Sexuality among Chinese mental health consumers in halfway houses of Hong Kong

OBJECTIVE: This study examined the sexuality of Chinese mental health consumers in halfway houses by incorporating the perspectives of consumers and staff. METHODS: A total of 193 consumers and 88 staff from 11 halfway houses in Hong Kong completed surveys about sexual needs, attitudes, and expression. Chi square analyses and t tests examined group differences. Needs related to nine sex-related activities were examined: finding a partner, dating, marriage, procreation, use of sex workers (persons who exchange sex for money), viewing pornography, masturbation, intimate physical contacts, and sexual intercourse. RESULTS: From 14% to 49% of consumers reported needs related to the nine activities. Acceptance of activities was higher among staff, and consumers were more conservative in sexual attitudes. Staff's members' reported level of sexual knowledge and level of comfort in addressing sexual issues were higher than consumers' reports of their own knowledge and comfort. CONCLUSIONS: The findings can inform the development of sexuality training programs for staff and consumers in halfway houses.     

Chinese attitudes towards sexual minorities in Hong Kong: Implications for mental health

Abstract

Intolerant attitudes and sexual prejudice against sexual minorities (lesbian, gay, bisexual, and questioning/queer-LGBQ) has been a long-standing global concern. In this article, Chinese attitudes towards sexual minorities are examined with reference to the cultural context in Hong Kong, a place where the East has intermingled with the West for over a century. Chinese sexuality manifested in Hong Kong is a mix of Confucian ideology and Christian thought. Traditional Confucian values of xiao (filial piety) and conventional religious thoughts of Christianity together influence Chinese attitudes towards sexual minorities. Though many governmental policies have been put in place and numerous laws have been enacted to protect the human rights of underprivileged and disadvantaged groups over the past few decades, sexual minorities are frequently being excluded from most of these protections. In Hong Kong, sexual prejudice exists not only among the general public, but also among educators and mental health professionals. Thus, Chinese sexual minorities experience sexual prejudice and minority stress in Hong Kong under unique cultural circumstances. This calls for inclusive policies and an embracing attitude towards sexual minorities so their mental health will not suffer.     

The situation of family caregivers for people with mental illnesses in Hong Kong

Family caregiving is very important in psychiatric rehabilitation for people with mental illnesses. By reviewing related studies, the writer describes the situation of family caregivers for people with mental illnesses. Studies showed that only 16.8% of them received psychiatric rehabilitation services. The other 83.2% relied on their family caregivers as the only support in their rehabilitation process. Forty percent of people with mental illnesses were cared for by their mothers. However, most of these family caregivers were fatigued and at risk of mental breakdown.     

Cognitive-behavioural group therapy for Hong Kong Chinese adults with mental health problems.

Ninety-one Chinese in the community, aged between 18 and 45, with mental health problems ranging from mild to moderate degree, were treated by cognitive behavioural group therapy (CBGT) for a period of 3 months. All subjects were assessed on multiple measures at 4 time points: screening, pre-treatment (after 3 months), post-treatment and at 3-month follow-up. Attendance was good. A standard practice manual was developed to ensure consistent treatment by 2 group workers. After controlling for the placebo effect in the waiting period, treatment effect was demonstrated which was sustained after a three month period. The all-round improvement included a decrease in psychiatric symptoms, improvement in self-assessment, better and more social activities and being more able to cope with problems. In terms of psychiatric diagnosis, depressed subjects gained the most benefit and personality disorder subjects the least. Parents seemed to benefit more than non-parents.     

Informal community care for mental health consumers in Hong Kong

Informal community care is crucial in community integration and rehabilitation of people with mental illness. In this paper, the writer describes the development of informal community care in Hong Kong. A self-help group, a relative group, integrative aftercare network, and the use of volunteers will be described and analyzed. However, these informal community care projects are underdeveloped. Participation is limited. Community integration is greatly hindered by public discrimination. The writer also suggests ways to develop the informal community care projects in Hong Kong.     

Urban-rural differences in student mental health: the Hong Kong scene.

Student mental health of Hong Kong urban and rural fifth formers and sixth-formers was assessed by examining their scores obtained from the General Health Questionnaire twice administered. The first administration was done soon after commencement of a school term and served as a baseline measure, and the second was done six weeks before the fifth-formers took an important public examination, a significantly stressful event. The results indicated that all groups of fifth-formers showed an increase in mean scores, reaching statistical significance only in urban boys and rural girls. The latter finding was used to explain urban-rural differences in mean scores. The significance of severe examination distress and its possible late psychiatric sequelae remained unanswered.     

Assessing mental health and its association with income and resource utilization in old-old Chinese in Hong Kong.

OBJECTIVES: The authors assessed mental health status and its association with income and resource utilization in old-old Chinese citizens in Hong Kong. METHODS: Stratified disproportional random sampling in 1991-92 assembled a cohort of 1,696 elderly community-dwelling subjects who were age 70 or above, measuring the age and education adjusted mean level of cognitive functioning and geriatric depression, by income groups and further investigating the association between mental health and income by incorporating deficiencies in activities of daily living (ADL) and the presence of major chronic conditions in the multivariate regressions. The association between mental health and resource utilization, including physician visits and use of medication, was examined by multivariate regression analyses. RESULTS: Better cognitive functioning was associated with higher income across groups. Lower geriatric depression was associated with higher income. Cognitive impairment was associated with the ADL deficiencies, and geriatric depression was associated with a number of major chronic conditions and higher resource utilization, including physician visits and medication use. CONCLUSIONS: Income was significantly associated with cognitive functioning and geriatric depression in elderly persons in Hong Kong. Mental health, ADL deficiency, major chronic conditions, and resource utilization are interrelated. The fact that aging in the population is associated with increasing cognitive impairment and geriatric depression presents new challenges in financing and delivering efficient and equitable health care in the region.     

Recovery in Hong Kong: service user participation in mental health services

This article provides an overview of mental health services (MHS) and the application of the recovery concept in Hong Kong, focusing on user participation. It presents stakeholders' views of the recovery movement in a round-table discussion format, demonstrating agreement that user participation merits more public and official attention. Some of the present difficulties with the movement are also reviewed. Social identity theory (SIT) is then analysed as a potentially useful framework for theorizing how service users' identities change as they become service providers. The paper then provides an overview of the current financial and political position of MHS, and identifies signs that the recovery approach is becoming accepted. It also addresses the cultural meanings of the concept, and sets out examples of its implementation in the health and social welfare sectors. Lastly, it summarizes the challenges facing service providers and users and concludes that as the recovery movement is still in its infancy in Hong Kong, more coordinated efforts are needed to establish the organizational support and policy framework, so that sustainable and evidence-based service provision can be achieved.     

Association between cultural factors and the caregiving burden for Chinese spousal caregivers of frail elderly in Hong Kong

Objectives: The aim of this study was to explore the relationship between cultural factors and the caregiving burden of Chinese spousal caregivers who provided care to their frail partners.

Method: A sample consisting of 102 Chinese caregivers for frail elderly spouses was recruited from home care services across various districts in Hong Kong. Structured interviews were conducted with the participants in their homes, measuring demographics, the functional status of the spouse, the degree of assistance required in daily care, perceived health, the caregiver's orientation to traditional Chinese family values, social support, coping, and caregiver burden.

Results: Findings of regression analysis indicated that gender, activities of daily living (ADL) status, orientation to traditional Chinese family values, passive coping, and marital satisfaction associated with caregiver burden. Being female, having lower functioning in ADL or a strong orientation toward traditional Chinese family values, employing the strategies of passive coping more frequent, or experiencing a low degree of marital satisfaction were associated with high levels of caregiver burden.

Conclusion: These findings provided a basis for developing appropriate interventions to minimize the caregiver burden of spousal family caregivers.     

Age- versus time-comparative self-rated health in Hong Kong Chinese older adults

OBJECTIVES: The main objectives were to examine the relation between age-comparative (self vs others of same age) self-rated health (SRH) and time-comparative (self this year vs last year) SRH, and to evaluate which was more strongly associated with specific physical health problems. METHODS: Cross-sectional data on two SRH measures and various physical health problems from 18749 male and 37413 female clients aged 65 or over from 18 Elderly Health Centres in Hong Kong were analysed using logistic regression with adjustment for potential confounders. RESULTS: Men were more likely to report 'better' and less likely to report 'worse' SRH than women. 'Normal' was the most common option but the proportions choosing this decreased with age on both SRH measures. There was a fairly weak but statistically significant correlation between these two measures, with Kappa coefficients of 0.125 and 0.167 for men and women, respectively. For both men and women, there were significantly positive linear trends between age-comparative SRH options from 'better' to 'worse' and physical health problems, such as respiratory diseases, musculoskeletal diseases, any active chronic diseases, functional disability, depressive symptoms, taking medication regularly, and admission to hospital last year. However, for time-comparative SRH, those who rated 'normal' had the smallest odds ratios in all of the physical health problems above than those who rated 'better' or 'worse'. CONCLUSIONS: The two SRH measures correlated with each other weakly but significantly. Age-comparative SRH was linearly, and time-comparative SRH was curvilinearly associated with physical health problems.     

Religion, health beliefs and the use of mental health services by the elderly

Background: Few studies have investigated whether elderly people of particular religious affiliations were more or less likely to seek treatment for mental illness, and whether it was related to their health beliefs.

Method: In the National Mental Survey of Elderly Singaporeans in 2004, data were collected on reported religious affiliations, and 1-year prevalence of mental disorders (DSM-IV diagnoses of psychiatric disorders) from diagnostic interviews using the Geriatric Mental State schedule, self-report of treatment for mental health problems, and health beliefs about the curability of mental illness, embarrassment and stigma, ease in discussing mental problems, effectiveness and safety of treatment, and trust in professionals.

Results: Compared to those with no religious affiliation, elderly people of all religious affiliations showed higher prevalence of mental health problems, yet reported less frequent treatment by healthcare professionals. In multivariate analyses, the adjusted odds ratio (95% confidence interval) of association with seeking treatment were for Christianity, 0.12 (0.02–0.57); Islam, 0.12 (0.01–1.31); Buddhism/Taoism, 0.59 (0.18–1.88); and Hinduism, 0.21 (0.02–2.56) versus no affiliation. Various religious affiliations differ from each other and from non-religious affiliation on some negative health beliefs, but they did not adequately explain why religious affiliates were less likely to seek treatment.

Conclusion: Further studies should evaluate the lower tendency of elderly people with religious affiliations to seek treatment for mental health problems.     

Cerebrovascular disease in Hong Kong Chinese

Our prospective study of cerebrovascular disease in Hong Kong confirms a previous clinical impression that stroke in the Chinese has a pattern different from that in Caucasians. We studied 540 patients (aged 20-70 years) with stroke. Computed tomography or autopsy was obtained in 86.1% and showed an increase in the proportion with lacunar infarction, striatocapsular infarction, and parenchymal hemorrhage relative to the frequencies in Caucasians. This increase in the incidence of cerebral hemorrhage occurs not only in semicomatose and comatose patients but also in alert patients (16.9%) and those with a lacunar syndrome (12.5%). Our findings suggest that cerebrovascular disease in the Chinese selectively affects small vessels, causing lacunes and hemorrhages. In future community studies on stroke prevalence, researchers should be cautious about interpreting similar prevalence rates as reflecting similar risk factors or pathologies.     

Myasthenia gravis in Hong Kong Chinese

A territory-wide study of myasthenia gravis (MG) was conducted in Hong Kong. Two hundred and sixty-two Chinese patients (159 adult and 103 paediatric onset) were identified, corresponding to a point prevalence and period prevalence of 53.5 and 62.2 per million respectively, and an average annual incidence of 4.0 per million population. Nine patients died, 7 from MG, giving a case fatality rate of 0.027. Female predominance was present in the whole group of patients (female to male ratio 1.6:1) and in those with adult disease (ratio 2.1:1), but not in those with onset in childhood (ration 1.1:1). Onset of disease was most common in the first 3 decades of life, and became less common in subsequent decades. Juvenile onset MG occurred in 39.3% of patients and restricted ocular MG in 47.9%. Familial occurrence was found in 5 patients. In the 159 adult onset patients, ocular disease was most common (32.7%), followed by mild generalised (29.6%), moderately severe generalised (24.5%), fulminating (11.9%) and late severe disease (1.3%). The mean age of onset of symptoms was 36.7 years. The symptomatology was similar to that of Caucasoid populations. Autoimmune thyroid disease was the commonest associated disease, and the incidence of thymoma among thymic abnormalities was high at 38%.     

China–Australia–Hong Kong tripartite community mental health training program

The present paper describes the unique mental health training cooperation between two countries involving three training sites to facilitate the improvement of mental health care and service delivery in China. The priority is to build workforce capacity to deliver appropriate mental health care and rehabilitation in the community. In response to this challenge, a training program was collaboratively planned between partners in both countries to provide a comprehensive training program for multiskilled case workers for mainland China. The development and key activities of the training and exchange program correspond to a diverse range of training programs across multiple levels of staff and sectors. The tripartite training program represents a unique, large scale training program that has contributed significantly to developing one of the largest global national mental health program of reform and building a national community mental health service system for China. Over their many years of cooperation, the Australian and Chinese partners have developed a model for successful collaboration, one based on mutual respect, exchange of expertise and a deep appreciation of cultural difference and its influences on broad aspects of health system development.     

Oral health of psychiatric in-patients in Hong Kong

BACKGROUND: Poor oral health has been reported among various psychiatric populations. Little is known regarding the oral health among psychiatric patients in Asia. AIMS: To examine the oral health status of a group of Chinese psychiatric in-patients in a long-term rehabilitation facility. METHODS: A dental survey using the WHO standardised dental evaluation form was conducted in adult psychiatric patients in a rehabilitation programme. A qualified dentist examined all consenting patients. RESULTS: Ninety-one patients (64.8% male; mean age: 44.7 +/- 9.9 years; mean length of illness: 20.3 +/- 11.5 years) were included in the study, the majority (80.2%) diagnosed with schizophrenia. Malocclusion was found in 79.1% of patients. The mean number of missing teeth was 9.5 +/- 8.9. Bleeding on probing, calculus, shallow and deep pockets were found in 7.1%, 71.8%, 72.9% and 28.2% of patients, respectively. Dental caries were found in 75.3% of dentate patients. The mean number of caries per patient was 5.5 +/- 6.1. Fifty-four per cent of patients needed dental extraction and 78.8% required conservative dental treatment. Older age and length of illness were significantly associated with poor dental health. CONCLUSIONS: Oral health status of chronic psychiatric patients seems to be considerably worse than that of the general population. Mental health professionals should pay more attention to preventive oral health habits of psychiatric patients.     

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.