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Previous studies showed that nightmares are prevalent and are associated with negative health outcomes. However, no empirical data is available demonstrating the extent to which nightmare disorder persists over time. Current literature provides a limited understanding of the trajectory and wider mental health outcomes of nightmare disorder. This longitudinal study examined the persistence and mental health outcomes of nightmare disorder. A total of 230 Hong Kong Chinese adults completed standardized assessments twice with an interval of about 6 months. Over half (66.7%) of the participants with probable nightmare disorder at baseline remained to meet the DSM-5 criteria for the disorder at follow-up. Participants with probable nightmare disorder at baseline were significantly more likely to screen positive for PTSD (82.1% vs 18.3%) (p <.001) (p <.001), and they reported higher rates of mental health service usage at both timepoints (p =.001 to.003). Baseline nightmare disorder severity was negatively associated with subsequent self-rated mental health (β = -.151, p =.010) and self-esteem (β = -.141, p =.009) and it also predicted subsequent PTSD symptoms (β =.122, p =.012). This study provides first empirical data showing that nightmare disorder could be persistent over time. Nightmare disorder symptoms are associated not only with PTSD symptoms but also with a broader range of mental health issues. This study points to the public health importance of identifying and managing nightmare disorder symptoms in the community. Additionally, the presence of nightmare disorder symptoms may be a helpful indicator for identifying post-traumatic stress. [ABSTRACT FROM AUTHOR]

Recent studies showed that the ICD-11 C-PTSD is associated with considerable individual and social consequences. This study focused on the persistence and psychological predictors of C-PTSD. We analyzed longitudinal survey data from a sample of Hong Kong adults (N = 230) with an interval of approximately six months. Participants completed standardized self-report measures of C-PTSD and various psychological factors (including self-criticism, self-compassion, ruminative response, event centrality, and experiential avoidance) at both timepoints. Over 80% of participants with probable C-PTSD at baseline remained to meet the criteria for PTSD/C-PTSD at follow-up, while over 50% of participants with probable PTSD at baseline remitted at follow-up. Participants with probable C-PTSD were characterized by greater use of mental health services at both timepoints. Additionally, hierarchical multiple regression showed that, among a variety of psychological factors, experiential avoidance was the only significant predictor of PTSD (β = 0.271, p =.001) and disturbances in self-organization (DSO) (β = 0.200, p =.011) symptoms, after controlling for baseline symptom severity and treatment usage. This study shows that C-PTSD persists over time and its symptoms are predicted by experiential avoidance. More efforts are needed to prevent and address C-PTSD in the community. We also offer insights into the management of trauma-related disorders. [ABSTRACT FROM AUTHOR]

Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (β = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated the high prevalence of dissociative symptoms and their association with considerable healthcare costs. However, there is a lack of studies that describe whether dissociative symptoms persist and lead to other clinical outcomes over time in the community. Objectives: This study investigated the persistence, predictors, and consequences of dissociative symptoms in the community. Methods: We analyzed longitudinal data in a sample of community health service users in Hong Kong (N = 173). Results: A relatively high proportion (63.6%) of participants with baseline dissociative symptoms continued to exhibit dissociative symptoms after approximately 9 months. Baseline non-betrayal trauma predicted subsequent dissociative symptoms (β =.141, p =.024). Participants with baseline dissociative symptoms were more likely to have received subsequent emergency mental health services (9.1% vs 0.7%, p =.005). Baseline dissociative symptoms significantly predicted subsequent post-traumatic symptoms (β =.165 to.191, p <.05) and difficulty in social and occupational participation (β = −.152 to −.182, p <.05) even after controlling for baseline scores, trauma exposure, and use of professional support. The predictive role of dissociative symptoms on subsequent disturbances in self-organization symptoms and social participation difficulty remained significant after applying the Bonferroni correction. Conclusions: This is one of the very few studies showing that dissociative symptoms are persistent to a certain degree and could predict other symptoms and subsequent impairments even in community settings. Factors that affect the trajectory of dissociative symptoms should be further investigated. Regular screening for dissociative symptoms is recommended. Considering its prevalence, persistence, and clinical and social consequences, dissociation should be given greater public health attention. Dissociative symptoms have been linked to considerable healthcare costs. The persistence and consequences of dissociation in the community had not been previously reported. This study showed that dissociative symptoms persisted to a certain degree and predicted subsequent impairments after approximately 9 months. Dissociation should be given greater public health attention. [ABSTRACT FROM AUTHOR]

Objective: Childhood trauma is associated with adulthood depressive symptoms, but very few studies explored potential social and interpersonal mediators behind this association. This study made the first attempt to test the potential mediating effects of interpersonal stress in the associations between childhood betrayal and non-betrayal trauma and depressive symptoms. Method: We analyzed data in a sample of English-speaking adults from diverse backgrounds (from 19 different countries, mainly from Western countries) (N = 468). We then replicated and compared the results with those in another convenience sample of Chinese-speaking younger adults with different cultural backgrounds and mental health status (N = 205). Results: The results in both samples indicated that (1) childhood betrayal trauma had a stronger relationship with depressive symptoms than childhood non-betrayal trauma and that (2) interpersonal stress was a significant mediator in the relationship between childhood betrayal trauma and depressive symptoms, even when childhood non-betrayal trauma was included as a covariate. The indirect effect of childhood non-betrayal trauma on depressive symptoms through interpersonal stress was not consistent in two samples. Conclusions: Our findings point to the importance of taking social and interpersonal contexts into account when investigating, preventing and managing depression in trauma-exposed populations. Early social interventions such as family interventions, interpersonal skills training and building social resources may have the potential to change the trajectory of the development of mental health problems in trauma survivors. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the leading causes of disability in China and worldwide, affecting the health and well-being of both stroke survivors and their family caregivers (i.e. stroke dyads). Dyadic interventions targeting both as active participants can be beneficial for the dyads' health and well-being. Psychoeducation is a potentially acceptable approach to developing participants' knowledge about their disease management to promote their recovery. This study aims to explore the feasibility, acceptability, and preliminary effects of a family-focused dyadic psychoeducational intervention for stroke dyads. Methods: This study was a single-blinded, parallel-group randomised controlled trial. Totally, a convenience sample of 40 stroke dyads was recruited. The intervention included three in-hospital face-to-face education sessions and four weekly post-discharge follow-up telephone counselling sessions. Feasibility was assessed by the rates of recruitment, attritions, and adherence to the intervention. Acceptability was evaluated via semi-structured qualitative interviews. Preliminary intervention effects were evaluated on primary (survivors' functioning and caregivers' burden) and secondary (caregivers' competence and dyads' coping, depressive and anxiety symptoms, family functioning, and dyadic relationship) outcomes. Results: Intervention feasibility was established with satisfactory recruitment (76.9%), attrition (10%), and intervention completion (75%) rates. Qualitative interviews suggested that the intervention was acceptable and useful to stroke dyads. The intervention effects on survivors' functioning were significant in the memory and thinking (F = 8.39, p = 0.022, η = 0.18) and mobility (F = 5.37, p = 0.026, η = 0.12) domains, but not significant on their overall functioning (F = 2.39, p = 0.131). Caregiver burden in the intervention group was significantly greater reduced at post-test than the control group, with a large effect size (F = 7.55, p = 0.013, η = 0.28). For secondary outcomes, this intervention suggested a significant effect on caregivers' competence (F = 5.20, p = 0.034, η = 0.22), but non-significant effects on other outcomes. Conclusions: The family-focused dyadic psychoeducation programme was feasible and acceptable for stroke dyads and showed preliminary effects for stroke dyads. These findings support a larger-scale controlled trial to further examine its intervention effects over a longer-term follow-up. Trial registration: This study was retrospectively registered as a randomised controlled trial in the ISRCTN Registry. Registration Date: October 10, 2022. Registration Number: ISRCTN18158500. [ABSTRACT FROM AUTHOR]

Purpose: Emerging infectious diseases are considered as a pressing challenge to global public health. Throughout public health response to emerging infectious diseases, emergency nurses are situated at the forefront of the healthcare system. The present study has explored emergency nurses' perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency department context. Methods: The present study used a qualitative descriptive approach. A purposive sampling method was employed to recruit emergency nurses who worked in public hospitals in Hong Kong. Semi-structured interviews were conducted to 24 emergency nurses. The data were interpreted using a thematic analysis strategy. Results: Five overarching themes emerged from the data: (1) the novelty of an emerging infectious disease, (2) the severity of an emerging infectious disease, (3) the proximity to an emerging infectious disease, (4) the complexity of an emerging infectious disease situation, and (5) the response levels towards an emerging infectious disease situation. Conclusion: It is anticipated that the information may help to predict the attitudes and behaviours of emergency nurses in future impending epidemic events, enhancing emergency nurses' preparedness towards in such situations. Abbreviations: EID: Emerging infectious disease; ED: Emergency department; SARS: Severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; WHO: World Health Organization; RN: Registered nurse; APN: Advanced practice nurse; NO: Nursing officer [ABSTRACT FROM AUTHOR]

Stroke can cause a variety of physical and psychosocial disturbances for both survivors and their family caregivers (i.e., stroke dyads). Dyadic psychoeducation appears to be a promising approach for providing knowledge of stroke and self-care or caregiving skills to improve stroke dyads' health outcomes. Therefore, a family-focused psychoeducation intervention was designed and tested to improve the health outcomes of stroke dyads. To examine the effects of a family-focused dyadic psychoeducational intervention on the functional and psychosocial outcomes of stroke survivors and family caregivers. A single-blinded, parallel-group randomised controlled trial with repeated-measures design. Two general hospitals and one rehabilitation facility in Jinan, China. Stroke survivors and family caregivers (N = 162 dyads). The dyads were randomly allocated to either psychoeducation or control group with usual care only (N = 81 dyads per group). The intervention included three structured face-to-face education sessions (one hour per session) in hospital pre-discharge and four weekly telephone counselling calls post-discharge. Study outcomes included survivor functioning and caregiver burden (primary outcomes), and other secondary outcomes (i.e., caregiving competence, dyads' coping, depressive and anxiety symptoms, family functioning, and dyadic relationship, as well as survivor healthcare utilisation and caregiving-related injury). Data were collected at baseline (T 0) and immediately (T 1) and 3 months post-intervention (T 2). The intervention effects were estimated using generalised estimating equation models. Participants in the psychoeducation group revealed significantly greater reductions on caregiver burden than the control group at T 1 (β = − 6.01, p = 0.026) and T 2 (β = − 6.73, p = 0.039), but non-significant effects on survivor functioning, except in emotion domain at T 1 (β = 7.22, p = 0.015). In addition, the intervention demonstrated significantly greater improvements on caregiving competence (β = 0.98, p = 0.013; β = 1.58, p < 0.001), survivors' depressive symptoms (β = − 1.56, p = 0.007; β = − 2.06, p = 0.005), and dyadic relationship (β = 0.26, p = 0.012; β = 0.27, p = 0.022) at T 1 and T 2 , as well as on survivor coping at T 2 (β = 6.73, p = 0.008). Our study added values on the benefits of family-focused dyadic psychoeducation to routine stroke rehabilitation and family care. Future research can evaluate its long-term effects for families of stroke survivors with diverse socio-demographic and stroke-related characteristics. Chinese Clinical Trial Registry (ChiCTR2100042684). Recruitment: March to June 2021. [ABSTRACT FROM AUTHOR]

Complex post-traumatic stress disorder (CPTSD) has recently been recognized as an official psychiatric diagnosis in ICD-11, after years of research and advocacy in the field. It has been suggested that dissociative symptoms are a major feature of CPTSD. This scoping review aimed to summarize the existing knowledge base on the relationship between dissociation and CPTSD, and to identify relevant research gaps. We searched the two largest and most widely used academic databases (i.e., the Web of Science and Scopus databases) and the ProQuest database and identified original studies published in English relevant to our research questions, namely: (1) Would CPTSD be associated with dissociative symptoms? 2) How common are dissociative symptoms among people with CPTSD? (3) What are the correlates of dissociative symptoms among people with CPTSD? In all, 26 studies were included. We found 10 studies which reported that people with CPTSD scored significantly higher on a dissociation measure than those without CPTSD, and 11 studies reported a positive correlation between CPTSD symptoms and psychoform/somatoform dissociation scores. While very few studies reported the prevalence and correlates of dissociative symptoms among people with CPTSD, there may be a considerable subgroup of people with CPTSD who have clinically significant levels of dissociative symptoms (e.g., 28.6–76.9%). Dissociation may also be associated with other comorbidities (e.g., DSM-IV Axis II features, shame, somatic symptoms) in people with CPTSD. We recommend that more studies are needed to investigate the prevalence of dissociative symptoms among people with CPTSD and examine how these symptoms are associated with other comorbid conditions and clinical needs in this vulnerable group. [ABSTRACT FROM AUTHOR]

Purpose: Nonviolent communication (NVC) has been increasingly recognized as a potentially beneficial approach that could promote empathy, resolve conflicts, and improve psychosocial well-being. No validated measure is available to assess or quantify NVC-specific characteristics or behaviors. This paper describes the development and pilot psychometric evaluation of a self-report measure for assessing behaviors characteristic of NVC (e.g., awareness of feelings, honest self-expression). Method: We analyzed data in an online convenience sample of young adults (N = 205). Results: The 7-item Nonviolent Communication Behaviors Scale (NVCBS) was found to have satisfactory internal consistency (α = 0.789 to 0.810), good test-retest reliability (ICC = 0.781) and a single-factor structure. The NVCBS was also positively correlated with empathy while negatively correlated with negative beliefs about emotions, demonstrating its construct validity. Discussion: The study provides a reliable and valid measure of NVC behaviors which can facilitate future studies on NVC. Directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Complex post-traumatic stress disorder (CPTSD) is a newly recognized trauma disorder in ICD-11. Little is known about the prevalence and correlates of CPTSD in primary care settings. Its cultural aspects also remained minimally explored. This study investigated the prevalence and sociocultural correlates of PTSD and complex PTSD among Chinese community health service users in Hong Kong. Methods: This study investigated ICD-11 PTSD and CPTSD in a sample of adults (N = 376) who had recently received services from Registered Chinese Medicine Practitioners in Hong Kong. Traditional Chinese medicine service is part of primary care services in Chinese societies. Participants completed self-report measures of CPTSD, trauma exposure, perceived family support, perceived caregiver's Chinese traditionality/modernity, participation (social activities and occupational productivity), depression and pain. Results: The past-month prevalence of ICD-11 PTSD and CPTSD was 5.6% and 18.4%, respectively, in our sample. Chi-square tests and one-way ANOVAs revealed that participants with CPTSD were younger and reported more trauma, lower family support, lower levels of social participation and productivity, more depressive symptoms and pain, and more social welfare and mental health service usages than those without PTSD. We found that perceived caregiver's Chinese modernity (e.g. egalitarianism) was negatively correlated with CPTSD symptoms. Apart from age, non-betrayal trauma had the strongest association with classical PTSD symptoms, while betrayal trauma and perceived family support had the strongest association with disturbances in self-organization symptoms. Conclusion: This study provides the first data regarding the prevalence and correlates of ICD-11 PTSD and CPTSD among community health service users in Hong Kong. PTSD and CPTSD are common but often unrecognized mental health problems which are associated with more impairments and more service needs. [ABSTRACT FROM AUTHOR]

Background: Evidence of socioeconomic inequality in COVID-19-related outcomes is emerging, with a higher risk of infection and mortality observed among individuals with lower education attainment. We aimed to evaluate the potential interventions against COVID-19 from the socioeconomic perspective, including improvement in education and intelligence. Methods: With a two-sample Mendelian randomization approach using summary statistics from the largest genome-wide association meta-analysis, univariable analysis was adopted to evaluate the total causal effects of genetically determined education attainment and intelligence on COVID-19 outcomes. Multivariable analysis was performed to dissect the potential mechanisms. Results: Genetic predisposition to higher education attainment by 1 SD (4.2 years) was independently associated with reduced risk of COVID-19 severity (OR = 0.508 [95% CI: 0.417–0.617]; p < 0.001). Genetically higher education attainment also lowered the risk of COVID-19 hospitalization (0.685 [0.593–0.791]; p < 0.001), but the association was attenuated after adjustment for beta estimates of intelligence in multivariable analysis. Genetically higher intelligence was associated with reduced risk of COVID-19 hospitalization (0.780 [0.655–0.930]; p = 0.006), with attenuation of association after adjustment for education attainment. Null association was observed for genetically determined education attainment and intelligence with SARS-CoV-2 infection. Conclusion: Education may act independently and jointly with intelligence in improving the COVID-19 outcomes. Improving education may potentially alleviate the COVID-19-related health inequality. [ABSTRACT FROM AUTHOR]

To improve the outcomes of depression treatment, personalized treatments that take individual needs into account are recommended. Recent research suggests that a subgroup of depressed people who suffer from co-occurring dissociation may be more likely to have encountered traumatic or stressful experiences and they may also have more psychosocial intervention needs. This study examined the prevalence and correlates of dissociative symptoms in an online convenience sample of people (N = 410) from 18 different countries/regions who reported clinically significant levels of depressive symptoms (indicated by Patient Health Questionnaire-9 score ≥10). Over 60% of participants exhibited clinically significant levels of dissociative symptoms (indicated by a Multiscale Dissociation Inventory total score >66). Compared with those with low levels of dissociative symptoms, participants with high levels of dissociative symptoms reported more traumas, interpersonal stress, depression and trauma-related symptoms. Emotional constriction in particular had a weak but significant negative correlation with the level of perceived medication benefits. The use of an online convenience sample could limit the generalizability of our findings. Our cross-sectional data could not demonstrate causal relationships between the study variables. The findings highlight a need for complex health interventions for depressed people with co-occurring dissociative symptoms, focusing not only on depressive symptoms but also addressing trauma and dissociation-related symptoms. [ABSTRACT FROM AUTHOR]

Background: Previous studies have examined public psycho-behavioural responses in the early stages of the epidemic, little is known after mass vaccination has been implemented. This study aimed to investigate the public's behavioural (adoption of COVID-19 precautionary measures) and psychological (depression, anxiety and stress) responses to COVID-19 and their relationships after the launch of the territory-wide vaccination programme in Hong Kong. Methods: A cross-sectional survey study using anonymous online or face-to-face questionnaires was conducted between June 2021 and September 2021. A convenience sample of Hong Kong Chinese residents aged ⩾18 years were recruited online by referrals and from a university-run community vaccination centre. Results: A total of 1893 valid questionnaires were received. The results showed that Hong Kong residents have high levels of adoption of precautionary measures and low levels of depression, anxiety and stress after the mass vaccination. Hierarchical regression analysis identified that in the fully adjusted model, the adoption of precautionary measures was a consistent protective factor (β ranged −1.51 to −1.67, p < 0.001) for depression, anxiety and stress amid the COVID-19 pandemic. Conclusions: This study offers new information on the public's psycho-behavioural responses to the pandemic, as well as insights into public health planning after introducing the mass vaccination. [ABSTRACT FROM AUTHOR]

The association and overlap between psychotic and dissociative phenomena have been increasingly recognized. Previous studies found that psychotic symptoms are closely associated with post-traumatic and dissociative symptoms and that these trauma-related phenomena may mediate the relationship between trauma and psychotic symptoms. It remained less explored which specific post-traumatic and dissociative symptom clusters are particularly associated with psychotic symptoms. This cross-sectional study used a data-driven approach (network analysis) to explore the associations among different psychotic and post-traumatic/dissociative symptom clusters in an online convenience predominantly female sample (N = 468)(59.2% had ever seen a psychiatrist). Participants completed well-established multidimensional measures that assessed different symptom clusters of psychosis, dissociation, and PTSD. In addition, multiple mediation analysis was conducted to examine which post-traumatic/dissociative symptoms could mediate the relationship between childhood and adulthood trauma and different psychotic symptoms. Our results confirmed previous findings that PTSD and dissociative symptoms are closely associated with psychotic symptoms. More importantly, both data-driven and multiple mediation analysis results indicated that identity dissociation was particularly associated with perceptual anomalies and bizarre experiences, while emotional constriction was particularly associated with negative symptoms. It is important to screen for trauma and dissociation and provide trauma-and dissociation-informed care when working with people at risk of or experiencing psychosis. Further longitudinal studies using more representative samples are needed. [ABSTRACT FROM AUTHOR]

The impacts of adverse childhood experiences (ACEs) have been well documented. One possible consequence of ACEs is dissociation, which is a major feature of post-traumatic psychopathology and is also associated with considerable impairment and health care costs. Although ACEs are known to be associated with both psychoform and somatoform dissociation, much less is known about the mechanisms behind this relationship. Little is known about whether social and interpersonal factors such as family environments would moderate the relationship between ACEs and somatoform dissociation. This paper discusses the importance of having a positive and healthy family environment in trauma recovery. We then report the findings of a preliminary study in which we examined whether the association between ACEs and somatoform dissociation would be moderated by family well-being in a convenience sample of Hong Kong adults (N = 359). The number of ACEs was positively associated with somatoform dissociative symptoms, but this association was moderated by the level of family well-being. The number of ACEs was associated with somatoform dissociation only when the family well-being scores were low. These moderating effects were medium. The findings point to the potential importance of using family education and intervention programs to prevent and treat trauma-related dissociative symptoms, but further investigation is needed. [ABSTRACT FROM AUTHOR]

People with dissociative symptoms are generally poly-symptomatic and require high levels of healthcare resources. Post-traumatic stress disorder (PTSD) and depressive symptoms are two major disabling comorbid symptoms in people with dissociative symptoms. While the sense of control over symptoms may be associated with PTSD and dissociative symptoms, the interplay among these factors over time remains unexplored. This study examined the predictors of PTSD and depressive symptoms in people with dissociative symptoms. Longitudinal data from 61 participants with dissociative symptoms were analyzed. Participants completed self-report measures of dissociative, depressive, and PTSD symptoms and the sense of control over symptoms two times (T1 & T2) with an interval of over one month. PTSD and depressive symptoms were not transient or time-specific, but they persisted over time in our sample. Hierarchical multiple regression analyses revealed that, after controlling for age, treatment usage and baseline symptom severity, T1 symptom management scores (β = −.264, p =.006) negatively predicted T2 PTSD symptoms, while T1 PTSD symptoms (β =.268, p =.017) positively predicted T2 depressive symptoms. T1 depressive symptoms (β = −.087, p =.339) did not predict T2 PTSD symptoms. The findings highlight the importance of improving symptom management skills and treating comorbid PTSD symptoms when working with people with dissociative symptoms. [ABSTRACT FROM AUTHOR]

Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms. This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms. We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31). More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r =.286 to.528, p <.001) and longitudinally (r =.181 to.462, p <.001) correlated with depressive symptoms. A sense of current threat (β =.146, p <.05) and negative self-concept (β =.173, p <.05) at baseline significantly predicted depressive symptoms after one year. These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice. Post-traumatic and dissociative symptoms are common in people with depressive symptoms. These symptoms generally persist over one year and predict more depressive symptoms at follow-up. Trauma-related symptoms should be regularly screened for in clinical settings. [ABSTRACT FROM AUTHOR]

Background: The overlapping symptoms of schizophrenia and dissociation have been increasingly recognized. This paper explains why it is reasonable to expect that there would be a substantial subgroup of patients diagnosed with schizophrenia spectrum disorders (SSDs) who suffer from pathological dissociation. Objective: As little is known about the prevalence of dissociative disorders and symptoms among patients with SSDs, we investigated the prevalence of dissociative disorders and symptoms among patients with SSDs. Method: We used both self-report measures and structured interviews to examine dissociative disorders and symptoms in a randomly recruited sample of inpatients with a clinical diagnosis of SSDs in Taiwan (N = 100). Results: Over 60% of participants exhibited pathological dissociation, and 54% had a dissociative disorder according to structured interview data; three participants met the DSM-5 diagnostic criteria for dissociative identity disorder. The concurrent validity of pathological dissociation in this sample was similar to that of depression among patients with schizophrenia reported in the literature. Participants with a dissociative disorder were more likely to report high-betrayal traumas and meet DSM-5 criteria for post-traumatic stress disorder; they also reported more psychotic symptoms than those without a dissociative disorder. Conclusions: This was one of very few studies that used structured interviews to examine pathological dissociation in patients with SSDs. The results indicate that pathological dissociation in SSDs is not uncommon. Clinical assessment should include measures of dissociation to facilitate early identification. Patients with dissociative disorders are often diagnosed with a psychotic disorder. Our study found that unrecognized dissociation is common in a sample of Taiwan inpatients with schizophrenia. Patients with schizophrenia spectrum disorders should be screened for dissociation. Trauma and dissociation are not rare among inpatients diagnosed with schizophrenia spectrum disorders in Taiwan. [ABSTRACT FROM AUTHOR]

Childhood adversities have been increasingly recognized as a significant risk factor for depression. However, the underlying mediating mechanism between childhood adversities and depression requires further investigation. The literature shows that childhood adversities are also closely associated with post-traumatic stress disorder (PTSD) symptoms and that PTSD symptoms can predict depressive symptoms. It remains unexplored whether PTSD symptoms can act as a mediator between childhood adversities and depression. The primary goal of this study was to examine whether PTSD symptoms would mediate the relationship between childhood adversities and depressive symptoms. We examined in a convenience sample of Hong Kong adults aged 18 or above (N = 418) whether PTSD symptoms would mediate the relationship between childhood adversities and depressive symptoms. We then examined and compared the results with those in another convenience sample of Chinese-speaking young adults (mainly from Taiwan and Hong Kong) aged between 18 and 24 (N = 205). Participants in both samples completed online surveys that included measures of childhood adversities, PTSD symptoms and depressive symptoms. Childhood adversities were significantly associated with depressive symptoms; and this relationship was mediated by PTSD symptoms in both samples. This study is one of very few studies demonstrating that PTSD symptoms mediate the relationship between childhood adversities and depressive symptoms. Our findings suggest that addressing unresolved PTSD symptoms for adults with childhood adversities may help in preventing or treating depressive symptoms. Therefore, PTSD symptoms should be taken into account in the prevention and management of depression. [ABSTRACT FROM AUTHOR]