Assessing negative symptoms in schizophrenia: Validity of the clinical assessment interview for negative symptoms in Singapore.

This study aimed to examine the validity of the Clinical Assessment Interview for Negative Symptoms (CAINS) in Singapore. 274 participants with schizophrenia were assessed on the CAINS, Scale for the Assessment of Negative Symptoms (SANS), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Assessment Scale (SOFAS) and the Simpson-Angus Extrapyramidal Side Effects Scale (SES). Factor analyses were conducted and Cronbach's coefficient alpha was calculated. Spearman's correlation coefficient was used to assess correlations. The 2-factor model of the CAINS failed to fit our data. Exploratory factor analysis of a randomly selected split-half of the sample yielded four factors: motivation-pleasure (MAP) social, MAP vocational, MAP recreational and expression (EXP), accounting for 73.94% of the total variance. Confirmatory factor analysis on the remaining sample supported this factor structure. Cronbach's alpha for the CAINS was 0.770. Significant correlations were observed between the CAINS total and the SANS total and PANSS negative subscale scores. Good divergent validity was shown by insignificant correlations with PANSS positive subscale score and CDSS total score. The MAP social and recreational factor scores had moderate correlations with the SANS anhedonia-asociality subscale scores, whereas the MAP vocational factor had the highest correlation with the avolition-apathy subscale of the SANS. EXP factor score correlated strongly with the SANS affective flattening and alogia subscales scores. In conclusion, the CAINS has good psychometric properties and can be used by clinicians to assess negative symptoms in individuals with schizophrenia in the local population.

Elderly suicide with and without a history of suicidal behavior: implications for suicide prevention and management.

This study examined the impact of a history of suicidal behavior on suicide among elderly people in Singapore. In this coroner register-based study, characteristics of 409 elderly people who died of suicide in Singapore between 2000 and 2004 were examined. Sixty-five people were classified with a history of previous suicidal behavior and 344 people without a history of suicidal behavior. Elderly people who died of suicide and had a past history of suicidal behavior were more likely to suffer from major psychiatric disorders (26.2% vs 10.2%, p = 0.001), encounter social problems in life (33.9% vs 21.5%, p = 0.038), have alcohol detected in the blood toxicology report at autopsy (23.1% vs. 12.8%, p = 0.036), receive psychiatric treatment in the past (60% vs. 37.5%, p < 0.001), have antidepressant detected in the blood toxicology report at autopsy (16.9% vs. 8.1%, p = 0.037), and be admitted to a mental hospital under the mental health legislation (36.9% vs. 11.6%, p < 0.001). Conversely, those without a past history of suicidal behavior were more likely to have a pre-suicidal plan for the fatal suicide act (11.1% vs. 1.5%, p = 0.011) and have received medical or surgical treatment in the past (22.1% vs. 9.2%, p = 0.018). For suicide prevention in Asians, psychiatrists should aggressively treat major psychiatric disorders, engage social services to resolve social problems in elderly people with a history of suicidal behavior, and reduce access to alcohol. Clinicians working in medical or surgical departments should routinely screen for suicide plans in elderly patients without a past history of suicidal behavior.

Validity and reliability of the Zarit Burden Interview in assessing caregiving burden.

INTRODUCTION: This study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore. MATERIALS AND METHODS: Adult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey. RESULTS: A total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149). CONCLUSION: The results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.

Predicting gains in dementia caregiving.

BACKGROUND: Caregiver gain is an important yet less-explored phenomenon. Being conceptually distinct from burden, factors associated with burden and gain can differ. This study aims to explore factors associated with the experience of gains in dementia caregiving. METHOD: Cross-sectional study involving caregivers recruited from a tertiary hospital dementia clinic and the local Alzheimer's Association. Caregivers completed a questionnaire containing the following scales: gain in Alzheimer's care Instrument (GAIN), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), Revised Memory and Behavioral Problems Checklist (RMBPC) and Zarit Burden Interview (ZBI). Demographic information for the person with dementia (PWD) and the caregiver was also recorded. Initial screening with univariate analyses (t tests, ANOVAs, Pearson's correlations) was performed to identify significant (p < 0.05) variables, which were then entered into a multiple regression model to identify variables associated with gain. RESULT: The final sample comprised 334 caregivers with a mean age of 51.5 years (SD = 10.9, range = 22-85), the majority of whom where Chinese (94.6%) females (71%). Mean GAIN score was 30 (SD = 6.6, range = 7-40). Regression analysis identified 3 factors significantly associated with gains (adjusted R(2) 32.3%): mental well-being of the caregiver, use of active management as a caregiving strategy, and participation in caregiver educational and support group programmes. CONCLUSION: The results have important implications for caregiver interventions. Interventions should target maintaining mental well-being, encouraging participation in educational and support programmes, and teaching appropriate coping and dementia specific management strategies to derive good outcomes.

Why family caregivers choose to institutionalize a loved one with dementia: a Singapore perspective.

AIM: To examine factors associated with family caregivers' choice of care setting (own home vs. nursing home) for their relatives with dementia. METHODS: Cross-sectional study involving caregivers recruited from a tertiary hospital dementia clinic and the local Alzheimer's association. Caregivers completed a questionnaire containing demographics of the person with dementia (PWD) and caregiver, their choice of care setting and the following scales: Gain in Alzheimer Care Instrument, General Health Questionnaire, Short Sense of Competence Questionnaire, Revised Memory and Behavioral Problems Checklist and Zarit Burden Interview. Multiple logistic regression was performed to identify significant variables associated with the outcome of interest. RESULTS: The final sample comprised 266 caregivers, the majority of whom were Chinese, female and children of PWD. Most (85.7%) preferred care at home, only 38 (14.3%) chose institutionalization. Four factors were associated with choice of nursing home: caregiver working (OR = 6.363, 2.120-19.086), no domestic maid (OR = 3.27, 1.458-7.331), lower caregiver gain (OR = 0.935, 0.882-0.992) and behavioral problems in PWD (OR = 1.011, 1.005-1.018). CONCLUSION: Strategies to minimize institutionalization must first address the provision of a dedicated caregiver at home. Consequently, interventions to help caregivers cope with behavioral problems in PWD and enhance caregiver gain are relevant.