Lawyer is one of the most stressful jobs, but lawyers' occupational stress is rather under-researched in China. Previous studies have shown that occupational stress and mental health are related to self-regulatory fatigue and health literacy in lawyers, but there is a lack of research on their interaction mechanism.

To explore the association of occupational stress and mental health in lawyers and the internal mechanism of action of self-regulatory fatigue and health literacy between them.

A convenience sample of 660 lawyers from 7 leading Chinese law firms were surveyed from May to June 2022 using questionnaires including a self-compiled Demographic Questionnaire, the Lawyers' Occupational Stress Scale, Symptom Checklist-90 (SCL-90), Self-regulatory Fatigue Scale (SRF-S) and National Residents' Health Literacy Surveillance Rapid Assessment Questionnaire (HLSRAQ). Stepwise regression was used to explore the mediating effect of self-regulatory fatigue between occupational stress and mental health, and bootstrap method was used to test the mediating effect of self-regulatory fatigue. Model 5 in PROCESS 3.4 was used to explore the moderated mediating effect of health literacy between occupational stress and mental health. Bootstrap method was used to test the moderating mediating effect of health literacy, and further simple slope test was used to test the moderating effect, and the effects of occupational stress on the mental health of lawyers with different health literacy levels were analyzed.

Six hundred and fifty-six cases (99.39%) who effectively responded to the survey were included for final analysis. The average scores of occupational stress, SCL-90, SRF-S and HLSRAQ were (106.9±34.8), 39.0 (15.0, 84.0), (39.4±10.0) and (13.9±3.7), respectively. Stepwise regression analysis showed that occupational stress could positively predict mental health (β=0.36, t=13.40, P<0.01). Self-regulatory fatigue also had a significant positive predictive effect on mental health (β=0.55, t=20.32, P<0.01). Bootstrap analysis showed that 95%CI of the total effect, indirect effect and direct effect of occupational stress on mental health did not include 0 (P<0.01). The moderated mediating effect analysis showed that the product of occupational stress and health literacy had a significant predictive effect on mental health (β=-0.02, t=-2.00, P<0.05). The Bootstrap method showed that the 95%CI of the indirect effect of lawyer occupational stress on mental health did not include 0 (P<0.01). Simple slope test showed that the association between them was found to be statistically significant regardless of being moderated by different levels of health literacy (P<0.01), and the predictive effect of occupational stress showed a downward trend with the improvement of health literacy level (P<0.01) .

Occupational stress influenced mental health in lawyers medicated by self-regulatory fatigue with health literacy as a moderator.

Population aging in China is deepening, and the widowed rate of the elderly is also on the rise. Widower is one of the most stressful events in the human life course, and its impact also affects the mental health and economic level of widower. In many studies on the impact of widower on the mental health of the elderly at home and abroad, the proxy variables used are traditional indicators, such as subjective well-being, loneliness, depression level, and some studies do not consider the endogeneity between widowhood and health status.

To evaluate the impact of widowhood on the mental health of older adults in China, and provide a basis and reference for formulating the mental health intervention program for older adults in China.

Using the 2018 China Health and Retirement Longitudinal Study (CHARLS) as the data source, 4 694 older adults aged 60 years and above were selected as study subjects and divided into the widowed group (n=644) and non-widowed group (n=4 050) . The mental frailty index was used as a perspective for evaluating the mental health status of older adults. Using propensity score matching (PSM) model, the propensity score was calculated by using Logit regression analysis, the robustness was tested by using standard deviation variation, common support bar graph and nuclear density distribution, the impact of widowhood on the physical and mental health of older adults was analyzed by using K-nearest neighbor matching, radius matching and kernel matching, and the heterogeneity was tested based on gender, household type and age.

Compared to the non-widowed group, the mental health of older adults in the widowed group was impaired (P<0.05) . Logit regression model results showed that female (OR=2.274, 95%CI=1.917-2.698) , age (OR=0.975, 95%CI=0.972-0.978) , secondary education level (OR=0.618, 95%CI=0.505-0.756) and monthly family consumption (OR=1.000, 95%CI=1.000-1.000) were correlated with widowhood (P<0.05) . The robustness test results after matching were better. The results of PSM showed that widowhood significantly increased the mental frailty index level (ATT ranged from 0.054 to 0.055, P<0.05) . The results of heterogeneity test showed that there were significant differences between urban and rural areas and among different age groups in the impact of widowhood on the mental frailty index of older adults, but there was no significant difference between male and female in the impact of widowhood on the mental frailty index of older adults. Among them, the impact of widowhood on the older adults in rural areas was more significant (ATT ranged from 0.072 to 0.075, P<0.05) , but the impact on older adults in urban areas was not significant; the impact on older adults in the low age group and high age group was more significant (ATT ranged from 0.061 to 0.081, P<0.05; 0.067-0.078, P<0.05) , but the impact on older adults in the middle age group was not significant.

Widowhood has a negative impact on the mental health of the older adults. The impact varies among different older adults. The widowed older adults in rural areas, just entering old age and in their later years need attention and psychosocial support.

Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHCs) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization's mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China's emergent mental health system.

A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either "somewhat agree/definitely agree", or "definitely disagree/somewhat disagree" on a five-point scale for agreement.

79% of statements received consensus with a mean score of 4.26 (i.e. "somewhat agree"). Agreed adaptations for mhGAP-IG.v2 included: an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians' roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide.

An adapted mhGAP-IG.v2 for depression recognises China's cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries.

General practitioners (GPs) mainly provide basic medical and health services. The construction of GPs human resources is closely related to the development of primary care system.

To investigate the current status of psychological capital (PsyCap) , professional identity, and intention to stay of GPs in China and explore the relationship among the above three.

A total of 4 632 GPs were selected for electronic questionnaire investigation in the eastern, central, and western China from March to May in 2021 by using a multi-stage stratified random sampling. The questionnaire mainly included basic information, PsyCap, professional identity, and intention to stay. Pearson correlation analysis, hierarchical multiple regression analysis and structural equation model were used to explore the relationship among professional identity, PsyCap, and intention to stay.

A total of 4 376 GPs were included with the effective response rate of 94.47%. The total scores of PsyCap, professional identity, and intention to stay were (102.89±16.94) , (33.93±8.95) , and (21.69±4.04) , respectively. Pearson correlation analysis showed that there were significant positive correlations between PsyCap and professional identity, professional identity and intention to stay, PsyCap and intention to stay (r=0.402, 0.459, 0.236, respectively, P<0.001) . The results of hierarchical multiple regression analysis showed positive predictive effects of PsyCap and professional identity on intention to stay (b=0.079 and 0.361, respectively, P<0.001) , and professional identity had a mediating effect between PsyCap and intention to stay. The structural equation model showed that PsyCap and professional identity had a positive predictive effect on intention to stay (b=0.032, P<0.05; b=0.446, P<0.001) , and professional identity had a part mediating effect between PsyCap and intention to stay.

The intention to stay among GPs in China is at a moderate level. There are positive correlations among PsyCap, professional identity, and intention to stay among GPs in China. PsyCap can affect intention to stay through professional identity. Improving the PsyCap and professional identity of GPs is conducive to improving their intention to stay.

Cognitive function is dynamic in post-stroke patients, however, there are limited studies on cognitive recovery after stroke. The definition of cognitive reverters and neuropsychological characteristics according to various definitions have not yet been investigated.

To investigate the neuropsychological characteristics of cognitive reverters after stroke based on the traditional definition and new definition according to Montreal Cognitive Assessment (MoCA) with a double threshold.

A total of 163 patients hospitalized for first onset acute ischemic stroke were recruited from the Department of Neurology of the Second Hospital of Hebei Medical University from December 2020 to February 2022 as the study subjects. All patients were assessed for cognitive function in the acute period of ischemic stroke using the MoCA at baseline. Cognitive function was assessed again at the 6-month post-stroke follow-up with the detailed neuropsychological tests refined at the same time, including the digit span task (DST) , Stroop color and word test (SCWT) , Chinese version of Boston naming test (BNT) , verbal fluency test (VFT) , clock drawing test (CDT) , and auditory verbal learning test (AVLT) . The enrolled patients were divided into the M1 group (MoCA scores <21) , M2 group (21 ≤MoCA scores≤25) and M3 group (MoCA scores≥26) according to the MoCA with adouble threshold. While the patients were also divided into the reverters 1 (R1) group, nonreverters 1 (NR1) group, R2 group and NR2 group according to the two definitions of reverters.

Patients were followed up after 6 months, of which 28 were lost to follow-up and 135 were finally included in the study. The average MoCA score in the acute period of stroke was (20.1±5.1) in 135 patients. There were 40 cases in the M1 group, 61 cases in the M2 group and 34 cases in the M3 group. The scores of the MoCA, forward DST, reverse DST, total DST, Chinese version of BNT, CDT, numbers of VFT-animal, VFT-fruit and VFT-vegetable, AVLT-immediate scores, AVLT-short delay scores, AVLT-long delay scores and AVLT-recognition scores in the M2 and M3 groups 6 months after stroke were higher than the M1 group (P<0.05) , Stroop C time consuming and numbers of Stroop C errors lower than M1 group (P<0.05) . The scores of the MoCA, reverse DST, total DST, AVLT-short delay score and AVLT-long delay score in the M3 group than the M2 group (P<0.05) . 120 patients of the 135 patients with MoCA scores<26 in the acute period of ischemic stroke were selected as the cognitive reveters study subjects. Compared with the MoCA scores during the acute period of ischemic stroke, 73 patients improved ≥2 points during the follow-up period in the R1 group and 47 patients improved <2 points in the NR1 group, with a recovery rate of 60.8% (73/120) . Patients in the R1 group had lower MoCA scores in the acute period of ischemic stroke than the NR1 group, and higher MoCA scores in the follow-up period than the NR1 group (P< 0.05) . Compared with the double threshold classification of MoCA in the acute period of stroke, 50 cases had increased scores and crossed over to the R2 group and 70 cases did not cross over to the NR2 group at follow-up, with a recovery rate of 41.7% (50/120) . Patients in the R2 group had higher MoCA score in the acute period of stroke, MoCA scores in the follold-up period, reverse DST scores, total DST scores, Chinese version of BNT scores, VFT-animal, VFT-vegetable number, CDT scores, AVLT-immediate scores, AVLT-short delay scores, AVLT-long delay scores, and AVLT-recognition scores during follow-up were higher than the NR2 group, and the Stroop C time consuming was lower than the NR2 group (P<0.05) .

There are varying degrees of impairment in attention, visuospatial function and delayed recall in post-stroke patients. There is no significant difference in neuropsychological characteristics between reverters and nonreverters. However, the scores of reverters are higher based on the definition using double threshold for MoCA scores, which is more relevant for clinical use.

Among people with various mental illnesses, those with schizophrenia have the highest incidence of aggressive behavior, which not only disturbs the medical environment, but also poses a great threat to family stability and social harmony. Previous regression analysis studies have shown that childhood trauma, self-esteem and resilience are influencing factors of aggressive behavior in schizophrenia patients, but few studies have explored the internal relationship between these four variables.

To explore the relationship between childhood trauma, self-esteem, resilience and aggressive behavior in schizophrenic patients using a self-constructed chain mediation model, and to clarify its internal mechanism.

A convenience sample of stable schizophrenia inpatients were selected from Daqing Third Hospital and Chifeng Anding Hospital from March 2021 to July 2022. A survey was conducted with them using a questionnaire consisting of general information questionnaire, Positive and Negative Symptom Scale (PANSS) , Childhood Trauma Questionnaire-Short Form (CTQ-SF) , Connor-Davidson Resilience Scale (CD-RISC) , Self-esteem Scale (SES) , and Aggressive Questionnaire (AQ) . Pearson correlation analysis was used to explore the correlation of AQ score with CTQ-SF, CD-RISC and SES scores. Multiple linear regression analysis was used to explore the influencing factors of aggressive behavior. AMOS 24.0 was used to construct the chain mediation model. The mediation effect of the chain mediation model was tested using Bootstrap method.

Three hundred and ten cases attended the survey, and 300 of them (96.8%) who responded effectively were finally included for analysis. The average scores of PANSS, CTQ-SF, SES, CD-RISC and AQ were (18.4±3.7) , (49.7±13.5) , (26.9±6.9) , (55.2±15.5) and (84.3±19.8) , respectively. Multiple linear regression analysis showed that childhood trauma〔B=0.551, 95%CI (0.421, 0.681) , P<0.001〕, self-esteem〔B=-0.661, 95%CI (-0.908, -0.413) , P<0.001〕and resilience〔B=-0.448, 95%CI (-0.561, -0.335) , P<0.001〕 were influencing factors of aggressive behavior. Pearson correlation analysis revealed that CTQ-SF scores were positively correlated with AQ scores (r=0.695, P<0.01) and negatively correlated with SES scores and CTQ-SF scores (r=-0.524, P<0.01; r=-0.565, P<0.01) ; SES scores were negatively correlated with AQ scores (r=-0.607, P<0.01) and positively correlated with CD-RISC scores (r= 0.522, P<0.01) ; the CD-RISC score was negatively correlated with the AQ scores (r=-0.681, P<0.01) . The chain mediation model test results showed that the goodness-of-fit of the model was good. Bootstrap test showed that the 95%CI of each mediation path did not include 0, and the mediation effect was significant. The overall effect of childhood trauma on aggressive behavior was significant〔β=0.810, 95%CI (0.743, 0.871) , P<0.001〕. The indirect effect of childhood trauma on aggressive behavior, that is, acting through the mediators of self-esteem and resilience, was significant〔β=0.473, 95%CI (0.362, 0.598) , P<0.001〕. The direct effect of childhood trauma on aggressive behavior was significant〔β=0.377, 95%CI (0.179, 0.485) , P<0.001〕.

Self-esteem and resilience play a chain mediating role between childhood trauma and aggressive behavior in patients with schizophrenia. In the future, a risk prediction model of aggressive behavior in schizophrenia patients can be constructed to assess the risk of aggressive behavior, which is contributive to early identification and management of those at risk of aggression, thereby reducing or preventing the occurrence of aggressive behavior.

Psychological capital (PsyCap) has a significant impact on individual attitude, behavior, and performance. Currently, studies on the level and associated factors of PsyCap among general practitioners (GPs) are limited.

To investigate the level of PsyCap and its associated factors among community GPs in China, providing evidence for human resource management in primary health care.

To conduct the questionnaire survey, 40 community health service institutions from their list of community health service institutions were randomly chosen, 4 632 GPs (40% of whom were on duty) were randomly selected from each community health service institution's duty roster on the day of the survey, and all five provinces (autonomous, municipalities) regions in the east, central, and west China were chosen by use of multi-stage stratified random sampling between March and May 2021. The questionnaire consisted of 3 sections: general information, workplace violence, and PsyCap, and statistical analysis was performed using general descriptive analysis, rank sum test, and generalized linear regression.

A total of 4 376 community GPs were finally included as eligible respondents. The total median score and average total score of PsyCap were 104 (20) and 4.33 (0.83), higher than the theoretical median (3.50 points). The region〔central China (b=1.355) 〕, age〔40~49 (b=2.609), ≥50 (b=4.035) 〕, marital status〔married (b=1.801) 〕, practice setting〔rural (b=2.088) 〕, holding an administrative post〔no (b=-1.734) 〕, weekly working hours〔>50 (b=2.743) 〕, average number of daily consultations〔20~39 (b=2.177) 〕, workload〔moderate (b=6.900), high (b=8.146) 〕, occupational stress〔moderate (b=-6.936), high (b=-10.309) 〕, occupational development opportunities〔general (b=2.073), more (b=7.747) 〕, and the frequency of workplace violence〔low (b=-3.132), medium (b=-3.990), high (b=-7.033) 〕were factors associated with the level of PsyCap among GPs significantly (P<0.05) .

The PsyCap of community GPs in China is at an upper medium level, and the associated factors are complicated. To improve the level of PsyCap among GPs, attention should be paid to their mental health status, and provide them with interventions targeting PsyCap-related factors to lessen the GPs' stress.

Worldwide, breast cancer has become the most common malignancy, and many breast cancer survivors struggle with psychological problems in treatment and recovery. The efficacy of mindfulness-based stress reduction (MBSR) in the psychological care of breast cancer patients has been confirmed in many systematic reviews (SRs) . However, due to inconsistent outcome measures used in various SRs, the review results cannot be directly applied to clinical practice.

To perform an overview of the SRs of the efficacy of MBSR in breast cancer patients, providing a reference for the making of psychological care interventions for these patients.

PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, JBI, CNKI, Wanfang Data, and CBM were searched from inception to July 2022 for SRs of patients with breast cancer treated with MBSR. Literature screening and data extraction were performed by two researchers independently. Methodological quality was assessed using the AMSTAR 2. The standardization of reporting quality was assessed using the PRISMA checklist. Quality of evidence and strength of recommendations were assessed using the GRADE approach. The confidence of evidence from qualitative SRs was assessed using the CERQual.

Fourteen SRs were included. The methodological quality of included SRs was generally low, with only one being of high quality and two fatally missing key items. The defects in reporting quality were mainly in study protocol registration, risk of bias assessment and funding sources. Fifteen outcomes and 73 evidence bodies (0, 31, 28 and 6 were classified as high, moderate, low, and very low quality, respectively, by the GRADE approach, and the other 8 were classified as low quality by the CERQual approach) were identified in the SRs in total. MBSR could relieve anxiety, depression, fatigue, and stress in breast cancer patients to varying degrees, whose efficacy has proven to be significant in a short-term, but is uncertain in a long-term.

Generally, SRs on MBSR improving psychological condition in breast cancer patients contain unsatisfactory quality of evidence, whose methodological quality and standardization level of reporting quality still need to be improved further. Moreover, the shorter-term effect of MBSR has been confirmed, but its long-term effect is uncertain, and requires to be evaluated by more high-quality, large-sample clinical studies.

Social environment and psychological factors have a notable impact on professional identity. Currently, there are no available studies on relationships between perception of workplace violence (WPV) by patients, psychological capital (PsyCap) , and professional identity among general practitioners (GPs) in China.

To investigate the relationships between perceived WPV by patients, PsyCap, and professional identity among GPs in China.

A self-administered electronic questionnaire survey was conducted with 4 632 GPs selected by use of stratified multistage random sampling from eastern, central, and western China between March and May 2021. The survey was used for collecting data mainly consisting of GPs' basic demographics, perceived WPV by patients, PsyCap, and professional identity. Spearman's correlation was used to analyze relationships between perceived WPV by patients, PsyCap, and professional identity. Hierarchical multiple regression analysis was used to analyze the effects of perceived WPV by patients and PsyCap on professional identity.

Altogether, 94.47% of the GPs (4 376/4 632) who handed in responsive questionnaires were included for analysis. Six hundred and twenty-four (14.26%) GPs had experienced WPV by patients in the past year. The average total scores of PsyCap and professional identity were (102.89±16.94) and (33.93±8.95) , respectively. The increase in the score of perceived WPV by patients was correlated with a decrease in the scores of PsyCap and its dimensions, and in the score of professional identity (P<0.01) . The increase in the scores of PsyCap and its dimensions was correlated with increased score of professional identity (P<0.01) . Hierarchical multiple regression analysis showed that the frequency of WPV by patients had a negative predictive effect on professional identity (low frequency, b=-0.071; intermediate frequency, b=-0.054; high frequency, b=-0.042; P<0.001) . PsyCap had a positively predicted effect on professional identity (b=0.330, P<0.001) , and it played a partial mediating role between perceived WPV by patients and professional identity.

The GPs' perceived WPV by patients, PsyCap, and professional identity are interrelated, and PsyCap plays a partial mediating role between perceived WPV by patients and professional identity. Great importance should be attached to the professional work environment, occupational status, and mental health among Chinese GPs.

Bariatric surgery is the effective treatment for obesity, however, the effect of surgery on patients' psychological status is still unclear.

To investigate the treatment effects of bariatric surgery on patients' psychological status one year after the surgery.

This is a retrospective cross-sectional study. This study selected 172 patients who underwent bariatric surgery in the department of general surgery, First Affiliated Hospital of Nanjing Medical University during June 2019 to June 2020, and collected their clinical data. The indicators of the treatment effects of bariatric surgery include body composition indicators〔Weight, Body mass index (BMI) , Percentage of excess weight loss (EWL%) , Body muscle mass (BM) , Body fat mass (BF) , Visceral fat (VSF) , metabolism-related biochemical indexes〔Alanine aminotransferase (ALT) , Aspartate aminotransferase (AST) , Total protein (TP) , Albumin (ALB) 〕, preoperative comorbidities, relief of comorbidities after surgery, postoperative complications, postoperative complaints, surgery methods; Indicators of the postoperative psychological status include quality of life, perceived stress, general well-being and satisfaction degree of surgery. This study used the12-item Short Form Survey (SF-12) , Chinese version of the Perceived Stress Scale (CPSS) , General Well-being Schedule (GWS) , Questionnaire of Bariatric Surgery Patient' Satisfaction Survey to investigate the psychological status. This study used the Pearson correlation analysis and Spearman rank correlation analysis to explore the correlation between body composition indicators and metabolic-related biochemical indexes and postoperative psychological status, used the multivariate linear regression analysis to explore the factors that affect postoperative psychological status.

One year after surgery, EWL% was (82.7±31.7) %, and BMI decreased by (10.3±4.3) kg/m². 96 patients (55.8%) had metabolic-related comorbidities such as type 2 diabetes mellitus, hypertension, fatty liver before surgery, 48 patients (27.9%) achieved complete remission, 30 patients (17.4%) achieved partial remission, and 18 patients (10.5%) had no remission after surgery. Patients'weight, BMI, BM, BF, VSF, ALT, AST were lower than those before surgery, the TP and ALB were higher than those before surgery (P<0.05) .The correlation analysis showed that patients' MCS scores were negatively correlated with ΔALT (r_s=-0.160, P=0.036) ; the CPSS scores were negatively correlated with EWL% (r=-0.181, P=0.017) and ΔBM% (r_s=-0.174, P=0.022) but positively correlated with ΔALT (r_s=-0.236, P=0.002) ; the GWS scores were negatively correlated with ΔALT (r_s=-0.228, P=0.003) and ΔAST (r_s=-0.216, P=0.004) ; the satisfaction of surgery were negatively correlated with ΔBMI (r=-0.171, P=0.025) , ΔBF% (r=-0.174, P=0.022) and ΔVSF (r=-0.154, P=0.043) but positively correlated with EWL% (r=0.284, P<0.001) . The multivariate linear regression analysis showed that postoperative stomachache (β=-0.239, P=0.002) and postoperative fatigue (β=-0.169, P=0.025) were factors that affect PCS scores; ΔALT (β=-0.181, P=0.017) and postoperative fatigue (β=0.171, P=0.024) were factors that affect MCS scores; EWL% (β=-0.188, P=0.010) , ΔBM% (β=-0.146, P=0.047) , ΔALT (β=0.219, P=0.003) and postoperative fatigue (β=0.169, P=0.022) were factors that affect CPSS scores; ΔALT (β=-0.254, P=0.001) and acid reflux (β=-0.251, P=0.001) were factors that affect GWS scores; ΔBMI (β=-0.245, P=0.010) , EWL% (β=0.247, P=0.003) and ΔBF% (β=-0.366, P<0.001) were factors that affect satisfaction of surgery. Among the 96 patients with preoperative comorbidities, multiple linear regression analysis showed that postoperative relief of comorbidities (β=0.411, P<0.001) and stomachache (β=-0.192, P=0.040) were factors that affect PCS scores; ΔALT (β=-0.273, P=0.006) and acid reflux (β=-0.263, P=0.008) were factors that affect MCS scores; postoperative relief of comorbidities (β=-0.220, P=0.024) , ΔALT (β=0.301, P=0.002) , stomachache (β=0.214, P=0.023) and ΔVSF (β=0.212, P=0.031) were factors that affect CPSS scores; postoperative relief of comorbidities (β=0.290, P=0.002) , ΔALT (β=-0.310, P=0.001) and stomachache (β=-0.271, P=0.004) were factors that affect GWS scores; postoperative relief of comorbidities (β=0.402, P<0.001) , ΔBF% (β=-0.452, P<0.001) and ΔBMI (β=-0.364, P<0.001) were factors that affect satisfaction of surgery.

Patients' BMI decreased significantly one year after bariatric surgery. The postoperative acid reflux, stomachache, fatigue and the increase of ΔBF% and ΔALT negatively affect patients'psychological status; the increase of EWL% and ΔBM% positively affect patients'psychological status. For patients with comorbidities, the higher the degree of postoperative comorbidity remission, the greater the positive impact on the patient's psychological status.

The prevalence of synthetic drug abuse is high. In China, synthetic drugs have become the most commonly abused drugs characterized by strong addiction and great difficulty in quitting. The addicts are easily prone to serious psychological dependence and other psychological problems, which leading to relapse after withdrawal treatment. Therefore, exploring the influencing factors of mental health status in individuals addicted to new synthetic drugs has clinical and social significance for the prevention and management of synthetic drug addicts.

To explore the associated factors of mental health status and their intercorrelations in individuals addicted to new synthetic drugs.

One hundred and ninety-six people getting addicted to new synthetic drugs with inpatient withdrawal treatment were selected from Ankang Hospital of Tianjin Municipal Public Security Bureau from January 2018 to April 2019. Sociodemographic data and drug abuse-related clinical data were collected. The Symptom Checklist-90 (SCL-90) , Eysenck Personality Questionaire-Revised, Short Scale For Chinese (EPQ-RSC) , and Simplified Coping Style Questionnaire (SCSQ) were used to investigate the mental health. Spearman rank correlation analysis was used to analyze the inercorrelations of the influencing factors of mental health. SPSS 22.0 software was used for statistical analysis, and AMOS 22.0 was used to build a model for path analysis of data.

The average total score of SCL-90 rated by the participants was (206.62±26.66) , which was higher than that rated by Chinese norm (P<0.001) . Moreover, the average score of each domain rated by the participants was also higher that rated by Chinese norm (P<0.001) . Spearman rank correlation analysis showed that the total score of SCL-90 was negatively correlated with age (r_s=-0.285, P<0.001) , and positive coping (r_s=-0.749, P<0.001) , but was positively correlated with economic income (r_s=0.210, P=0.003) , daily dose of a new synthetic drug (r_s=0.375, P<0.001) , negative coping (r_s=0.754, P<0.001) , and dimensions of personality traits 〔psychoticism (r_s=0.915) 、introversion and extroversion (r_s=0.748) 、neuroticism (r_s=0.549) 、lying (r_s=0.979) , P<0.001) 〕. Path analysis revealed that personality traits and coping styles could directly or indirectly affect the mental health status, and coping styles played a partial mediating role in the relationship of personality traits with mental health status.

The prevalence of normal mental health was low in people addicted to new synthetic drugs, which was mainly associated with personality traits and coping styles. In view of this, it is suggested to improve the mental health of these addicts by taking actions to develop positive coping styles and reduce negative coping styles according to their personality traits.

The mental health of trainees receiving the three-year standardized general practice residency program (SGPRP) has been valued recently, and psychological problems are considered to be one major type of causes of their failure to complete the full training. So understanding the mental health status and associated factors of psychological problems in these GP trainees are of important significance for the development of residency training policies and programs.

To explore the mental health status and causes of psychological problems in GP trainees of SGPRP, improving the attention of SGPRP managers and the society given to the mental health of GP trainees.

This was a mixed-method sequential explanatory study. In January 2021, by use of convenience sampling, all in-service GP trainees of SGPRP were recruited from Peking University Shenzhen Hospital to attend a self-administered survey to complete the Demographic Questionnaire compiled by our research team and the Symptom Checklist 90 (SCL-90) . The total score and domain scores of the SCL-90 were analyzed overall, then were compared among the trainees by grade. For understanding the main life events triggering emotional or psychological problems and their associations with residency training program or specialty, and GP trainees' preferred assistance as well as suggestions for the development of SGPRP, from February to June 2021, purposive and heterogeneous sampling were used to recruit GP trainees with mental health assessment to attend an in-depth, semi-structured interview using phenomenological research procedure. The interview results were recorded, and transcribed, then coded using NVivo 12, and analyzed using Colaizzi's seven-step analysis and thematic analysis.

All GPs (n=84) responded to the survey, with a 100% response rate. The mean total SCL-90 score and the mean total symptom index for 84 GP trainees were (149.61±50.55) , and (1.66±0.56) , respectively. Of them, 29 (34.5%) had a total score≥160. The prevalence of obsessive-compulsive, depression, interpersonal sensitivity, anxiety, paranoid ideation, anger-hostility, psychoticism, somatization and phobic-anxiety (prevalence of symptoms in each domain was defined as domain score≥2) was 53.6% (45/84) , 39.3% (33/84) , 34.5% (29/84) , 26.2% (22/84) , 22.6% (19/84) , 21.4% (18/84) , 19.0% (16/84) , 14.3% (12/84) , and 14.3% (12/84) , respectively. The depression domain score varied significantly across GP trainees by grade (P<0.05) . The prevalence of depression was 48.4% (15/31) in grade 2 GP trainees. In total, 21 GP trainees attended the interview, 14 (66.7%) of whom had a total SCL-90 score≥160. Four themes emerged from the analysis: impact of personal problems on psychological status; harm and benefits caused by interpersonal interactions at work; psychological stress related to the residency base; lack of confidence related to specialty choice.

The high prevalence of psychological problems in GP trainees may be closely related to personal factors and problems encountered during residency training. In view of this, psychological guidance and crisis intervention should be listed as an important part of residency training management, and efforts should be made to enhance the trainees' sense of existence and belonging as well as self-confidence, thereby helping them to successfully complete the training.