Reliability and Validity of the Japanese Version of the Barriers to Access to Care Evaluation Scale Version 3 for People With Mental Disorders: an Online Survey Study.

It is a serious problem when people with mental disorders avoid, delay, discontinue, or do not use treatment and support, despite the existence of evidence-based treatment and support methods. In this study, we aimed to clarify the factor structure of BACE v3, a scale to measure barriers to accessing mental health care, and to examine its reliability and validity among Japanese people with mental disorders. An online survey with 268 participants, 20 years old and over, who had received care from mental health services in the past 12 months was conducted. Exploratory and confirmatory factor analysis (EFA and CFA) were used to examine the structure of the BACE v3. Internal consistency and test-retest reliability of all subscales were examined. Convergent validity [correlation of one of the subscales of the BACE v3, the treatment stigma subscale with the Stigma Scale for Receiving Psychological Help (SSRPH) and with the Internalized Stigma of Mental Illness Scale (ISMI)] was assessed. EFA identified two factors (treatment stigma and non-stigma), and the results suggested that the factor structure of the Japanese version of BACE v3 was similar to the original 2-factor structure. Regarding the CFA result, the goodness-of-fit indices showed marginal fit (root mean square error of approximation = 0.087; Tucker-Lewis index = 0.842; standardized root mean square residual = 0.078; comparative fit index = 0.86). The internal consistency of the treatment stigma subscale was α = 0.90, and the intraclass correlation coefficient was 0.76 (confidence interval: 0.70-0.81). The internal consistency of the non-stigma subscale was α = 0.83, and the intraclass correlation coefficient was 0.64 (confidence interval: 0.56-0.71). The score of the treatment stigma subscale was significantly and positively correlated with the SSRPH and ISMI. Thus, the BACE v3 has acceptable consistency, reliability and validity for the assessment of barriers to accessing mental health care including treatment stigma among people with mental disorders in Japan.

Mentally disordered offenders discharged from designated hospital facilities under the medical treatment and supervision act in Japan: Reoffending and readmission.

BACKGROUND: Current Japanese forensic mental health legislation (Medical Treatment and Supervision Act [MTSA]) was enacted in 2003. Little is known, however, about the actual outcomes for the offender patients detained within hospitals under this provision. AIM: This study aimed to quantify reoffending and readmission following patients' discharge from forensic psychiatric hospital units across Japan and explore related risk factors. METHODS: We followed up 526 offenders with mental disorder who had been detained under the MTSA and who were subsequently discharged from any of the 28 hospitals nationwide between 2007 and 2015. RESULTS: The total cumulative reoffence rate was found to be 2.5% (1.1-3.9%) after 1 year and 7.5% (4.6-10.4%) after 3 years. The rate of serious reoffending was 0.4% (-0.18% to 0.99%) after 1 year and 2.0% (0.4-3.6%) after 3 years. The cumulative admission rate to local psychiatric hospitals following a discharge was 21.8% after 6 months and 37.6% after 1 year. Patients who had been discharged from their MTSA order but transferred to a general psychiatric hospital before open community residence-because it was necessary to build community supports-were more likely to reoffend than those discharged directly to the community. Patients who had been diagnosed with a substance use disorder (F10-F19) and had one subsequent admission were at higher risk of further readmissions. CONCLUSIONS: The low reoffending rates could be attributed to the intensive treatment and care plans required by the MTSA. The high rate of readmission to psychiatric hospitals may indicate shortcomings in community mental health services in Japan.

Neuropsychological Impairment and Its Association with Violence Risk in Japanese Forensic Psychiatric Patients: A Case-Control Study.

BACKGROUND: In Japan, the legislation directing treatment of offenders with psychiatric disorders was enacted in 2005. Neuropsychological impairment is highly related to functional outcomes in patients with psychiatric disorders, and several studies have suggested an association between neuropsychological impairment and violent behaviors. However, there have been no studies of neuropsychological impairment in forensic patients covered by the Japanese legislation. This study is designed to examine the neuropsychological characteristics of forensic patients in comparison to healthy controls and to assess the relationship between neuropsychological impairment and violence risk. METHODS: Seventy-one forensic patients with psychiatric disorders and 54 healthy controls (matched by age, gender, and education) were enrolled. The CogState Battery (CSB) consisting of eight cognitive domains, the Iowa Gambling Task (IGT) to test emotion-based decision making, and psychological measures of violence risk including psychopathy were used. RESULTS: Forensic patients exhibited poorer performances on all CSB subtests and the IGT than controls. For each group, partial correlational analyses indicated that poor IGT performance was related to psychopathy, especially antisocial behavior. In forensic patients, the CSB composite score was associated with risk factors for future violent behavior, including stress and noncompliance with remediation attempts. CONCLUSION: Forensic patients with psychiatric disorders exhibit a wide range of neuropsychological impairments, and these findings suggest that neuropsychological impairment may increase the risk of violent behavior. Therefore, the treatment of neuropsychological impairment in forensic patients with psychiatric disorders is necessary to improve functional outcomes as well as to prevent violence.

Neuroeconomics of psychopathy: risk taking in probability discounting of gain and loss predicts psychopathy.

BACKGROUND: This study investigated the relationships between psychopathy and impulsive and risky decision making, by utilizing intertemporal and probabilistic choices for both gain and loss, in addition to the Iowa gambling task. METHODS: The Psychopathic Personality Inventory-Revised - a 154-item measure that assesses psychopathic traits by self-report - was used with a 4-point response scale to assess 113 undergraduate students from three Japanese universities. Participants' performance on the Iowa Gambling Task and four behavioral neuroeconomic tasks of discounting - delayed gain, delayed loss, uncertain gain, and uncertain loss - were estimated. RESULTS: Risky decisions in probability discounting of gain and loss were associated with psychopathy. Psychopathic traits had no relationship with performance on the Iowa Gambling and were not significantly related to delay discounting. CONCLUSIONS: Psychopathy is predicted by risky decision in probability discounting of gain and loss, but not strongly associated with future myopia. Implications of the present findings for neuroeconomics and neurolaw are discussed.