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Psychometric properties of the Chinese version of the school refusal assessment scale–revised in a clinical sample of adolescents and their caregivers with depressive disorders

School refusal behavior (SRB) is a prevalent and functionally heterogeneous problem among children and adolescents that can lead to serious academic, social, and psychological consequences. The School Refusal Assessment Scale–Revised (SRAS-R) is the most widely used instrument for identifying the functional motivations underlying school refusal, yet its psychometric properties have not been examined in Chinese clinical populations. The present study aimed to translate and culturally adapt the SRAS-R into Chinese and to evaluate its psychometric properties in a clinical sample of adolescents with depressive disorders. A total of 171 adolescent outpatients (age range 12–19 years; M = 15.5, SD = 1.90; 67.3% female) diagnosed with DSM-5 depressive disorders and meeting criteria for school refusal behavior completed both child and parent versions of the Chinese SRAS-R. Confirmatory factor analysis (CFA) using diagonally weighted least squares estimation was conducted. After removing Items 20 and 24, the four-factor model yielded strong CFI and RMSEA values for both parent (CFI = 0.99, RMSEA = 0.021, SRMR = 0.094) and child reports (CFI = 0.98, RMSEA = 0.028, SRMR = 0.097), although SRMR values were marginally above the prespecified threshold. Internal consistency reliability ranged from marginal to good across subscales (Cronbach’s α: parent = 0.664–0.815; child = 0.700–0.864), with parent-reported Factor 4 showing the weakest reliability. Factor 1 (avoidance of aversive school situations) obtained the highest mean scores for both informants, consistent with the depression-related negative affectivity characteristic of this clinical sample. Cross-informant discrepancy analyses revealed that children reported significantly higher scores than parents on Factor 2 (escape from social/evaluative situations; p = .017, d = 0.18) and Factor 4 (pursuit of tangible reinforcement; p <.001, d = 0.27), suggesting that parents may underestimate internally driven motivations. Intraclass correlation coefficients indicated fair to good parent–child agreement (ICC = 0.45–0.62), with the highest agreement for Factor 1 and the lowest for Factor 4. The findings provide initial internal-structure and reliability evidence for the Chinese SRAS-R in this single-site clinical sample and underscore the need for multi-informant assessment, while future studies should examine convergent, discriminant, criterion-related, and predictive validity in more diverse samples.
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Path and Bayesian network analyses in the complex design of a well-being survey via New Zealand’s Integrated Data Infrastructure

IntroductionIn mental health research involved with sensitive features and privacy issues, using integrated data offers an efficient alternative to traditional approaches such as interviews or in−person data collection. These conventional methods frequently face logistical barriers, including low response rates among study populations. Using integrated data from multiple existing administrative and survey sources provides protection for participants and economic savings for researchers, despite being constrained by the limitations of the original data sources. Our research questions were: 1) Can we conduct path and network analyses of school absenteeism, psychosocial factors, and mental health outcomes using the integrated survey data from New Zealand’s Integrated Data Infrastructure (IDI)? and 2) How can we account for the complex design of the General Social Survey (GSS) to ensure representative inference?Materials and methodsThe study population was New Zealand youth enrolled in school, aged 15 years and older in 2018, who participated in the 2018 GSS. The study analyzed the Ministry of Education data integrated with the 2018 GSS survey data from New Zealand’s IDI. To explore the relationship between outcomes of including the WHO-5, “perceived life worthwhileness”, “perceived general health”, and predictors including school absenteeism, psychosocial factors, and family factors, quantile mixed−effects regression, path analysis, and Bayesian network (BN) analysis were used. The complex survey design was calibrated using replicated weights from the GSS, a design-based method for complex sampling, in path and regression analyses, and bootstrap resampling, in BN analysis.ResultsIn descending order from the weighted path model, overall life satisfaction (standardized path coefficient: 0.36), perceived health condition (0.34), ease in accepting cultural identity (0.12), and trust in the education system (0.07) were all significantly (positively) related to students’ mental health well-being (WHO-5). Perceived life worthwhileness correlated with the WHO-5 but was only connected to overall life satisfaction. Similar factors were identified for perceived health, with additional attributing factors, such as fear of crime in the area and the family’s overall well-being.ConclusionThe integration of Bayesian networks and path analysis offers rigorous methods for detecting complex interrelationships among integrated mental health outcomes from population data and variables from a complex survey design.
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Integrated care pathway in individuals with Long COVID: STIMULATE-ICP, a cluster-randomized, phase 3 trial

Nature Medicine, Published online: 28 July 2026; doi:10.1038/s41591-026-04552-x

This cluster-randomized phase 3 trial examining the effectiveness of integrated care pathways comparing usual care with the addition of MRI imaging (Coverscan), or a digitally enabled rehabilitation platform app, or both (Coverscan + app), or neither, found specialist Long COVID care improved fatigue response in all arms.

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Comprehensive Human Vagus Nerve Map Unveiled

Scientists at Northwell Health’s Feinstein Institutes for Medical Research said they have released the world’s first comprehensive human vagus nerve anatomical map. The achievement could change our understanding of the autonomic nervous system and accelerate the development of bioelectronic medicine and neuromodulation therapies, according to the researchers.

The first dataset release, collected over three years from 30 human donors encompassing 60 vagus nerves, is now available to the global scientific community via SPARC Science.

The vagus nerve is the longest cranial nerve and a critical “information superhighway,” consisting of two main bundles (one on the left side of the neck and the other on the right side of the neck) containing more than 200,000 individual nerve fibers stretching from the brainstem to all major organs.

Stavros Zanos, MD, PhD [Feinstein Institutes]
Stavros Zanos, MD, PhD [Feinstein Institutes]

The nerve manages automatic functions such as heart rate, breathing and digestion, and serves as the body’s “on/off switch” for immune response and inflammation. To better understand the function of each vagal fiber, this new dataset resource offers a 3D view into the intricate anatomy of the human vagus nerve, utilizing techniques such as microCT imaging, immunohistochemistry, and ultrasound.

By mapping the organization of fascicles and fibers, investigators expect to gain critical insights into how the vagus nerve communicates with various organs and influences human health and disease.

“This dataset represents a major step forward in bioelectronic medicine, offering the most detailed anatomical reconstruction of the human vagus nerve to date,” said Stavros Zanos, MD, PhD, associate professor in the Institute of Bioelectronic Medicine at the Feinstein Institutes and co-leader of the project. “For the first time, we can visualize the vagus nerve’s complex architecture that will allow us to design more precise, effective and safe neuromodulation therapies and devices.”

The accomplishment marks a milestone that began with a $6.7 million National Institutes of Health (NIH) grant awarded to the Feinstein Institutes in October 2022 for its Reconstructing Vagal Anatomy (REVA) project, part of the NIH Common Fund’s SPARC program. The successful delivery of the map was supported by Peter J. Pappas, Jr., whose donation provided philanthropic support towards the goals of this project.

Kevin J. Tracey, MD [[Feinstein Institutes]
Kevin J. Tracey, MD [Feinstein Institutes]

“Decoding the vagus nerve’s intricate language is an important advance for science and medicine,” said Kevin J. Tracey, MD, president and CEO of the Feinstein Institutes, Karches Family Distinguished Chair in Medical Research and author of the book The Great Nerve: The New Science of the Vagus Nerve and How to Harness Its Healing Reflexes. “This knowledge will further empower researchers to re-engineer human biology and unlock novel therapies for future patients.”

The Feinstein Institutes for Medical Research is a global scientific leader in bioelectronic medicine and vagus nerve stimulation, where medical researchers use modern technology to develop new device-based therapies to treat disease and injury, according to a Feinstein spokesperson, who points out that the field of bioelectronic medicine integrates insights from neuroscience, molecular medicine and biomedical engineering, and researchers at the Feinstein Institutes leverage the connection between the brain and the immune system to develop bioelectronic medicine interventions.

The vagus nerve helps regulate blood pressure, heart rate, sleep, mood, breathing, bladder function, digestion, and the immune system. [Feinstein Institutes]
The vagus nerve helps regulate blood pressure, heart rate, sleep, mood, breathing, bladder function, digestion, and the immune system. [Feinstein Institutes]

The discovery that initiated the field of bioelectronic medicine—called the “inflammatory reflex”—was made more than 30 years ago by Tracey, continues the Feinstein official. This discovery emerged from studies on vagus nerve signaling and showed that the brain and body communicate to regulate inflammation and, if uncontrolled, inflammation could lead to disease, said Tracey.

It was the first FDA-approved vagus nerve stimulation device in July 2025 to treat rheumatoid arthritis. Northwell Health was the first in the nation to implant the newly approved treatment in patients in August 2025.

Today, engineers, computer scientists, immunologists, neuroscientists and clinicians develop cutting-edge medicine, including neuroimmune modulation, miniature implants for stimulating and recording the vagus nerve, noninvasive ultrasound neuromodulation to suppress inflammation, and novel brain-computer interfaces to overcome injuries of the nervous system, according to a Feinstein Institutes statement. These collaborative efforts are focused on converging to create personalized, precise treatments that hold promise in treating acute and chronic diseases, often with fewer side effects compared to current therapies.

Scientists believe these treatments have the potential to enhance or replace existing treatments across a range of conditions such as arthritis, heart disease, inflammatory bowel diseases, diabetes, cancer, and autoimmune disorders. By producing bioelectronic medicine knowledge, disease and injury could one day be treated by our own nerves without costly and potentially harmful pharmaceuticals, predict a number of researchers.

 

 

 

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