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BACKGROUND: Internet-based mental health interventions have been demonstrated to be effective in alleviating psychological distress and promoting mental well-being. However, real-world uptake and engagement of such interventions have been low. Rather than being stand-alone interventions, situating internet-based interventions under a stratified stepped care system can support users to continue with mental health practice and monitor their mental health status for timely services that are commensurate with their needs. A user-centered approach should be used in the development of such web-based platforms to understand the facilitators and barriers in user engagement to enhance platform uptake, usability, and adherence so it can support the users' continued adoption and practice of self-care for their mental health. OBJECTIVE: The aim of this study was to describe the design process taken to develop a web-based stratified stepped care mental health platform, TourHeart+, using a user-centered approach that gathers target users' perceptions on mental self-care and feedback on the platform design and incorporates them into the design. METHODS: The process involved a design workshop with the interdisciplinary development team, user interviews, and 2 usability testing sessions on the flow of registration and mental health assessment and the web-based self-help interventions of the platform. The data collected were summarized as descriptive statistics if appropriate and insights are extracted inductively. Qualitative data were extracted using a thematic coding approach. RESULTS: In the design workshop, the team generated empathy maps and point-of-view statements related to the possible mental health needs of target users. Four user personas and related processes in the mental health self-care journey were developed based on user interviews. Design considerations were derived based on the insights drawn from the personas and mental health self-care journey. Survey results from 104 users during usability testing showed that the overall experience during registration and mental health assessment was friendly, and they felt cared for, although no statistically significant differences on preference ratings were found between using a web-based questionnaire tool and through an interactive chatbot, except that chatbot format was deemed more interesting. Facilitators of and barriers to registering the platform and completing the mental health assessment were identified through user feedback during simulation with mock-ups. In the usability testing for guided self-help interventions, users expressed pain points in course adherence, and corresponding amendments were made in the flow and design of the web-based courses. CONCLUSIONS: The design process and findings presented in the study are important in developing a user-centric platform to optimize users' acceptance and usability of a web-based stratified stepped care platform with guided self-help interventions for mental well-being. Accounting for users' perceptions and needs toward mental health self-care and their experiences in the design process can enhance the usability of an evidence-based mental health platform on the web.

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The COVID-19 pandemic has a unprecedented impact on the way individuals make sense of the interconnected nature of themselves in relation to the world. This study investigated the mediating role of transcendental awareness and compassion in the association of interconnectedness with a sense of civic duty and collective action participation during COVID-19 using a longitudinal design. A total of 336 young adult participants were recruited at baseline and were asked to complete measures of interconnectedness, transcendental awareness, compassion, civic duty, and collective action participation at three time points over a 6-month period. Path analysis was used to test the hypothesized mediation model. The results showed that compassion fully mediated the positive association between interconnectedness and collective action participation and partially mediated the positive association between interconnectedness and civic duty. Transcendental awareness also partially mediated the positive association between interconnectedness and civic duty but not collective action participation. This study highlighted the potential of interconnectedness in promoting civic duty and engagement in collective action through transcendental awareness and compassion during the COVID-19 pandemic.

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Introduction: Perceived loneliness and depression are risk factors threatening mental well-being of older people. Yet, hardiness, a modifiable internal resource that supports functional resilience, may enhance the capacity of adjusting to challenges arising from age-related physical and psychosocial changes. Hence, hardiness can be a protective factor of mental health. This study examined the role of hardiness in the relationship between perceived loneliness and depressive symptoms among older people in Hong Kong.Methods: 424 Cantonese-speaking Chinese participants, aged 60 years or above, completed a self-reported questionnaire set related to perceived loneliness, hardiness, and depressive symptoms. Structural equation modeling was used to test the proposed model.Results: Results revealed that hardiness partially mediated the positive association between perceived loneliness and depressive symptoms [ß = .18, p < .001, BC 95% CI (.10, .27)] with good data-model fit [χ2(32) = 36.34, p = .27; CFI = .998; TLI = .997; RMSEA = .018; SRMR = .022].Conclusion: Older people with higher level of perceived loneliness reported less hardiness. Lower levels of hardiness, in turn, correlated with increased self-reported depressive symptoms. The potential benefits of hardiness for promoting mental health of older people was discussed.

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Relatively little is known about the emotional processes underlying the association between adult attachment styles and psychological distress. This study aims to examine the role of contentment in terms of intensity and duration in the positive associations between anxious and avoidant attachment styles and psychological distress. A sample of 284 Chinese university students completed a self-reported questionnaire on attachment styles, intensity and duration of contentment, and anxiety and depressive symptoms. Structural equation modeling revealed that duration of contentment mediated the positive associations of anxious attachment style with anxiety symptoms [ß = 0.05, p = 0.004; BC 95% CI (0.02,0.11)] and depressive symptoms [ß = 0.04, p = 0.03; BC 95% CI (0.003,0.09)], model fit: χ2(259) = 455.06, p < 0.001, CFI = 0.95, TLI = 0.94, RMSEA = 0.05, SRMR = 0.07. Participants with higher anxious attachment style were more likely to report shorter duration of contentment, which was, in turn, associated with higher anxiety and depressive symptoms. The results suggest a positive emotional pathway underlying the association between anxious attachment style and psychological distress. Implications based on the findings are discussed.

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BACKGROUND: This study investigated the associations of savoring with cancer-specific physical symptoms, psychological distress, and psychological well-being and the moderating effect of savoring in the associations between physical symptoms and psychological outcomes among cancer patients. METHODS: A total of 263 Chinese adults recently diagnosed with cancer (mean time since diagnosis = 43.72 days, SD = 38.20) were recruited and administered a questionnaire assessing cancer-specific physical symptoms, perceived capability of savoring the moment, psychological distress, and psychological well-being within six months following diagnosis. RESULTS: Structural equation modeling revealed significant associations of savoring with physical symptoms and psychological distress and well-being (ß = -0.41-0.54, p < 0.0001). Savoring significantly moderated the association between physical symptoms and depressive symptoms. Simple slope tests revealed that the association was not significant at higher levels of savoring (estimate = 0.15, z = 0.49, p = 0.62) whereas it was stronger at lower (estimate = 1.11, z = 4.81, p < 0.001) and medium (estimate = 0.63, z = 3.04, p < 0.01) levels of savoring. The effects of demographic and medical covariates were controlled for in all models. CONCLUSIONS: The findings suggest that savoring is positively associated with physical and psychological functioning among people with cancer. The link between physical symptoms and depressive symptoms could be exacerbated at lower levels of savoring. Fostering savoring beliefs and practices could be a significant psychological component of symptom management among cancer patients. Copyright © 2016 John Wiley & Sons, Ltd.

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BACKGROUND: Recovery experience including psychological detachment from caregiving and savoring positive moments in life could be complementary coping processes for cancer caregivers. This study aims to examine the nature of their associations with caregiving burden and anxiety and depressive symptoms among Chinese cancer caregivers in Hong Kong. METHODS: A total of 155 Chinese caregivers of recently diagnosed cancer patients (mean time since diagnosis = 42.57 days, SD = 39.25) were recruited from two major government-funded hospitals and administered a questionnaire assessing psychological detachment, savoring, caregiving burden, anxiety and depressive symptoms, and demographics. RESULTS: Controlling for demographic and medical covariates, structural equation modeling revealed significant associations of detachment, savoring, and their interaction term with caregiving burden and anxiety and depressive symptoms. Detachment and savoring were inversely associated with caregiving burden only when the other was at lower/medium levels. Detachment was inversely associated with anxiety and depressive symptoms at lower/medium levels of savoring, but savoring was inversely associated with anxiety and depressive symptoms across all levels of detachment. CONCLUSIONS: Detachment and savoring could overshadow the positive impact of the other on caregiving burden if either one is at higher levels, while they could demonstrate concurrent positive impact on burden when both are at lower/medium levels. Savoring could have a prioritized role in ameliorating caregivers' anxiety and depressive symptoms, supplemented by detachment. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

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BACKGROUND: This study examined the prevalence and critical predictors of anxiety and depressive symptoms and self-rated health, following the Umbrella Movement in Hong Kong. METHODS: Random digit dialing recruited a population-representative sample of 1208 Chinese Hong Kong citizens (mean age=46.89 years; 63% female) in the first two weeks of February 2015. Respondents gave their informed consent and reported personal, social, and economic resource loss since the Umbrella Movement (Conservation of Resources-Evaluation), current anxiety symptoms (State-Trait Anxiety Inventory) and depressive symptoms (Patient Health Questionnaire-9), and self-rated health (1=very good, 4=very bad). RESULTS: A total of 47.35% (95% CI=44.55, 50.17) respondents reported moderate/severe anxiety symptoms and 14.4% (95% CI=12.54, 16.50) reported moderate/severe depressive symptoms; 9.11% (95% CI=7.61, 10.86) reported "poor" or "very poor" health. Multivariable regressions revealed that personal and social resource loss was associated with higher anxiety and depressive symptoms and greater odds of "very poor" health (adjusted odds ratios/incidence rate ratios=5-102%), independent of lower education level and income and being unmarried. LIMITATIONS: This study was cross-sectional in nature and thus could not determine causality from the associations between resource loss and outcome variables. Second, the telephone survey relied on self-reports; response bias and social desirability could influence respondents' answers and discount data validity. Third, potential confounders such as preexisting mental and physical health issues and concurrent predictors like exposure to the Umbrella Movement were not assessed. CONCLUSIONS: This is one of the first studies following any recent political movement (e.g., The Arab Spring) to quantify distress and the associated correlates of distress among affected citizens. Perceived psychosocial resource losses were critical predictors of poor outcomes.

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OBJECTIVE: This study examined whether and how changes in positive affect and mindfulness predicted changes in cortisol secretion and psychological distress in adaptation to examination stress. DESIGN: A sample of 105 college students completed a questionnaire set and provided salivary samples before (T1), during (T2) and after (T3) an examination period. RESULTS: Latent change score modelling revealed that T1-T2 and T2-T3 increases in mindfulness were associated with larger T2-T3 decrease in area-under-the-curve ground of cortisol awakening response (CARg), whereas T2-T3 increases in both positive affect and mindfulness were associated with larger T2-T3 decrease in anxiety symptoms (comparative fit index = .96; Tucker-Lewis index = .93-.95; root-mean-square error of approximation = .04-.08; standardised root-mean-square residual = .08-.10). T1-T2 and T2-T3 increases in positive affect were not associated T2-T3 decrease in CARg, whereas T1-T2 increases in positive affect and mindfulness were not associated with T2-T3 decrease in anxiety symptoms. CONCLUSION: The levels of post-stress recovery from anxiety symptoms could depend on concurrent increases in positive affect and mindfulness, whereas the levels of post-stress decline in cortisol secretion could depend on increases in mindfulness both during and after stress. Directions for translating the present findings into stress management programmes in college settings are discussed.

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