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Objectives: Caregiver beliefs about the causes of attention-deficit/hyperactivity disorder (ADHD) may influence caregiver intentions to let children with ADHD receive treatment. In this survey study, we intended to determine the proportion of caregivers who attribute the overemphasis of the education system on child academic performance as the etiology of their children's ADHD and the factors related to this attribution. Methods: In total, 213 caregivers of children with ADHD participated in this study and were asked whether they regarded the overemphasis of the education system on child academic performance as the etiology of their children's ADHD. Affiliate stigma was assessed using the Affiliate Stigma Scale. Each caregiver rated their child's ADHD and oppositional defiant disorder symptoms using the short Chinese version of the Swanson, Nolan, and Pelham, Version IV Scale. The depression and anxiety of the caregivers were assessed using the Beck Depression Inventory and Beck Anxiety Inventory, respectively. Results: The results were found that 58 (27.2%) caregivers regarded the overemphasis of the education system on child academic performance to be the etiology of their children's ADHD. Affiliate stigma of caregivers was significantly associated with caregiver attribution (p < 0.05). Caregiver depression (p < 0.01) and anxiety (p < 0.01) were significantly associated with caregiver attribution of the etiology of ADHD in bivariate logistic regression analysis models; the associations became nonsignificant after the effect of affiliate stigma being considered. Conclusion: Health professionals should consider caregiver-attributed etiologies when they are developing intervention programs for enhancing the mental health of caregivers and their children with ADHD. [ABSTRACT FROM AUTHOR]

Methamphetamine is garnering concern due to its increasing use worldwide. Depression and sleep quality are major mental health issues in substance users. Heart rate variability biofeedback (HRVBFB) has shown promising results in terms of reducing depression and increasing sleep quality. The present study aimed to explore the effects of HRVBFB on these two issues in methamphetamine users. Sixty-one methamphetamine users were enrolled and allocated randomly into a treatment as usual (TAU) group and a HRVBFB plus TAU group. The levels of depressive symptoms and sleep quality were assessed at intake, end of the intervention, and end of follow-up. Compared with baseline, the levels of depressive symptoms and poor sleep quality were decreased at the end of the intervention and follow-up in the HRVBFB group. The HRVBFB group exhibited a greater decrease in depressive symptoms and a better improvement in sleep quality than the TAU group. The associations of HRV indices with levels of depressive symptoms and poor sleep quality were different in the two groups. Our results showed that HRVBFB is a promising intervention for reducing depressive symptoms and improving sleep quality in methamphetamine users. The benefits with respect to depressive symptoms and poor sleep quality can extend beyond the end of HRVBFB intervention. [ABSTRACT FROM AUTHOR]

Background and Objectives: Heroin use is a severe problem worldwide. To develop more effective treatments for heroin abusers, a comprehensive psychosocial model of heroin use should be established and examined. We created and assessed a neuroticism, depression, attitudes, and heroin addiction (NDA) model.Methods: In this cross-sectional study, 234 patients undergoing methadone replacement treatment were recruited from psychiatric clinics. We used Structural Equation Modeling (SEM) to assess all for neuroticism, depression, and a positive outcome expectancy (POE) (attitudes).Results: The full model had acceptable goodness-of-fit indices, but neuroticism was not significantly associated with a POE or heroin use. A reduced model that deleted insignificant paths had better goodness-of-fit indices, and neuroticism had indirect effects on heroin use via depression and a POE CONCLUSIONS: Our findings provide evidence that depression, neuroticism, and POE affect heroin use. We also found that POE mediates between depression and heroin use. Despite the emotional regulation strategies recommended to help heroin abusers with depression to reduce the likelihood of their heroin use, teaching them with negative attitudes using heroin should also be considered when developing treatments for heroin abusers with depression.Scientific Significance: Our findings provide a comprehensive mechanism of addiction that is integrated with emotion, cognition, and personality. Drug-related beliefs and emotional regulation can be targeted to reduce the likelihood of relapse in abusers with higher levels of neuroticism. (Am J Addict 2018;27:139-143). [ABSTRACT FROM AUTHOR]

Patients with major depressive disorder (MDD) exhibit atypical brain activities in the frontal, temporal, and parietal lobes. The study aimed to investigate the effects of standardized weighted low-resolution electromagnetic tomography Z -score neurofeedback (swLZNFB) on symptoms of depression and anxiety, electroencephalography (EEG) parameters, and deep brain activities in patients with MDD. Forty-eight patients with MDD comorbid with anxiety symptoms were assigned to the swLZNFB group and the control group. Participants completed the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) and a 5-minute resting EEG at the pre-and post-tests. The swLZNFB group received ten sessions of one-hour treatment twice weekly. The control group received treatment as usual. The scores for BDI-II and BAI, number of EEG abnormalities, percentage of EEG abnormalities, and current source density (CSD) measured in the prefrontal cortex (PFC), anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and amygdala were compared at pre-and post-tests between the two groups. There were decreased scores of BDI-II and BAI, number of EEG abnormalities, and percentage of EEG abnormalities at post-test compared with pre-test in the swLZNFB group, and lower scores of BDI-II and BAI at post-test in the swLZNFB group compared with the control group. Moreover, decreased CSD of beta1 and beta3 in the PFC, ACC, PCC, and amygdala at post-test compared to pre-test in the swLZNFB group. Not a randomized controlled trial. Ten sessions of swLZNFB reduced clinical symptoms and atypical brain activities, it serves as a potential psychological intervention for patients with MDD. • swLORETA obtains the current source density (CSD) of electric dipole. • Z-score neurofeedback compared patients' EEG with a normative database. • swLORETA Z-score neurofeedback decrease symptoms of depression and brain activity. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the differences in mental health and behavioral problems among young adults with borderline personality symptoms of various severities.Methods: 500 college students participated in this study. Borderline personality symptoms were evaluated using the Taiwanese version of the Borderline Symptom List (BSL-23). Mental health problems were assessed using the Symptom Checklist-90-Revised Scale. Suicidality and other behavioral problems were assessed using questions from the epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia and BSL-23 Supplement. According to the distribution of BSL-23 scores at the 25th, 50th, and 75th percentiles, the participants were divided into 4 groups: No/Mild, Moderate, Severe, and Profound. Analysis of variance and the chi-square test were used to compare mental health and behavioral problems among the 4 groups.Results: All mental health problems differed significantly among the 4 groups. The severity of nearly all mental health problems increased with that of borderline personality symptoms. The proportions of most behavioral problems differed significantly among the 4 groups. The Profound group was more likely to have behavioral problems than the other 3 groups.Conclusion: Young adults who had more severe borderline personality symptoms had more severe mental health and behavioral problems. [ABSTRACT FROM AUTHOR]

Background and Objectives: Prevailing literature explains how depression, compulsion, and mindfulness affect heroin use; however, there is no comprehensive framework that explains their overall relationships. We therefore proposed and examined a hypothetical depression-compulsion-heroin use and mindfulness (DCHm) model.Methods: We recruited 234 male heroin users. Self-reported levels of depression, mindfulness, compulsion to use, and severity of heroin use were measured. Structural equation modeling was used to examine the proposed DCHm model.Results: Compulsion was a mediator between depression and heroin use. In addition, the DCHm model had satisfactory model fit indices. Depression indirectly affected heroin use through compulsion to use. The moderating effects of mindfulness in the two competing models were compared between the high- and low-mindfulness groups. The DCHm model in the high-mindfulness group had more favorable model fit indices than it did in the low-mindfulness group.Conclusions: Through learned emotional regulation strategies, addicted people with higher mindfulness were less likely to compulsively take drugs because of a depressive mood than were those with lower mindfulness. Furthermore, effective emotion-regulation strategies should be developed and examined in future studies.Scientific Significance: These results raise questions about the effect of compulsion on heroin use disorders. Mindfulness-based approaches to emotional regulatory strategies should be developed based on these findings. Further experimentation and prospective studies are needed to more fully examine the moderating role of mindfulness on depression and compulsion. [ABSTRACT FROM AUTHOR]

Background/purpose: The aim of this study was to examine the correlations between the severity of alprazolam dependence and socio-demographic characteristics, the characteristics of alprazolam use, psychiatric comorbidity, and beliefs toward alprazolam use among long-term alprazolam users in Taiwan.Methods: A total of 148 long-term alprazolam users participated in this study. The Chinese version of the Severity of Dependence Scale was used to assess participants' severity of alprazolam dependence in the preceding month. Their socio-demographic characteristics, family function characteristics, dosage of prescribed alprazolam, duration of alprazolam use, alcohol use pattern, pain reliever and cigarette use pattern, severity of depressive symptoms, psychiatric diagnosis, and belief toward alprazolam use were investigated.Results: The results of multiple regression analysis indicated that a longer duration of alprazolam use, severe depressive symptoms, a high level of belief in the necessity of alprazolam treatment, and a high level of concern about the potential adverse consequences of alprazolam use were significantly associated with more severe alprazolam dependence.Conclusion: Doctors should closely monitor the severity of alprazolam dependence among long-term users, especially patients' levels of depression, beliefs in the necessity of alprazolam treatment, and their concerns over the adverse consequences of continued treatment with alprazolam. [ABSTRACT FROM AUTHOR]

Sexual orientation microaggressions (SOMs) may negatively affect lesbian, gay, and bisexual (LGB) individuals' mental health. However, the moderating effects of gender nonconformity and biological sex on the relationship between SOMs and anxiety and depressive symptoms has never been examined. We evaluated the moderating effect of gender nonconformity on the association of SOMs with anxiety and depressive symptoms among LGB young male and female adults. We hypothesized that the associations of SOMs with anxiety and depressive symptoms weakened with increasing gender nonconformity among gay and bisexual men but strengthened with increasing gender nonconformity among lesbian and bisexual women. In total, 1000 self-identified LGB young adult individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, anxiety was assessed using the State subscale on the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. The two-way moderation models stratified by sex examined the moderating effects of gender nonconformity on the association between SOMs and anxiety symptoms in the male and female participants. The three-way moderated moderation models were used to determine whether gender nonconformity and sex jointly moderated the associations between SOMs and anxiety and depressive symptoms. In the two-way moderation models stratified by sex, gender nonconformity exerted opposite moderating effects on the association between SOMs and anxiety and depressive symptoms in the male and female participants. For the male participants, the association between SOMs and anxiety (β = −0.08) and depressive symptoms (β = −0.09) weakened with increasing gender nonconformity. For the female participants, the association between SOMs and anxiety (β = 0.08) and depressive symptoms (β = 0.13) strengthened with increasing gender nonconformity. The three-way moderated moderation models further confirmed that sex moderated the moderating effects of gender nonconformity on the associations between SOM and anxiety (β = −0.16, p =.047) and depressive symptoms (β = −0.22, p <.001). The cross-sectional study design limited the inferences that could be made concerning the temporal relationship between SOMs and mental health problems. The association between SOMs and anxiety and depressive symptoms weakened with increasing gender nonconformity in gay and bisexual men, whereas the association between SOMs and anxiety and depressive symptoms strengthened with increasing gender nonconformity in lesbian and bisexual women. • Lesbian, gay, and bisexual (LGB) individuals have been experienced sexual orientation microaggressions (SOMs), nonconformity and mental disorders. • The moderation of gender nonconformity between anxiety and depressive symptoms, and SOMs was further moderated sex. • The social stereotypes and expectations associated with biological sex may account for these moderation effects. [ABSTRACT FROM AUTHOR]

Introduction To examine the prevalence rates and correlates of dependence on, misuse of, and beliefs regarding use of hypnotics in elderly psychiatric patients with long-term use of zolpidem, estazolam, or flunitrazepam. Methods A total of 139 psychiatric outpatients 65 or more years of age who used zolpidem, estazolam, or flunitrazepam for at least 3 months were studied. The levels of hypnotic dependence and beliefs regarding hypnotic use (necessity and concern) were assessed. Three patterns of hypnotic misuse in the past 1 month were also explored. The correlates of high dependence, misuse, and unfavorable attitude and high concern toward hypnotic use were examined using logistic regression analyses. Results A total of 28.8%, 7.9%, 12.2%, and 22.3% of participants reported high dependence on, misuse of, unfavorable attitude toward, and high concern toward hypnotic use, respectively. Males were more likely to report unfavorable attitude toward hypnotic use than females. Elders with significant depression were more likely to report high concern toward hypnotic use than those without significant depression. Elders with high concern toward hypnotic use were more likely to report high dependence on hypnotics than those with low concern. Elders with significant depression and taking zolpidem were more likely to misuse hypnotics than those without significant depression and taking estazolam or flunitrazepam, respectively. Discussion Clinicians should monitor the possibility of dependence on and misuse of hypnotics among elderly psychiatric patients who had the correlates identified in this study. [ABSTRACT FROM AUTHOR]

Introduction The aim of the study is to compare the reinforcement sensitivity between online and offline interaction. The effect of gender, Internet addiction, depression, and online gaming on the difference of reinforcement sensitivity between online and offline were also evaluated. Methods The subjects were 2,258 college students (1,066 men and 1,192 women). They completed the Behavior Inhibition Scale and Behavior Approach Scale ( BIS/ BAS) according to their experience online or offline. Internet addiction, depression, and Internet activity type were evaluated simultaneously. Results The results showed that reinforcement sensitivity was lower when interacting online than when interacting offline. College students with Internet addiction decrease fewer score on BIS and BAS after getting online than did others. The higher reward and aversion sensitivity are associated with the risk of Internet addiction. Discussion The fun seeking online might contribute to the maintenance of Internet addiction. This suggests that reinforcement sensitivity would change after getting online and would contribute to the risk and maintenance of Internet addiction. [ABSTRACT FROM AUTHOR]

Background: Zolpidem and zopiclone are the two most commonly prescribed Z-drugs approved to treat insomnia. Objectives: To examine the demographic and clinical correlates of dependence and beliefs about hypnotic use among long-term zolpidem and zopiclone users in psychiatric treatment for insomnia. Methods: A total of 392 psychiatric outpatients who received zolpidem or zopiclone treatment for at least 3 months for insomnia were studied. Participants' severity of hypnotic dependence and beliefs about the use of hypnotics to treat sleep problems were assessed. The correlation of dependence and beliefs about zolpidem and zopiclone treatment with demographic characteristics, hypnotic-using behaviors, co-use of addictive substances, and depressive symptoms were analyzed using multiple regression analysis models. Results: Zolpidem users reported more severe dependence and a lower level of necessity regarding the use of hypnotics than zopiclone users did. High equivalent doses of hypnotics and long duration of use were significantly associated with severe dependence and a low level of necessity. Severe depressive symptoms were signiciantly associated with severe dependence, a low level of necessity, and a low level of concern. Educational level was also associated with the levels of concern and necessity. Conclusions/Importance: There were differences in the level of dependence and belief about hypnotic use between zolpidem and zopiclone users. The correlates of dependence and belief identified in this study can serve as the basis for prevention and intervention programs. [ABSTRACT FROM AUTHOR]

Aims Patients with premenstrual dysphoric disorder ( PMDD) experience moderate to severe physical and mood symptoms during the luteal phase of their menstrual cycle. The purposes of this study were to examine whether there were significant differences in frontal alpha asymmetry between PMDD and non- PMDD women during a depressive induction condition during the luteal and follicular phases and to examine the relations between premenstrual distress and depressive symptoms, and frontal alpha asymmetry. Material and Methods The participants included 12 college women with PMDD and 12 without PMDD as controls. Frontal electroencephalograms ( F3/ F4) were measured during the luteal and follicular phases of the menstrual cycle in the following sequence: resting baseline, depressive induction, depressive recall, recovery, and relaxation. Premenstrual distress questionnaires and the Beck Depression Inventory II were administered. Results The participants with PMDD had higher frontal alpha asymmetry than those without PMDD during the depressive induction and relaxation conditions only during the luteal phase. For PMDD and non- PMDD during the luteal phase, a positive correlation was observed between negative affect (measured by premenstrual distress questionnaires) and frontal alpha asymmetry under the depressive induction stage. In addition, higher Beck Depression Inventory II somatic depression was positively correlated with frontal alpha asymmetry under the depressive induction stage. Conclusions This study supports the significant difference between PMDD and non- PMDD on frontal alpha asymmetry, and frontal alpha asymmetry was related to negative affect and somatic depression, while participants with PMDD were in the depressive mood during the luteal phase. [ABSTRACT FROM AUTHOR]

Hostility online has not been evaluated by an empirical investigation. This study aims to evaluate (a) the difference between hostility in the real world and that online and (b) whether the difference is associated with Internet addiction, depression, or online activities. A total of 2,348 college students (1,124 males and 1,224 females) were recruited and completed the Chen Internet Addiction Scale, the Center for Epidemiological Studies' Depression Scale, and the questionnaire for online activity. Further, the Buss-Durkee Hostility Inventory-Chinese version-short form was utilized to evaluate hostility in both real and virtual worlds. The results demonstrated that the levels of all four dimensions of hostility were lower when getting online than those in the real world. Subjects with Internet addiction had higher hostility both in the real world and online as do subjects with depression. Further, college students with Internet addiction had increased expressive hostility behavior and those with depression had decreased hostility cognition, hostility affection, and suppressive hostility behavior when getting online. Lastly, the buffering effect of the Internet on hostility was attenuated among subjects paying the most online time in chatting, and those using the Internet mainly for online gaming had higher expressive hostility behavior not only in the real world but also online. These results suggest that attention should be paid to interventions concerning aggressive behavior among subjects with Internet addiction or online gaming and chatting. On the other hand, depressed college students would be less hostile after entering the Internet. It is suggested that the Internet would be one possible interactive media to provide intervention for depression. [ABSTRACT FROM AUTHOR]

Aim: The goal of treating major depressive disorder is to achieve remission. This prospective study aimed to identify predictors of remission in a cohort of depressive inpatients who received fluoxetine. Methods: A total of 131 newly hospitalized patients with major depressive disorder received a fixed dose of 20 mg/day (the recommended dose from the literature) of fluoxetine for 6 weeks. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale at weeks 0, 1, 2, 3, 4 and 6. Remission was defined as a score of ≤7 on the 17-item Hamilton Depression Rating Scale after 6 weeks of treatment. We compared the remitters and non-remitters in terms of baseline variables. The Short-Form-36 pain interference item was used to assess pain. It was classified as high (score ≥ 3) or low (score < 3). Results: A total of 31 (27.7%) of 112 completers remitted after 6 weeks of treatment. The remitters and non-remitters did not differ in baseline variables, except pain interference, baseline depression severity, and depression improvement at week 1. Conclusion: These findings obtained from newly hospitalized major depression patients support the previous notion that pain interference, depression severity, and early improvement can be the predictors for remission. Patients with high pain interference, a greater depression severity or a less early improvement are likely to require aggressive treatment early. These data require confirmation and extension to outpatients and other antidepressants. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to examine the direct and indirect effects of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), disaster-exposure experience, gender, and perceived family support on suicide risk (including suicide ideation and attempt) in adolescents 3 months after they had experienced Typhoon Morakot-associated mudslides in Taiwan using a structural equation model (SEM). Methods: Two hundred and seventy-one adolescents in the worst affected mountainous regions of southern Taiwan were recruited. Suicide risk and diagnoses of PTSD and MDD were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. The direct and indirect effects of PTSD, MDD, disaster-exposure experience, gender, and perceived family support on suicide risk were examined using SEM. Results: The results of SEM indicated that increased disaster-exposure experience and female gender had direct influences on an increased suicide risk and indirect influences on increased suicide risk that were mediated by PTSD and MDD. Perceived high family support directly decreased suicide risk. Both PTSD and MDD had direct influences on an increased suicide risk, and PTSD had an indirect influence on an increased suicide risk that was mediated by MDD. Conclusions: Gender, disaster-exposure experience, perceived high family support, PTSD, and MDD all had effects on suicide risk in adolescents who had experienced the threat of mudslides caused by Typhoon Morakot. The results provide healthcare professionals with a comprehensive understanding to develop intervention programs to prevent and intervene in suicide risk. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to examine whether different domains of quality of life (QOL) are differently affected by depressive disorders by comparing QOL of subjects with and without depressive disorders, and to examine the association of QOL with self-stigma, insight and adverse effects of medication among subjects with depressive disorders. Method: The QOL on the four domains of the WHOQOL-BREF Taiwan version were compared between the 229 subjects with depressive disorders and 106 control subjects. Among the depressive subjects, the association between the four QOL domains and subjects' self-stigma, insight, and adverse effects of medication were examined using multiple regression analyses by controlling for the influence of depression, socio-demographic and clinical characteristics and family function. Results: Depressive subjects had poorer QOL on the physical, psychological and social relationship domains than the non-depressive control group. The depressive subjects who had more severe self-stigma had poorer QOL on all four domains. The depressive subjects who perceived more severe adverse effects from medication had poorer QOL on the physical, psychological and environmental domains. However, insight was not associated with any domain of QOL in patients with depressive disorders. Conclusions: The results of this study demonstrate that different domains of QOL are differently affected by depressive disorders, and that clinicians must consider the negative influences of self-stigma and adverse effects from medication on QOL of subjects with depressive disorders. Depression and Anxiety 26:1033–1039, 2009. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Background: The differences in brain activity between patients with major depressive disorder (MDD) and healthy adults have been confirmed by functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and electroencephalography (EEG). The prefrontal lobe and posterior cingulate cortex (PCC) are related to emotional regulation in patients with MDD. However, the high cost and poor time resolution of fMRI and PET limit their clinical application. Recently, researchers have used high time resolution of standardized weighted low-resolution electromagnetic tomography (swLORETA) to investigate deep brain activity. This study aimed to convert raw EEG signals into swLORETA images and explore deep brain activity in patients with MDD and healthy adults. Methods: BrainMaster EEG equipment with a 19-channel EEG cap was used to collect resting EEG data with eyes closed for 5 min. NeuroGuide software was used to remove the EEG artifacts, and the swLORETA software was used to analyze 12,700 voxels of current source density (CSD) for 139 patients with MDD and co-morbid anxiety symptoms (mean age = 43.08, SD = 13.76; 28.78% were male) and 134 healthy adults (mean age = 40.60, SD = 13.52; 34.33% were male). Deep brain activity in the frontal lobe and PCC at different frequency bands was analyzed, including delta (1–4 Hz), theta (5–7 Hz), alpha (8–11 Hz), beta (12–24 Hz), beta1 (12–14 Hz), beta2 (15–17 Hz), beta3 (18–24 Hz), and high beta (25–29 Hz). Results: There was lower delta and theta and higher beta, beta1, beta2, beta3, and high-beta activity at the prefrontal lobe (dorsal medial prefrontal cortex [dmPFC], ventral medial prefrontal cortex [vmPFC], and dorsal lateral prefrontal cortex [dlPFC], ventral lateral prefrontal cortex [vlPFC], orbital frontal cortex [OFC]) and PCC in MDD patients compared with healthy adults. There was no significant difference in alpha activity between the two groups. Conclusion: This study indicates brain hyperactivity in the right prefrontal lobe (dlPFC and vmPFC) and PCC in patients with MDD with co-morbid anxiety symptoms, and the dlPFC and PCC were also related to emotion regulation in MDD. Inhibiting high-beta activity or restoring delta and theta activity to the normal range in the right frontal lobe and PCC may be possible in z-score neurofeedback protocols for patients with MDD in future studies. [ABSTRACT FROM AUTHOR]

Aims: The aim of the present study was to investigate the magnitude and independence of the effects of childhood physical abuse on adolescent depression, problem drinking and perceived poor mental health in Taiwanese indigenous and non-indigenous adolescents living in rural areas controlling for individual and familial characteristics. Methods: A sample of adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. The associations between childhood physical abuse and adolescent depression, problem drinking and perceived poor health status were examined on univariate and multivariate logistic regression. Results: Of the 1684 adolescents who completed the questionnaires, 374 (22.2%) reported that they had experienced physical abuse in childhood. Controlling for individual and familial factors, childhood physical abuse significantly increased the risk of depression, problem drinking and perceived poor health status in the present sample of adolescents on multivariate logistic regression. Conclusion: History of childhood physical abuse should be elicited from adolescents in treatment for depression, alcohol abuse or physical discomfort of unknown etiology. This finding may be of clinical benefit in terms of the design and implementation of intervention. [ABSTRACT FROM AUTHOR]

Aims: The aim of the present study was to gain insight into the prevalence of depression and its association with self-esteem, family, peer and school factors in a large-scale representative Taiwanese adolescent population. Methods: A total of 12 210 adolescent students were recruited into the present study. Subjects with a score >28 on the Center for Epidemiological Studies' Depression Scale were defined as having significant depression; the Rosenberg Self-Esteem Scale, Adolescent Family and Social Life Questionnaire and Family C-APGAR Index were applied to assess subjects' self-esteem, family, peer and school factors. The association between depression and correlates were examined on t-test and χ2 test. The significant factors were further included in logistic regression analysis. Results: Among 9586 participants (response rate: 86.3%), the prevalence of depression was 12.3%. The risk factors associated with depression in univariate analysis included female gender, older age, residency in urban areas, lower self-esteem, disruptive parental marriage, low family income, family conflict, poorer family function, less satisfaction with peer relationships, less connectedness to school, and poor academic performance. After adjusting the effects of sex, age and location, only subjects with lower self-esteem, higher family conflict, poorer family function, lower rank and decreased satisfaction in their peer group, and less connectedness to school were prone to depression on logistic regression. Conclusion: The prevalence of depression is high in Taiwanese adolescents, and the multiple factors of family, peer, school and individuals are associated with adolescent depression. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this cross-sectional study was to examine the relationships between insight and psychosocial adjustment in outpatients with bipolar I disorder in clinical remission. Methods: Using the Schedule of Assessment of Insight (SAI) and its expanded version (SAI-E), we evaluated 50 consecutive patients with bipolar I disorder in remission to determine their level of insight. We also evaluated their psychosocial adjustment using the Community Life Scale. Relationships among psychosocial adjustment, insight, residual affective symptoms, and demographic and clinical characteristics were examined. Results: The results of the multiple regression analysis indicated that having a higher total SAI or SAI-E insight score and having no residual affective symptoms were significantly associated with better psychosocial adjustment in patients with bipolar I disorder. Conclusions: In this cross-sectional study, better insight and less residual affective symptoms were correlated with good psychosocial adjustment. To address the causality issue, a longitudinal study is needed. [ABSTRACT FROM AUTHOR]

The aims of the present study were to compare the quality of life (QoL), depression and stress between patients with malignant breast cancer and those with benign breast tumors. The present study also examined the factors related to QoL among the patients who were receiving active treatment for breast cancer. Among the 97 patients participating in the study, 73 patients were diagnosed as having malignant breast cancer (malignant group) and 24 as having benign tumors (benign group). All the participants completed the World Health Organization Questionnaire on Quality of Life to determine their QoL. The level of depression, stress, and demographic characteristics were also collected. Quality of life, depression and stress were compared between the malignant and benign groups, and the factors related to QoL were also examined. It was found that the malignant group had poorer physical and psychological QoL and higher life stress. Depression was significantly associated with QoL for both the malignant and benign groups, and the stress from health problem was the most significant predictors for QoL among the malignant group. The breast cancer patients suffered more severe psychological difficulty under active treatment than did the benign group patients. This will have great impact on their QoL, as in Western society. Depression and stress need to be recognized and aggressive psychological and/or medical intervention needs to be carried out in order to diminish the impact on QoL. [ABSTRACT FROM AUTHOR]

Higher functional connectivity within the default mode network (DMN) has been found in functional magnetic resonance imaging (fMRI) studies of major depressive disorder (MDD). We used electroencephalogram (EEG) coherence as an index of functional connectivity to examine group differences in DMN between the MDD and healthy control (HC) groups during the resting state. MDD patients with comorbid anxiety symptoms (n = 154) and healthy controls (n = 165) completed the questionnaires of depression, anxiety, and rumination. A 19-channel EEG recording was measured under resting state for all participants. EEG coherences of the delta, theta, alpha, beta, and high beta in the anterior DMN (aDMN), posterior DMN (pDMN), aDMN-pDMN, DMN-parahippocampal gyrus (PHG), and DMN-temporal gyrus were compared between the two groups. The correlations between rumination, anxiety, and DMN coherence were examined in the MDD group. (1) No difference was found in the delta, theta, alpha, and beta within the DMN brain regions between the two groups; the MDD group showed higher high beta coherence within DMN brain regions than the HC group. (2) Rumination was negatively correlated with theta coherence of aDMN, and positively correlated with beta coherence of aDMN and with alpha coherence of pDMN and DMN-PHG. (3) Anxiety was positively correlated with high beta coherence of aDMN, pDMN, and DMN-PHG. MDD patients with comorbid anxiety symptoms exhibited hypercoherence within the DMN brain regions. Hypercoherences were related to symptoms of rumination, and anxiety may be a biomarker for MDD patients with comorbid anxiety symptoms. • Depression had higher high beta coherences within default mode network (DMN). • Rumination was positively correlated with alpha coherence of posterior DMN. • Anxiety was positively correlated with high beta coherence of posterior DMN. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the association between affiliate stigma and depression in caregivers of children with attention-deficit/hyperactivity disorder (ADHD) in Taiwan and evaluated the moderating effects of perceived family support, self-esteem, and children's behavioral problems on the association.Methods: The affiliate stigma and depressive symptoms of 400 caregivers of children with ADHD were assessed using the Affiliate Stigma Scale and Center for Epidemiological Studies Depression Scale, respectively. A general linear model (GLM) was used to examine the association between affiliate stigma and depression symptoms. The interaction models of the GLM and the Johnson-Neyman technique were used to examine the moderating effects of caregivers' family support and self-esteem and children's internalizing problems and ADHD symptoms on the association.Results: Affiliate stigma was positively associated with the depression level in caregivers of children with ADHD. The level of the association between affiliate stigma and depression symptoms was negatively associated with the levels of family support and self-esteem but positively associated with the levels of child's internalizing problems and ADHD symptoms.Limitations: The cross-sectional design limited the possibility of determining the causal relationships among the variables.Conclusions: Prevention and intervention strategies should aim to reduce affiliate stigma and depression symptoms, as well as to target the moderators of the association. [ABSTRACT FROM AUTHOR]

Background: Alpha-asymmetry neurofeedback (ALAY) was applied to patients with major depressive disorder (MDD) based on the theory of frontal alpha asymmetry. Neurophysiological studies have found a higher high-beta activity of electroencephalography (EEG) at the posterior cortex among patients with comorbid MDD and anxiety symptoms. The present study examined the effects of ALAY and high-beta down-training (Beta) neurofeedback in symptoms of depression and anxiety and EEG parameters.Method: Eighty-seven patients with comorbid MDD and anxiety symptoms were allocated to the ALAY, Beta, or control groups. Both neurofeedback groups received ten-session neurofeedback. All participants completed the Beck Depression Inventory II (BDI-II), Beck Anxiety Inventory (BAI), and five minutes resting EEG recording at pre-test and post-test. EEG raw signals were transformed into an A1 score [log (F4 alpha) - log (F3 alpha)], P3 and P4 high-beta power.Results: BDI-II and BAI scores decreased at post-test in both ALAY and Beta groups, but no significant difference between the two groups. No significant interaction effect in A1 score at pre-test and post-test between the ALAY, Beta, and control groups. The P3 high-beta was significantly decreased in the Beta group, an increase in the control group, and no change in the ALAY group at post-test compared to the pre-test.Conclusions: Both neurofeedback groups decreased symptoms of depression and anxiety. The Beta group was more effective in decreasing high-beta power at the parietal cortex compared to other groups. This non-invasive psychological intervention can be used in the future for patients with comorbid MDD and anxiety symptoms. [ABSTRACT FROM AUTHOR]

The aim of this study investigated the prevalence of Internet addiction (IA) in a large representative sample of secondary school students and identified the risk and protective factors. Using a crosssectional design, 2170 participants were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling. The prevalence of IA was 17.4% (95% confidence interval, 15.8%-19.0%). High impulsivity, low refusal self-efficacy of Internet use, high positive outcome expectancy of Internet use, high disapproving attitude of Internet use by others, depressive symptoms, low subjective well-being, high frequency of others' invitation to Internet use, and high virtual social support was all independently predictive in the logistic regression analysis. The prevalence of IA among secondary school students in Taiwan was high. Results from this study can be used to help educational agencies and mental health organizations create policies and design programs that will help in the prevention of IA in adolescents. [ABSTRACT FROM AUTHOR]

The family caregivers of people with mental illness may internalize the public stereotypes into the affiliate stigma (i.e., the self-stigma of family members). This study aimed to compare the affiliate stigma across schizophrenia, bipolar disorder, and major depressive disorder, and to investigate potential factors associated with affiliate stigma. Each caregiver of family members with schizophrenia (n = 215), bipolar disorder (n = 85), and major depressive disorder (n = 159) completed the Affiliate Stigma Scale, Rosenberg Self-Esteem Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, and Beck Anxiety Inventory. After controlling for potential confounders, the hierarchical regression models showed that caregivers of a family member with schizophrenia had a higher level of affiliate stigma than those of bipolar disorder (β = -0.109; p < 0.05) and major depressive disorder (β = -0.230; p < 0.001). Self-esteem, developmental burden, and emotional burden were significant factors for affiliate stigma. The affiliate stigma of caregivers is associated with their self-esteem, caregiver burden, and by the diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the prevalence rates of suicidal intent and its correlates among adolescents diagnosed with ADHD in Taiwan. A total of 287 adolescents aged 11-18 years and diagnosed with ADHD participated in this study. Their suicidal ideation and suicide attempts were assessed. Logistic regression analysis was used to examine the associations of suicide with individual, family, peer, ADHD, and psychopathology factors. A total of 12.2% of the participants reported suicidal ideation or a suicide attempt. A logistic regression analysis model showed that adolescents who were older, were bullying perpetrators, and reported high depression level were more likely to have suicidal intent. These three factors were also significantly correlated with suicidal ideation; however, only having high depression level was significantly correlated with suicidal attempts. The results of this study showed that a high proportion of adolescents with ADHD reported suicidal ideation or a suicide attempt. Multiple factors were significantly associated with suicidal intent among adolescents with ADHD. Clinicians, educational professionals, and parents of adolescents with ADHD should monitor the possibility of suicide in adolescents with ADHD who exhibit the correlates of suicidal intent identified in this study. [ABSTRACT FROM AUTHOR]

Abstract: Background: Insight refers to an awareness and attribution of disorders and attitude toward treatment. While neurocognitive studies indicate that lack of insight is associated with frontal lobe dysfunction, little is known about the neurobiochemical profile of insight. We investigated the neurobiochemical characteristics of insight within the frontal lobe using proton magnetic resonance spectroscopy (1H MRS) among elderly people with major depressive disorders in remission. Methods: Seventy-five elderly patients with major depressive disorder in remission underwent assessment of insight using the Mood Disorders Insight Scale (MDIS), including awareness, attribution, and need for treatment. Brain 1H MRS spectra were acquired from voxels located in the left frontal lobe. Ratios of N-acetylaspartate (NAA), choline, and myo-inositol reference to total creatine (tCr) were calculated. Correlations between these biochemical ratios and insight were examined. Secondary analyses included the association of biochemical ratios with each of the subscales of insight. Results: Twenty (26.7%) study participants scored full points on the MDIS scale. Total scores of MDIS correlated with NAA/tCr (rho=0.31; p <0.006) in the left frontal lobe. Secondary analyses showed the depressive elders with inadequate attribution to their disease had lower levels of NAA/tCr than those with full insight regarding attribution. Conclusions: Biochemical changes on 1H MRS support that the left frontal lobe may involve insight and relate more specifically to disease attribution. Lower levels of NAA/tCr suggest that the neuronal dysfunction in the left frontal lobe is associated with inadequate insight in late-life depression. [Copyright &y& Elsevier]