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OBJECTIVE: This paper investigates the relationships between physical activity (PA), school bullying, emotion regulation self-efficacy (ERS), and interpersonal relationship distress (IRD) among junior high school students. It also examines the underlying mechanisms of school bullying to provide insights into reducing adolescent bullying and to lay the groundwork for preventing and controlling aggressive behaviors. METHODS: A survey was conducted on 484 students (240 males, 12.18 ± 0.8 years) from 4 secondary schools using the Physical Activity Rating Scale (PARS), Emotional Management Self-Efficacy Scale (EMSS), Interpersonal Relationship Distress Scale (IRDS), and Campus Bullying Scale (CBS) to examine the effects among the variables. A stratified random sampling method was used to select the sample, and data were collected with a structured questionnaire. The data were analyzed using SPSS 24.0 and AMOS 24.0 statistical software. The analysis included Pearson correlation analysis, structural equation modeling, and bias-corrected percentile Bootstrap methods. RESULTS: (1) PA negatively predicts IRD, which in turn has an indirect effect on bullying (PA → IRD → Bullying), ES = -0.063. Additionally, EM and IRD act as mediators between PA and school bullying (PA → EM → IRD → Bullying), ES = 0.025. (2) PA negatively predicts IRD, which has an indirect effect on being bullied (PA → IRD → Being bullied), ES = -0.044. EM and IRD serve as chain mediators between PA and being bullied (PA → EM → IRD → Being bullied), ES = -0.071. CONCLUSION: PA can positively predict bullying, but it can be mitigated through EM to reduce IRD, thereby decreasing the occurrence of campus bullying and being bullied.

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Home-dwelling people with dementia rely on their family members to be able to stay at home. This affects the family caregivers' quality of life (QoL). However, less is known about how male and female caregivers differ in their QoL. Our study aimed to investigate gender differences in caregivers' quality of life (QoL), whether emotional relationships influence QoL, and how their QoL changes over time. The study applied a cross-sectional and a longitudinal design to examine a total of 208 caregivers, 158 female and 50 male caregivers, and their family member with dementia. Regression analysis and t-tests were performed to identify what characteristics about caregivers and care receivers influence male and female QoL, and whether caregivers' QoL developed after one year. Both male and female caregivers' depression influenced their QoL. For females, their own social distress influenced their QoL, and for males, their experience of their care receivers' overemotional attitude influenced their QoL. From baseline to one-year follow-up their QoL decreased while their distress and experience of care receivers' emotional attitudes was stable. Significant gender-specific differences were found, indicating that gender must be considered when approving caregivers' needs and planning interventions for caregivers.

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Forgiveness plays an important role in restoring and maintaining cooperative relationships. Previous studies have demonstrated that young children could forgive transgressors both as a third party and as a victim. However, the research on young children's understanding of forgiveness is scant. This study focused on the two main functions of forgiveness-the restoration of a damaged relationship between the victim and the transgressor and the positive emotional change in the victim toward the transgressor. In this study, 48 4-year-olds (25 girls), 50 5-year-olds (21 girls), and 50 6-year-olds (21 girls) in Japan heard stories in which a victim either did or did not forgive a transgressor. They answered questions about the relationship between the victim and the transgressor and the victim's feelings toward the transgressor. Regarding the restoration of a damaged relationship, 4- to 6-year-olds understood that the restoration could occur in the presence of forgiveness. Yet, 6-year-olds showed more distinctive belief than 4- and 5-year-olds that the damaged relationship remains unrestored without forgiveness from the victim. For emotional changes, 6-year-olds understood that the forgiving victim would experience positive emotional changes, whereas the unforgiving victim would not. However, 4- and 5-year-olds expected positive emotional changes even without forgiveness, although they anticipated greater changes after forgiveness. The results show that the understanding of the important functions of forgiveness is present at 4 years of age and matures by 6 years of age. Children may develop a sophisticated understanding of the functions of forgiveness later than the actual forgiving behavior.

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The development of social relationships influences a person's self-concept, which in turn affects their perceptions and neural correlates in social interactions. This study employed an EEG-based hyperscanning technique and a longitudinal design to investigate how the evolution of interpersonal relationships impacts inter-brain synchrony during nonverbal social-emotional interactions. The framework for this study is based on the self-expansion model. We found that dyads exhibited enhanced affective sharing abilities and increased brain-to-brain synchrony, particularly in the gamma rhythm across the frontal, parietal, and left temporoparietal regions, after seven months together compared to when they first met. Additionally, the results indicate that inter-brain coupling evolves as relationships develop, with synchrony in nonverbal social-emotional interactions increasing as self-expansion progresses. Crucially, in the deep learning model, interpersonal closeness can be successfully classified by inter-brain synchrony during emotional-social interactions. The longitudinal EEG-hyperscanning design of our study allows for capturing dynamic changes over time, offering new insights into the neurobiological foundations of social interaction and the potential of neural synchrony as a biomarker for relationship dynamics.

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WHAT IS KNOWN ON THE SUBJECT?: Patients with chronic schizophrenia become vulnerable to stress when admitted to psychiatric wards, lacking the abilities to independently cope with stress. Therefore, it is crucial to focus on the stress associated with hospitalization. Stress increases when interpersonal functioning is impaired due to schizophrenia symptoms. Social support acts as a protective factor against stress, boosting coping skills and problem-solving abilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Interpersonal relationships, marital status, having cohabited before hospitalization and hospitalization type were associated with hospitalization stress in patients with chronic schizophrenia. Patients with chronic schizophrenia continue aging (mean 55.73 ± 11.14) within closed psychiatric hospitals due to their long-term hospitalizations (mean 14.24 ± 11.37). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to use a standardized nursing assessment including interpersonal relationships, family support system and hospitalization type that may affect hospitalization stress in patients with chronic schizophrenia. Mental health nurses should develop tailored interventions to reduce hospitalization stress for long-stay patients with chronic schizophrenia that consider aging, illness duration, and length of hospital stay, as well as psychiatric symptoms. Mental health nurses need to make efforts to help the families of patients with schizophrenia solidify an important support system by participating in treatment plans and intervention programs, checking on the patients' condition, and spending time with them. ABSTRACT: INTRODUCTION: Patients with chronic schizophrenia in psychiatric hospitals often experience increased stress due to living in closed spaces and frequently lack the coping skills necessary for independent stress management. AIM: To explore interpersonal relationships, social support and hospitalization stress, and identify the factors associated with hospitalization stress in patients with chronic schizophrenia in psychiatric hospitals. METHOD: This cross-sectional study included 135 patients who had been diagnosed with schizophrenia for over 2 years, recruited from two psychiatric hospitals in City B, South Korea through convenience sampling. We conducted descriptive statistics and quantile regression. RESULTS: Interpersonal relationships, marital status, cohabiting before hospitalization, and voluntary admission were significant factors influencing the hospitalization stress at the 90th percentile. DISCUSSION: Standardized nursing assessment, active family support, and tailored stress management programs including interpersonal relationships are needed to reduce hospitalization stress in patients with chronic schizophrenia. IMPLICATIONS FOR PRACTICE: To identify the 90th percentile group for hospitalization stress among patients with chronic schizophrenia, it is essential to consider interpersonal relationships, marital status, pre-hospitalization cohabitation, type of hospitalization, as well as aging and prolonged hospitalization. Mental health nurses should develop and implement family therapy-based interpersonal relationship programs to reduce hospitalization stress in patients with chronic schizophrenia and actively involve families in the process.

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Although prior research has implied that emotional contagion occurs automatically and unconsciously, convincing evidence suggests that it is significantly influenced by individuals' perceptions of their relationships with others or with collectives within specific social contexts. This implies a role for self-representation in the process. The present study aimed to offer a novel explanation of the interplay between social contexts and emotional contagion, focusing on the contextualized nature of self-representation and exploring the social factors that shape emotional contagion. It further posits a causal loop among social contexts, self-representation, and emotional contagion. Drawing from the lens of self-representation, this study concludes with a discussion on potential research directions in this field, commencing with an exploration of the antecedents and consequences of emotional contagion and self-representation.

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Seven preregistered experimental studies investigated a potential mediator (self-blame) and moderator (the perceived responsibility of the helper for the help recipient's behavior) of Weiner's attribution-emotion-action model. When participants considered a nonchild close other experiencing depression, higher perceived controllability was related to lower sympathy, which correlated with less willingness to provide support; however, among parents considering their child experiencing depression, perceived controllability was either positively associated with sympathy (study 1) or did not influence sympathy (study 2). Offering an explanation, studies 3a/3b indicated a significantly weaker relationship between controllability and responsibility attributions when the target of help was the participant's child. Study 4 investigated the underlying mechanism. Parents experienced self-blame when the cause was controllable, which lowered the association between controllability and responsibility attributions. Studies 5 and 6 revealed this pattern was not specific to the parent-child relationship but occurred whenever the potential helper felt responsible for the help recipient's behavior.

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Purpose: Despite growing evidence of significant role of leader perfectionism in the workplace, few theoretical accounts have delved into intricate dynamics of interpersonal relationships impacted by leader perfectionism, nor have they explored the extent to which these interactions might stimulate employee unethical behavior. From an interpersonal relationship perspective, based on interpersonal complementarity theory, this study proposes a link between leader perfectionism and employee deviant behavior while assessing the mediating impact of supervisor-subordinate relationship conflict, and the moderating influence of employee narcissism. Methods: This study employed three-wave surveys, with 335 employees (female 55.8%, 26-35 years old 67.4%, bachelor's degree 61.5%, worked 3-10 years 67.4%, worked with their current leader 1-5 years 66.3%) across 11 enterprises in Chinato reduce the risk of common method bias. On this basis, MPLUS 7.4 was used to test the confirmatory factor analysis of data, and SPSS 24.0 was used to test the hypotheses. Results: (1) Leader perfectionism has a positive effect on supervisor-subordinate relationship conflict. (2) Leader perfectionism has a significantly positive effect on employee deviant behavior via supervisor-subordinate relationship conflict. (3) Employee narcissism positively moderates the relationship between leader perfectionism and supervisor-subordinate relationship conflict, and further positively moderates the indirect effect of leader perfectionism on employee deviant behavior via supervisor-subordinate relationship conflict. Conclusion: This study reveals the mechanism of how employee through deviant behavior as a opposition to leader perfectionism from an interpersonal relationship perspective, which provides theoretical and practical implications for reducing the negative impact of leader perfectionism and employee deviant behavior.

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AIM: This study adopted a three-wave random intercept cross-lagged panel model to explore the longitudinal reciprocal relationships between (a) the teacher-student relationship (TSR) quality and (b) the parent-child relationship (PCR) quality and positive affect among Chinese primary school students. SAMPLES: Two primary school student samples, including 3505 and 2505 students, were tracked with their perceived relationship quality with math teachers and parents and their positive affect levels in mathematics learning over three academic years. RESULTS: The results demonstrated that more closeness with parents could significantly predict students' subsequent higher level of positive affect in mathematics learning. However, more closeness with their math teachers did not show significant prediction. Meanwhile, more conflict with math teachers and parents could significantly predict their subsequent lower degree of perceived positive affect in mathematics learning. That is, a reciprocal association lines in the PCR quality and positive affect, whereas only a unidirectional association exists between the TSR and positive affect. The predictions of the experienced positive affect on their perceived interpersonal relationships with math teachers and parents were stronger than those in the reverse association. CONCLUSIONS: This study identifies that while the effects of closeness with math teachers and parents on positive affect in students' math learning differ, conflict with math teachers and parents indeed harms students' experienced positive affect in math learning. More attention should also be paid to fostering positive affect in math learning.

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Art therapy, as an effective therapeutic intervention, is used to improve positive self-image and self-awareness, promote insight, and enhance therapeutic communication. This study aimed to evaluate the efficacy of art psychotherapy on ego functions, emotion regulation, and interpersonal relationship styles of individuals with neurotic personality organization. Using a quasi-experimental pretest-posttest design, 60 participants were assigned to intervention and control groups, each further divided into three subgroups (n = 10 per subgroup). The intervention group engaged in online art therapy sessions twice weekly over nine weeks, while the control group received no intervention. Data analysis involved descriptive statistics, paired samples t-tests, and independent t-tests. There was a significant decrease in the intervention group's judgmental subdimensions of the Ego Function Assessment Scale. A significant decrease was found in the intervention group in "awareness" (p < 0.01), "clarity" (p < 0.05), and "impulse" (p < 0.001) subdimensions and total scores of the Difficulties in Emotion Regulation Scale. There was no statistical difference between the intervention and control groups' mean pretests and posttests and comparing those groups with each other concerning IRSQ scores. The online group art therapy led to successful improvements in participants' ego functions and emotion regulations.

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Chinese address terms exhibits a high degree of variability. Guided by the extended context of situation framework within the field of systemic functional linguistics, and taking the dialogues of the modern Chinese TV drama In the Name of People as examples, this study investigated how the bystander influences the choice of address terms. It is found that the appearance of the bystander influences the choice of address terms. Yet, it is not a direct process but is mediated by conversational atmosphere. Specifically, the presence of a bystander triggers "situational synergy" or changes interpersonal relationship, and then change the conversational atmosphere, both paths ultimately impact the choice of address terms. The underlying forces that lead to the variability of Chinese address terms are guan ben wèi and miàn zǐ. This study suggests the intricate impact of context on language choice, as well as the interdependency of context variables. In addition, by taking the concept of face beyond its European/North American milieu, and relocating it following the Chinese point of view, group orientation is valued, which contributes to face study.

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BACKGROUND: Longitudinal integrated clerkships (LICs) and traditional block rotations (TBRs) employ different designs that provide various learning experiences for students. In this study, we explored students' clinical participation and interpersonal interactions in LICs and TBRs at 2 metropolitan hospitals in Taiwan. METHODS: In April 2018, we enrolled 15 LIC and 29 TBR students. We conducted a cross-sectional survey which required the students to outline a typical daily schedule during their internal medicine rotations and draw an ecomap of the clinical team members. With the patient in the center as a reference, the size of each circle in an ecomap indicated the importance of the member; the distances and number of connecting lines between two circles represented the relationship and frequency of interaction, respectively, between the corresponding members. We analyzed the results and compared the responses of the LIC and TBR students. RESULTS: The LIC students spent more time on direct patient care and in the outpatient clinic/operation room, whereas the TBR students participated more in educational activities and in observation behind their seniors. In the ecomap analysis, the LIC students had a closer relationship with attending physicians and had better interactions with patients and preceptors than did the TBR students. Conversely, the TBR students felt closer to and interacted more frequently with interns and residents. CONCLUSIONS: The LIC students had more opportunities to care for patients directly and engaged in interactions with patients and attending physicians more frequently than did the TBR students. TRIAL REGISTRATION: Ethical approval for the study was obtained from the Institutional Review Board of Tri-Service General Hospital (TSGHIRB 2-106-05-018).

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BACKGROUND: The purpose of this study was to analyze the effects of general characteristics, fatigue, depression, self-efficacy, job stress and interpersonal relationships on the quality of life (QoL) of caregivers in nursing hospitals and use them as basic data for intervention programs to improve the quality of life of caregivers. METHODS: The participants in the study were 137 caregivers, aged 52-76, who were actively working in nursing hospitals. Data were collected from caregivers by visiting 9 hospitals in 6 cities, with a questionnaire of fatigue, depression, self-efficacy, job stress, interpersonal relationship, quality of life. RESULTS: Age, marriage, marital satisfaction, education, education experience of QoL, monthly income, perceived economic status, hobby or leisure activity, and number of disease showed differences in the degree of QoL at a statistically significant level. In stage 1, economic status (ß = -0.18, p = 0.033) and hobby or leisure activity (ß = 0.19, p = 0.025) were influencing factors (F = 4.58, p < 0.001). In stage 2, monthly income (ß = -0.19, p = 0.034) and perceived economic status (ß = -0.18, p = 0.035) were influencing factors. In stage 3, age (ß = -2.80, p = 0.006), perceived economic status (ß = -2.41, p = 0.017), self-efficacy (ß = 3.19, p = 0.002) and interpersonal relationship (ß = 7.12, p < 0.001) were influencing factors which showed 61.5% explanatory power (F = 12.88, p < 0.001). Since the subject's fatigue, depression, and stress did not affect the quality of life, further research is needed. CONCLUSIONS: In order to improve the quality of life of caregivers, it would be necessary to develop interventions for raising their self-efficacy and interpersonal relationship by considering their degree of economic status, hobby or leisure activity, monthly income, and age.

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Purpose: This study assessed the moderating effect of gender on the indirect effects of positive and negative parenting styles on Internet addiction through interpersonal relationship problem. Methods: A cross-sectional survey of randomly sampled 1194 college students recruited voluntarily from three universities in China was conducted to assess the variables of positive and negative parenting styles, interpersonal relationship problem, and Internet addiction. Results: Positive parenting style, such as emotional warmth, was a protective factor for the development of Internet addiction, whereas negative parenting style, such as rejection and overprotection, was a potential risk factor for Internet addiction. Furthermore, interpersonal relationship problem completely mediated the association between positive parenting style and Internet addiction but partially mediated the relationship between negative parenting style and Internet addiction. Finally, gender moderated the indirect effect of parenting style on Internet addiction through interpersonal relationship problem. Conclusion: The correlation between positive parenting style and interpersonal relationship problem was considerably weaker among females, whereas the association between interpersonal relationship problem and Internet addiction was much stronger among females. For the prevention and intervention of Internet addiction, it is important to increase positive parenting style for males while enhancing interpersonal skills training for females. Further longitudinal studies should discuss the effects of paternal and maternal parenting styles on Internet addiction.

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BACKGROUND: Lung cancer remains a major global health concern due to its high incidence and mortality rates. With advancements in medical treatments, an increasing number of early-stage lung cancer cases are being detected, making surgical treatment the primary option for such cases. However, this presents challenges to the physical and mental recovery of patients. Peplau known as the "mother of psychiatric associations" has formulated a theory of interpersonal relationships in nursing. Through effective communication between nurses and patients over four periods, she has established a good therapeutic nurse-patient relationship. Therefore, this study aimed to explore the effect of perioperative multimodal nursing based on Peplau's interpersonal relationship theory on the rehabilitation of patients with surgical lung cancer. METHODS: We retrospectively analyzed 106 patients with non-small cell lung cancer who underwent thoracoscopic lobectomy at our department between June 2021 and April 2022. Patients were categorized into two groups according to the different nursing intervention techniques. The Peplau's group comprised 53 patients who received targeted nursing interventions, and the control group comprised 53 patients who received conventional nursing care. We observed the patients' illness uncertainty, quality of life, and clinical symptoms in both groups. RESULTS: Patients in the Peplau's group had significantly lower illness uncertainty scores and a significantly higher quality of recovery than those in the control group. However, there were no significant differences in length of post-anesthesia care unit stay, complication rates, and visual analog scores between both groups. CONCLUSION: The multimodal perioperative nursing based on Peplau's interpersonal relationship theory not only reduces the illness uncertainty of patients with lung cancer surgery and improves their QoR but also expands the application of this theory in clinical practice, guiding perioperative nursing of patients with lung cancer. IMPLICATIONS: These findings provide practical information for standardized care in a hectic anesthetic care setting. IMPACT: The assessed anesthesia nursing model helps reduce uncertainty and promote early recovery in patients with cancer at various stages of their disease, which expands the scope of therapeutic practice and existing theories. It also serves as a guide for care in the anesthesia recovery room. REPORTING METHOD: We adhered to the relevant Equator guidelines and the checklist of items in the case-control study report. PATIENT OR PUBLIC CONTRIBUTION: Patients cooperated with medical staff to complete relevant scales.

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BACKGROUND:  Children roaming the streets estimated at 1 in 10 by a 2021 United Nation Children's Funds (UNICEF) report is a growing problem, in cities of lower- and middle-income African countries. Studies of street children with no family ties abound, but there is a paucity of studies on children on the street who exist within families and return home daily. We explored the family dynamics of children on the streets of Ibadan, emphasising family structure, resources and relationships. METHODS:  Using an exploratory design based on a qualitative approach 53 participants were interviewed, including children on the streets, parental figures, child-welfare officers and street shop owners. Participants were selected from streets in the five urban local government areas of Ibadan, Nigeria. Recorded data were transcribed, and framework analysis was performed. RESULTS:  The family dynamics included family structural problems, poor family resources and poor parent-child relationships. The family structural problems included: broken homes, large families and ambivalence around polygamy as subthemes. Family resources comprised: poor economic resources, poor social resources, educational challenges, cultural ambivalence and spiritual backdrops. The family relationships patterns included: poor adaptability, economic-oriented partnership, poor growth support, poor emotional connection and poor family bonding. CONCLUSION:  The dynamics driving a family's choice for child streetism in Ibadan, mostly to hawk, are devaluation of family life, parenting irresponsibility, and poor filial relationship, underscored by economic constraints and socio-cultural decadence. The results of this research buttress the need for family-level interventions to forestall the escalating phenomenon of child streetism in Ibadan, Nigeria.Contribution: This research highlights the family dynamics of children on the streets, and buttresses family-level interventions are necessary to forestall escalating child-streetism in Ibadan, Nigeria.

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BACKGROUND: Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation. METHODS: In a pre-post-follow-up design, n = 53 different-sex couples including women with current depression were randomly assigned to a 10-week-long CBCT®-fC (Cognitively-Based Compassion Training/intervention for couples) or treatment-as-usual (TAU) condition. Multi-level linear regression models and post-hoc contrasts were calculated to determine changes in depressive symptoms, mindfulness and self-compassion, interpersonal functioning and neuroendocrine markers collected during a partnership appreciation task (PAT) in the laboratory before and after CBCT-fC treatment. RESULTS: While CBCT-fC led to a comparable decrease of depressive symptoms as TAU, the training specifically increased self-compassion and mindfulness versus TAU. Interestingly, interpersonal functioning did not improve, which was also reflected in participants' preferred self-focus in-between-session practices, instead of practices with interpersonal focus. There were no group-specific changes in psychobiological stress-marker reactivity. CONCLUSIONS: CBCT-fC was effective in decreasing current depressive symptomatology and increasing mindfulness, and self-compassion. Especially the motivation to participate, such as improving interpersonal functioning, should be addressed and intrinsic motives of the partners to be involved. In highly burdened individuals, self-regulation may need to be improved before co-regulation can be addressed, which would requiring longer treatments. Facilitating factors for engaging in the practice between-sessions seem meaningful.

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BACKGROUND: During the COVID-19 pandemic, nurses' workload increased dramatically, and nurses faced the risk of infection and multiple ethical dilemmas. In such a situation, nurse burnout was elevated, which tended to exacerbate depression in nurses. Although previous studies have demonstrated the relationship between burnout and depression among nurses, the exact mechanisms remain unclear. Furthermore, environmental factors are also essential to a person's psychological health. Therefore, this study intended to investigate the potential mechanisms of depression caused by nurse burnout and whether burnout among frontline nurses during the COVID-19 pandemic exacerbated its effect on depression in nurses as an environmental factor. METHODS: A total of 4517 nurses were enrolled in this study. A moderated mediation model was established to investigate the relationship between burnout and positive coping styles, interpersonal relationships, and depression utilizing the SPSS PROCESS 3.3 macro. The direct effect of burnout on depression was also investigated with the moderated mediation model. RESULTS: The indirect effects of positive coping styles (ß = 0.04, 95% CI: 0.03 to 0.04) and interpersonal relationships (ß = 0.12, 95% CI: 0.10 to 0.13) were revealed. Being a frontline nurse caring for COVID-19 patients moderated the direct effect of burnout on depression (ß = 0.12, 95% CI: 0.08 to 0.16). CONCLUSION: This study offers strong evidence for the mediating role of positive coping styles and interpersonal relationships in the relationship between nurse burnout and depression, in addition to illustrating the need for more psychological support for frontline nurses caring for COVID-19 patients.

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BACKGROUND: Individuals with multimorbidity and complexity have multifaceted care needs requiring integrated and collaborative care from nurses, families, and health care teams. Nurses, as the frontline care professionals, should develop therapeutic relationships with patients and their families and professional relationships with health care team members to ensure the delivery of effective integrated care. Failure to develop effective interpersonal and professional relationships can negatively affect patient care. OBJECTIVE: The purpose of this study was to explore nurses' challenges with developing interpersonal and professional relationships during integrated care for individuals with multimorbidity and complexity. METHODS: A descriptive qualitative design was used. We interviewed a purposive sample of 19 nurses with experience of caring for individuals with multimorbidity and complexity across two hospitals in Pakistan. Semi-structured interviews were used for data collection, and data were analyzed using reflexive thematic analysis. RESULTS: Two challenges were identified affecting the relationships between patients' families and nurses, and two challenges influencing the professional relationships within the team. Families withheld information, controlled care access of their relatives, posed unrealistic demands, and abused nurses, affecting nurse-family relationships. Power struggles to demonstrate authority in decision-making were common within health care teams, affecting nurses' professional capacity to provide effective care. CONCLUSIONS: Health care team, patient, and family collaboration is instrumental in improved care for individuals with multimorbidity and complexity. Nurse leaders and health care organizations should take initiatives to address nurses' interpersonal confrontations to support them in the provision of quality care.

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BACKGROUND: Research suggests that genetic variants linked to serotonin functioning moderate the association between environmental stressors and depressive symptoms, but examining gene-environment interactions with single polymorphisms limits power. METHODS: A multilocus genetic profile score (MGPS) approach to measuring serotonergic multilocus genetic variation and examined interactions with interpersonal relationship, insomnia with depressive symptoms as outcomes in an adolescent sample (average age = 14.15 ± 0.63 years since first measurement; range: 13 to 15). RESULTS: (1) interpersonal relationship predicted adolescent depressive symptoms; (2) insomnia mediated the effect of interpersonal relationships on adolescent depressive symptoms; (3) the THP2 gene rs4570625 polymorphism G allele was a key risk factor for depressive symptom, and the MGPS moderated the effects of teacher-student relationship and insomnia on adolescent depressive symptom. Specifically, as the MGPS increased, the effects of insomnia on adolescent depressive symptom were enhanced; further, when the MGPS score increased, the effect of teacher-student relationship on depression showed a similar phenomenon with an increased slope and enhanced prediction; and (4) the results of sensitivity analysis showed that multilocus genetic interaction with the environment had a better explanatory power and stability for depression than single polymorphism studies. CONCLUSION: MGPS provides substantial power to examine gene-environmental interactions linked to affective outcomes among adolescents.

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