Effectiveness of Antenatal Emotional Self‐Management Training Program in Prevention of Postnatal Depression in Chinese Women

PURPOSE: This study aimed to study the effectiveness of an emotional self‐management training program to antenatal women in the prevention of postnatal depression. DESIGN AND METHODS: The sample comprised 240 women who were at 32 weeks antenatal. They were randomly assigned into the intervention group and the control group. FINDINGS: On completion of the program, the intervention group reported significantly lower mean Patient Health Questionnaire‐9 and Edinburgh Postnatal Depression Scale scores than the control group. Fewer participants from the intervention group were diagnosed as having postnatal depression using the Structured Clinical Interview for DSM‐IV. PRACTICE IMPLICATIONS: An antenatal emotional self‐management training that may lower the risk of developing postnatal depression among Chinese women is recommended.     

Pathway to care for postnatal depression after implementation of the Comprehensive Child Development Service in a regional hospital in Hong Kong

Introduction: The Comprehensive Child Development Service (CCDS) launched in Hong Kong in 2005 aimed to identify and manage postnatal depression early. Under the CCDS, postnatal women are screened routinely for depression with the Edinburgh Postnatal Depression Scale. The purpose of the present study was to investigate the pathway to care for postnatal depression after the implementation of CCDS. Methods: During the period from July 2008 to December 2008, 114 Chinese women with postnatal depression were recruited from a perinatal out‐patient psychiatrist clinic which received referrals from the “CCDS route” and the “conventional route”. The participants were interviewed by a semi‐structured questionnaire for their pathway to care, including the duration of untreated depression (DUD) and the carers from whom they sought help for postnatal depression. All the participants were assessed by the Beck Depression Inventory (BDI) and the Global Assessment of Functioning (GAF) scale. Results: Sixty‐six percent of the participants were referred to the clinic through the “CCDS route” and 34% through the “conventional route”. As compared with the CCDS referral group, the conventional group had significantly longer DUD (U [N=114]=446.00, P=0.000), higher BDI score (U [N=114]=393.50, P=0.000) and lower GAF score (U [N=114]=462.50, P=0.000). Discussion: CCDS was found to be associated with the early intervention of postnatal depression.     

The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia

Background The Edinburgh Postnatal Depression Scale (EPDS) has been widely used to assess maternal depression following childbirth in a range of English speaking countries, and increasingly also in translation in non-English speaking ones. It has performed satisfactorily in most validation studies, has proved easy to administer, is acceptable to women, and rates of depression in the range of 10–20% have been consistently found. Methods The performance of the EPDS was compared across different population samples in Australia: (i) Women born in Australia or in another English speaking country who completed the EPDS in English as part of the 1994 postal Survey of Recent Mothers (SRM) 6–7 months after birth (n = 1166); (ii) Women born in non-English speaking countries who also completed the EPDS in English in the same survey (n = 142); and (iii) Women born in Vietnam (n = 103), Turkey (n = 104) and the Philippines (n = 106) who completed the EPDS 6–9 months after birth in translation in the Mothers in a New Country Study (MINC) study (total n = 313). The pattern of item responses on the EPDS was assessed in various ways across the samples and internal reliability co-efficients were calculated. Exploratory factor analyses were also conducted to assess the similarity in the factor solutions across the samples. Results The EPDS had good construct validity and item endorsement by women was similar across the samples. Internal reliability of the scale was also very satisfactory with Cronbach’s alpha for each sample being ≥8. Between 39 and 46% of the variance in each of the three main samples was accounted for by one principal factor ‘depression’ (6–7 items loading), with two supplementary factors ‘loss of enjoyment’ (2 items loading) and ‘despair/self-harm’ (2–3 items loading) accounting for a further 20–25% of the variance. Alternative one and two factor solutions also showed a great deal of consistency between the samples. Conclusions The good item consistency of the EPDS and the relative stability of the factor patterns across the samples are indicative that the scale is understood and completed in similar ways by women in these different English speaking and non-English speaking population groups. With the proviso that careful translation processes and extensive piloting of translations are always needed, these findings lend further support to the use of the EPDS in cross-cultural research on depression following childbirth.     

Psychotic-Like Experiences in Major Depression and Anxiety Disorders: A Population-Based Survey in Young Adults

Objective: Population-based surveys have confirmed that psychotic-like experiences are prevalent in the community. However, it is unclear if these experiences are associated with common mental disorders. The aim of this study was to examine the prevalence of psychotic-like experiences in those with affective and anxiety disorders. Methods: Subjects were drawn from the Mater-University of Queensland Study of Pregnancy. Delusion-like experiences were assessed with the Peters Delusional Inventory (PDI). The Composite International Diagnostic Interview (CIDI) was used to identify individuals with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) lifetime diagnoses of major depression, anxiety disorder, substance use/dependence, and psychotic disorders. The influence of affective and anxiety disorders on PDI and CIDI psychosis-related items’ scores were assessed with logistic regression, with adjustments for age, sex, and the presence of the other comorbid psychiatric diagnoses. Results: Having either a lifetime diagnosis of major depressive disorder or an anxiety disorder was associated with significantly higher PDI total scores (highest vs lowest quartile adjusted odds ratios [ORs] and 95% confidence intervals [CIs] = 4.43, 3.09–6.36; 3.08, 2.26–4.20, respectively). The odds of endorsing any CIDI hallucination or delusion item was increased in those with a major depressive or anxiety disorder. The presence of current anxiety disorder symptoms was significantly associated with PDI score (OR = 5.81, 95% CI = 3.68–9.16). Conclusion: While psychotic-like experiences are usually associated with psychotic disorders, individuals with depression and anxiety are also more likely to report these symptoms compared with well individuals. Psychotic-like experiences are associated with a range of common mental disorders.     

Comparative performance of long and short forms of the Geriatric Depression Scale in mildly demented Chinese

OBJECTIVE: This study aims to investigate if a brief version (four items) of the Geriatric Depression Scale works equally well with mildly demented as with nondemented patients in young-old and old-old persons, and to compare its diagnostic performances with those of the 15- and the 30-item version of the scale. METHOD: Four hundred and forty-two older persons were given a GDS interview and received an independent psychiatric evaluation. Receiver operating characteristic curves were separately plotted for the young-old demented, old-old demented, young-old nondemented, and old-old nondemented. RESULTS: The four-item version yielded comparable performance to the 15- and the 30-item version of the GDS, regardless of age and dementia status. It is reasonably robust to the effects of age and mild dementia, whether alone or in combination. Nonetheless, among the old-old demented, only a third of those tested positive were actually positive, but this problem was not specific to the four-item version. CONCLUSIONS: The four-item version can be used in lieu of the longer versions to conserve clinical and research resources where appropriate, and a cutoff of 1/2 can be applied across the board. Little, if any, information is lost when this brief version is used instead of the longer ones.     

Genetics of familial amyloidotic polyneuropathy in a Hong Kong Chinese kindred

Familial amyloidotic polyneuropathy type 1 (FAP1, MIM176300) is an autosomal dominant disease caused by mutations in the transthyretin (TTR) gene. An extended Chinese kindred of FAP1 was first reported in Hong Kong in 1989, three of the four histologically proven subjects have deceased. TTR gene mutations were not studied then. A DNA-based diagnosis was performed on FAP1 by restriction analysis and direct DNA sequencing was carried out on a symptomatic member of this family who had undergone a liver transplantation. It showed a substitution of thymine by cytosine in the second base of codon 30 in exon 2 of the TTR gene, with the creation of a novel HhaI restriction endonuclease site. Valine is substituted by alanine (V30A) in the mutant TTR. Both restriction analysis and direct sequencing revealed the same mutation in one of the two asymptomatic siblings. This mutation was first reported in a FAP1 family of German descent.     

A general population study of the Chinese Whiteley-7 index in Hong Kong

Objective

To examine the psychometric properties of the Chinese seven-item Whiteley Index (WI-7) in the general population of Hong Kong.

Methods

A random community-based telephone survey of 3014 respondents aged 15–65 was conducted using a fully structured questionnaire that included the WI-7, 15-item Patient Health Questionnaire (PHQ-15), Sheehan Disability Scale (SDS), and items about the frequency of health service use, perceived helpfulness of doctors, level of satisfaction with doctors, and sociodemographic variables. A sub-sample of 199 respondents was re-interviewed to assess test–retest reliability.

Results

The WI-7 exhibited satisfactory internal consistency (Cronbach's α=0.73) and stable one-month test-retest reliability. The most commonly endorsed item was “worrying a lot about one's health” (55.7%), followed by “worrying about getting the disease oneself if it is brought to his/her attention” (48.7%) and “bothered by many different pains and aches” (33.9%). Age, gender, and monthly family income significantly predicted WI-7 score. Confirmatory factor analysis revealed that a 2-factor structure was superior to a 1-factor structure in fitting the data. WI-7 total score was positively associated with PHQ-15 somatic distress, SDS impairment, number of healthcare visits, lower levels of perceived helpfulness of doctors and of satisfaction with doctors.

Conclusion

The Chinese WI-7 exhibits satisfactory reliability and internal validity in a general population. It is a promising tool for the empirical examination of health anxiety which is a common experience with a mostly typical epidemiological profile among Chinese people in Hong Kong.     

Recurrence after a first untreated seizure in the Hong Kong Chinese population

PURPOSE: There is wide variation in the reported prognosis after a first unprovoked generalized tonic-clonic convulsion and in the risk factors that are associated with recurrence. Estimates for the risk of recurrence range from 26 to 71%. We investigated the likelihood of a second attack in Hong Kong Chinese patients. METHODS: One hundred thirty-two patients with a first convulsion that was unexplained by acute neurological or medical causes were retrospectively ascertained. Patients' demographic details, potential risk factors for recurrence, and current seizure status were recorded. Survival analysis was performed using the Kaplan-Meier procedure. RESULTS: The cumulative probability of a second attack at 1, 2, 3, and 4 years was 30, 37, 42, and 47%, respectively. Seizures in patients with abnormal computer tomography scans of the brain were associated with an increased risk of recurrence on multivariate analysis. CONCLUSIONS: Thirty percent of the sample population experienced a second seizure after 1 year. An additional 17% continue to be at risk of a second convulsion during the next 3 years.     

Depression in dementia: a comparative and validation study of four brief scales in the elderly Chinese

AIM: The study aimed to determine: (i) the diagnostic accuracy of four brief depression scales, the Geriatric Depression Scale (GDS), Even Briefer Assessment Scale for Depression (EBAS DEP), Single Question and Cornell Scale for Depression in Dementia (Cornell) in an elderly Chinese population with varying dementia severity; and (ii) which scale had the best diagnostic performance. METHOD: All four scales were administered to 88 elderly outpatients with dementia: 66 without and 22 with depression. Receiver Operating Characteristic (ROC) analysis was used to establish the optimal cut-off scores of the GDS, EBAS DEP and Cornell scales. The patients' dementia-severity was dichotomously categorized into mild and moderate-severe dementia, and the above analysis was repeated in both these groups to look at changes in the scales' diagnostic performance as dementia advances. RESULTS: The best diagnostic scale for detecting depression in dementia was the Cornell scale. Its optimal cut-off score was 6/7 (sensitivity 91.7%, specificity 80.0%) in the mild dementia group and 12/13 (sensitivity 70.0%, specificity 87.0%) in the more advanced dementia group. The optimal cut-off scores of the GDS and EBAS DEP also shifted to higher values when moving from the mild to the more advanced dementia groups, indicating the increasing difficulty on all these scales to detect depression with worsening cognitive impairment. The Single Question, however, was more robust with much less changes in its diagnostic parameters in both dementia cohorts: sensitivity 58.3%, specificity 90.0% for mild dementia, and 60.0 and 84.8%, respectively, for more advanced dementia. CONCLUSION: An efficient strategy to diagnose depression in dementia amongst elderly Chinese patients is to administer the Single Question followed by, when necessary, the Cornell scale.     

Risk of depression in patients with chronic respiratory diseases: results from two large cohort studies in Chinese elderly from Hong Kong

OBJECTIVE: Although it has been suggested that depression is common in patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), few studies on the association between chronic respiratory diseases and depression have been conducted in the community. METHOD: Data from the baseline examination of two cohort studies, Mr and Ms Os, Hong Kong were used. Three thousand nine hundred and ninety-eight Hong Kong men and women aged 65 to 92 were recruited. Depression was assessed by face-to-face interview, using the short-form of a validated Chinese version of the Geriatric Depression Scale (GDS). Chronic respiratory disease was assessed by subjects' self reports of chronic respiratory disease (chronic bronchitis, emphysema and asthma) diagnosed by medical doctors. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CI) for depression among subjects with chronic respiratory diseases relative to those without (controls) were calculated, after adjustments were made for potential confounders. RESULTS: Chronic respiratory disease was associated with a higher prevalence of depressive disorders with an odds ratio of 1.58 (95% CI = 1.12-2.13) after adjustment was made for age, sex, cigarette smoking, alcohol drinking and history of cardiovascular diseases when compared with controls. For those subjects with self report of chronic respiratory disease and who screened positive for depression (n = 44), none were on antidepressants. Among subjects who screened positive for depression without self-report of chronic respiratory disease (n = 328), only 2.74% (n = 9) were on antidepressants. CONCLUSIONS: We conclude that chronic respiratory disease is independently associated with depression in Chinese elderly. Moreover, depression in the elderly is under-treated in those with and without chronic respiratory disease. Clinicians, especially primary care physicians in the community, should be more aware of increased prevalence of depression in patients with chronic respiratory disease.     

Moderating effect of communication difficulty on the relationship between depression and pain: a study on community-dwelling older adults in Hong Kong

Objectives: This study examined the relationship between depression and pain, and the moderating effect of communication difficulty on this relationship, among community-dwelling older adults in Hong Kong.

Method: We used logistic regression to analyze secondary data regarding 12,402 Chinese older adults applying for long-term care service in Hong Kong in 2012.

Results: Approximately 30% of participants were depressed and 37% experienced communication difficulty. Depression was associated with increased pain. Communication difficulty was found to moderate the relationship between depression and pain. Pain scores increased more when individuals who experienced communication difficulty reported being depressed, compared to those who did not experience communication difficulty.

Conclusion: The moderating effect of communication difficulty may be explained by the interaction between depression and communication difficulty. Participants who were depressed and concurrently experienced communication difficulty may be more likely to catastrophize their pain and may tend to report or experience more pain. Health care professionals need to be aware of the different effects of communication difficulty on the pain experiences of older adults. Psychosocial intervention may be provided to minimize older adults’ communication barriers to pain management.     

A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women

Objective: The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for postpartum depression (PPD). We systematically reviewed the published evidence on its validity in detecting PPD and antepartum depression (APD) up to July 2008. Method: Systematic review of validation studies of the EPDS included 1987–2008. Cut‐off points of 9/10 for possible PPD, 12/13 for probable PPD and 14/15 for APD were used. Results: Thirty‐seven studies met the inclusion criteria. Sensitivity and specificity of cut‐off points showed marked heterogeneity between different studies. Sensitivity results ranged from 34 to 100% and specificity from 44 to 100%. Positive likelihood ratios ranged from 1.61 to 78. Conclusion: Heterogeneity among study findings may be due to differences in study methodology, language and diagnostic interview/criteria used. Therefore, the results of different studies may not be directly comparable and the EPDS may not be an equally valid screening tool across all settings and contexts.     

A Study of Depression in Two Cultures: A Transcultural Study with Japanese and Australian Clinically Depressed Patients

Abstract: Recently there has emerged a growing interest in transcultural aspects of depressive disorders. Unlike earlier studies, recent research has concentrated on using standardized assessment and evaluation procedures in an effort to reduce "differences" associated with research techniques. The following paper reports a study which, using the WHO developed Standardized Assessment of Depressive Disorders (WHO/SADD) schedule, examines the nature of depressive symptomatology in Australian and Japanese clinically depressed patients. While results supported the presence of a "symptom core" common to both cultures, some unexpected findings in relation to "feelings of guilt" and "severity of depression" were noted.     

Depressive symptoms of elderly Chinese in Guangzhou,Hong Kong,and Taipei

Objectives: Understanding the socio-cultural context is an important pre-requisite for understanding global aging and mental health. This study aimed to examine the variation in the types of depressive symptoms of aging Chinese in three ethnic Chinese societies.

Method: Data were based on a mixed purposive and random sample of aging Chinese in Guangzhou, Hong Kong, and Taipei. The 891 Chinese participants of 65 years or older were included. Depressive symptoms were measured by a Chinese 15-item Geriatric Depression Scale. Factor analysis was used to identify the factor structure of the scale when used with elderly Chinese in the three cities.

Results: There are ‘within-ethnic group’ differences in manifestation of depressive symptoms. Symptoms of the elderly Chinese in Guangzhou and Hong Kong were similarly related to items that indicate uncertainty and disinterest in living. The ones in Taipei expressed symptoms indicating disinterest and a negative mood. These differences were probably due to the variations in the socio-cultural, demographic, and structural characteristics among the three cities.

Conclusion: Depressive symptoms can be culturally related and manifested differently by people sharing a similar ethnicity. The same ethnicity does not mean homogeneity. The findings should be useful for mental health practitioners in Western societies working with older Chinese immigrants. Knowing the mental health characteristics of these client groups will facilitate the designing of appropriate assessment and intervention tools to fit the culturally unique mental health needs of different subgroups in these ethno-cultural communities.     

Validation of the Chinese version of the Mood Disorder Questionnaire in a psychiatric population in Hong Kong

Aims:  The aim of the present study was to determine the validity of a Chinese version of the Mood Disorder Questionnaire (MDQ) as a screening instrument for bipolar disorder in a psychiatric outpatient population in Hong Kong.
Methods:  A total of 185 patients primarily being treated for mood disorders were asked to fill in the Chinese MDQ and supply other personal data during their scheduled clinic visit. The mean age was 43.0 years and 65.9% were female. A subsample of 102 randomly selected subjects, stratified by the MDQ symptom score, received a telephone-based Structured Clinical Interview for DSM-IV (SCID). Sixty-two patients (60.8%) were suffering from bipolar disorder (bipolar I, n  = 48; bipolar II, n  = 9; bipolar disorder not otherwise specified, n  = 5), 35 (34.3%) from depressive disorder, and one (1.0%) from substance dependence, while four (3.9%) were unaffected by either mood or alcohol/substance use disorder. The internal consistency, factor structure and operating characteristics of the Chinese MDQ were analyzed.
Results:  The internal consistency of the Chinese MDQ, evaluated using Cronbach alpha, was 0.82. Principal component analysis with varimax rotation indicated an 'energized-activity' factor and an 'irritability-racing thoughts' factor, which explained 47.2% of the rotated variance. The optimal cut-off was seven or more manic symptoms occurring within the same time period, which yielded a sensitivity of 0.73 and a specificity of 0.88 for detecting bipolar disorder. An additional criterion that the symptoms cause impairment resulted in significant loss of sensitivity.
Conclusion:  The Chinese MDQ is a valid screening instrument for bipolar disorder in a psychiatric outpatient population.