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BackgroundConsidering the huge population in China, the available mental health resources are inadequate. Thus, our study aimed to evaluate whether mental questionnaires, serving as auxiliary diagnostic tools, have efficient diagnostic ability in outpatient psychiatric services.MethodsWe conducted a retrospective study of Chinese psychiatric outpatients. Altogether 1,182, 5,069, and 4,958 records of Symptom Checklist-90 (SCL-90), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), respectively, were collected from March 2021 to July 2022. The Mann–Whitney U test was applied to subscale scores and total scores of SCL-90, HAM-A, and HAM-D between the two sexes (male and female groups), different age groups, and four diagnostic groups (anxiety disorder, depressive disorder, bipolar disorder, and schizophrenia). Kendall's tau coefficient analysis and machine learning were also conducted in the diagnostic groups.ResultsWe found significant differences in most subscale scores for both age and gender groups. Using the Mann–Whitney U test and Kendall's tau coefficient analysis, we found that there were no statistically significant differences in diseases in total scale scores and nearly all subscale scores. The results of machine learning (ML) showed that for HAM-A, anxiety had a small degree of differentiation with an AUC of 0.56, while other diseases had an AUC close to 0.50. As for HAM-D, bipolar disorder was slightly distinguishable with an AUC of 0.60, while the AUC of other diseases was lower than 0.50. In SCL-90, all diseases had a similar AUC; among them, bipolar disorder had the lowest score, schizophrenia had the highest score, while anxiety and depression both had an AUC of approximately 0.56.ConclusionThis study is the first to conduct wide and comprehensive analyses on the use of these three scales in Chinese outpatient clinics with both traditional statistical approaches and novel machine learning methods. Our results indicated that the univariate subscale scores did not have statistical significance among our four diagnostic groups, which highlights the limit of their practical use by doctors in identifying different mental diseases in Chinese outpatient psychiatric services.

The COVID-19 vaccine has been administered to over 200 countries and regions. With the unprecedented vaccination scale and speed, vaccination correlated mental health issues should be paid precise attention to. This study aims to assess the association between socio-demographic factors and mental health following vaccination and to analyze the mediation effect of vaccine hesitancy. This study recruited 2112 individuals who took two doses of the COVID-19 vaccine in Shanghai. Structural equation modeling was performed to assess factors associated with anxiety and depression of the vaccinated individuals and the underlying mechanism. The results yielded that vaccine hesitancy partially mediated/suppressed the effect from gender and employment status to anxiety/depression and fully mediated the effects from education to anxiety/depression. This study advanced the understanding of mental health disparity among different socio-demographic groups after vaccination and the impact of vaccine hesitancy on the vaccinated population’s mental health. The finding offered insights into the possible mental vulnerability of people holding a hesitant attitude before vaccination and suggested that vaccine hesitancy played a crucial role in people’s mental health after vaccination. Health promotion programs can target vaccine hesitancy to prevent unfavorable mental health consequences among specific populations.

Side effects in the psychotherapy are sometimes unavoidable. Therapists play a significant role in the side effects of psychotherapy, but there have been few quantitative studies on the mechanisms by which therapists contribute to them.We designed the psychotherapy Side Effects Questionnaire-Therapist Version (PSEQ-T) and released it online through an official WeChat account, where 530 therapists participated in the cross-sectional analysis. The therapists were classified into groups with and without perceptions of clients' side effects. A number of features were selected to distinguish the therapists by category. Six machine learning-based algorithms were selected and trained by our dataset to build classification models. We leveraged the Shapley Additive exPlanations (SHAP) method to quantify the importance of each feature to the therapist categories.Our study demonstrated the following: (1) Of the therapists, 316 perceived clients' side effects in psychotherapy, with a 59.6% incidence of side effects; the most common type was "make the clients or patients feel bad" (49.8%). (2) A Random Forest-based machine-learning classifier offered the best predictive performance to distinguish the therapists with and without perceptions of clients' side effects, with an F1 score of 0.722 and an AUC value of 0.717. (3) "Therapists' psychological activity" was the most relevant feature for distinguishing the therapist category.Our study revealed that the therapist's mastery of the limitations of psychotherapy technology and theory, especially the awareness and construction of their psychological states, was the most critical factor in predicting the therapist's perception of the side effects of psychotherapy.

The two-child policy has been implemented in China since 2016 and has attracted the attention of the world. Adolescents may face huge psychological challenges in the process of changing family structures and relationships. To date, no mental health survey of adolescents from two-child families has been conducted. We investigated the prevalence and risk factors for childhood trauma, anxiety, and depression in two-child families in a statistically representative sample of Chinese senior high school students from Shanghai. A total of 426 participants were randomly selected from 1,059 students of four senior high schools in different districts of Shanghai. The childhood trauma questionnaire-short form (CTQ-SF), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used as the screening tools. We found that the overall prevalence of childhood trauma, anxiety, and depression among senior high school students in two-child families was 46.70% (95% CI, 39.93–53.47%), 22.17% (95% CI, 16.53–27.81%), and 35.85% (95% CI, 29.34–42.36%), respectively. The two-child families was an important factor associated childhood trauma, emotional neglect, and physical neglect (χ2 = 5.984, p = 0.014; χ2 = 4.071, p = 0.044; χ2 = 4.202, p = 0.040). Ranking in two-child families was a risk factor for childhood trauma (β = −0.135, p = 0.048). Parental preference was a significantly correlated with physical abuse, physical neglect, anxiety, and depression (β = −1.581 to 0.088, p < 0.05). Meanwhile, emotional abuse, physical abuse, emotional neglect, and physical neglect of participants in the two groups were positively correlated with anxiety and depression (r = 0.195–0.478, p < 0.05). There was a significant relationship between sexual abuse and anxiety symptoms in the one-child family group (r = 0.161, p < 0.05). The findings suggest that the overall prevalence of childhood trauma, anxiety and depression among adolescents from two-child families in China was high. The two-child families and family ranking are important factors associated childhood trauma, while parental preference is related to anxiety and depression. These results highlight an urgent need to be addressed by adolescents' mental health service providers and policy-makers.

Background: Side effects in psychotherapy are sometimes unavoidable. Therapists play a significant role in the side effects of psychotherapy, but there have been few quantitative studies on the mechanisms by which therapists contribute to them. Methods: We designed the Psychotherapy Side Effects Questionnaire-Therapist Version (PSEQ-T) and released it online through an official WeChat account, where 530 therapists participated in the cross-sectional analysis. The therapists were classified into groups with and without perceptions of clients’ side effects. A number of features were selected to distinguish the therapists by category. Six machine learning–based algorithms were selected and trained by our dataset to build classification models. To make the prediction model interpretable, we leveraged the Shapley Additive exPlanations (SHAP) method to quantify the importance of each feature to the therapist categories.Results: Our study demonstrated the following: 1) Of the therapists, 316 perceived the side effects of the clients in the ongoing psychotherapy sessions, with a 59.6% incidence of side effects. Among all 7 perception types of the side effects, the most common type was “make the clients or patients feel bad” (49.8%). 2) A random forest–based machine-learning classifier offered the best predictive performance to distinguish the therapists with and without perceptions of clients’ side effects, with an F1 score of 0.722 and an AUC value of 0.717. 3) When “therapists’ psychological activity” was considered a possible cause of the side effects in psychotherapy by the therapists, it was the most relevant feature for distinguishing the therapist category.Conclusions: Our study revealed that the therapist's mastery of the limitations of psychotherapy technology and theory, especially the awareness and construction of their own psychological states, was the most important factor in predicting the therapist's perception of the side effects of psychotherapy.

Dieser Beitrag beschreibt, in welchem Zustand die Autorengruppe die grose psychiatrische Klinik in Pudong, einem neuen Teil von Shanghai, vorfand, und wie sie hofft, mit Einfuhrung systemischen Denkens und Handelns die Arbeitsweise zu verandern. Wo bisher ausschlieslich ein medizinisches Modell psychischer Storungen und die medikamentose Behandlung vorgeherrscht haben, soll nun – mit einer systemischen Schulung des Personals uber alle Berufsgruppen hinweg – eine verstehende, ressourcenorientierte, auf Rehabilitation abzielende, familienorientierte Therapie entstehen. Hindernisse sind in den weitgehend fehlenden sozialpsychiatrischen Angeboten, in der immer noch stark ausgepragten Stigmatiserung psychischer Krankheiten und in der Lebenssituation der Familien zu sehen.

Background: Factors related to medication adherence in patients with schizophrenia have always been key to the treatment and rehabilitation of these patients. However, the treatment modes in different countries are not the same, and there is no research on the factors influencing medication adherence under different mental health service modes. Objectives: The purpose of this study was to explore medication adherence and its influencing factors in patients with schizophrenia in the Chinese institutional environment. Methods: We conducted a cross-sectional study of hospitalized persons living with schizophrenia from November 2018 to January 2019. A systematic sampling method was used to select 217 hospitalized persons living with schizophrenia. The Medication Adherence Rating Scale (MARS), Positive and Negative Syndrome Scale (PANSS), General Self-Efficacy Scale (GSES), Schizophrenia Quality of Life Scale (SQLS), and Scale of Social Skills for Psychiatric Inpatients (SSPI) were used to explore medication compliance and its influencing factors in the Chinese institutional environment. Results: The descriptive analysis and ANOVA showed that there were no significant differences in medication adherence when assessed by demographic characteristics such as sex, marital status, and education level (p &gt, 0.05). A correlation analysis showed that there was no significant correlation between medication adherence and mental symptoms (p &gt, 0.05) but that there was a positive correlation with self-efficacy, quality of life, and activities of daily living (p &lt, 0.01). The linear regression analysis showed that self-efficacy, psychosocial factors, symptoms/side effects, and activities of daily living had significant effects on medication adherence (F = 30.210, p &lt, 0.001). Conclusions: Our findings show that the self-efficacy, quality of life, and social function of patients with schizophrenia are important self-factors influencing medication adherence in the Chinese institutional environment.

Background: Side effects in psychotherapy are a common phenomenon, but due to insufficient understanding of the relevant predictors of side effects in psychotherapy, many psychotherapists or clinicians fail to identify and manage these side effects. The purpose of this study was to predict whether clients or patients would experience side effects in psychotherapy by machine learning and to analyze the related influencing factors.Methods: A self-compiled “Psychotherapy Side Effects Questionnaire (PSEQ)” was delivered online by a WeChat official account. Three hundred and seventy participants were included in the cross-sectional analysis. Psychotherapy outcomes were classified as participants with side effects and without side effects. A number of features were selected to distinguish participants with different psychotherapy outcomes. Six machine learning-based algorithms were then chosen and trained by our dataset to build outcome prediction classifiers.Results: Our study showed that: (1) the most common side effects were negative emotions in psychotherapy, such as anxiety, tension, sadness, and anger, etc. (24.6%, 91/370); (2) the mental state of the psychotherapist, as perceived by the participant during psychotherapy, was the most relevant feature to predict whether clients would experience side effects in psychotherapy; (3) a Random Forest-based machine learning classifier offered the best prediction performance of the psychotherapy outcomes, with an F1-score of 0.797 and an AUC value of 0.804. These numbers indicate a high prediction performance, which allowed our approach to be used in practice.Conclusions: Our Random Forest-based machine learning classifier could accurately predict the possible outcome of a client in psychotherapy. Our study sheds light on the influencing factors of the side effects of psychotherapy and could help psychotherapists better predict the outcomes of psychotherapy.

Background This study aimed to explore the characteristics of event-related potentials induced by facial emotion recognition in patients with first-episode schizophrenia and in their siblings. Methods In this case-control study, 30 first-episode schizophrenia patients, 26 siblings, and 30 healthy controls were enrolled. They completed facial emotion recognition tasks from the Ekman Standard Faces Database as an induction for evoked potentials. Evoked potential data were obtained using a 64-channel electroencephalography system. Average evoked potential waveforms were computed from epochs for each stimulus type. The amplitudes and latency of the event-related potentials for P100 (positive potential 100 ms after stimulus onset), N170 (negative potential 170 ms after stimulus onset), and N250 (fronto-central peak) were investigated at O1, O2, P7, and P8 electrode locations. Results There were significant differences between the groups for P100 amplitude (F = 11.526, P

Demographic and clinical information for the study participants (meanâ Âąâ SD). Table S2. Comparison of the schizophrenia, healthy controls and high-risk groups for correct recognition of three kinds of facial expression. (DOC 52 kb)

Aim The aim of this study was to examine the reliability, validity, sensitivity and specificity of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome (APS) in a college population. Methods The participants were recruited from a university. Five hundred seventy-nine students completed the CPQ-16 and the Symptom Checklist-90. One class (n = 79) was randomly selected to be retested with the CPQ-16 after 2 weeks. A randomly selected group of 49 individuals who tested positive and 50 individuals who tested negative were interviewed using the Structured Interview for Prodromal Syndromes (SIPS). Results The internal consistency reliability was good (Cronbach's α = 0.72). The test–retest reliability was 0.88. The total score on the CPQ-16 was moderately to highly correlated with the total score on the Symptom Checklist-90 and all of the subscales (r = 0.39–0.67, P

Background Although many studies have examined executive functions and facial emotion recognition in people with schizophrenia, few of them focused on the correlation between them. Furthermore, their relationship in the siblings of patients also remains unclear. The aim of the present study is to examine the correlation between executive functions and facial emotion recognition in patients with first-episode schizophrenia and their siblings. Methods Thirty patients with first-episode schizophrenia, their twenty-six siblings, and thirty healthy controls were enrolled. They completed facial emotion recognition tasks using the Ekman Standard Faces Database, and executive functioning was measured by Wisconsin Card Sorting Test (WCST). Hierarchical regression analysis was applied to assess the correlation between executive functions and facial emotion recognition. Results Our study found that in siblings, the accuracy in recognizing low degree ‘disgust’ emotion was negatively correlated with the total correct rate in WCST (r = −0.614, p = 0.023), but was positively correlated with the total error in WCST (r = 0.623, p = 0.020); the accuracy in recognizing ‘neutral’ emotion was positively correlated with the total error rate in WCST (r = 0.683, p = 0.014) while negatively correlated with the total correct rate in WCST (r = −0.677, p = 0.017). People with schizophrenia showed an impairment in facial emotion recognition when identifying moderate ‘happy’ facial emotion, the accuracy of which was significantly correlated with the number of completed categories of WCST (R2 = 0.432, P

Duration of untreated psychosis (DUP) is believed to exert a deleterious effect on cognitive and social function. However, to date, results remain inconclusive.To investigate the effect of time and DUP on cognitive and social functioning in first-episode schizophrenia (FES) subjects in Shanghai, China.FES patients were subjected to a comprehensive neuropsychological battery, the Personal and Social Performance scale (PSP) and the Positive and Negative Symptoms Scale (PANSS) at baseline, 6 month and 1 year. DUP was defined as the time from onset of first psychotic symptoms to first contact made with psychiatric services.Though the rate of non-completers in our observational study was relatively high (40%), we did not find any significant differences between the completers and non-completers (P-values0.05). Significant impairments in verbal learning and memory and executive function were noted over the course of 1 year. Meanwhile, social function improved significantly over the course of 1 year. Although, DUP did not share any significant relationship with cognitive or social function the effect estimate (range: - 0.03 to 0.02) of an increase of 1 month in DUP was clinically non-negligible in this study.In Chinese FES patients, the longitudinal course of cognitive function tends to worsen in verbal learning and memory, executive function and motor speed, while that of social function tends to improve. DUP was not found to be associated with cognitive or social deterioration in Chinese FES.

The role of protective factors in symptom formation and prognosis in schizophrenia has been shown in many studies, but research in the early phases of psychosis is limited, particularly among the nonclinical subjects. Protective factors associated with the severity of symptoms and clinical outcomes might be meaningful to the establishment of prevention systems and to the development of optimal psychosocial interventions prior to the onset of psychosis. The present study compares self-reported levels of self-esteem, social support and resilience of 32 university students at clinical high risk for psychosis (CHR) and 32 healthy controls in a longitudinal study design. Associations between protective factors with symptoms of psychosis were assessed in the CHR group. Individuals at CHR showed significantly lower self-esteem, social support and resilience compared to healthy controls. In the CHR group, lower social support and lower self-esteem were associated with more severe positive, negative and depressive symptoms. Multiple regression analyses revealed that self-esteem was the only significant determinant for negative, depressive symptoms and global functioning. In addition, we found that subjects who were fully recovered at a 6-month follow-up survey were greater resilient and showed lower depressive symptoms at baseline. The result implied that resilience intervention could be effective on early prevention of the onset of psychosis. Moreover, implications and limitations of this study will be discussed.

The aim of this study was to examine the reliability, validity, sensitivity and specificity of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome (APS) in a college population.The participants were recruited from a university. Five hundred seventy-nine students completed the CPQ-16 and the Symptom Checklist-90. One class (n = 79) was randomly selected to be retested with the CPQ-16 after 2 weeks. A randomly selected group of 49 individuals who tested positive and 50 individuals who tested negative were interviewed using the Structured Interview for Prodromal Syndromes (SIPS).The internal consistency reliability was good (Cronbach's α = 0.72). The test-retest reliability was 0.88. The total score on the CPQ-16 was moderately to highly correlated with the total score on the Symptom Checklist-90 and all of the subscales (r = 0.39-0.67, P0.001). A cut-off CPQ-16 score of 9 was used to differentiate between those with a APS diagnosis on the SIPS versus those with no SIPS diagnoses; this cut-off value yielded 85% sensitivity, 87% specificity, a positive predictive value of 63% and a positive likelihood ratio of 6.69. The area under the ROC curve (AUC) was significant for the CPQ-16 total score (AUC = 0.93, SE = 0.026, 95% CI = 0.87-0.98, P0.001). Based on the proposed cut-off score, the CPQ-16 yielded a positive rate of 5.0% (29/579).The CPQ-16, administered in a face-to-face interview, demonstrated high reliability and the ability to identify college students at risk for psychosis.

Background and Aims Given the difficulty of treating schizophrenia and other forms of psychosis, researchers have shifted focus to early detection and intervention of individuals at clinical high risk (CHR) for psychosis. Previous studies have shown that elements in family functioning could predict symptom outcome in CHR individuals. However, associations between self reported family functioning and symptom or functioning outcome of CHR individuals was rarely reported. Our study aimed to investigate the characteristics and the role of family functioning in the development of CHR individuals among young adolescents. Methods A sample of 32 CHR individuals was recruited from 2800 university students. The characteristics of family perception were evaluated by both Family Assessment Device (FAD) and Family cohesion and adaptability evaluation Scale II (FACES II). 6 month follow up data was available with 25 of the recruited CHR individuals. Baseline socio-demographic characteristics and family functioning were compared between CHR and control group. We also measured the associations between different dimensions of perceived family functioning and both severity of prodromal symptoms and global functioning at baseline and 6-month follow up. Results CHR individuals showed more maladaptive family functioning compared to control in nearly all of the dimensions of FAD and FACES II except for Affective Involvement. Better Problem Solving and Affective Responsiveness predicted less severe positive and negative symptoms respectively. Family cohesion and adaptability were not only correlated with the baseline severity of general symptoms, but also positively associated with the general and disorganized symptom outcome. Conclusions This study contributed preliminary evidence towards the associations between family perception and symptom outcome of CHR individuals. It also provided evidence for the importance of family interventions on CHR individuals.

Most studies on psychotic-like experiences in the non-clinical population were based on self-reported surveys, without any attempt to validate the clinical interview. The present study aimed to test whether the Attenuated Psychosis Syndrome (APS) could be detected in a college population by checking self-report results against an additional interview. A two-stage screening process was used in a sample of 579 college students (16–22 years old): a 16-item Chinese version of the Prodromal Questionnaire (CPQ-16) followed by the Structured Interview for Psychosis-Risk Syndromes (SIPS). Psychopathology symptoms were assessed using the Symptom Checklist-90 (SCL-90). There were 20 (3.5%) students who met the criteria for the APS according to SIPS. Compared with control students, the students with APS were more likely to be from divorced families and had more psychopathology based on the SCL-90. Certain factors on the SCL-90, including Obsessive-Compulsive (OBS), Interpersonal Sensitivity (INT), and Depression (DEP) were significantly correlated with positive psychosis risk symptoms on the SIPS, but only DEP had a strong correlation with the total score on the SIPS. These results demonstrate that the APS can be detected in a college sample and that psychosis risk symptoms are associated with co-occurring psychopathology.