Applying Rasch model analysis in the development of the cantonese tone identification test (CANTIT).

OBJECTIVE: Applying Rasch analysis to evaluate the internal structure of a lexical tone perception test known as the Cantonese Tone Identification Test (CANTIT). DESIGN: A 75-item pool (CANTIT-75) with pictures and sound tracks was developed. Respondents were required to make a four-alternative forced choice on each item. A short version of 30 items (CANTIT-30) was developed based on fit statistics, difficulty estimates, and content evaluation. Internal structure was evaluated by fit statistics and Rasch Factor Analysis (RFA). STUDY SAMPLE: 200 children with normal hearing and 141 children with hearing impairment were recruited. RESULTS: For CANTIT-75, all infit and 97% of outfit values were < 2.0. RFA revealed 40.1% of total variance was explained by the Rasch measure. The first residual component explained 2.5% of total variance in an eigenvalue of 3.1. For CANTIT-30, all infit and outfit values were < 2.0. The Rasch measure explained 38.8% of total variance, the first residual component explained 3.9% of total variance in an eigenvalue of 1.9. CONCLUSIONS: The Rasch model provides excellent guidance for the development of short forms. Both CANTIT-75 and CANTIT-30 possess satisfactory internal structure as a construct validity evidence in measuring the lexical tone identification ability of the Cantonese speakers.

12-Month naturalistic outcomes of depressive disorders in Hong Kong's primary care.

BACKGROUND: In Asia, the role of primary care physicians (PCPs) in mental health delivery is not clearly defined and what happens to patients following a depressive episode remains poorly understood. OBJECTIVE: To examine the 12-month naturalistic outcomes of depression in primary care and the impact of PCP identification. METHODS: A cohort study was conducted. A total of 10179 adults were consecutively recruited from the waiting rooms of 59 PCPs across Hong Kong to complete a survey which screened for depression. Blinded doctors provided data on their diagnosis and management; 539 screened-positive and 3819 screened-negative subjects consented to telephone follow-up at 3, 6 and 12 months. Study instruments included Patient Health Questionnaire-9, Centre for Epidemiologic Studies Depression Scale 20 and Short-Form Health Survey Version 2.0 (SF-12v2) and self-reported mental health and primary care service use. RESULTS: 12-month remission rate was 60.31%. PCP detection had no association with remission. Identified patients had poorer health-related quality of life (HRQOL) at baseline but a faster rate of recovery in SF-12v2 mental component scores. PCP detection was associated with greater mental health service use at 12, 26 and 52 weeks, while GP consultation rates were only increased at 12 weeks. CONCLUSIONS: Over 1 year, ~60% of depressed patients experience symptom resolution, while 40% continue to suffer a chronic or remitting course of illness. Identification of depression by a PCP does not appear to affect remission of mood symptoms at 12 months, but is associated with a faster rate of recovery of HRQOL. PCP detection raises GP consultation rates temporarily however appears to enable more patients to access mental health services over 12 months.

Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network.

BACKGROUND: This study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong. METHODS: A cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management. RESULTS: 10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice.In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor. CONCLUSION: About one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.

The epidemiology and natural history of depressive disorders in Hong Kong's primary care.

BACKGROUND: Depressive disorders are commonly managed in primary care and family physicians are ideally placed to serve as central providers to these patients. Around the world, the prevalence of depressive disorders in patients presenting to primary care is between 10-20%, of which around 50% remain undiagnosed. In Hong Kong, many barriers exist preventing the optimal treatment and management of patients with depressive disorders. The pathways of care, the long term outcomes and the factors affecting prognosis of these patients requires closer examination. METHODS/DESIGN: The aim of this study is to examine the prevalence, incidence and natural history of depressive disorders in primary care and the factors influencing diagnosis, management and outcomes using a cross-sectional study followed by a longitudinal cohort study.Doctors working in primary care settings across Hong Kong have been invited to participate in this study. On one day each month over twelve months, patients in the doctor's waiting room are invited to complete a questionnaire containing items on socio-demography, co-morbidity, family history, previous doctor-diagnosed mental illness, recent mental and other health care utilization, symptoms of depression and health-related quality of life. Following the consultation, the doctors provide information regarding presenting problem, whether they think the patient has depression, and if so, whether the diagnosis is new or old, and the duration of the depressive illness if not a new diagnosis. If the doctor detects a depressive disorder, they are asked to provide information regarding patient management. Patients who consent are followed up by telephone at 2, 12, 26 and 52 weeks. DISCUSSION: The study will provide information regarding cross-sectional prevalence, 12 month incidence, remission rate, outcomes and factors affecting outcomes of patients with depressive disorders in primary care. The epidemiology, outcomes, pathways of care, predictors for prognosis and service needs for primary care patients with depressive disorders will be described and recommendations made for policy and service planning.

The Psychometric Properties of the Center for Epidemiologic Studies Depression Scale in Chinese Primary Care Patients: Factor Structure, Construct Validity, Reliability, Sensitivity and Responsiveness.

BACKGROUND: The Center for Epidemiologic Studies Depression Scale (CES-D) is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness. METHODS AND RESULTS: The psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9) and the Short Form-12 Health Survey (version 2) Mental Component Summary (SF-12 v2 MCS). The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78) and SF-12 v2 MCS (coefficient: -0.75). Internal consistency was assessed by McDonald's omega hierarchical (ωH). The ωH value for the general depression factor was 0.855. The ωH values for "somatic", "depressed affect", "positive affect" and "interpersonal problems" were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value <0.01 and all effect size statistics >0.2). The CES-D was externally responsive, with the AUC>0.7. CONCLUSIONS: The CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original four-factor and bi-factor structure, the CES-D is supported for cross-cultural comparisons of depression in multi-center studies.

Lexical tone perception in native speakers of Cantonese.

PURPOSE: This study aimed at investigating (1) tone perception development among typically-developing Cantonese speakers and (2) the hierarchy of tone perception difficulty among the 15 tone contrasts. METHOD: Two-hundred typically-developing children aged 3-10 and a group of 25 normal hearing adults were recruited. They were tested on a pool of 75-item calibrated recorded speech signals. Participants responded to each stimulus by pointing at the corresponding picture displayed on a computer screen from a choice of four. RESULT: There was a gradual increase in tone perception accuracy from children aged 3-6. After age 6, tone perception accuracy was similar to adults with an average error rate of 3-8%. The two tone contrasts that listeners consistently found difficult to distinguish were T2T5 (high-rising vs low-rising) and T3T6 (mid-level vs low-level). In addition, all children groups also showed difficulty in T4T6 identification (low-falling vs low-level). CONCLUSION: Tone perception is not error-free even among native Cantonese-speaking adults. Overall tone identification performance improved steadily from age 3 to age 6. Based on the participants' performance, a three-tier set of tone groups, with an increasing level of difficulty for identification, is proposed for rehabilitation purposes. These tone groups are (1) Easy: T1T2, T1T3, T1T4, T1T5, T1T6, and T2T3, (2) Medium: T2T4, T2T6, T3T4, and T4T5, and (3) Hard: T2T5, T3T5, T3T6, T4T6, and T5T6.

Help-seeking intentions and subsequent 12-month mental health service use in Chinese primary care patients with depressive symptoms.

OBJECTIVE: To identify the factors associated with 12-month mental health service use in primary care patients with depressive symptoms. DESIGN: Cross-sectional followed by 12-month cohort study. SETTING AND PARTICIPANTS: 10 179 adult patients were recruited from the waiting rooms of 59 primary care clinics across Hong Kong to complete a questionnaire which screened for depression. 518 screened-positive participants formed the cohort and were telephoned at 3, 6 and 12 months to monitor mental health service use. PRIMARY AND SECONDARY OUTCOMES: ▸ Help-seeking preferences; ▸ Intention to seek help from a healthcare professional; ▸ 12-month mental health service use. RESULTS: At baseline, when asked who they would seek help from if they thought they were depressed, respondents preferred using friends and family (46.5%) over a psychiatrist (24.9%), psychologist (22.8%) or general practitioner (GP; 19.9%). The presence of depressive symptoms was associated with a lower intention to seek help from family and friends but had no effect on intention to seek help from a healthcare professional. Over 12 months, 24.3% of the screened-positive cohort reported receiving services from a mental health professional. Factors associated with service use included identification of depression by the GP at baseline, having a past history of depression or other mental illness, and being a public sector patient. Having a positive intention to seek professional help or more severe depressive symptoms at baseline was not associated with a greater likelihood of receiving treatment. CONCLUSIONS: Mental health service use appears to be very low in this setting with only one in four primary care patients with depressive symptoms receiving treatment from a psychiatrist, GP or psychologist over a year. To help reduce the burden of illness, better detection of depressive disorders is needed especially for patients who may be undertreated such as those with no prior diagnosis of depression and those with more severe symptoms.