Measurement of neuropsychiatric symptoms in the older adults with mild cognitive impairment based on speech and facial expressions: a cross-sectional observational study.

OBJECTIVES: To examine the association between speech and facial features with depression, anxiety, and apathy in older adults with mild cognitive impairment (MCI). METHODS: Speech and facial expressions of 319 MCI patients were digitally recorded via audio and video recording software. Three of the most common neuropsychiatric symptoms (NPS) were evaluated by the Public Health Questionnaire, General Anxiety Disorder, and Apathy Evaluation Scale, respectively. Speech and facial features were extracted using the open-source data analysis toolkits. Machine learning techniques were used to validate the diagnostic power of extracted features. RESULTS: Different speech and facial features were associated with specific NPS. Depression was associated with spectral and temporal features, anxiety and apathy with frequency, energy, spectral, and temporal features. Additionally, depression was associated with facial features (action unit, AU) 10, 12, 15, 17, 25, anxiety with AU 10, 15, 17, 25, 26, 45, and apathy with AU 5, 26, 45. Significant differences in speech and facial features were observed between males and females. Based on machine learning models, the highest accuracy for detecting depression, anxiety, and apathy reached 95.8%, 96.1%, and 83.3% for males, and 87.8%, 88.2%, and 88.6% for females, respectively. CONCLUSION: Depression, anxiety, and apathy were characterized by distinct speech and facial features. The machine learning model developed in this study demonstrated good classification in detecting depression, anxiety, and apathy. A combination of audio and video may provide objective methods for the precise classification of these symptoms.

Developing a machine learning model for detecting depression, anxiety, and apathy in older adults with mild cognitive impairment using speech and facial expressions: A cross-sectional observational study.

BACKGROUND: Depression, anxiety, and apathy are highly prevalent in older people with preclinical dementia and mild cognitive impairment. These symptoms have also proven valuable in predicting the progression from mild cognitive impairment to dementia, enabling a timely diagnosis and treatment. However, objective and reliable indicators to detect and distinguish depression, anxiety, and apathy are relatively scarce. OBJECTIVE: This study aimed to develop a machine learning model to detect and distinguish depression, anxiety, and apathy based on speech and facial expressions. DESIGN: An observational, cross-sectional study design. SETTING(S): The memory outpatient department of a tertiary hospital. PARTICIPANTS: 319 older adults diagnosed with mild cognitive impairment. METHODS: Depression, anxiety, and apathy were evaluated by the Public Health Questionnaire, General Anxiety Disorder, and Apathy Evaluation Scale, respectively. Speech and facial expressions of older adults with mild cognitive impairment were digitally captured using audio and video recording software. Open-source data analysis toolkits were utilized to extract speech, facial, and text features. The multiclass classification was used to develop classification models, and shapely additive explanations were used to explain the contribution of each feature within the model. RESULTS: The random forest method was used to develop a multiclass emotion classification model, which performed well in classifying emotions with a weighted-average F1 score of 96.6 %. The model also demonstrated high accuracy, precision, and recall, with 87.4 %, 86.6 %, and 87.6 %, respectively. CONCLUSIONS: The machine learning model developed in this study demonstrated strong classification performance in detecting and differentiating depression, anxiety, and apathy. This innovative approach combines text, audio, and video to provide objective methods for precise classification and remote monitoring of these symptoms in nursing practice. REGISTRATION: This study was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR1900023892; registration date: June 19th, 2019).

A nurse-led positive psychological intervention among elderly community-dwelling adults with mild cognitive impairment and depression: A non-randomized controlled trial.

BACKGROUND: Older adults with mild cognitive impairment (MCI) and depression have a higher dementia conversion rate, which requires timely intervention. OBJECTIVES: A non-randomized controlled trial was conducted to explore the effect of a nurse-led positive psychological intervention (PPI) in relieving depression and promoting cognition in this population. METHODS: A total of 70 older adults were enrolled, with 35 each in the intervention and control groups. The control group received one-to-one health education, and the intervention group received a 40- to 60-minute PPI for eight successive weeks. RESULTS: During the intervention, most participants reached the standard of active participation, and 2.86% continued to complete homework every day during follow-up. The Patient Health Questionnaire-9 (PHQ-9) score in the intervention group was significantly lower than that in the control group at the end of intervention (t = -3.64, p < 0.05) and at 3-month follow-up (t = -4.48, p < 0.05). Interaction effects of time and group on PHQ-9 scores (F = 8.11, p < 0.001), with significant differences between the groups in scores (F = 9.11, p < 0.05) and times (F = 23.58, p < 0.05) was observed. In the Montreal Cognitive Assessment (MoCA) scale, the intervention group had significantly higher scores than controls at the end of intervention (t = 7.28, p < 0.05) and 3-month follow-up (t = 8.01, p < 0.05). Cognition in the two groups was significantly affected by intergroup effects (F = 42.80, p < 0.001), interaction effects (F = 30.38, p < 0.001), and time effects (F = 33.67, p < 0.05). CONCLUSIONS: Although the effects tended to decrease in follow-up, the nurse-led PPI was feasible and valid in relieving depression and promoting cognition among older participants with MCI and depression. The present findings warrant further exploration. TWEETABLE ABSTRACT: A nurse-led positive psychological intervention was applicable among elderly MCI adults with depression and effective in relieving depression and promoting cognition.

Nationally funded health management projects for older adults in China and the United States: Comparative analysis based on data from two principal institutions.

Objectives: To systematically summarize and compare the health management projects on the aged population funded by the National Institutes of Health (NIH) in the US and the National Natural Science Foundation of China (NSFC) in China. Methods: All elderly-related projects from 2007 to 2022 were retrieved by searching the project titles, abstracts, and keywords such as "older adults," "elderly," "aged," "health management," and so on. Python, CiteSpace, and VOSviewer were used to extract, integrate, and visualize the relevant information. Results: A total of 499 NSFC projects and 242 NIH projects were retrieved. For both countries, prestigious universities and institutions received the most funded projects; the projects that got the most funds were longitudinal studies. Both countries attach great importance to investment in the health management of the aged population. However, different focuses existed in health management projects for older adults in the two countries due to distinct national conditions and development levels. Conclusions: The analysis results of this study can provide a reference for other countries with similar challenges of population aging. Effective measures should be taken to promote the transformation and implementation practice of the project achievements. Nurses can benefit from these projects and facilitate the translation of relevant research findings into clinical practice to improve nursing quality for older adults.

Cross-disciplinary training of nursing informatics and nursing engineering at the postgraduate level: A feasibility analysis based on the qualitative method.

BACKGROUND: The trend of interdisciplinary education is becoming increasingly prominent. Nursing informatics and nursing engineering have received much attention and development at different levels of nursing education in many Western countries. Meanwhile, in China, the cultivation of interdisciplinary nursing talents has either not been initiated or has only entered an initial stage. OBJECTIVES: This study aims to explore experts' opinions from nursing, informatics and engineering on the feasibility of interdisciplinary education at graduate master's level in nursing through interview. DESIGN: This was a descriptive qualitative study. SETTING: Interviews were conducted online or face to face. PARTICIPANTS: Experts in the fields of nursing, informatics, and engineering who met the study qualifications were enrolled. METHODS: This study used a purposive sampling method and collected data via semi-structured interviews. A total of 14 experts were involved based on data saturation, which eight were interviewed face-to-face and six were interviewed online. A content analysis method was used to summarize and analyze the attitudes, opinions, and suggestions of experts. RESULTS: A total of 579 min of interviews with 66,387 words were transcribed and analyzed after 30-50 min time range of each interview, and 4 themes were established. A consensus was obtained on the necessity and importance of interdisciplinary education. Policy guidance, financial support, and mutual recognition were the prerequisites for the cultivation. Moreover, feasibility of interdisciplinary education depends on multi-cooperation, including society, university, and hospital. Finally, a linkage mechanism among relevant stakeholders was required. CONCLUSION: The necessity and feasibility of such integrated training was concluded. Learning from the experience of relevant countries, China should launch an interdisciplinary training model suitable for its national condition.

The mediating role of resilience in the relationship between social support and quality of life among patients after radical cystectomy: A structural equation model analysis.

AIM: This study aimed to examine the relationship between social support and quality of life in urostomy patients and identify the mediating role of resilience in that relationship. DESIGN: A cross-sectional design. METHODS: Participants included 232 patients who were recruited from a tertiary hospital in Beijing during March 2020 and August 2020. They completed questionnaires about perceived social support, resilience and ostomy-related quality of life. Structural equation modelling was performed to analyse the data. RESULTS: The mean age of patients was 65.79 (SD = 8.67) years, and the mean length of time after surgery was 42.14 (SD = 15.76) months. Urostomy patients' quality of life, social support and resilience were all above moderate. Social support had a positive direct effect on the quality of life and a positive indirect effect on the quality of life through the mediating role of resilience.

Status of core competencies of wound, ostomy and continence nurses and their influence on career success: a cross-sectional study.

OBJECTIVES: The wound, ostomy and continence nursing practice has its own scope and standards, and each standard requires relevant competency. However, the core competencies of wound, ostomy and continence nurses that contribute to the career success are poorly known. To identify associations between career success and core competencies of wound, ostomy and continence nurses in China. DESIGN: A cross-sectional survey with a convenience sample. SETTING: Participants were recruited from 108 hospitals in 28 provinces. PARTICIPANTS: A total of 123 wound, ostomy and continence nurses were surveyed. MEASURES: Career success, core competencies and demographic characteristics of wound, ostomy and continence nurses, were measured in this study. METHODS: A survey was distributed to 123 wound, ostomy and continence nurses were recruited from 108 hospitals in 28 provinces. Multivariate logistic regression was undertaken to explore associations between career success outcomes and core competency scores of wound ostomy and continence nurses and their demographic characteristics. RESULTS: The career success and core competency of wound, ostomy and continence nurses were both above average. Nurses who had higher total scores of core competency were more likely to have higher career success, including total score (OR=4.90), career satisfaction (OR=5.58) and perceived internal (OR=4.55)/external (OR=3.42) organisation competitiveness. Higher competency in interpersonal communication (OR=7.70) and more time for wound care per month (OR=8.80) predicted higher career satisfaction. Additionally, nurses with higher professional development were more likely to score higher in perceived internal organisation competitiveness of career success (OR=4.36) and the overall career success (OR=5.96). CONCLUSIONS: The career success and core competency of the wound, ostomy and continence nurses in China were at an above average level. The associations between career success and core competency of the wound, ostomy and continence nurses were positive, suggesting that competency enhancement could improve nurses' career success.

Distinguishing apathy and depression in older adults with mild cognitive impairment using text, audio, and video based on multiclass classification and shapely additive explanations.

OBJECTIVES: This study aimed to develop a classification model to detect and distinguish apathy and depression based on text, audio, and video features and to make use of the shapely additive explanations (SHAP) toolkit to increase the model interpretability. METHODS: Subjective scales and objective experiments were conducted on 319 mild cognitive impairment (MCI) patients to measure apathy and depression. The MCI patients were classified into four groups, depression only, apathy only, depressed-apathetic, and the normal group. Speech, facial and text features were extracted using the open-source data analysis toolkits. Multiclass classification and SHAP toolkits were used to develop a classification model and explain the contribution of specific features. RESULTS: The macro-averaged f1 score and accuracy for overall model were 0.91 and 0.90, respectively. The accuracy for the apathetic, depressed, depressed-apathetic, and normal groups were 0.98, 0.88, 0.93, and 0.82, respectively. The SHAP toolkit identified speech features (Mel-frequency cepstral coefficient (MFCC) 4, spectral slopes, F0, F1), facial features (action unit (AU) 14, 26, 28, 45), and text feature (text 6 semantic) associated with apathy. Meanwhile, speech features (spectral slopes, shimmer, F0) and facial expression (AU 2, 6, 7, 10, 14, 26, 45) were associated with depression. Apart from the shared features mentioned above, new speech (MFCC 2, loudness) and facial (AU 9) features were observed in the depressive-apathetic group. CONCLUSIONS: Apathy and depression shared some verbal and facial features while also exhibited distinct features. A combination of text, audio, and video could be used to improve the early detection and differential diagnosis of apathy and depression in MCI patients.

China's cultivation of master nursing specialist: A qualitative content analysis of the stakeholders.

AIM: To assess the Master of Nursing Specialist (MNS) in China from the perspectives of relevant stakeholders to assist the sustained development of the MNS program. BACKGROUND: With the growing demand for quality nursing care, the cultivation of higher-level specialized nursing professionals continues to be challenging. DESIGN: A descriptive qualitative study. METHODS: The study used a convenience sampling method. Stakeholders of MNS education in the interviews included graduates of the MNS program, hospital administrators and healthcare policymakers. The individual semi-structured interviews were conducted via telephone, online interview, or face-to-face between April and December 2020. All interview materials were audio-recorded and transcribed verbatim and were analyzed using the qualitative content analysis approach. RESULTS: A total of 27 stakeholders completed the interviews, including 11 MNS graduates, 11 hospital administrators and 5 healthcare policymakers. Attitudes about and confirmation of the MNS program were collected as well as suggestions about further optimization. Three themes or categories were identified: the paradox of MNS prospects, current conditions of MNS education and strategic actions for further optimization. CONCLUSIONS: Our findings were based on the relevant stakeholders' views toward MNS education, providing a multidimensional view when combined. The results reflected the current state and future direction of MNS education in China, which will help sustain the development of MNS programs. The practice and experience in China will enlighten other developing countries with similar backgrounds.

Identification of four patterns for self-management behaviors in clients with schizophrenia: A cross-sectional study.

This study aimed to describe different patterns of self-management behaviors among clients with schizophrenia in China. Two hundred twenty-eight clients with schizophrenia living in eight communities of Beijing were investigated using the Self-Management Instrument for Persons with Schizophrenia and a Demographic and Clinical Characteristics Questionnaire. Cluster analysis was performed to categorize the data. Four distinct self-management behavior patterns and variables of clients associated with non-adherent self-management were identified. The self-management behaviors and demographic characteristics were similar in each pattern but different among patterns. These findings could guide the development of more personalized and cost-effective self-management interventions for different patterns of clients in the future.

Does Psychological Capital Mediate Occupational Stress and Coping Among Nurses in ICU.

As an exploitable positive psychological state that individual performs during growth and development processes, psychological capital (PsyCap) was deemed as an essential factor in occupational health. This study aims to explore mediating effects of PsyCap on the relationship between job stress and coping style among ICU nurses. A cross-sectional sample of 288 nurses was recruited. A high-level of occupational stress (2.32 ± 0.69) and PsyCap (4.62 ± 0.93) were found among participants who mainly used a positive coping style (2.04 ± 0.59). PsyCap was significantly negatively correlated with job stress (ß = -0.250; p < .01) and positively with coping style (ß = 0.416; p < .01). Structural equation model analysis revealed that job stress negatively influenced PsyCap, while PsyCap positively influenced coping style. Results verified the mediating role of PsyCap and suggested that an increase in PsyCap contributes to better control of job stress and the improvement of one's coping style.

The role of self-efficacy in mediating between professional identity and self-reported competence among nursing students in the internship period: A quantitative study.

AIM: This study explored the relationship between self-efficacy, professional identity and competence among nursing students and analyzed the mediating role of self-efficacy in the relationship between professional identity and competence. BACKGROUND: Increasing attention has been paid to the cultivation of competence among nursing students; however, few studies to date have analyzed its related factors and examined their relationship. DESIGN: A quantitative study with a descriptive design was performed in this study, adopting an online survey with convenience and snowball sampling. A cross-sectional sample of 887 nursing students in the internship period of their education program in mainland China was recruited from November to December 2020. METHODS: The Nursing Students Competence Instrument, Professional Identity Questionnaire for Nurse Students and General Self-efficacy Scale were distributed online. Descriptive statistics, Pearson's correlation, structural equation modeling (SEM) and the bootstrap method were employed in data analysis. RESULTS: Competence was significantly and positively correlated with professional identity (r = 0.598; P < 0.01) and self-efficacy (r = 0.692; P < 0.01). SEM analysis revealed that professional identity (ß = 0.31; P < 0.01) or self-efficacy (ß = 0.31; P < 0.01) could have a positive impact on competence. Meanwhile, self-efficacy played a mediating role in the relationship between professional identity and competence, with an indirect effect of professional identity creation through self-efficacy accounting for 52% of the total effect. CONCLUSIONS: Self-efficacy mediates the relationship between professional identity and competence to some extent. School educators and clinical tutors should pay greater attention to students' professional identity and self-efficacy to improve students' competence.

Acceptability and feasibility of public square dancing for community senior citizens with mild cognitive impairment and depressive symptoms: A pilot study.

OBJECTIVES: To explore the acceptability and feasibility of public square dancing among community residents with mild cognitive impairment (MCI) and depressive symptoms. METHODS: This mixed-method study consisted of a quantitative and a qualitative phase. From January to July 2018, a total of 241 community-dwelling senior citizens who complained of memory loss in one community in the Haidian District in Beijing were approached and screened, and 41 qualified for the study. Among them, 35 senior citizens participated in the public square dancing intervention. By the end of the three-month follow-up, 31 senior citizens completed the whole study. The Subjective Exercise Experience Scale (SEES) was used to survey senior citizens at the end of the three-month public square dancing intervention and follow-up to measure the participants' subjective exercise experience. Then 15 senior citizens were interviewed to collect attitudes, opinions, and suggestions related to the intervention. RESULTS: During the intervention, 90.6% of senior citizens met the requirement for defined hours. All senior citizens continued to dance at the three-month follow-up, and 32.3% met the requirement for defined hours. The scores of psychological well-being (11.03 ± 2.82 vs. 14.87 ± 3.93, P < 0.001) and fatigue (11.00 [8.00, 12.00] vs. 14.00 [9.00, 18.00], P < 0.001) increased at the end of the three-month follow-up. Qualitative research results extracted four major themes: increased confidence and a sense of accomplishment; easy to learn, close to real life, and sense of belonging; promotes physical and mental health; future expectations include music selection, reduced weather disruption, and self-organizing workouts. CONCLUSION: Public square dancing proved to be an acceptable, viable, and valuable intervention for MCI residents with depressive symptoms, which could be carried out by nursing staff in the community. Future studies should consider the appropriate population, intensity, and frequency of public square dancing and its effect on specific cognitive functions.

Effects of nurse-led square dancing on older patients with mild cognitive impairment combined with depressive symptoms: A pilot study.

OBJECTIVE: The present study aimed to verify the feasibility and preliminary effects of nurse-led square dancing designed to improve older adults' cognitive function and depressive symptoms who with MCI. METHODS: A quasi-experimental pilot study design was adopted for the present study. Screening for cognitive function was conducted among older adults (≥ 60 years old) living in two communities in Beijing who complained of memory loss. A total of 107 older patients with MCI and depressive symptoms were diagnosed after obtaining informed consent. Thirty-five patients selected from each community were included in the study as control and intervention groups, respectively. The two groups of patients received health education while the intervention group participated in a square dance intervention program led by nurses three times per week for 60 min per session over a period of three months. The Montreal Cognitive Assessment-Peking version (MoCA-P) and Geriatric Depression Scale (GDS-30) were used to assess the cognitive function and depressive symptoms of patients in the two groups at three time intervals; before intervention, at the end of the three-month intervention period, and over a three-month follow-up period after the end of intervention. RESULTS: Feasibility of the intervention was established with a high completion rate of 90%. Data collection for 63 out of 70 patients enrolled for the study was completed after six months. MoCA-P and GDS-30 scores of the intervention group were significantly different after the intervention when compared with the control group. A significant improvement in cognition was observed in the intervention group, and depressive symptoms decreased after intervention and follow-up when compared with the control group. During the intervention and follow-up phases, the MoCA-P score of the intervention group increased gradually with time. Furthermore, the MoCA-P and GDS-30 scores of the control group remained unchanged. CONCLUSION: This study has revealed that square dance intervention exerts a positive impact on cognitive function and depressive symptoms among older patients suffering from MCI and depressive symptoms. The results of this study support the feasibility and preliminary effects of square dancing on relieving cognitive decline and depressive symptoms. Square dancing is a recommended type of intervention that can be applied to the local Chinese population because of its simplicity, convenience, and suitability for the older adults.

Development and implementation of a standardized training program for newly graduated mental health nurses: Process and preliminary outcomes.

BACKGROUND: Training programs are crucial for newly graduated nurses transitioning from nursing school to independent clinical nursing careers. However, few studies have focused on the training of newly graduated mental health nurses. OBJECTIVES: The aim of this study was to develop, implement, and preliminarily evaluate a standardized training program for newly graduated nurses entering psychiatric nursing. DESIGN: The Delphi technique was adopted for program development, and a quasi-experimental design was employed for program implementation. SETTINGS: Six mental health institutions were involved in the practice training, and among these, three university-affiliated psychiatric hospitals were the study sites for theoretical training. PARTICIPANTS: A total of 180 newly graduated nurses hired by the six hospitals were involved and 154 finished the training program. METHODS: The program was developed using the Delphi method based on the results of a literature review and semi-structured interview with clinical practitioners. Change in mental health nurses' core competencies before and after the program was compared during program implementation. Focus group interviews were employed to collect the opinions and influence of the standardized training program after the intervention, and content analysis was used to analyze it. RESULTS: A two-round Delphi expert consultation was done, and 7 core competency elements and 37 training topics were designed for the standardized training program. The six-month training program consisted of two months for course training and four months of practical training, which were guided by a manual. Total CIRN scale score improved (142.29 ± 34.87 vs. 160.35 ± 32.46, P < 0.01) after receiving the program as did the scores for each dimension (P < 0.01). Participants gave positive feedback and suggested optimal training length and certification for the program. CONCLUSIONS: The standardized training program focused on mental health nursing proved to be a viable method of novice nurse training and resulted in positive outcomes. The program length and its long-term effects deserve further exploration to determine the best practical training program for sustaining optimal development of mental health nursing.

Does workplace violence, empathy, and communication influence occupational stress among mental health nurses?

Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care. This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population. A socio-demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy - Health Professions version, and Nurses' Clinic Communication Competence Scale were administered to 539 mental health nurses from three top-grade tertiary research hospitals in the Beijing-Tianjin-Hebei region. The analysis revealed a high level of job stress (3.06 ± 0.69) and a moderate prevalence of workplace violence (6.21 ± 2.94) existed among participants when compared with among other nurses. Meanwhile, participants' empathy (114.78 ± 15.99) and communication (4.31 ± 0.60) abilities were similar to or higher than those of other nursing populations. Mental health nurses with varying years of practice experience distinct levels of job stress. A linear regression analysis revealed that, while practice years (ß = 0.104; P < 0.05) and workplace violence (ß = 0.264; P < 0.01) aggravated occupational stress levels, empathy (ß = -0.147; P < 0.01) facilitated reductions in stress. Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses. Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed.

Mindfulness in nursing students: The five facet mindfulness questionnaire in samples of nursing students in China, the Philippines, and South Africa.

Mindfulness as a clinical strategy for helping manage physical and psychological symptoms is gathering an impressive evidence base. It is also being embraced widely for personal and professional development. As a therapeutic intervention for nurses working across a spectrum of settings, it helps expand practice, and integrating mindfulness in nursing undergraduate and graduate curricula is imminent. In the present study, we outline the development and measurement of mindfulness as a personality trait and therapeutic intervention, and advocate the use of a questionnaire alternative to expensive and impractical laboratory measures. The aims of the present study were to examine and compare the use and reliability of the Five Facet Mindfulness Questionnaire (FFMQ) in samples of nursing students from South Africa, China, and the Philippines, and compare the findings in the nursing student samples to other student and non-student samples. Three samples of students of nursing from China (n = 193), the Philippines (n = 243), and South Africa (n = 131) completed the 31-item FFMQ. The internal consistency was acceptable, and the correlations were significant among all facets and the total score. Although the total mean scores between the three samples were not significantly different, there were significant and interesting differences in the facet scores, and these are discussed in the light of likely cultural influences, and comparative data from other samples of students and clinical populations. The instrument shows promise for future use in educational research as a tool for curriculum change, for personal and professional development of nurses, and as a clinical tool for determining mindfulness changes over time.

Validation of the Violence Risk Screening-10 instrument among clients discharged from a psychiatric hospital in Beijing.

The Violence Risk Screening-10 is one of the few instruments available for evaluating violence risk in mental health clients during and after hospitalization. This prospective study examined the applicability of this brief instrument with a sample of 289 clients in the 6 months after discharge from a general psychiatric hospital in Beijing. During the research period, 24 of the 289 clients demonstrated aggression. The receiver-operator characteristic curve yielded an area under the curve of 0.62. At the cut-off point of 4.5, its sensitivity/specificity was 79.2%/33.3%, and the corresponding positive/negative predictive value was 9.9%/94.5%. The predictive accuracy of this instrument was lower compared with the results of the original study, and was also less accurate than when it was administered while the clients were in the hospital. While promising in its utility for use beyond the hospital, it deserves further modification prior to its wide use across culturally-diverse China.