A film-based intervention to reduce child maltreatment among migrant and displaced families from Myanmar: Protocol of a pragmatic cluster randomized controlled trial.

BACKGROUND: Child maltreatment is a global public health crisis with negative consequences for physical and mental health. Children in low- and middle-income countries (LMIC)-particularly those affected by poverty, armed conflict, and forced migration-may be at increased risk of maltreatment due to heightened parental distress and disruptions to social support networks. Parenting interventions have been shown to reduce the risk of child maltreatment as well as improve a range of caregiver and child outcomes, yet large-scale implementation remains limited in low-resource displacement settings. This study will examine the impact of an entertainment-education narrative film intervention on reducing physical and emotional abuse and increasing positive parenting among migrant and displaced families from Myanmar living in Thailand. METHOD: The study is a pragmatic, superiority cluster randomized controlled trial with approximately 40 communities randomized to the intervention or treatment as usual arms in a 1:1 ratio. Participating families in the intervention arm will be invited to attend a community screening of the film intervention and a post-screening discussion, as well as receive a poster depicting key messages from the film. Primary outcomes are changes in physical abuse, emotional abuse, and positive parenting behaviour. Secondary outcomes include caregiver knowledge of positive parenting, caregiver attitudes towards harsh punishment, caregiver psychological distress, and family functioning. Outcomes will be assessed at 3 time points: baseline, 4 weeks post-intervention, and 4-month follow up. A mixed methods process evaluation will be embedded within the trial to assess intervention delivery, acceptability, perceived impacts, and potential mechanisms of change. DISCUSSION: To our knowledge, this study will be the first randomized controlled trial evaluation of a film-based intervention to reduce child maltreatment among migrant and displaced families in a LMIC. An integrated knowledge translation approach will inform uptake of study findings and application to potential scale up pending evaluation results. TRIAL REGISTRATION: The study was prospectively registered with the Thai Clinical Trials Registry on 22 February 2023 (TCTR20230222005).

Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study.

BACKGROUND: Intensive case management (ICM) programmes for psychotic patients are effective in improving outcomes, but often unfeasible in resource-poor settings, as they typically require extensive human resources and expertise. We developed and evaluated the effectiveness of a less intensive case management program (LICM), led by community health workers, on one-year social functioning and service use. METHODS: A prospective cohort study was conducted on patients aged 18 and above residing in a hospital catchment area. Outcomes were compared between LICM (n = 64) and non-LICM participants (n = 485). A counterfactual framework approach was applied to assess causal effects of the LICM on outcomes. The programme effectiveness was analyzed by augmented-inverse probability of treatment weighting (AIPW) to estimate potential outcome mean (POM) and average treatment effect (ATE). Outcomes were employment status and use of emergency, inpatient and outpatient services. Analyses were stratified by the number of previous psychotic relapse (≤ 1, > 1) to assess heterogeneity of treatment effect on those in an early and later stages of psychotic illness. RESULTS: In the early-stage cohort, the likelihood of being employed at one year post-baseline was significantly greater in LICM participants than non-LICM participants (ATE 0.10, 95%CI 0.05-0.14, p < 0.001), whereas service use of all types, except outpatient, was not significantly different between the two groups. In the later-stage cohort, the likelihoods of employment between the two groups at post-baseline were similar (ATE -0.02, 95%CI -0.19-0.15, p = 0.826), whereas service use of all types was significantly higher in LICM participants. CONCLUSION: LICM in a setting where community mental services are scarce may benefit those at an early stage of psychotic illness, by leading to better social functioning and no higher use of unscheduled services at the end of the programme, possibly through their better prognosis and medication adherence. A more intensive case management model may be appropriate for those in a later stage of the illness.

Home-Based Contingency Management Delivered by Community Health Workers to Improve Alcohol Abstinence: A Randomized Control Trial.

AIM: To evaluate the effectiveness of home-based contingency management (CM) in improving abstinence in an incentive-dependent manner among alcoholic individuals. METHODS: A 12-week, home-visit (HV) only controlled, randomized incentive-ranging trial of 161 adults with current alcohol dependence was recruited using social network theory techniques. Participants randomly received HV, low- (CM-L) or higher-magnitude CM (CM-H). Community health workers made regular home visits, monitored drinking behavior and delivered CM as appropriate. Two follow-up visits at weeks 13 and 16 were conducted to assess whether abstinence would still be maintained after the interventions discontinued. Rates of continuous reported abstinence (primary), numbers of positive breath samples (secondary) over the intervention period and rates of prolonged reported abstinence (secondary) were evaluated. RESULTS: CM did not significantly improve the rates of continuous reported abstinence across the 12-week intervention period (odds ratio (OR) for trend 1.2, 95% confidence interval (CI) 0.7-2.1, P = 0.601). There was a significant reduction, however, in the average number of positive breath samples submitted by the CM-H group (generalized linear model, ß -0.5, 95% CI -0.9 to -0.2, P = 0.005). The CM-H arm also had a significantly higher abstinence rate during the follow-up period (OR 3.4, 95% CI 1.3-8.8, P = 0.013). Event history model suggested that the CM-H condition had significantly higher chances of achieving renewed abstinence across the study period (OR 2.0, 95% CI 1.3-3.2, P = 0.003). CONCLUSIONS: Home-based CM with sufficient incentive is promising in reducing alcohol use and in improving rates of abstinence over time. Allowing for a certain grace period may better capture the delayed treatment effect of home-based CM.

A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System.

Objectives: To examine the impacts of changes in social determinants of health (SDH) toward changes in cognition. Methods: Longitudinal data came from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011. Cognitive impairment was measured by category fluency and delayed recall. Generalized estimating equation (GEE) was used to investigate changes in cognition by taking SDH and other variables including age, gender, marital status, education, and depression into the model. Results: GEE revealed longitudinal effects of wealth index and working status against cognition. Older Thais living with richest wealth index (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95% CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion: Poorer wealth index and being unemployed were served as a risk factor for cognitive impairment over time. Increasing age was still the major risk for cognitive impairment.

Estimating Impact Based on Stages of Mental Illness on Employment and Earnings in Bangkok Metropolitan Region.

BACKGROUND: Evidence suggests mental disorders are associated with substantial economic burden. However, as the status of mental illness tends to change over time, estimating the burden based on cross-sectional presence or severity of illness may be problematic. An approach based on illness staging may provide a more stable estimate. AIMS OF THE STUDY: We aim to explore whether three predefined stages of mental illness (i.e. early active, remitted, chronic) have differential impact on employment and earnings. METHODS: A community survey of household population aged 18 and over in a university hospital's catchment area within Bangkok Metropolitan Region (BMR) was conducted (N=3877). The third version of the World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) was administered to assess lifetime and 12-month common major mental disorders and the Kessler Psychological Distress Scale (K6) to assess current psychological distress. Multivariate approaches were used to estimate the observed and expected annual earnings and employment for persons with mental illness at each stage, controlling for sociodemographic variables. RESULTS: Increasing level of chronicity, from the early active to the remitted and then to the chronic stage, was associated with increasing reduction in earnings (beta --0.14 95% CI -0.15 to --0.13, p = 0.004). All stages of illness were significantly associated with reduced earnings, with individuals at chronic stage having 12-month earnings averaging 78,522 Thai baht (USD 2,356) less than those without a history of mental illness, followed by those at remitted (38,703 baht or USD 1,161) and early active stages (25,870 baht or USD 776), with the same values for control variables. Remitted and chronic stages, but not early active one, were associated with reduced odds of paid employment. The estimated societal-level loss in earnings was 26.9 billion baht (USD 808.2 million) in the total BMR population. DISCUSSION: The findings suggest that all stages of mental disorders, particularly chronic one, are associated with substantial individual- and societal-level burden, and highlight differences in employment and earnings gaps among individuals at each stage of illness. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Mental health service should be provided in close coordination with vocational and welfare services in order to alleviate financial and work difficulties faced by mentally ill people at various stages of illness. IMPLICATIONS FOR HEALTH POLICIES: There is a need to tailor disability benefits and employment promotion schemes to the needs of mentally ill people at each stage in order to maximize their productivity and quality of life. IMPLICATIONS FOR FURTHER RESEARCH: Direct and other indirect costs of mental illness should be further investigated. Longitudinal studies would help to clarify how much of the reported association is due to mental illness causing unemployment and reduced earnings or vice versa.

ASSESSMENT OF A NEW SMOKING CESSATION PROGRAM AT THAMMASAT UNIVERSITY HOSPITAL, PATHUM THANI, THAILAND.

The Smoking Cessation Clinic (SCC) at Thammasat University Hospital had only 27 patients from October 2013 to September 2014 and a quit rate of only 3.7%. A new smoking cessation program was implemented at the end of 2014 to improve success rates. This new program is an interdisciplinary program that includes several health care specialists. The study aimed to examine the characteristics of the smokers and the outcomes after implementing the new program with an interdisciplinary approach at the SCC in order to gain data to improve the efficacy of the SCC. This prospective descriptive study was conducted by the SCC from December 2014 to December 2015. During the study period 111 patients attended the SCC under the new program and all were included in the survey; 100 (90.1%) were men. The mean (±SD) age of these patients was 56.5±13.5 years. The mean (±SD) age of onset of smoking was 18.5±5.5 years. Smoking cessation in the program was checked by measuring the exhaled carbon monoxide levels at 6 months after reporting smoking cessation. A level less than 10 parts per million was considered not to be a smoker. Of the 111 patients, 14 (12.6%) had reported smoking cessation and had an exhaled carbon monoxide level less than 10 parts per million. The new smoking cessation program was attended by more patients and had a higher success rate than the previous smoking cessation program, although the smoking cessation success rate was still low. Further studies are needed to determine which factors improved cessation rates and to determine other factors associated with successful smoking cessation in the study population.

The effect of asset-based wealth inequality on problem drinking among rural Thai elders: a prospective population-based cohort study.

Evidence on the link between income inequality and alcohol-related problems is scarce, inconclusive and dominated by studies from the developed world. The use of income as a proxy measure for wealth is also questionable, particularly in developing countries. The goal of the present study is to explore the contextual influence of asset-based wealth inequality on problem drinking among Thai older adults. A population-based cohort study with a one-year follow-up was nested in a Demographic Surveillance System (DSS) of 100 villages in western Thailand. Data were drawn from a random sample of 1104 older residents, aged 60 or over (one per household) drawn from all 100 villages, of whom 982 (89%) provided problem drinking data at follow-up. The primary outcome measure was a validated Thai version of the Alcohol-Used Disorder Identification Test for problem drinking. Living in areas of high wealth inequality was prospectively associated with a greater risk for problem drinking among older people (adjusted odds ratio 2.30, 95% confidence intervals 1.02-5.22), after adjusting for individual-level and village-level factors. A rise in wealth inequality over the year was also independently associated with an increased risk of problem drinking (adjusted odds ratio 2.89, 95% confidence intervals 1.24-6.65). The associations were not explained by the social capital, status anxiety or psychosocial stress variables. The data suggest that wealth inequality and an increase in inequality across time lead to a greater risk of problem drinking. Efforts should be directed towards reducing gaps and preventing large jumps in inequality in the communities. Further research should investigate the effect of asset-based inequality on various health risk behaviors and its specific mediating pathways.

Migration of children and impact on depression in older parents in rural Thailand, southeast Asia.

CONTEXT Migration is feared to be associated with abandonment and depression in older parents "left behind" in rural areas of low- and middle-income countries. OBJECTIVE To test for prospective associations between (1) out-migration of all children and subsequent depression in parents and (2) having a child move back and an improvement in parents' depression. DESIGN A cohort study with a 1-year follow-up. SETTING A population-based study nested in a demographic surveillance site of 100 villages in rural Thailand. Most out-migration is to the capital city. PARTICIPANTS A stratified random sample of 1111 parents 60 years and older (1 per household) drawn from all 100 villages, of whom 960 (86%) provided depression data at follow-up. MAIN OUTCOME MEASURES Scoring 6 or more on the Thai version of the EURO-D depression scale at follow-up. RESULTS Depression prevalence was 22%. At baseline, 155 (16%) had all their children migrated from the district and 806 (84%) had at least 1 child living in the district. Having all children out-migrated at baseline, compared with having none or some children out-migrated, predicted a smaller odds of depression, after controlling for baseline sociodemographic and health measures (odds ratio [OR], 0.43; 95% CI, 0.20-0.92). Having a child move back in the study year was associated with greater odds of depression at follow-up when adjusted for baseline measures (OR, 1.75; 95% CI, 1.04-2.94), although this was no longer significant after adjusting for changes in disability and marital status since baseline (OR, 1.72; 95% CI, 0.99-2.98). CONCLUSIONS Contrary to our hypothesis, parents whose children are not migrants may be at greater risk of depression than those with migrant children. More understanding is needed about the risks for depression in older rural populations and about the effectiveness of interventions.

Rural-Urban Migration and Experience of Childhood Abuse in the Young Thai Population.

Evidence suggests that certain migrant populations are at increased risk of abusive behaviors. It is unclear whether this may also apply to Thai rural-urban migrants, who may experience higher levels of psychosocial adversities than the population at large. The study aims to examine the association between migration status and the history of childhood sexual, physical, and emotional abuse among young Thai people in an urban community. A population-based cross-sectional survey was conducted in Northern Bangkok on a representative sample of 1052 young residents, aged 16-25 years. Data were obtained concerning: 1) exposures-migration (defined as an occasion when a young person, born in a more rural area moves for the first time into Greater Bangkok) and age at migration. 2) outcomes-child abuse experiences were assessed with an anonymous self report adapted from the Conflict Tactics Scales (CTS). There were 8.4%. 16.6% and 56.0% reporting sexual, physical, and emotional abuse, respectively. Forty six percent of adolescents had migrated from rural areas to Bangkok, mostly independently at the age of 15 or after to seek work. Although there were trends towards higher prevalences of the three categories of abuse among early migrants, who moved to Bangkok before the age of 15, being early migrants was independently associated with experiences of physical abuse (OR 1.9 95%CI 1.1-3.2) and emotional abuse (OR 2.0, 95%CI 1.3-3.0) only. Our results suggest that rural-urban migration at an early age may place children at higher risk of physical and emotional abuse. This may have policy implications for the prevention of childhood abuse particularly among young people on the move.

Family violence and its 'adversity package': a community survey of family violence and adverse mental outcomes among young people.

BACKGROUND: Limited research has examined the relationship between common forms of family violence and their impacts. We (1) examine the co-occurrence of exposure to domestic violence (EDV) and physical abuse (PA) in childhood and their relations to intimate partner violence (IPV) in adulthood among the young Thai people, and (2) describe their associations with common adverse mental outcomes. METHODS: A population-based cross-sectional survey was conducted in a community in Bangkok on a representative sample of 1,052 young residents, aged 16-25 years. Measurements were as follows: (1) exposures--the Conflict Tactics Scales were used to assess EDV and PA in childhood and IPV in adulthood, and (2) outcomes--common mental disorder and suicidal ideation were assessed with Clinical Interview Schedule-Revised, illicit drug use with Diagnostic Interview Schedule, and problem drinking with Alcohol Use Disorder Identification Test. RESULTS: Those who reported EDV and PA were highly likely to report IPV (OR 9.3, 95% CI 4.4-19.4). In general, strong associations were found between exposure to each form of the violent experiences and all the adverse outcomes (adjusted odds ratios ranged from 1.7 to 5.7). Those who had been exposed to the three types of violence, compared to none, were most likely to report all the adverse outcomes (odds ratios ranged from 4.3 to 17.3). CONCLUSION: Those who had experienced both kinds of the childhood violence were particularly likely to get re-victimised later in their life. A dose-response relationship was observed between the extent of exposure to violence and the adverse outcomes. There is a need to identify and prevent these experiences and their impact on children and young people.

Disability and late-life depression: a prospective population-based study.

BACKGROUND: Previous researches in developed countries have established depression as a risk factor for disability in the elderly, but little has focused on disability as a contributor to depression. OBJECTIVE: The present study aims: 1) to describe the 3-month incidences of depression among Thai elders with and without disability and 2) to investigate the prospective relationship between the disability and depression. MATERIAL AND METHOD: A 3-month prospective population-based cohort study of 358 elders (142 severe, 89 moderate 127 mild or non-disabled people), aged 60 years and older and living in rural and urban communities, was conducted. Depression was assessed by Euro-D Thai version at baseline and 3 months follow-up. Disability was assessed by World Health Organization Disability Assessment Schedule (WHODAS-II). Impairment was assessed by a modified version of the Burvill Physical Illness Scale. Logistic regression modeling was used to determine whether impairment and disability were independently associated with the onset of late-life depression. RESULTS: The 3-month incidences were 5%, 14.29% and 22.61% among the elders with no/mild, moderate and severe disability respectively. Both severe disability and a high number of impairments were each significantly associated with risk of depression (RR3.25 95% CI 1.29-8.18 and RR2.33 95% CI 1.15-4.73, respectively), independently of age, gender and socioeconomic status. CONCLUSION: Disability is one of the main contributors in depression in late-life. Improving community and public facilities and accessing to health services (e.g., medical rehabilitation) for disabled older people may not only help to enhance their quality of life but also help to prevent depression.

Child abuse and risky behaviors among youths.

BACKGROUND: Child abuse is an important health issue but it is little known how abuse experiences in childhood and current health risk behaviors are related. OBJECTIVES: To (a) study the prevalence and characteristics of child abuse experience, (b) test the hypothesis that youths with a history of child abuse would have more health risk behaviors compared to their non-abused counterparts and (c) study the associations between child abuse experience, family and social risk factors, and current health risk behaviors. MATERIAL AND METHOD: A cross-sectional population survey was conducted on a sample of 488 young people aged 16-25, living in suburban community of Pathumthani Province. MEASURES: The standard questionnaires used consisted of (1) The Conflict Tactics Scales (CTS) for child abuse experience (2) Health risk behaviors using Diagnostic Interview Schedule (DIS), Alcohol-Use Disorder Identification Test (AUDIT), sexual risk behavior screening test, modified Youth Risk Behavior Survey Questionnaire to measure substance use, alcohol, sexual risk behaviors, other risk behaviors respectively. Linear regression was performed to estimate the independent association of abuse experience with the risky behavioral outcomes. RESULTS: Prevalence of child abuse was approximately 30% of the sampled group. Childhood physical abuse was the most common form of abuse (15%) while sexual abuse was the second most common (12%). There were strong graded relationships between the number of abusive experiences and the health risk behaviors. Factors associated with having health risk behaviors included male gender older age, experiences of abuse, low level of parental education, friends who were involved with potential health risk activities, and no close relatives. CONCLUSION: Child abuse was not uncommon among Thai youths. Abusive experience and some family and social factors increased the risk of risky behaviors among youth.

Validation and factor structure of the Thai version of the EURO-D scale for depression among older psychiatric patients.

OBJECTIVES: To assess the concurrent and the construct validity of the Euro-D in older Thai persons. METHOD: Eight local psychiatrists used the major depressive episode section of the Mini International Neuropsychiatric Interview to interview 150 consecutive psychiatric clinic attendees. A trained interviewer administered the Euro-D. We used receiver operating characteristic (ROC) analysis to assess the overall discriminability of the Euro-D scale and principal components factor analysis to assess its construct validity. RESULTS: The area under the ROC curve for the Euro-D with respect to major depressive episode was 0.78 [95% confidence interval (CI) 0.70-0.90] indicating moderately good discriminability. At a cut-point of 5/6 the sensitivity for major depressive episodes is 84.3%, specificity 58.6%, and kappa 0.37 (95% CI 0.22-0.52) indicating fair concordance. However, at the 3/4 cut-point recommended from European studies there is high sensitivity (94%) but poor specificity (34%). The principal components analysis suggested four factors. The first two factors conformed to affective suffering (depression, suicidality and tearfulness) and motivation (interest, concentration and enjoyment). Sleep and appetite constituted a separate factor, whereas pessimism loaded on its own factor. CONCLUSION: Among Thai psychiatric clinic attendees Euro-D is moderately valid for major depression. A much higher cut-point may be required than that which is usually advocated. The Thai version also shares two common factors as reported from most of previous studies.

Rural-urban migration and depression in ageing family members left behind.

BACKGROUND: It has been suggested that rural-urban migration will have adverse consequences for older parents left behind. AIMS: To describe correlates of outmigration and to estimate any association between outmigration of children and depression in rural-dwelling older parents. METHOD: Population-based survey of 1147 parents aged 60 and over in rural Thailand. We randomly oversampled parents living without children. We defined an outmigrant child as living outside their parent's district, and measured depression as a continuous outcome with a Thai version of the EURO-D. RESULTS: Outmigration of all children, compared with outmigration of some or no children, was independently associated with less depression in parents. This association remained after taking account of social support, parent characteristics, health and wealth. Parents with all children outmigrated received more economic remittances and they perceived support to be as good as that of those with children close by. CONCLUSIONS: Outmigration of children was not associated with greater depression in older parents and, after taking account of a range of possible covariables, was actually associated with less parental depression. This could be explained by pre-existing advantages in families sending more migrants and by the economic benefits of migration.

Rural-urban migration, illicit drug use and hazardous/harmful drinking in the young Thai population.

AIMS: Limited data are available about whether rural-urban migration, often characterized by exposure to urban life stress and a reduction in social network and support, can affect the prevalence of illicit drug use and hazardous/harmful drinking. The purpose of our study was to examine the prevalence of these risky behaviours among Thai young adults and to describe their association between their migration status and these outcomes. DESIGN: A population-based cross-sectional survey. SETTING: A representative sample of 1052 residents, aged 16-25 years (467 males and 585 females) in a suburban community of Bangkok in 2003 and 2004. MEASUREMENTS: (i) Exposures-migration (defined as the occasion when a young person born in a more rural area moves for the first time into Greater Bangkok); and (ii) outcomes-illicit drug use was assessed with an anonymous self-report adapted from the Diagnostic Interview Schedule (DIS) and hazardous/harmful drinking with Alcohol Use Disorder Identification Test (AUDIT). FINDINGS: The results showed that 10.9% (82 males and 17 females) had illicit drug use and 24.3% (179 males and 62 females) hazardous and harmful drinking. In multivariate analysis, rural-urban migration was not associated with illicit drug use, whereas hazardous/harmful drinking was associated independently with being late migrants, who moved at the age of 15 or older. CONCLUSIONS: Illicit drug use and hazardous/harmful drinking were common among young Thais. The potential effect of migration on hazardous and harmful drinking identified in this study may be helpful for the design and implementation of preventive measures.

A prospective study in one year cumulative incidence of depression after ischemic stroke and Parkinson's disease: a preliminary study.

BACKGROUND AND AIMS: 1) To measure the one year cumulative incidence of depression after ischemic stroke event and 2) to compare its incidence with that of Parkinson's disease (PD) in an outpatient neurology department. MATERIALS AND METHODS: Stroke patients were recruited after their first diagnosis and PD patients were recruited during the same recruitment period. Main measures included: 1) disability (Barthel Index and Modified Rankin Scale), 2) cognitive function (Thai Mental State Examination and 3) depression (Clinical Interview Schedule-Revised). The patients were assessed at 1, 2, 3, 6 and 12 months. RESULTS: Seventy-seven stroke patients with hemispheric infarction and 59 PD patients were recruited. The baseline characteristics of the two groups were comparable except that stroke patients were 4 years younger. The cumulative one year incidence of depression was 12% after stroke and 5.1% in PD with no significant difference. Cox regression analysis showed that the risk for depression among stroke cohort was almost three times higher, although not statistically significant, than that among PD cohort (hazard ratio 2.92). In stroke, depression mainly occurred within 3 months after the event but in PD, depression developed randomly throughout the follow up period. CONCLUSION: The one year cumulative incidence of post-stroke depression in the Thai population is much lower than in the Caucasian population. However, its adjusted cumulative incidence was much higher to that of PD. The findings are in line with previous studies that stroke significantly contributes to the pathogenesis of depression.

The experience of abuse and mental health in the young Thai population A preliminary survey.

OBJECTIVES: The aims of this study were to examine the prevalence of child abuse exposure among Thai people in a suburban community and to describe the association of abuse experiences with common mental disorders (CMD), alcohol use disorders and substance use. METHODS: A population-based cross-sectional survey was conducted in Northern Bangkok on a representative sample of 202 young residents, aged 16-25 years. RESULTS: Thirty eight percent of the respondents reported experiencing some form of abuse during childhood, with 5.8% having been subjected to sexual penetration, 11.7% having been physically abused and 31.8% emotionally abused. A graded relationship was found between the extent of exposure to abuse during childhood and mental problems. After controlling for potential confounders, CMD remained significantly associated with emotional abuse, and alcohol use disorders remained associated with sexual abuse. Strong but non-significant trends were present for associations between CMD and sexual abuse and all forms of abuse with substance use. CONCLUSION: Child abuse experiences were common among the respondents. Childhood abuse, particularly sexual abuse, has a potentially devastating impact on adult mental health.

The ability of primary health care physicians to detect mental disorders in a university hospital setting.

OBJECTIVE: To determine how primary health care physicians differ in their ability and the factors underlying the differences between them in the ability to recognize mental disorders. METHOD: The group studied consisted of 15 primary health care physicians detecting mental disorders in 750 randomly selected adult patients of the general practice clinic in Thammasat University Hospital. The GHQ-28-Thai version was used as the reference method in the identification of psychiatric cases compared with the physicians' own assessment. Univariate and multivariate statistical analysis were used. RESULTS: There was a great variation in the ability of the physicians to detect mental disorders. The recognition ability was associated with the medical school from which the physician graduated. The discrimination ability was not associated with any factors. CONCLUSION: The medical school plays a role in determining the ability to detect mental disorders. This information would usually inform future developments in psychiatry teaching at both undergraduate and postgraduate levels.