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BackgroundThe Arsenic (+3 oxidation state) methyltransferase (AS3MT) gene has been identified as a top risk gene for schizophrenia in several large-scale genome-wide association studies. A variable number tandem repeat (VNTR) of this gene is the most significant expression quantitative trait locus, but its role in brain activity in vivo is still unknown.MethodsWe first performed a functional magnetic resonance imaging (fMRI) scan of 101 healthy subjects during a memory span task, trained all subjects on an adaptive memory span task for 1 month, and finally performed another fMRI scan after the training. After excluding subjects with excessive head movements for one or more scanning sessions, data from 93 subjects were included in the final analyses.ResultsThe VNTR was significantly associated with both baseline brain activation and training-induced changes in multiple regions including the prefrontal cortex and the anterior and posterior cingulate cortex. Additionally, it was associated with baseline brain activation in the striatum and the parietal cortex. All these results were corrected based on the family-wise error rate method across the whole brain at the peak level.ConclusionsThis study sheds light on the role of AS3MT gene variants in neural plasticity related to memory span training.

The influence of China's "one-child" policy on the mental health of children and adolescents is still unclear. This study examined the associations between number of children and children's mental health using data from the national school children and adolescents survey of China. Mental health was measured using the Achenbach's Child Behavior Checklist (CBCL). Linear regression models were used to explore the relationship between number of children per family and children's mental health. A total of 64,017 students were enrolled, with 68.60 % from one-child families. Compared with children from one-child families, those from multiple-children families had significantly higher scores on the total CBLC and each of its subscales (all P <0.001). Analyses suggested children from multiple-child families have a higher risk of mental health problems (total problems on the CBCL: adjusted B=2.217, 95 %CI=1.883–2.550, P <0.001). Regular mental health assessments should be implemented and effective interventions should be developed for those in need. • This was the first national study to compare mental health problems between one-child families and families with multiple children in China. • Compared with child from one-child families, those from multiple-children families had significantly higher scores on the total CBLC and each of its subscales. • Children and adolescents from families with multiple children appear to be at a higher risk of mental health problems, as assessed by the CBCL, compared to those from one-child families. [ABSTRACT FROM AUTHOR]

Background: This study examined the prevalence of depressive symptoms (depression hereafter) and its association with quality of life (QOL) among pregnant and postnatal women in China. Methods: In this multi-center, cross-sectional study, 1,060 pregnant and postnatal women from eight hospitals were assessed. Depression and QOL were measured using the Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life Questionnaire - brief version, respectively. Results: The prevalence of depression was 7.45% (95% CI: 5.87–9.04%) in the sample. Women with depression had lower QOL in physical, psychological, social and environmental domains compared to those without. Women with physical comorbidities were more likely to suffer from depression (OR = 2.391, 95% CI = 1.384–4.130, P = 0.002). Conclusion: Due to its negative association with QOL, increased attention should be paid to depression in pregnant and postnatal women. Regular screening assessment and preventive measures should be adopted to reduce risk of depression in this population. [ABSTRACT FROM AUTHOR]

Objective: Poor mental health is associated with impaired social functioning, lower quality of life, and increased risk of suicide and mortality. This study examined the prevalence of poor general mental health among older adults (aged 65 years and above) and its sociodemographic correlates in Hebei province, which is a predominantly agricultural area of China. Methods: This epidemiological survey was conducted from April to August 2016. General mental health status was assessed using the 12-item General Health Questionnaire (GHQ-12). Results: A total of 3,911 participants were included. The prevalence of poor mental health (defined as GHQ-12 total score ≥ 4) was 9.31% [95% confidence interval (CI): 8.4–10.2%]. Multivariable logistic regression analyses found that female gender [ P < 0.001, odds ratio (OR) = 1.63, 95% CI: 1.29–2.07], lower education level (P = 0.048, OR = 1.33, 95% CI: 1.00–1.75), lower annual household income (P = 0.005, OR = 1.72, 95% CI: 1.17–2.51), presence of major medical conditions (P < 0.001, OR = 2.95, 95% CI: 2.19–3.96) and family history of psychiatric disorders (P < 0.001, OR = 3.53, 95% CI: 2.02–6.17) were significantly associated with poor mental health. Conclusion: The prevalence of poor mental health among older adults in a predominantly agricultural area was lower than findings from many other countries and areas in China. However, continued surveillance of mental health status among older adults in China is still needed. [ABSTRACT FROM AUTHOR]

This study aimed to examine the prevalence of sexual harassment (SH) toward Chinese psychiatric nurses and its association with quality of life (QOL). A total of 2124 psychiatric nurses were consecutively recruited from 10 psychiatric hospitals distributed across 10 provinces of China; of them, 1,449 were included for analyses. Participants' socio-demographic characteristics, experiences of workplace SH in the past year, and QOL were recorded. Overall, 21.5% (n = 311) of participants reported SH, with 8.4% (n = 121) reporting once, 7.1% (n = 103) reporting twice and 6.0% (n = 87) reporting three times or more. Psychiatric nurses who experienced SH had lower QOL in physical, psychological, social, and environmental domains. Multiple logistic regression analysis found that nurses with shorter clinical experience were more likely to experience SH. Workplace SH toward psychiatric nurses is common in mental health treatment settings in China. Considering its deleterious impact on nurses' well-being and care quality, effective staff training on the management of SH and a zero tolerance policy against SH should be developed for this population. • Little is known on the prevalence rates of sexual harassment (SH) toward psychiatric nurses in China. • Overall, 21.5% of Chinese psychiatric nurses reported SH. Those who experienced SH had lower quality of life. • Effective staff training on the management of SH and policy against SH should be developed for this population. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms are common in empty-nest elderly in China, but the reported prevalence rates across studies are mixed. This is a meta-analysis of the pooled prevalence of depressive symptoms (depression hereafter) in empty-nest elderly in China. Methods: Two investigators independently conducted a systematic literature search in both English (PubMed, EMBASE, PsycINFO, Web of Science, and Cochrane Library) and Chinese (CNKI and Wan Fang) databases. Data were analyzed using the Comprehensive Meta-Analysis program. Results: A total of 46 studies with 36,791 subjects were included. The pooled prevalence of depression was 38.6% (95%CI: 31.5–46.3%). Compared with non-empty-nest elderly, empty-nest elderly were more likely to suffer from depression (OR=2.0, 95%CI: 1.4 to 2.8, P <0.001). Subgroup and meta-regression analyses revealed that mild depression were more common in empty-nest elderly than moderate or severe depression (P <0.001). In addition, living alone (P =0.002), higher male proportion (β =0.04, P <0.001), later year of publication (β =0.09, P <0.001) and higher study quality score (β =0.62, P <0.001) were significantly associated with higher prevalence of depression. Conclusion: In this meta-analysis, the prevalence of depression in empty-nest elderly was high in China. Considering the negative impact of depression on health outcomes and well-being, regular screening and appropriate interventions need to be delivered for this vulnerable segment of the population. [ABSTRACT FROM AUTHOR]

Background: In China, workplace violence (WPV) toward health-care professionals has been a major concern, but no meta-analysis on this topic has been published. This study is a meta-analysis of the pooled prevalence of WPV against health-care professionals in China and its associated risk factors. Method: English- (PubMed, PsycINFO, and Embase) and Chinese-language (Chinese National Knowledge Infrastructure, WanFang, and SinoMed) databases were systematically searched. Data on the prevalence of WPV and the subtypes of violence experienced by health-care professionals in China were extracted and pooled using random-effects models. Findings: A total of 47 studies covering 81,771 health-care professionals were included in the analyses. The overall prevalence of WPV from 44 studies with available data was 62.4% (95% confidence interval [CI] = [59.4%, 65.5%]). The estimated prevalence of physical violence, psychological violence, verbal abuse, threats, and sexual harassment were 13.7% (95% CI [12.2%, 15.1%]), 50.8% (95% CI [46.2%, 55.5%]), 61.2% (95% CI [55.1%, 67.4%]), 39.4% (95% CI [33.4%, 45.4%]), and 6.3% (95% CI [5.3%, 7.4%]), respectively. Males were more likely to experience WPV than females. Interpretation: WPV against health-care professionals appears to be a significant issue in China. Relevant policies and procedures related to WPV should be developed. Staff should be provided with adequate training, education, and support to implement violence management policies to ensure safety at the workplace. [ABSTRACT FROM AUTHOR]

Objective: This meta-analysis examined the prevalence of poor sleep quality and its associated factors in patients with hypertension in China. Methods: Both English (PubMed, PsycINFO, EMBASE) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched. The random-effects model was used to estimate the prevalence of poor sleep quality in Chinese patients with hypertension. The funnel plot and Egger's tests were used to assess publication bias. Results: The prevalence of poor sleep quality in 24 studies with 13,920 hypertensive patients was 52.5% (95% confidence interval [CI]: 46.1–58.9%). In contrast, the prevalence of poor sleep quality in six studies with 5,610 healthy control subjects was 32.5% (95% CI: 19.0–49.7%). In these studies, compared to healthy controls, the pooled odds ratio (OR) of poor sleep quality was 2.66 (95% CI: 1.80–3.93) for hypertensive patients. Subgroup and meta-regression analyses revealed that patients in hospitals were more likely to have poor sleep quality than patients in the community. Studies with smaller sample size, studies using convenience or consecutive sampling and those published in Chinese reported higher prevalence of poor sleep quality. Furthermore, poor sleep quality was more common in older and male hypertensive patients, while the proportion of poor sleep quality was negatively associated with survey year. Conclusion: Appropriate strategies for screening, prevention, and treatment of poor sleep quality in this population should be developed. [ABSTRACT FROM AUTHOR]

Background: Little empirical evidence is known about the sleep quality of frontline health professionals working in isolation units or hospitals during the novel coronavirus disease (COVID-19) outbreak in China. This study thus aimed to examine the prevalence of poor sleep quality and its demographic and correlates among frontline health professionals. Methods: This is a multicenter, cross-sectional survey conducted in Liaoning province, China. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Results: A total of 1,931 frontline health professionals were recruited. The prevalence of poor sleep quality was 18.4% (95%CI: 16.6%–20.11%). Multivariate logistic regression analysis found that older age (OR=1.043, 95%CI=1.026–1.061, P < 0.001), being nurse (OR=3.132, 95%CI=1.727–5.681, P < 0.001), and working in outer emergency medical team (OR=1.755, 95%CI=1.029–3.064, P =0.039) were positively associated with poor sleep quality. Participants who were familiar with crisis response knowledge were negatively associated with poor sleep quality (OR=0.70, 95%CI=0.516–0.949, P =0.021). Conclusion: The prevalence of poor sleep quality was relatively low among frontline health professionals during the COVID-19 epidemic. Considering the negative impact of poor sleep quality on health professionals' health outcomes and patient outcomes, regularly screening and timely treatments are warranted to reduce the likelihood of poor sleep quality in health professionals. [ABSTRACT FROM AUTHOR]

Burnout is common in mental health nurses because of work-related stress. Burnout has a negative impact on nurses' health and work performance. The prevalence of high burnout in mental health nurses has been inconclusive across studies. This meta-analysis aimed to estimate the pooled prevalence of high burnout in mental health nurses in China. Electronic databases (PubMed, EMBASE, PsycINFO, Web of Science, CNKI, WanFang and SinoMed) were independently and systematically searched from their commencement date up to 14 May 2018. Studies that reported the prevalence of any of the 3 burnout dimensions (high Emotional Exhaustion (EE), Depersonalization (DP), and low Personal Accomplishment (PA)) as measured by the Maslach Burnout Inventory (MBI) were included and analyzed using the random-effects model. A total of 19 studies were included in this meta-analysis. The pooled prevalence of high EE was 28.1% (95% CI: 20.4–35.8%), DP was 25.4% (18.1–32.6%) and low PA was 39.7% (28.3–51.1%). Subgroup analyses found that short working experience, use of MBI-Human Services Survey (HSS), and younger age had moderating effects on prevalence of high burnout. Burnout is common in mental health nurses in China. Considering its negative impact on health and work performance, regular screening, preventive measures and effective interventions should be implemented. • Burnout is common in mental health nurses, but its prevalence is mixed across studies. • The pooled prevalence of high EE was 28.1%, DP was 25.4% and low PA was 39.7%. • Short working experience, use of MBI-HSS, and younger age had moderating effects on prevalence of high burnout. • Regular screening, preventive measures and effective interventions should be conducted. [ABSTRACT FROM AUTHOR]

Objective: The aim of this systematic review and meta-analysis was to examine the prevalence of voluntary and involuntary psychiatric admissions for severe mental illness in China and explore their associated factors.Methods: The PubMed, Cochrane Library, PsycINFO, EMBASE, CNKI, CQVIP, and WanFang databases were systematically searched for the span since their inception to October 2018. Meta-analyses were conducted with the random-effects model.Results: Fourteen studies with 94,305 patients were included in the analyses. The voluntary and involuntary admission rates were 30.3% (95% confidence interval [CI]=18.06% to 46.23%) and 32.3% (95% CI=10.39% to 66.21%), respectively, for severe mental illness and 19.6% (95% CI=14.09% to 26.54%) and 44.3% (95% CI=5.98% to 90.88%), respectively, for schizophrenia. Meta-regression analyses found an increase in the voluntary admission rate between 1998 and 2018.Conclusions: The voluntary admission rate for severe mental illness has increased in China, whereas the involuntary admission rate has remained high, particularly for schizophrenia. Concerted efforts should be made to further decrease the rate of involuntary admissions. [ABSTRACT FROM AUTHOR]

China is facing rapid population aging and the country has the world's largest aging population. The rapid demographic shift in aging population is associated with many social and health problems, in particular mental health issues. The aim of this article is to summarize the challenges and recent progress in mental health-care delivery and clinical research for older people in China. [ABSTRACT FROM AUTHOR]

Workplace violence (WPV) is common in mental health services in China, but its multi-center prevalence measured using standardized rating scales has rarely been reported. This study aimed to explore the prevalence of verbal and physical violence against nurses working in psychiatric hospitals and examine its independent socio-demographic correlates in China. This was a cross-sectional study conducted in 11 major psychiatric hospitals in China using a 9-item self-reported workplace violence scale. A total of 1906 psychiatric nurses were recruited to participate in this study. The one-year prevalence of verbal and/or physical workplace violence (WPV) was 84.2% (95% CI: 82.4–85.8). The prevalence rates of verbal abuse, threats and physical violence were 79.3% (95% CI: 77.4–81.1), 70.9% (95% CI: 68.8–73.0) and 57.9% (95% CI: 55.7–60.2), respectively. Multiple logistic regression analysis revealed that working in department of psychiatry (OR = 3.42, P < 0.001), having moderate (OR = 2.05, P = 0.009), severe (OR = 2.04, P = 0.015) or extremely severe (OR = 3.21, P < 0.001) anxiety level of WPV and working in hospitals with a WPV reporting system (OR = 1.88, P < 0.001) were significantly associated with WPV. WPV against nurses is a serious occupational and public health concern in Chinese psychiatric hospitals. Appropriate preventive measures should be undertaken to reduce the risk of WPV in healthcare settings. • Workplace violence is common in mental health services in China, but multicentre studies on psychiatric nurses are rare. • One-year prevalence of verbal and/or physical workplace violence in nursing staff in Chinese psychiatric hospitals was 84.2%. • Appropriate preventive measures should be undertaken to reduce the risk of workplace violence in healthcare settings. [ABSTRACT FROM AUTHOR]

With the widespread implementation of antiretroviral therapy in many countries, the HIV/AIDS epidemic has declined. However, little is known about the prevalence of adherence rate to Highly Active Antiretroviral Therapy (HAART) in patients with HIV infection in China. This is the first meta-analysis of cross-sectional studies of treatment adherence (≥ 95%) to HAART in Chinese patients. Both English (PubMed, PsycINFO, EMBASE, and Web of Science) and Chinese (WanFang, CNKI, and SinoMed) databases were systematically and independently searched by three investigators. Studies with adherence rate estimates of HAART were included. Adherence rate estimates of each eligible study were extracted and pooled using the random-effects model. A total of 40 studies conducted in China were eligible and analyzed. The mean rate of ≥ 95% adherence to HAART was 81.1% (95%CI: 75.1%–88.0%, I2 = 97.3%) at one week, 80.9% (95%CI: 74.7%–85.9%, I2 = 96.6%) at one month, and 68.3% (95%CI: 46.1%–84.4%, I2 = 97.1%) at 3 months or longer. Subgroup analyses revealed that samples with no gender predominance, low education level, middle economic region, rural area, older age (42.3 years), and recent publication (2013 or later) were correlated to higher HAART adherence. The average rate of HAART adherence was relatively high in China, which indicates effective HIV/AIDS policy, prevention and control measures. However, the HAART adherence rate decreased over the study time period. [ABSTRACT FROM AUTHOR]

Purpose: To compare mobile phone addiction (MPA) patterns between Tibetan and Han adolescents in China. Design and Methods: The study was carried out in two provinces of China. The Mobile Phone Addiction Scale (MPAS) was used to assess MPA. Findings: Seven hundred and five Tibetan and 606 Han students participated in the study. The MPAS total score was 24.4 ± 11.4 in the whole sample; 27.3 ± 10.8 and 20.9 ± 11.2 in Tibetan and Han students, respectively. Quality of life (QOL) in the physical, psychological, social, and environmental domains was negatively associated with MPA. Practice Implications: Compared with Han students, Tibetan students were found to have more severe MPA. Given its negative impact on QOL, appropriate measures for the prevention of MPA should be developed, particularly for Tibetan middle school students. [ABSTRACT FROM AUTHOR]

Purpose: A meta‐analysis on sleep duration and patterns in patients with diabetes in China. Design and methods: Two investigators independently carried out a systematic literature search in both international and Chinese databases. Findings: A total of 47 studies with 98 911 patients were included. The pooled mean sleep duration was 7.15 hours/day in patients with diabetes and 7.49 hours/day in healthy controls. The estimated percentage of short sleep duration of less than 6 hours/day was 23.0% in patients with diabetes and 12.3% in healthy controls, while the proportion of short sleep duration of less than 7 hours/day was 38.0% in patients with diabetes and 14.1% in healthy controls. Practice implications: Short sleep duration was common in Chinese patients with diabetes. [ABSTRACT FROM AUTHOR]

Little is known about suicidality in Chinese men who has sex with men (MSM) infected with human immunodeficiency virus (HIV). This study investigated suicidality and its clinical correlates in Chinese MSM with HIV infection. Suicidality, demographic and clinical characteristics were assessed in 410 MSM with HIV infection consecutively recruited from a public HIV clinic in China. The prevalence of suicidality was 10.7% in Chinese HIV-infected MSM. Compared with those without suicidality, MSM with suicidality were more likely to be younger, unmarried and unemployed, and have more frequent insomnia, lower CD4 lymphocyte counts, and higher GAD-7 and CSE-D total scores. Multiple logistic regression analyses revealed that suicidality was independently associated with unemployment (p = 0.03, OR = 0.3, 95% CI = 0.1-0.9), age (p < 0.01, OR = 0.9, 95% CI = 0.8-0.9), CD4 lymphocyte counts (p = 0.02, OR = 0.9, 95% CI = 0.9-1.0), and the GAD-7 total score (p < 0.001, OR = 1.3, 95% CI = 1.1-1.5). Suicidality is common in Chinese MSM with HIV infection. There is an urgent need to develop comprehensive suicide prevention program and mental health services for this population. [ABSTRACT FROM AUTHOR]

To investigate the prevalence of depressive syndrome and their association with demographic and clinical characteristics in Chinese patients infected with the human immunodeficiency virus (HIV). A total of 416 patients with HIV infection were consecutively screened and enrolled in the study. Depressive syndrome was assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D). The proportion of depressive syndrome was 36.3%. Patients with depressive syndrome were younger, and were more likely to have severe anxiety symptoms, religious beliefs and psychological treatment. Multiple logistic regression analyses revealed that religious beliefs (p = 0.001, OR = 3.9, 95% CI = 1.7-8.6) and more severe anxiety symptoms (p = 0.001, OR = 1.6, 95% CI = 1.4-1.7) were independently associated with depressive syndrome. Regular screening for depressive syndrome and appropriate biopsychosocial interventions are urgently needed for this population. [ABSTRACT FROM AUTHOR]

This is a meta-analysis of the pooled prevalence of sleep disturbances and its associated factors in Chinese university students. English (PubMed, PsyclNFO, Embase) and Chinese (SinoMed, Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from inception until 16 August 2016. The prevalence of sleep disturbances was pooled using random-effects model. Altogether 76 studies involving 112 939 university students were included. The overall pooled prevalence of sleep disturbances was 25.7% (95% CI: 22.5-28.9%). When using the screening scales Pittsburgh Sleep Quality Index, Athens Insomnia Scale and Self-Rating Sleeping State Scale, and the diagnostic criteria of the Chinese Classification of Mental Disorders (Second Edition), the pooled prevalence of sleep disturbances was 24.1% (95% CI: 21.0-27.5%) and 18.1% (95% CI: 16.4-20.0%), respectively. The percentages of students dissatisfied with sleep quality and those suffering from insomnia symptoms were 20.3% (95% CI: 13.0-30.3%) and 23.6% (95% CI: 18.9-29.0%), respectively. Subgroup analyses revealed that medical students were more vulnerable to sleep disturbances than other student groups. There was no significant difference between males and females, and across geographic locations. Sleep disturbances are common in Chinese university students. Appropriate strategies for prevention and treatment of sleep disturbances in this population need greater attention. [ABSTRACT FROM AUTHOR]

Introduction To date no study has compared the treatment patterns for schizophrenia specifically between China and Japan. This study examined the cross-national differences in the use of psychotropic drugs and electroconvulsive therapy (ECT) in schizophrenia. Method Data on 3248 schizophrenia inpatients (n = 1524 in China and n = 1724 in Japan) were collected by either chart review or interviews during the designated 3 study periods between 2001 and 2009. Patients' socio-demographic and clinical characteristics, prescriptions of psychotropic drugs, and ECT use were recorded using a standardized protocol and data collection procedure. Results Multivariate analyses revealed that compared to their Japanese counterparts, Chinese inpatients had a shorter length of current hospitalization, were significantly less frequently prescribed second-generation antipsychotics (except clozapine), antipsychotic polypharmacy, benzodiazepines, and mood stabilizers, and more likely to receive clozapine, antidepressants, and ECT. Discussion Substantial variations in inpatient treatment patterns for schizophrenia were found between China and Japan. The common use of ECT and clozapine in Chinese inpatients and the frequent use of antipsychotic polypharmacy and high antipsychotic doses in Japanese inpatients need to be addressed. [ABSTRACT FROM AUTHOR]

BACKGROUND There are no data about the frequency of major depression in patients with liver disease related to Hepatitis B virus (HBV) in China. This study examined the prevalence of major depression and its clinical correlates and association with quality of life (QOL) in patients with HBV-related liver diseases. METHOD Altogether 634 patients with HBV-related liver diseases met study entry criteria and completed the survey. The diagnosis of major depression was established with the Mini International Neuropsychiatric Interview (MINI). Socio-demographic and clinical characteristics, Global Assessment of Functioning (GAF) and QOL were measured. RESULTS The prevalence of major depression was 6.4%. Multivariable logistic regression analyses revealed that insomnia (P = 0.01, OR = 5.5, 95%CI = 1.4–21.6) and global functioning (P < 0.001, OR = 0.6, 95% CI = 0.5–0.7) were independently associated with major depression. Major depression was associated with both poor physical (F (1, 634) = 4.0, P = 0.04) and mental QOL (F (1, 634) = 26.2, P < 0.001). CONCLUSIONS Given the negative impact of depression on patients' QOL, more attempts should be made to identify and treat it in HBV-related diseases. [ABSTRACT FROM AUTHOR]

Purpose To describe the prevalence and clinical correlates of insomnia in schizophrenia patients treated in primary care. Design and Methods Six hundred and twenty-three schizophrenia patients from 22 primary care services were recruited. Findings The prevalence of at least one type of insomnia was 28.9% (180/623), while those of difficulty initiating sleep, difficulty maintaining sleep, and early morning wakening were 20.5%, 19.6%, and 17.7%, respectively. Only 53.3% of patients suffering from insomnia received treatment. Practice Implications Insomnia is common in Chinese patients with schizophrenia treated in primary care and the rate of treatment appears low. [ABSTRACT FROM AUTHOR]

Introduction Little has been reported about the demographic and clinical features of major depressive disorder (MDD) with comorbid dysthymia in Chinese patients. This study examined the frequency of comorbid dysthymia in Chinese MDD patients together with the demographic and clinical correlates and prescribing patterns of psychotropic drugs. Methods Consecutively collected sample of 1178 patients with MDD were examined in 13 major psychiatric hospitals in China. Patients' demographic and clinical characteristics and psychotropic drugs prescriptions were recorded using a standardized protocol and data collection procedure. The diagnosis of dysthymia was established using the Mini International Neuropsychiatric Interview. Medications ascertained included antidepressants, antipsychotics, benzodiazepines, and mood stabilizers. Results One hundred and three (8.7%) patients fulfilled criteria for dysthymia. In multiple logistic regression analyses, compared to non-dysthymia counterparts, MDD patients with dysthymia had more depressive episodes with atypical features including increased appetite, sleep, and weight gain, more frequent lifetime depressive episodes, and less likelihood of family history of psychiatric disorders. There was no significant difference in the pattern of psychotropic prescription between the 2 groups. Conclusions There are important differences in the demographic and clinical features of comorbid dysthymia in Chinese MDD patients compared with previous reports. The clinical profile found in this study has implications for treatment decisions. [ABSTRACT FROM AUTHOR]

This is the first meta-analysis of the pooled prevalence of insomnia in the general population of China. A systematic literature search was conducted via the following databases: PubMed, PsycINFO, EMBASE and Chinese databases (China National Knowledge Interne (CNKI), WanFang Data and SinoMed). Statistical analyses were performed using the Comprehensive Meta-Analysis program. A total of 17 studies with 115,988 participants met the inclusion criteria for the analysis. The pooled prevalence of insomnia in China was 15.0% (95% Confidence interval [CI]: 12.1%-18.5%). No significant difference was found in the prevalence between genders or across time period. The pooled prevalence of insomnia in population with a mean age of 43.7 years and older (11.6%; 95% CI: 7.5%-17.6%) was significantly lower than in those with a mean age younger than 43.7 years (20.4%; 95% CI: 14.2%-28.2%). The prevalence of insomnia was significantly affected by the type of assessment tools (Q = 14.1, P = 0.001). The general population prevalence of insomnia in China is lower than those reported in Western countries but similar to those in Asian countries. Younger Chinese adults appear to suffer from more insomnia than older adults. Trial Registration: CRD [ABSTRACT FROM AUTHOR]

Objective This study examined the pattern of adjunctive antidepressant use in schizophrenia patients and its demographic and clinical correlates in a nationwide survey in China. Methods Fourteen thousand and thirteen patients in 45 Chinese psychiatric hospitals or centers were interviewed (4,486 in 2002, 5,288 in 2006, and 4,239 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Chi-square test, independent-samples t test, Mann-Whitney U test, and multiple logistic regression analysis were used in data analyses. Results Antidepressant use was found in 5.2% of the study population with 4.6% in 2002, 4.3% in 2006, and 6.9% in 2012, respectively. A significant increase in use from 2006 to 2012 was found ( p < .001). Multiple logistic regression analyses in the whole population revealed that patients receiving adjunctive antidepressants were more likely to be outpatients in tertiary referral centers (level-III hospitals) and who had an earlier age of onset, less severe global illness, but more depressive symptoms. They were less likely to receive first-generation antipsychotics but more likely to receive benzodiazepines (R2 = 0.255, p < .001). Conclusions Despite an increasing trend, the frequency of antidepressant use in schizophrenia in China was considerably lower than in Western countries. The benefits and risks associated with concomitant use of antidepressants in schizophrenia need to be studied further. [ABSTRACT FROM AUTHOR]

Few studies on long-term functional outcome have been conducted in post-stroke patients in China. The objective of this study was to conduct a nationwide survey in China to investigate the 5-year prevalence of post-stroke disability and its correlation factors. A total of 893 patients with ischemic stroke were included. Demographic, clinical and neuro-imaging information were collected with standardized instruments that assessed stroke severity, depression, cognitive impairment, stroke recurrence and physical disability. Disability was assessed with the modified Ranking Score (mRS), of which a cutoff score ≥2 indicates disability. Statistical analysis included chi-square tests, two independent samples t-tests, Mann-Whitney U test and multiple logistic regression analysis. The frequency of disability in this study population was 45%. Multivariate analyses revealed that older age, lower education level, previous history of stroke, stroke severity at admission, depression, cognitive impairment at 3 months, and stroke recurrence within 5 years follow up were all significantly associated with post-stroke disability. The disability rate in 5-year post-stroke was high in Chinese patients. Treatment of depression, secondary prevention of stroke and rehabilitation may benefit disabled patients with stroke in China. [ABSTRACT FROM AUTHOR]

Purpose: To examine the knowledge and attitudes of patients and their relatives as well as patients' subjective experience with electroconvulsive therapy (ECT) in China. Design and Methods: Up to 420 responders including patients receiving ECT (n = 210) and their relatives (n = 210) were assessed with self‐reported questionnaires. Findings: Patients and their relatives did not receive adequate information before ECT, particularly about the mode of its delivery, risks, and adverse effects. The most common adverse effect of ECT reported by patients was memory impairment. Both patients and their relatives had positive attitudes toward ECT and appeared satisfied with its therapeutic effects. Practice Implications: Mental health professionals need to address the inadequate information on ECT provided to patients and their relatives prior to the treatment. [ABSTRACT FROM AUTHOR]

Background: Injection drug users (IDUs) are at high-risk for acquiring human immunodeficiency virus, hepatitis C virus, and other infections, and delaying the switch from non-injection drug use to injection to drug use could reduce the spread of these infections.Objectives: To estimate the incidence of switching from non-injected heroin use (usually smoking or “chasing”) to injection and to investigate the risk factors for this change.Methods: We reviewed the socio-demographic and clinical data of 7305 heroin-dependent patients treated at a detoxification clinic of a university-affiliated psychiatric hospital in China from January 2000 to February 2009.Results: Within 1 year, the majority of non-injection drug users (NIDUs) transitioned to IDUs (59.4% within 6 months and 76.7% within 12 months). Multiple logistic regression analysis showed that marital status, years of education, employment status, age at onset of heroin use, duration of drug abuse, and initial dose were associated with the switch from NIDU to IDU. Being married (B = −0.410, OR = 0.664), being employed (B= −0.243, OR = 0.784), and older age at onset (B= −0.040, OR = 0.961) were protective factors. More education (B = 0.120, OR = 1.128), longer duration of drug abuse (B= 0.010, OR = 1.010), and a higher dose at initial drug use (B= 0.234, OR = 1.264) were risk factors.Conclusions/Importance: The study has identified several risk factors for the switch to injection among heroin users. Understanding these factors can help design new approaches to more specifically target high-risk populations and high-risk behaviors to delay or prevent the transition to injection. [ABSTRACT FROM PUBLISHER]

Objective Little is known about the use of electroconvulsive therapy (ECT) in older Chinese psychiatric patients. This study examined the frequency of ECT and the demographic and clinical correlates in older psychiatric patients hospitalized in a large psychiatric institution in Beijing, China. Methods This was a retrospective chart review of 2339 inpatients aged 60 years and older treated over a period of 8 years (2007-2013) in a university-affiliated psychiatric institution in Beijing. Sociodemographic and clinical data were collected from the electronic chart management system for discharged patients. Results The rate of ECT use was 28.1% in the whole sample; 37.9% in those with bipolar disorders, 43.6% in major depression, 21.2% in schizophrenia, and 10.7% in other diagnoses. ECT ('ECT group') was associated with 60-65-year age group, high risk for suicide and low risk for falls at the time of admission, use of mood stabilizers and antidepressants, lack of health insurance, and having major medical conditions and diagnosis of major depression. The above significant correlates explained 24.9% of the variance of ECT use ( p < 0.001). Conclusions In a major psychiatric hospital in China, the use of ECT was common among older patients. ECT use in older patients treated in other clinical settings warrants further investigations. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective The objective of this meta-analysis is to estimate the pooled prevalence of suicidal ideation and suicide attempts in the general population of Mainland China. Methods A systematic literature search was conducted via the following databases: PubMed, PsycINFO, MEDLINE, China Journals Full-Text Databases, Chongqing VIP database for Chinese Technical Periodicals, and Wan Fang Data. Statistical analysis used the Comprehensive Meta-Analysis program. Results Eight studies met the inclusion criteria for the analysis; five reported on the prevalence of suicidal ideation and seven on that of suicide attempts. The estimated lifetime prevalence figures of suicidal ideation and suicide attempts were 3.9% (95% confidence interval: 2.5%–6.0%) and 0.8% (95% confidence interval: 0.7%–0.9%), respectively. The estimated female–male ratio for lifetime prevalence of suicidal ideation and suicide attempts was 1.7 and 2.2, respectively. Only the difference of suicide attempts between the two genders was statistically significant. Conclusion This was the first meta-analysis of the prevalence of suicidal ideation and suicide attempts in the general population of Mainland China. The pooled lifetime prevalence of both suicidal ideation and suicide attempts are relatively low; however, caution is required when assessing these self-report data. Women had a modestly higher prevalence for suicide attempts than men. The frequency for suicidal ideation and suicide attempts in urban regions was similar to those in rural areas. [ABSTRACT FROM AUTHOR]

Purpose No study has investigated hyperprolactinemia and its risk factors in Chinese psychiatric patients. This study examined the prevalence of hyperprolactinemia and its relationship with demographic and clinical characteristics in inpatients in a large psychiatric institution in Beijing, China. Design and Methods A consecutive sample of 617 psychiatric inpatients formed the study sample. Basic sociodemographic and clinical data including serum prolactin level were collected. Findings The prevalence of hyperprolactinemia was 55.9% in the whole sample, and 56.8% and 43.2% for women and men, respectively. The corresponding figures were 59.6%, 40.0%, 53.6%, and 50.8% in schizophrenia spectrum disorders, major depression, bipolar disorders, and other psychiatric disorders, respectively ( p = 0.09). In univariate analyses, patients having hyperprolactinemia were younger, more likely to receive risperidone, amisulpride, and first-generation antipsychotics, but less likely to receive clozapine and aripiprazole. In multiple logistic regression analysis, hyperprolactinemia was independently associated with younger age, more use of risperidone or amisulpride and first-generation antipsychotics, and less use of clozapine and aripiprazole ( r2 = 0.197). Practice Implications Hyperprolactinemia is very common in Chinese psychiatric inpatients. Given the potentially harmful consequences of hyperprolactinemia and its preventable nature, effective measures to lower the frequency hyperprolactinemia in patients with major psychiatric disorders should be implemented in Chinese mental health facilities. [ABSTRACT FROM AUTHOR]

Purpose Physical restraint ( PR) is a highly controversal topic in psychiatry. Little is known about PR among psychiatric inpatients in China. This study examined the frequency of PR and its relationships with demographic and clinical characteristics among a large psychiatric institution in the Hunan Province, China. Design and Methods The study included a consecutively assessed sample of 160 psychiatric inpatients. Sociodemographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview. Findings The frequency of PR was 51.3% in the whole sample; 63.2% among female and 39.2% among male patients. In multiple logistic regression analysis PR was independently associated with male gender ( p = 0.001, odds ratio [ OR] = 0.2, 95% confidence interval [ CI] 0.1-0.6), less outpatient treatment prior to admission ( p = 0.03, OR = 0.3, 95% CI 0.1-0.9), more frequent use of mood stabilizers ( p = 0.002, OR = 5.6, 95% CI 1.9-16.7), more aggressive behavior prior to admission ( p = 0.002, OR = 1.1, 95% CI 1.04-1.2), and younger age ( p = 0.04, OR = 0.97, 95% CI 0.93-0.99). Practice Implications PR is very common in clinical practice in China. Its demographic and clinical correlates are similar to findings in Western settings. [ABSTRACT FROM AUTHOR]

Purpose There have been no data about long-term benzodiazepine ( BZD) use and its correlates in patients with major depressive disorder ( MDD) in China. This study aimed to examine the prevalence of long-term BZD use (more than three months) and its demographic and clinical correlates in Chinese patients with MDD. Design and Methods A total of 1,192 patients with MDD were examined in 10 mental health centers in China. Patients' socio-demographic and clinical characteristics and prescriptions for psychotropic drugs were recorded using a standardized form. Findings A large portion of patients (36.2%) received long-term BZD treatment. Univariate analyses revealed that long-term BZD users were older, poorer, and had more impaired occupational functioning than patients not taking BZDs. Long-term BZD users had fewer psychotic symptoms and took less antipsychotic drugs. In multivariate analyses, long-term BZD use was independently associated with older age and more severe impaired occupational functioning; long-term BZD users were less likely to receive antipsychotic medications and traditional antidepressants (tricyclic antidepressants, tetracyclic antidepressant, and monoamine oxidase inhibitors). Practice Implications Long-term BZD use was common in patients with MDD in China. A host of demographic and clinical factors were independently associated with long-term BZD use. [ABSTRACT FROM AUTHOR]

This study aimed to determine the frequency and sociodemographic/clinical correlates of insomnia in Chinese patients aged ≥60 years suffering from chronic obstructive pulmonary disease (COPD). In this case-control study of 142 outpatients with COPD and 218 sex- and age-matched control subjects, COPD patients were recruited from a prospective study sample hospitalized in Hong Kong for acute COPD exacerbation (≥2 major COPD symptoms or >1 major+minor COPD symptoms for ≥2 consecutive days). Controls were recruited from social centres in Hong Kong. Activity of daily living was assessed with the Instrumental Activities of Daily Living Scale, life events were evaluated using the Life Event Scale, depressive symptoms were ascertained with the Geriatric Depression Scale, and quality of life was measured using the Medical Outcomes Study Short Form-12. Early, middle and late insomnia were measured using items 4, 5 and 6 of the Hamilton Rating Scale for Depression. The frequency of ≥1 type of insomnia was 47.2% in patients and 25.7% in controls; frequencies of early, middle and late insomnia in patients were 24.6%, 31.0%, and 26.1%, respectively, compared to 14.7%, 14.7% and 11.9% in controls. Group differences were non-significant after controlling for relevant covariates. However, in multiple logistic regression analysis, more physical illnesses ( p = 0.02, OR = 1.3, 95% CI = 1.1-1.7) and more severe depressive symptoms ( p = 0.009, OR = 1.1, 95% CI = 1.03-1.3) were independently associated with any type of insomnia in COPD patients, accounting for 21.3% of the variance. A significant proportion of older adult Chinese COPD patients suffer from insomnia that warrants more attention in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Background: The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) is a newly introduced screening tool, while the Montgomery–Asberg Scale (MADRS) is commonly used in research and clinical practice in China. Converting the total scores between the two instruments could facilitate the comparison of different studies. Methods: This study included 1164 patients with major depressive disorder (MDD). The diagnosis was established using the Mini International Neuropsychiatric Interview (MINI). The severity of depressive symptoms was assessed with the Chinese versions of MADRS (C-MADRS) and QIDS-SR (C-QIDS-SR) at baseline and 6 weeks later (exit point). Total scores of both scales were converted using Item Response Theory (IRT) analysis. Results: At baseline, the C-MADRS and C-QIDS-SR were not unifactorial, therefore the conversion between them could not be performed. At exit, the C-MADRS and C-QIDS-SR were unifactorial, meeting the unidimensionality assumption of the IRT approach. Depression severity thresholds for the QIDS-SR are suggested as 6–10 for mild, 11–15 for moderate, 16–20 for severe, 21+ for very severe depression and ≤5 for remission (www.ids-qids.org). Based on the results of this study, the corresponding C-MADRS thresholds are 9–17 for mild, 18–24 for moderate, 25–33 for severe, 34+ for very severe depression and ≤7 or 8 (7.5) for remission. Conclusions: The conversion of C-QIDS-SR and C-MADRS total scores would help researchers understand findings across different studies using these scales. [Copyright &y& Elsevier]

Abstract: Background: No study has examined the effect of cognitive-behavioral therapy (CBT) on moderate–severe major depressive disorders (MDD) in China. The objective of this study was to evaluate the effect of CBT, antidepressants alone (MED), combined CBT and antidepressants (COMB) and standard treatment (ST; i.e., receiving psycho-educational intervention and/or medication treatment determined by treating psychiatrists) on depressive symptoms and social functioning in Chinese patients with moderate–severe MDD. Method: A total of 180 patients diagnosed with MDD according to ICD-10 were randomly allocated to one of the four treatment regimens for a period of 6 months. Depressive symptoms were measured using the Hamilton Rating Scale for Depression (HAMD) and the Quick Inventory of Depressive Symptomatology-Self-Report (C-QIDS-SR). Remission threshold was defined as a C-QIDS-SR total score of <5. Social functioning was evaluated with the Work and Social Adjustment Scale (WSAS). All outcome measures were evaluated at entry, and at 3- and 6-months follow-up. Results: At the 6-months assessment, the remission rates in the whole sample (n=96), the MED, the CBT, the COMB and the ST groups were 54.2%, 48%, 75%, 53.5% and 50%, respectively. Following the treatment periods, there was no significant difference in any of the study outcomes between the four groups. However, the CBT showed the greatest effect in the HAMD total score with the effect size=0.94, whereas the ST has only a moderate effect size in the WSAS total score (effect size=0.47). Conclusions: The findings support the feasibility and effectiveness of CBT as a psychosocial intervention for Chinese patients with moderate–severe MDD. We also found that single treatment using MED or CBT performed equally well as the combined CBT-antidepressant treatment in controlling the remission. The study provided important knowledge to inform the mental health care planning in China. [Copyright &y& Elsevier]