To examine the change trends in health literacy levels among Chinese residents from 2016 to 2024, providing evidence for the formulation of health policies and health education interventions.

Utilizing health literacy monitoring data of Chinese residents from 2016 to 2024,this study employed the Mantel-Haenszel chi-square test for trend and linear trend regression models.It analyzed the changing characteristics of health literacy across urban and rural areas,the eastern,central,and western regions,as well as three aspects(basic knowledge and concepts,healthy lifestyles and behaviors,and basic skills) and six categories of health literacy issues (safety and first aid,scientific health concepts,health information,chronic disease prevention and control,basic medical care,and infectious disease prevention and control).

From 2016 to 2024, the health literacy levels of Chinese residents were 11.58%,14.18%,17.06%,19.17%,23.15%,25.40%,27.78%,29.70%,and 31.87%,respectively.The cumulative increase over the nine years was 20.29%,with an average annual growth rate of 13.65%.A rising trend in national health literacy levels was observed from 2019 to 2020.Disparities existed among different regions,with the eastern region having the highest level and the western region the lowest.Notably,the rate of improvement in health literacy among residents in the central region after 2019 was faster than in other regions.The residents in rural areas experienced rapid and substantial growth in health literacy,with the urban-rural gap gradually narrowing from 2022 onwards.A "know-do" gap was identified among the three aspects of health literacy.All six categories of health literacy issues showed upward trends,with significant increases in basic medical care and infectious disease prevention and control literacy between 2019 and 2020.Chronic disease prevention literacy and health information literacy grew at a relatively faster pace.

The health literacy level of Chinese residents demonstrated a sustained and steady upward trend from 2016 to 2024.Future health promotion efforts should adhere to region-specific and tiered implementation principles,with targeted enhancements in key dimensions such as basic skills,basic medical care,and infectious disease prevention and control.While maintaining the current growth rate,greater emphasis should be placed on the qualitative improvement of health literacy.

To investigate the current status of pulmonary rehabilitation implementation for patients undergoing extracorporeal membrane oxygenation (ECMO) in 30 intensive care units(ICU) in Anhui province,and to analyze its influencing factors.

In December 2024,30 ICU units from 29 hospitals in Anhui Province were selected.A self-designed questionnaire on the current status of pulmonary rehabilitation implementation for ECMO patients was used for the survey.

Among the 30 ICU units,24(80.00%) conducted systematic assessments before initiating ECMO pulmonary rehabilitation.The assessment and implementation personnel were primarily ICU physicians,nurses,and respiratory therapists.Basic pulmonary rehabilitation techniques were widely applied; however,participation by rehabilitation therapists was insufficient,and the application of advanced techniques was limited.Overall,the standards for the implementation process were incomplete.Besides basic pulmonary rehabilitation,13 ICU units (43.33%) implemented pulmonary rehabilitation during ECMO support.There were statistically significant differences between ICU units implementing pulmonary rehabilitation and those not implementing pulmonary rehabilitation in terms of the number of ECMO cases performed in the past year,availability of rehabilitation therapists,pulmonary rehabilitation implementation protocols,and presence of emergency response plans for pulmonary rehabilitation(P<0.05).Reasons for not implementing pulmonary rehabilitation during ECMO included insufficient experience (100.00%),safety concerns(88.24%),prioritizing treatment over rehabilitation (70.59%),and lack of an implementation team(58.82%).

Pulmonary rehabilitation for ECMO patients in tertiary hospitals in Anhui province has achieved a certain foundation.However,further improvements are needed in resource allocation,multidisciplinary collaboration,process standardization,and family involvement to enhance the implementation rate and level of pulmonary rehabilitation for ECMO patients.

To explore the application effect of an exercise nudge program based on the theory of planned behavior in patients undergoing adjuvant chemotherapy after colorectal cancer surgery.

A total of 56 colorectal cancer patients undergoing postoperative adjuvant chemotherapy in a tertiary grade A hospital in Shanghai were selected as the study subjects.They were randomly divided into an intervention group and a control group,with 28 cases in each group.The control group received routine follow-up and guidance from a health education booklet.The intervention group received an exercise nudge program based on the theory of planned behavior.The intervention lasted for 12 weeks.Exercise adherence,exercise self-efficacy,6-minute walk test,and grip strength were evaluated in both groups.The incidence of adverse events during exercise was also compared between the two groups.

The interaction effects between time and group on overall exercise adherence and adherence in various dimensions were statistically significant(P<0.05).The time effect, group effect, and interaction effect on exercise self-efficacy scores were statistically significant(P<0.001).The time effect and interaction effect on the 6-minute walk test and grip strength were statistically significant(P<0.001).The incidence of muscle soreness and cardiac discomfort in the intervention group was lower than that in the control group(P<0.05).

The exercise intervention combining nudge strategy and the theory of planned behavior is safe and feasible.It helps improve exercise self-efficacy and exercise adherence in colorectal cancer chemotherapy patients and enhances their physical function.

To explore the implementation effect of chain management led by stoma specialty nurses in patients with temporary enterostomy undergoing adjuvant chemoradiotherapy,aiming to enhance their comprehensive management and early postoperative recovery.

A total of 67 patients scheduled for temporary enterostomy and adjuvant chemoradiotherapy admitted to the Gastrointestinal Surgery Department of our hospital from June 2022 to October 2023 were selected as the control group and received routine care.Another 67 patients from November 2023 to October 2024 were selected as the experimental group.Led by stoma specialty nurses,a two-dimensional management system was constructed,integrating a horizontal organizational management chain and a vertical service chain.This system linked three key phases,perioperative,chemoradiotherapy,and home intermission periods,to implement chain management for enterostomy patients.Comparisons were made between the two groups regarding the incidence of postoperative stoma-related complications,unplanned readmission rates,and quality of life(COH-QOL-OQ) scores at discharge and three months post-discharge.

The incidence of postoperative stoma-related complications was lower in the experimental group than that in the control group(8.96% vs.34.34%,P<0.001).At discharge and 3 months post-discharge,the physical health,mental health,social health,and spiritual health scores of the COH-QOL-OQ were significantly higher in the intervention group than those in the control group(P<0.001).The unplanned readmission rates of the experimental group(1.49%) and the control group(5.97%) showed no statistically significant difference(P=0.362).

The chain management model led by specialty nurses could reduce the risk of stoma-related complications,improve patient quality of life.And it could provide a reference for implementing systematic and continuous management strategies for patients with temporary enterostomy undergoing adjuvant chemoradiotherapy.

To explore the dynamic change trajectories of disease information needs,psychological needs, and social needs in breast cancer patients undergoing chemotherapy,and to identify the influencing factors for each trajectory category, thereby providing a basis for developing precise clinical interventions.

A convenience sampling method was used to select 146 breast cancer patients undergoing their first chemotherapy session.A longitudinal follow-up survey was conducted over eight chemotherapy cycles(T1-T8) using the Breast Cancer Patients Needs Scale and the Benefit Finding Scale. Latent class growth modeling was applied to analyze the change trajectories of the three types of needs, and multinomial logistic regression was used to explore the influencing factors of the trajectory categories.

The three types of needs in breast cancer patients undergoing chemotherapy all showed a declining trend with population heterogeneity:1) Two trajectory categories were identified for disease information needs:low information needs declining group(58.2%) and high information needs declining group(41.8%);2) Three trajectory categories were identified for psychological needs: low psychological needs group(35.6%),moderate psychological needs group(41.8%),and high psychological needs group(22.6%);3) Two trajectory categories were identified for social needs:low social needs group(69.2%) and high social needs group(30.8%).Multivariate analysis showed that surgery and benefit finding were influencing factors for the disease information needs trajectory(both P<0.05);comorbidities with other chronic diseases and benefit finding were influencing factors for the psychological needs trajectory(both P<0.05);comorbidities with other chronic diseases,metastasis,and benefit finding were influencing factors for the social needs trajectory(all P<0.05).

The change trajectories of the three types of needs in breast cancer patients undergoing chemotherapy exhibit population heterogeneity.And they are influenced by different factors.Clinical staff can combine the characteristics of patients' need trajectories and influencing factors to implement targeted interventions, continuously meeting patients' dynamic needs.

To investigate the key risk factors for secondary ectopics of catheter after central venous catheter insertion(PICC) through peripheral veins,and to construct and validate a risk prediction model based on the random forest algorithm.

The data of 590 preterm infants hospitalized in the department of neonatology of a tertiary specialty hospital in Shanxi province with PICC catheterization were retrospectively collected,and the data were randomly divided into training set(n=413) and validation set(n=177) in a ratio of 7∶3.Eighteen clinical indicators were selected as predictors for whether secondary ectopic of the catheter occurred at the tip after PICC catheterization in preterm infants.Based on the random forest algorithm,a risk prediction model for secondary ectopic ectopic of PICC catheters in preterm infants was constructed,the importance of risk factors was ranked,and a SHAP plot was plotted to explain the contribution of each variable to the prediction of model output.The confusion matrix analysis of the model was carried out using the validation set data,and the prediction effect of the model was evaluated by using the accuracy,sensitivity,specificity and receiver operating characteristic(ROC) curves.

The incidence of secondary ectopic of PICC catheter in 413 preterm infants in the training set was 39.0%,and the key factors screened by the random forest algorithm were the first X-ray localization result,secondary catheter fixation,mechanical ventilation,and weight gain rate,respectively.In the validation set,the accuracy of the risk prediction model was 81.92%,the sensitivity was 71.21%,the specificity was 88.29%,the positive predictive value was 78.33%,the negative predictive value was 83.76%,and the AUC value was 0.870(95%CI:0.817-0.923).

The risk prediction model constructed based on the random forest algorithm demonstrates good predictive performance.It could potentially provide a scientific basis for the safe and efficient clinical use of PICC in premature infants.

To explore the latent profiles of cognitive function in lung cancer patients and their influencing factors.

A total of 296 lung cancer patients who visited the oncology department of a tertiary grade A hospital in Chongqing from January to August 2025 were selected as the survey subjects.General information questionnaire,Functional Assessment of Cancer Therapy-Cognitive Function Scale,Exercise Adherence Scale,and Self-Rating Anxiety Scale were used for investigation.Latent profile analysis was employed to explore the latent profiles of cancer-related cognitive impairment,while univariate analysis and multinomial Logistic regression analysis were used to investigate the influencing factors of latent profiles in cancer-related cognitive impairment patients.

Cancer-related cognitive impairment patients could be classified into three latent profiles:high cognitive function group(67.2%),moderate cognitive function group(22.6%),and low cognitive function group(10.1%).Multinomial Logistic regression results showed that educational level,tumor stage,age,exercise adherence,and anxiety were influencing factors of latent profiles of cognitive function in lung cancer patients(all P<0.05).

Cancer-related cognitive function in lung cancer patients exhibits group heterogeneity.It suggests that healthcare professionals should develop more targeted intervention measures based on the influencing factors of different categories of lung cancer patients' cognitive function levels.

To focus on the appropriateness of long-term care insurance(LTCI) financing levels. It measured the coordination between LTCI financing levels and regional economic capacity,as well as aging pressure.The goal is to provide empirical evidence and policy recommendations for sustainable LTCI development.

We built a coupling coordination degree model with three subsystems:financing level,economic development,and population structure.We selected three cities as samples:city X(northern Jiangsu),city N(central Jiangsu),and city C(southern Jiangsu).Data came from field surveys, statistical yearbooks,and government reports.We used the entropy method to determine indicator weights.We calculated composite indices for each subsystem and assessed the coupling coordination levels.

The results showed significant regional differences and dynamic changes.City N improved steadily and reached a "barely coordinated" stage.City X remained trapped in a state of "slight imbalance" at the antagonistic stage, plagued by the "scissors effect" between fixed-amount financing, population outflow,and rising service costs.In contrast,economically developed city C experienced a mismatch between high economic carrying capacity and low financing levels due to the rigid model of "fixed contributions coupled with medical insurance dependency," causing its coupling coordination degree to shift from "slight imbalance" to "on the verge of imbalance".

The appropriateness of LTCI financing depends on multiple factors.These include financing mechanisms,population structure,and payment structures.It is also closely linked to regional economic development.We recommend establishing a long-term "proportional financing+dynamic adjustment" mechanism.We also suggest implementing region-specific strategies based on a two-dimensional matrix of "economic level+aging degree".Finally,we propose optimizing the linkage between payment structures and financing mechanisms.

To investigate the correlation between handgrip strength and quality of life in cancer patients,and to analyze gender differences.

A total of 291 cancer patients hospitalized in the oncology department of a hospital in Guangxi Zhuang Autonomous Region from October 2023 to January 2024 were selected.A survey was conducted using a general information questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30(EORTC QLQ-C30).Patients' handgrip strength was measured,and nutritional risk was assessed using the Nutritional Risk Screening 2002 (NRS2002).Spearman correlation analysis was used to analyze the correlation between handgrip strength and quality of life in cancer patients of different genders,and linear regression analysis was further used to explore the impact of handgrip strength on patients' quality of life.

In male cancer patients,handgrip strength was positively correlated with functional domain scores and global health status scores(P<0.05),and negatively correlated with fatigue and pain scores in the symptom domain(P<0.05).In female cancer patients, handgrip strength was negatively correlated with the single-item scores for appetite loss and diarrhea(P<0.05),and positively correlated with financial difficulties scores(P<0.05).The multivariate regression model after adjusting for confounding factors showed that in male patients, greater handgrip strength was associated with higher scores in functional domains and global health status(P<0.05),and lower fatigue scores in the symptom domain(P<0.05).In female patients,greater handgrip strength was associated with lower scores for appetite loss and higher scores for financial difficulties(P<0.05).

Handgrip strength has an impact on function,fatigue,and global health status in male cancer patients,and on appetite loss and financial difficulties in female cancer patients.As a simple and objective measurement indicator,handgrip strength can be used for the auxiliary assessment of quality of life in cancer patients.

To systematically review the research status,hotspots,frontiers,and development trends in the field of elderly care service personnel training both based on bibliometric methods,providing theoretical support and practical references for the localized construction and high-quality development of China's elderly care service personnel training system.

Using the Web of Science core collection and CNKI(China National Knowledge Infrastructure) as data sources,relevant literature published from January 1,1999 to May 26,2025 was retrieved.A total of 1 147 valid documents(394 English,753 Chinese) were visually analyzed using CiteSpace 6.4.R1 software.This included analysis of the temporal characteristics of publication volume,author and institutional collaboration networks,as well as comparative studies of keyword co-occurrence,clustering(all Q values>0.3,all S values>0.7),timeline dynamic evolution,and keyword bursts.

Chinese literature publication volume showed a significant growth trend in the past decade(reaching 90 articles in 2024),while English literature publication volume stabilized after 2007(peaking at 38 articles in 2021).Core issues identified in both Chinese and English literature include three aspects:research subjects were predominantly focused on nursing,with insufficient attention paid to multidisciplinary talents such as clinical medicine and rehabilitation therapy;author and institutional collaboration networks were loose,and a medical-education collaboration model had not yet been formed;significant regional disparities existed,with higher research activity in developed countries and China's first-tier cities.Hotspot comparisons revealed that Chinese literature focuses on the integration of medical and elderly care,industry-education integration,smart elderly care,and policy-driven personnel team building,whereas English literature emphasized long-term care,end of life care,advance care planning,and service quality assessment.

Training personnel for elderly care services is a crucial link in addressing population aging.The differences and frontier trends in Chinese and English literature revealed by this study can provide important references for China to build a localized,multidisciplinary,and medically-educationally integrated elderly care personnel training system,thereby facilitating the high-quality development of elderly care services.

To systematically review evidence on parental stress management on child care for extremely low birth weight premature infants after discharge,providing reference for healthcare professionals to develop effective and targeted intervention measures.

Systematic searches were conducted in the Cochrane Library,Web of Science,PubMed,CNKI,Wanfang Data,VIP,CBM,guideline databases,and professional association websites for clinical practice guidelines,expert consensuses,evidence summaries,systematic reviews,and clinical decisions related to parental stress management on child care for extremely low birth weight premature infants after discharge.Two researchers independently evaluated the quality of the literature,extracted,integrated,and graded the evidence.

A total of 14 articles were included,comprising 4 guidelines,2 clinical decisions,2 evidence summaries,3 systematic reviews,and 3 expert consensuses.Thirty pieces of evidence were summarized across four aspects:parental mental health support,family and social support and resource security,discharge preparation and education training,and continuous support after discharge.

Healthcare professionals should apply this evidence in combination with specific contexts and choose targeted measures to help parents better cope with parenting challenges and improve the quality of life for extremely low birth weight premature infants and their families.

To systematically evaluate the risk factors for the occurrence of colorectal polyps.

A computerized search was conducted in CNKI,VIP,WanFang Database,CBM,PubMed,Cochrane Library,and EMbase Database for studies on the risk factors of colorectal polyps.The search period spanned from the establishment of the databases to June 2,2025.Two researchers independently performed literature screening,quality assessment,and data extraction.Meta-analysis was conducted using Review Manager 5.4 software,and Egger's test was performed using Stata 18.0 software.

A total of 29 studies were included,involving 9 987 patients.The results of the meta-analysis showed that age[OR=1.08,95%CI(1.06,1.11)],male[OR=1.63,95%CI(1.43,1.85)],smoking[OR=1.93,95%CI(1.68,2.21)],alcohol consumption[OR=1.58,95%CI(1.36,1.83)],abnormal triglycerides[OR=1.65,95%CI(1.43,1.90)],obesity[OR=1.67,95%CI(1.31,2.12)],fatty liver[OR=2.87,95%CI(1.87,4.40)],diabetes[OR=3.34,95%CI(2.10,5.31)],high-fat diet[OR=3.27,95%CI(2.24,4.78)],helicobacter pylori infection[OR=1.71,95%CI(1.38,2.13)],abnormal uric acid[OR=1.57,95%CI(1.22,2.03)],gallbladder disease[OR=1.78,95%CI(1.43,2.23)],family history of cancer[OR=2.43,95%CI(1.61,3.68)],abnormal cholesterol[OR=1.92,95%CI(1.39,2.65)],waist circumference[OR=1.71,95%CI(1.04,2.80)],hyperlipidemia[OR=1.54,95%CI(1.23,1.93)],and family history of polyps[OR=8.27,95%CI(2.22,30.86)] were risk factors for the occurrence of colorectal polyps.

There are many risk factors for colorectal polyps.Medical staff should enhance awareness of disease screening and provide personalized and precise intervention through a multidisciplinary integration model,reduce the incidence of precancerous polyps and alleviate the disease burden.

To translate the Patient Readiness for Shared Decision-Making Questionnaire(Ready^SDM) into Chinese and to test its reliability and validity among cancer patients in China.

A research team was formed.The original questionnaire underwent forward translation,back-translation,cross-cultural adaptation,and a pilot study following the Brislin translation model,culminating in the Chinese version of the Ready^SDM.A survey was conducted among 383 cancer patients from a tertiary hospital in Zhengzhou to evaluate the reliability and validity of the Chinese version of the Ready^SDM.

Exploratory factor analysis extracted four common factors,explaining 70.063% of the total variance.Confirmatory factor analysis indicated a good model fit.The finalized Chinese version of the Ready^SDM comprises 18 items across four dimensions:Information on Treatment Options,Communication with Healthcare Providers,Feelings and Experiences in the Decision-Making Process,and Decision-Making Preferences and Willingness.The item-level content validity index ranged from 0.875 to 1.000,and the scale-level content validity index was 0.988.The overall Cronbach's α coefficient for the questionnaire was 0.927,and the split-half reliability coefficient was 0.809.

The Chinese version of the Ready^SDM demonstrates good reliability,validity,and practicality.It is suitable for assessing the readiness for shared decision-making among Chinese cancer patients and can serve as an effective tool to advance shared decision-making practices in clinical settings.

To develop an exercise adherence scale for maintenance hemodialysis(MHD) patients based on behavioral change theory and test its reliability and validity,aiming to provide a tool for measuring exercise adherence in MHD patients.

Guided by the Capability-Opportunity-Motivation Behavior(COM-B) model and the Theoretical Domains Framework(TDF),an initial item pool was constructed through literature review and semi-structured interviews.The initial version of the scale was determined after two rounds of Delphi expert consultations(n=20).Item selection was conducted based on survey results from 293 MHD patients,followed by validity and reliability testing in another sample of MHD patients.

The developed exercise adherence scale for maintenance hemodialysis patients consisted of two parts:Part 1 is the exercise adherence process subscale for MHD,including three dimensions(capability,opportunity,motivation) with 35 items;Part 2 is the exercise adherence outcome subscale for MHD,a single dimension with 12 items.Exploratory factor analysis extracted three common factors,with a cumulative variance contribution rate of 57.706%;confirmatory factor analysis showed good model fit;the Cronbach's α coefficient for the process subscale was 0.954,split-half reliability was 0.712,and test-retest reliability was 0.907;the test-retest reliability for the outcome subscale was 0.932.

The developed exercise adherence scale for maintenance hemodialysis patients demonstrates good reliability and validity and can be used to assess exercise adherence in MHD patients.

To analyze the characteristics of the Braden Scale using the Rasch model and to evaluate its applicability in critically ill AIDS patients,so as to provide a reference for developing a Braden Scale with an overall difficulty level that aligns with the actual conditions of critically ill AIDS patients.

A cross-sectional survey was conducted involving 104 critically ill AIDS patients from the second intensive care unit of Chengdu Public Health Clinical Medical Center.The Braden Scale was used for assessment,and the measurement results were analyzed using the Rasch model.

The person reliability of the Braden Scale was 0.70,the item reliability was 0.99,and the internal consistency was 0.838.The Rasch score explained 27% of the variance,with the first component standardized residual eigenvalue being 1.6.The Braden Scale items were independent,demonstrating good unidimensionality and internal fit(infit MNSQ range:0.58-1.23).However,the "sensory perception" item showed poor fit with the Rasch model(outfit MNSQ=2.37).The difficulty gradients and differences between the options of the Braden Scale items were uneven.

The Braden Scale is a unidimensional tool with good reliability.However,its overall difficulty level does not align well with the capabilities of critically ill AIDS patients.It is recommended to appropriately reduce the difficulty of certain items and adjust the difficulty gradients between items to ensure uniform difficulty differences,thereby improving the applicability of the Braden Scale in critically ill AIDS patients.

To translate the Nighttime Collaboration Difficulties between Nurses and Physicians for Nurses(NCDNP-N) into Chinese and to test its reliability and validity.

Following Brislin's translation model,the original English scale underwent forward translation,back-translation,and cross-cultural adaptation.After a pre-test,the Chinese version of the NCDNP-N was formed.A convenience sample of 448 nurses was selected to evaluate the scale's reliability and validity.

The Chinese version of the NCDNP-N showed the item-level content validity index(I-CVI) ranging from 0.83 to 1.00,and the scale-level content validity index(S-CVI/Ave) of 0.98.Exploratory factor analysis extracted three common factors with eigenvalues greater than 1,namely "barriers to night shift handover","dissatisfaction with night shift physicians' behaviors",and "burden of collaboration with night shift physicians",which cumulatively accounted for 85.749% of the total variance.Confirmatory factor analysis results indicated a good model fit.The scale's Cronbach's α coefficient was 0.917,split-half reliability was 0.812,and test-retest reliability was 0.886.

The Chinese version of the NCDNP-N demonstrates good reliability and validity.And it can be used to measure the level of nighttime collaboration difficulties between nurses and physicians in China.

To analyze the influence of spousal cognition on organ donation willingness among medical staff,providing a reference for standardizing organ donation practices and improving actual donation rates.

A non-probability sampling method was used to conduct a questionnaire survey on organ donation cognition and spousal donation willingness among medical staff couples.A multiple linear regression model was employed to analyze the impact of spousal organ donation cognition on donation willingness.

The median organ donation cognition score of potential donors among medical staff was 3.70(3.30,4.00),while the median spousal cognition score was 3.50(3.20,3.80).The median organ donation willingness score of potential donors was 4.32(3.94,4.94),and the median spousal donation willingness score was 4.18(3.71,4.65).Multivariate analysis revealed that clarity regarding the purpose of organ donation,duration of marriage,frequency of participation in organ donation public welfare activities,and the spousal organ donation cognition score were significant factors influencing the organ donation willingness of potential donors(P<0.05).

There is a disparity in organ donation cognition between medical staff and their spouses.Enhancing spousal communication, improving spousal cognition through multiple channels,and maintaining a stable marital relationship contribute to fostering more supportive attitudes from spouses towards potential posthumous organ donation.

To investigate the application effect of outpatient short-term automatic thought recognition training in patients with comorbid anxiety and depression,and to provide references for optimizing outpatient treatment strategies.

A total of 82 patients with comorbid anxiety and depression were divided into an automatic thought training combined with pharmacotherapy group(combined treatment group,37 cases) and a pharmacotherapy alone group(medication alone group,45 cases).The Hamilton Anxiety Scale(HAMA) and Hamilton Depression Scale(HAMD) were used as primary outcome measures.A linear mixed-effects model was used to compare symptom changes between the two groups from the first outpatient visit to the last outpatient visit.

The linear mixed-effects model showed a statistically significant group-by-time interaction effect for HAMD total scores between the two groups(P<0.001).The combined treatment group showed greater changes in depression total scores at the end of 4 weeks and 8 weeks of treatment compared with the medication alone group(P<0.05).The combined treatment group also showed greater changes in anxiety total scores at the end of 8 weeks compared with the medication alone group(P=0.02).

In patients with comorbid anxiety and depression,combined automatic thought training demonstrates better clinical efficacy in symptom improvement compared with pharmacotherapy alone.