Changes in younger stroke survivors' body perception as indicated in body drawings: A comparison between Expressive Arts-based Intervention and control groups.

Stroke-related deficits affect stroke survivors' perception of their bodies and possibly impede their progress in rehabilitation and well-being. This study adopted a pre-and post-test design to compare the changes in body perception among younger stroke survivors after participating in an 8-week Expressive Arts-based Intervention (EABI) (n = 32) with the control group (n = 30). Each participant partook in structured drawing interviews at baseline (T0) and 8-week follow-up/post-intervention (T1). The data were analyzed using content analysis. More EABI (n = 27) than control (n = 14) participants reported positive changes in body perception and applied lighter colours or created a more symmetrical drawing at T1. They shared that EABI promoted these positive changes by facilitating the reconnection with one's body and self. While some control participants experienced positive changes in body perception, others tended to apply darker colours or the same colour to show negative or no changes in body perception. More control (n = 8) than EABI (n = 3) participants reported negative thoughts about their bodies and negative influences from other individuals and the environment. The findings suggested that EABI can change stroke survivors' body perception. EABI can be considered one of the interventions that may help foster positive changes in body perception.

Associations between COVID-19 mental impact and distress, resilience, burnout and well-being in Hong Kong community adults: A structural equation model.

The COVID-19 pandemic poses substantial risks to individuals' physical and mental health and prolonged psychological responses to the pandemic could lead to emotional exhaustion. The present study aimed to examine the mediating role of COVID-19 related mental impact and distress in the relationship among resilience, burnout, and well-being. The present study recruited 500 community adults (mean age = 38.8 years, SD = 13.9; 76% females) in Hong Kong via an online survey in autumn 2021. The participants completed the Mental Impact and Distress Scale: COVID-19 (MIDc) and validated measures on resilience, burnout, and well-being. Confirmatory factor analysis was conducted to evaluate the psychometric properties of the MIDc. Direct and indirect effects of resilience on burnout and well-being via MIDc were examined via structural equation modeling. Confirmatory factor analysis supported factorial validity for the three factors of MIDc (situational impact, anticipation, and modulation). Resilience showed negative effects on the MIDc (ß = -0.69, SE = 0.04, p < 0.01) and burnout (ß = 0.23, SE = 0.06, p < 0.01). Burnout was positively associated with MIDc (ß = 0.63, SE = 0.06, p < 0.01) and negatively associated with well-being (ß = -0.47, SE = 0.07, p < 0.01). Resilience showed a significant and positive indirect effect (αßγ = 0.203, 95% CI = 0.131 to 0.285) on well-being via MIDc and burnout. The results support a potential mediating role for MIDc as psychological responses in the relationship among resilience and burnout and well-being.

Comparison of passive drool and cotton-based collection methods for salivary C-reactive protein measurement.

Saliva collection and handling procedures for salivary C-reactive protein (CRP) can be challenging due to a lack of standardized protocols. This study compared two collection methods used to quantify salivary CRP. Twenty-two Chinese adults provided two unstimulated whole saliva samples using passive drool and cotton-based collection devices in two consecutive mornings at baseline and 1 month later. The effects of various factors on CRP levels were analyzed using linear mixed models. Salivary CRP levels were significantly affected by collection time and method, but not day or wave. The CRP peaked upon awakening and declined 45 min later. CRP levels were significantly higher in the passive drool than in the cotton-based method. The Bland-Altman plot revealed relative and proportional biases. The difference in the CRP levels between the methods decreased as the CRP levels increased. Results suggest that passive drool and cotton-based collection methods should not be used interchangeably for measuring low levels of salivary CRP.

Psychometric properties of the Chinese version of Five Facet Mindfulness Questionnaire-short form in cancer patients: a Bayesian structural equation modeling approach.

BACKGROUND: Mindfulness has emerged as an important correlate of well-being in various clinical populations. The present study evaluated the psychometric properties of the 20-item short form of the Five Facet Mindfulness Questionnaire (FFMQ-SF) in the Chinese context. METHODS: The study sample was 127 Chinese colorectal cancer patients who completed the FFMQ-SF and validated physical and mental health measures. Factorial validity of the FFMQ-SF was assessed using Bayesian structural equation modeling (BSEM) via informative priors on cross-loadings and residual covariances. Linear regression analysis examined its convergent validity with the health measures on imputed datasets. RESULTS: The five-factor BSEM model with approximate zero cross-loadings and one residual covariance provided an adequate model fit (PPP = 0.07, RMSEA = 0.06, CFI = 0.95). Satisfactory reliability (ω = 0.77-0.85) was found in four of the five facets (except nonjudging). Acting with awareness predicted lower levels of perceived stress, negative affect, anxiety, depression, and illness symptoms (ß = - 0.37 to - 0.42) and better quality of life (ß = 0.29-0.32). Observing, nonjudging, and nonreacting did not show any significant associations (p > .05) with health measures. Acting with awareness was not significantly correlated (r < 0.15) with the other four facets. CONCLUSION: The present findings provide partial support for the psychometric properties of the FFMQ-SF in colorectal cancer patients. The nonjudging facet showed questionable validity and reliability in the present sample. Further studies with larger sample sizes are needed to elucidate the viability of FFMQ-SF as a measure of mindfulness facets in cancer patients.

Longitudinal measurement invariance in urbanization index of Chinese communities across 2000 and 2015: a Bayesian approximate measurement invariance approach.

BACKGROUND: The Urbanicity Scale was developed based on the China Health and Nutrition Survey (CHNS) to measure the urbanization index of communities according to 12 components. The present study was designed to systematically investigate the factorial validity, reliability, and longitudinal measurement invariance (LMI) of the Urbanicity Scale. METHODS: Six waves of CHNS data from 2000 to 2015 were adopted. The factor structure and reliability of the Urbanicity Scale for 301 communities were examined using Bayesian exploratory factor analysis. Metric and scalar LMIs were evaluated using both the conventional exact and a novel approximate LMI approach via Bayesian structural equation modeling across various timeframes. RESULTS: The findings verified the one-factor structure for the Urbanicity Scale, with adequate reliability. LMI was established for the Urbanicity Scale only over a shorter timeframe from 2006 to 2009 but not over a longer timeframe from 2000 to 2015. Partial LMI was found in the factor loadings and item intercepts for the Urbanicity Scale over the 2004 to 2011 period. CONCLUSION: Interpretation of the temporal change in urbanicity was supported only for a shorter (2006 to 2009) but not a longer timeframe (2000 to 2015). Adjustments addressing the partial non-invariance of the measurement parameters are needed for the analysis of temporal changes in urbanicity between 2004 and 2011.

Mindfulness facets predict quality of life and sleep disturbance via physical and emotional distresses in Chinese cancer patients: A moderated mediation analysis.

OBJECTIVE: Colorectal cancer survivors are at risk of symptom burden and emotional distress. Dispositional mindfulness has been linked with better sleep quality and quality of life (QoL) in these patients. This longitudinal study aimed to examine the associations among mindfulness facets, symptom burden, emotional distress, and functional outcomes. METHODS: Study sample of this three-wave, 2-month survey was 127 Chinese colorectal cancer survivors. The participants completed the Five Facet Mindfulness Questionnaire, Memorial Symptom Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and SF-12 health survey. Moderated mediation analyses examined the direct and indirect effects of mindfulness facets on QoLs and sleep quality via symptom burden and emotional distress, using acting with awareness as a moderator. RESULTS: The mindfulness facets had no significant direct effects on functional outcomes 2 months later. Awareness and nonreacting showed significant and positive indirect effects on physical and mental QoL via symptom burden and emotional distress 1 month later, respectively. Awareness, nonjudging, and nonreacting significantly predicted better sleep quality indirectly via emotional distress. Nonreacting showed stronger indirect effects on the functional outcomes among patients with greater awareness. CONCLUSIONS: This study demonstrates longitudinal linkages between dispositional mindfulness and functioning in cancer survivors via symptom burden and emotional distress. Acting with awareness and nonreacting are the two facets that displayed clinical relevance in predicting better sleep quality and QoL.

Comparing dyadic cognitive behavioral therapy (CBT) with dyadic integrative body-mind-spirit intervention (I-BMS) for Chinese family caregivers of lung cancer patients: a randomized controlled trial.

PURPOSE: The study adopted a randomized controlled trial to compare the effect of culturally compatible psychosocial interventions on multiple aspects of quality of life (QoL) for family caregivers of lung cancer patients. METHODS: 157 Chinese informal caregivers of lung cancer patients were recruited together with the family members for whom they were providing care, and randomly assigned to either integrative body-mind-spirit intervention (I-BMS) or cognitive behavioral therapy (CBT). Patient-caregiver dyads attended the same arm of intervention in separate groups for 8 weeks. Assessments of generic QoL, anxiety, depression, perceived stress, insomnia, and caregiving burden were measured before intervention (T0), within 1-week (T1), 8-week (T2), and 16-week (T3) post-intervention. RESULTS: Adopting the intention-to-treat analysis, family caregivers in receipt of both I-BMS and CBT exhibited a statistically significant improvement in generic QoL immediately following intervention and at follow-up assessments, with moderate effect size. Improvement of insomnia was found at T1 for both modes, which deteriorated at follow-up; both modes reduced anxiety and perceived stress at follow-up. No intervention effect was observed in depression and domains of caregiving burden. There was no significant interaction effect between intervention type and time. No main or interaction effect between sample background variables and intervention type was found to predict symptomatic changes at T1 and T3. CONCLUSIONS: Culturally attuned I-BMS and CBT exhibited equivalent effectiveness in improving psychological distress and generic QoL for family caregivers of lung cancer patients. To improve the evaluation of outcomes, future study could benefit from incorporating a usual care control.

Psychometric validation of Fuld Object Memory Evaluation in older adults with cognitive impairments.

OBJECTIVES: Mild cognitive impairment (MCI) refers to an early but abnormal state of cognitive impairment with minimal functional impairment. The present study aimed to evaluate the validity of Fuld Object Memory Evaluation (FOME) as a measure of episodic memory function. METHOD: The study sample included 204 Chinese older adults with cognitive impairments. The participants completed five recall trials and a delayed trial in FOME, neurocognitive measures on digit spans and trail making, and daily functioning. Discriminative power of FOME to differentiate between MCI and dementia was inspected via receiver operating characteristic curve analysis. RESULTS: FOME showed good test-retest reliability and convergent validity with digit spans and trail making. Controlling for gender, age, and education, lower levels of FOME total retrieval, verbal fluency, and daily functioning significantly predicted a higher likelihood of dementia compared to MCI. The optimal cut-off scores for total retrieval, verbal fluency, and daily functioning to differentiate dementia were 37/38 (77% sensitivity and 83% specificity), 28/29 (85% sensitivity and 72% specificity), and 14/15 (92% sensitivity and 78% specificity), respectively, in the younger subgroup. The corresponding figures were 34/35 (69% sensitivity and 76% specificity) and 27/28 (92% sensitivity and 62% specificity), and 11/12 (74% sensitivity and 80% specificity), respectively, in the older subgroup. CONCLUSION: The findings support the FOME as a valid assessment tool of episodic memory function in older Chinese adults. The combined use of FOME and daily functioning is recommended to distinguish persons with dementia from MCI.

Dyadic associations between psychological distress and sleep disturbance among Chinese patients with cancer and their spouses.

BACKGROUND: Patients with cancer and their spouses usually both suffer, but the dyadic effects have not been thoroughly investigated. This study examined the dyadic effects of psychological distress on sleep disturbance in Chinese couples affected by cancer. METHODS: Patients with cancer and their spouses (N = 135) participated in this study. The Hospital Anxiety and Depression Scale and Pittsburgh Sleep Quality Index were used to measure anxiety, depression, and sleep disturbance. RESULTS: There were significant patient-spouse associations on anxiety (r = 0.48, P < .01), depression (r = 0.55, P < .01), and sleep disturbance (r = 0.30, P < .01). Analyses using the actor-partner interdependence model showed that anxiety had significant actor effects, rather than partner effects, on sleep disturbance in both patients and their spouses, but depression had both actor and partner effects. In addition to providing evidence for the concordance in distress and sleep disturbance in patients with cancer and their spouses, the findings indicate a mutual influence of depression on sleep disturbance among the couples. CONCLUSIONS: Clinicians and health care providers are suggested to integrate depression management as a component of sleep therapies and involve both patients and their spouses in treatment programs.

Study protocol on comparative effectiveness of mindfulness meditation and qigong on psychophysiological outcomes for patients with colorectal cancer: a randomized controlled trial.

BACKGROUND: Colorectal cancer imposes threats to patients' well-being. Although most physical symptoms can be managed by medication, psychosocial stressors may complicate survival and hamper quality of life. Mindfulness and Qigong, two kinds of mind-body exercise rooted in Eastern health philosophy, has been found effective in symptoms management, improving mental health, and reducing stress. With these potential benefits, a randomized controlled trial (RCT) is planned to investigate the comparative effectiveness of mindfulness and Baduanjin intervention on the bio-psychosocial wellbeing of people with colorectal cancer. METHODS/ DESIGN: A 3-arm RCT with waitlist control design will be used in this study. One hundred eighty-nine participants will be randomized into (i) Mindfulness, (ii) Baduanjin, or (iii) waitlist control groups. Participants in both the Baduanjin and mindfulness groups will receive 8-weeks of specific intervention. All three groups will undergo four assessment phases: (i) at baseline, (ii) at 4-week, (iii) at 8-week (post-intervention), and 6-month post-intervention (maintenance). All participants will be assessed in terms of cancer-related symptoms and symptom distress, mental health status, quality of life, stress level based on physiological marker. DISCUSSION: Based on prior research studies, participants in both the mindfulness and Baduanjn intervention group are expected to have better symptoms management, lower stress level, better mental health, and higher level of quality of life than the control group. This study contributes to better understanding on the common and unique effectiveness of mindfulness and Baduanjin qigong, as such patients and qualified healthcare professionals can select or provide practices which will produce maximum benefits, satisfaction, adherence, and sustainability. TRIAL REGISTRATION: The trial has been registered in the Clinical Trials Centre of the University of Hong Kong ( HKCTR-2198 ) on 08 March 2017.

Randomized controlled trial of supportive-expressive group therapy and body-mind-spirit intervention for Chinese non-metastatic breast cancer patients.

PURPOSE: This study aimed to evaluate the efficacy of supportive-expressive group (SEG) therapy and body-mind-spirit (BMS) intervention on emotional suppression and psychological distress in Chinese breast cancer patients. METHODS: This three-arm randomized controlled trial assigned 157 non-metastatic breast cancer patients to BMS, SEG, or social support control group. SEG focused on emotional expression and group support, whereas BMS emphasized relaxation and self-care. All groups received 2-h weekly sessions for 8 weeks. The participants completed measurements on emotional suppression, perceived stress, anxiety, and depression at baseline and three follow-up assessments in 1 year. RESULTS: Using latent growth modeling, overall group difference was found for emotional suppression (χ 2(2) = 8.88, p = 0.012), marginally for perceived stress (χ 2(2) = 5.70, p = 0.058), but not for anxiety and depression (χ 2(2) = 0.19-0.94, p > 0.05). Post-hoc analyses revealed a significant and moderate reduction (Cohen d = 0.55, p = 0.007) in emotional suppression in SEG compared to control group, whereas BMS resulted in a marginally significant and moderate fall (d = 0.46, p = 0.024) in perceived stress. Neither SEG nor BMS significantly improved anxiety and depression (d < 0.20, p > 0.05). CONCLUSIONS: The present results did not demonstrate overall effectiveness for either BMS or SEG therapy in the present sample of Chinese non-metastatic breast cancer patients. The participants appear to derive only modest benefits in terms of their psychological well-being from either intervention.

Dimensionality of the Center for Epidemiologic Studies Depression Scale: an exploratory bi-factor analytic study.

OBJECTIVE: The Center for Epidemiologic Studies Depression Scale (CES-D) is a widely used instrument for measuring depressive symptoms. Though conventional factor analytic evaluations supported the use of four sub-scales for the CES-D, existing studies have yet to adopt the bi-factor analytic approach in psychometric assessment of the 20-item inventory. The present study aimed to apply both confirmatory factor analysis and exploratory bi-factor analysis to evaluate the dimensionality of the CES-D. METHODS: Current scoring practice of the CES-D (single-factor, four-factor, and second-order models) was tested using confirmatory factor analyses in a sample of 706 Chinese persons with insomnia and depressive symptoms. As an alternative, exploratory bi-factor analysis was conducted to examine the utility of the general depression factor and specific factors. RESULTS: Existing measurement models on the CES-D did not provide an adequate model fit to the data in terms of model fit indices and discriminant validity. The bi-factor model revealed a general depression factor that accounted for the majority of the item variance. The three specific factors (somatic symptoms, positive affect, and interpersonal problems) provided little unique information over and above the general factor and plausibly represent a methodological artifact rather than a substantive factor. CONCLUSION: The present study demonstrated empirical support for the bi-factor model as a realistic representation of the underlying structure of the CES-D. Researchers and clinicians are better served by simply using a single measure of depression.

The relationships of change in work climate with changes in burnout and depression: a 2-year longitudinal study of Chinese mental health care workers.

Mental health care workers face heavy emotional demand and are prone to work burnout. Work burnout has been associated with poor mental health and work climate, which refers to individual perceptions about work setting. The purpose of this study was to examine whether intra-individual changes in work climate were associated with intra-individual changes in burnout and depression over two years. The present sample included Chinese mental health care workers (N = 312; mean age = 38.6, SD = 9.9) working in a psychosocial rehabilitation institution. The participants completed questionnaires on work climate, work burnout and depression at seven time points across two years. Parallel process latent growth modeling was used to analyze the associations of change between work climate and burnout and depression. Work climate displayed a logarithmic decreasing trend while burnout and depression displayed logarithmic increasing trends over two years. Baseline levels of work climate were negatively and moderately associated with baseline levels of burnout and depression (r = -.44 to -.60, p < .01). Changes in work climate were negatively and moderately associated with change in burnout (r = -.43, p < .01) and change in depression (r = -.31, p < .05). Change in burnout was positively and strongly associated (r = .58, p < .01) with change in depression. The current results support temporal relationships among changes in work climate, burnout and depression across time. Practical implications for future preventive work in burnout interventions were discussed within this population.

Toward a Holistic Approach to Spiritual Health Care for People With Schizophrenia.

Medical and behavioral treatments are the predominant types of rehabilitation services for people with schizophrenia. Spirituality in people with schizophrenia remains poorly conceptualized, thereby limiting knowledge advancement in the area of spiritual health care services. To provide a framework for better clinical and research practices, we advocate a holistic approach to investigating spirituality and its application in spiritual health care services of people with schizophrenia.

Addressing holistic health and work empowerment through a body-mind-spirit intervention program among helping professionals in continuous education: A pilot study.

To examine the effectiveness of a body-mind-spirit (BMS) intervention program in improving the holistic well-being and work empowerment among helping professionals in continuous education. Forty-four helping professionals, who were in their first-year part-time postgraduate study, participated in the present study. All participants attended a 3-day BMS intervention program which emphasized a holistic approach to health and well-being. Ratings on their levels of physical distress, daily functioning, affect, spirituality, and psychological empowerment at work were compared before and immediately after the intervention. Participants reported significantly lower levels of negative affect and physical distress, and were less spiritually disoriented after the intervention. Enhanced levels of daily functioning, positive affect, spiritual resilience, and tranquility were also reported. Results also suggested that participants were empowered at work, and specifically felt more able to make an impact on work outcomes. The 3-day BMS intervention program produced a positive and measurable effect on participants' holistic well-being and empowerment at work. Educators in related fields could incorporate holistic practices into the curriculum to better prepare the future practitioners, leading to better outcomes both to the professionals themselves and their clients or patients.

HIV/AIDS-related deaths in China, 2000-2012.

This study examined the time trend and pattern of HIV/AIDS-related deaths in China. Data on HIV deaths and AIDS deaths were provided by the Chinese Ministry of Health. Time trend of the overall death rates over the period 2000-2012 was examined using Poisson regression models. Pattern of AIDS deaths was examined for the period 2006-2012, using the age-, gender-, and region-specific death rates. The results indicated that HIV/AIDS-related death rate increased significantly in China over the past decade, with an average annual percentage change of 22.3%. A vast majority of the deaths occurred among those aged between 20 and 65 years, with two age peaks. The death rate was higher for males than females and in rural areas than urban areas. A total of 83% of the deaths occurred among rural residents and 67% among males. The upward trend and distribution pattern of HIV/AIDS-related deaths depicted in the present study not only provides valuable information for additional understanding of the dynamics of the HIV/AIDS epidemic in China, but also has implications for evidence-based public health intervention strategies and policies as well as for further studies.

Re-examining the factor structure and psychometric properties of the Mini-Mental Adjustment to Cancer Scale in a sample of 364 Chinese cancer patients.

PURPOSE: The Mini-Mental Adjustment to Cancer Scale (Mini-MAC) is widely used to evaluate cancer patients' psychological responses. Validation studies of the scale have shown methodological shortcomings and inconsistency in the factor solutions. The aim of this study was to examine the factor structure and psychometric properties of the Mini-MAC. METHODS: A large sample of 364 Chinese patients with breast or colorectal cancer completed the Mini-MAC and psychosocial measures (general health, perceived stress, anxiety, and depression). Exploratory factor analyses examined the relative fit of two- to six-factor models using robust weighted least square estimation and oblique target rotation. Convergent validity was evaluated via correlations between the Mini-MAC factor scores and the psychosocial outcomes. RESULTS: The five-factor model showed the best model fit and largely replicated the original Mini-MAC's helpless/hopeless (HH), anxious preoccupation (AP), fighting spirit (FS), fatalism (FA), and cognitive avoidance (CA) subscales. The five factors had acceptable reliability (Cronbach's α = 0.67-0.88) and 4-month test-retest reliability (r = 0.45-0.64). HH, AP, and CA were positively associated with the psychosocial outcomes (r = 0.19-0.60). Modest and negative correlations were found between the psychosocial outcomes and FS and FA. CONCLUSIONS: The results support the Mini-MAC's original five-factor structure with satisfactory reliability and convergent validity. The results demonstrate that the Mini-MAC is a valid measure for assessing psychological responses in cancer patients.

Psychometric properties of the Chalder Fatigue Scale revisited: an exploratory structural equation modeling approach.

OBJECTIVE: Previous validation studies of the Chalder Fatigue Scale (CFS) suffer methodological shortcomings. The present study aimed to re-evaluate its psychometric properties using exploratory structural equation modeling (ESEM). METHODS: A Chinese sample of 1259 community-dwelling residents completed the 11-item Chinese CFS and a variety of health measures (anxiety, depression, exhaustion, sleep disturbance, and quality of life). In addition to traditional confirmatory factor analysis, ESEM was performed to assess the fit of two- and three-factor models using robust maximum likelihood estimation and oblique geomin rotation. Convergent validity of the CFS was examined via associations with five covariates (gender, age, exercise, perceived health, and life event) and the health measures in the ESEM model. RESULTS: The ESEM models displayed a superior fit to confirmatory factor models. The three-factor ESEM model showed a satisfactory model fit to the data but not for the two-factor model. The three factors were physical fatigue (three items, α = .800), low energy (four items, α = .821), and mental fatigue (four items, α = .861). The factors exhibited convergent validity with the model covariates and health measures. CONCLUSION: The results demonstrate the satisfactory reliability and convergent validity for the three-factor structure of the CFS as a valid measure of fatigue symptoms in the general population. Future psychometric studies could adopt the ESEM approach as a practical alternative to traditional confirmatory factor analysis.

Psychometric validation of the consensus five-factor model of the Positive and Negative Syndrome Scale.

BACKGROUND: The Positive and Negative Syndrome Scale (PANSS) is widely used for clinical assessment of symptoms in schizophrenia. Instead of the traditional pyramidal model, recent literature supports the pentagonal model for the dimensionality of the PANSS. AIM: The present study aimed to validate the consensus five-factor model of the PANSS and evaluate its convergent validity. METHODS: Participants were 146 Chinese chronic schizophrenic patients who completed diagnostic interviews and cognitive assessments. Exploratory structural equation modeling (ESEM) was performed to investigate the dimensionality of the PANSS. Covariates (age, sex, and education level) and concurrent outcomes (perceived stress, memory, daily living functions, and motor deficits) were added in the ESEM model. RESULTS: The results supported the consensus 5-factor underlying structure, which comprised 20 items categorized into positive, negative, excitement, depression, and cognitive factors with acceptable reliability (α=.69-.85) and strong factor loadings (λ=.41-.93). The five factors, especially the cognitive factor, showed evident convergent validity with the covariates and concurrent outcomes. CONCLUSION: The results support the consensus five-factor structure of the PANSS as a robust measure of symptoms in schizophrenia. Future studies could explore the clinical and practical utility of the consensus five-factor model.

Psychometric properties of a Chinese version of the Stigma Scale: examining the complex experience of stigma and its relationship with self-esteem and depression among people living with mental illness in Hong Kong.

BACKGROUND: Stigma of mental illness is a global public health concern, but there lacks a standardized and cross-culturally validated instrument for assessing the complex experience of stigma among people living with mental illness (PLMI) in the Chinese context. AIM: This study examines the psychometric properties of a Chinese version of the Stigma Scale (CSS), and explores the relationships between stigma, self-esteem and depression. METHODS: A cross-sectional survey was conducted with a community sample of 114 Chinese PLMI in Hong Kong. Participants completed the CSS, the Chinese Self-Stigma of Mental Illness Scale, the Chinese Rosenberg Self-Esteem Scale, and the Chinese Patient Health Questionnaire-9. An exploratory factor analysis was conducted to identify the underlying factors of the CSS; concurrent validity assessment was performed via correlation analysis. RESULTS: The original 28-item three-factor structure of the Stigma Scale was found to be a poor fit to the data, whereas a revised 14-item three-factor model provided a good fit with all 14 items loaded significantly onto the original factors: discrimination, disclosure and positive aspects of mental illness. The revised model also displayed moderate to good internal consistency and good construct validity. Further findings revealed that the total stigma scale score and all three of its subscale scores correlated negatively with self-esteem; but only total stigma, discrimination and disclosure correlated positively with depression. CONCLUSION: The CSS is a short and user-friendly self-administrated questionnaire that proves valuable for understanding the multifaceted stigma experiences among PLMI as well as their impact on psychiatric recovery and community integration in Chinese communities.