The audiologic characteristics for children with cochlear nerve deficiency and the association with the outcome of cochlear implant surgery.

Anxiety and depressive disorders have become major mental health problems contributing to the global burden of disease. Global burden of disease data indicate that more than 1 billion people worldwide live with mental disorders, among which anxiety disorders and depressive disorders are the most common types. Anxiety and depression not only reduce individuals’ quality of life and social functioning, but also impose a heavy burden on public health systems and socioeconomic development. In China, a national epidemiological survey showed that the lifetime prevalence of any mental disorder among adults was approximately 16.6%, with depressive disorders and anxiety disorders being the main types of emotional disorders. Meanwhile, the accelerated process of population aging and the high prevalence of chronic non-communicable diseases have further compounded mental health risks among residents. Existing studies have shown that residents’ mental health status is closely related to physical health status, subjective health evaluation, and health-related literacy, suggesting the need to explore the mechanisms influencing mental health outcomes from the perspectives of physical health, mental health cognition, and integrated health. Self-rated health (SRH) is a comprehensive health indicator commonly used in community surveys. It can integrate physical symptoms, functional status, and psychological experience, reflecting individuals’ subjective evaluation of their overall health. Previous studies have shown that poorer SRH is associated not only with physical outcomes such as mortality, chronic diseases, and functional limitations, but also with depression, anxiety, and their co-occurrence. A cross-lagged analysis based on China Health and Retirement Longitudinal Study (CHARLS) data showed a bidirectional association between SRH and depressive symptoms, and SRH could predict subsequent depression; follow-up studies from other countries have also suggested that SRH can predict future risks of depression and anxiety. Studies based on samples of older adults and community surveys in China have shown that individuals with co-occurring depression and anxiety have poorer SRH, and those with poorer SRH have higher detection rates of psychological symptoms. In addition, other studies have also suggested that chronic diseases may affect anxiety and depressive states through pathways such as pain, functional limitation, economic pressure, and health uncertainty. In recent years, anxiety-depression comorbidity (ADC) has gradually been regarded as a mental health state with independent public health significance. A systematic review indicated that comorbid levels of depressive and anxiety symptoms may interact with each other. The Netherlands Study of Depression and Anxiety (NESDA) cohort study also showed that anxiety disorders and depressive disorders have complex comorbidity patterns, and individuals with comorbidity usually have a greater symptom burden and poorer course characteristics. Therefore, analyzing anxiety, depression, and ADC as separate outcomes may help explore the risk characteristics of single symptom states and comorbid states within the spectrum of interrelated psychological symptoms, while also improving the precision of the study findings. Mental health literacy (MHL) refers to the knowledge, attitudes, and abilities that enable individuals to identify, understand, and respond to mental health problems, and is an important psychosocial resource for mental health promotion. When Jorm et al. proposed the concept of MHL, they emphasized that it includes the ability to recognize mental disorders, knowledge of risk factors, and self-help strategies. Recent studies by Elshamy et al. and Chua et al. further indicated that insufficient knowledge of mental illness, stigmatizing attitudes, and barriers to service access may affect individuals’ recognition, expression, and help-seeking for psychological distress, suggesting that MHL is reflected not only in knowledge level but also in stigma awareness and help-seeking decision-making ability. Meanwhile, SRH and chronic disease status may affect individuals’ level of MHL. A study by He et al. showed that having chronic disease was an influencing factor for lower MHL attainment among residents, suggesting that the burden of chronic disease may weaken mental health knowledge, attitudes, and coping abilities. A study by Kim et al. in Korea showed that individuals with poorer subjective health status had a higher likelihood of depression, suggesting a link between poor SRH and insufficient health information comprehension. Furthermore, MHL may affect anxiety, depression, and ADC. A review study from Australia showed that insufficient recognition of mental health problems and stigmatizing attitudes may hinder timely help-seeking, thereby increasing the risk of persistent or worsening psychological symptoms. A Chinese population-based survey showed that low MHL was associate