Sleep problems in Chinese elderly in Hong Kong.

BACKGROUND: To examine the sleep habits and one-year prevalence of sleep disturbance (difficulty in falling asleep, broken sleep and early morning wakening) as well as insomnia (subjectively inadequate or poor sleep) in an elderly Chinese population in Hong Kong. METHOD: In Phase 1, a representative sample of elderly aged 70 years or above were interviewed with a sleep questionnaire, and Cantonese versions of the Mini-Mental State Examination (CMMSE) and Geriatric Depression Scale(CGDS). In Phase 2, those with scores suggestive of cognitive impairment on CMMSE or depression on CGDS were interviewed by psychiatrists for making clinical diagnoses according to DSM IV. RESULTS: 1,034 elderly were interviewed in Phase 1. Occasional or persistent sleep disturbance were reported by 75% and insomnia in 38.2% of elderly. Slightly less than half of elderly with sleep disturbance complained of insomnia. Advancing age was associated with a higher rate of sleep disturbance while females had a higher rate of insomnia. Factors associated with sleep disturbance and insomnia included poor perceived health, past history of smoking, current depressive disorders, more chronic physical illness, more life events and more somatic complaints. Only 2.8% of the sample had taken sleeping pills within a one-year period. CONCLUSIONS: Sleep disturbance and insomnia are two separate but overlapping constructs and should be differentiated. Sleep disturbance is very common in the elderly and may be due to physiological changes with ageing. In contrast, those with a concommitant complaint of insomnia have impaired physical and mental health and may merit more medical attention.

A discriminant analysis of neuropsychological effect of low lead exposure.

The purpose of this study is to determine the contribution of psychological tests in discriminating neuropsychological effects of low lead exposure. The sample consists of 49 workers occupationally exposed to lead and a control group of 36 non-exposed workers. Their performance on various neuropsychological measures was subject to a discriminant analysis using the SPSS DISCRIMINANT subprogramme. The results indicate that simple reaction time, Digit Symbol (WAIS) and Trail-Making Test (Part A) provide the best combination of tests for the detection of neurotoxic effect of low lead exposure.

Work stress among six professional groups: the Singapore experience.

Recent developments in stress research have called for attention to how social structures influence the stress and coping processes. This paper examines the experience of work stress among professionals in Singapore and argues that workers' experiences in the workplace are influenced not only by individual personality and job nature, but also by structural forces shaping the profession, the social organization of work institutions and the development of the economy. Data were collected from a survey of professionals in Singapore conducted in 1989-1990. The sample consisted of 2570 men and women from six different professions and para-professions, namely general practitioners, lawyers, engineers, teachers, nurses and life insurance personnel. Results showed that performance pressure and work-family conflicts were perceived to be the most stressful aspects of work. These two stressors also significantly contributed to the experience of overall work stress. Further, stress arising from work-family conflicts, performance pressure and poor job prospects was negatively associated with the level of work satisfaction. These findings were discussed in the contexts of increasing professionalization and de-professionalization and the growing emphases on productivity and efficiency in a quickly developing economy.

Self-rated economic condition and the health of elderly persons in Hong Kong.

Studies have documented that health and income are important variables affecting the quality of life in old age. However, there is little knowledge about whether perceived financial sufficiency affects the health of elderly persons. Recent research has documented that in addition to material and behavioural determinants, psychosocial pathways also have an influence on health inequalities. This is the first paper to examine the relation between self-rated economic condition (measured with a single item question) and reported health conditions (i.e., somatic complaints, diagnosed physical diseases, functional health (Activities of Daily Living), self-rated health, and mental health status (General Health Questionnaire-30 [GHQ-30]) among elderly persons in Hong Kong. The respondents of the study were persons aged 65 and over residing in public housing estates in the Southern District of Hong Kong Island. Four hundred and fifty respondents were interviewed in 1995 by means of a structured questionnaire. The study found that although it did not record the actual income levels of the respondents, the subjective measure vividly demonstrated the health differentials among the elderly respondents. Multiple regression analyses suggested that self-rated economic condition was a significant predictor of the number of somatic complaints and physical illnesses reported, as well as of functional health, self-rated health, and mental health status (controlling for socio-demographic variables). However, the measure explained a higher proportion of variance in models related to psychological health than those related to physical health. The findings substantiated the role of psychosocial processes in understanding perceived health and illness and health inequalities in particular.

Work stress and psychological well-being among the nursing profession in Singapore.

OBJECTIVE: To investigate the work stress of nursing and its relationship with the psychological well-being of the nurses. DESIGN: A survey research method was adopted in which a questionnaire was designed for data collection. SETTING: The study was conducted in the hospital setting. SUBJECTS: Nurses (N = 1,043) of different grades participated in this study on an anonymous and voluntary basis. MEASURES: A work stress measure (ie, the Nursing Stress Inventory) and GHQ-12 were incorporated in a questionnaire which also contained items on subject's background information. RESULTS: The eight areas of work stress identified were found to be negatively related to psychological well-being of the nurses, with stronger effects on anxiety and depression than sense of adequacy. CONCLUSION: Certain work stressors were more detrimental than those others. They may also exert differential effects on the affective and cognitive stress reactions.

Coping and family relationships in stress resistance: a study of job satisfaction of nurses in Singapore.

This study examined the role of coping strategies and family relationships in mitigating the negative effect of work stress on nurses. The findings indicated that nurses who adapted to work stress with high job satisfaction were more inclined to adopt approach coping methods (problem orientation, ability enhancement, and change of perspective) than those who reported low job satisfaction under high work stress. The stress-resistant nurses were also distinguished by a less frequent use of defensive or avoidance coping in handling of their emotional reactions to stress. They perceived greater family support than did the distressed nurses. Implications of the findings and limitation of the study were discussed.

Clinical experience with phototherapy.

Clinical experience with phototherapy in 3,999 infants with non-haemolytic hyperbilirubinaemia and 427 infants with hyperbilirubinaemia associated with G6PD deficiency is presented. For non-haemolytic hyperbilirubinaemia, phototherapy was extremely effective in extremely preterm infants with very low birth weight (gestation less than or equal to 32 weeks, birth weight less than or equal to 1,500 gm) and least effective in full term infants with very low birth weight (gestation greater than 37 weeks, birth weight less than or equal to 1,500 gm) and large preterm infants (gestation less than 37 weeks, birth weight greater than 2,270 gm). The failure rate of phototherapy for non-haemolytic hyperbilirubinemia was only 2.00/1,000 infants. The bilirubin rebound was usually mild; repeat phototherapy was required in only 30 infants (7.50/1,000) with the response to the second exposure comparable to that of the first. No infant required a third exposure. Phototherapy was effective in reducing bilirubin levels in hyperbilirubinaemia associated with G6PD deficiency, the effectiveness being, however, less than in babies with non-haemolytic hyperbilirubinaemia (G6PD normal status). There was no failure in this group of babies. Only a small proportion of infants required a second exposure (4.68/1,000). All the infants tolerated phototherapy well with none developing any illness that could be attributed to the exposure. This clinical experience demonstrates that phototherapy is effective and safe for the treatment of non-haemolytic hyperbilirubinaemia or hyperbilirubinaemia associated with G6PD deficiency.

Effects of occupational exposure to toluene: a neuropsychological study on workers in Singapore.

The neuropsychological functionings of workers (n = 29) occupationally exposed to low level of toluene (mean blood toluene level 1.25 ug/ml, standard deviation [SD] 0.37 ug/ml) were assessed by a test battery based on the recommendation of US National Institute of Occupational Safety and Health. The data revealed that the exposed workers performed poorer than a control group (mean blood toluene level 0.16 ug/ml, SD 0.06 ug/ml) in short-term memory, sustained attention and concentration, visual scanning, perceptual-motor speed, and finger dexterity. Results of the study confirmed that exposure to toluene may result in different degree of impairments of brain functions.

Help-seeking preference of college students in urban China after the implementation of the "open-door" policy.

A sample of 466 college students (228 males, 238 females) in urban China completed a questionnaire to indicate their help-seeking preferences with respect to 8 types of problem. The results indicated that our subjects, particularly male students, preferred to rely on their own in resolving their problems, although this self-reliant tendency was less obvious for problems of future employment and severe psychological distress. When help was sought, the tendency to rely on parents was found to be stronger among females than males. Male students were more likely than their female counterparts to seek help from friends and psychiatric consultation. Nevertheless, there was still great reluctance among the college students to use mental health services, particularly psychiatric consultation. Lack of credibility of the professionals was a barrier more negative than stigmatization which prevented students from seeking psychiatric consultation. Moral rather than psychosocial attribution of psychiatric illness was most predictive of the tendency to use mental health services. Findings inconsistent with those reported in other Chinese communities are discussed.

Help-seeking pattern of psychiatric outpatients in urban China.

The subjects of this study (N = 1297, male = 600, females = 697) were first time adult patients (aged 20 to 59 years) who sought psychiatric treatments at a mental health centre in Shanghai over a period of 12 months. Compared with adult population in Shanghai, the patients were of higher educational levels and were over-represented by the unmarried, separated, or divorced. A higher proportion of the patients were in their early adulthood. The most common presenting problems were sleep disturbance, somatic symptoms, and paranoid ideation. About 25% of the patients took their own initiative to seek psychiatric treatments and more than half (55.2%) were referred by their spouse or relatives. Decision for psychiatric treatments was made after a long delay since the first onset of illness (average = 2.7 years). Consistent with findings reported in other Chinese communities, their paths to seeking psychiatric treatments were diverted primarily through Western-style or traditional Chinese physicians. Stigmatization associated with psychiatric illness and lack of trust in psychiatric services were major deterring factors in seeking psychiatric treatments.

The psychological well-being of the Chinese elderly living in old urban areas of Hong Kong: a social perspective.

Using the Geriatric Depression Scale-15 (GDS-15) and the short form of the General Health Questionnaire-12 (GHQ-12), this study found that the Chinese elderly who live in old urban areas of Hong Kong are at risk of suffering from poor mental health because of their relatively deprived social conditions. It was also found that the respondent's scores in the GDS-15 correlated with their social conditions, including type of housing, availability of helpers, financial status and family support. However, Chinese elderly people often avoid seeking help because of the fear of being stigmatised. There is a need for more research in the future to study their needs and problems so that social work practitioners can be well informed and culturally competent to help this disadvantaged group.

Life strain and psychological distress of older women and older men in Hong Kong.

This study examined the life strain and psychological distress among a group of older adults (N = 1034, 51.2% female) in Hong Kong. Data were collected through individual interviews in which a standardized questionnaire was administered. The results indicated that older women had more somatic complaints and poorer self-rated health. Family network and interdependent relationships were significantly poorer among the older women than in the older men. Women were also found to experience a higher level of psychological distress (as measured by GDS-15 and GHQ-12) than did men. Perceived financial strain and poor physical health had similar direct effect on the psychological distress of both older women and older men. In contrast to Western findings, a poor family network was observed to exert a greater direct effect on psychological distress than an inadequate social network of friends. Generally, a good social network was found to mitigate the negative impact of life strain factors among older men, but not among older women.

Cross-validation of a short form of the CES-D in Chinese elderly.

OBJECTIVE: To establish the reliability and validity of a 10-item short form of the CES-D (CESD-10). DESIGN: Cross-sectional and longitudinal follow-up over 3 years. Standardized questionnaire and face-to-face interview were conducted. SETTING: Community and psychogeriatric assessment clinic of a voluntary organization. PARTICIPANTS: Five hundred and fifty-four elderly in the general community, 30 elderly from a community centre and 31 elderly patients with depressive symptoms. MEASURES: Instruments other than the CESD-10 included Activities of Daily Living (ADL), the Life Satisfaction Scale (LSS), the Lubben Social Network Scale, a single-item measure of self-rated health. RESULTS: Reliability of the CESD-10 in terms of internal consistency was satisfactory (Cronbach alpha = 0.78-0.79). Moderate consistency over a period of 3 years was also found to be significant (r = 0.44, p < 0.01). The CESD-10 showed comparable accuracy to the original CES-D in classifying cases with depressive symptoms (kappa = 0.84, p < 0.01). Significant relationships of the CESD-10 with impairments of daily functioning, life satisfaction, social support, and self-rated health were established. The CESD-10 also differentiated significantly between groups of 'normal' and clinically depressed elderly. CONCLUSION: The CESD-10 attained satisfactory content and temporal reliability. Its construct and concurrent validity were established. With its brevity, it should prove a useful mental health measure for the elderly.