Dan Zhang

Bio: Dan Zhang is an academic researcher from Shandong University. The author has contributed to research in topics: Social support & Loneliness. The author has an hindex of 8, co-authored 16 publications receiving 190 citations.

Loneliness and depression symptoms among the elderly in nursing homes: A moderated mediation model of resilience and social support

Abstract: Loneliness has been identified as a risk factor for depressive symptoms. Resilience and social support have been regarded as underlying protective factors. Little is known about the complex relations among these factors in the nursing home elderly. This study aimed to assess the prevalence of depressive symptoms, explore whether resilience mediated the association between loneliness and depressive symptoms, and investigate whether social support moderated the indirect or direct effect of mediation model. A total of 323 nursing home elderly were recruited in Jinan City, China. Loneliness, resilience, social support and depressive symptoms were measured. Results shown the association between loneliness and depressive symptoms was partially mediated by resilience. Besides, the indirect effect of the mediation model was moderated by social support. When the level of social support was higher, the indirect effect of loneliness on depressive symptoms through resilience was weaker. The incidence of depressive symptoms among the nursing home elderly could not be neglected. The findings suggest that interventions, such as improving resilience and social support, may help break the link between loneliness and depressive symptoms among the elderly in nursing homes.

Association between social support and health-related quality of life among Chinese rural elders in nursing homes: the mediating role of resilience

Abstract: This study aims to confirm the relationship between social support and health-related quality of life (HRQOL) among rural Chinese elders in nursing homes, and to examine the mediating role of resilience in the impact of social support on HRQOL. A cross-sectional survey of 205 elders aged 60 and above was conducted in five rural public nursing homes. Sociodemographic characteristics, the SF-36 questionnaire, and information about social support and resilience were collected. The researchers administered the questionnaires to the participants in a face-to-face setting. Descriptive analysis and a correlation matrix were used to indicate characteristics of the participants and bivariate correlations, respectively. The mediation analyses, composed of regression analysis and PROCESS analysis, were preformed to test both direct and indirect effects of social support on HRQOL, namely the mediating role of resilience. Social support was positively related to HRQOL (β = 0.303, p < 0.001) among Chinese rural elders in nursing homes. The mediating role of resilience in the relationship between social support and HRQOL was confirmed (a*b bootstrapped 95% confidence interval = [0.098, 0.257]), which revealed that social support had an indirect effect on HRQOL through resilience. Resilience partially mediates the relationship between social support and HRQOL. The mediation model provides a better understanding of how social support and resilience work together to affect HRQOL, and it could guide the interventions in health care for promoting HRQOL among Chinese rural elders in nursing homes.

The moderating effect of social support on the relationship between physical health and suicidal thoughts among Chinese rural elderly: A nursing home sample

Abstract: Suicide rate is relatively high among Chinese rural elderly. While there has been some exciting work on reporting and preventing suicide among community-dwelling elderly, only a few published studies have addressed the issues of rural nursing homes in China. This study aimed to investigate the relationship among perceived social support, physical health, and suicidal thoughts of the elderly living in Chinese rural nursing homes. It also examined the moderating effects of social support on the path from physical health to suicidal thoughts of the rural institutional elderly in China. This study investigated 205 participants aged 60 years and above in Chinese rural nursing homes. Participants' suicidal thoughts, perceived social support, and physical health were assessed. This study conducted descriptive analysis, Student's t-test, and Pearson's chi-square test to test how physical health and social support predicted suicidal thoughts, as well as the moderating effects of family's, friends', and others' social support on physical health and suicidal thoughts. Both physical health and perceived social support were significantly related to suicidal thoughts. Perceived social support from family, friends, and significant others moderated the relationship between physical health and suicidal thoughts. Findings of this study suggested that increasing social support and improving physical health would be effective in both suicide prevention and intervention for the residents in Chinese rural nursing homes.

Gastric cancer risk in patients with premalignant gastric lesions

Abstract: BACKGROUND & AIMS A cascade of precursor lesions (eg, atrophic gastritis, intestinal metaplasia, and dysplasia) precedes most gastric adenocarcinomas. Quantification of gastric cancer risk in patients with premalignant gastric lesions is unclear, however. Consequently, endoscopic surveillance is controversial, especially in Western populations. METHODS To analyze current surveillance practice and gastric cancer risk in patients with premalignant gastric lesions, all patients with a first diagnosis between 1991 and 2004 were identified in the Dutch nationwide histopathology registry (PALGA); follow-up data were evaluated until December 2005. RESULTS In total, 22,365 (24%) patients were diagnosed with atrophic gastritis, 61,707 (67%) with intestinal metaplasia, 7616 (8%) with mild-to-moderate dysplasia, and 562 (0.6%) with severe dysplasia. Patients with a diagnosis of atrophic gastritis, intestinal metaplasia, or mild-to-moderate dysplasia received re-evaluation in 26%, 28%, and 38% of cases, respectively, compared with 61% after a diagnosis of severe dysplasia (P < .001). The annual incidence of gastric cancer was 0.1% for patients with atrophic gastritis, 0.25% for intestinal metaplasia, 0.6% for mild-to-moderate dysplasia, and 6% for severe dysplasia within 5 years after diagnosis. Risk factors for gastric cancer development were increasing severity of premalignant gastric lesions at initial diagnosis (eg, severe dysplasia, hazard ratio 40.14, 95% confidence interval 32.2-50.1), increased age (eg, 75-84 years, hazard ratio 3.75, 95% confidence interval 2.8-5.1), and male gender (hazard ratio 1.50, 95% CI 1.3-1.7). CONCLUSIONS Patients with premalignant gastric lesions are at considerable risk of gastric cancer. As current surveillance of these patients is inconsistent with their cancer risk, development of guidelines is indicated.

Social support and mental health among health care workers during Coronavirus Disease 2019 outbreak: A moderated mediation model.

Abstract: Purposes During the outbreak of Coronavirus Disease 2019 (COVID-19) all over the world, the mental health conditions of health care workers are of great importance to ensure the efficiency of rescue operations. The current study examined the effect of social support on mental health of health care workers and its underlying mechanisms regarding the mediating role of resilience and moderating role of age during the epidemic. Methods Social Support Rating Scale (SSRS), Connor-Davidson Resilience scale (CD-RISC) and Symptom Checklist 90 (SCL-90) were administrated among 1472 health care workers from Jiangsu Province, China during the peak period of COVID-19 outbreak. Structural equation modeling (SEM) was used to examine the mediation effect of resilience on the relation between social support and mental health, whereas moderated mediation analysis was performed by Hayes PROCESS macro. Results The findings showed that resilience could partially mediate the effect of social support on mental health among health care workers. Age group moderated the indirect relationship between social support and mental health via resilience. Specifically, compared with younger health care workers, the association between resilience and mental health would be attenuated in the middle-aged workers. Conclusions The results add knowledge to previous literature by uncovering the underlying mechanisms between social support and mental health. The present study has profound implications for mental health services for health care workers during the peak period of COVID-19.

Prevalence of depression and anxiety and correlations between depression, anxiety, family functioning, social support and coping styles among Chinese medical students.

Abstract: Medical students experience depression and anxiety at a higher rate than the general population or students from other specialties. While there is a growing literature on the high prevalence of depression and anxiety symptoms and about potential risk factors to the prevalence of depression and anxiety symptoms among medical students, there is a paucity of evidence focused on the prevalence of depression and anxiety symptoms and associations with family function, social support and coping styles in Chinese vocational medicine students. This study aims to investigate the prevalence of depression and anxiety symptoms among Chinese medical students and assess the correlation between depression/anxiety symptoms and family function, social support and coping styles. A sample of 2057 medical students from Chongqing Medical and Pharmaceutical College in China was investigated with a self-report questionnaire, which included demographic information, Zung self-rating depression scale, Zung Self-Rating Anxiety Scale, Family APGAR Index, Social Support Rating Scale and Trait Coping Style Questionnaire. The prevalence of depression and anxiety symptoms among the medical students was 57.5 and 30.8%, respectively. Older students(≥20 years) experienced higher levels of depression and anxiety. More depression and anxiety symptoms were exhibited among students with big financial burden, big study-induced stress and poor sleep quality. Students with large employment pressure showed more anxiety symptoms. Students who live alone or had bad relationship with their lovers or classmates or friends showed higher depression and anxiety scores. Depression and anxiety symptoms had highly significant correlations with family functioning, social support and coping style. Academic staffs should take measures to reduce depression and anxiety among medical students and to provide educational counseling and psychological support for students to cope with these problems.

Being left-behind, mental disorder, and elderly suicide in rural China: a case-control psychological autopsy study.

Abstract: Background Suicide rate among rural elderly is the highest among all age groups in China, yet little is known about the suicide risks in this rapidly growing vulnerable population. Methods This matched case-control psychological autopsy study was conducted during June 2014 to September 2015. Consecutive samples of suicides aged 60 or above were identified in three provinces (Shandong, Hunan, and Guangxi) in China. Living comparisons were 1:1 matched with the suicides in age (±3 years old), gender, and living location. Risk factors included demographic characteristics, being left-behind, mental disorder, depressive symptoms, stressful life events, and social support. Results A total of 242 suicides and 242 comparisons were enrolled: 135 (55.8%) were male, mean (s.d.) age was 74 (8) years. The most frequently used suicide means were pesticides (125, 51.7%) and hanging (95, 39.3%). Independent risks of suicide included unstable marital status [odds ratio (OR) 4.19, 95% confidence interval (CI) 1.61-10.92], unemployed (compared with employed, OR 4.43, 95% CI 1.09-17.95), depressive symptoms (OR 1.34, 95% CI 1.21-1.48), and mental disorder (OR 6.28, 95% CI 1.75-22.54). Structural equation model indicated that the association between being left-behind and suicide was mediated by mental disorder, depressive symptoms, stressful life events, and social support. Conclusions Unstable marital status, unemployed, depressive symptoms, and mental disorder are independent risk factors for suicide in rural elderly. Being left-behind can elevate the suicide risk through increasing life stresses, depressive symptoms, mental disorder, and decreasing social support. Elderly suicide may be prevented by restricting pesticides, training rural physicians, treating mental disorders, mitigating life stress, and enhancing social connection.