive status, providing new insights into the effective prevention and intervention of cognitive decline among older adults.

Effects of perceived stress on turnover intention of female healthcare staff: a serial multiple mediation model

BackgroundHealthcare staff in China, especially females, work in a high-pressure, high-load, and high-risk environment, which affects the physical and mental health, the efficiency and quality of work, and increases turnover intention. The present study investigated the relationship between perceived stress and turnover intention in female healthcare staff, and the effects of future-oriented coping and work-family balance on this relationship.MethodsFour hundred thirty-five female medical workers were recruited to perform a perceived stress scale, future-oriented coping inventory, work-family balance scale and turnover intention scale. Meanwhile, serial multiple mediation analysis was performed using PROCESS.Results1) Perceived stress positively predicted the level of turnover intention in female healthcare staff; 2) Preventive coping and proactive coping showed mediation effects on the relationship between perceived stress and turnover intention, and preventive coping positively related to proactive coping; 3) The work-family balance also showed mediation effects on the relationship between perceived stress and turnover intention; 4) Preventive coping, proactive coping and work-family balance showed a serial multiple mediation on the relationship between perceived stress and turnover intention in female healthcare workers.ConclusionsPerceived stress affects the level of turnover intention in female healthcare staff through preventive coping, proactive coping, and work-family balance. In addition, the sequential model of future-oriented coping was validated among female healthcare staff.

Creating AI business value through BPM capabilities

PurposeAlthough businesses continue to take up artificial intelligence (AI), concerns remain that companies are not realising the full value of their investments. The study aims to provide insights into how AI creates business value by investigating the mediating role of Business Process Management (BPM) capabilities.Design/methodology/approachThe integrative model of IT Business Value was contextualised, and structural equation modelling was applied to validate the proposed serial multiple mediation model using a sample of 448 organisations based in the EU.FindingsThe results validate the proposed serial multiple mediation model according to which AI adoption increases organisational performance through decision-making and business process performance. Process automation, organisational learning and process innovation are significant complementary partial mediators, thereby shedding light on how AI creates business value.Research limitations/implicationsIn pursuing a complex nomological framework, multiple perspectives on realising business value from AI investments were incorporated. Several moderators presenting complementary organisational resources (e.g. culture, digital maturity, BPM maturity) could be included to identify behaviour in more complex relationships. The ethical and moral issues surrounding AI and its use could also be examined.Practical implicationsThe provided insights can help guide organisations towards the most promising AI activities of process automation with AI-enabled decision-making, organisational learning and process innovation to yield business value.Originality/valueWhile previous research assumed a moderated relationship, this study extends the growing literature on AI business value by empirically investigating a comprehensive nomological network that links AI adoption to organisational performance in a BPM setting.

Analysis of the chain mediation effect between intergenerational support and mental health of older adults in urban China: a structural equation model.

This study aimed investigate the impact of intergenerational support on the mental health of older adults in urban China. It also sought to evaluate the chain mediation effect of attitudes toward younger people and willingness to interact with younger people within a non-familial context between intergenerational support and mental health. Data were derived from a community survey that adopted quota sampling in mainland China in 2022 (N = 780). Structural equation modeling was used to analyze the data, and the bootstrap technique was used to test the mediation effect. A significant positive association was found between intergenerational support and the mental health of older adults in urban China (B = 0.852, 95% confidence interval CI [0.157,1.617]). Intergenerational support had a specific indirect effect on mental health through older adults' attitudes toward younger people within a non-familial context (B = 0.665, 95% CI [0.443,1.046]). There was a chain mediation effect (B = 0.126, 95% CI [0.069,0.224]) in relation to attitudes toward younger people and the willingness to interact with younger people between intergenerational support and mental health. Mediation accounted for 44.44% of the total effects in the model. These findings help identify modifiable factors that can improve the mental health of older adults. In line with the proposed serial multiple mediation model, this study provides theoretical and practical insights concerning the synergistic effect of intergenerational support at the family level and intergenerational interaction at the community level. Policy and social service implications are also discussed.

The relationship between appearance anxiety and depression among students in a medical university in China: a serial multiple mediation model.

Appearance anxiety and depression have become common and global public health problems worldwide, especially among adolescents. However, few studies have revealed the mechanisms between them. This study aimed to explore the multiple mediating roles of interpersonal sensitivity and social support between appearance anxiety and depression among medical college students. With 13 invalid samples excluded, 724 college students participated in our survey and completed questionnaires. The average age of 724 samples was 19.8 ± 2.02 including freshman to senior year and graduate school and above; 31.9% of the participants were male and 68.1% were female. SPSS 25.0 and Hayes' PROCESS macro were used for statistical description, correlation analysis and built multiple mediation models. Appearance anxiety can not only directly affect depression, but also indirectly affect depression through three significant mediating pathways: (1) IS (B = 0.106, 95% CI [0.082-0.132]), which accounted for 49.77% of the total effect, (2) SS (B = 0.018, 95% CI [0.008-0.031]), which accounted for 8.45% of the total effect, and (3) IS and SS (B = 0.008, 95% CI [0.003-0.014]), which accounted for 3.76% of the total effect. And the total mediating effect was 61.97%. It is a cross-sectional research method and the causal relationship is unclear. This study found that lower interpersonal sensitivity and higher social support can effectively reduce depression caused by appearance anxiety among college students. The schools and relevant departments should take measures to reduce the interpersonal sensitivity of college students and establish reliable social support, so as to reduce the occurrence of depression.

Suicidal ideation in Chinese patients with advanced breast cancer: a multi-center mediation model study

PurposeThe pathways underpinning suicide ideation (SI) and certain physical and psychological factors in patients with advanced breast cancer remain unclear. This study develops and validates a mediation model that delineates the associations between several multidimensional variables and SI in Chinese patients with advanced breast cancer.MethodsPatients with advanced breast cancer (n = 509) were recruited as study participants from 10 regional cancer centers across China from August 2019 to December 2020. Participants were required to complete five questionnaires using an electronic patient-reported outcomes (ePRO) system: 9 item- Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), 5-level EQ-5D (EQ-5D-5L), and MD Anderson Symptom Inventory (MDASI). Risk factors for SI were identified using multivariable logistic regression, and inputted into serial multiple mediation models to elucidate the pathways linking the risk factors to SI.ResultsSI prevalence was 22.8% (116/509). After adjusting for covariates, depression (odds ratio [OR] = 1.384), emotional distress (OR = 1.107), upset (OR = 0.842), and forgetfulness (OR = 1.236) were identified as significant independent risk factors (all p < 0.05). The ORs indicate that depression and distress have the strongest associations with SI. Health status has a significant indirect effect (OR=-0.044, p = 0.005) and a strong total effect (OR=-0.485, p < 0.001) on SI, mediated by insomnia severity and emotional distress.ConclusionsThere is a high SI prevalence among Chinese patients with advanced breast cancer. Our analysis revealed predictive pathways from poor health to heightened SI, mediated by emotional distress and insomnia. Regular management of distress and insomnia can decrease suicide risk in this vulnerable population.

Investigating the mediating roles of executive functioning and rumination in the relations between dispositional mindfulness and depression among high school students

AbstractThis study investigates the intricate relations between dispositional mindfulness, executive functioning, rumination, and depression among Chinese high school students. It aims to understand how dispositional mindfulness can potentially predict depression in this demographic, providing insights for preventive interventions targeting adolescent depression. Despite growing recognition of mindfulness in mental health, its relations between executive functioning, rumination, and depression in high school students is not fully understood. The study involved 608 high school students (59.5% female; M age = 16.37 SD = 0.53) from the southwestern region of China. Data were collected using established scales: the Mindful Attention Awareness Scale (MAAS), the Teenage Executive Functioning Inventory (TEXI), the Ruminative Response Scale (RRS), and the Centre for Epidemiological Studies Depression Scale (CES-D). The analysis revealed significant correlations: a significant positive association between mindfulness and executive functioning capabilities, alongside notable negative associations between mindfulness and both rumination and depression, and a negative correlation between executive functioning and both rumination and depression.A positive correlation was observed between rumination and depression. Analytical the mediation model indicated that mindfulness predicts depression in directly, with this predictive effect being partially mediated by executive functioning and rumination in a serial multiple mediation model. These results corroborate the initial hypotheses and highlight the intricate interactions between mindfulness, executive functioning, rumination, and depression in high school student. This study underscores the importance of mindfulness, executive functioning, and rumination in understanding adolescent depression. The findings offer valuable insights for future research and highlight key areas for potential preventive strategies in adolescent mental health.

The pathways of increasing online celebrity brand equity and followers' hotel booking intention: a serial multiple mediation model

PurposeFrom a consumer–brand relationship (CBR) perspective, this study proposes a serial multiple mediation model to explore the pathways (e.g. cognitive, affective and hybrid) to increase online celebrity brand equity (OCBE) and follower's hotel booking intentions (FBI).Design/methodology/approachPaper-based and online surveys were used to collect data from 443 respondents who had been using TikTok and had followed at least one online celebrity on TikTok, while that online celebrity had reviewed one or more types of accommodation. A serial multiple mediation model was evaluated through covariance-based structural equation modeling.FindingsThe results confirmed the hybrid cognitive–affective and cognitive–affective–conative pathways among antecedents and components of OCBE and FBI.Originality/valueFrom a CBR perspective, this study provides a serial multiple mediation model to increase OCBE via hybrid cognitive–affective pathways and to drive FBI via cognitive–affective–conative pathways. These sequential relationships contribute to the human branding literature by defining a mechanism of how online celebrities can efficiently attract followers, thus driving online celebrity brand loyalty and hotel booking intentions.Research limitations/implicationsThe results should be validated in other cultural contexts to generalize findings and broaden the range of target respondents to include international followers and those within other nations.

The relationship between family communication and family resilience in Chinese parents of depressed adolescents: a serial multiple mediation of social support and psychological resilience

BackgroundFamily resilience plays a crucial role in helping depressed adolescents overcome challenges. However, studies examining family resilience in depressed adolescents are currently scarce. This study, guided by the family resilience framework, aimed to investigate the serial-multiple mediation of social support and psychological resilience between family communication and family resilience in Chinese families of depressed adolescents.MethodsIn 229 parents of adolescents with major depressive disorder, 20.1% comprises of fathers, while 79.9% comprises of mothers. The mean age of depressed adolescents was 14.84 (±1.76) years, and the mean age of parents of these depressed adolescents was 43.24 (±4.67) years. The Family Resilience Assessment Scale (FRAS), the Psychological Resilience of Parents of Special Children Questionnaire, and the Social Support Rating Scale, Family Assessment Device (FAD) were used to collected data. Descriptive, univariate, and Pearson correlation analyses were used in preliminary analyses. To explore mediation, we employed a serial-multiple mediation model (PROCESS model 6).ResultsFamily communication was positively correlated with family resilience, social support, and psychological resilience. Mediation analysis revealed indirect effects of family communication on family resilience, which were mediated solely by either social support or psychological resilience, or through multiple mediation pathways involving both social support and psychological resilience.ConclusionsFamily communication positively and directly affects the family resilience of depressed adolescents, and a higher level of social support and psychological resilience can help improve family resilience. These findings not only provide empirical evidence supporting the family resilience framework but also have practical implications for future family interventions targeting depressed adolescents.

Depressive Symptoms and Sleep Quality Mediate the Relationship Between Race and Quality of Life Among Patients With Heart Failure: A Serial Multiple Mediator Model.

Black patients with heart failure (HF) report worse quality of life (QoL) than White patients. Few investigators have examined mediators of the association between race and QoL, but depressive symptoms and sleep quality are associated with QoL. The aim of this study was to determine whether depressive symptoms and sleep quality are mediators of the relationship between race and QoL among patients with HF. This was a cross-sectional study. We included 271 outpatients with HF. Self-reported race (White/Black), depressive symptoms (Patient Health Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), and QoL (Kansas City Cardiomyopathy Questionnaire) were collected at baseline. A serial multiple mediator analysis was conducted using the PROCESS macro for SPSS. Ninety-six patients (35.4%) were Black. Black participants reported higher levels of depressive symptoms and poorer sleep quality than White participants. Race was not directly associated with QoL but indirectly associated with QoL through depressive symptoms and poorer sleep quality. Because of higher levels of depressive symptoms and poorer sleep quality, Black participants reported poorer QoL than White participants. Depressive symptoms and sleep quality together mediated the relationship between race and QoL. These findings suggest that screening for depressive symptoms and sleep quality could identify patients at risk for poor QoL, especially in Black patients.

Effects of Social Support on Medication Adherence Among Patients with Schizophrenia: Serial Multiple Mediation Model.

This study aims to explore the serial mediating effect of stigma and depression on the association between social support and medication adherence. A cross-sectional survey was undertaken in the Changning District of Shanghai using a five-part questionnaire from August to December 2023. A convenient sampling method was employed, and 35 patients with schizophrenia were invited from each of the 9 streets in Changning District to participate in the survey, resulting in a total of 305 valid questionnaires collected. The questionnaire measured social support, stigma, depression, medication adherence, and demographic characteristics. Data analysis involved descriptive statistics, independent samples t-tests, ANOVA, Pearson correlation analysis, and the bootstrap method. There was a direct and significantly positive association between social support and medication adherence (β = 0.69, p < 0.001). Moreover, increased levels of stigma (β = - 0.45, p = 0.013) and depression (β = - 0.09, p = 0.017) were both associated with a decline in medication adherence. Bootstrapping analysis revealed that the association between social support and medication adherence operated indirectly through stigma (β = 0.11, 95% CI: 0.03, 0.18). Additionally, social support was indirectly associated with medication adherence through depression (β = 0.15, 95% CI: 0.04, 0.30). Further analysis indicated that social support had an indirect association with medication adherence through both stigma and depression (β = 0.04, 95% CI: 0.01, 0.07). Stigma and depression serially mediate the association between social support and medication adherence among patients with schizophrenia. This serial multiple mediation model underscores the importance of integrating social support interventions with psychological interventions aimed at reducing stigma and depression, thereby effectively enhancing medication adherence in patients with schizophrenia.

Teacher perceptions of administrator actions in COVID-19 and its impact on emotional exhaustion: A moderation analysis of teacher self efficacy

School districts, administrators, and teachers faced an unprecedented challenge as schools closed due to COVID-19. SBAE teachers were no exception to this and faced the unique challenge of teaching technical content through virtual platforms. The purpose of this study was to explore SBAE teacher emotional exhaustion amid the shared trauma of the COVID-19 pandemic. This study examined emotional exhaustion, teacher self-efficacy, technological pedagogical content knowledge (TPACK), and perceived supportive actions from administration in [State] SBAE teachers. Paired samples t-tests indicated increases in emotional exhaustion – with a medium effect size – in participants from spring to autumn of 2020. A serial multiple mediator model indicated supportive administrator actions significantly predicted TPACK and emotional exhaustion, while TPACK significantly predicted teacher self-efficacy at the time of measurement. Within the mediation model, no significant indirect effects were found. Further research should examine the factors behind administrative support for teachers to help mitigate emotional exhaustion in the teacher population.

Could 70 Be the New 60? Investigating the Association Between Internet Use and Subjective Age Among Chinese Older Adults.

The widespread use of the Internet brings both opportunities and challenges for older adults. To understand its potential benefits and drawbacks, we focus on the association between Internet use and multiple indicators of subjective age (threshold age, felt age, and look age) and the underlying mechanisms. A nationally representative sample of older adults aged 60 and over from 3 waves (collected in 2016, 2018, and 2020) of the China Longitudinal Aging Social Survey was used in the analysis. A 3-step random-effect model and mediation analysis were used to examine the relationship between Internet use and subjective age and the mediating roles of volunteering and feeling valued by society. Structural equation modeling with a serial multiple mediation model was conducted for robustness checks. The participants generally considered 70 as the threshold for "old age." Although the mediation analysis did not show a significant indirect effect of Internet use on older adults' subjective age through volunteering, Internet use was linked with older adults' subjective age directly and indirectly through feeling valued by society. Compared to moderate Internet users, nonusers felt less valued by society and, therefore, had a younger threshold age and older subjective ages. Heavy Internet users showed a lower level of participation in volunteer activities. The results support previous theories about the mental and social health benefits of Internet use among older adults. However, Internet use intensity should receive more attention; excessive use may reduce the duration of older adults' offline social interactions.

The Serial Multiple Mediation Model of District Satisfaction, District Attachment and City Attachment on City Identity: Istanbul

Yerleşim yerine yönelik memnuniyetin mekana bağlanmayı artırdığı, mekana bağlanmanın da mekan kimliği üzerinde olumlu etkiye sahip olduğu ayrı ayrı pek çok araştırmada incelenmiş; ancak memnuniyet, bağlanma ve kimlik arasındaki ilişkilerin bir arada incelendiği sınırlı sayıda çalışma olduğu görülmüştür. Bu çalışmada, İstanbul özelinde ilçeye yönelik memnuniyet ve şehir kimliği arasındaki ilişkide ilçeye bağlanma ve şehre bağlanmanın seri çoklu aracılık etkisi incelenmiştir. Araştırma, İstanbul’un farklı ilçelerinde yaşayan, yaşları 17 ile 64 arasında değişen 228 katılımcı ile gerçekleştirilmiştir. Veri toplama araçları arasında İlçe Memnuniyeti Ölçeği, Mekana Bağlanma Ölçeği, Mekan Kimliği Ölçeği ve Sosyo-demografik bilgi formu yer almaktadır. Araştırmanın sonuçları ilçe memnuniyeti ve şehir kimliği arasındaki ilişkide (1) ilçeye bağlanma ve (2) ilçeye bağlanma ve şehre bağlanmanın seri çoklu aracı etkiye sahip olduğunu göstermiştir. Bulgular şehirle kurulan ilişkide yaşanılan ilçenin önemli olduğunu göstermiştir.

P200: Association between sleep disturbance and subjective well-being among community- dwelling older people: a serial multiple mediation model

Objective:Sleep disturbance is negatively associated with subjective well-being in older people, but the potential underlying mechanisms of this association remain unclear. This study aimed to disentangle the pathways linking subjective versus objective sleep disturbance to subjective well-being through the serial mediation effect of loneliness and depression among community- dwelling older people.Methods:This cross-sectional study was conducted in Sakai city of Japan. A total of 212 aged 65 and over participated in this study. The Athens Insomnia Scale, UCLA Loneliness Scale, Geriatric Depression Scale, and Self-perceived well-being were used to assess subjective sleep quality, loneliness, depression, and subjective well-being, respectively. A non-wearable actigraphy device was used to evaluate the objective sleep quality. Total sleep time, sleep latency, sleep efficiency, wake after sleep onset, number of awakenings, and average activity during sleep were recorded. Serial multiple mediation analysis was performed using SPSS PROCESS Version 4.1 macro. This study was approved by the Institutional Review Board of Osaka University.Results:Subjective sleep disturbance was found to impact subjective well-being through three significant mediation pathways: (1) loneliness (B=-0.024, 95% CI=-0.055, -0.004), which accounted for 25.72% of the total effect, (2) depression (B=-0.020, 95% CI=-0.044, -0.001), which accounted for 20.94% of the total effect, and (3) loneliness and depression (B=-0.008, 95% CI=-0.019, -0.001), accounting for 8.93% of the total effect. The total mediating effect was 55.58%. As for the objective sleep disturbance, the wake after sleep onset can indirectly impact subjective well-being through loneliness (B=0.005, 95% CI=0.001, 0.010), depression (B=-0.005, 95% CI=-0.011, -0.001), and both (B=0.002, 95% CI=0.001, 0.004); the number of awakenings can indirectly impact subjective well-being through loneliness (B=0.041, 95% CI= 0.012, 0.085), depression (B=-0.034, 95% CI=-0.076, -0.002), and both (B=0.018, 95% CI=0.005, 0.036); the average activity during sleep can also indirectly impact subjective well- being through loneliness (B=0.137, 95% CI=0.034, 0.275), depression (B=-0.128, 95% CI=- 0.282, -0.010), and both (B=0.055, 95% CI=0.011, 0.118).Conclusion:These findings provided new insights into possible avenues for improving subjective well- being among older people through sleep-based interventions with a multi-faceted approach to mental health.

Relationship between Physical Activity, Handgrip Strength, Depressive Symptoms, and Cognitive Impairment in Korean older adults

AbstractBackgroundPhysical activity, muscle strength, depressive symptoms, and cognitive function are intertwined in later life. This study aimed to investigate the association physical activity (PA), relative handgrip strength (RHGS), depressive symptoms, and cognitive impairment in Korean older adults.MethodThis study consisting of 512 community‐dwelling Korean older adults (417 female, 95 male) aged 65 years and older (74.8±5.4 years) in S‐city, Gyeonggi‐do. PA and handgrip strength were assessed with the Global Physical Activity Questionnaire and using a dynamometer (GRIP‐D; Takei Ltd, Niigata, Japan). Depressive symptoms were evaluated using the Korean form of the Center for Epidemiologic Studies Depression (CES‐D) Scale. Cognitive impairment was assessed with the Mini‐Mental State Examination for Dementia Screening (MMSE‐DS) of Korean version. The PROCESS V3.4 macro for SPSS based on the bootstrap method was used to determine the mediating effects of PA and RHGS on the relationship between depressive symptoms and cognitive impairment.ResultMultiple logistic regression showed that insufficient PA was associated with high odds of a cognitive impairment ((OR = 2.972, 95%CI = 1.749‐5.052, p = .002) compared with sufficient PA (OR = 1). Weak RHGS (OR = 3.540, 95%CI = 2.156‐5.814, p&lt;.001) was associated with high odds of the cognitive impairment compared with normal RHGS (OR = 1). Depressive symptoms (OR = 2.676, 95%CI = 1.594‐4.492, p&lt;.001) were associated with higher odds of the cognitive impairment compared with normal depression status (OR = 1). Particularly, depressive symptoms were found to have both direct and indirect effects on cognitive impairment. As predicted, PA and RHGS partially mediated the relationship between depressive symptoms and cognitive impairment (PA: B = –0.017, 95%CI = –0.028 ‐ –0.009, p&lt;.001; RHGS: B = –0.005, 95%CI = –0.007 ‐ –0.003, p&lt;.001). In addition, serial mediation analysis indicates that the association between depressive symptoms and cognitive impairment was partially mediated by PA and RHGS in a sequential manner (B = –0.004, 95%CI = –0.006 ‐ –0.002, p&lt;.001).ConclusionAccording to the results of the serial multiple mediation model, the elderly should be encouraged to continue their physical activity in daily life, which not only improves and maintaining muscular strength but also reduces the negative impact of depressive symptoms on cognitive impairment.

Leisure crafting and work engagement among Chinese ICU nurses: The multiple mediation effect of recovery experience and humanistic care ability.

Based on the conservation of resources theory, this study explored the intermediary role of intensive care unit (ICU) nurses' recovery experience and humanistic care ability between leisure crafting and work engagement. As the ICU is an important life-saving department, the level of work engagement of nurses directly affect the quality of life and health outcomes of patients. Actively seeking countermeasures to improve the work engagement level of ICU nurses is of great significance to enhancing the nursing quality of the ICU. According to the theory of resource conservation, the resources owned by individuals are limited and must be replenished promptly and effectively to maintain relatively stable physical, mental, and working states. Therefore, determining ways for ICU nurses to supplement the consumed resources effectively and efficiently in a limited time to maintain a high level of work engagement is the main concern of this study. In this cross-sectional study from January 2023 to March 2023, 478 ICU nurses were recruited by convenience sampling. The survey tools included the Leisure Crafting Scale, the Utrecht Work Engagement Scale-9, the Caring Ability Inventory, and the Recovery Experience Questionnaire. Descriptive data and Pearson correlation coefficients were analyzed via SPSS 26.0 (IBM Corp.). PROCESS v4.0 (by Andrew F. Hayes) Macro Model 6 was applied to analyze the serial multiple mediator models. We used the STROBE checklist to report the results. First, the results showed that leisure crafting, humanistic care ability, and recovery experience were positively correlated with work engagement. Second, recovery experience and humanistic care ability played a partially mediating role between leisure crafting and work engagement, respectively. Third, recovery experience and humanistic care ability also had a serial mediation effect between leisure crafting and work engagement. The findings of the study indicated that improving nurses' active control of leisure time may have particularly positive effects on ICU nurses' work engagement through increasing recovery experience and humanistic care ability. Administrators can formulate intervention measures to improve the leisure crafting level of ICU nurses, promote work-life balance, which enhances recovery and supports engagement with patient-focused humanistic care, and have a positive impact on the work engagement of ICU nurses.

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model

BackgroundAdolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms.MethodsWe analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes’ procedures (2008).ResultsImmature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters.ConclusionsMaladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.