COULD FAMILY WELL-BEING MODERATE THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD EXPERIENCES AND SOMATOFORM DISSOCIATION? A PRELIMINARY INVESTIGATION.

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

Substance abuse among mothers in Taiwan: Investigating its prevalence and testing the trauma model.

Substance abuse is a serious problem in our society. In particular, household or parental substance abuse could lead to adverse childhood experiences for the affected children. However, little is known about the prevalence of substance abuse among parents, especially in Asian societies. Moreover, although the trauma model of addiction has significant implications for the prevention and treatment of substance abuse, most evidence comes from Western samples. To address these knowledge gaps, we examined the prevalence of substance abuse in a sample of mothers in Taiwan and tested the trauma model of substance abuse. A total of 867 Taiwanese mothers completed standardized self-report assessments in 2023. The screening results indicated that the 12-month prevalence of drug abuse and alcohol abuse was 12.3% and 7.3%, respectively; 15.5% had either or both drug and alcohol abuse. Most types of trauma exposure were associated with drug abuse severity, while interpersonal stress and dissociative symptoms were associated with alcohol abuse severity, even after controlling for a variety of demographic and health variables as well as general psychopathology (i.e., depressive symptoms). The relatively high prevalence of substance abuse among Taiwanese mothers in our sample is concerning, particularly when compared to the rates reported in other Asian samples. We also provide preliminary cross-cultural evidence supporting the self-medication theory and the trauma model of substance abuse in the Asian context. We discuss the potential importance of addressing trauma and stress to prevent substance abuse and call for follow-up studies.

Borderline personality disorder features and their relationship with trauma and dissociation in a sample of community health service users.

BACKGROUND: Previous studies have indicated that borderline personality disorder (BPD) is closely associated with trauma and dissociation. Nevertheless, BPD is a heterogeneous condition, and not all people with BPD have severe dissociation. This study examined whether the relationship of BPD features with trauma and dissociation would remain significant after controlling for some general non-specific mental health distress. We also made the first attempt to explore which specific BPD features would be particularly associated with dissociation. METHODS: We analyzed survey data from a sample of community health service users in Hong Kong (N = 376). Hierarchical multiple regression and data-driven network analysis were used. RESULTS: The lifetime prevalence of DSM-5 BPD was 16.0% in our sample. Of participants who met criteria for BPD, 43.3% scored above cutoff on the dissociation measures, thus possibly having clinically significant dissociative symptoms. BPD features were associated with adulthood trauma and psychoform dissociation even after controlling for age, depression and self-esteem. Network analysis showed that some BPD features - including impulsivity, identity disturbance and suicidal/self-mutilation behaviors - were particularly associated with dissociation; other BPD features such as interpersonal-related problems had relatively weak to no connection with dissociation. CONCLUSIONS: Our results suggested that some particular BPD features might be dissociative in nature, although further longitudinal research is required. We argue that a trauma-informed perspective should be employed when working with clients presenting with BPD features despite these features being commonly stigmatized. Further research on the intervention needs of the people with BPD who suffer from high levels of dissociation is required.

What role does mindfulness play in regulating fear of COVID-19 and associated mental health? The results of a cross-sectional study.

Objectives: The pandemic has greatly impacted people's lives and mental health. Therefore, it is now especially important to help people maintain good mental health. The positive effects of mindfulness-based practices on mental health have been demonstrated previously. However, no consensus has yet been reached on the potential mechanisms of mindfulness. This study adopted the two-component model of mindfulness to explain the relationships between fear of COVID-19, and mental health. We proposed the following hypothetical model: (1) fear of COVID-19 could affect orientation to experience; (2) orientation to experience could affect mental health. Directly; (3) fear of COVID-19 could mental health directly; (4) orientation to experience could be a mediator between fear of COVID-19 and mental health. Methods: We conducted an online survey in the present study. Three hundred and forty-four respondents were recruited to participate in the present study. After informed consent, they completed the questionnaires on the websites. The participants were asked to complete a questionnaire including the Beck Depression Inventory-II, Beck Anxiety Inventory, the Taiwan version of the Five Facet Mindfulness Questionnaire, and the Fear of COVID-19 Scale. Descriptive analysis and structural equation modeling were used to analyze the data and examine the goodness-of-fit indices. Results: Our results not only showed orientation to experience playing as a mediator between fear of COVID-19 and mental health; but also confirmed the roles of nonjudgment and nonreactivity in regulating emotions. Conclusion: Experimentation and longitudinal study could be applied to examine the roles of nonjudgment and nonreactivity in the future.

Relationship between Bullying Victimization and Quality of Life in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) in Taiwan: Mediation of the Effects of Emotional Problems and ADHD and Oppositional Defiant Symptoms.

This cross-sectional study investigated the mediating effects of emotional problems including depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) symptoms on the association between bullying victimization and quality of life (QoL) among adolescents with ADHD in Taiwan. A total of 171 adolescents diagnosed as having ADHD participated in this study. Adolescents completed the School Bullying Experience Questionnaire, the Taiwanese Quality of Life Questionnaire for Adolescents, the Taiwanese version of the Children's Depression Inventory and the Multidimensional Anxiety Scale for Children. Caregivers completed the Chinese version of the Swanson, Nolan, and Pelham Version IV Scale. Structural equation modeling (SEM) was used to examine the relationships among the variables. The results of SEM revealed that bullying victimization indirectly correlated with QoL through the mediation of emotional problems in adolescents with ADHD, whereas ADHD and ODD symptoms did not mediate the association between bullying victimization and QoL. Bullying victimization should be actively prevented and intervened on to ensure better QoL in adolescents with ADHD. Moreover, emotional problems should be alleviated among adolescents with ADHD with bullying victimization experience to maintain their QoL.

Craving and implicit attitude toward heroin use and their relationships with the levels of heroin dependence and methadone adherence in heroin users.

Craving is a core feature of heroin use disorder. Craving for heroin is a conscious cognitive process. Recently, implicit (i.e., an implicit attitude toward heroin use) cognitive processes have been thought to be precursors of cravings. This study aimed to explore the associations of craving and implicit attitude toward heroin use with the level of heroin use disorder and adherence to methadone maintenance treatment (MMT). This study recruited 213 intravenous heroin users (196 males and 17 females) from MMT clinics of two hospitals. The mean age of participants was 42.3 years. They provided details of their severity of heroin use disorder and craving for heroin via questionnaires and also completed a computerized test to assess implicit attitude toward heroin use. The relationships between implicit attitude, craving, age, heroin use disorder, and MMT adherence were examined using path analysis. Craving was positively related to heroin use disorder (beta = 0.4). Implicit attitude directly and indirectly positively contributed to heroin use disorder (betas: 0.1 and 0.3). Craving was positively related to MMT adherence (beta: 0.2), whereas implicit attitude had an indirect effect on MMT adherence (beta: 0.03). Age was negatively associated with craving but was not associated with implicit attitude toward heroin. Methadone dosage was negatively associated with craving. Craving is significantly associated with the levels of heroin use disorder and MMT adherence. Meanwhile, craving mediates the relationship between implicit attitude and heroin use disorder, as well as MMT adherence. Implicit attitude also contributes to the level of heroin use disorder directly. For reducing craving, adequate dosage may be necessary.

Cross-Sectional Study on Relationships Among FoMO, Social Influence, Positive Outcome Expectancy, Refusal Self-Efficacy and SNS Usage.

OBJECTIVES: Use of social networking sites (SNS; i.e., Facebook or Instagram) is common, and people use SNS to communicate and share information. Literature indicates the extent of SNS usage could be influenced by fear of missing out (FoMO). FoMO means a process of appraisal and psychological need for SNS use. This study proposes a model that integrates three determinants of social cognitive theory (SCT) to explain the impact of FoMO on SNS usage. DESIGN: A cross-sectional study was conducted using data from 259 participants recruited from a website. MAIN OUTCOME MEASURES: The analysis focused on FoMO, social influence, positive outcome expectancy, refusal self-efficacy, and SNS-related behavior cloud-based sites. Data are examined using descriptive analysis and structural equation modeling. RESULTS: The proposed model reported proper goodness of fit. FoMO did not directly or indirectly impact SNS usage through the determinants of SCT. However, social influence and refusal self-efficacy had a direct effect. CONCLUSIONS: The roles of the three determinants of SCT vary by stage of SNS usage. FoMO and refusal self-efficacy are more strongly related with SNS addiction. Further research, particularly longitudinal and intervention studies, is needed to examine the effects of specific factors on SNS addiction.

Relationship between Self-Identity Confusion and Internet Addiction among College Students: The Mediating Effects of Psychological Inflexibility and Experiential Avoidance.

Internet addiction (IA) has become a major public health problem among college students. The aim of this study was to examine the relationship between self-identity confusion and IA and the mediating effects of psychological inflexibility and experiential avoidance (PI/EA) indicators in college students. A total of 500 college students (262 women and 238 men) were recruited. Their levels of self-identity were evaluated using the Self-Concept and Identity Measure. Their levels of PI/EA were examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The relationships among self- identity, PI/EA, and IA were examined using structural equation modeling. The severity of self-identity confusion was positively associated with both the severity of PI/EA and the severity of IA. In addition, the severity of PI/EA indicators was positively associated with the severity of IA. These results demonstrated that the severity of self-identity confusion was related to the severity of IA, either directly or indirectly. The indirect relationship was mediated by the severity of PI/EA. Self-identity confusion and PI/EA should be taken into consideration by the community of professionals working on IA. Early detection and intervention of self-identity confusion and PI/EA should be the objectives for programs aiming to lower the risk of IA.

A randomized controlled trial of mindfulness in patients with schizophrenia✰.

Cognitive Behavioral Therapy (CBT) is frequently used to attenuate the severity of positive schizophrenia symptoms; however, few studies have focused on attenuating negative symptoms. Recently, researchers have become interested in the effects of mindfulness-based intervention (MBI) on schizophrenia, but the lack of evidence-based results from random clinical trials (RCTs) has limited their effectiveness. Moreover, longitudinal data must be examined using appropriate study designs. We recruited 60 schizophrenia patients and randomly assigned them to an MBI or to a treatment-as-usual group. Negative symptoms, positive symptoms, mindfulness, and depression were assessed at baseline, post-course, and at a 3-month follow-up. Descriptive analysis and generalized estimating equations (GEEs) were used to examine the effects of MBI. We found that MBI mitigated the severity of negative symptoms and of general schizophrenic psychopathology except for the positive symptoms and for those of depression. Unexpectedly, we did not find long-term effect of mindfulness on negative symptoms. Larger sample sizes, long-term practical course, more rigorous study procedures, and a double-blind design should be considered in future studies.

The relationships between depression, neuroticism, and attitudes (NDA model) in heroin abusers in Taiwan.

BACKGROUND AND OBJECTIVES: Heroin use is a severe problem worldwide. To develop more effective treatments for heroin abusers, a comprehensive psychosocial model of heroin use should be established and examined. We created and assessed a neuroticism, depression, attitudes, and heroin addiction (NDA) model. METHODS: In this cross-sectional study, 234 patients undergoing methadone replacement treatment were recruited from psychiatric clinics. We used Structural Equation Modeling (SEM) to assess all for neuroticism, depression, and a positive outcome expectancy (POE) (attitudes). RESULTS: The full model had acceptable goodness-of-fit indices, but neuroticism was not significantly associated with a POE or heroin use. A reduced model that deleted insignificant paths had better goodness-of-fit indices, and neuroticism had indirect effects on heroin use via depression and a POE CONCLUSIONS: Our findings provide evidence that depression, neuroticism, and POE affect heroin use. We also found that POE mediates between depression and heroin use. Despite the emotional regulation strategies recommended to help heroin abusers with depression to reduce the likelihood of their heroin use, teaching them with negative attitudes using heroin should also be considered when developing treatments for heroin abusers with depression. SCIENTIFIC SIGNIFICANCE: Our findings provide a comprehensive mechanism of addiction that is integrated with emotion, cognition, and personality. Drug-related beliefs and emotional regulation can be targeted to reduce the likelihood of relapse in abusers with higher levels of neuroticism. (Am J Addict 2018;27:139-143).

Relationship between borderline personality symptoms and Internet addiction: The mediating effects of mental health problems.

Aim To examine the relationship between borderline personality symptoms and Internet addiction as well as the mediating role of mental health problems between them. Methods A total of 500 college students from Taiwan were recruited and assessed for symptoms of Internet addiction using the Chen Internet Addiction Scale, borderline personality symptoms using the Taiwanese version of the Borderline Symptom List and mental health problems using four subscales from the Symptom Checklist-90-Revised Scale (interpersonal sensitivity, depression, anxiety, and hostility). Structural equation modeling (SEM) was used to test our hypothesis that borderline personality symptoms are associated with the severity of Internet addiction directly and also through the mediation of mental health problems. Results SEM analysis revealed that all paths in the hypothesized model were significant, indicating that borderline personality symptoms were directly related to the severity of Internet addiction as well as indirectly related to the severity of Internet addiction by increasing the severity of mental health problems. Conclusion Borderline personality symptoms and mental health problems should be taken into consideration when designing intervention programs for Internet addiction.

Relationship between psychological inflexibility and experiential avoidance and internet addiction: Mediating effects of mental health problems.

Internet addiction became a major mental health problem in college student. Our objective was to examine the relationship between psychological inflexibility and experiential avoidance (PIEA) and Internet addiction (IA) and the mediating effects of mental health problem indicators. 500 college students (238 men and 262 women) participated in this study. The level of PIEA was examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The levels of depression, anxiety, interpersonal sensitivity, and hostility were evaluated using the Symptom Checklist-90 item-Revised Scale. The relationship among PIEA, mental health problems, and IA was examined using structural equation modeling. The severity of PIEA was positively associated with the severity of IA as well as positively associated with the severity of mental health problems. In addition, the severity of mental health problem indicators was positively associated with the severity of IA. These results provide the severity of PIEA is directly related to the severity of IA and indirectly related to the severity of IA through increasing the severity of mental health problems. The PIEA should be one of the target objectives when administer cognitive-behavioral therapy to college students with IA and mental health problems.

An integrated model of depression, compulsion, and mindfulness among heroin abusers in Taiwan.

BACKGROUND AND OBJECTIVES: Prevailing literature explains how depression, compulsion, and mindfulness affect heroin use; however, there is no comprehensive framework that explains their overall relationships. We therefore proposed and examined a hypothetical depression-compulsion-heroin use and mindfulness (DCHm) model. METHODS: We recruited 234 male heroin users. Self-reported levels of depression, mindfulness, compulsion to use, and severity of heroin use were measured. Structural equation modeling was used to examine the proposed DCHm model. RESULTS: Compulsion was a mediator between depression and heroin use. In addition, the DCHm model had satisfactory model fit indices. Depression indirectly affected heroin use through compulsion to use. The moderating effects of mindfulness in the two competing models were compared between the high- and low-mindfulness groups. The DCHm model in the high-mindfulness group had more favorable model fit indices than it did in the low-mindfulness group. CONCLUSIONS: Through learned emotional regulation strategies, addicted people with higher mindfulness were less likely to compulsively take drugs because of a depressive mood than were those with lower mindfulness. Furthermore, effective emotion-regulation strategies should be developed and examined in future studies. SCIENTIFIC SIGNIFICANCE: These results raise questions about the effect of compulsion on heroin use disorders. Mindfulness-based approaches to emotional regulatory strategies should be developed based on these findings. Further experimentation and prospective studies are needed to more fully examine the moderating role of mindfulness on depression and compulsion.

Heroin craving and its correlations with clinical outcome indicators in people with heroin dependence receiving methadone maintenance treatment.

BACKGROUND: Craving for substance use has been added as one of the diagnostic criteria of substance use disorders in DSM-5. However, further research is necessary to examine and expand the clinical potential of craving in the assessment and treatment for heroin users. This study aimed to examine the psychometrics of the Desire for Drug Questionnaire-Chinese Mandarin version (DDQ-CM) and its clinical utility of assessing craving for heroin measured among heroin users with methadone maintenance treatment (MMT). METHOD: Self-reported craving for heroin use was measured on the DDQ-CM and visual analog scale among 314 intravenous heroin users receiving MMT. Self-reported heroin dependence, attitude toward heroin use, readiness to change heroin use, and depression were collected. RESULTS: The results found that although the original three-factor model was acceptable for applying the DDQ-CM for heroin users with MMT, only the concurrent validity of the subscales of Desire and Intention and Negative Reinforcement was supported but not that of Control. Meanwhile, the levels of craving on the subscales of Desire and Intention and of Negative Reinforcement on the DDQ-CM were positively associated with the levels of heroin dependence, positive and negative attitudes toward heroin use, and depression, but negatively associated with readiness to change heroin use. CONCLUSIONS: This study supported the application of the subscales of Desire and Intention and Negative Reinforcement on the DDQ-CM to measure heroin craving in Taiwanese-Chinese heroin users and supported the clinical implication of craving in heroin users with MMT.

Individual and peer factors associated with ketamine use among adolescents in Taiwan.

The aim of this cross-sectional study was to examine the individual (demographic characteristics, substance-using behaviors, emotional status, and negative outcome expectancy) and peer factors associated with ketamine use in Taiwanese adolescents. A total of 9,860 adolescents completed the self-report questionnaires without omission. Demographic characteristics, substance-using behaviors, emotional status, negative outcome expectancy, and peer factors were compared between the ketamine users and non-users using the Mann-Whitney U test and the Chi-square test, and then significant factors were further selected for stepwise logistic regression analysis to examine the associated factors of ketamine use. Sixty-nine (0.7%) participants reported having used ketamine in the past year. The results of logistic regression analysis indicated that ketamine users were more likely to use marijuana, smoke cigarettes, have peers using illicit drugs, and have a lower level of negative outcome expectancy regarding using ketamine than ketamine non-users. The associated factors found in this study should be taken into consideration when developing prevention and intervention programs for ketamine use in adolescents.

An expanded self-medication hypothesis based on cognitive-behavioral determinants for heroin abusers in Taiwan: a cross-sectional study.

BACKGROUND: This study proposed and examined an expanded self-medication hypothesis (eSMH) model based on cognitive behavioral determinants, including the direct effects of negative emotional states, positive outcome expectancies and refusal self-efficacy on heroin use, and the mediating roles of positive outcome expectancies and refusal self-efficacy between negative emotional states and heroin use. METHODS: A total of 360 male heroin abusers were recruited from a drug abuse treatment center in Taiwan. Participants were asked to complete a set of questionnaires on frequency of heroin use, anxious/depressive mood, positive outcome expectancies, and refusal self-efficacy. Structural equation modeling was used to examine the eSMH model. RESULTS: Results showed that the eSMH model displayed proper goodness-of-fit. Positive outcome expectancies and negative emotional status were significant predictors of heroin use, whereas refusal self-efficacy was not a significant predictor. Additionally, positive self-efficacy was a mediator between negative emotional status and heroin use. CONCLUSION: Results support a reduced eSMH model and suggest a significant role of positive self-efficacy in the relationship between negative affective states and heroin use. This relationship should be examined in the longitudinal study, and should be given clinical consideration in treatment of individuals struggling with heroin abuse and negative affective states.

Higher incidence of major complications after splenic embolization for blunt splenic injuries in elderly patients.

BACKGROUND: Nonoperative management (NOM) of blunt splenic injuries has been widely accepted, and the application of splenic artery embolization (SAE) has become an effective adjunct to NOM. However, complications do occur after SAE. In this study, we assess the factors leading to the major complications associated with SAE. MATERIALS AND METHODS: Focusing on the major complications after SAE, we retrospectively studied patients who received SAE and were admitted to 2 major referral trauma centers under the same established algorithm for management of blunt splenic injuries. The demographics, angiographic findings, and factors for major complications after SAE were examined. Major complications were considered to be direct adverse effects arising from SAE that were potentially fatal or were capable of causing disability. RESULTS: There were a total of 261 patients with blunt splenic injuries in this study. Of the 261 patients, 53 underwent SAE, 11 (21%) of whom were noted to have 12 major complications: 8 cases of postprocedural bleeding, 2 cases of total infarction, 1 case of splenic abscess, and 1 case of splenic atrophy. Patients older than 65 years were more susceptible to major complications after SAE. CONCLUSION: Splenic artery embolization is considered an effective adjunct to NOM in patients with blunt splenic injuries. However, risks of major complications do exist, and being elderly is, in part, associated with a higher major complication incidence.

Complications associated with embolization in the treatment of blunt splenic injury.

BACKGROUND: Nonoperative management (NOM) of blunt splenic injuries is widely accepted, and the use of splenic artery embolization (SAE) has become a valuable adjunct to NOM. We retrospectively review and discuss the complications derived from SAE. MATERIALS AND METHODS: The medical records of 152 consecutive patients with blunt splenic trauma admitted to our trauma center during a 33-month period were retrospectively reviewed. The patients were managed according to an established algorithm. The record review focused on the method of patient management (operative versus nonoperative) and use of SAE. The complications encountered following SAE are discussed in detail. RESULTS: Altogether, 73 patients underwent emergency surgery (58 splenectomies, 15 splenorrhaphies), and 79 patients had NOM. Of the 79 patients with NOM, 58 were successfully treated; 2 patients required splenectomy after 24 hours. The remaining 21 patients had SAE, including 18 distal and 3 proximal embolizations. Major complications occurred in 28.5% of the SAE-treated patients and included total splenic infarction, splenic atrophy, and postprocedure bleeding. Minor complications occurred in 61.9% of the patients and included fever, pleural effusion, and partial splenic infarction. CONCLUSION: SAE is considered a valuable adjunct to NOM in the treatment of blunt splenic injuries; however, risks of major and minor complications do exist, and SAE should be offered with caution and followed up appropriately.

Early selective angioembolization improves success of nonoperative management of blunt splenic injury.

The role of angioembolization in the management of patients with blunt spleen injury is still under debate. Our study examined the impact of splenic artery embolization (SAE) on the outcome of such patients. We reviewed 114 consecutive blunt abdominal trauma patients with isolated splenic injury over a period of 40 months, including 61 patients seen before (Group A) and 53 patients seen after (Group B) the adoption of SAE. Hemodynamically unstable patients underwent the abdominal exploration and stable patients were evaluated with CT scans of abdomen and pelvis. Patients underwent SAE based on the findings of CT scans, including contrast extravasation or large hemoperitoneum. For initially stable patients, there were no differences in nonoperative management success rate between Groups A and B in regards to injury severity score > or =16, age, or grades of splenic injury > or =3. In comparison, among patients with large hemoperitoneum found by abdominal CT, Group B had significantly better nonoperative management success rates (P < 0.05). SAE was successful to control bleeding in 80 per cent of patients. Partial splenic infarction was noted in all patients after the procedure but it resolved by six months. By using criteria developed based on abdominal CT scans for angioembolization, we are able to improve nonoperative splenic salvage rate.