JianLi Wang’s research while affiliated with Jining Medical University and other places

Population health issues are addressed by various regional initiatives in the Canadian province of Nova Scotia (NS). A need for research on the root causes of health inequities suggests there may be a lack of evidence to inform current initiatives within the region. To address this gap, a three-phase sequential mixed methods study called Advancing Health Equity in NS by Exploring Gaps in Healthcare Delivery will operationalize Intersectionality Theory and employ an integrated knowledge translation approach to identify and explore gaps in health service delivery. This will promote a better understanding of how to improve the integration of health equity in health service and delivery systems and thus population health and well-being. The following objectives will be addressed in each phase: 1) create an inventory of NS-relevant knowledge that relates to health equity, 2) examine the integration of health equity in NS health service and delivery systems using a context-specific health equity lens, and 3) mobilize knowledge on how gaps in service delivery can be addressed to improve the integration of health equity and better meet the needs of people living in NS. The study results from this protocol will be used to integrate health equity in NS health service and delivery systems, enhancing the quality of care for populations rendered vulnerable by structural inequalities, and working to prevent negative impacts to health and wellbeing. Supplementary Information The online version contains supplementary material available at 10.1007/s43999-025-00062-4.

Background There are fewer studies on prospective predictors of first-time suicidal thoughts and behaviors (STB) among first-year university students and fewer studies prospectively identifying and screening for those at high risk of suicide among college students. This study assessed the impact of prospective baseline variables on the risk of new STB onset among first-year university students over two years and developed a multivariate risk prediction model. Methods 4,560 first-year university students (38.4% males, mean age:18.34) from China participated and completed this prospective cohort study over a three-year period from 2018 to 2020. LASSO regression, and logistic regression models under resilient networks, were used for risk predictor variable screening and final prediction model building. Independent validation sets were used for external validation of the models. Independent validation sets were used for external validation of the models. Area Under the Curve (AUC), accuracy, F1 scores, and Hosmer-Lemeshow test metrics were used to evaluate the model performance. Results The incidence rates of suicidal thoughts, suicidal behaviors, and STB within two years were 4.89%,1.03%, and 4.96%, respectively. Predictors in the final model included females, always solo activity, bigotry under pressure, socially oriented perfectionism, drinking to relieve stress, autonomy attitude, poorer parental marriage satisfaction, maternal emotional warmth, perceived others social support, and number of lifetime severe traumatic events. The predictive model had an AUC of 0.738 (95% CI: 0.697–0.780) for predictive accuracy in the training dataset as well as 0.710 (95% CI: 0.657–0.763) for predictive accuracy in the validation dataset, which represents a high degree of model discrimination. Conclusion Based on this predictive model of suicidal thoughts and behaviors, this study may help to assess and screen college students at risk for STB and develop suicide prevention strategies for at-risk populations.

Objective Unhealthy family functioning and Protocadherin 9 (PCDH9) have been recognized as potential environmental and genetic risk factors for major depressive disorder (MDD). This study examined the effects of the interaction between PCDH9 and family functioning on MDD in first-year university students. Methods A cohort of 6985 first-year university students in China was established in 2018 and was followed for one year. The blood samples from 4866 of these participants (38.88% males, mean age:18.42) were genotyped. MDD was assessed using the Composite International Diagnostic Interview-3.0 (CIDI-3.0), while family functioning was evaluated with the Family Assessment Device (FAD). Logistic regression was used to examine the interaction of these two risk factors. Results The one-year prevalence of MDD was 2.4%. Among first-year university students, the AA genotype of rs9540720 (PCDH9) was a protective factor for MDD (OR=0.47, 95% CI: 0.23–0.88, P=0.025). Affective responsiveness was a risk factor for MDD (OR=1.77, 95% CI: 1.13–2.78, P=0.013). The interaction between AA genotype of rs9540720 and general functioning was statistically significant for MDD (OR=6.83, 95% CI: 1.16–39.27, P=0.031), indicating that unhealthy family functioning may exacerbate the risk of MDD in carriers of this genotype. Conclusion University students carrying the AA genotype of rs9540720(PCDH9) may have a higher probability of developing MDD when they have unhealthy family functioning. The etiological mechanism of depression in university students is explained from the perspective of gene-environment interaction and provides a theoretical basis for subsequent effective identification and screening of high-risk groups for depression in university students.

Background Research has shown that perceptions of a mental health need are closely associated with service demands and are an important dimension in needs assessment. Perceived and unmet mental health needs are important factors in the decision-making process regarding mental health services planning and resources allocation. However, few prediction tools are available to be used by policy and decision makers to forecast perceived and unmet mental health needs at the population level. Objective We aim to develop prediction models to forecast perceived and unmet mental health needs at the provincial and health regional levels in Canada. Methods Data from 2018, 2019, and 2020 Canadian Community Health Survey and Canadian Urban Environment were used (n=65,000 each year). Perceived and unmet mental health needs were measured by the Perceived Needs for Care Questionnaire. Using the 2018 dataset, we developed the prediction models through the application of regression synthetic estimation for the Atlantic, Central, and Western regions. The models were validated in the 2019 and 2020 datasets at the provincial level and in 10 randomly selected health regions by comparing the observed and predicted proportions of the outcomes. Results In 2018, a total of 17.82% of the participants reported perceived mental health need and 3.81% reported unmet mental health need. The proportions were similar in 2019 (18.04% and 3.91%) and in 2020 (18.1% and 3.92%). Sex, age, self-reported mental health, physician diagnosed mood and anxiety disorders, self-reported life stress and life satisfaction were the predictors in the 3 regional models. The individual based models had good discriminative power with C statistics over 0.83 and good calibration. Applying the synthetic models in 2019 and 2020 data, the models had the best performance in Ontario, Quebec, and British Columbia; the absolute differences between observed and predicted proportions were less than 1%. The absolute differences between the predicted and observed proportion of perceived mental health needs in Newfoundland and Labrador (−4.16% in 2020) and Prince Edward Island (4.58% in 2019) were larger than those in other provinces. When applying the models in the 10 selected health regions, the models calibrated well in the health regions in Ontario and in Quebec; the absolute differences in perceived mental health needs ranged from 0.23% to 2.34%. Conclusions Predicting perceived and unmet mental health at the population level is feasible. There are common factors that contribute to perceived and unmet mental health needs across regions, at different magnitudes, due to different population characteristics. Therefore, predicting perceived and unmet mental health needs should be region specific. The performance of the models at the provincial and health regional levels may be affected by population size.

Background Depression is a highly prevalent and disabling mental health problem. Self-help has been strongly advocated for dealing with depression. Built upon the research on risk prediction modeling and risk communication, we developed a coach-guided, personalized depression risk communication tool (PDRC) for sharing information about individualized depression risk and evidence-based self-help strategies. The primary objective of this project is to evaluate the impact of the PDRC on the 12-month risk of major depressive episode (MDE) in Canadians who are at high risk of MDE. Methods This is an assessor-blinded randomized controlled trial (RCT) with two arms. We will recruit 500 males and 500 females in the communities across the country. Individuals are eligible, if they: (1) are 18 years or older, (2) have not had a depressive episode in the past two months, (3) are at high risk of MDE based on the sex-specific risk predictive algorithms for MDE (predicted risk of 6.5% + for men and of 11.2% + for women), (4) can communicate in either English or French, and (5) agree to be contacted for follow-up interviews. After screening and baseline assessment, participants will be randomized by sex into intervention and control group in a 1:1 ratio. Participants in the intervention group will receive the coach-guided PDRC. The participants are assessed at baseline, 3 and 12 months via computer assisted telephone interview system, regarding the presence of MDE, depressive and anxiety symptoms, use of self-help strategies, mental health services use and self-efficacy. Discussion The coach-guided PDRC may empower users to actively engage in self-management, leading to reduced risk of MDE. If successful, the coach-guided PDRC will lead to a novel selective prevention program that is closely aligned with the tiered mental health services model, contributing to early prevention of depression and better mental health wellbeing. Date of trial registration : 2024-10-02. Protocol version and date December 6, 2024. Version #1. Trial registration : NCT06619366.

Background Despite the increasing substance use in Canada, our understanding of how substance use varies based on the intersections of gender, ethnicity/race, and income sources among preclinical populations remains limited. Thus, this study aimed to investigate, among clients of mental health and addiction (MHA) intake in Nova Scotia: 1) the prevalence of substance use by gender, ethnicity, and income source; 2) the routes of substance administration; 3) factors associated with substance use. Understanding how gender, ethnicity, and income sources intersect to influence substance use patterns is essential for designing prevention and treatment strategies tailored to an individual’s unique needs. Additionally, exploring the various routes of substance administration can provide insight into potential health risks, helping to inform harm reduction strategies. Methods This cross-sectional study included 22,500 adults who contacted MHA central intake in Nova Scotia in 2020 and 2021. Clients were assessed for substance use, substance use frequency, route of substance administration, and mental and physical health problems. The prevalence of substance use was examined as a function of gender, ethnicity, and income source. Multinomial logistic regression was used to investigate factors associated with substance use. Results Among the included MHA Intake clients, 36.1% reported daily substance use. The highest prevalence of daily substance use was identified among homeless (69.7%) and non-White men on social assistance/disability (60.9%). Also, non-White individuals on social assistance/disability were more likely to engage in frequent (aOR = 2.66, 95% =1.64, 4.30) and daily (aOR = 2.82, 95% CI: 2.08, 3.82) substance use compared to White individuals. Being young (aged 19-29), lack of access to private insurance, current/past mental illness, moderate/high suicide risk, and presence of two or more psychosocial stressors, were associated with occasional, frequent, and daily substance use alike. Conclusions The high prevalence of daily substance use among MHA Intake service users in Nova Scotia highlights the need for prevention and treatment strategies to address individual and structural level factors contributing to daily substance use.

Background Perfectionism is a pivotal factor in the etiology and prognosis of major depression. Nevertheless, there is a scarcity of longitudinal research examining the association between perfectionism and major depressive disorder (MDD). The objective of this study was to explore the impact of perfectionism on MDD among a cohort of first-year Chinese university students. Methods This study employed a longitudinal design to investigate the relationship between perfectionism and MDD in a sample of first-year Chinese university students (n=8079). Socially prescribed perfectionism and almost perfectionism were measured using the Multidimensional Perfectionism Scale (MPS) and the Almost Perfect Scale-Revised (APS-R), while MDD was assessed using the Composite International Diagnostic Interview (CIDI-3.0). Random effects logistic regression modeling was utilized to estimate the associations between the variables. Results The findings revealed that the incidence of MDD was 0.6%. Lifetime exposure to severe traumatic events (≥10) (OR=2.619, 95% CI: 1.502–4.565) and almost perfectionism (OR=1.015, 95% CI: 1.004–1.026) were identified as significant risk factors for MDD. Conclusion It is evident that perfectionism is linked to an increased susceptibility to MDD. However, additional longitudinal studies focusing on university students are imperative to delve deeper into the influence of perfectionism on the initial manifestation of MDD.

Background Youth and young adults have a high prevalence of major depressive disorder (MDD). Limited longitudinal research has explored the relationship between different dimensions of psychological stress and MDD. This study aimed to estimate the effect of psychological stress on the risk of first onset MDD in a sample of Chinese freshmen. Methods Using a longitudinal design, 8079 Chinese first-year students were recruited at baseline, and 6985 were followed up one year later. The Psychological Stress Scale for College Students was utilized to evaluate the levels of psychological stress. MDD was evaluated using the Chinese version of the Composite International Diagnostic Interview (CIDI-3.0). Logistic regression modeling was utilized to estimate the associations between dimensions of psychological stress and the risk of MDD. Results Two dimensions of psychological stress, namely learning stress (OR=1.05, 95% CI:1.01–1.09, P=0.017) and economic stress (OR=1.11, 95% CI:1.04–1.19, P=0.001), were significantly associated with the risk of MDD. Other dimensions of psychological stress (specify family stress, interpersonal stress, intimate relationship stress, employment stress and appearance stress) were not associated with MDD. Conclusion Psychological stress, especially learning and economic stresses, could increase the risk of MDD in university students. These factors should be incorporated into mental health prevention and intervention programs at universities to reduce the risks of MDD.