Xinshu She

All Publications

• Impact of vision impairment and ocular morbidity and their treatment on quality of life in children: a systematic review. Ophthalmology Li, D., Chan, V. F., Virgili, G., Mavi, S., Pundir, S., Singh, M. K., She, X., Piyasena, P., Clarke, M., Whitestone, N., Patnaik, J. L., Xiao, B., Cherwek, D. H., Negash, H., O'Connor, S., Prakalapakorn, S. G., Huang, H., Wang, H., Boswell, M., Congdon, N. 2023

  Abstract

  This review summarizes existing evidence on the impact of vision impairment and ocular morbidity and their treatment on children's quality of life (QoL).Myopia and strabismus are associated with reduced QoL among children. Surgical treatment of strabismus significantly improves affected children's QoL.We conducted a systematic review and meta-analysis by screening articles in any language in nine databases published from inception through August 22, 2022, for publications addressing the impact of vision impairment, ocular morbidity and their treatment on QoL in children. We reported pooled standardized mean differences (SMDs) using random-effects meta-analysis models. Quality appraisal was done with the Joanna Briggs Institute (JBI) and American National Institutes of Health (NIH) tools. This study was registered with PROSPERO, number CRD42021233323.Our search identified 29 118 articles, of which 44 studies (0.15%) were included for analysis and included 32 318 participants from 14 countries between 2005 and 2022. Seventeen observational and four interventional studies concerned vision impairment, while 10 observational and 13 interventional studies described strabismus and other ocular morbidities. Twenty-one studies were included in the meta-analysis. The QoL scores did not differ between children with and without vision impairment. (standard mean difference [SMD]5, -1.04; 95% confidence interval [CI], -2.11, -0.03, p=0.06, 9 studies). Myopic children demonstrated significantly lower QoL scores than those with normal vision (SMD, -0.60; 95% CI, -1.09, -0.11, p=0.02, 7 studies). Children with strabismus showed a significantly lower QoL score compared to those without (SMD, -1.19; 95% CI, -1.66, -0.73, p<0.001, 7 studies). Strabismus surgery significantly improved QoL in children (SMD, 1.36; 95% CI, 0.48, 2.23, p<0.001,7 studies). No randomized controlled trials concerning refractive error and QoL were identified in this review. Among all included studies, 35 (79.5%) scored as low to moderate quality, the remaining met all quality appraisal tools criteria.Reduced QoL was identified in children with myopia and strabismus. Surgical correction of strabismus improves the QoL of affected children, which supports insurance coverage of strabismus surgery. Further studies, especially randomized controlled trials, investigating the impact of correction of myopia on QoL are needed.

  View details for DOI 10.1016/j.ophtha.2023.09.005

  View details for PubMedID 37696451

• Parenting stress and adolescent academic burnout: the chain mediating role of mental health symptoms and positive psychological traits CURRENT PSYCHOLOGY Liu, C., She, X., Lan, L., Wang, H., Wang, M., Abbey, C., Singh, M. K., Rozelle, S., Tong, L. 2023

  View details for DOI 10.1007/s12144-023-04961-y

  View details for Web of Science ID 001028438100006

• Perceived family support and student outcomes in rural China: a mediation analysis CURRENT PSYCHOLOGY Abbey, C., Xue, H., Kennedy, T., Barket, B., Dai, Q., Ly, T., Su, W., Rozelle, S., Wang, H., She, X., Singh, M. 2023

  View details for DOI 10.1007/s12144-023-04488-2

  View details for Web of Science ID 000975871900002

• Depression, anxiety, stress symptoms and their determinants among secondary students with vision impairment in rural Northwestern China during the COVID-19 pandemic. Frontiers in public health Li, D., Chan, V. F., Wang, H., Zhang, H., Virgili, G., Whitestone, N., Xiao, B., Singh, M. K., She, X., Mackenzie, G., Boswell, M., Mavi, S., Rozelle, S., Congdon, N. 2023; 11: 1282826

  Abstract

  The measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children's mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.A cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.Responses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63-0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81-0.97) and longer study time (OR, 0.82, 95% CI: 0.74-0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08-1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66-0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04-1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85-0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01-1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.28) and older age (OR,1.12, 95% CI: 1.004-1.24).A considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups.

  View details for DOI 10.3389/fpubh.2023.1282826

  View details for PubMedID 38328549

  View details for PubMedCentralID PMC10847594

• Internal Capabilities and External Resources of Academically Resilient Students in Rural China ADVERSITY AND RESILIENCE SCIENCE Abbey, C., Wang, H., Ji, C., Wu, N., Rozelle, S., She, X., Singh, M. 2022; 3 (4): 347-364

  View details for DOI 10.1007/s42844-022-00073-x

  View details for Web of Science ID 001205743600007

• Association between mental health and executive dysfunction and the moderating effect of urban-rural subpopulation in general adolescents from Shangrao, China: a population-based cross-sectional study. BMJ open Lin, Q., Abbey, C., Zhang, Y., Wang, G., Lu, J., Dill, S. E., Jiang, Q., Singh, M. K., She, X., Wang, H., Rozelle, S., Jiang, F. 2022; 12 (8): e060270

  Abstract

  To examine the association between mental health and executive dysfunction in general adolescents, and to identify whether home residence and school location would moderate that association.A population-based cross-sectional study.A subsample of the Shanghai Children's Health, Education, and Lifestyle Evaluation-Adolescents project. 16 sampled schools in Shangrao city located in downstream Yangtze River in southeast China (December 2018).1895 adolescents (48.8% male) which were divided into three subpopulations: (A) adolescents who have urban hukou (ie, household registration in China) and attend urban schools (UU, n=292); (B) adolescents who have rural hukou and attend urban schools (RU, n=819) and (C) adolescents who have rural hukou and attend rural schools (RR, n=784).The Depression Anxiety and Stress Scale-21 was used to assess adolescent mental health symptoms, and the Behaviour Rating Inventory of Executive Function (parent form) was applied to measure adolescent executive dysfunction in nature setting.Mental health symptoms were common (depression: 25.2%, anxiety: 53.0%, stress: 19.7%) in our sample, and the prevalence rates were lower among UU adolescents than those among the RR and RU, with intersubgroup differences in screen exposure time explaining most of the variance. We found the three types of symptoms were strongly associated with executive dysfunction in general adolescents. We also observed a marginal moderating effect of urban-rural subgroup on the associations: UU adolescents with depression (OR 6.74, 95% CI 3.75 to 12.12) and anxiety (OR 5.56, 95% CI 1.86 to 16.66) had a higher executive dysfunction risk when compared with RR youths with depression (OR 1.93, 95% CI 0.91 to 4.12) and anxiety (OR 1.80, 95% CI 1.39 to 2.33), respectively.Rural adolescents experienced more mental health symptoms, whereas urban individuals with mental health problems had a higher executive dysfunction risk.

  View details for DOI 10.1136/bmjopen-2021-060270

  View details for PubMedID 35998954

• Impact of vision impairment and ocular morbidity and their treatment on depression and anxiety in children: A systematic review. Ophthalmology Li, D., Chan, V. F., Virgili, G., Piyasena, P., Negash, H., Whitestone, N., O'Connor, S., Xiao, B., Clarke, M., Cherwek, D. H., Singh, M. K., She, X., Wang, H., Boswell, M., Prakalapakorn, S. G., Patnaik, J. L., Congdon, N. 2022

  Abstract

  TOPIC: This systematic review and meta-analysis summarizes existing evidence to establish whether vision impairment, ocular morbidity and their treatment are associated with depression and anxiety in children.CLINICAL RELEVANCE: Understanding and quantifying these associations support early detection and management of mental health symptoms in children with vision impairment and ocular morbidity. Additionally, this review provides evidence in favour of insurance coverage for timely strabismus surgery.METHODS: We searched nine electronic databases from inception to February 18, 2021, including observational and interventional studies assessing whether vision impairment and/or ocular morbidity and their treatment are associated with depression and/or anxiety in children. We used narrative synthesis and meta-analysis with the residual maximum likelihood method. A protocol was registered and published on The International Prospective Register of Systematic Reviews (PROSPERO, CRD42021233323).RESULTS: Among 28,992 studies, 28,956 (99.9%) were excluded as duplicates or unrelated content. Among 36 remaining studies, 21 (58.3%) were observational studies concerning vision impairment, eight (22.2%) were observational studies concerning strabismus, and seven (19.4%) were interventional studies. Vision-impaired children experienced significantly higher scores of depression (Standard Mean Difference [SMD] 0.57, 95% Confidence Interval (CI) 0.26-0.89, 11 studies) and anxiety (SMD 0.61, 95% CI 0.40-0.821, 14 studies) than normally-sighted children. In particular, myopic children experienced higher scores of depression (SMD 0.59, 95% CI 0.36-0.81, six studies) than normally-sighted children. Strabismus surgery significantly improved symptoms of depression (SMD: 0.59 95% CI 0.12-1.06, three studies) and anxiety (SMD: 0.69 95% CI 0.24-1.14, four studies) in children.DISCUSSION: Among children, vision impairment is associated with greater symptoms of depression and anxiety. Surgical treatment of strabismus improved these symptoms. Further randomized controlled trials exploring the impact of public health measures for myopia correction on mental health in children are needed. Scaling up access to strabismus surgery could improve the mental health of affected children.

  View details for DOI 10.1016/j.ophtha.2022.05.020

  View details for PubMedID 35660416

• Parenting centers and caregiver mental health: Evidence from a large-scale randomized controlled trial in China. Child development Jiang, Q., Dill, S., Sylvia, S., Singh, M. K., She, X., Wang, E., Medina, A., Rozelle, S. 2022

  Abstract

  This study conducts an exploratory analysis of the impacts of a center-based early childhood development intervention on the mental health of caregivers, using data from a cluster-randomized controlled trial of 1664 caregivers (Mage =36.87years old) of 6- to 24-month-old children in 100 villages in rural China. Caregivers and children in 50 villages received individual parenting training, group activities and open play space in village parenting centers. The results show no significant overall change in caregiver-reported mental health symptoms after 1year of intervention. Subgroup analyses reveal heterogeneous effects by caregiver socioeconomic status and identity (mother vs. grandmother). Findings suggest that early childhood development interventions without targeted mental health components may not provide sufficient support to improve caregiver mental health.

  View details for DOI 10.1111/cdev.13782

  View details for PubMedID 35481708

• Internal Capabilities and External Resources of Academically Resilient Students in Rural China Adversity and Resilience Science Abbey, C., Wang, H., Ji, C., Wu, N., Rozelle, S., She, X., Singh, M. K. 2022; Aug 22
• Adolescent mental health disparities in rural Guizhou vs. urban Beijing: A comparative analysis from China Global Pediatrics She, X., Zhao, D., Li, M. 2022; September
• Associations Between Parental Depression, Self-efficacy, and Early Childhood Development in Malnourished Haitian Children. Global pediatric health She, X., Perera, S., Andre, M., St Fleur, J., Hilaire, J., Evans, A., Long, J., Wing, D., Carpenter, C., Wilson, K., Palfrey, J., Stulac, S. 2022; 9: 2333794X221098311

  Abstract

  Background. Haiti lacks early childhood development data and guidelines in malnourished populations. Literature shows that developmental interventions are crucial for improving developmental outcomes malnourished children. This study examines the prevalence of early childhood development delays in a cohort of malnourished Haitian children and their associations with parental depression and self-efficacy. Methods. We used cross-sectional data from 42 patients 6 months to 2 years old in Saint-Marc, Haiti. We assessed their developmental status using the Ages and Stages Questionnaire. Parents were surveyed on depression symptoms and self-efficacy using validated surveys developed for low-resource settings. Demographic and socio-economic data were included. Prevalence of early childhood development delays and high parental depression risk were calculated. Multivariable logistic regression analyses were used to test whether parental depression risk and low self-efficacy were associated with a higher risk for childhood developmental delays. Results. Among participants, 45.2% (SD = 7.7%) of children with a recorded ASQ met age-specific cutoffs for developmental delay in one or more domains. 64.3% (SD = 7.4%) of parents were at high risk for depression. 47.6% (SD = 7.7%) of parents reported relatively low self-efficacy. Multivariable analysis showed that low parental self-efficacy was strongly associated with developmental delays (OR 17.5, CI 1.1-270.0) after adjusting for socioeconomic factors. Parental risk for depression was associated with higher odds (OR 4.6, CI 0.4-50.6) of children having developmental delays but did not reach statistical significance in this study. Conclusion. Parental self-efficacy was protectively associated with early childhood developmental delays in malnourished Haitian children. More research is needed to design contextually appropriate interventions.

  View details for DOI 10.1177/2333794X221098311

  View details for PubMedID 35592789

• Depressive and Anxiety Symptoms among Children and Adolescents in Rural China: A Large-Scale Epidemiological Study International Journal of Environmental Research and Public Health Qi, J., She, X., Sarah, D. E., Silvia, S., Wang, H., Singh, M., Boswell, M., Rozelle, S. 2022; 19 (9): 5026
• Associations Between Parental Depression, Self-efficacy, and Early Childhood Development in Malnourished Haitian Children Global Pediatric Health She, X., Perera, S., Andre, M., Hilaire, J., St Fleur, J., Evans, A., Long, J., Wing, D., Wilson, K., Palfrey, J., Stulac, S. 2022
• Association of Child Mental Health with Child and Family Characteristics in Rural China: A Cross-Sectional Analysis. International journal of environmental research and public health Wang, H., Abbey, C., She, X., Rozelle, S., Ma, X. 2021; 18 (10)

  Abstract

  Assessing the mental health problems encountered by school children and understanding the contributing factors are crucial to inform strategies aimed at improving mental health in low-resource contexts. However, few studies have investigated the mental health problems among disadvantaged children in poorer countries. This study examines the prevalence of mental health problems in rural China and their association with child and family characteristics. The study uses survey data from 9696 children in 120 rural primary schools and measures child mental health using the Strengths and Difficulties Questionnaire (SDQ). Overall, 17.9% of the sample children were found to be in the abnormal range of the SDQ total difficulties scores. The mean score was 12.93 (SD = 4.94). Abnormal scores were associated with child and family characteristics, including older child age (Odds Ratio, OR = 0.704, 95% CI: 0.611, 0.810; p < 0.001), gender (OR = 1.235, 95% CI: 1.112, 1.371; p < 0.001), and academic performance (OR = 0.421, 95% CI: 0.369, 0.480; p < 0.001). Reading time was found to be protective for mental health. Risk factors include excessive screen time (OR = 1.685, 95% CI: 1.409, 2.016; p < 0.001) and being bullied (OR = 3.695, 95% CI: 3.301, 4.136; p < 0.001). Our study suggests that future mental health illness prevention programs in rural China should consider targeting different aspects of children's social contexts.

  View details for DOI 10.3390/ijerph18105107

  View details for PubMedID 34065853

• Perinatal Mental Health Problems in Rural China: The Role of Social Factors. Frontiers in psychiatry Jiang, Q., Guo, Y., Zhang, E., Cohen, N., Ohtori, M., Sun, A., Dill, S., Singh, M. K., She, X., Medina, A., Rozelle, S. D. 1800; 12: 636875

  Abstract

  Background: Perinatal mental health is important for the well-being of the mother and child, so the relatively high prevalence of perinatal mental health problems in developing settings poses a pressing concern. However, most studies in these settings focus on the demographic factors associated with mental health problems, with very few examing social factors. Hence, this study examines the prevalence of the depressive, anxiety and stress symptoms among pregnant women and new mothers in rural China, and the associations between these mental health problems and social factors, including decision-making power, family conflicts, and social support. Methods: Cross-sectional data were collected from 1,027 women in their second trimester of pregnancy to 6 months postpartum in four low-income rural counties in Sichuan Province, China. Women were surveyed on symptoms of mental health problems using the Depression, Anxiety, and Stress Scale (DASS-21) and social risk factors. Multivariate logistic regression analyses were conducted to examine social risk factors associated with maternal mental health problems, with results reported as odds ratios (OR) and 95% confidence intervals (CI). Results: Among all respondents, 13% showed symptoms of depression, 18% showed symptoms of anxiety, 9% showed symptoms of stress, and 23% showed symptoms of any mental health problem. Decision-making power was negatively associated with showing symptoms of depression (OR = 0.71, CI: 0.60-0.83, p < 0.001) and stress (OR = 0.76, CI: 0.63-0.90, p = 0.002). Family conflict was positively associated with depression (OR = 1.53, CI: 1.30-1.81, p < 0.001), anxiety (OR = 1.34, CI: 1.15-1.56, p < 0.001), and stress (OR = 1.68, CI: 1.41-2.00, p < 0.001). In addition, social support was negatively associated with depression (OR = 0.56, CI: 0.46-0.69, p < 0.001), anxiety (OR = 0.76, CI: 0.63-0.91, p = 0.002), and stress (OR = 0.66, CI: 0.53-0.84, p < 0.001). Subgroup analyses revealed that more social risk factors were associated with symptoms of anxiety and stress among new mothers compared to pregnant women. Conclusion: Perinatal mental health problems are relatively prevalent among rural women in China and are strongly associated with social risk factors. Policies and programs should therefore promote individual coping methods, as well as target family and community members to improve the social conditions contributing to mental health problems among rural women.

  View details for DOI 10.3389/fpsyt.2021.636875

  View details for PubMedID 34950062

• Pediatricians Also Need to Follow Good Advice and Get Some Rest She, X. American Academy of Pediatrics Voices Blog. 2021
• Elevated Blood Lead Levels in Infants and Children in Haiti, 2015. Public health reports (Washington, D.C. : 1974) Carpenter, C., Potts, B., von Oettingen, J., Bonnell, R., Sainvil, M., Lorgeat, V., Mascary, M. C., She, X., Jean-Baptiste, E., Palfrey, S., Woolf, A. D., Palfrey, J. 2018: 33354918807975

  Abstract

  Few studies have reported blood lead levels (BLLs) in Haitian children, despite the known presence of lead from environmental factors such as soil, water, leaded paint and gasoline, improperly discarded batteries, and earthquakes. We sought to determine the prevalence of elevated blood lead levels (EBLLs) among healthy Haitian children.We enrolled children aged 9 months to 6 years from 3 geographic areas in Haiti (coastal, urban, and mountain) from March 1 through June 30, 2015. We obtained anthropometric measurements, household income, potential sources of lead exposure, and fingerstick BLLs from 273 children at 6 churches in Haiti. We considered a BLL ≥5 μg/dL to be elevated.Of 273 children enrolled in the study, 95 were from the coastal area, 78 from the urban area, and 100 from the mountain area. The median BLL was 5.8 μg/dL, with higher levels in the mountain area than in the other areas ( P < .001). BLLs were elevated in 180 (65.9%) children. The prevalence of EBLL was significantly higher in the mountain area (82 of 100, 82.0%; P < .001) than in the urban area (42 of 78, 53.8%) and the coastal area (56 of 95, 58.9%; P < .001). Twenty-eight (10.3%) children had EBLLs ≥10 μg/dL and 3 (1.1%) children had EBLLs ≥20 μg/dL. Exposure to improperly discarded batteries ( P = .006) and living in the mountain area ( P < .001) were significant risk factors for EBLLs.More than half of Haitian children in our study had EBLLs. Public health interventions are warranted to protect children in Haiti against lead poisoning.

  View details for DOI 10.1177/0033354918807975

  View details for PubMedID 30426830

• Art in Healing: A Quality Improvement Project for Inpatient Pediatrics in Haiti She, X., Andre, M., Hilaire, J., Wilson, K., Palfrey, J., St-hilaire, R. AMER ACAD PEDIATRICS. 2018

  View details for DOI 10.1542/peds.141.1_MeetingAbstract.450

  View details for Web of Science ID 000540809200454

• Measuring the Gap: A Health Assessment of Rural Chinese Children Compared to Urban Children. Global pediatric health She, X., Zhao, D., Scholnick, J. 2016; 3: 2333794X15625298-?

  Abstract

  China is a large country where rapid development is accompanied by growing inequalities. How economic inequalities translate to health inequalities is unknown. Baseline health assessment is lacking among rural Chinese children. We aimed at assessing baseline student health of rural Chinese children and comparing them with those of urban children of similar ages. A cross-sectional study was conducted using the 2003 Global School-Based Student Health Survey among 100 students Grade 4 to 6 from rural Guizhou, China. Results were summarized and compared with public data from urban Beijing using multivariate logistic regression models. Rural children are more likely to not wash their hands before a meal (odds ratio [OR] = 5.71, P < .01) and after using the toilet (OR = 5.41, P < .01). They are more likely to feel sick or to get into trouble after drinking (OR = 7.28, P < .01). They are more likely to have used drugs (OR = 8.54, P < .01) and to have no close friends (OR = 8.23, P < .01). An alarming percentage of rural (8.22%) and urban (14.22%) children have had suicidal ideation in the past year (OR = 0.68, P > .05). Rural parents are more likely to not know their children's whereabouts (OR = 1.81, P < .05). Rural children are more than 4 times likely to have serious injuries (OR = 4.64, P < .01) and to be bullied (OR = 4.01, P < .01). In conclusion, school-age rural Chinese children exhibit more health risk behaviors and fewer protective factors at baseline compared to their urban counterparts. Any intervention aimed at improving child health should take this distributive gap into consideration.

  View details for DOI 10.1177/2333794X15625298

  View details for PubMedID 27335999

  View details for PubMedCentralID PMC4784561

• Dispatch from Haiti: We can do better on childhood vaccination coverage She, X. Boston Children’s Hospital’s Clinical Health Blog. 2015
• An innovative AIDS education curriculum for fifth-grade students Carolan, H., Amaize, M. A., Riser, T., Schuettinger, K., She, X., Takruri, A., Zariv, S. New Orleans Department of Health Policy and AIDS Funding. 2010