Routine depression screening and diagnosing strategy for cancer inpatients.

BACKGROUND: Clinical practice guidelines frequently recommend systematic screening for depression in cancer patients to improve recognition and prompt appropriate management. We aimed to screen major depressive disorder (MDD) in cancer inpatients using a structured tool and explore its applicability. METHODS: Cancer inpatients were routinely screened by nurses using the Taiwanese Depression Questionnaire (TDQ), and for those screened positive, this was followed by a non-mandated referral to a psychiatrist for clinical evaluation and diagnosis. Patients who completed this two-stage procedure comprised the analysis sample. RESULTS: Routine screening of 8800 patients in a period of 27 months yielded 1087 (26.9%) positive first-time screens. Of them, 298 (27.4%) completed the psychiatric consultation. Depressive disorders were diagnosed in 185 patients (62.1%), mainly adjustment disorder (23.8%) and MDD (21.5%). The estimated prevalence of MDD was 21.5%. Area under the curve was 0.72, a result produced by the receiver operating characteristic curve of the TDQ scores relative to the clinical psychiatric diagnoses of MDD. A TDQ cutoff score of ≧26 provided an optimal diagnostic accuracy for MDD. CONCLUSIONS: This two-stage depression screening and diagnosing strategy is practical for improving recognition of MDD and other depressive disorders in cancer patients and could be routinely applied, rather than selectively, in a comprehensive cancer care system.

Male Asian international students' perceived racial discrimination, masculine identity, and subjective masculinity stress: a moderated mediation model.

This study examined male Asian international college students' perceptions of racial discrimination, subjective masculinity stress, centrality of masculine identity, and psychological distress by testing a moderated mediation model. Participants were 160 male Asian international college students from 2 large public universities. Participants' perceived racial discrimination was positively related to their subjective masculinity stress only at high (but not low) levels of masculine identity centrality. Additionally, subjective masculinity stress was positively related to psychological distress, although this association was stronger among those who reported high levels of masculine identity centrality. The authors also detected a moderated mediation effect in which subjective masculinity stress mediated the relationship between perceived racial discrimination and psychological distress only at high (but not low) levels of masculine identity centrality. These findings contribute to the counseling psychology literature by highlighting the connections between race- and gender-related stressors as well as the relevance of masculine identity to an understanding of men's mental health.

The relations of temperament reactivity and effortful control to children's adjustment problems in China and the United States.

The relations of parents' and teachers' reports of temperament anger-irritability, positive emotionality, and effortful control (attention focusing and inhibitory control) to children's externalizing and internalizing problems were examined in Chinese (N = 382) and U.S. (N = 322) samples of school-age children. Results suggested that in both cultures, low effortful control and high anger-irritability were associated with high externalizing problems, although the relations were stronger in the Chinese sample than in the U.S. sample. Low positive emotionality was associated with high internalizing problems in both cultures. However, high positive emotionality was associated with noncomorbid externalizing problems (teachers' reports) in the Chinese sample but not in the U.S. sample. These findings suggest that there are considerable cross-cultural similarities in the temperament-adjustment associations, although some cross-cultural differences might exist. Implications of the findings for the detection and intervention of adjustment problems in Chinese children are discussed.

The development of valid subtypes for depression in primary care settings: a preliminary study using an explanatory model approach.

A persistent theme in the debate on the classification of depressive disorders is the distinction between biological and environmental depressions. Despite decades of research, there remains little consensus on how to distinguish between depressive subtypes. This preliminary study describes a method that could be useful, if implemented on a larger scale, in the development of valid subtypes of depression in primary care settings, using explanatory models of depressive illness. Seventeen depressed Hispanic patients at an inner city general practice participated in explanatory model interviews. Participants generated illness narratives, which included details about symptoms, cause, course, impact, health seeking, and anticipated outcome. Two distinct subtypes emerged from the analysis. The internal model subtype was characterized by internal attributions, specifically the notion of an "injured self." The external model subtype conceptualized depression as a reaction to life situations. Each subtype was associated with a distinct constellation of clinical features and health seeking experiences. Future directions for research using explanatory models to establish depressive subtypes are explored.

A population-based study of childhood sexual contact in China: prevalence and long-term consequences.

OBJECTIVES: This study provides national estimates of the prevalence of childhood sexual contact and its association with sexual well-being and psychological distress among adults in China. METHOD: A national stratified probability sample of 1,519 women and 1,475 men aged 20-64 years in urban China completed a computer-administered survey in 1999-2000. The data from this survey on both adult-to-child and peer-to-peer sexual contact before age 14 were subjected to descriptive and multivariate analyses that were adjusted for both sampling weights and sampling design. RESULTS: The overall prevalence of reported childhood sexual contact was 4.2%, with prevalence higher among men (5.1%) than among women (3.3%) and higher among those aged 20-29 years (8.3%). Childhood sexual contact was associated with multiplex consequences, including hyper-sexuality (high levels of masturbation, thoughts about sex, varieties of sexual practices, partner turnover), adult sexual victimization (unwanted sex, unwanted sexual acts, sexual harassment), sexual difficulties (genitor-urinary symptoms, sexually transmitted infections, sexual dysfunctions), and psychological distress. Psychological distress was largely mediated by adult sexual victimization, sexual difficulties, and hyper-sexuality. CONCLUSIONS: Despite the relatively modest prevalence of childhood sexual contact among Chinese adults, the association with multiplex adult outcomes suggests that much as in the West early sexual contact is a significant issue. PRACTICE IMPLICATIONS: The findings underscore the importance of public education about childhood sexual contact and abuse in China. The findings suggest a need for public health campaigns that tackle the stigma associated with being abused and encourage victims to report abusive behavior to proper sources. The findings are also consistent with new efforts to alleviate the negative long-term impact of childhood sexual abuse.

Validation of the multiple language versions of the Hopkins Symptom Checklist-37 for refugee adolescents.

The objective of this study is to provide preliminary psychometric properties of the Hopkins Symptom Checklist-37 (HSCL-37A) for refugee adolescents. The HSCL-37A is a modification of the well-known HSCL-25 and assesses symptoms of internalizing and externalizing problems that have been associated with reactions to trauma. Four independent heterogeneous samples (N=3890) of unaccompanied refugee minors, immigrants, and native Dutch and Belgian adolescents were assessed at school. The confirmative factor analyses, per language version, support the two-factor structure of internalizing and externalizing behavior. The total and subscales show good internal consistency and acceptable test-retest reliability in spite of the heterogeneous sample populations. The construct, content, and criterion validity of the HSCL-37A were also examined and found to be good. The findings of this study suggest that the HSCL-37A is a reliable and valid instrument to be used among culturally diverse refugee adolescents to assess emotional distress and maladaptive behaviors.

Association of short stature with life satisfaction and self-rated health in children and adolescents: the CASPIAN-IV study.

BACKGROUND: Data on stature in Iranian children and adolescents at national level are limited. The purpose of this study was to investigate the association of short stature with life satisfaction (LS) and self-rated health (SRH) in children and adolescents. METHODS: Data were obtained from a nationwide survey entitled childhood and adolescence surveillance and prevention of adult non-communicable disease (CASPIAN IV). Participants were 14,880 children and adolescents, aged 6-18 years, who were selected using multistage, cluster sampling method from rural and urban areas of 30 provinces of Iran. LS and SRH were evaluated for every participant by the validated questionnaire prepared based on the global school-based student health survey of the World Health Organization (WHO). Height was measured according to the standard protocol. Short stature was defined as height less than -2 standard deviation (SD) below the mean height for age and sex. RESULTS: Overall, 13,484 participants with a mean (SD) age of 12.5 (3.36) years (49.24% girls, 50.75% boys) completed the study (response rate 90.6%). The prevalence of short stature, poor SRH and life dissatisfaction was 9%, 20.04% and 20.09%, respectively. Although in the univariate model, participants with short stature had significantly lower odds of LS [odds ratio (OR): 0.83, 95% confidence interval (CI): 0.71-0.97] and good SRH (OR: 0.79, 95% CI: 0.68-0.92), in the multivariate model, only the association of short stature with good SRH remained statistically significant (OR: 0.82, 95% CI: 0.69-0.98). CONCLUSIONS: Results of the present study show that participants with short stature are at the greater risk of poor SRH and decreased LS in comparison with the subjects with normal height.

Motivation for Psychotherapy and Illness Beliefs in Turkish Immigrant Inpatients in Germany: Results of a Cultural Comparison Study.

OBJECTIVE: Some immigrant populations, for instance, Turkish immigrants, suffer from worse mental health than the general population. Moreover, psychotherapeutic treatment does not work well in this group. This might be explained by lower motivation for psychotherapy and particular illness beliefs as important early predictors of treatment outcome. We investigate differences in these predictors between Turkish immigrant inpatients and inpatients without a migration background and evaluate whether particular illness beliefs have a negative impact on motivation for psychotherapy. METHOD: Turkish immigrant inpatients and inpatients without a migration background (N = 100), suffering from depressive disorder, somatoform disorder, and/or adjustment disorder, completed questionnaires assessing motivation for psychotherapy, depressive and somatic symptoms, illness perception, illness-related locus of control, and causal illness attributions. RESULTS: Despite a higher symptom burden, motivation for psychotherapy was lower in Turkish immigrant inpatients than in inpatients without a migration background (d = 0.54). This was fully explained by stronger beliefs in supernatural causes of illness and higher fatalistic-external illness-related locus of control in the Turkish immigrant sample (mediation analysis; R (2) = 0.27). CONCLUSIONS: Turkish immigrants believe in supernatural or fatalistic causes of illness and fatalistic-external locus of control to a greater extent than German inpatients without a migration background. These beliefs reduce motivation for psychotherapy and need to be addressed in psychotherapeutic treatment in order to secure positive treatment outcomes.

Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress.

We report that infertile women in Japan as well as in the Western world have high levels of emotional distress, anxiety, and depression. The reasons for anxiety and depression in infertile women are easy to presume but remain unclear. We conducted the present study to assess the relationship between the anxiety and depression of infertile Japanese women and their thought processes and emotional well-being with regard to their infertility. A cross-sectional questionnaire was administered to 101 infertile Japanese women who visited the infertility clinic at Tokai University. Inventories included the Hospital Anxiety and Depression Scale (HADS) and our original infertility questionnaire, which is composed of 22 questions to assess attitudes and emotional status in facing the stigma of infertility. After factor analysis, comparison between the HADS and the infertility questionnaire was made with simultaneous multiple regression analyses. Anxiety and depression in childless Japanese women were significantly associated with lack of husband's support and feeling stress. Our findings should prove useful in designing and implementing psychological support programs for infertile Japanese women. Psychological interventions to relieve or diminish these conditions might have significant therapeutic benefits for women attending infertility clinics in Japan.

Adjustment disorders in Asians and Asian Americans.

In the DSM-5, adjustment disorders have undergone a conceptual shift with a new designation as a constellation of stress-related conditions in response to exposure to a distressing event which may be perceived as traumatic or non-traumatic. This is in contrast to its previous description in DSM-IV-TR, which focused on the presence of significant distress following a crisis event, but did not require the individual to meet the criteria for a more serious disorder. This paper will present a brief overview of the clinical nosology, etiology, and treatment modalities for adjustment disorders with Asian and Asian American populations.

Relations between shyness-sensitivity and internalizing problems in Chinese children: moderating effects of academic achievement.

Shy-sensitive children are likely to develop adjustment problems in today's urban China as the country has evolved into an increasingly competitive, market-oriented society. The main purpose of this one-year longitudinal study was to examine the moderating effects of academic achievement on relations between shyness-sensitivity and later internalizing problems in Chinese children. A sample of 1171 school-age children (591 boys, 580 girls) in China, initially at the age of 9 years, participated in the study. Data on shyness, academic achievement, and internalizing problems were collected from multiple sources including peer evaluations, teacher ratings, self-reports, and school records. It was found that shyness positively and uniquely predicted later loneliness, depression, and teacher-rated internalizing problems, with the stability effect controlled, for low-achieving children, but not for high-achieving children. The results indicate that, consistent with the stress buffering model, academic achievement may be a buffering factor that serves to protect shy-sensitive children from developing psychological problems.

Complicated grief in Aboriginal populations.

To date there have been no studies examining complicated grief (CG) in Aboriginal populations. Although this research gap exists, it can be hypothesized that Aboriginal populations may be at increased risk for CG, given a variety of factors, including increased rates of all-cause mortality and death by suicide. Aboriginal people also have a past history of multiple stressors resulting from the effects of colonization and forced assimilation, a significant example being residential school placement. This loss of culture and high rates of traumatic events may place Aboriginal individuals at increased risk for suicide, as well as CG resulting from traumatic loss and suicide bereavement. Studies are needed to examine CG in Aboriginal populations. These studies must include cooperation with Aboriginal communities to help identify risk factors for CG, understand the role of culture among these communities, and identify interventions to reduce poor health outcomes such as suicidal behavior.

The anger syndrome hwa-byung and its comorbidity.

BACKGROUND: The aim of this study was to identify patients with hwa-byung (HB), a Korean culture-related anger syndrome, and to compare the comorbidities of HB with those of other psychiatric disorders. METHODS: The study participants included 280 patients with depressive disorders, anxiety disorders, somatoform disorders, adjustment disorders, or self-labeled hwa-byung. For all patients, the DSM-IV diagnosis was made using the Korean version of the Structured Clinical Interview for the DSM-IV Diagnosis (SCID-1). The diagnosis of HB was made according to research diagnostic criteria of HB. Assessment of HB symptoms was performed using the Hwa-byung Scale. RESULTS: Female patients were more and mean age was older in HB group than non-HB group. Of 280 patients, 183 patients were diagnosed with HB. Forty-seven of these patients had only HB, and the rest had various comorbid DSM-IV diagnoses, with major depressive disorder (MD) and generalized anxiety disorder (GAD) being the most frequent. The distributions of single diagnoses and comorbid diagnoses were similar for HB, MD and GAD. LIMITATIONS: Sample size may be small, axis II diagnoses were not assessed, and patients with psychotic features were not included. CONCLUSIONS: Our results suggest that HB, which comprises unique anger-related symptoms, is comparable to MD or GAD in comorbidity profile.

Sexual abuse in childhood and the mentally disordered female offender.

This study examines the role that a history of child sexual abuse played in the diagnosis and treatment of mental disorders in a sample of 321 female offenders incarcerated in a maximum-security prison for women. The results show that a history of child sexual abuse increases the likelihood that an inmate would receive mental health treatment. Psychotropic medication is frequently prescribed in response to adjustment problems associated with childhood sexual abuse. White women who exhibit adjustment problems associated with a history of child sexual abuse are especially likely to be diagnosed as mentally disordered at admission and to be sent to the mental health unit for treatment. In the absence of a diagnosed mental disorder at admission, women who receive psychotropic medication to help them adjust to prison life are likely to be diagnosed with a mental disorder later on.

Treatment decision difficulties and post-operative distress predict persistence of psychological morbidity in Chinese women following breast cancer surgery.

BACKGROUND: The patterns and determinants of longer-term psychological morbidity in women following breast cancer surgery have not been described for Chinese populations. METHODS: Chinese women were assessed at 3-days, 4-months and 8-months following breast surgery, on treatment decision-making difficulty (TDMD), satisfaction with treatment outcome (E-OI), self efficacy (GSeS), optimism (C-LOT-R), consultation satisfaction (C-MISS-R), physical symptom distress (PSD) and psychological morbidity (CHQ-12) and compared using polynomial logistic models. RESULTS: Of 303/405 women providing complete data, 33% received chemotherapy and 26% radiotherapy. GSeS, CLOTR and TDMD scores were moderate. Though the proportion of women meeting psychological morbidity case-criteria declined from 78% (95% Confidence Interval 73-83%) at Baseline to 64% (59-69%) at 8-months, almost 50% (44-54%) of women remained distressed over the 8-month period. After adjustment for demographic and clinical factors, severity of psychological morbidity at 4-months was predicted by PSD, disappointment and higher Baseline CHQ12, and among moderate/severe cases only, greater TDMD and pessimistic outlook. At 8-months, CHQ12 scores were predicted by PSD, Baseline CHQ-12, and difficulties with TDM. CONCLUSION: TDM difficulties, early post-surgical psychological and physical symptom distress indicate risk for prolonged distress in Chinese women following breast cancer surgery.

[Subjective illness beliefs of Turkish migrants with mental disorders--specific characteristics compared to german patients]. / Subjektive Krankheitskonzepte türkischer Migranten mit psychischen Störungen--Besonderheiten im Vergleich zu deutschen Patienten.

OBJECTIVE: Knowledge about culture- and migration-specific characteristics of subjective illness beliefs in Turkish patients is necessary for adequate treatment. METHODS: Analysis of subjective illness beliefs in Turkish patients (F3; F4; n = 79) in comparison to matched Germans (n = 79) using a modified version of the Illness Perception Questionnaire IPQ-R. Differences were explored by t-tests and chi(2)-tests. RESULTS: Turkish patients believed significantly stronger in a chronical timeline of illness and in negative illness consequences, while German patients believed significantly stronger in treatment control and personal control. Turkish patients more often mentioned external causes of their disease compared to Germans. CONCLUSIONS: The results provide explanations of the deficient health care situation for Turkish migrants in Germany.

Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees.

OBJECTIVE: This paper explores the impact of pre-migration trauma, post-migration living difficulties and social support on the current mental health of 63 resettled Sudanese refugees. METHOD: A semistructured interview including questionnaires assessing sociodemographic information, pre-migration trauma, anxiety, depression and posttraumatic stress, post-migration living difficulties and perceived social support were administered assisted by a bilingual community worker. RESULTS: Resettled refugees from Sudan evidenced a history of trauma. Less than 5% met criteria for posttraumatic stress but 25% reported clinically high levels of psychological distress. The results indicate that social support--particularly perceived social support from the migrant's ethnic community--play a significant role in predicting mental health outcomes. Pre-migration trauma, family status and gender were also associated with mental health outcomes. CONCLUSIONS: Refugees in Australia may constitute a particularly vulnerable group in terms of mental health outcomes. Culturally specific sequelae in terms of social isolation and acculturation may be particularly problematic for these migrants.