Subjective quality of life in outpatients with schizophrenia in Hong Kong and Beijing: relationship to socio-demographic and clinical factors

Purpose This study compared the subjective quality of life (SQOL) in schizophrenia patients living with their families in Hong Kong (HK) and Beijing (BJ) and explored the relationship between SQOL and basic socio-demographic and clinical factors. Materials and methods Two hundred and sixty-four clinically stable outpatients with schizophrenia were randomly selected in HK and 258 counterparts matched according to age, sex, age at onset, and length of illness in BJ. SQOL and psychiatric status were assessed with standard rating instruments. Results There was no significant difference in any of SQOL domains between the two cohorts after controlling for potentially confounding variables. Positive, depressive and anxiety symptoms and drug-induced extrapyramidal side effects (EPS) were all significantly correlated with SQOL. Multiple regression analysis revealed that only depressive symptoms predicted all SQOL domains in both groups. Having removed depressive symptoms from the model, positive symptoms predicted all domains, anxiety predicted all but social domains, use of benzodiazepines (BZD) predicted all but physical domains, EPS predicted physical domain, and history of suicide predicted social domain in HK; anxiety predicted all domains, positive symptoms predicted all but physical domains, EPS, use of BZD and history of suicide all predicted physical domains, and length of illness predicted environmental domain in BJ. Conclusion Despite considerable differences between the two sites in terms of health care delivery and the economic conditions of the subjects, SQOL did not differ between HK and BJ. The conclusion is in line with previous studies that suggested that patients’ SQOL was independent of their living standard as long as it reached a certain minimum level. SQOL was more strongly related to the severity of depressive symptoms and had weak association with socio-demographic factors.     

Impact of sociodemographic and clinical factors on subjective quality of life in schizophrenia patients in Beijing, China

The impact of sociodemographic and clinical factors on subjective quality of life (SQOL) in Chinese schizophrenia outpatients was explored. Randomly selected subjects with schizophrenia (N = 273) were assessed with respect to their sociodemographic, clinical characteristics, and SQOL. Compared with the Chinese general population, patients had significantly lower scores in the physical and social SQOL domains. Multiple regression analyses revealed that depressive symptoms inversely predicted all SQOL domains; positive symptoms negatively predicted psychological, social, and environmental SQOL domains whereas educational level, extrapyramidal side effects, anxiety, history of suicide attempts, employment status, monthly income, number of hospitalization, and length of illness all significantly contributed to 1 or 2 SQOL domains.     

Reliability and validity study of Silver's test for Hong Kong-Chinese with dementia

There has been great concern regarding the functional and cognitive abilities of elderly people in performing activities of daily living. 'Silver's test' has been widely used to assess the abilities and mental functions of the aging population in Hong Kong. The purpose of this study was to establish the validity and reliability of a Chinese version of Silver's test (CVST) for Hong Kong-Chinese with dementia. A sample of 78 (21 male and 57 female) elderly subjects was recruited through two-stage cluster sampling. They were administered both the CVST and the Chinese Mini-Mental Status Examination (MMSE). Spearman rank-order correlation coefficient (rs) and intra-class correlation coefficient (ICC) showed that the CVST had a very good inter-rater reliability (rs=0.9573, P=0.000; ICC=0.9966) and test-retest reliability (rs=0.9693, P<0.001; ICC=0.9769). The internal consistency of the test was satisfactory (Cronbach's alpha=0.8396). The Mann-Whitney U-test showed that the CVST could discriminate the demented elderly subjects from the non-demented subjects, suggesting the best cut-off score to be 34, yielding a high sensitivity of 96.4% and equally good specificity of 96.7%. There was also a high positive correlation (rs=0.9218, P<0.001) between the total scores of the CVST and the MMSE. Suggestions for the modification of Silver's test were also made. In conclusion, the initial reliability and validity of the CVST has been established for Hong Kong-Chinese with dementia. It appears to be a sensitive and practical cognitive assessment acceptable to this population.     

Is fatigue associated with suicidality in stroke?

Tang W-K, Lu J-Y, Mok V, Ungvari GS, Wong K-S. Is fatigue associated with suicidality in stroke?

Objective

To evaluate the relationship between poststroke fatigue and suicidality (SI) in Chinese patients with first or recurrent stroke.

Design

Cross-sectional survey.

Setting

Acute stroke unit of a general hospital.

Participants

Patients with acute ischemic stroke (N=595) admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong.

Interventions

Not applicable.

Main Outcome Measures

SI was assessed with the Geriatric Mental State Examination at 3 months after the subjects' index stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). The association between the mean FSS score and SI was examined and adjusted for potential confounders, including age, sex, marital status, previous stroke, depression, Mini-Mental State Examination score, and neurologic deficits in terms of the National Institutes of Health Stroke Scale score.

Results

Seventy-six (12.8%) of the patients had SI (the SI group). The FSS score was significantly higher in the SI group (4.0±1.4 vs 2.8±1.2). The FSS score remained a significant predictor of SI in the subsequent forward logistic regression (odds ratio=1.5), adjusting for the possible confounders.

Conclusions

These findings should alert clinicians that early identification and treatment of fatigue may reduce the suicidal risk in stroke patients.     

Examining item bias in the anxiety subscale of the Hospital Anxiety and Depression Scale in patients with chronic obstructive pulmonary disease

The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument for depression and anxiety in medically compromised patients. The purpose of this study was to examine the differential item functioning (DIF) of the anxiety subscale of the HADA (HADS-A). A research assistant administered the HADS-A to 166 Chinese patients with chronic obstructive pulmonary disease (COPD) who were consecutively admitted to a rehabilitation hospital. Although the HADS-A was overall uni-dimensional, there were one mute item and two items with borderline misfit. Only one item had a DIF for arterial oxygen saturation. No item had DIF for other indicators of the severity of COPD. In conclusion, this study found that for one item the HADS-A has significant item bias for the severity of disease in patients with COPD.     

Training patients with schizophrenia with the community re-entry module

Background There is increasing evidence indicating that the Community Re-entry Module (CRM), a brief, structured instrument, could guide an effective intervention for patients with schizophrenia. This study evaluated the effectiveness of the Chinese version of the CRM with respect to improvement in psychiatric symptoms, social functioning as well as relapse and re-hospitalization rates in comparison with a supportive counseling (SC) intervention. Method Ninety-six outpatients with DSM-IV schizophrenia were randomly allocated to either CRM (N=48) or an equally intensive intervention of SC (N=48). The CRM was composed of 16 one-hour sessions, which were conducted with groups of 6–8 patients on a twice-a-week schedule. The two groups received routine psychiatric outpatient care during the intervention. Participants were assessed on an intention-to-treat basis with the Positive and Negative Syndrome Scales (PANSS), with the Social Disability Screening Schedule (SDSS) by two independent raters before and immediately after intervention, and at 6-month follow-up. The number of relapse and re-hospitalization were also documented. Results The CRM group significantly improved in terms of psychiatric symptoms and social functioning compared with the SC group. Rates of relapse and re-hospitalization in the CRM group were lower although the difference between the two groups was not statistically significant. Conclusions The study supports the feasibility and effectiveness of the Chinese version of the CRM as an effective psychosocial intervention for Chinese patients with schizophrenia to improve psychopathology, social functioning and relapse and re-hospitalization rates.