Meditation Moderates the Relationship between Insecure Attachment and Loneliness: A Study of Long-Term Care Residents in Thailand.

Background and Objectives: Loneliness is prevalent among residents of long-term care settings, posing significant challenges to their mental wellbeing. Insecure attachment has been identified as a contributing factor to loneliness in this population. Previous research has suggested that meditation may have beneficial effects on mental health outcomes. This study aimed to examine the relationship between meditation, insecure attachment, and loneliness among residents of long-term care facilities in Thailand. Specifically, the study sought to investigate the moderating effect of meditation on the association between insecure attachment (both avoidance and anxiety) and loneliness. Materials and Methods: A cross-sectional study was conducted involving 236 residents living in long-term care homes in Thailand. Participants completed self-report measures including the 18-item Revised Experience of Close Relationship questionnaire (to assess attachment anxiety and avoidance), the Inner Strength-Based Inventory (to measure meditation practice), and the 6-item Revised Version of the University of California Los Angeles Loneliness Scale. Moderation analyses were performed to explore the role of meditation in the relationship between insecure attachment and loneliness. Results: The mean age of participants was 73.52 years, with females accounting for 57.6% of the sample. Among the participants, 58.4% reported engaging in meditation, with practice frequency ranging from often to daily. The mean meditation score was 2.92 out of 5, indicating regular but not daily practice. Meditation was found to moderate the relationship between insecure attachment (both avoidance and anxiety) and loneliness. Specifically, the moderation effect between attachment anxiety and loneliness was significant (B = 0.44, SE = 0.21, 95% CI [0.30, 0.86]), as was the interaction effect between attachment anxiety and loneliness (B = -0.34, SE = 0.17, 95% CI [-0.67, -0.02]). Conclusions: The findings suggest that the impact of meditation practice on loneliness is influenced by an individual's attachment dimension. Meditation demonstrates a moderating effect on attachment avoidance, anxiety, and loneliness, with variations observed in the direction of these effects. The clinical implications of these findings and recommendations for further research are discussed.

Social Inhibition and Depressive Symptoms among Couples with Children with Autism Spectrum Disorder: The Mediating Role of Perceived Family Support.

Background and Objectives: A limited understanding exists regarding the intricate dynamics between the levels of social inhibition exhibited by both wives and husbands concerning their perceived family support and depressive symptoms, particularly within couples who are parents of children diagnosed with autism spectrum disorder (ASD). Materials and Methods: This study used the actor-partner interdependence mediation model to analyze data collected from 397 pairs of Chinese parents with children diagnosed with ASD. Results: The findings of the study revealed significant indirect actor effects, indicating that the levels of social inhibition exhibited by both wives and husbands were associated with their own depressive symptoms through their respective perceptions of family support. In general, the study did not find significant partner effects, except for some indirect effects of wives on their husbands' depressive symptoms through the wives' perceived social support. Conclusions: In line with related studies, social inhibition was associated with depressive symptoms. At the same time, perceived family support could be a mediator of depression. Gender differences in emotional expression, influenced by cultural norms and distinct role expectations within the family context, may elucidate why only wives' perceived family support could impact husbands' depressive symptoms. These results underscore the potential importance of interventions aimed at addressing social inhibition and enhancing perceived family support to alleviate depressive symptoms in this population. Additionally, encouraging family support for both wives and husbands' involvement in collaboration may be of benefit in improved outcomes for both parents and children within families affected by ASD.

Syntactic Errors in Older Adults with Depression.

Background and Objectives: This study investigated the differences in syntactic errors in older individuals with and without major depressive disorder and cognitive function disparities between groups. We also explored the correlation between syntax scores and depression severity. Materials and Methods: Forty-four participants, assessed for dementia with the Mini-Cog, completed the 15-item Geriatric Depression Scale (TGDS-15) and specific language tests. Following a single-anonymized procedure, clinical psychologists rated the tests and syntax scores. Results: The results showed that the depressive disorders group had lower syntax scores than the non-depressed group, primarily on specific subtests. Additionally, cognitive test scores were generally lower among the depressed group. A significant relationship between depression severity and syntax scores was observed (r = -0.426, 95% CI = -0.639, -0.143). Conclusions: In conclusion, major depressive disorder is associated with reduced syntactic abilities, particularly in specific tests. However, the relatively modest sample size limited the sensitivity of this association. This study also considered the potential influence of cultural factors. Unique linguistic characteristics in the study's context were also addressed and considered as potential contributors to the observed findings.

The Prevalence of Elder Abuse and its Association with Frailty in Elderly Patients at the Outpatient Department of a Super-Tertiary Care Hospital in Northern Thailand.

Background and Objectives: The global population is undergoing rapid aging, resulting in an increase in geriatric syndromes and hidden health issues such as elder abuse. However, the prevalence of elder abuse varies across different settings. The objective of this study is to determine the prevalence and factors associated with elder abuse at the outpatient department of a super-tertiary care hospital in northern Thailand. Materials and Methods: This cross-sectional study involved 210 elderly patients who visited Maharaj Nakorn Chiang Mai Hospital between May and August 2022. The participants completed several assessments, including the Mini-Cog, Thai Geriatric Depression Scale-6, Core Symptom Index-15, FRAIL scale, Barthel Activities of Daily Living, Interview Guideline for Screening for Elder Abuse, and Diagnostic Criteria for Elder Abuse. Fisher's exact test was used to examine the association between the factors and elder abuse. Results: The Screening for Elder Abuse yielded noteworthy results, with 15.7% of the elderly patients having experienced psychological abuse. However, only a smaller subset of study participants, comprising five individuals or 2.38%, met the diagnostic criteria for elder abuse. Furthermore, statistical analysis revealed no significant correlation between elder abuse and the other factors examined in the study. Conclusions: As a result, it is crucial for hospitals to consider preventive measures and implement routine screening protocols.

Word Recognition Program for Thai Older People with High Risk of Dementia: A Quasi-Experimental One-Group Study.

INTRODUCTION: Dementia is one of the most common disorders among older people. This condition causes cognitive impairment, which can affect memory, thinking, expressive or comprehension language. It affects work and daily life. The purpose of this study was to examine the effects of a word recognition program on naming and quality of life in older people with high risk of dementia. The purpose of this study was to examine the effects of a word recognition program on naming and quality of life in older people with high risk of dementia. METHODS: A one-group, quasi-experimental pretest-posttest study was conducted at Maeka Subdistrict Administrative Organization, Chiang Mai, Thailand, and participants' home setting from December 2021 to March 2022. Participants were 6 Thai elderly persons with a high risk of dementia according to MEST10 cut-off score, including 1 (16.66%) male and 5 (83.34%) females. They were assessed on naming using the WAB test. Additionally, they were assessed on quality of life using the WHOQOL-BREF-THAI. The word recognition program delivered 30 min per day for 5-week duration. The results were analyzed by using descriptive statistics and the Wilcoxon signed-rank test to compare the effect on the intervention program. RESULTS: The older people with high risk of dementia significantly gained in naming after receiving the word recognition program (MD = -9.00 ± 2.344; 95% CI: -20.00 to -4.00; p = 0.031). However, they did not significantly gain in quality of life after receiving the word recognition program (MD = -4.50 ± 3.393; 95% CI: -10.50 to 1.00; p = 0.418). DISCUSSION/CONCLUSION: The current study demonstrates that a 5-week intervention of the word recognition program may be effective in naming to enhance language skills for Thai older people with high risk of dementia.

Development of the Story Telling Examination for Early Mild Cognitive Impairment (Pre-Mild Cognitive Impairment) Screening.

INTRODUCTION: Cognitive function prior to mild cognitive impairment (MCI) has become a burgeoning interest. Tools used to detect this early period before MCI are being pilot-tested. This study aimed to develop a new test to detect pre-MCI and to examine its content validity and feasibility. METHODS: The Story Telling Examination for Early MCI Screening (STEEMS), an audio cognitive test, was developed. It covers ten cognitive domains, e.g., executive function, language fluency, abstract reasoning. Face and content validity were examined by experts in geriatric psychiatry and psychology. The content validity index was 1.00. STEEMS comprised 12 items with 2-4 types of scoring. The tool was further examined in 16 pilot samples for feasibility among healthy participants having no cognitive impairment (Montreal Cognitive Assessment [MoCA] test score ≥25, Mini-Cog ≥3) and no depressive symptoms (Geriatric Depression Scale <6). RESULTS: The 16 healthy older individuals aged 59-73 years, mean age was 65.06 ± 4.07 years, were predominantly males (68.8%). STEEMS scores ranged from 10 to 25, with a mean of 18.38 (SD = 4.2). Thirteen percent obtained 100% correct on the STEEMS, 63% scored 68-92% correct, and 25% scored 40-60% correct. The pre-MCI scores are illustrated by a bell curve's graphical depiction, suggesting a normal distribution probability distribution. Correlation between STEEMS and MoCA test scores was observed. STEEMS showed to be feasible for early elderly or late adults as being brief and easy to understand. The time spent to administer was predictably less than 7 min. DISCUSSION/CONCLUSION: STEEMS could potentially serve as a tool for pre-MCI screening. Further study and investigation in a larger population are required.

Effect of cancer stage on health-related quality of life of patients with epithelial ovarian cancer.

We compared the quality of life (QoL) of women with early versus advanced epithelial ovarian cancer and examined predicting factors for the poor QoL. We classified 157 participants into 108 with early disease (stage I-II) and 49 with advanced disease (stage III-IV). They completed two questionnaires: EORTC QLQ-C30 and Chiang Mai University (CMU) ovarian cancer QoL. For EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL, functional scales, and summary scores. The advanced group had worse scores on symptom scales specifically appetite loss and constipation. For CMU Ovarian Cancer QoL, the advanced group had worse scores only in the gastrointestinal domain but not in urinary, lymphatic, and sexual/hormonal domains. These findings remained mostly unchanged after excluding those with recurrence. In multivariable analysis, currently receiving treatment was consistently associated with worse QoL scores. The advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy.IMPACT STATEMENTWhat is already known on this subject? Survival outcome for women with epithelial ovarian cancer varies depending mainly on stage. Those who survive advanced stage disease could expect long-term disease and treatment-related morbidities that significantly affected QoL. However, there has been very limited information regarding QoL of women who have the early disease in comparison to those with more advanced disease especially in the context of Asian culture.What do the results of this study add? Apart from the higher prevalence of gastrointestinal symptoms reported by the patients with advanced disease, the general well-being and other symptom-specific domains of QoL were comparable between women with early and advanced diseases. Receiving treatment is a consistent predictor for poor QoL.What are the implications of these findings for clinical practice and/or further research? In comparison to early-stage epithelial ovarian cancer, the advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy. This information will be useful for patient counselling. Future research should examine the underlying causes of this finding.

Health-related quality of life for early-stage cervical cancer survivors after primary radical surgery followed by radiotherapy versus radical surgery alone.

This study compared the quality of life (QoL) of 265 stage IA2-IIA cervical cancer patients treated with radical surgery alone (group 1: 137 patients) versus those who underwent primary radical surgery followed by radiotherapy (group 2: 128 patients) and identified clinical characteristics that predict the poor quality of life. All participants completed quality of life questionnaires: EORTC QLQ-C30 and CMU cervical cancer QoL. For the EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL scale and summary scores. Group 1 participants had better scores on the physical functioning domain and some symptom scales/items. For the CMU Cervical Cancer QoL, group 1 participants had better scores on gastrointestinal, lymphatic, and sexual/hormonal domains. In multivariable analysis, adjuvant radiation was consistently associated with poor quality of life in most domains. In general, early-stage cervical cancer survivors had a satisfactory quality of life. The clinical significance of the quality of life score differences between the study groups remains debateable.Impact statementWhat is already known on this subject? For women with early cervical cancer, surgery is the main treatment providing not only a good chance for a cure by total removal of the cancer but also an opportunity to preserve the hormone-producing function of the ovary as well as the flexibility of the vagina. However, radiation treatment may be indicated after surgery in some patients depending on the findings from surgery. Because of the concern about increased complications and decreased long-term quality of life following the combined treatments, some may elect to avoid surgery and receive radiation alone in the first place. In this study, we compared the quality of life of women who had surgery alone to those who had surgery followed by radiation. This information is currently lacking in the medical literature.What do the results of this study add? We found that, in general, women with early cervical cancer had a satisfactory quality of life. For a patient who is surgically fit and chooses to receive primary surgery, if radiation is subsequently required, she could still expect the acceptable long-term quality of life-although slightly less satisfactory than receiving surgery alone but not inferior to those who receive primary radiation treatment.What are the implications of these findings for clinical practice and/or further research? These findings will be useful for pre-treatment counselling and posttreatment supportive care. The information regarding disease-related and treatment-induced morbidity should be thoroughly discussed with the patients before and after treatment. Also, the use of questionnaires examining general well-being together with a cancer-specific quality of life is recommended for the systematic evaluation of cancer survivors.

Investigating psychometric properties of the arm activity measure - Thai version (ArmA-TH) sub-scales using the Rasch model.

BACKGROUND: This study investigated the ArmA-TH sub-scale measurement properties based on item response theory using the Rasch model. METHODS: Patients with upper limb hemiplegia resulting from cerebrovascular and other brain disorders were asked to complete the ArmA-TH questionnaire. Rasch analysis was performed to test how well the ArmA-TH passive and active function sub-scales fit the Rasch model by investigating unidimensionality, response category functioning, reliability of person and item, and differential item functioning (DIF) for age, sex, and education. RESULTS: Participants had stroke or other acquired brain injury (n = 185), and the majority were men (126, 68.1 %), with a mean age of 55 (SD 22). Most patients (91, 49.2 %) had graduated from elementary/primary school. For the ArmA-TH passive function scale, all items had acceptable fit statistics. The scale's unidimensionality and local independence were supported. The reliability was acceptable. A disordered threshold was found for five items, and none indicated DIF. For the ArmA-TH active function scale, one item was misfit and three were locally dependent. The reliability was good. No items showed DIF. All items had disordered thresholds, and the data fitted the Rasch model better after rescoring. CONCLUSIONS: Both sub-scales of ArmA-TH fitted the Rasch model and were valid and reliable. The disordered thresholds should be further investigated.

Association of job loss, income loss, and financial burden with adverse mental health outcomes during coronavirus disease 2019 pandemic in Thailand: A nationwide cross-sectional study.

BACKGROUND: Economic crises during the coronavirus disease (COVID-19) pandemic severely impacted mental health outcomes. However, there is limited evidence on this issue in Thailand. We aimed to evaluate the association of economic burden during the first phase of the pandemic and the risk of adverse mental health outcomes in the Thai population. METHODS: We recruited 2,303 participants aged 18 years or above with employment/full-time jobs before the national lockdown in April-May 2020. The measures of economic burden were job loss, income loss, and financial problems related to the outbreak. The outcomes included depressive symptoms, anxiety, and perceived stress. The association between economic burden and adverse mental health outcomes was evaluated using multivariable logistic regression models. RESULTS: Individuals who lost their jobs during the COVID-19 pandemic had a higher risk of perceived stress compared to those who maintained their job (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.28-4.51; p = .006). A higher risk of anxiety was observed in individuals with a monthly income loss of 50% (adjusted OR, 1.42; 95% CI, 1.03-1.99; p = .035; individuals without income loss, reference group) or over. Self-reported financial problems were significantly associated with adverse mental health outcomes (nonexperienced financial problems, reference group): Adjusted ORs of 1.84 (95% CI, 1.34-2.51; p < .001) for depressive symptoms, 2.00 (95% CI, 1.48-2.71; p < .001) for anxiety, and 2.12 (95% CI, 1.51-2.95; p < .001) for perceived stress. CONCLUSIONS: Economic burden, especially self-reported financial problems, was associated with adverse mental health outcomes. However, long-term studies are needed to address the mental health consequences of COVID-19 and economic downturns.

Loneliness and problematic internet use: testing the role of interpersonal problems and motivation for internet use.

BACKGROUND: A number of factors have been demonstrated to be associated with Problematic Internet Use (PIU); otherwise known as Internet Addiction), which is mostly concerned with psychological problems such as loneliness. This study aimed to examine how and in what way loneliness influenced PIU. METHODS: A self-report measurement on loneliness, the Internet addiction test (IAT) and instruments on interpersonal problems were administered to 318 medical students (57% females); mean age totaled 20.88 years (SD = 1.8). We performed a mediation analysis to evaluate direct effects of loneliness on IAT, as well as indirect effects mediated by interpersonal problems. In addition, motivation for internet use was added to the mediation model and tested whether it acted as the second mediator (serial mediation model) or a moderator (moderated mediation model). RESULTS: After controlling for sex and age, socially inhibited problems exhibited full mediation whereas the remainder showed partial mediation effects, with the exception that intrusive and cold interpersonal problems indicated no mediating role. Negative motivation and motivation for being accepted had mediation effects for all types of interpersonal problems. Motivation for working was found to be a significant mediator and moderator of the most interpersonal problems. Intrusive and cold styles became a mediator only when some motivation variables were added to the model, implying that not only psychological problems should be included when analyzing PIU, but also other variables such motivation for internet use. The percent of variance explained, by IAT score, increased from 13% in the mediation model to 33% by the moderated mediation model, and 43% using the serial mediation model. CONCLUSION: The study suggested the crucial role of loneliness and interpersonal problems on PIU, for which motivation for internet use explained how each interpersonal problem would be associated. This may provide some insight regarding the pathological characteristics of those using the internet as a coping strategy.

Attachment anxiety, depression, and perceived social support: a moderated mediation model of suicide ideation among the elderly.

OBJECTIVES: Issues concerning the association among attachment anxiety, depression and suicidal ideation among the elderly have rarely been explored. The present study investigated the relationship among attachment anxiety, depression and perceived support concerning suicidal ideation among older people. DESIGN: Cross-sectional study. SETTING: Tertiary care settings. PARTICIPANTS: The authors recruited 191 elderly patients from 10 tertiary care settings in Thailand. MEASUREMENTS: Participants provided data on their suicidal ideation and suicidal attempt using Module C of the Mini-International Neuropsychiatric Interview. Their attachment anxiety was assessed using the revised Experience of Close Relationship questionnaire (ECR-R-18), while their level of depression was investigated using the Geriatric Depression Scale. In addition, their perception of being supported was ascertained using the Multidimensional Scale of Perceived Social Support. We performed two mediation analyses and moderation analyses separately using the product of coefficients approach. First, we created a mediation model to examine the role of attachment anxiety and depression on suicidal ideation. Second, a moderated mediation model was created to explore the relationship of perceived social support as a moderator of depression. RESULTS: We found that depression significantly mediated the association between attachment anxiety and suicidal ideation. The association between depression and suicidal ideation was moderated by the level of perceived social support. CONCLUSION: Findings of this study may broaden our understanding of how suicidal ideation develops among the elderly and further stimulate future research exploring the interaction of positive and negative factors of suicidality among the elderly. Implications of the findings were also discussed.

Thai version of the dry eye-related quality-of-life score questionnaire: preliminary assessment for psychometric properties.

BACKGROUND: This study aimed to develop a Thai version of the Dry Eye-Related Quality-of-Life Score (DEQS-Th) questionnaire and evaluate its validity, reliability, and feasibility among Thai participants. METHODS: The DEQS-Th, a 15-item self-report measuring dry eye and its impact on quality of life (QOL) was developed based on the DEQS. The questionnaire was divided into two subscales: Bothersome Ocular Symptoms (six questions), and Impact on Daily Life (nine questions). It employed a 5-point Likert scale, addressing on both the frequency and the degree of symptoms. Backward and forward and cultural adaptation process translation methods were employed. Thirty healthy participants were enrolled to evaluate the feasibility of the DEQS-Th in terms of difficulty and convenience. Reliability was assessed using internal consistency determined by Cronbach's alpha, with values > 0.7 considered acceptable. Convergent validity was determined by the correlation between DEQS-Th and overall health status. Confirmatory factor analysis was conducted for its factor structure. RESULTS: The participants' mean age was 38.6 ± 12.9 years, and 23 (76.7%) were females. The mean time to complete the questionnaire was 9.3 ± 2.7 min. The Cronbach's alpha of the ocular symptoms subscale, impact on QOL subscale, and summary score on frequency and degree were 0.80 and 0.70, 0.89 and 0.89, and 0.90 and 0.89, respectively. The overall health status significantly correlated with the summary score (r = 0.564, p = .001), subscale ocular symptoms (r = 0.594, p = .001), and impact on QOL scores (r = 0.626, p < .001) of the DEQS-Th, respectively. A one-factor model fitted the data the best for both the ocular symptoms subscale (CFI = 1.000, TLI = 1.000, RMSEA = 0.000) and the impact on QOL subscale (CFI = 0.998, TLI = 0.997, RMSEA = 0.053). CONCLUSION: When tested among normal participants, the DEQS-Th is a valid and reliable measurement for dry eye symptoms and impact on QOL.

Perceived stress and depressive symptoms not neuropsychiatric symptoms predict caregiver burden in Alzheimer's disease: a cross-sectional study.

BACKGROUND: Caregiver burden affects the caregiver's health and is related to the quality of care received by patients. This study aimed to determine the extent to which caregivers feel burdened when caring for patients with Alzheimer's Disease (AD) and to investigate the predictors for caregiving burden. METHODS: A cross-sectional study was conducted. One hundred two caregivers of patients with AD at Maharaj Nakorn Chiang Mai Hospital, a tertiary care hospital, were recruited. Assessment tools included the perceived stress scale (stress), PHQ-9 (depressive symptoms), Zarit Burden Interview-12 (burden), Clinical Dementia Rating (disease severity), Neuropsychiatric Inventory Questionnaires (neuropsychiatric symptoms), and Barthel Activities Daily Living Index (dependency). The mediation analysis model was used to determine any associations. RESULTS: A higher level of severity of neuropsychiatric symptoms (r = 0.37, p < 0.01), higher level of perceived stress (r = 0.57, p < 0.01), and higher level of depressive symptoms (r = 0.54, p < 0.01) were related to a higher level of caregiver burden. The direct effect of neuropsychiatric symptoms on caregiver burden was fully mediated by perceived stress and depressive symptoms (r = 0.13, p = 0.177), rendering an increase of 46% of variance in caregiver burden by this parallel mediation model. The significant indirect effect of neuropsychiatric symptoms by these two mediators was (r = 0.21, p = 0.001). CONCLUSION: Caregiver burden is associated with patients' neuropsychiatric symptoms indirectly through the caregiver's depressive symptoms and perception of stress. Early detection and provision of appropriate interventions and skills to manage stress and depression could be useful in reducing and preventing caregiver burden.

Drug-related problems of antipsychotics in treating delirium among elderly patients: A real-world observational study.

WHAT IS KNOWN AND OBJECTIVE: Delirium is more common and life-threatening among the elderly. Currently, no other medications, including antipsychotics, have been approved for delirium. The number of practice guidelines recommends antipsychotics to be the first option among selected patients. This study aimed to identify the type of drug-related problems (DRPs) concerning antipsychotics use among elderly patients with delirium. METHODS: A retrospective observational study was conducted by collecting data from 2013 to 2016 in Maharaj Nakorn Chiang Mai Hospital, Thailand. Inpatients who were 60 years and over, diagnosed with delirium by ICD-10 diseases coding F05.X and treated with antipsychotics for delirium were included. A modified version of the American Society of Hospital Pharmacists classification criteria (mASHP-delirium) was used. RESULTS AND DISCUSSION: A total of 379 patients were enrolled. Mean daily dose of haloperidol (oral) was 1.06 ± 1.33 mg, haloperidol (intramuscular) 2.71 ± 1.88 mg, haloperidol (intravenous; IV) 3.42 ± 1.97 mg, risperidone was 0.71 ± 0.52 mg, and quetiapine was 19.26 ± 15.63 mg. Among all, 427 events were classified as DRPs. The most common DRPs included inappropriate duration, dose, route of administration or dosage form accounting for the 416 events (97.4%), followed by actual adverse drug reactions (extrapyramidal symptoms; EPS), 6 events (1.4%) and potential drug-drug interactions for 5 events (1.2%). Of those 416 events, 200 events (48.1%) antipsychotics were continued after discharge and continued for more than 10 days. Dosage exceeding initial dose or maximum daily dose accounted for 179 events (43.0%). Other DRPs such as inappropriate route haloperidol IV and receiving the extended-release dosage form of quetiapine involve 26 (6.3%) and 11 (2.6%) events, respectively. WHAT IS NEW AND CONCLUSION: To the best of our knowledge, this is the first study using mASHP-delirium to identify DRPs of antipsychotics in treating delirium among elderly patients. Several DRPs were found that might lead to severe adverse drug reactions, particularly EPS and QTc interval prolongation. However, all DRPs could be prevented by developing antipsychotic setting protocols and specialty consulting systems to communicate among healthcare providers caring for vulnerable groups of patients. In addition, a prospective pharmacist intervention is required.

Exposure to COVID-19-Related Information and its Association With Mental Health Problems in Thailand: Nationwide, Cross-sectional Survey Study.

BACKGROUND: The COVID-19 pandemic has had a negative impact on both the physical and mental health of individuals worldwide. Evidence regarding the association between mental health problems and information exposure among Thai citizens during the COVID-19 outbreak is limited. OBJECTIVE: This study aimed to explore the relationship between information exposure and mental health problems during the COVID-19 pandemic in Thailand. METHODS: Between April 21 and May 4, 2020, we conducted a cross-sectional, nationwide online survey of the general population in Thailand. We categorized the duration of exposure to COVID-19-related information as follows: <1 h/day (reference group), 1-2 h/day, and ≥3 h/day. Mental health outcomes were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Perceived Stress Scale-10, and the Insomnia Severity Index for symptoms of depression, anxiety, perceived stress, and insomnia, respectively. Multivariable logistic regression models were used to evaluate the relationship between information exposure and the risk of developing the aforementioned symptoms. An ancillary analysis using multivariable multinomial logistic regression models was also conducted to assess the possible dose-response relationship across the severity strata of mental health problems. RESULTS: Of the 4322 eligible participants, 4004 (92.6%) completed the online survey. Of them, 1481 (37.0%), 1644 (41.1%), and 879 (22.0%) participants were exposed to COVID-19-related information for less than 1 hour per day, 1 to 2 hours per day, or 3 or more hours per day, respectively. The major source of information related to the COVID-19 pandemic was social media (95.3%), followed by traditional media (68.7%) and family members (34.9%). Those exposed to information for 3 or more hours per day had a higher risk of developing symptoms of depression (adjusted odds ratio [OR] 1.35, 95% CI 1.03-1.76; P=.03), anxiety (adjusted OR 1.88, 95% CI 1.43-2.46; P<.001), and insomnia (adjusted OR 1.52, 95% CI 1.17-1.97; P=.001) than people exposed to information for less than 1 hour per day. Meanwhile, people exposed to information for 1 to 2 hours per day were only at risk of developing symptoms of anxiety (adjusted OR 1.35, 95% CI 1.08-1.69; P=.008). However, no association was found between information exposure and the risk of perceived stress. In the ancillary analysis, a dose-response relationship was observed between information exposure of 3 or more hours per day and the severity of mental health problems. CONCLUSIONS: These findings suggest that social media is the main source of COVID-19-related information. Moreover, people who are exposed to information for 3 or more hours per day are more likely to develop psychological problems, including depression, anxiety, and insomnia. Longitudinal studies investigating the long-term effects of COVID-19-related information exposure on mental health are warranted.

Relationship between Personality Traits and the Inner Strengths.

BACKGROUND: Zuckerman-Kuhlman-Aluja Personality questionnaire (ZKA-PQ) measures five psychobiologically based personality factors (activity, aggression, extraversion, neuroticism, and sensation seeking). The inner strength (from the ten perfections based on Theravada Buddhism) deems positive character, which includes truthfulness, perseverance, wisdom, generosity, morality (five precepts), mindfulness and meditation, patience and endurance, equanimity, determination, and loving kindness measured by the strength-based inventory (SBI). Our aim was to unfold the relationship between ZKA factors and SBI. METHODS: 642 Thai (age mean = 28.27, SD = 10.61) individuals (males 26.2%, females 73.8%) filled out our questionnaire battery: (1) Zuckerman-Kuhlman-Aluja Personality questionnaire - 200 items, 20 facets, five factors: Aggressiveness, Sensation Seeking, Activity, Extraversion, Neuroticism. (Cronbach alphas: 0.88, 0.81, 0.83, 0.89, 0.91 for AG, SS, AC, EX, NEU, respectively). (2) Strength-based inventory - 10 items, measuring 10 inner strength (Cronbach alpha: 0.68). Pearson correlation, neural network modelling and person-oriented methodology (model-based clustering) were conducted for analysis. RESULTS: Our correlational results revealed that inner strengths are negatively related to Aggression (r=-0.44**), Neuroticism (r=-0.43**), Sensation seeking (r=-0.16**), whereas positively related to Extraversion (r=0.37**) and Activity (r=0.24**). Highest correlations were found between AG and patience (-0.43**) and NEU and perseverance (r=-0.40**), both with negative sign. According to neural network modelling Activity was most related to Perseverance, Aggression to lack of Patience, Neuroticism to lack of Perseverance and Equanimity, Sensation Seeking to lack of Morality. Extraversion was most weakly related to inner strengths, but it was related to all other personality dimensions. Model based clustering revealed four typical personality profiles: resilients (41.8%), extraverted undercontrollers (29.0%), introverted undercontrollers (10.6%) and overcontrolled (18.6%). Results showed that resilients had highest inner strength levels, whereas overcontrolled ones had the lowest. CONCLUSION: Negative traits are, as expected, conversely related with strength, while positive traits (extraversion and activity) are positively related with strength. Our results confirm that resilient personality pattern can be linked to the inner strengths measured by SBI scale, which was based on 10 Buddhist perfections. Further results should be addressed how increase in inner strength can be related to changes in biologically based personality dimensinos towards the resilient pattern.

Effects of Combined Physical Movement Activity and Multifaceted Cognitive Training in Older People with Mild Neurocognitive Disorder in a Rural Community: A Randomized Control Trial.

INTRODUCTION: Cognitive deterioration in older people with mild neurocognitive disorders (mNCD) increases the risk of progress to major NCD. Health professionals worldwide are trying to find strategies for prevention. There is a limited number of studies that deal with cultural conditions in northern Thailand. OBJECTIVES: This study aimed to investigate the effects of a combination of physical movement activity and multifaceted cognitive training on cognitive function in older people with mNCD. METHODS: A randomized control trial involving 70 mNCD people, according to DSM-5 criteria, was conducted on an intervention group and a control group (n = 35 each). The program for the intervention group included 24 sessions (twice a week). The outcome measures on cognitive function were assessed before and after the intervention by means of composite cognitive measures for older people, i.e., the Trail-Making Test (TMT), Digit Span (DS), Verbal Fluency (VF), Word-List Learning (WLL), and Block Design (BD). RESULTS: The combined intervention enhanced cognitive function. TMT-A was significantly improved in the intervention group. There were significant improvements in DS sequence scores, letter verbal fluency (LVF), and category verbal fluency (CVF). Comparing the groups, there were significant differences in LVF including immediate and delayed recall. BD improved significantly in the intervention group. CONCLUSIONS: The combined intervention appeared to be effective in delaying/preventing cognitive deterioration and cognitive functional decline in people with mNCD. Further studies on a variation of treatments suited to cultural conditions and their effects are needed. Trials in other communities are also recommended.

The role of perceived stress and cognitive function on the relationship between neuroticism and depression among the elderly: a structural equation model approach.

BACKGROUND: Depression comprises common psychological problems, and has been strongly related to neuroticism and perceived stress. While neuroticism has been shown to have a direct effect on depression, it also has an indirect effect via perceived stress. Among the elderly, cognitive function produces influences that should not be overlooked when investigating depression. This study aimed to determine the role of mediating effects of perceived stress as well as cognitive function on neuroticism and depression among elderly patients. METHODS: This research constituted a secondary analysis, with data collected during the pre-operative period of 429 elderly individuals undergoing elective, noncardiac surgery. The evaluation included the Perceived Stress Scale, the Neuroticism Inventory, the Montreal Cognitive Assessment, and the Geriatric Depression Scale. Structural equation modeling was used to investigate the hypothesized model. RESULTS: Neuroticism exhibited a significant indirect effect on perceived stress via depression and cognition (ß = 0.162, 95% CI 0.026, 0.322, p = .002). Neuroticism initially had a direct effect on depression (ß = 0.766, 95% CI 0.675, 0.843 p = 0.003); thereafter, it was reduced after covariates were added (ß = 0.557, 95% CI 0.432, 0.668 p = 0.002). Based on this model, the total variance explained by this model was 67%, and the model showed an acceptable fit with the data. CONCLUSIONS: Both perceived stress and cognitive function partially mediated the effect of neuroticism on depression, with perceived stress exhibiting a greater effect. TRIAL REGISTRATION: The study protocol has been registered at Clinicaltrials.gov under registered number: NCT02131181.

Development and validation of a screening instrument for borderline personality disorder (SI-Bord) for use among university students.

BACKGROUND: The screening instrument for borderline personality disorder (SI-Bord) consists of a 5-item self-reported questionnaire on the key features of BPD from the DSM-5 using a 5-point Likert scale. This study investigated its validity and reliability in screening for BPD in university students. METHODS: A cross-sectional study was conducted on a sample of university students in Thailand between November and December 2019. An online assessment gathered demographic data and results from the SI-Bord, the Perceived Stress Scale-10 (PSS-10) and the Patient Health Questionnaire-9 (PHQ-9). Participants whose SI-Bord scores were ≥ 1 were randomly selected to be interviewed and assessed for a BPD diagnosis by four psychiatrists using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) as a reference point. An intraclass correlation coefficient (ICC) of 0.925 (95% CI, 0.805-0.979) ensured inter-rater reliability between the four psychiatrists. The diagnostic sensitivity and specificity of the SI-Bord, as compared to that of the SCID-II, were determined to indicate the cut-off score. The Receiver Operating Characteristics (ROC) was analyzed to evaluate its diagnostic accuracy. RESULTS: The study included 342 students aged 18-25 years (the mean age was 20.25 ± 1.4 years), 80.4% of whom were female. Among the 68 participants selected for an online interview, 16 were diagnosed with BPD. The cut-off score of the SI-Bord was > 9, as suggested by the Youden index, yielding a sensitivity of 56.3% and a specificity of 92.3%. It had a positive predictive value of 69.2% and negative predictive value of 87.3%. The SI-Bord had adequate discriminative power between cases and non-cases of BPD, with the area under the ROC curve being 0.83. Cronbach's alpha for the SI-Bord was 0.76, indicating acceptable internal consistency. The SI-Bord score was positively correlated to PHQ-9 and PSS-10 scores (r = 0.67 and r = 0.69, p < 0.001, respectively) and negatively correlated to MSPSS (r = - 0.50, p < 0.001). The prevalence of BPD in the sample was 6.4%, according to the cut-off score > 9. CONCLUSION: The SI-Bord demonstrated good reliability and validity for screening BPD in university students. However, a study in non-Thai and other population groups should be warranted.