Comparison of unweighted and item response theory-based weighted sum scoring for the Nine-Questions Depression-Rating Scale in the Northern Thai Dialect.

BACKGROUND: The Nine-Questions Depression-Rating Scale (9Q) has been developed as an alternative assessment tool for assessing the severity of depressive symptoms in Thai adults. The traditional unweighted sum scoring approach does not account for differences in the loadings of the items on the actual severity. Therefore, we developed an Item Response Theory (IRT)-based weighted sum scoring approach to provide a scoring method that is more precise than the unweighted sum score. METHODS: Secondary data from a study on the criterion-related validity of the 9Q in the northern Thai dialect was used in this study. All participants were interviewed to obtain demographic data and screened/evaluated for major depressive disorder and the severity of the associated depressive symptoms, followed by diagnosis by a psychiatrist for major depressive disorder. IRT models were used to estimate the discrimination and threshold parameters. Differential item functioning (DIF) of responses to each item between males and females was compared using likelihood-ratio tests. The IRT-based weighed sum scores of the individual items are defined as the linear combination of individual response weighted with the discrimination and threshold parameters divided by the plausible maximum score based on the graded-response model (GRM) for the 9Q score (9Q-GRM) or the nominal-response model (NRM) for categorical combinations of the intensity and frequency of symptoms from the 9Q responses (9QSF-NRM). The performances of the two scoring procedures were compared using relative precision. RESULTS: Of the 1,355 participants, 1,000 and 355 participants were randomly selected for the developmental and validation group for the IRT-based weighted scoring, respectively. the gender-related DIF were presented for items 2 and 5 for the 9Q-GRM, while most items (except for items 3 and 6) for the 9QSF-NRM, which could be used to separately estimate the parameters between genders. The 9Q-GRM model accounting for DIF had a higher precision (16.7%) than the unweighted sum-score approach. DISCUSSION: Our findings suggest that weighted sum scoring with the IRT parameters can improve the scoring when using 9Q to measure the severity of the depressive symptoms in Thai adults. Accounting for DIF between the genders resulted in higher precision for IRT-based weighted scoring.

Time-series analysis of trends in the incidence rates of successful and attempted suicides in Thailand in 2013-2019 and their predictors.

BACKGROUND: Suicide rates are of increasing concern worldwide. There are approximately 4000-5000 deaths by suicide each year in Thailand. This study examined trends in annual incidence rates and predictors of successful and attempted suicides in Thailand (2013-2019). METHODS: Secondary data analysis was conducted on data from two national-level databases: The National Health Security Office and the National Death Certification Registry System. Time-related trends and predictors of successful and attempted suicides were calculated using joinpoint regression and multivariable logistic regression analyses, respectively. RESULTS: Of all successful suicide cases from 2013 to 2019, about 80% involved men, with an average age of 45.37 (± 16.43) years. Predictors of successful suicide included male sex, older age, using highly lethal methods, and no prior psychiatric treatment. Among individuals admitted to hospitals following a suicide attempt from 2013- to 2019, the average age at first admission was 38.83 ± 22.47 years, with women more heavily represented than men. Only 2.3% of these patients received psychiatric treatment in the hospital. Predictors of attempted suicide included female sex; adolescent or adult; and mental, alcohol, or substance-related disorder(s). Age-standardized annual rates per 100,000 people showed that, through 2019, suicide incidence increased slightly, and attempts decreased. CONCLUSIONS: There was a significantly increasing trend in successful suicide during the 7 years; the increase was more notable among men. The study highlights sex-related gaps in public health owing to an identified higher incidence of suicide among men, and a higher incidence of suicide attempts in women adolescents, emphasizing the need to consider sex-sensitive issues in individual as well as societal contexts.

Mediation model of comorbid anxiety disorders in late-life depression.

BACKGROUND: A number of studies have been conducted on risk factors of comorbid anxiety disorders regarding late-life depression (LLD). This study investigated the associated factors and their relationship to comorbid anxiety disorders in LLD. METHODS: Participants included 190 elderly Thais (73.2% female, with a mean age of 68.39 ± 6.74 years) with depressive disorders, diagnosed according to DSM-IV Diagnosis Axis I disorders assessed by Mini-International Neuropsychiatric Interview. Demographic data, medical and psychiatric history, family psychiatric history, past depression, family history of depression, Neuroticism Inventory and 7-Item Hamilton Depression Rating Scale (HAMD-7) were analyzed for path analysis using Structural Equation Model framework. The bootstrapping method was used for testing indirect effects. RESULTS: Being female was associated with comorbid anxiety disorders with an indirect effect (ß = - 0.032, P = 0.018) through neuroticism, depression severity, history and family history of depression. Family history of depression had no effect on comorbidity (P = 0.090). Neuroticism had an indirect effect on comorbid anxiety disorders (ß = 0.075, P = 0.019) via depression severity as reflected by HAMD-7 score (ß = 0.412, P = < 0.001). Total variance explained from this model was 11%. This model had good-fit index with Chi-square > 0.05, CFI and TLI > 0.95 and RMSEA < 0.06. CONCLUSION: Neuroticism mediates the effect of relationship between sex, family history and history of depressive disorders and comorbid anxiety disorders in LLD. Moreover, depression severity is a mediator for neuroticism and comorbid anxiety disorders. Longitudinal studies are warranted to indicate the importance of effective treatment of depression to lower the risk of developing comorbid anxiety disorders among depressed elderly.

Confirmatory factor analysis of the revised version of the Thai multidimensional scale of perceived social support among the elderly with depression.

OBJECTIVE: Difficulties in modeling the Multidimensional Scale of Perceived Social Support (MSPSS) have occurred, and these were corrected in the revised version of the Thai MSPSS. However, the revised version has not been tested in elderly populations. The present study aimed at confirming the factor structure of the revised version of the MSPSS among the elderly with depressive disorders, in populations with or without depressive disorders. METHODS: Eight hundred and three elderly patients were recruited from four tertiary hospitals; 190 (23.7%) had depressive disorders. All completed the revised Thai MSPSS consisting of 12 items, using a 7-point Likert scale. Confirmatory factor analysis (CFA) of the MSPSS was conducted in both groups. RESULTS: The mean age was 69.24 years (SD 6.88), and 70% of the sample was female. There were no significant difference in demographic data between two groups. The revised version of the Thai MSPSS provided excellent internal consistency. The three-factor model was clearly superior to other alternative models in both depressed and non-depressed groups. CFA for the whole group revealed an acceptable model fit: χ2 = 147.44, df = 45, p < 0.001; Tucker-Lewis Index 0.975; Comparative Fit Index 0.982; Good Fit Index 0.966; and root-mean-square error of approximation 0.056. The fit statistics in the depressed group was better than in the non-depressed group across all models. CONCLUSIONS: Due to its robust factor structure, these data support the use of the revised MSPSS as a brief instrument for assessing perceived social support in the elderly with or without depressive disorders.

Attempted Suicide Triggers in Thai Adolescent Perspectives.

The study goal was to describe attempted suicide triggers in Thai adolescents. A descriptive exploratory qualitative study approach was used utilizing in-depth interviews with twelve adolescents who had attempted suicide and six of their parents. Content analysis was conducted. Attempted suicide triggers were (1) severe verbal criticisms and expulsion to die by a significant family member, (2) disappointed and unwanted by boyfriend in first serious relationship, (3) unwanted pregnancy, and (4) mental illness leading to intense emotions and irresistible impulses. These attempted suicide triggers should be of concern and brought into suicide prevention management programs such as emotional management, effective communication for adolescents and family.

Hypnosis as an Adjunct for Managing Pain in Head and Neck Cancer Patients Post Radiotherapy.

Background: Many factors contribute to pain in cancer patients. Hypnotherapy is the mental processes, involving conscious and unconscious awareness to understanding of the pain to correct thought, improve emotional acceptance, and reduce pain by the patient themselves. Objective: To examine the effects of hypnotherapy on pain reduction in the patient's with head and neck cancer after radiation therapy. Material and Method: A randomized controlled clinical trial was conducted with the 68 patients who were divided into two groups, i.e., 34 patients undergoing hypnotherapy and 34 patients received usual care. Visual analogue scales (VAS) were used for pain assessment. Results: Sixty-eight patients were recruited in the present study and half were randomly assigned to hypnotherapy group. One participant in the treatment and two participants in the control groups discontinued before the end of the study. Demographic data were comparable in the two groups. No complication was found during, immediately after, or five days after the procedure. After adjusted with baseline, gender, age, non-opioid, week-opioid, and strong-opioid, hypnosis treatment demonstrated significantly less pain score -1.966, (95% CI -2.260 to -1.673, p-value <0.001) than the control group. Conclusion: Hypnosis can reduce pain in patients with head and neck cancer after radiation therapy and it is much better when using combination with the strong opioids. The hypnosis command can be used to reduce chronic pain for cancer patients with head and neck in addition to the usual treatments. Relationships between clinician and patient, patient's knowledge, exploring patient's difficulties, and hypnosis training are all important factors to be considered before the hypnotherapy.

Developing a risk prediction model for death at first suicide attempt-Identifying risk factors from Thailand's national suicide surveillance system data.

More than 60% of suicides globally are estimated to take place in low- and middle-income nations. Prior research on suicide has indicated that over 50% of those who die by suicide do so on their first attempt. Nevertheless, there is a dearth of knowledge on the attributes of individuals who die on their first attempt and the factors that can predict mortality on the first attempt in these regions. The objective of this study was to create an individual-level risk-prediction model for mortality on the first suicide attempt. We analyzed records of individuals' first suicide attempts that occurred between May 1, 2017, and April 30, 2018, from the national suicide surveillance system, which includes all of the provinces of Thailand. Subsequently, a risk-prediction model for mortality on the first suicide attempt was constructed utilizing multivariable logistic regression and presented through a web-based application. The model's performance was assessed by calculating the area under the receiver operating curve (AUC), as well as measuring its sensitivity, specificity, and accuracy. Out of the 3,324 individuals who made their first suicide attempt, 50.5% of them died as a result of that effort. Nine out of the 21 potential predictors demonstrated the greatest predictive capability. These included male sex, age over 50 years old, unemployment, having a depressive disorder, having a psychotic illness, experiencing interpersonal problems such as being aggressively criticized or desiring plentiful attention, having suicidal intent, and displaying suicidal warning signals. The model demonstrated a good predictive capability, with an AUC of 0.902, a sensitivity of 84.65%, a specificity of 82.66%, and an accuracy of 83.63%. The implementation of this predictive model can assist physicians in conducting comprehensive evaluations of suicide risk in clinical settings and devising treatment plans for preventive intervention.

Efficacy of traditional Thai massage as adjunctive therapy in patients with major depressive disorder.

Background: Major depressive disorder (MDD) is the most common mental ailment. Moreover, it is one of the most incapacitating medical conditions. Although antidepressant medication has traditionally been the mainstay of treatment, adjunctive therapy may provide therapeutic advantages that reduce the severity of depression. Methods: An experiment using randomization and control groups was undertaken. A total of forty-eight individuals diagnosed with severe depressive illness and undergoing antidepressant medication were selected and randomly assigned to either get traditional Thai massage (TTM) treatment, consisting of 90-minute sessions twice a week for eight weeks, or to be part of the control group, which continued with their regular daily activities. The main assessment tools used were the Hamilton Depression Rating Scale (HAM-D), the Clinical Global Impression-Severity (CGI-S), and the Khon Kaen University Depression Inventory 14 (KKU-DI-14). Secondary outcomes, such as blood pressure (BP) and quality of life measured by The EuroQol-5D-5L (EQ-5D-5L), were assessed both before and after the first therapy, as well as at the last session at the 8th week. Results: The TTM group showed a statistically significant decrease in the HAM-D score within the eighth week of therapy compared to the control group (5.14 points, 95% confidence interval=2.92 to 7.37 points, P<0.001). Conclusion: These findings suggest that combining TTM with antidepressant medication may effectively reduce depression scores and improve quality of life scores.

Factor Structures in the Depressive Symptoms Domains in the 9Q for Northern Thai Adults and Their Association with Chronic Diseases.

Most of the common models to examine depression are one-factor models; however, previous studies provided several-factor structure models on each depressive symptom using the Patient Health Questionnaire-9 (PHQ-9). The Nine-Questions Depression-Rating Scale (9Q) is an alternative assessment tool that was developed for assessing the severity of depressive symptoms in Thai adults. This study aimed to examine the factor structure of this tool based on the factor structure models for the PHQ-9 provided in previous studies using confirmatory factor analysis (CFA). We also examined the association of chronic diseases and depressive symptoms using the Multiple Indicators Multiple Causes model among 1346 participants aged 19 years old or more without psychiatric disorders. The results show that the two-factor CFA model with six items in the cognitive-affective domain and three items in the somatic domain provided the best fit for depressive symptoms in the study population (RMSEA = 0.077, CFI = 0.953, TLI = 0.936). Dyslipidemia was positively associated with both cognitive-affective symptoms (ß = 0.120) and somatic depressive symptoms (ß = 0.080). Allergies were associated with a higher level of cognitive-affective depressive symptoms (ß = 0.087), while migraine (ß = 0.114) and peptic ulcer disease (ß = 0.062) were associated with a higher level of somatic symptoms. Increased age was associated with a lower level of somatic symptoms (ß = -0.088). Our findings suggested that considering depressive symptoms as two dimensions yields a better fit for depressive symptoms. The co-occurrence of chronic diseases associated with depressive symptoms should be monitored.

Using MoCA-Thai to evaluate cognitive impairment in patients with schizophrenia.

BACKGROUND: Schizophrenia is a chronic devastating illness with specific effects on cognitive function. A few studies have been performed on Asian patients. OBJECTIVE: To examine prevalence of cognitive impairment and associated factors in Thai patients with schizophrenia. MATERIAL AND METHOD: A descriptive cross-sectional study of patients with schizophrenia that were selected consecutively from a psychiatric outpatient clinic at Srinagarind Hospital, Khon Kaen University between June 2008 andDecember 2009 was conducted. The Montreal Cognitive Assessment-Thai version (MoCA-T) test was used to evaluate cognitive functions. Associated factors such as age of onset, type of antipsychotics were assessed by collecting data from medical records. Data analysis used descriptive statistics, and univariate analysis used Chi-square. RESULTS: Seventy-five patients with schizophrenia were recruited The majority of cases was single, male, had low education, and manifested paranoia. The prevalence of cognitive impairment was 81.3%. Significant factors associated with cognitive impairment were the year of education lower than 12 (OR = 9.25, 95% CI 1.90-45.03, p = 0.002) and those who had taken typical and combined antipsychotic drugs (OR = 5.97, 95% CI 1.66-21.55, p = 0.005). CONCLUSION: Thai patients with schizophrenia showed a high prevalence of cognitive impairment. Therefore, clinicians should assess cognitive function and cognitive remedy

Characteristics and burden of hospitalization because of intentional self-harm: Thai national, hospital-based data for 2010.

BACKGROUND: There is a paucity of data on intentional self-harm and suicide in Thailand. It is crucial to re-evaluate the burden and health outcomes. OBJECTIVE: To measure the character and burden of acts of intentional self-harm in the Thai hospitalized population. MATERIAL AND METHOD: Acts of intentional-self harm were categorized using ICD 10 classification. All of inpatient-related data were analyzed using SPSS 17. RESULTS: Overall intentional self-harm in 2010 led to 24,924 hospitalizations and 854 deaths; an incidence of 35.6/100,000 people with the highest level in two age groups: 18-25 and 26-40 year-olds. Self-poisoning (89%) was the most common method and pesticide was the leading used chemical agents. The total cost of treatment was 149,672,190 baht and the mean length of stay was 2.9 +/- 6.7 days. The mortality rate increased as the population got older with the highest rate being 10.6% for 70-79 year-olds. In 33.8% of cases, psychiatric co-diagnosis were found with anxiety disorders was the leading comorbidity. CONCLUSION: The incidence of intentional self-harm was medium to high, compared to other East Asians countries. Self-poisoning by exposure to pesticides was the most common self-harm method. Age over 60 had the highest mortality rate. Having a psychiatric co-diagnosis was common.

Breathing meditation by medical students at Khon Kaen University: effect on psychiatric symptoms, memory, intelligence and academic achievement.

OBJECTIVE: To examine the short-term effects on fifth-year medical students of a 4-week, breathing meditation-based, stress reduction intervention on psychiatric symptoms, memory function, intelligence, and academic achievement. MATERIALS AND METHOD: Using a randomized control trial, the meditation group practiced every 8.00 to 8.20 a.m. before beginning daily learning schedule. Meditation emphasized mindful awareness of the breath during inhaling and exhaling. The control group went about their normal activities in the other room. The psychiatric symptoms were measured using the Symptom Checklist-90 (SCL-90), the memory used the Wechsler Memory Scale-I (WMS-I), the intelligence used the Raven's Advanced Progressive Matrices (APM), and the academic achievement used psychiatry course MCQ examination score. Analysis was done using Ancova statistic. RESULTS: Fifty-eight volunteer medical students during their psychiatry rotation between June 2008 and May 2009, were randomized into either in the meditation (n = 30) or the control (non-meditation) (n = 28) group. There was no significant difference between the groups in their respective SCL-90, WMS-I, APM, and psychiatry course MCQ examination score. CONCLUSION: Among normal, intelligent, mentally healthy persons, short-term breathing meditation practice will not likely change psychiatric symptoms, memory function, intellectual performance, and academic achievement.

A Double-Blind, Placebo-Controlled Study of Appropriate Site of Botulinum Toxin Therapy in Hemifacial Spasm.

INTRODUCTION: Hemifacial spasm (HFS) is a condition causing poor quality of life. Treatment with botulinum toxin A (BTX) injection is effective. Only one randomized controlled trial with a single-blind fashion has evaluated if oral injection is needed in HFS. The present study aimed to evaluate the necessity of oral BTX injection in HFS by a randomized, double-blind, placebo-controlled method. METHODS: We conducted a double-blind, placebo-controlled trial in patients with HFS who never received BTX treatment. Eligible patients randomly received either 15 units of BTX around the eye and normal saline around the mouth (group A) or 15 units of BTX around both the eye and the mouth (group B). The primary outcomes were self-reported symptoms and observed frequency of spasms, while the secondary outcome was the duration of improvement or the time between the injection and the recurrence of symptoms to the same condition as before treatment. Student t test and survival analyses were used to compare the duration of symptoms between both groups. The mean changes were compared to secondary outcomes between the two groups. RESULTS: There were 60 patients enrolled, half in each group. Baseline characteristics between both groups were similar. The mean (SD) of the duration of improvement in group A and B was 22.97 (18.85) and 17.53 (14.90) weeks, respectively (p = 0.220). There was no difference between both groups by survival analysis. Group B had a higher percentage of mouth improvement but there was no difference in the percentage of eye improvement, visual analog scale of eye and mouth spasm, or frequency of eye and mouth spasm. Group B had a higher incidence of side effects particularly mouth drooping (30% vs 10%) than group A (p = 0.053). CONCLUSION: The mouth injection of BTX may not be necessary for HFS. It may be beneficial to reduce mouth symptoms with a higher rate of mouth drooping.

Dermatoglyphic traits in Thai schizophrenia patients: a matching case-control study.

OBJECTIVE: To compare fingerprint patterns, means of dermatoglyphic variables i.e., total finger ridge count, total a-b ridge count, pattern complexity index, and fingerprint pattern asymmetry between patients with schizophrenia and normal controls. MATERIAL AND METHOD: A cross-sectional, matching case-control was conducted. Thirty-four males and 34 females with schizophrenia and an equal number of age and sex matched normal controls were selected. Fingerprints and partial palm prints of all of the subjects were obtained using the Automated Inkless Fingerprint Imaging Software and the transparent-adhesive tape technique, respectively. Using paired t-tests (p < 0.05), the cases and controls, males and females separately, were compared for fingerprint pattern asymmetry, total finger ridge counts (TFRC), a-b ridge counts of the right (RABRC), left (LABRC), and both hands (TABRC), and pattern complexity index (PCI). RESULTS: Between cases and controls, neither sex had any significant differences in the mean scores for the pattern asymmetries, TFRC, right-left-ABRC and TABRC. However, the mean scores for PCI were significantly different between the male cases and controls (2.82 vs. 4.94, p = 0 009). CONCLUSION: Only male patients exhibited average scores for complex patterns (whorls minus arches less than 2), which might be a biomarker for screening of schizophrenia in males.

Risperidone long-acting injection (RLAI): the 12-week efficacy and tolerability in Thai patients with chronic schizophrenia.

BACKGROUND: Although oral atypical antipsychotics have improved the outcomes in schizophrenia, the patient medication adherence plays role as the important factor to clinical potential of the drugs. Therefore, the long-acting formulations of antipsychotics have been developed to improve the treatment compliance in patient with schizophrenia and risperidone long-acting injection (RLAI) is the first long-acting injectable drug since then. OBJECTIVE: To evaluate the efficacy and tolerability of long-acting risperidone injection in Thai patients with chronic schizophrenia for 12 weeks treatment. MATERIAL AND METHOD: This was a non-randomized, open-label, single-arm study, performed at 5 centers in Thailand. The eligible patients with schizophrenia diagnosed by DSM-IV criteria were enrolled. Patients received long-acting risperidone injection 25, 37.5 or 50 mg every 2 weeks. Efficacy assessments were measured by Manchester Psychiatric Rating Scale (MPS), CGI-S and SF-36 at baseline, week 6 and week 12 or endpoint visit. Tolerability assessments were measured by Yale Extrapyramidal Symptoms Rating Scale (YESS), Visual analogue scale 10-cm for pain at injection site, body weight (BW) and incidence of adverse events. RESULTS: Of 184 patients recruited, 160 patients (87%) completed the study. RLAI produced a significant improvement (p < 0.001) in MPS positive score from baseline to endpoint, 4.4 +/- 3.7 to 1.6 +/- 2.6. There was also significant reduction in MPS negative score, from 3.06 +/- 2.68 to 0.93 +/- 1.61 at endpoint (p < 0.001). The CGI-S score improved significantly from baseline to endpoint (p < 0.001), as reflected by the increase the proportion of patients rated as "not ill" or "borderline ill" from 5.9% at baseline to 53.2% at endpoint. Quality of life measured on the SF-36 scale was improved in all domains except bodily pain. Movement disorders, measured by YESS, were significantly reduced following RLAI introduction. Treatment with this drug was well tolerated and no significant weight gain occurred during the study. CONCLUSION: This study suggests that RLAI produces symptomatic improvement in chronic schizophrenia patients, along with improvement of movement disorders and had a good tolerability and adherence to treatment.

Validity and reliability study of the Thai version of WHO Schedules for Clinical Assessment in Neuropsychiatry version 2.1.

OBJECTIVE: To determine the validity and reliability of the Thai version of WHO Schedule for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1. MATERIAL AND METHOD: The SCAN interview book version 2.1 was translated from English into Thai. The content validity of the translation was verified by examining the back-translation. Whenever inconsistencies were encountered, the Thai version was adapted to convey the meaning of the original. The revised Thai version was then field-tested in 4 regions of Thailand for comprehensibility of the relatively technical language. Re-edition of the Thai version was made in accordance with suggestions from the field trial. The complete SCAN Thai version was put into the computerized I-Shell program for inter and intra-rater reliability study. RESULTS: Based on the response from Thai subjects and consultations with competent and well SCAN-trained psychiatrists, content validity was established. The inter- and intra-rater agreement of somatoform and dissociative symptoms module were 0.77, 0.85; anxiety: 0.79, 0.84; mood: 0.80, 0.86; eating disorders: 0.73, 0.76; use of alcohol: 0.66, 0.82; stress and adjustment disorders: 0.90, 0.94; psychosis: 0.68, 0.76; cognitive impairment: 0 72, 0.78 and observed behavior, affect and speech module were 0.45 and, 0.51 respectively. CONCLUSION: The SCAN version 2.1 Thai version proved to be a reliable tool for assessing psychiatric illness among Thais.

Prevalence and associated factors of comorbid anxiety disorders in late-life depression: findings from geriatric tertiary outpatient settings.

PURPOSE: The study evaluated the prevalence of comorbid anxiety disorders in late-life depression (LLD) and identified their associated factors. PATIENTS AND METHODS: This study involved 190 elderly Thais with depressive disorders diagnosed according to the Mini-International Neuropsychiatric Interview (MINI). Anxiety disorders were also diagnosed by the MINI. The 7-item Hamilton Depression Rating Scale (HAMD-7), Montreal Cognitive Assessment, Geriatric Depression Scale (GDS), Core Symptoms Index, Neuroticism Inventory, Perceived Stress Scale and Multidimensional Scale for Perceived Social Support were completed. Descriptive statistics and ORs were used for analysis. RESULTS: Participants included 139 females (73.2%) with a mean age of 68.39±6.74 years. The prevalence of anxiety disorders was 7.4% for generalized anxiety disorder (GAD), 4.7% for panic disorder, 5.3% for agoraphobia, 1.1% for social phobia, 2.1% for obsessive-compulsive disorder and 3.7% for post-traumatic stress disorder, with an overall prevalence of 16.84%. The comorbidity of anxiety disorders was associated with gender (P=0.045), history of depressive disorder (P=0.040), family history of depressive disorder (P=0.004), GDS (P=0.037), HAMD-7 (P=0.001), suicidality (P=0.002) and neuroticism (P=0.003). History of alcohol use was not associated. CONCLUSION: The prevalence of anxiety in LLD was comparable to other studies, with GAD and agoraphobia being the most prevalent. This study confirmed the role of depression severity and neuroticism in developing comorbid anxiety disorders.

Prevalence, clinical and psychosocial variables of depression, anxiety and suicidality in geriatric tertiary care settings.

OBJECTIVE: The study investigated the prevalence of depressive and anxiety disorders and suicide risk in geriatric outpatients in tertiary care hospitals. MATERIALS AND METHODS: An observational, cross-sectional study was conducted with 803 participants aged 60 and above attending geriatric outpatient clinics in tertiary care hospitals in Thailand. Participants were assessed using DSM-IV-TR criteria to calculate the prevalence of deressive and anxiety disorders, and their suicide risk. Montreal Cognitive Assessment (MoCA), Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support, Core Symptom Index (CSI), 15-item Geriatric Depression Scale (GDS-15), Neuroticism Inventory (NI) and the Revised Experience of Close Relationships Questionnaire (ECR-R) were administered. Quality of life was assessed using the EuroQoL (EQ-5D). RESULTS: The prevalence rate for depressive disorders was 23.7%, anxiety disorders was 6.4%, and current suicide risk was 20.4%. PSS, MSPSS, GDS, CSI, and NI scores were significantly higher in all clinical disorders and a suicide group compared with nonclinical subjects. MoCA and ECR-R did not differentiate between clinical disorder and nonclinical samples. Comparing all four outcomes, the EQ-5D differed most in the mixed depressive-anxiety disorder and nonclinical groups (t = 12.20, p < .001). CONCLUSION: The present findings revealed a high prevalence of depression, anxiety and suicidality among elderly patients attending tertiary care hospitals. Perceived stress, perceived social support, and neuroticism scores were significantly higher in this group. Role of sociodemographic, clinical and psychosocial variables as risk factors for these clinical disorders should be further examined.

Validity and reliability study of the Thai version of WHO schedules for clinical assessment in neuropsychiatry: sections on psychotic disorders.

OBJECTIVE: To determine the validity and reliability of the Thai version of the WHO Psychotic Disorders Sections of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.1 MATERIAL AND METHOD: The SCAN interview version 2.1 Psychotic Symptoms Sections (Section 16: Perceptual disorders other than hallucinations, Section 17: Hallucinations, Section 18: Experiences of thought disorder and replacement of will, and Section 19: Delusions) were translated into Thai. The content validity of the translation was established by comparing a back-translation of the Thai version to the English original. Whenever inconsistencies were encountered, the Thai version was adapted to convey the meaning of the original. The revised Thai version was then field-tested in 4 regions (Suanprung Psychiatric Hospital, Jitavejkhonkaen Hospital, Srithanya Hospital and Suansaranrom Psychiatric Hospital, each place comprised 20 volunteers ) for comprehensibility of the relatively technical language. Between October 2004 and July 2006, thirty persons were recruited for the reliability study (16 males; 14 females). Sixteen persons were schizophrenic patients (9 males; 7 females) and 14 (7 males; 7 females) were normal persons or nonpsychotic psychiatric patients. Education and occupations varied widely. The subjects were interviewed by a psychiatrist competent in using the Thai version of SCAN and these interviews were recorded on video for later re-rating. RESULTS: Based on the response from Thai subjects and consultations with competent psychiatrists, content validity was established The time taken to interview a schizophrenic patient averaged 140.2 +/- 36.0 minutes (range, 75-193) vs. 81.9 +/- 25.9 minutes (range, 48-124) for a comparison subject. The respective mean +/- SD of inter-rater reliability (kappa) of Section 16, 17, 18 and 19 was 0.66 +/- 0.17, 0.71 +/- 0.16, 0. 70 +/- 0.22 and 0.64 +/- 0.23. Some items in some sections had 100 percent agreement between raters. The respective intra-rater reliability was 0.65 +/- 0. 11, 0. 74 +/- 0.17, 0.86 +/- 0.17 and 0.80 +/- 0.18. Some sections had items with 100 percent agreement from the same rater even when rated 2 weeks apart. More than half of the items in each section had kappa values, both inter-rater and intra-rater, at least in substantial level. CONCLUSION: The Thai version of the Psychotic Disorders Sections of SCAN version 2.1 proved to be a valid and reliable tool for assessing psychotic symptoms among Thais.

Cross-cultural validation and inter-rater reliability of the Personal and Social Performance scale, Thai version.

OBJECTIVE: To cross-culturally validate and examine the inter-rater reliability of the Personal and Social Performance scale (PSP), Thai version (Thai-PSP). MATERIAL AND METHOD: The authors translated, back translated, and conducted a panel review on the source, translated, and back translated version of the PSP. After nine psychiatrists, who were new to the PSP or the Thai-PSP had received a three-hour session of training, they jointly watched four tape-recorded interviews and used the Thai-PSP for independent rating of the patients' functioning. RESULTS: The score ranges for items 1 (socially useful activities), 2 (personal/social relationships), and 3 (self-care) were between 0 (absent) and 4 (severe). The score range was between 0 (absent) and 3 (marked) for item 4 (disturbing/aggressive behavior). The total scores of four patients were rated between 2 (21-30 points) and 8 (81-90 points). The intraclass correlation coefficients (95% confidence intervals) of each item and total score were as follows: 0.63 (0.28-0.96) for item 1, 0.75 (0.42-0.98) for item 2, 0.69 (0.35-0.97) for item 3, 0.52 (0.17-0.94) for item 4, and 0.75 (0.41-0.98) for the total score. CONCLUSION: The results of the present study confirm the reliability of PSP and Thai-PSP as well as the ease of training.