Problematic Use of Internet Associates with Poor Quality of Life via Psychological Distress in Invididuals with ADHD.

Background: Problematic use of internet (PUI) may have negative impacts on psychological distress and quality of life (QoL). This situation might be more profound in people with attention-deficit/hyperactivity disorder (ADHD) due to poorer behavioral control and regulatory capacity. However, there is little evidence regarding mediated effects in the associations between PUI, psychological distress, and QoL in people with ADHD. Aims: To investigate mediating effects of psychological distress in the associations of problematic smartphone use (PSPU), problematic use of social media (PUSM), and problematic gaming (PG) with QoL in individuals with ADHD. Methods and Procedures: PUI behaviors of participants with ADHD (n = 99) were assessed using the Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, and Internet Gaming Disorder-Short Form. Psychological distress was assessed using the Depression, Anxiety, Stress Scale and QoL using the Kid-KINDL. Outcomes and Results: Psychological distress mediated the associations between PUI and different domains of QoL, except for self-esteem QoL. There were also positively direct effects between PG and physical QoL, PUSM and friends' QoL, and PSPU and physical QoL. Conclusions and Implications: PUI may associate with poor QoL in people with ADHD via psychological distress. Programs on reducing PUI for people with ADHD are needed.

Sleep Quality and Self-Stigma Mediate the Association Between Problematic Use of Social Media and Quality of Life Among People With Schizophrenia in Taiwan: A Longitudinal Study.

OBJECTIVE: Problematic use of social media (PUSM) may affect sleep quality and self-stigma in people with schizophrenia and consequently reduce their quality of life (QoL). This longitudinal study investigated if sleep quality and self-stigma mediated relationships between PUSM and QoL. METHODS: One-hundred-and-ninety-three outpatients with schizophrenia were recruited from a psychiatric center in Taiwan from April 2019 to August 2021 and participated in a longitudinal study at intervals of three months between measurements. QoL was assessed using the World Health Organization Quality of Life Questionnaire Brief Version; sleep quality using the Pittsburgh Sleep Quality Index; self-stigma using the Self-Stigma Scale-Short; and PUSM using the Bergen Social Media Addiction Scale. Via SPSS 20.0, general estimating equation models assessed temporal associations between variables. Via R software, mediating effects of self-stigma and sleep quality were examined through Monte Carlo simulations with 20,000 repetitions. RESULTS: Mean scores of physical, psychological, social and environmental QoL ranged from 11.86 to 13.02. Mean scores of sleep quality and self-stigma were 9.1±4.5 and 2.2±0.8, respectively. Sleep quality and self-stigma were directly related to QoL (p<0.001) and mediated indirect relationships between PUSM and all components of QoL with a range of 95% confidence intervals spanning from -0.0591 to -0.0107 for physical QoL; -0.0564 to -0.0095 for psychological QoL; -0.0292 to -0.0035 for social QoL; and -0.0357 to -0.0052 for environmental QoL. CONCLUSION: Sleep quality and self-stigma mediated relationships between PUSM and QoL in people with schizophrenia. Developing interventions targeting PUSM, sleep, and self-stigma may help improve QoL in people with schizophrenia.

Bidirectional association between major depressive disorder and dementia: Two population-based cohort studies in Taiwan.

BACKGROUND: Major depressive disorder (MDD) and dementia are both major contributors to the global burden of disease. Despite existing literature on the association between MDD and dementia, there is a lack of a nationwide longitudinal cohort study that considers the competing risk of death. Therefore, this study assessed the bidirectional associations between MDD and dementia over an 11-year period in population-based settings, accounting for death as a competing risk. METHODS: We conducted two population-based retrospective cohort studies in Taiwan. We identified 80,742 patients diagnosed with MDD in 2009-2010 and matched them with patients without MDD by sex, age, and year of diagnosis to assess the relative risk of dementia. We also identified 80,108 patients diagnosed with dementia in 2009-2010 and matched them with patients without dementia by sex, age, and year of diagnosis to assess the relative risk of MDD. All patients were followed until they received a diagnosis of new onset MDD or new onset dementia, their death, or the end of 2019. Cause-specific hazards models were used to estimate adjusted hazard ratios (aHRs). RESULTS: The incidence density (ID) of dementia was higher in patients with MDD than in patients without MDD (7.63 vs. 2.99 per 1000 person-years), with an aHR of 2.71 (95% confidence interval [CI]: 2.55-2.88). The ID of MDD was higher in patients with dementia than in patients without dementia (12.77 vs. 4.69 per 1000 person-years), with an aHR of 2.47 (95% CI: 2.35-2.59). CONCLUSIONS: This population-based study found a bidirectional association between MDD and dementia. Our findings suggest the need to identify dementia in patients with MDD and vice versa.

Problematic smartphone use and two types of problematic use of the internet and self-stigma among people with substance use disorders.

BACKGROUND AND AIMS: Guided by the Interaction of Person-Affect-Cognition-Execution (I-PACE) model and a self-stigma framework, this study aimed to investigate relationships between cognitive and affective self-stigma and behavioral self-stigma, problematic use of internet (PUI), and problematic smartphone use (PSU) among people with substance use disorders (SUDs). It also examined mediating roles for affective self-stigma in the relationships between cognitive self-stigma and behavioral self-stigma/PUI/PSU. METHODS: Using a cross-sectional design, 530 participants diagnosed with SUDs in Taiwan were recruited from a psychiatric center in Taiwan. Mediation models were investigated using the Hayes' Process Macro Model 4. RESULTS: Mediation analyses indicated that cognitive self-stigma was directly associated with behavioral self-stigma (p < 0.001), but not with either types of PUI or PSU (p-values ranging from 0.41 to 0.76). Affective self-stigma was directly related to behavioral self-stigma (p < 0.001), two types of PUI, and PSU (ß = 0.24-0.30; all p < 0.001); cognitive self-stigma was indirectly associated with behavioral self-stigma (ß = 0.53; 95  % bootstrapping CI = 0.46, 0.60), two types of PUI, and PSU (ß = 0.20-0.25; 95  % bootstrapping CI = 0.08-0.14, 0.31-0.37) via a mediating effect of affective self-stigma. DISCUSSION AND CONCLUSION: Findings support the I-PACE model in a self-stigma context. The findings also suggest that addressing affective self-stigma may help prevent or reduce behavioral self-stigma, PUI, and PSU among people with SUDs. Longitudinal studies are warranted to investigate over time relationships between self-stigma and PUI/PSU in people with SUDs.

Emergency department visits and associated factors among people with dementia residing in nursing homes in Taiwan: a one-year cohort study.

BACKGROUND: Residing in a nursing home (NH) may increase emergency department (ED) utilization in patients with dementia; however, evidence regarding the status of and predictors for ED utilization of NH residents with dementia remains unclear, especially in Asia. This study aimed to assess the incidence density of ED visits and associated factors for the risk of ED utilization among NH residents with dementia. METHODS: This one-year cohort study followed 6595 NH residents with dementia aged ≧ 40 years from Taiwan's National Health Insurance Research Database between 2012 and 2014. The Andersen-Gill extension of Cox regression analysis with death as a competing risk was applied to investigate the association of the risk of all causes and the most common causes of ED utilization with the predisposing, enabling, and need factors as defined by the Andersen model. RESULTS: All participants encountered 9254 emergency visits in the 5371.49 person-years observed, representing incidence densities of ED visits of 1722.80 per 1000 person-years. Among them, respiratory disease was the most common cause of ED visits. The significant predictors for the risk of all-cause and respiratory-cause ED visits included: (1) predisposing factors (i.e., age and gender); (2) enabling factors (i.e., regional variables); and (3) need factors (i.e., prolonged ventilator dependence and comorbidity status). CONCLUSIONS: Predisposing, enabling, and need factors could influence ED visits among studies patients. NH providers should consider these factors to develop strategies for reducing ED utilization.

Risks of organ failures and deaths associated with young-onset dementia after hospitalizations for motor vehicle crash injuries: a nationwide population-based retrospective cohort study.

Patients with dementia are at increased risks of adverse consequences associated with motor vehicle crash injury (MVCI). However, studies of the association for patients with young-onset dementia (YOD) are limited. Therefore, we aim to investigate whether YOD was associated with adverse outcomes after hospitalization for MVCI. In this retrospective cohort study, we identified 2052 MVCI patients with YOD (aged 40-64 years) between 2006 and 2015 and included 10 260 matched MVCI patients without YOD (matching ratio: 1:5) from Taiwan's National Health Insurance Research Database and the Taiwan Police-Reported Traffic Accident Registry. We evaluated the intensive care unit (ICU) admission, organ failure, in-hospital and 30-day mortalities, length of hospital stay, and hospital costs. Compared with participants without dementia, patients with YOD had higher rates of ICU admission (34.31% vs. 20.89%) and respiratory failure (6.04% vs. 2.94%), with a covariate-adjusted odds ratio of 1.50 (95% CI 1.33-1.70) and 1.63 (95% CI 1.24-2.13), respectively. The patients also exhibited higher in-hospital mortality (4.73% vs. 3.12%) and 30-day mortality (5.12% vs. 3.34%) than their non-YOD counterparts, but the risk ratio was not significant after adjusting for transport mode. Moreover, the log means of hospital stay and cost were higher among patients with YOD (0.09 days; 95% CI 0.04-0.14 and NT$0.17; 95% CI 0.11-0.23, respectively). This cohort study determined that YOD may be adversely associated with hospital outcomes among MVCI patients. However, the association between YOD and mortality risk may depend on transport mode.

Health-care utilization among dementia patients with or without comorbid depression in Taiwan: A nationwide population-based longitudinal study.

BACKGROUND: Few studies have examined the association of comorbid depression with health-care utilization among dementia patients. This study compared health-care utilization between dementia patients with and without comorbid depression. METHODS: Using Taiwan's National Health Insurance Research Database, we identified 10,710 patients with newly diagnosed dementia between 2005 and 2014: 1785 had comorbid depression (group 1) and 8925 did not (group 2). Patients were tracked for 1 year to evaluate outpatient, emergency, and inpatient service utilization and length of hospital stay (LOS). Multivariable regression was applied to examine the association between comorbid depression and health-care utilization and analyze factors associated with inpatient visits and LOS. RESULTS: Group 1 had significantly fewer outpatient visits (ß = -0.115; p < 0.001), more inpatient visits (ß = 0.157; p = 0.005), and a longer LOS (ß = 0.191; p < 0.001) than did group 2. The groups did not differ significantly in emergency visits (ß = 0.030; p = 0.537). In group 1, age, gender, and specific comorbidities were predictors of inpatient visits; those factors and salary-based insurance premiums were predictors of LOS. CONCLUSION: Group 1 utilized less outpatient care but more inpatient care, suggesting health-care service for these patients may be needed to improvement.

Exploring mediational roles for self-stigma in associations between types of problematic use of internet and psychological distress in youth with ADHD.

BACKGROUND: Several studies have linked the problematic use of the Internet (PUI) to psychological distress. Youth with attention deficit hyperactivity disorder (ADHD) are considered a particular disadvantaged population with a high risk of developing PUI, psychological distress, and self-stigma. Nonetheless, the interrelationships of PUI, self-stigma, and psychological distress in adolescents with ADHD are not well understood. AIMS: This study investigated whether self-stigma mediates relationships between different forms of PUI, such as problematic gaming (PG), problematic social media use (PSMU), problematic smartphone use (PSPU), and psychological distress (i.e., depression, anxiety, and stress), in children with ADHD. METHODS AND PROCEDURES: We recruited 100 youth with ADHD (mean age=10.80 [SD=3.07] years; 84 boys) from psychiatric outpatient clinics in Taiwan. All participants were assessed for PUI (via Internet Gaming Disorder-Short Form for PG, Bergan Social Medica Addiction Scale for PSMU, and Smartphone Application-Based Addiction Scale for PSPU), self-stigma (via Self-Stigma Short-Scale), and psychological distress (via Depression, Anxiety, Stress Scale). OUTCOMES AND RESULTS: The results of path and bootstrapping analyses indicated that self-stigma mediated the associations between PSMU and PSPU, but not PG, and depression, anxiety, and stress. CONCLUSIONS AND IMPLICATIONS: This study expands the extant literature by revealing that self-stigma mediates the association between specific forms of PUI and psychological distress in adolescents with ADHD. Interventions aimed at reducing self-stigma and PUI, particularly PSMU and PSPU, may help decrease psychological distress among adolescents with ADHD.

Temporal associations between depressive features and self-stigma in people with substance use disorders related to heroin, amphetamine, and alcohol use: a cross-lagged analysis.

BACKGROUND: Depression is a mental health problem and substance use concerns are socially unacceptable behaviors. While depression and substance use may individually impact self-concept and social relationships, their co-occurrence can increase the risk of self-stigmatization. However, there is no evidence regarding how depression and self-stigma may influence each other over time. The aim of the current study was to evaluate the cross-sectional and longitudinal relationships between features of depression and self-stigma in people with substance use disorders. METHODS: Overall, 319 individuals with substance use disorders (273 males) with a mean (± SD) age of 42.2 (± 8.9) years were recruited from a psychiatric center in Taiwan by convenience sampling. They were assessed for features of depression and self-stigma at four times over a period of nine months using the depression subscale of the Depression Anxiety Stress Scales (DASS-21) and Self-Stigma Scale-Short S (SSS-S), respectively. Repeated-measures analyses of variance, Pearson correlations and cross-lagged models using structural equation modeling examined cross-sectional and temporal associations between depression and self-stigma. RESULTS: Positive cross-sectional associations were found between depressive features and all assessed forms of self-stigma over time (0.13 < r < 0.92). Three models of cross-lagged associations between different forms of self-stigma and depressive features indicated good fit indices (comparative fit index > 0.98). The direction of associations between depressive features towards self-stigma was stronger than the opposite direction. CONCLUSION: Positive associations between depressive features and self-stigma were found in people with substance use disorders. Although these associations may be bidirectional longitudinally, the directions from depressive features to self-stigma may be stronger than the reverse directions, suggesting treatment of depression in earlier stages may prevent self-stigmatization and subsequent poor outcomes in people with substance use disorders.

Comparisons of psychological distress and self-stigma among three types of substance use disorders receiving treatment-as-usual approaches: real-world data from a 9-month longitudinal study.

Background: Substance use is an important issue worldwide and people with substance use disorders (SUDs) have been reported to have high levels of psychological distress and self-stigma. Therefore, psychological distress and self-stigma in people with SUDs are considerable. Objective: The present study used a longitudinal design to examine whether treatment-as-usual approaches in Taiwan improve psychological distress and self-stigma among people with three types of SUDs (heroin, amphetamine, and alcohol use disorders). Design: A 9-month longitudinal design involving four assessments spaced 3 months apart. Methods: Convenience sampling was used to recruit people with heroin (n = 112), amphetamine (n = 151), and alcohol (n = 56) use disorders from outpatient psychiatric center in Southern Taiwan. Psychological distress was assessed using the Depression, Anxiety, Stress Scale (DASS-21), and self-stigma was assessed using the Self-Stigma Scale-Short (SSS-S). Generalized estimating equation (GEE) models were constructed to understand between-group differences in psychological distress and self-stigma over time. Results: Patients with heroin and amphetamine use disorders had lower levels of psychological distress as compared with those with alcohol use disorder. Levels of psychological distress were lower at Time 2 to Time 4 as compared with Time 1. Patients with heroin and amphetamine use disorders had higher levels of self-stigma as compared with those with alcohol use disorder. Self-stigma levels remained stable over time. The dropout rate of receiving treatment-as-usual approach in the 9-month study was 60%. Conclusion: Treatment as usual for SUDs among outpatients in Taiwan may decrease psychological distress but not self-stigma. However, such effects need to be further examined given the high drop-out rates and absence of a control condition. The findings suggest that self-stigma may warrant additional treatment for patients with SUDs.

Temporal associations between problematic use of the internet and self-stigma among people with substance use disorders: A cross-lagged model across one year.

Self-stigma is a common experience for people with substance use disorders (SUDs). Understanding factors associated with self-stigma may aid in intervention development. This study investigated the reciprocal relationship between three types of problematic use of the internet [PUI; i.e. problematic use of social media (PUSM), problematic smartphone use (PSPU), and problematic gaming (PG)] and self-stigma among people with SUDs. This longitudinal study involved five waves of a survey given to individuals with SUDs in Taiwan. A total of 319 participants (85% male), with a mean age of 42.2 years (SD = 8.9), were recruited. The Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, Internet Gaming Disorder-Short Form, and Self-Stigma Scale-Short Form were used. No significant associations between PUI and self-stigma were found in early waves (i.e., Waves 1 and 2). The earliest significant finding was identified between Wave 2 PSPU (smartphone) and Wave 3 self-stigma. Additionally, Wave 3 PSPU (smartphone) and PG (gaming) were associated with Wave 4 self-stigma, and Wave 4 PSPU (smartphone), PG (gaming), and PUSM (social media) were associated with Wave 5 self-stigma. Therefore, all three types of PUI (internet) may elevate self-stigma at different time points for individuals with SUDs. However, the reciprocal effects between self-stigma and PUI (internet) only occurred in PUSM (social media) at a later stage (i.e., from Wave 4 to Wave 5). In conclusion, people with SUDs who have PUI (internet) are at increased likelihood of developing more self-stigma, which may then increase subsequent PUSM (social media), forming a vicious cycle.

Effects of sleep quality on the association between problematic internet use and quality of life in people with substance use disorder.

BACKGROUND: Problematic internet use, especially in people with substance use disorder, may negatively affect their quality of life (QoL). However, it is unclear whether sleep quality is a key mediator in the association between problematic internet use and QoL among people with substance use disorder. AIMS: This study aimed to investigate the relationship between problematic internet use and QoL and how sleep quality may mediate the association between these two variables. METHOD: Overall, 319 people (85% male) with substance use disorder (mean age 42.2 years, s.d. 8.9) participated in a cross-sectional study in Taiwan. The Smartphone Application-Based Addiction Scale, Bergan Social Media Addiction Scale, Internet Gaming Disorder-Short Form, Pittsburgh Sleep Quality Index and World Health Organization Quality of Life Questionnaire Brief Version were used. RESULTS: The prevalence of sleep problems was 56%. There were significant and direct associations between sleep quality and two types of problematic internet use, and between sleep quality and different dimensions of QoL. All types of problematic internet use were significantly and negatively correlated with QoL. Mediated effects of sleep quality in relationships between the different types of problematic internet use and all dimensions of QoL were significant, except for problematic use of social media. CONCLUSIONS: Different types of problematic internet use in people with substance use disorder may be directly associated with reduced QoL. Sleep quality as a significant mediator in this association may be an underlying mechanism to explain pathways between problematic internet use and QoL in this population.

Rasch Modeling and Differential Item Functioning of the Self-Stigma Scale-Short Version among People with Three Different Psychiatric Disorders.

Self-stigma is prevalent in individuals with psychiatric disorders and can profoundly affect people. A unified assessment with sound psychometric properties is needed for evaluating self-stigma across psychiatric conditions. The aim of this study was to examine the psychometric properties of the Self-Stigma Scale-Short version (SSS-S) using Rasch modeling. Six-hundred and twelve participants with substance use disorders (n = 319), attention-deficit/hyperactivity disorder (n = 100), and schizophrenia (n = 193) completed the SSS-S. Rasch results confirmed the unidimensionality of the nine items of the SSS-S. The four-point Likert scale of the SSS-S reflected monotonical increases along the self-stigma continuum. No ceiling or floor effects were detected. Among the three subdomains of the SSS-S, cognitive items appeared to be the most robustly endorsed, and behavioral items were the least endorsed. Two items in the SSS-S displayed differential item functioning across the three diagnoses. Additionally, SSS-S scores showed weak to moderate correlation with depression, anxiety, and stress scale scores. The SSS-S had overall satisfactory psychometric properties. Healthcare professionals may use this assessment to assess self-stigma in multiple psychiatric groups, and information gained may facilitate improved care.

Association Between Young-Onset Dementia and Risk of Hospitalization for Motor Vehicle Crash Injury in Taiwan.

Importance: Several studies have suggested that older-onset dementia is associated with an increased risk of motor vehicle crash injury (MVCI). However, evidence of an association between young-onset dementia and the risk of MVCI is insufficient, particularly in Asia. Objective: To investigate the association between young-onset dementia and MVCI-related hospitalization in Taiwan. Design, Setting, and Participants: In this nationwide, population-based cohort study in Taiwan, a cohort of 39 344 patients aged 40 to 64 years with incident dementia diagnosed between 2006 and 2012 was matched 1:1 with a cohort of participants without dementia by age, sex, and index year (initial diagnosis of dementia). Participants were identified from Taiwan's National Health Insurance Research Database (NHIRD). Data were analyzed between March 25 and October 22, 2021. Exposures: Dementia, defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Main Outcomes and Measures: Hospitalization for MVCI, determined using linked data from Taiwan's Police-Reported Traffic Accident Registry and the NHIRD from January 1, 2003, to December 31, 2015. Hazard ratios (HRs) for MVCI-related hospitalization were estimated using Cox proportional hazards regression models adjusted for sex, age, salary-based insurance premium, urbanization level, and comorbidities. Results: Of the 78 688 participants, 47 034 (59.8%) were male; the mean (SD) age was 54.5 (7.4) years. During the 10-year follow-up period, the incidence density of MVCI-related hospitalization was 45.58 per 10 000 person-years (95% CI, 42.77-48.39 per 10 000 person-years) among participants with dementia and 24.10 per 10 000 person-years (95% CI, 22.22-25.99 per 10 000 person-years) among participants without dementia. Compared with participants without dementia, patients with young-onset dementia were at higher risk of MVCI-related hospitalization (adjusted HR [aHR], 1.83; 95% CI, 1.63-2.06), especially those in younger age groups (aged 40-44 years: aHR, 3.54; 95% CI, 2.48-5.07) and within a shorter period (within 1 year of follow-up: aHR, 3.53; 95% CI, 2.50-4.98) after dementia was diagnosed. Patients with young-onset dementia also had a higher risk of being a pedestrian when the crash occurred (aHR, 2.89; 95% CI, 2.04-4.11), having an intracranial or internal injury (aHR, 2.44; 95% CI, 2.02-2.94), and having a severe injury (aHR, 2.90; 95% CI, 2.16-3.89). Conclusions and Relevance: In this retrospective cohort study, patients in Taiwan with a diagnosis of young-onset dementia had a higher risk of MVCI-related hospitalization than did individuals without dementia and the risk varied by age, disease duration, transport mode, injury type, and injury severity. These findings suggest a need for the planning of strategies to prevent transportation crashes among patients with young-onset dementia.

Paternal and maternal psychiatric disorders associated with offspring autism spectrum disorders: A case-control study.

A family history of psychiatric diseases was suggested as one risk factor for autism spectrum disorders (ASD). Our aim was to assess the association of paternal and maternal diagnosis of psychiatric disorders with the risk of ASD in offspring in Taiwan. We conducted a population-based case-control study. Using several linked national databases, we obtained 1,000,939 singleton birth records born between 2004 and 2008. We followed these children up to 2015 for cases of ASD, using diagnostic codes in the National Health Insurance databases. There were 8,933 ASD cases and each case was matched to ten controls by sex and year of birth. We extracted their parental diagnosis of psychiatric disorders and performed conditional logistic regression models to assess the association of interest. Our sample included 8,933 cases and 89,330 controls. Eighty-six percent of the sample were boys. After adjustment for parental age, family income, and urbanization, we found that parental psychiatric diseases were significantly associated with ASD, including schizophrenic and psychotic disorders, mood, anxiety and personality disorders, with adjusted odds ratios ranging from 1.32 to 2.39. Notably, the effect estimates were all larger for maternal diagnosis than paternal diagnosis when stratified by mothers or fathers. Cases of ASD are more likely to be born to parents with psychiatric disorders than their counterparts. Maternal psychiatric diagnosis seems to have a larger influence than paternal diagnosis. Both genetics and maternal environmental factors may contribute to the association observed between parental psychiatric diseases and child ASD.

A longitudinal study of the effects of problematic smartphone use on social functioning among people with schizophrenia: Mediating roles for sleep quality and self-stigma.

Background and aims: Individuals with schizophrenia may often experience poor sleep, self-stigma, impaired social functions, and problematic smartphone use. However, the temporal relationships between these factors have not been investigated. The present study used a longitudinal design to examine potential mediating roles of poor sleep and self-stigma in associations between problematic smartphone use and impaired social functions among individuals with schizophrenia. Methods: From April 2019 to August 2021, 193 individuals with schizophrenia (mean [SD] age = 41.34 [9.01] years; 88 [45.6%] males) were recruited and asked to complete three psychometric scales: the Smartphone Application-Based Addiction Scale to assess problematic smartphone use; the Pittsburgh Sleep Quality Index to assess sleep quality; and the Self-Stigma Scale-Short Scale to assess self-stigma. Social functioning was evaluated by a psychiatrist using the Personal and Social Performance Scale. All measures were assessed five times (one baseline and four follow-ups) at three-month intervals between assessments. Results: General estimating equations found that problematic smartphone use (coefficient = -0.096, SE = 0.021; P < 0.001), sleep quality (coefficient = -0.134, SE = 0.038; P < 0.001), and self-stigma (coefficient = -0.612, SE = 0.192; P = 0.001) were significant statistical predictors for social functioning. Moreover, sleep quality and self-stigma mediated associations between problematic smartphone use and social functioning. Conclusion: Problematic smartphone use appears to impact social functioning longitudinally among individuals with schizophrenia via poor sleep and self-stigma concerns. Interventions aimed at reducing problematic smartphone use, improving sleep, and addressing self-stigma may help improve social functioning among individuals with schizophrenia.

Psychometric Testing of Three COVID-19-Related Scales Among People with Mental Illness.

Fear of novel coronavirus 2019 (COVID-19) may result in psychological health problems among different populations. Moreover, believing COVID-19 information and preventive COVID-19 infection behaviors are relevant constructs associated with fear of COVID-19. Therefore, the present study validated three instruments assessing fear, beliefs, and preventive behaviors related to COVID-19 among individuals with mental illness. Moreover, relationships between the three constructs were examined. Individuals with mental illness (N = 400; 178 females; mean age = 46.91 years) completed the Fear of COVID-19 Scale (FCV-19S), Believing COVID-19 Information Scale (BCIS), Preventive COVID-19 Infection Behaviors Scale (PCIBS), and Depression Anxiety Stress Scale-21 (DASS-21). The FCV-19S, BCIS, and PCIBS demonstrated a single-factor structure with satisfactory fit indices. Moreover, believing COVID-19 information positively and significantly associated with fear of COVID-19, and fear of COVID-19 negatively and significantly associated with preventive behaviors and positively and significantly associated with psychological distress. The FCV-19S, BCIS, and PCIBS may assist healthcare providers in assessing COVID-19-related information among individuals with mental illness. Consequently, relevant programs may be designed to help individuals with mental illness going through the period of crisis.

The mediating role of perceived social support in the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders.

WHAT IS KNOWN ON THE SUBJECT?: Individuals diagnosed with substance use disorders may perceive stigma and suffer from mental health problems. Perceived stigma is related to poor mental health among individuals diagnosed with substance use disorders. The social support deterioration deterrence model proposes that stressors (e.g. perceived stigma) negatively affect mental health via reduced perceived social support. To the best of the present authors' knowledge, the model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper used structural equation modelling to show that the social support deterioration deterrence model could explain the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders. Perceived support from family and perceived support from friends are mediators in the association between perceived stigma and depression among individuals diagnosed with substance use disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychosocial interventions to increase perceived support from family and friends would be helpful in addressing perceived stigma effects on mental health. ABSTRACT: Introduction Although the relationship between perceived stigma and mental health outcomes is documented in the existing literature, very few studies have investigated the mechanism linking perceived stigma and mental health outcomes among individuals diagnosed with substance use disorders. To the best of the present authors' knowledge, the social support deterioration deterrence model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. Aim/Question Guided by the social support deterioration deterrence model, the present study investigated the mediating role of perceived support from three types of social network members (i.e. significant others, family members, and friends) in the association between perceived stigma and depression in individuals diagnosed with substance use disorders. Method The study employed a cross-sectional survey design comprising 300 participants diagnosed with substance use disorders in Taiwan. Results Results of a structural equation modelling analysis indicated that perceived stigma was significantly associated with depression. The relationship between perceived stigma and depression was partially mediated by perceived family support and perceived friend support. Discussion Consistent with the prediction of the social support deterioration deterrence model, the negative effect of perceived stigma on depression for individuals diagnosed with substance use disorders is through the mediating effect of social support. Implications for practices Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders.

Fear of COVID-19 Scale (FCV-19S) across countries: Measurement invariance issues.

AIM: The threats of novel coronavirus disease 2019 (COVID-19) have caused fears worldwide. The Fear of COVID-19 Scale (FCV-19S) was recently developed to assess the fear of COVID-19. Although many studies found that the FCV-19S is psychometrically sound, it is unclear whether the FCV-19S is invariant across countries. The present study aimed to examine the measurement invariance of the FCV-19S across eleven countries. DESIGN: Cross-sectional study. METHODS: Using data collected from prior research on Bangladesh (N = 8,550), United Kingdom (N = 344), Brazil (N = 1,843), Taiwan (N = 539), Italy (N = 249), New Zealand (N = 317), Iran (N = 717), Cuba (N = 772), Pakistan (N = 937), Japan (N = 1,079) and France (N = 316), comprising a total 15,663 participants, the present study used the multigroup confirmatory factor analysis (CFA) and Rasch differential item functioning (DIF) to examine the measurement invariance of the FCV-19S across country, gender and age (children aged below 18 years, young to middle-aged adults aged between 18 and 60 years, and older people aged above 60 years). RESULTS: The unidimensional structure of the FCV-19S was confirmed. Multigroup CFA showed that FCV-19S was partially invariant across country and fully invariant across gender and age. DIF findings were consistent with the findings from multigroup CFA. Many DIF items were displayed for country, few DIF items were displayed for age, and no DIF items were displayed for gender. CONCLUSION: Based on the results of the present study, the FCV-19S is a good psychometric instrument to assess fear of COVID-19 during the pandemic period. Moreover, the use of FCV-19S is supported in at least ten countries with satisfactory psychometric properties.

Internet gaming as a coping method among schizophrenic patients facing psychological distress.

BACKGROUND AND AIMS: Patients with schizophrenia are known to use potentially addictive psychoactive substances as self-medication and to ease psychological distress. Other potentially addictive behaviors such as online gaming are also used to self-medicate and ease psychological distress. However, the role of online gaming and problematic gaming (in the form of internet gaming disorder [IGD]) has not previously been investigated for patients with schizophrenia facing distress. METHODS: One hundred and four participants diagnosed with schizophrenia were recruited and completed a number of psychometric scales including the Personal and Social Performance Scale (PSPS), Internet Gaming Disorder Scale-Short Form (IGDS-SF9), Self-Stigma Scale-Short (SSS-S), and Depression, Anxiety, Stress Scale (DASS-21). RESULTS: The results showed significant negative associations between PSPS, IGDS-SF9, and DASS-21, and significant positive correlations between the IGDS-SF-9, SSS-S and DASS-21. Moreover, IGD did not mediate the association between self-stigma and depression. However, IGD significantly mediated the association between self-stigma and anxiety, and the association between self-stigma and stress. In addition, (i) age and self-stigma were significant predictors for IGD; (ii) social function and self-stigma were significant predictors for depression; (iii) social function, self-stigma, and IGD were significant predictors for anxiety; and (iv) self-stigma and IGD were significant predictors for stress. CONCLUSION: The findings suggest that online gaming may be a coping strategy for individuals with schizophrenia with psychological stress and self-stigma and that for some of these individuals, their gaming may be problematic.