The Brain Economy: Advancing Brain Science to Better Understand the Modern Economy.

The coming years are likely to be turbulent due to a myriad of factors or polycrisis, including an escalation in climate extremes, emerging public health threats, weak productivity, increases in global economic instability and further weakening in the integrity of global democracy. These formidable challenges are not exogenous to the economy but are in some cases generated by the system itself. They can be overcome, but only with far-reaching changes to global economics. Our current socio-economic paradigm is insufficient for addressing these complex challenges, let alone sustaining human development, well-being and happiness. To support the flourishing of the global population in the age of polycrisis, we need a novel, person-centred and collective paradigm. The brain economy leverages insights from neuroscience to provide a novel way of centralising the human contribution to the economy, how the economy in turn shapes our lives and positive feedbacks between the two. The brain economy is primarily based on Brain Capital, an economic asset integrating brain health and brain skills, the social, emotional, and the diversity of cognitive brain resources of individuals and communities. People with healthy brains are essential to navigate increasingly complex systems. Policies and investments that improve brain health and hence citizens' cognitive functions and boost brain performance can increase productivity, stimulate greater creativity and economic dynamism, utilise often underdeveloped intellectual resources, afford social cohesion, and create a more resilient, adaptable and sustainability-engaged population.

Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial.

Given the growing evidence that a range of lifestyle factors are involved in the etiology of depression, a 'lifestyle medicine' approach can be potentially safe and cost-effective to prevent or treat depression. To examine the effects and acceptability of a group-based, integrative lifestyle medicine intervention as a standalone treatment for managing depressive symptoms, a pilot randomized controlled trial (RCT) was conducted in a Chinese adult population in 2018. Participants (n = 31) with PHQ-9 score above the cut-off of ≥ 10, which was indicative of moderate to severe depression, were recruited from the general community in Hong Kong and randomly assigned to lifestyle medicine group (LM group) or care-as-usual group (CAU group) in a ratio of 1:1. Participants in the LM group received 2-hour group sessions once per week for six consecutive weeks, which covered diet, exercise, mindfulness, psychoeducation, and sleep management. Linear mixed-effects model analyses showed that the LM group had a significant reduction in PHQ-9 scores compared to the CAU group at immediate posttreatment and 12-week posttreatment follow-up (d = 0.69 and 0.73, respectively). Moreover, there were significantly greater improvements in anxiety, stress, and insomnia symptoms (measured by DASS-21 and ISI) at all time points in the LM group (d = 0.42-1.16). The results suggests that our 6-week group-based, integrative lifestyle intervention program is effective in lowering depressive, anxiety, stress, and insomnia symptoms in the Chinese population. Further studies in clinical populations with a larger sample size and longer follow-up are warranted.

Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review.

BACKGROUND: The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs. METHODS: We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available. RESULTS: A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or "low-tech" care must also remain available. CONCLUSIONS: The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.

Mental health problems, needs, and service use among people living within and outside Wuhan during the COVID-19 epidemic in China.

BACKGROUND: Crisis mental health services for the general population are an essential component in combating the COVID-19 epidemic. To facilitate planning of mental health services, empirical data on mental health problems and service utilization of populations affected by the epidemic are urgently needed. This study investigated the prevalence of mental health problems of residents within and outside Wuhan, China, as well as their patterns of mental health service utilization. METHODS: From January 27 to February 2, 2020, an online cross-sectional survey recruited residents from 4 subpopulations: Wuhan residents (n=2,617), migrants from Wuhan (those who left Wuhan before lockdown, n=930), other Hubei residents (n=633), and residents of other provinces of China ("other residents", n=3,561). Participants' mental health problems and patterns of utilization of mental health services in recent days were assessed with standardized assessments. RESULTS: Among the 4 groups, Wuhan residents had the highest rate of any type of mental health problem (i.e., psychological distress: 41.9%), followed by migrants from Wuhan (34.2%), other Hubei residents (24.8%), and other residents (21.1%). Rates of perceived mental health needs and utilization of mental health services during recent days were 10.2% and 1.9% for Wuhan residents, 8.4% and 1.8% for migrants from Wuhan, 6.2% and 1.1% for other Hubei residents, and 6.4% and 1.0% for other residents, respectively. Overall, 63.0% mental health service users received services via internet and telephone, and 83.1% participants with perceived mental health needs ascribed their lack of help-seeking to barriers to accessibility and availability. CONCLUSIONS: The COVID-19 epidemic is associated with unprecedented levels of mental health problems and needs in affected residents. To address the unmet mental health needs, internet- and telephone-based mental health services should be widely provided to residents, especially those in the worst-affected regions.

Unmedicated patients with schizophrenia in economically underdeveloped areas of China.

OBJECTIVES: Untreated schizophrenia commonly leads to poor prognosis. The medication treatment rate of schizophrenia patients in economically underdeveloped areas of China has not been well-studied. This study aimed to examine the pattern of unmedicated schizophrenia patients in economically underdeveloped rural and urban areas of China. METHOD: A total of 4240 schizophrenia patients in Lanzhou (1720 rural and 2520 urban patients) registered in the community mental-health service system in Lanzhou, Gansu province were included. Their socio-demographic and clinical characteristics including medication treatment status were collected and analyzed. RESULTS: The proportion of unmedicated schizophrenia patients was 22.5% (n = 953) in the whole sample, with 32.3% (556/1720) in rural and 15.8% (397/2520) in urban patients (X2=161.1, P < 0.001). Multiple logistic regression analyses revealed that unmedicated schizophrenia patients in rural area were more likely to be older (OR=1.02, 95%CI: 1.01-1.03), male (OR=1.35, 95%CI: 1.07-1.71), unmarried (OR=0.71, 95%CI: 0.55-0.91), and have lower educational level (OR=0.39, 95%CI: 0.24-0.65), longer illness duration (OR=1.01, 95%CI: 1.00-1.02) and less frequent admissions (OR=0.46, 95%CI: 0.38-0.54). In contrast, unmedicated patients in urban area were more likely to be older (OR=1.01, 95%CI: 1.00-1.02), unmarried (OR=0.77, 95%CI: 0.61-0.98), employed (OR=2.38, 95%CI: 1.87-3.04), and have lower educational level (OR=0.49, 95%CI: 0.37-0.65), better financial status (OR=0.60, 95%CI: 0.48-0.76) and less frequent admissions (OR=0.81, 95%CI: 0.75-0.87). CONCLUSIONS: The rate of unmedicated schizophrenia patients is high in economically underdeveloped areas of China, particularly in rural areas. Effective policies and measures should be implemented urgently to improve the treatment rate in this population.

Exploration of the psychometric properties of the 33-item Hypomania Checklist - external assessment (HCL-33-EA).

BACKGROUND: Misdiagnosis of bipolar disorder (BD) is common in clinical practice, leading to inappropriate treatment and detrimental consequences. The 33-item Hypomania Checklist (HCL-33) is a newly developed screening instrument for hypomanic symptoms in patients with BD. The 33-item Hypomania Checklist-external assessment (HCL-33-EA) is a version of the HCL-33 for carers of patients with mood disorders. In this study, the psychometric properties of the HCL-33-EA in a Chinese population were explored. METHOD: A total of 182 inpatients and 240 carers were recruited in this study. Patients were diagnosed with bipolar depression or major depressive disorder (MDD) according to the International Classification of Diseases (ICD-10). The patients completed the HCL-33, while their carers filled out the HCL-33-EA. RESULTS: The HCL-33-EA showed high internal consistency (Cronbach's alpha = 0.876) with two-factorial dimensions. Paired samples t-test revealed that the mean score of the HCL-33-EA was significantly lower than that of the HCL-33 (t = 10.1, p < 0.001). Spearman's rho showed that the two instruments were significantly and positively correlated (r = 0.46, p < 0.001). CONCLUSION: The HCL-33-EA has acceptable psychometric properties and could be an effective screening tool for patients' carers, enabling identification of the symptoms of hypomania.

Mobile phone addiction in Tibetan and Han Chinese adolescents.

PURPOSE: To compare mobile phone addiction (MPA) patterns between Tibetan and Han adolescents in China. DESIGN AND METHODS: The study was carried out in two provinces of China. The Mobile Phone Addiction Scale (MPAS) was used to assess MPA. FINDINGS: Seven hundred and five Tibetan and 606 Han students participated in the study. The MPAS total score was 24.4 ± 11.4 in the whole sample; 27.3 ± 10.8 and 20.9 ± 11.2 in Tibetan and Han students, respectively. Quality of life (QOL) in the physical, psychological, social, and environmental domains was negatively associated with MPA. PRACTICE IMPLICATIONS: Compared with Han students, Tibetan students were found to have more severe MPA. Given its negative impact on QOL, appropriate measures for the prevention of MPA should be developed, particularly for Tibetan middle school students.

Inclusion of mental health in global economic development.

The APEC Mental Health Roadmap has a vision to strengthen mental health and reduce the economic impact of mental illness in the Asia Pacific. To facilitate its implementation, the APEC Digital Hub will heighten exchange and dissemination of best practices in Asia Pacific mental health partnerships, and increase multi-sectoral recognition to invest in mental health to support economic growth.

Internet addiction in Tibetan and Han Chinese middle school students: prevalence, demographics and quality of life.

Internet addiction (IA) is common amongst young people, but no data on IA are available in Tibetan middle school students in China. This study compared the prevalence of IA between Tibetan and Han Chinese middle school students, and examined its association with quality of life. The study was conducted in two middle schools in the Tibetan area of Qinghai province and two Han Chinese middle schools in Anhui province, China. Internet addiction, depressive symptoms and quality of life were measured using standardized instruments. Totally, 1,385 students completed the assessments. The overall prevalence of IA was 14.1%; 15.9% in Tibetan students and 12.0% in Han students. After controlling for the covariates, the prevalence of IA was significantly higher in Tibetan students than in Han students (OR = 3.5, p < 0.001). More severe depressive symptoms, religious beliefs and male gender were positively associated with IA, while good family relationship was negatively associated with IA. Internet addiction was also associated with significantly lower QOL in physical, psychological and environmental domains. Internet addiction appears to be common in Chinese middle school students, particularly amongst Tibetan Chinese students. Considering its negative impact on quality of life, appropriate educational programs and preventive measures for IA should be urgently developed.

Physical comorbidities in older adults receiving antidepressants in Asia.

BACKGROUND: The present study explored the patterns of physical comorbidities and their associated demographic and clinical factors in older psychiatric patients prescribed with antidepressants in Asia. METHODS: Demographic and clinical information of 955 older adults were extracted from the database of the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) project. Standardized data collection procedure was used to record demographic and clinical data. RESULTS: Proportion of physical comorbidities in this cohort was 44%. Multiple logistic regression analyses showed that older age (OR = 1.7, P < 0.001), higher number of depressive symptoms (OR = 1.09, P = 0.016), being treated in psychiatric hospital (OR = 0.5, P = 0.002), living in high income countries/territories (OR = 2.4, P = 0.002), use of benzodiazepines (OR = 1.4, P = 0.013) and diagnosis of 'other psychiatric disorders' (except mood, anxiety disorders and schizophrenia) (OR = 2.7, P < 0.001) were significantly associated with physical comorbidities. CONCLUSIONS: Physical comorbidities in older patients prescribed with antidepressants were common in Asia. Integrating physical care into the treatment of older psychiatric patients should be urgently considered.

Psychometric properties of the Chinese version of the Functioning Assessment Short Test (FAST) in bipolar disorder.

OBJECTIVES: Bipolar disorder (BD) is often associated with significant functional impairment. However, there is currently no valid and reliable instrument for this variable that is both brief and easy to administer in China. We thus aimed to evaluate the psychometric properties of the Chinese version of the Functioning Assessment Short Test (FAST) in Chinese adults with BD. METHODS: In this sample of adult subjects, 176 with BD and 53 healthy controls were included. The Chinese version of the FAST, the Young Mania Rating Scale (YMRS), the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Global Assessment Functioning (GAF) were administered, and the psychometric analysis of the FAST was conducted. RESULTS: The internal consistency (Cronbach's alpha) was 0.89 and 0.88 for the FAST at the baseline and week 1, respectively. Four domains (occupational functioning, cognitive functioning, interpersonal relationship and financial issues) at baseline had high item-total correlations. The FAST assessments at baseline and week 1 were highly correlated, indicating high test-retest reliability. The FAST total score was strongly associated with GAF total scores at week 0 (r  = -0.952, p < 0.001), HDRS (r = 0.575, p < 0.001) and YRMS (r = 0.394, p < 0.001) and at week 1 (r  = -0.945, p < 0.001; r  = 0.582, p < 0.001; r  = 0.363, p < 0.001), respectively, suggesting high concurrent validity. The FAST showed four dimensional measurement properties in exploratory factor analysis at baseline. CONCLUSIONS: The Chinese version of the FAST has satisfactory psychometric properties in terms of validity and reliability in Chinese adults with BD.

The assessment of decision-making competence in patients with depression using the MacArthur competence assessment tools: A systematic review.

PURPOSE: This is a systematic review of the usefulness of the MacArthur Competence Assessment Tools (MacCAT) in assessing the decision-making competence in patients with depression. DESIGN AND METHODS: A systematic literature search was performed. FINDINGS: Eleven studies met the search criteria. The decision-making capacity was impaired in 9-31% of the patients with depression. There was inconsistency regarding the differences of MacCAT scores between patients with depression and controls, while relatively large effect sizes were found on the Appreciation and Reasoning MacCAT subscales. PRACTICE IMPLICATIONS: The MacCAT appears to be a useful tool for measuring decision-making capacity in patients with depression, but the association between depression and competence is not consistent. The mechanisms mediating such association are likely to be complex and multifactorial.

Quality of life and clinical correlates in older adults living in the community and in nursing homes in Macao.

AIM: There have been no previous studies of quality of life (QOL) in older adults in Macao. This study aimed to examine QOL in relation to the sociodemographic and clinical characteristics of adults aged ≥50 years in Macao. METHODS: A sample of 451 subjects (203 living in the community, 248 living in nursing homes) was interviewed using standardized instruments. Basic sociodemographic and clinical data including QOL were collected. RESULT: There were no significant differences between the community and nursing home groups in any of the QOL domains. Multiple linear regression analyses revealed that poor physical QOL was significantly predicted by severe depressive symptoms, insomnia, major medical conditions, unmarried status, and lower education ( F 11,438 = 26.2, P < 0.001), which accounted for 38.2% of the variance. Poor psychological QOL was significantly predicted by severe depressive symptoms and lower educational level ( F 11,438 = 24.3, P < 0.001), which accounted for 36.4% of the variance. Poor social QOL was significantly predicted by severe depressive symptoms, male gender, and unmarried status ( F 11,438 = 5.6, P < 0.001), which accounted for 12.5% of the variance. Poor environment QOL was significantly predicted by lower educational level, severe depressive symptoms, and younger age ( F 11,438 = 6.6, P < 0.001), which accounted for 12.1% of the variance. CONCLUSION: Older Macanese adults had poorer scores on physical and social QOL domains than the general Hong Kong Chinese population. Their QOL was more strongly related to severe depressive symptoms, major medical conditions, and insomnia.

The MacArthur Competence Assessment Tools for assessing decision-making capacity in schizophrenia: A meta-analysis.

OBJECTIVE: This meta-analysis aimed to examine the decisional capacity measured by the MacArthur Competence Assessment Tools (MacCAT) in schizophrenia. METHOD: English (PubMed, PsycINFO, Embase, Cochrane Library databases and the Cochrane Controlled Trials Register) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from 1995 until August 1, 2016. Weighted and standardized mean differences were calculated. The random effects model was used in all cases. RESULTS: Altogether 10 studies were identified, with 7 studies using the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) and 3 studies using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). The meta-analysis showed that there was significant impairment in decision-making capacity in schizophrenia patients compared to the healthy control group in terms of Understanding (SMD=-0.81, 95% CI: -1.06 to -0.56, P<0.001), Reasoning (SMD=-0.57, 95% CI: -0.80 to -0.34, P<0.001), Appreciation (SMD=-0.87, 95% CI: -1.20 to -0.53, P<0.001), and Expression a choice (SMD=-0.24, 95% CI: -0.43 to -0.05, P=0.01). CONCLUSION: Compared to the control group, schizophrenia patients are more likely to have impaired decision-making capacity in clinical research and treatment as measured by the MacCAT instruments. Researchers and clinicians need to consider the impaired decisional capacity in schizophrenia patients providing informed consent.

Relationship of Sleep Duration with Sociodemographic Characteristics, Lifestyle, Mental Health, and Chronic Diseases in a Large Chinese Adult Population.

STUDY OBJECTIVES: Pattern of sleep duration and its correlates have rarely been reported in China. This study examined the sleep duration and its relationship with sociodemographic variables, lifestyle, mental health, and chronic diseases in a large Chinese adult population. METHODS: This cross-sectional study used multistage stratified cluster sampling. A total of 17,320 participants from Jilin province were selected and interviewed using standardized assessment tools. Basic socio-demographic and clinical data were collected. Sleep duration was classified as short (< 7 h per day), long (> 9 h per day) and medium sleep (7-9 h per day). RESULTS: The mean age of the sample was 42.60 ± 10.60 y, with 51.4% being female. The mean sleep duration was 7.31 ± 1.44 h. Short and long sleepers accounted for 30.9% and 6.9% of the sample, respectively. Multinomial logistic regression analysis revealed that older age, current smoking, irregular meal pattern, lack of physical exercise, poor mental health, and chronic diseases or multimorbidity were positively associated with short sleep. Being married and living in rural areas were, however, negatively associated with short sleep. In addition, living in rural area, current smoking, current alcohol use and lack of physical exercise were positively associated with long sleep, while older age and lower education were negatively associated with long sleep. CONCLUSION: Given the high frequency of short sleep and its negative effect on health, health professionals should pay more attention to sleep patterns in general health care. Nationwide epidemiologic surveys in China are needed to further explore the relationship between sleep duration and health.

Use of electroconvulsive therapy in older Chinese psychiatric patients.

OBJECTIVE: Little is known about the use of electroconvulsive therapy (ECT) in older Chinese psychiatric patients. This study examined the frequency of ECT and the demographic and clinical correlates in older psychiatric patients hospitalized in a large psychiatric institution in Beijing, China. METHODS: This was a retrospective chart review of 2339 inpatients aged 60 years and older treated over a period of 8 years (2007-2013) in a university-affiliated psychiatric institution in Beijing. Sociodemographic and clinical data were collected from the electronic chart management system for discharged patients. RESULTS: The rate of ECT use was 28.1% in the whole sample; 37.9% in those with bipolar disorders, 43.6% in major depression, 21.2% in schizophrenia, and 10.7% in other diagnoses. ECT ("ECT group") was associated with 60-65-year age group, high risk for suicide and low risk for falls at the time of admission, use of mood stabilizers and antidepressants, lack of health insurance, and having major medical conditions and diagnosis of major depression. The above significant correlates explained 24.9% of the variance of ECT use (p < 0.001). CONCLUSIONS: In a major psychiatric hospital in China, the use of ECT was common among older patients. ECT use in older patients treated in other clinical settings warrants further investigations.