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Background: Postintensive care syndrome (PICS) has adverse multidimensional effects on nearly half of the patients discharged from ICU. Mental disorders such as anxiety, depression and post-traumatic stress disorder (PTSD) are the most common psychological problems for patients with PICS with harmful complications. However, developing prediction models for mental disorders in post-ICU patients is an understudied problem. Aims: To explore the risk factors of PICS mental disorders, establish the prediction model and verify its prediction efficiency. Study Design: In this cohort study, data were collected from 393 patients hospitalized in the ICU of a tertiary hospital from April to September 2022. Participants were randomly assigned to modelling and validation groups using a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was performed to select the predictors, multiple logistic regression analysis was used to establish the risk prediction model, and a dynamic nomogram was developed. The Hosmer-Lemeshow (HL) test was performed to determine the model's goodness of fit. The area under the receiver operating characteristic (ROC) curve was used to evaluate the model's prediction efficiency. Results: The risk factors of mental disorders were Sepsis-related organ failure assessment (SOFA) score, Charlson comorbidity index (CCI), delirium duration, ICU depression score and ICU sleep score. The HL test revealed that p = .249, the area under the ROC curve = 0.860, and the corresponding sensitivity and specificity were 84.8% and 71.0%, respectively. The area under the ROC curve of the verification group was 0.848. A mental disorders dynamic nomogram for post-ICU patients was developed based on the regression model. Conclusions: The prediction model provides a reference for clinically screening patients at high risk of developing post-ICU mental disorders, to enable the implementation of timely preventive management measures. Relevance to Clinical Practice: The dynamic nomogram can be used to systematically monitor various factors associated with mental disorders. Furthermore, nurses need to develop and apply accurate nursing interventions that consider all relevant variables. [ABSTRACT FROM AUTHOR]

Mental health has become a significant public health problem that impacts both economic and social development, with severe mental disorders (SMDs) being the top priority. Over recent years, Beijing, China, has introduced several policies to reduce the economic burden on patients with mental health disorders. The aim of this study was to investigate the current status and composition of patients' medical expenses following the introduction of multiple medical policies, explore the factors that may impact the utilisation of medical services and provide a reference and basis for subsequent policy improvements. Multistage sampling was used to select a representative study population. A retrospective survey was used to collect patient information and data on medical expenses in 2019. Descriptive statistics were applied to analyse the current status of patients' medical expenses, and a two-part model was used to examine the factors influencing healthcare utilisation and to model predicted expenses. Among 4940 participants, the average outpatient expenses of patients with SMD who incurred medical expenses were 8373.61 Yuan, and the average hospitalisation expenses were 81,594.05 Yuan. The out-of-pocket expenses were 29.22% of outpatient expenses and 8.13% of inpatient expenses. Factors such as age, household status, economic status, marital status, participation in the Community Free-Medication Service (CFMS) and the type of disease diagnosed influenced the differences in medical expenses and utilisation of services. The medical expenses of patients with SMD in Beijing are high, but a number of introduced policies have effectively reduced these costs for patients. Future studies should focus on the impact of factors such as age, economic status, participation in the CFMS and the type of disease diagnosed on medical expenses. [ABSTRACT FROM AUTHOR]

Objective: Occupational function assessment is essential for rehabilitation of severe mental illness but lacks comprehensive tools. Method: This study examines the psychometric properties of the Chinese versions of the Vocational Cognitive Rating Scale (VCRS) and the Work Behavior Inventory (WBI) in 60 chronic patients from a psychiatric daycare center and identifies clinical correlates of occupational function measured on the Positive and Negative Syndrome Scale (PANSS). Results: The Chinese VCRS and WBI showed adequate internal consistency, interrater and test–retest reliability, and good convergent validity with the Comprehensive Occupational Therapy Evaluation Scale. Factor analysis favored a one-factor solution of the VCRS; and a four-factor structure in the WBI including Efficiency, Social Interaction, Appropriateness, and Regularity. The VCRS and Efficiency were predicted by fewer disorganization but greater affective symptoms. Social Interaction was negatively predicted by resistance symptoms. Appropriateness was associated with all but negative symptoms. Regularity was predicted by fewer negative symptoms. Considering work behavior altogether, WBI total scores were predicted by fewer negative, fewer disorganization, and greater affective symptoms. Conclusions and Implication for Practice: Findings suggest that the Chinese VCRS and WBI have sound psychometric properties and are suitable for both clinical trials and for planning personalized rehabilitation programs. Impact and Implications: This study provided the first validation of the Vocational Cognitive Rating Scale and the Work Behavior Inventory—two functional assessment tools regarding work performance specific to patients with mental illness—in an Asian country. We derived a new factor structure for finding unique relationships between clinical profiles and each facet of various work behaviors. The findings provide evidence to support a more delicate assessment of occupational function while providing a fundamental foundation for developing future personalized rehabilitation programs. [ABSTRACT FROM AUTHOR]

Objective: Guided by the ecosystem theory model framework, we aimed to explore the influence of three ecological dimensions (social, family and psychological factors) on suicidal intention in people with severe mental illness (SMI). We hypothesized that three factors influence suicidal intention, and that psychological factors may play a mediating role in the influence of social and family factors on suicidal intention. Methods: We collected 994 patients with SMI aged 18 and above from May 2021 to March 2022 in the Fourth Hospital of Fuzhou City. We used logistic regression to analyse the association between social, family, psychological factors and suicidal intention. Furthermore, we explored the mediating effects among the influencing factors. Results: Younger male patients with schizophrenia were more likely to have suicidal intention due to psychosocial family factors (p <.05). Social factors (poor interpersonal relations, social retreat, social activities outside the home), family factors (parental functions, activities within the family, family functions), psychological factors (anxiety, depression, interest in the outside world, overt aggression, lack of accountability and planning) were all independent risk factors for suicidal intention in patients. Mediation analysis showed anxiety and depression mediated the role of social and family factors on suicidal intention (p <.05). Conclusion: Social, family and psychological factors were important risk factors for suicidal intention, with anxiety and depression being partial mediators for suicidal intention. Therefore, interventions that enhance family and social functioning and reduce anxiety and depression may be effective in reducing suicidal intention in SMI. [ABSTRACT FROM AUTHOR]

Global epidemiological evidence indicates high rates of mental illness but low rates of diagnosis among older people. In China, service providers identify older adults with mental disorders in varied ways. Taking Shanghai as an example, this study revealed how the identification methods of geriatric mental health disorders in nonspecialized institutions diverge, providing a reference for the integration of services. A purposive sampling method was adopted to conduct semi-structured interviews with 24 service providers from various nonspecialized geriatric mental health care institutions. Interview audio was recorded with consent and converted into verbatim transcripts. The interview data were analysed thematically. Although service providers from the health care system tended to apply a biomedical-oriented assessment, those from the social care system typically identified mental disorders among older people based on selective attention and interpersonal relationships. Although there are stark differences, the various identification mechanisms implicitly converge—the relationship with clients has become an important consideration. Geriatric mental health issues urgently require the integration of formal and informal care resources. Referring to the idea of task transfer, social identification mechanisms are expected to be a useful supplement to traditional biomedical-oriented identification. [ABSTRACT FROM AUTHOR]

Studies have previously demonstrated that anxious attachment shapes the association between childhood traumatic experiences and somatic pain; however, it remains unclear how this relationship is influenced by anxious attachment in patients with depression. This study investigated how anxious attachment influences the relationship between childhood traumatic experiences and pain symptoms in depressed patients from a social psychological perspective. A total of 139 adult patients with depression participated in this study; the level of depression was assessed by a psychiatric professional. Childhood trauma, pain symptoms, and attachment dimensions were tested by various questionnaires. The moderating role of anxious attachment in the trauma‐pain association was examined using the PROCESS Model 1. Our findings showed that in depressed patients, childhood maltreatment had a significant positive impact on the severity of pain ratings. Moreover, anxious attachment influenced the relationship between childhood trauma and pain symptoms. Our study indicated that anxious attachment is not necessarily a negative outcome for depressed patients; moderate levels of anxious attachment alleviate childhood trauma‐related pain symptoms in individuals with highly traumatic experiences. Understanding the traumatic experiences and attachment styles of depressed patients with pain complaints can help to develop intervention strategies. [ABSTRACT FROM AUTHOR]

Objective To explore the intertemporal decision - making disorder in patients with Parkinson's disease (PD). Methods From January 2020 to August 2021, a total of 36 patients with PD (PD group) who diagnosed and treated in The Second People's Hospital of Hefei and The Second Affiliated Hospital of Soochow University were selected, and 39 healthy controls (control group) with matched gender, age and eudcation were recruited. Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Mini-Mental State Examination (MMSE), Verbal Fluency Test (VFT), Digit Span Test (DST), and Stroop Color-Word Test (SCWT) were used to evaluate the neuropsychological characteristics, the delay-discount rate K value in the intertemporal decision - making paradigm were used to evaluate the intertemporal decision-making ability. Results Compared with control group, the PD group had a decrease in MMSE score (Z = -4.536, P = 0.000), correct number of VFT (Z = -4.555, P = 0.000), correct repetition of DST-forwards (Z = -4.696, P = 0.000) and DST-backwards (Z = -3.261, P = 0.001), while had an increase in HAMA score (Z = - 5.153, P = 0.000), HAMD score (Z = - 5.637, P = 0.000), Stroop C-A (Z = - 7.105, P = 0.000) and K value (Z = - 3.209, P = 0.004). Correlation analysis showed that there was no correlation between K value and MMSE score, correct number of VFT, Stroop C -- A, and correct repetition of DST-forwards and DST - backwards in PD patients (P > 0.05, for all). Conclusions Patients with PD have symptoms of intertemporal decision-making disorder. They can't reasonably balance the value of delayed reward, prefer immediate reward, and have more impulsive decision-making behavior. [ABSTRACT FROM AUTHOR]

This essay reflects on the still‐present difficulty in approaching contemporary rural mediumship as coeval with their urban psychotherapeutic counterparts. Drawing on ethnographic work in rural Henan province in central China, I describe how both rurality and spirit mediumship have been rendered anachronistic through national imaginaries, anti‐superstition campaigns, and psychiatric discourses. The essay centers on the case of a spirit medium located in the psychiatric unit, and the social evolutionary and developmentalist temporalities condensed in her cultural psychiatric diagnosis. I then turn to the medium's ritual work and cosmological account, which invert mediumship's position in space and time. The essay approaches mediumship's rituals as a form of chronotopic labor, which reworks the spatio‐temporal coordinates they inherit from within. It closes by bringing together the conundrums of rural mediumship and those of urban psychotherapeutic and diasporic worlds, to consider psychic landscapes of dislocation, and other formulations of futures to come. [ABSTRACT FROM AUTHOR]

The 12-item Chinese Health Questionnaire (CHQ-12) has been widely used for screening mental disorders. This study aims to examine the internal consistency and factor structure of CHQ-12 and its suitability for use in the elderly Chinese population. This is a cross-sectional study. A total of 8526 elderly people aged ≥60 years from 11 cities in Shanxi Province were selected for participation in this study by stratified random cluster sampling. Cronbach's alpha was employed to assess internal consistency. An exploratory factor analysis (EFA) was performed to explore the underlying factor structure of the CHQ-12 in the elderly. A confirmatory factor analysis (CFA) was then conducted to test and compare the goodness-of-fit between possible factor structure obtained from the EFA and the unidimensional structure, which was originally recommended. The Cronbach's alpha for CHQ-12 was 0.838. The EFA extracted three factors, which explained 55.985% of the total variance of the data. The CFA of the three-factor model resulted in an acceptable model fit (Comparative Fit Index = 0.98, Tucker–Lewis Index = 0.97, Normed Fit Index = 0.98, Expected Cross-Validation Index = 0.28, Root-Mean-Square Error of Approximation = 0.071). The item loadings ranged from 0.58 to 0.82. Correlation coefficients among the three factors ranged from 0.40 to 0.75. The CHQ-12 presented satisfactory internal consistency and structural validity in the Chinese elderly population. The CFA of the three-factor structure expressed a preferred model fit in comparison to the unidimensional model. The three-factor structure of the CHQ-12 interpreted three different aspects of mental health: somatic symptoms, anxiety and worry, and depression/poor family relationship. • First study to explore the factor structure of CHQ-12 in a large sample of the elderly Chinese population. • CHQ-12 had satisfactory internal consistency and structural validity among the elderly population. • Exploratory factor analysis generated three factors - somatic symptoms, anxiety, and depression/poor family relationship. • The three-factor structure of CHQ-12 showed the preferred fit to the data in comparison to the unidimensional model. [ABSTRACT FROM AUTHOR]

Drawing on fieldwork conducted in a clinical setting in China, this article makes a contribution to the special issue's examination of the ambiguity of kinship's mutuality by engaging systemic family therapy. Family therapists are no strangers to the negative in family life. 'We-ness' could be a suffocating embrace and potentially the nourishing condition for even the most severe of psychiatric diagnoses. While practitioners understand the purpose of treatment in terms 'individuation', I argue for seeing family therapy as a technology of kin therapeutics for working on relational tangles that have caused someone to take responsibility for something she or he cannot control. While systemic therapy may appear to valorise a self-determined, rational subject, I highlight instead what practitioners themselves know all too well – that human lives are interconnected, and I underscore the existential import of their concern for the entangled adolescent therapeutic action works to set 'free'. [ABSTRACT FROM AUTHOR]

Background despite unique gender patterns of suicide among older people in rural China, research addressing this issue is scarce. This study aims to clarify the gender-specific risk factors of late-life suicide in rural China. Methods the study included 242 persons (51% male) aged 60 and above who had committed suicide between June 2014 and September 2015 in the rural areas of three provinces of China. Using 1:1 matched case-control design, 242 living controls matched in age, gender and neighbourhood were randomly selected. Psychological autopsy interviews and psychological assessments were conducted with two informants for each suicide and living control, respectively. Results men used alcohol before suicide more than women (12.6 versus 4.7%, P  < 0.05). There was no gender difference in suicide method, suicide intent and previous attempts. Univariate analysis showed that married status, mental disorder, depressive symptoms, hopelessness, impulsivity, loneliness, social support, family function and quality of life were associated with suicide in both genders. For men, other risk factors were chronic physical illness and functions of daily living. Variables remaining in the multivariable model for both men and women were depressive symptoms and hopelessness. Discussion depression and hopelessness are the two major risk factors for suicide among both older men and woman in rural China. Suicide prevention programmes focusing on depression and hopelessness in this population are indicated. Also needed are continued efforts to develop and refined gender-specialised strategies to identify high-risk individuals or groups and to enhance targeted support in the rural community. [ABSTRACT FROM AUTHOR]

Mental health is directly related to people's physical health, social adaptation and study and work efficiency. Mental health education for college students has also become the focus of education in China. By combining the knowledge network with the psychological scales, this study tried to not only find the most significant abnormal psychology but also evaluate the relationship between different abnormal psychology of college students. The data of this study were the 'The symptom Checklist scale (SCL-90)' questionnaire of the 2017 freshman census of a university in China. The data were statistically analyzed by means of knowledge network method including centrality, systematic clustering and K-plex analysis. From the results, we can see that the 'phobic anxiety' was the core dimension; all the mild symptoms were clustered into one type, and all the severe symptoms were clustered into another type; other dimensions were more closely related in addition to 'interpersonal sensitivity' and 'somatization'. In psychological measurement research, knowledge network method can be combined to better evaluate the psychological state of the groups and obtain more complete assessment results, which provides a basis for the revision of the psychological scales in terms of balance and item setting. [ABSTRACT FROM AUTHOR]

This study investigates Chinese people's opinions about the diagnosis of grief and the factors associated with their opinions. Among 1041 participants who completed the online survey, over half (56.5%) agreed that grief could be a mental disorder under certain circumstances, such as harm to self or others, functional impairment, and persistent grief. Primary reasons against the diagnosis were that grief is normal and its intensity decreases over time. A small proportion of opponents also expressed concerns about stigmatization resulting from labeling grief as being pathological. Younger, male, and full-time employed adults tended to support diagnosing grief as a mental disorder. [ABSTRACT FROM AUTHOR]

In China, nursing is a profession with considerable stress, which may cause both physiological and psychological problems. The present study conducted a cross‐temporal meta‐analysis of 244 papers using the Symptom Checklist 90 (SCL‐90) to investigate the changes in the mental health level of Chinese nurses (N = 71,286) from 1998 to 2016. Results showed that (a) relationships between scores of all nine types of mental problems in the SCL‐90 and year were significantly positive, indicating that the mental health level of nurses decreased steadily in the past 19 years; (b) relationships between three social indicators (patient‐to‐nurse ratio, unemployment rate, and divorce rate) and scores of all nine types of mental problems in the SCL‐90 were significantly positive, suggesting that the increase in these social indicators may be responsible for the decrease in Chinese nurses' mental health level. [ABSTRACT FROM AUTHOR]

• Adults who were exposed to earthquake in the prenatal period had a higher rate of schizophrenia. • Prevalence of other DSM-IV axis I disorders were not found on adults exposed to earthquake. • Prenatal earthquake stress exposure as not a significant risk of DSM-IV axis I disorders. Tangshan earthquake which had a magnitude of 7.8 killed approximately 250,000 people in China in 1976. In the present study, we sought to determine the prevalence and risks of mental disorders in adults who experienced earthquake as an infant or in the prenatal period. This cross-sectional cohort study recruited participants based on the urban resident registry of Tangshan, Hebei province, 2013 using a multistage stratified cluster sampling method with selection probabilities proportional to size. We recruited subjects who were born between July 29, 1975 and April 28, 1978 that was one year before and 1.9 years after the occurrence of Tangshan Earthquake, respectively. Current psychiatric diagnoses and lifetime psychiatric diagnoses were obtained through the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Research Version. Unconditional logistic regression analysis was performed to analyze risk factors of mental disorders. Totally1380 subjects were included with 392 subjects exposed to the earthquake in the fetal period, 399 subjects who experienced the earthquake during their infancy, and 589 subjects who had no exposure to the earthquake. Twenty-one (2.7%; current 1.9%) subjects exposed to earthquake were diagnosed with major depressive disorder versus 2.3% (current 1.5%) in the non-exposure group. Five (0.6%; current 0.6%) subjects with exposure to earthquake had bipolar disorder versus 0.9% in the non-exposure group.Thirteen (1.6%; current 1.6%) subjects with exposure to earthquake had schizophrenia versus 0.2% in the non-exposure group (P= 0.006). Furthermore, 5.2% (current 3.7%) subjects with exposure to earthquake had anxiety disorders versus 5.7% (current 3.9%) in the non-exposure group. Moreover, 8.1% (current 7.0%)subjects with exposure to earthquake had alcohol use disorders versus 7.1% (current 5.3%) in the non-exposure group. Furthermore, the prevalence of schizophrenia of the prenatal exposure group (2.3%) was significantly higher than the other two groups (χ2 = 10.273, P = 0.006); however, no statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders among the three groups (P > 0.05). Our multivariate regression analysis showed that prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders. Adults who were exposed to earthquake in the prenatal period had a significantly higher rate of schizophrenia than those who were not exposed or who experienced earthquake in their infancy. No statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders between those exposed and those not exposed to earthquake. Furthermore, prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders. [ABSTRACT FROM AUTHOR]

Mental health stigma has serious ramifications on people with a severe mental illness (SMI). Stigma damages self‐esteem, recovery outcomes, family relationships, socialization abilities, access to housing, and career prospects. The cultural tendencies of Chinese people have been shown to be associated with particularly high levels of stigmatization. These cultural tenets can result in high levels of self‐stigma due to experiencing shame and a perceived need to keep mental illness a secret. Although there is a lack of existing evidence, it is possible that such experiences present unique challenges to Chinese mothers diagnosed with SMI when they parent their children. Therefore, this qualitative study explored the experiences of parenting and self‐stigmatization of Chinese mothers with SMI. Individual semi‐structured interviews were conducted with 15 mothers who were direct carers of their children aged under 18 and who were receiving community‐based care in Hong Kong. Manual inductive thematic analysis was used to analyse the interview data. Three main themes related to self‐stigmatization emerged from the interviews: (i) distancing and being distanced; (ii) doubting myself; and (iii) struggling for control. The experiences of self‐stigmatization appeared to damage these mothers' self‐efficacy, which may negatively affect their parenting self‐esteem, tendency to seek professional help, and ability to manage their own mental health. Strategies to improve self‐efficacy, including psychoeducation, and additional childcare support/resources are required for mothers with SMI so they can better manage and balance the demands of motherhood and their mental healthcare needs. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread application of the Chinese version of Symptom Check List 90 (SCL-90) amongst undergraduate students, researchers have not thoroughly evaluated its psychometric features with representative samples of Chinese undergraduate students. Aim: To evaluate its psychometric properties based on a large, representative sample of Chinese undergraduate students. Methods: A total of 4456 Chinese undergraduate students (age range = 17-25 years) completed the SCL-90. Correlation analysis, confirmatory factor analysis and structural equation modeling were used to evaluate its reliability and validity. Results: The evidence for item-total correlations, internal consistency reliability, intraclass correlation coefficients and composite reliability, and the hypothesized factor structure was satisfactory. The evidence for convergent validity was acceptable; however, the evidence for discriminant validity was not satisfactory. Conclusion: Based on a large, representative sample of Chinese undergraduate students, the Chinese version of the SCL-90 revealed both strengths and limitations, suggesting the need for further research. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study investigated whether an integrated, community-based and nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay in children. The study also considered how the programme could be sustained to promote early development in children aged under 3 years in the poorest areas of rural China. Study design A quasi-experimental design was applied, with data collection before and after a 2-year programme implementation, in both intervention and comparison (control) areas. Methods From July 2014, the Integrated Early Childhood Development (IECD) programme was implemented in poverty-stricken areas in four counties of China. Nurturing care intervention focusing on five components (child health, nutrition, responsive care, protection and early learning support) was delivered mainly by the village early childhood development centre and township/village clinic. Another two counties of similar per capita gross domestic product, geographical characteristics, under-five mortality rate, under-five underweight prevalence and ethnicity to the four programme counties were selected as the comparison and received no IECD programme intervention. The Ages & Stages Questionnaire was used to evaluate the neurodevelopmental outcome of children; the overall suspected developmental delay (SDD) referred to any developmental delay in the communication, gross-motor, fine-motor or problem-solving or personal-social domains of the questionnaire. Children underwent anthropometric measurements and haemoglobin concentration testing through peripheral blood. Face-to-face interviews of caregivers were conducted to collect intervention use, cognitive stimulation and child-protection behaviours. A difference-in-differences regression approach, adjusting for confounding factors, was applied to estimate intervention impact on the neurodevelopmental outcomes in the children. Path analysis was employed to examine the mediating effects of growth, nutrition status, cognitive stimulation and child-protection behaviours through which the IECD intervention predicted children's developmental health. Results In total, 2953 children aged under 3 years and their caregivers were enrolled at baseline, and 2745 child-caregiver pairs completed the postintervention assessment. Prevalence of overall SDD was reduced by 18% (from 37% at baseline to 19% at postintervention) in intervention counties, which is a significant difference compared with the 10% reduction in control counties (from 30% to 20%), with an adjusted odds ratio of 0.69 (95% confidence interval: 0.54–0.89). Consistent findings were found across domains. Path analysis indicated that the effect of the intervention on promoting developmental health was mediated by multiple nurturing care-associated factors, including cognitive stimulation frequency, positive discipline, length-for-age growth and haemoglobin concentration. Conclusions The community-based integrated intervention could significantly prevent developmental delay in children aged under 3 years in rural China. Highlights • A community-based, integrated and nurturing care-supporting intervention was established in rural areas. • Intervention reduced the prevalence of developmental delay in disadvantaged children. • Family processes mediated the link between intervention and early development. [ABSTRACT FROM AUTHOR]

Objective Few studies have addressed informed consent in Chinese psychiatric practice. We wished to explore psychiatrists' attitudes toward informed consent in Shanghai after promulgation of the first national law for mental health care in China: the National Mental Health Law. Method A total of 398 psychiatrists were recruited from seven psychiatric hospitals in Shanghai. Their anthropometric data were collected. A confidential, self-report questionnaire addressing attitudes toward the informed consent process was completed by all participants. Results Most respondents would like to inform patients/guardians of the diagnosis (95.2%), treatment plan (93.5%), treatment goals and potential adverse effects of prescribed medications (94.7%), and alternative treatment plans (71.9%). In addition, 58.4% of psychiatrists thought that the informed consent process for physical restraint was difficult to follow. According to logistic regression, psychiatrists not trained to use the National Mental Health Law were more likely to have a negative attitude toward the informed consent process compared with those trained (adjusted odds ratio = 0.21; 95% confidence interval: 0.07–0.59; p = 0.003). Conclusions Psychiatrists trained to use the National Mental Health Law had more positive attitudes toward the informed consent process. Lack of such training could affect the attitudes of psychiatrists toward the informed consent process in China. [ABSTRACT FROM AUTHOR]

Background In the US, recent years have seen a significant increase in the number of internationally adopted children, especially those from China, with congenital medical conditions. To date, there is little research on the long-term wellbeing of international adoptees with congenital medical conditions. Method We investigated the relationship between congenital conditions and post-adoption mental disorder diagnosis and treatment in 235 female youth who were adopted from China about 15 years prior. The youth provided survey data on type of congenital conditions that they had, their developmental difficulties at the time of adoption, type of mental disorders that they currently had and the type of treatments that they were currently receiving. Results At adoption, the adoptees with congenital medical conditions were, on average, 20 months older than those without congenital medical conditions and had more developmental difficulties. The adopted youth who had two or more congenital conditions at adoption were more than twice as likely as their peers without congenital conditions to have mental disorder diagnoses (62.5% versus 27.63%), and >2.5 times as likely to be receiving treatments (54.17% versus 20.39%). Youth with two or more congenital medical conditions at adoption were 5.5 times as likely as their peers with no congenital conditions to currently have three or more mental disorder diagnoses (33.3% versus 5.9%), and were about 3 times as likely as their peers with no congenital conditions to be receiving medical/psychological treatments (25.0% versus 8.55%). Path analysis showed that developmental difficulties at adoption functioned as a full mediator between the number of congenital conditions at adoption and current number of current mental disorders and number of treatments. [ABSTRACT FROM AUTHOR]

There is little research into the patterns of mental health services use, related factors, and barriers in help-seeking behaviors among the community population in northwestern China. We conducted a community-based survey among the general population in Xi’an City with the stratified two-stage systematic selection scheme using the World Health Organization Composite International Diagnostic Interview version 3.0 computer-assisted personal interview (CIDI-CAPI 3.0). We interviewed 2447 individuals aged 16 years or older. The lifetime prevalence estimate of mental disorders was 21%. However, the lifetime use rate of mental health services of the 2447 responding subjects was 2.45% and 4.67% among those subjects who reported a mental disorder. Several variables were associated with lower use of mental health services: rural residence and divorced or unmarried. Among the group with mental disorders, 15/21 sought help from non-mental health specialty services such as a general physician (13/21). The high prevalence rate of mental disorders but low rate of mental health services use raises a significant public health issue in northwestern China. Reduction in the resource gap and encouraging people to seek treatment remain a challenge to the mental health services system. [ABSTRACT FROM AUTHOR]

This research study examines the 1 year rate of recovery and remissions for consumers recently discharging from mental hospitals and identifies factors predicting recovery and remissions in the Hong Kong context. By adopting a prospective longitudinal follow-up research design, a cohort of Chinese people discharged from the mental hospitals and participating in a community-based psychosocial program was followed for 1 year. These individuals were assessed by using standardized assessment scales at baseline, 6 months, and 12 months of follow-up. At 1 year follow up, the rates of recovery, functional and symptomatic remission were 8.0%, 23.0% and 79.3% respectively. Logistic regression analyses indicted that: current recovery was significantly predicted by baseline functioning level and achieving open employment, symptomatic remission was significantly predicted by previous symptom severity and having open employment at baseline, while functional remission was significantly predicted by previous functioning level and having open employment. Result indicates that it is more difficult to achieve functional remission and recovery than symptomatic remission for consumers recently discharging from mental hospitals. Also, symptomatic remission is found not a sufficient condition for recovery, while functional remission plays a vital role in recovery. Helping consumers to achieve open employment and improve social functioning are identified as the predicting factors for recovery and functional remission in the local context. [ABSTRACT FROM AUTHOR]

Objective: Severe mental illness (SMI) represents major social and public health problem in China, especially in low- or middle-income regions. We aim to assess the prevalence and distribution of SMI in Hunan province in central China. Methods: Multistage stratified random sampling methods were used to select qualified subjects in 123 districts and counties in Hunan province. 89465 individuals were randomly identified, and 72999 (81.6%) completed the supplemental 12-Item General Health Questionnaire (GHQ-12) and Cue questionnaire of psychiatric abnormal behaviors. 6082 suspected individuals having high or moderate risk, or psychiatric cues, were administered the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) by psychiatrists. Results: 720 respondents were definitely diagnosed as SMI. The 1-month and lifetime prevalence was 9.35‰ and 10.10‰, respectively. The most frequent SMI was schizophrenia, followed by bipolar disorder, intellectual disability, epileptic mental disorder, paranoid psychosis and schizoaffective disorders, with 1-month prevalence ranging from 0.11‰ to 6.50‰ and lifetime prevalence ranging from 0.24‰ to 6.86‰. Multivariate logistic regression analysis revealed that lower education, farmer occupation, retirees or jobless/unemployed, unmarried or divorced and age of 30–64 years old were major factors that associated with the increased risk of SMI. In addition, only 33.3% of 528 patients who completed questionnaire sought help in psychiatric institutions, and up to 51.7% of 720 patients were not referred to the SMI management system in Hunan province. Conclusions: These findings provided a large-scale prevalence data of SMI in a provincial sample of China. The psychiatric disorders brought economical and psychological burden for family and society, which may shed light on the significance of scaling up province-wide mental health service and strengthening the SMI management. [ABSTRACT FROM AUTHOR]

Background/purpose: The association between adverse mental health and unhealthy lifestyle behaviors in migrant workers remains poorly defined in Chinese rural-to-urban migrants.Methods: A cross-sectional study was conducted regarding health-related behaviors in 5484 migrants (51.3% males) employed in Shanghai for at least 6 months. The Chinese version of the Symptom Checklist-90-Revised (SCL-90-R) was used to assess migrant mental health status. Logistic regression was applied to determine the contribution of adverse mental health to lifestyle behaviors.Results: Of the 5484 migrants, 21.1% had potential mental health problems and 63.1% had an unhealthy lifestyle. The three most prevalent mental disorders were obsessions-compulsions (O-C; 13.7%; 751/5484), interpersonal sensitivity (I-S; 11.0%; 603/5484), and hostility (HOS; 10.8%; 590/5484). Compared with the male participants, the female participants exhibited significantly increased mean scores for phobic anxiety (PHOB) and anxiety (ANX) (p < 0.001). Logistic regression indicated that after adjustment for potential confounding factors in both genders, an unhealthy lifestyle score was significantly associated with all nine subscales of the SCL-90-R. The male participants with psychoticism [PSY; odds ratio (OR) = 4.908, 95% confidence interval (CI) 2.474-9.735], ANX (OR = 4.022, 95% CI 2.151-7.518), or depression (DEP; OR = 3.378, 95% CI 2.079-5.487) were the most likely to have an unhealthy lifestyle. In the female participants, an unhealthy lifestyle was most associated with HOS (OR = 2.868, 95% CI 2.155-3.819), PSY (OR = 2.783, 95% CI 1.870-4.141), or DEP (OR = 2.650, 95% CI 1.960-3.582).Conclusion: Lifestyle behaviors were significantly associated with mental health in rural-to-urban migrant workers, and these findings indicate the need to develop targeted psychological interventions to foster healthy lifestyles in migrants. [ABSTRACT FROM AUTHOR]

This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate. [ABSTRACT FROM AUTHOR]

Negative attitudes toward people with mental illness are a widespread concern and may vary across countries. This study used a 36-item questionnaire to compare attitudes toward people with mental illness and beliefs about the causes of mental illness among medical students from the United States, Brazil, Ghana, Nigeria, and China (N = 1131). Exploratory factor analysis identified the underlying factor structure of the questionnaire, and analysis of covariance was then used to compare factors representing four nonstigmatized attitudes across students from the five countries. US Medical students scored highest on all four factors, followed by those from Brazil. Nigerian and Ghanaian students scored lowest on nonsupernatural etiology of mental illness, and Chinese students showed the lowest score on personal social acceptance and public policy acceptance of people with mental illness. Differences in medical student attitudes between these five countries suggest underlying sociocultural differences in attitudes with the more stigmatized attitudes in developing countries. [ABSTRACT FROM AUTHOR]

Anxiety symptoms are the prevalent mental disorders for transgender women. However, only a few studies are available pertaining to this problem among Chinese Transgender women. Chinese Transgender women are a vulnerable population which is exposed to discrimination and loss of social support due to their gender identity and transition. This study was conducted to estimate the prevalence and factors associated with anxiety symptoms among Chinese transgender women. A cross-sectional study was performed by convenience sampling. This comprised of 209 Chinese transgender women in Shenyang, China. The Zung Self-Rating Anxiety Scale (SAS) was used to assess anxiety symptoms for these transgender women. Hierarchical multiple regression analysis was performed to explore the associated factors of SAS. The prevalence of anxiety symptoms in Chinese transgender women was found to be 34.5%. Regression analyses indicated that SAS was associated with casual partnership, friend discrimination and social support in the final model. Sexual partnership and discrimination contributed the most to the model, R-square, accounting for 19.2% and 15.5% of the total variance respectively. Chinese transgender women showed considerably high level of anxiety symptoms. It was also found that they were exposed to significant transition challenges, such as high risk sexual partnership, excessive discrimination and a reduction in social support. Furthermore, anxiety symptoms was best predicted by the absence or presence of a casual partner, friend discrimination and social support rather than the disclosure of their gender identity, knowledge of HIV prevention and health service. Improvement of social support, reduction of friend discrimination and determination of the characteristics of risky sexual partnerships especially for the casual partner can help to attenuate anxiety symptoms and increase mental well-being for transgender women. [ABSTRACT FROM AUTHOR]

Background: The 12-item General Health Questionnaire (GHQ-12) is a commonly used screening instrument for measuring mental disorders. However, few studies have measured the mental health of Chinese professionals or explored the factor structure of the GHQ-12 through investigations of young Chinese civil servants. Method: This study analyses the factor structure of the GHQ-12 on young Chinese civil servants. Respondents include 1051 participants from six cities in eastern China. Exploratory Factor Analysis (EFA) is used to identify the potential factor structure of the GHQ-12. Confirmatory Factor Analysis (CFA) models of previous studies are referred to for model fitting. Results: The results indicate the GHQ-12 has very good reliability and validity. All ten CFA models are well fitted with the actual data. Conclusion: All the ten models are feasible and fit the data equally well. The Chinese version of the GHQ-12 is suitable for professional groups and can serve as a screening tool to detect anxiety and psychiatric disorders. [ABSTRACT FROM AUTHOR]

Importance: It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.Objective: To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.Design, Setting, and Participants: Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47,609 individuals; 2,032,942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV-identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.Main Outcomes and Measures: Lifetime history of physical conditions was ascertained via self-report of physician's diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.Results: Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets.Conclusions and Relevance: These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course. [ABSTRACT FROM AUTHOR]

There is a significant gap between mental health service coverage and the need for these services in China. In particular, workforce shortages impair several aspects of China's national mental health service system, including access to timely diagnosis and treatment in rural areas, expansion of general hospital psychiatric consultation-liaison services, and leadership in establishing a collaborative stepped-care system. This column focuses on China's ongoing efforts to develop its mental health workforce to ensure a sustainable supply of psychiatrists and allied mental health professionals. [ABSTRACT FROM AUTHOR]

Objective Schizophrenia is a severe mental disorder. Its prevalence appears inconsistent in different regions of China; thus, we conducted this meta-analysis to estimate the prevalence of schizophrenia in mainland China. Method Studies on the prevalence of schizophrenia in mainland China were identified from electronic databases up to July 2013. Meta-analysis was used for prevalence of schizophrenia estimate. Results For lifetime prevalence of schizophrenia, prevalence of 5.44 per 1000 (overall), 5.33 per 1000 (males), 5.51 per 1000 (females), 6.60 per 1000 (urban) and 4.73 per 1000 (rural) were estimated; there was no significant difference between males and females, while prevalence for urban dwellers was higher than for rural ( OR = 1.44, 95% CI: 1.30-1.59). For point prevalence of schizophrenia, prevalence of 4.62 per 1000 (overall), 4.63 per 1000 (males), 4.95 per 1000 (females), 5.15 per 1000 (urban) and 4.44 per 1000 (rural) were estimated; no statistical difference was found in males and females, but prevalence for urban dwellers was higher than for rural ( OR = 1.20; 95% CI: 1.02-1.41). Conclusion The prevalence estimate results were consistent with the international prevalence estimate of schizophrenia in mainland China. There was no significant difference between males and females, while prevalence for urban dwellers was higher than for rural. [ABSTRACT FROM AUTHOR]

Background: On April 14, 2010, an earthquake registering 7.1 on the Richter scale shook Qinghai Province in southwest China. The earthquake caused numerous casualties and much damage. The epicenter, Yushu County, suffered the most severe damage. As a part of the psychological relief work, the present study evaluated the mental health statuses of the people affected and identified the mental disorder risk factors related to earthquakes. Methods: Five hundred and five earthquake survivors living in Yushu County were investigated 3-4 months after the earthquake. Participant demographic data including gender, age, marital status, ethnicity, educational level, and religious beliefs were collected. The Earthquake-Specific Trauma Exposure Indicators assessed the intensity of exposure to trauma during the earthquake. The PTSD Checklist-Civilian version (PCL-C) and the Hopkins Symptoms Checklist-25 (HSCL-25) assessed the symptoms and prevalence rates of probable Posttraumatic Stress Disorder (PTSD) as well as anxiety and depression, respectively. The Perceived Social Support Scale (PSSS) evaluated subjective social support. Results: The prevalence rates of probable PTSD, anxiety, and depression were 33.7%, 43.8% and 38.6%, respectively. Approximately one fifth of participants suffered from all three conditions. Individuals who were female, felt initial fear during the earthquake, and had less social support were the most likely to have poor mental health. Conclusions: The present study revealed that there are serious mental problems among the hard-hit survivors of the Yushu earthquake. Survivors at high risk for mental disorders should be specifically considered. The present study provides useful information for rebuilding and relief work. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the frequency, clinical characteristics, and comorbidity of borderline personality disorder (BPD) among psychiatric outpatients in two clinics at Shanghai Mental Health Center. A cross-sectional investigation was conducted. From 3,075 outpatients screened using the Personality Diagnostic Questionnaire-IV+, 2,284 patients positive for a personality disorder were assessed using the Structured Clinical Interview for DSM-IV Personality Disorders. The frequency of BPD among the psychiatric outpatients was 5.8%, with afrequency of 3.5% among males and 7.5% among females ( p < .01). BPD was found to have extensive comorbidity with Axis I and II disorders. This study proves that BPD does occur in China. The detected frequency among outpatients is lower than that reported in North America. [ABSTRACT FROM AUTHOR]

LIU W., GERDTZ M.F. & LIU T.Q. (2011) A survey of psychiatrists' and registered nurses' levels of mental health literacy in a Chinese general hospital. International Nursing Review 58, 361-369 Background: Mental health literacy (MHL) is the term used to describe people's knowledge and beliefs about mental disorders which aid in the recognition, management or the prevention of illness. Health professionals' levels of MHL will shape the therapeutic relationship in which they work in partnership with patients. Studies have been conducted in Australia and Singapore to determine levels of MHL among members of the general public and health professionals. To date, no such studies have been published in Chinese populations. Aim: The study aims to compare levels of MHL between registered nurses and psychiatrists in a Chinese general hospital. The paper reports participants' diagnosis and beliefs about interventions used to manage depression and schizophrenia. Methods: A descriptive cross-sectional survey was undertaken among a group of psychiatrists and registered nurses in the psychiatric department of one large teaching hospital in China ( n = 70). Participants completed the survey by rating written vignettes related to depression and schizophrenia. Results: The psychiatrists were highly accurate in correctly diagnosing both depression and schizophrenia; the registered nurses were less so for diagnosing depression. In terms of treatment options, the two groups reached a broad agreement on beliefs about the use of mental health interventions, but differed significantly in the use of some specific mental health interventions. Conclusions: This study provides preliminary information about levels of MHL among Chinese mental health professionals and describes their attitudes towards the helpfulness of interventions used to restore mental health and well-being. Future large-scale studies are required to identify factors that influence beliefs about the use of mental health interventions. The findings have implications for further education of registered nurses in the specialization of mental health nursing in China. [ABSTRACT FROM AUTHOR]

Background: Early interventions can improve treatment outcomes for individuals with major psychiatric disorders and with nonspecific symptoms but increasingly impaired cognitive perception, emotions, and behaviour. One way used to identify people susceptible to psychosis is through the schizotypal personality trait. Persons with schizotypal characteristics have been identified with the widely used Schizotypal Personality Questionnaire-Brief. However, no suitable instruments are available to screen individuals in the Taiwanese population for evidence of early psychotic symptoms. Objectives: The purpose of this study was to test the sensitivity and specificity of the Chinese version of the Schizotypal Personality Questionnaire-Brief for identifying undergraduate students’ susceptibility to psychosis. Design: Two-stage, cross-sectional survey design. Setting and participants: The self-administered scale was tested in a convenience sample of 618 undergraduate students at a medical university in Taiwan. Among these students, 54 completed the scale 2 weeks apart for test–retest reliability, and 80 were tested to identify their susceptibility to psychosis. Data collection and analysis: In Stage I, participants with scores in the top 6.5% were classified as the high-score group (n =40). The control group (n =40) was randomly selected from the remaining participants with scores <15 and matched by gender. These 80 students were asked to participate in psychiatric interviews in Stage II. The instrument was tested for reliability using intraclass correlation coefficients and the Kuder-Richardson formula 20. The instrument was analysed for optimal sensitivity and specificity using odds-ratio analysis and receiver operating characteristic curves. Results: The 22-item Chinese version of the Schizotypal Personality Questionnaire-Brief had a 2-week test–retest reliability of 0.82 and internal consistency of 0.76. The optimal cut-off score was 17, with odds ratios of 24.4 and an area under the receiver operating characteristic curves of 0.83. The instrument had a sensitivity of 80.0% and specificity of 85.9% in identifying undergraduate students’ susceptibility to psychosis. Conclusions: The Chinese version Schizotypal Personality Questionnaire-Brief is a reliable instrument, but should not be used as a screening tool until its psychometric properties have been evaluated in more detail. Other screening tools need to be used in future studies with the CSPQ-B to improve the accuracy of identifying susceptibility to psychosis among young adults. [Copyright &y& Elsevier]

Influenced by governmental policy, school psychological services in the Chinese mainland are a recent phenomenon with a history of only about 20 years, which can be divided into two stages: exploration and development. To give a comprehensive account of the development of school psychological services in the Chinese mainland, this article reviews their developmental history, analyses their status quo and features, identifies some contemporary problems, and suggests possible directions for the future development. [ABSTRACT FROM PUBLISHER]

Psychotropic medications are often used to treat problem behaviours in people with intellectual disability which not only occur frequently but also tend to persist over time. This study examined the pattern of prescription of such medications to manage problem behaviours for adults with intellectual disabilities in a specialist psychiatric unit in Hong Kong. Individuals aged 18 or above with problem behaviours and receiving psychotropic medication for treatment in hospital, outpatient and community settings were studied. Their demographic and clinical information was collected. The type and dosage of medications were retrieved from the computer database and analysed. Those with psychotic disorder and mood (affective disorder) were excluded. After screening, 236 patients met the inclusion criteria. People with moderate intellectual disability accounted for most of the cohort (46%). Autism spectrum disorder was the commonest psychiatric diagnosis (35%) and aggression the commonest problem behaviour (52%). Antipsychotics, mood stabilisers and antidepressants were prescribed to 96%, 20% and 13% of the subjects respectively. The profile of problem behaviour in the Chinese population with intellectual disability is consistent with the findings reported in the world literature. Antipsychotic drugs are the most commonly prescribed class of psychotropic medication used to treat such behaviours. Although the current evidence is not strong enough to support a clear-cut recommendation on the use of medications, the dichotomous notion of 'prescription' or 'no prescription' for problem behaviours may be simplistic. [ABSTRACT FROM AUTHOR]

This article surveys the past, present, and future trends of counseling in China. Historically, mental health problems were addressed within the family. Currently, psychotherapy from trained practitioners is available on a limited basis, at least in urban settings. The challenge of mental health in China is tremendous, and the efforts to meet that challenge are encouraging. The authors recommend that in the future, prevention and intervention services be offered that are ecosystemic, strengths-based, and culturally appropriate. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to determine the population-attributable risk (PAR) of completed suicide among Hong Kong Chinese with axis I psychiatric diagnoses. Methods: With a case-control psychological autopsy method, 150 suicide decedents aged 15-59 were compared for axis I psychiatric diagnoses and psychosocial variables with 150 randomly selected age and gender-matched persons living in the community. Results: In the presence of other, non-disease-related social risk factors (unemployment and unmanageable debt), past suicide attempt independently accounted for 44% of the PAR of suicide, followed by current major depressive disorder (27%), schizophrenia spectrum disorders (22%), and substance use disorder or pathological gambling (16%). Other diagnoses (such as anxiety and phobic disorders, dysthymia, adjustment disorders, and past major depressive episode) accounted for 24% of PAR. Conclusions: Psychiatric morbidity remains the major risk factor for suicide in Hong Kong despite well-developed psychiatric services. Mental health policy should be refined to target clinical groups at high risk of suicide. [ABSTRACT FROM AUTHOR]

Background: The study aimed to determine the prevalence of alcohol use, episodic heavy drinking, and alcohol dependence and their socio-demographic correlates in Beijing, China. Methods: A total of 5,926 subjects were randomly selected in Beijing and interviewed using the Composite International Diagnostic Interview (CIDI 1.0). Data on basic socio-demographic and current major medical conditions were also collected. Results: The 12-month prevalence of alcohol use and episodic heavy drinking were 32.5 and 13.8%, respectively. The 12-month and lifetime prevalence of alcohol dependence were 1.7 and 4.3%, respectively. Age above 24 years, male sex, being married and employed, low education level (junior high school, primary school or illiterate), rural residence, and having comorbid psychiatric disorders were all significantly associated with a higher likelihood of alcohol-related disorders. Only 2.4% of the subjects with alcohol dependence were receiving treatment, and a mere 1.4% had sought treatment from mental health professionals. Conclusions: Nationwide surveys are urgently needed to further explore the prevalence of alcohol-related disorders in China. [ABSTRACT FROM AUTHOR]

The article presents a study on Parasomnia among psychiatric outpatients in Hong Kong, China which aims to identify the prevalence rate of sleep disorders including sleep-related eating disorder (SRED) and rapid eye movement sleep behavior-like disorder (RSBD-like disorder). It cites a 3-phase design of structured questionnaire, interviews and polysomnography of the subjects. It shows that such occurence are due to mental illness, sleep disturbances and psychotropic medications.

The cognitive profiles of children with Developmental Reading Disorder (RD) and Attention-Deficit/Hyperactivity Disorders (ADHD) have been extensively studied in alphabetic language communities. Deficits in phonological processing and rapid naming have been implicated as core features of RD although whether the latter is a deficit specific to RD remains controversial. Similar research aiming to explore the cognitive profiles of children with both RD and ADHD in non-alphabetic language communities is limited. The specificity of rapid naming deficit to RD among Chinese has yet to be studied. In the first study, 43 Chinese children with confirmed diagnoses of RD + ADHD were assessed on their cognitive abilities in relating to reading. In the second study, the specificity deficit hypothesis of rapid naming to RD but not ADHD was examined. A digit naming test was administered to the RD + ADHD group (43 subjects) and an ADHD only group (49 subjects). In regard to cognitive profiling, rapid naming and orthographic knowledge were found to be the most common deficits among the Chinese RD + ADHD group. This co-morbid group was also found to have a significant deficit performance on the rapid naming task than the ADHD only group. The present findings support the double dissociation hypothesis in cognitive deficit between RD and ADHD. The results of both studies are discussed with reference to the findings of the Western counterparts. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the reliability and validity of the DAS-A in a sample of 308 Chinese adults in Hong Kong. Method: The reliability of the DAS-A and its relevant sub-scales was measured using internal consistency (Cronbach's alpha) and Guttman split-half reliability. Principal components analysis was performed to assess construct validity. Discriminant validity of the DAS-A was performed by examining whether the DAS-A could discriminate between the depressed and the non-depressed subjects in this study. Results: The split-half reliability of the DAS-A was found to be r = 0.87; Cronbach's alpha was 0.945; and item-total correlations ranged between 0.36 and 0.75. Factor analysis revealed three factors that were similar to those that were found in other studies: Performance Evaluation, Need for Approval, and Anaclitic Self-Esteem. Discriminant validity suggested that the DAS-A discriminated successfully between the non-depressed and the depressed groups. Nevertheless, some differences were noticed in the relative strength of the factors and in the distribution of the scale items into the three factors. Conclusion: It was hoped that with this type of cross-cultural information, the universality of the constructs of the DAS-A could be reliably demonstrated. [ABSTRACT FROM AUTHOR]

Objectives: To examine the appraisal of caregiving experience by relatives of patients suffering from severe mental disorders. Participants and Methods: Relatives of patients suffering from major psychiatric disorders were assessed with the Chinese version of the Experience of Caregiving Inventory. Clinical correlates of the appraisal of caregiving were evaluated with the Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, and the Mastery Scale. Results: A total of 81 patients and 129 caregivers were recruited. There was a positive correlation between positive and negative appraisals as measured by the Experience of Caregiving Inventory (r = 0.32, p = 0.003). Positive psychotic and depressive symptoms did not show any significant relationship with the Experience of Caregiving Inventory scores. A regression analysis of the Experience of Caregiving Inventory scores (n = 81) showed that negative appraisal was influenced by the Global Assessment of Functioning 1 year before index admission and the educational levels of the caregivers, while positive appraisal was associated with the employment status of patients and the educational levels of the caregivers. Conclusions: The caregiving experience is affected by different factors. Interventions for caregivers should focus on the specific needs of the families using a multi-dimensional perspective. [ABSTRACT FROM AUTHOR]

MOST PAST research findings suggest that phonological deficit is unique to developmental dyslexia insofar as alphabetic languages are concerned. The present study investigated the existence of any similar unique reading-related cognitive deficits associated with developmental dyslexia in a nonalphabetic script, Chinese. The pattern of morbidity among various developmental disorders was also examined. One hundred six Chinese children with different types of developmental disorders or learning difficulties, including developmental dyslexia (DYS), attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD), and borderline intelligence (BI) were tested on literacy, rapid-naming, phonological, orthographic, and visual processing skills. It was found that (a) the comorbidity rates among these developmental disorders were high; (b) the DYS-only group was most impaired in rapid naming and orthographic processing and performed significantly worse than other "pure" groups; (c) the ADHD-only and DCD-only groups performed very closely to the average normal range in literacy and cognitive domains; and (d) the cognitive profile of the DYS+ADHD group resembled that of the DYS-only group, while that of the DYS+DCD group resembled some characteristics of both the "pure" groups. The authors conclude that rapid-naming deficit and orthographic deficit are unique marker deficits of developmental dyslexia in Chinese, while children with ADHD or DCD are less impaired in literacy and reading-related cognitive areas. Implications for educational and clinical practices are also discussed. [ABSTRACT FROM AUTHOR]

Background: Until recently there were no hospital services for people with psychiatric problems in Tibet. Aims: To provide an assessment of the next steps in developing psychiatric treatment in Tibet. Method: Review of the literature, a survey and a diagnostic check of people currently in contact with health services for a psychiatric disorder. Results: More than 75% of patients received an inaccurate diagnosis and inappropriate or inadequate psychiatric care. Conclusion: Services must be developed based on current research, evidence of need and also by building resources within the country through psychiatric training and continuing medical education. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the trend in mental disability in individuals aged 60 and older in China, drawing from a sample survey from 1987 to 2006,

Background We evaluated the utility of the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) and measured the prevalence of major depression six weeks after confinement among Chinese women in Hong Kong. Method A prospective cohort of 145 women completed the EPDS, the 12-item General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) six weeks after giving birth. They were then assessed with the Structured Clinical Interview for DSM-III-R, non-patient version (SOD-NP) to establish psychiatric diagnosis. The criterion validity of EPDS was tested against this clinical diagnosis, and the concurrent validity against the GHQ and BDI scores was also evaluated. The internal consistency of the scales was measured by Cronbach's α coefficient. Results The Chinese EPDS had satisfactory psychometric properties and a cut-off score of 9/10 is recommended for screening depressive illness in a general postnatal population. At six weeks post-partum, 5.5% of the study population suffered from major depression. Conclusions The Chinese EPDS will be useful for screening for postnatal depression. [ABSTRACT FROM AUTHOR]

Background. Artificial Neural Network (ANN), as a potential powerful classifier, was explored to assist psychiatric diagnosis of the Composite International Diagnostic Interview (CIDI). Method. Both Back-Propagation (BP) and Kohonen networks were developed to fit psychiatric diagnosis and programmed (using 60 cases) to classify neurosis, schizophrenia and normal people. The programmed networks were cross-tested using another 222 cases. All subjects were randomly selected from two mental hospitals in Beijing. Results. Compared to lCD-10 diagnosis by psychiatrists, the overall kappa of BP network was 0.94 and that of Kohonen was 0.88 (both P< 0.01). In classifying patients who were difficult to diagnose, the kappa of BP was 0.69 (P<0.01). ANN-assisted ClDl was compared with expert system assisted CIDI (kappa=0.72-0.76); ANN was more powerful than a traditional expert system. Conclusion. ANN might be used to improve psychiatric diagnosis. [ABSTRACT FROM AUTHOR]

The author reviews conceptual and empirical issues regarding the interaction of neurasthenia, somatization and depression in Chinese culture and in the West. The historical background of neurasthenia and its current status are discussed, along with the epidemiology and phenomenology of somatization and depression. Findings are presented from a combined clinical and anthropological field study of 100 patients with neurasthenia in the Psychiatry Outpatient Clinic at the Hunan Medical College. Eighty-seven of these patients made the DSM-III criteria of Major Depressive Disorder; diagnoses of anxiety disorders were also frequent. Forty-four patients were suffering from chronic pain syndromes previously undiagnosed, and cases of culture-bound syndromes also were detected. For three-quarters of patients the social significances and uses of their illness behavior chiefly related to work. Although from the researcher's perspective 70% of patients with Major Depressive Disorder experienced substantial improvement and 87% some improvement in symptoms when treated with antidepressant medication, fewer experienced decreased help seeking, and a much smaller number perceived less social impairment and improvement in illness problems (the psychosocial accompaniment of disease including maladaptive coping and work, family and school problems). These findings are drawn on to advance medical anthropology and cultural psychiatry theory and research regarding somatization in Chinese culture, the United States and cross culturally. The author concludes that though neurasthenia can be understood in several distinctive ways, it is most clinically useful to regard it as bioculturally patterned illness experience (a special form of somatization) related to either depression and other diseases or to culturally sanctioned idioms of distress and psychosocial coping. [ABSTRACT FROM AUTHOR]