Cultural contributions to adults' self-rated mental health problems and strengths: 7 culture clusters, 28 societies, 16 906 adults.

BACKGROUND: It is unknown how much variation in adult mental health problems is associated with differences between societal/cultural groups, over and above differences between individuals. METHODS: To test these relative contributions, a consortium of indigenous researchers collected Adult Self-Report (ASR) ratings from 16 906 18- to 59-year-olds in 28 societies that represented seven culture clusters identified in the Global Leadership and Organizational Behavioral Effectiveness study (e.g. Confucian, Anglo). The ASR is scored on 17 problem scales, plus a personal strengths scale. Hierarchical linear modeling estimated variance accounted for by individual differences (including measurement error), society, and culture cluster. Multi-level analyses of covariance tested age and gender effects. RESULTS: Across the 17 problem scales, the variance accounted for by individual differences ranged from 80.3% for DSM-oriented anxiety problems to 95.2% for DSM-oriented avoidant personality (mean = 90.7%); by society: 3.2% for DSM-oriented somatic problems to 8.0% for DSM-oriented anxiety problems (mean = 6.3%); and by culture cluster: 0.0% for DSM-oriented avoidant personality to 11.6% for DSM-oriented anxiety problems (mean = 3.0%). For strengths, individual differences accounted for 80.8% of variance, societal differences 10.5%, and cultural differences 8.7%. Age and gender had very small effects. CONCLUSIONS: Overall, adults' self-ratings of mental health problems and strengths were associated much more with individual differences than societal/cultural differences, although this varied across scales. These findings support cross-cultural use of standardized measures to assess mental health problems, but urge caution in assessment of personal strengths.

Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol.

Studies have consistently showed that informal caregivers have worse health, more medical consultations, anxiety and depression, and lower quality of life than those who do not provide such care. Positive outcomes of psychoeducation interventions have been found, but many of them are relatively long in duration, making them less cost-effective in implementation. The proposed study is a multi-site, three-arm randomized controlled trial of a mindfulness-based intervention for Chinese family caregivers. Effects of the intervention will be compared with those of an evidence-based psychoeducation program and treatment-as-usual. Two hundred forty cross-generational caregivers of frail older adults with moderate to severe levels of frailty will be recruited and randomly assigned to mindfulness-based intervention, psychoeducation, and treatment-as-usual experimental conditions. Program effectiveness will be analyzed on measures of caregiver burden, depression, anxiety, positive caregiving experience, spirituality, family conflict, and the biomarker of heart rate variability. Measures on coping styles, experiential avoidance, and self-efficacy will be explored to see if they mediate the changes to participant improvements in outcomes. Six-month follow-up will be included to investigate the maintenance effects. This study will provide evidence on mindfulness-based interventions on caregivers of frail older adults and expand the existing models of intergenerational caregiving in Chinese culture.

Foreign Language Learning in Older Adults: Anatomical and Cognitive Markers of Vocabulary Learning Success.

In recent years, foreign language learning (FLL) has been proposed as a possible cognitive intervention for older adults. However, the brain network and cognitive functions underlying FLL has remained largely unconfirmed in older adults. In particular, older and younger adults have markedly different cognitive profile-while older adults tend to exhibit decline in most cognitive domains, their semantic memory usually remains intact. As such, older adults may engage the semantic functions to a larger extent than the other cognitive functions traditionally considered the most important (e.g., working memory capacity and phonological awareness). Using anatomical measurements and a cognitive test battery, the present study examined this hypothesis in twenty cognitively normal older adults (58-69 years old), who participated in a two-month Italian learning programme. Results showed that the immediate learning success and long-term retention of Italian vocabularies were most consistently predicted by the anatomical measures of the left pars orbitalis and left caudal middle frontal cortex, which are implicated in semantic and episodic memory functions. Convergent evidence was also found based on the pattern of cognitive associations. Our results are consistent with a prominent role of semantic and episodic memory functions in vocabulary learning in older learners.

Prospective Memory Training for Healthy Older Adults: A Systematic Review.

OBJECTIVES: This review systematically synthesizes existing evidence of prospective memory training for healthy older adults (> 55 years). Existing prospective memory training include strategy-based, process-based and combined regimens. Strategy-based training focuses on different mnemonics to compensate for aging declines in prospective memory. Process-based training aims to restore related cognitive processes to support prospective memory. Combined training utilizes both strategy-based and process-based regimens to enhance prospective memory performance. METHODS: A total of 349 studies were identified from the Cochrane Library, EBSCO, PsycINFO and PubMed databases. RESULTS: Using predefined inclusion and exclusion criteria, 11 studies were included in the review. There were six studies of strategy-based training, two studies of process-based training and three studies of combined training. CONCLUSIONS: Overall, strategy-based training appears to facilitate prospective memory for healthy older adults. However, it is impossible to draw conclusions for process-based and combined training due to the preliminary nature of current evidence. CLINICAL IMPLICATIONS: Mental imagery or the use of external aids can be useful strategy-based approaches to facilitate prospective memory in older adults. Strategy-based training should target multiple prospective memory phases simultaneously to encourage transfers. Further studies will be required to draw conclusions on the effectiveness of process-based and combined training.

The buffer of resilience in the relations of gender-related discrimination, rejection, and victimization with depression among Chinese transgender and gender non-conforming individuals.

BACKGROUND: According to the minority stress theory, the minority stressors of gender-related discrimination, rejection, and victimization will increase depression in the transgender and gender non-conforming (TGNC) population. However, few studies focused on these relations in the context of mainland China, and the positive perspective of their resilience still remained unstudied. METHODS: This cross-sectional study recruited 361 TGNC individuals through the online community of TGNC people. The participants were involved in this study by measuring their experiences of gender-related discrimination, rejection, victimization, resilience, and depression. The SPSS and PROCESS were used to assess the relations of the studied variables. RESULTS: High rates of gender-related discrimination, rejection, and victimization were reported by TGNC participants in this study (80.1%, 98.9%, and 77.0% accordingly). The participants who had experienced gender-related discrimination and victimization showed a significantly higher level of depression than those who never experience such unfair treatments. Besides, gender-related discrimination and resilience significantly contributed to the variance of the depression (R2 adjusted=0.344, F=21.674, p<0.01), and their resilience was found to play a moderating role between discrimination and depression. LIMITATIONS: A longitudinal study may need to examine the causal effects, and the limitations of the online data should be noted. CONCLUSIONS: The Chinese TGNC people are living in a relatively unfavorable environment with experiencing high rates of gender-related unfair treatments, which can be detrimental to their mental health status. However, their resilience can be a buffer for them in facing adversity. Intervention and educational programs might be developed accordingly.

Cross-Cultural Examination of University Education and Ego Integrity in Late Adulthood: Implications for Policy and Practice.

Studies on education generally find that higher education has a positive impact on various aspects of life. Nevertheless, studies focused on elderly people and their psychosocial health and development seldom view higher education as an important factor. Our aim was to explore the relation between higher education and ego integrity, a measure based on Erikson's concept of psychological maturity in later life. We used four national samples of non-institutionalized elderly people from Cameroon (N = 238), China (N = 254), Czech Republic (N = 167), and Germany (N = 240). Relationships between ego integrity and several possible moderator variables were tested by multivariate regressions in each sample. Between-subject ANOVA was employed to test differences in ego integrity between university educated and non-university educated people. We found that ego integrity is affected by culture in interaction with gender and the level of education attained. University-educated people reported higher ego integrity than persons with lower education in three of four cultural samples, which suggests a relatively stable relationship between university education and ego integrity when controlling for gender, age, and working status. These findings highlight the importance of education in late adulthood. In terms of policies and practice, they underscore the importance of reduction of educational inequalities as well as desirability of improved access to higher education, expansion of opportunities for the achievement of complete education in later life, and facilitation and support of lifelong learning.

A Chinese version of the young children's participation and environment measure: psychometric evaluation in a Hong Kong sample.

PURPOSE: To investigate the psychometric properties of a Chinese-translated version of the Young Children's Participation and Environment Measure. MATERIALS AND METHODS: The Young Children's Participation and Environment Measure was translated into Chinese using cultural adaptation by adding/replacing with activities relevant to Chinese culture. Parents of 53 children aged 2-5 years with developmental disabilities and of 50 typical developing children completed the questionnaires. Internal consistency, test-retest reliability, known-group validity, and discriminant validity were examined using Cronbach's alpha, intraclass correlation coefficient, Mann-Whitney U tests, and Spearman's rank correlation coefficients respectively. RESULTS: Internal consistency was acceptable for most scales (α = 0.42-0.89). Test-retest reliability of the summary scores was moderate to high for all scales (intraclass correlation coefficient = 0.65-0.90). Known-group validity was supported by demonstrating significant differences by disability status in all community participation scales, two daycare/preschool participation scales, and one home participation scale. Low or negative correlations between the scores of some scales and children's cognition (ρ = 0.27-0.32; -0.36-to-0.35) and parental stress (ρ = -0.42-to-0.31) supported discriminant validity. CONCLUSION: This study provided psychometric evidence supporting the use of the Young Children's Participation and Environment Measure to assess Chinese children's participation and environmental support.IMPLICATIONS FOR REHABILITATIONThe Young Children's Participation and Environment Measure is translated into Chinese using a cultural adaptation process.The Chinese version of the Young Children's Participation and Environment Measure demonstrates evidence for internal consistency, test-retest reliability (including the minimal detectable change).The Chinese version of the Young Children's Participation and Environment Measure demonstrates evidence for known-group validity and discriminant validity.The Chinese version of the Young Children's Participation and Environment Measure holds promise for use in children aged 2-5 years to assess their participation and identify environmental barriers warranting intervention.

Development and pilot evaluation of the Cognition domain of the Hong Kong Comprehensive Assessment Scales for Toddlers.

Purpose: To describe the development of the Cognition domain of the Hong Kong Comprehensive Assessment Scales for Toddlers (HKCAS-T).Methods: Participants included 345 toddlers aged 18-41 months, with 258 recruited from Maternal and Child Health Centers (MCHCs) and 87 with cognitive delay recruited from Child Assessment Centers (CACs). They were individually administered the 83-item pilot version by medical practitioners or educational psychologists between 2017 and 2019 in MCHCs and CACs in Hong Kong.Results: Rasch analysis results supported the unidimensionality of the pilot version, after removing six items. Analysis of covariance results indicated that both the 83-item version and the 77-item version could differentiate between children of different age groups, and children with typical development from children with cognitive delay. Internal consistency and interrater reliability were 0.90 or above.Conclusions: The Cognition domain of the HKCAS-T is a promising developmental assessment tool for the assessment of toddlers. Cognition assessment, preschool, Chinese.

The detrimental impacts of negative age stereotypes on the episodic memory of older adults: does social participation moderate the effects?

BACKGROUND: Older adults' cognitive abilities can be impaired through priming of negative age stereotypes. However, it is unclear whether the effects of negative priming can be extended to episodic memory, which is believed to be the most age-sensitive type among the long-term memory systems, in Asian populations. Social participation has recently emerged as a potential protective factor for maintaining the cognitive function of older adults. The purpose of this study was to examine the effects of negative age stereotype priming on episodic memory and the moderating role of social participation in the priming effect. METHODS: A total of 105 community-dwelling older adults residing in Hong Kong were randomly allocated to two experimental conditions. Participants were primed either with negative age stereotype words (n = 53) or neutral words (n = 52) using an implicit priming task. Episodic memory performance was assessed using the Hong Kong List Learning Task (HKLLT), which includes total learning, two delayed recalls and a recognition task. Analysis of covariance (ANCOVA) was used to assess group differences in the priming task and memory performance, while a series of moderation analyses were performed to examine the moderating effects of social participation. RESULTS: The group that received negative age stereotype priming performed significantly worse than the group that received neutral words in their episodic memory test. Additional analyses showed that socially active individuals might be less prone to the effects of negative age stereotypes for the recognition task only. CONCLUSIONS: Older adults who are more socially active might be more immune to the effects of negative age stereotype priming on episodic memory. These results provide initial support for the hypothesis that social participation might act as an effective strategy to ward against negative age stereotype priming. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04202120 (first posted December 17, 2019), (Retrospectively registered).

Sense of Community Mediating Between Age-Friendly Characteristics and Life Satisfaction of Community-Dwelling Older Adults.

The growth of age-friendly community initiatives underscores a paradigmatic shift from the individual to the community, addressing dynamic transactions between people and the environment they are living in. The purpose of the present study is to address the gap in existing research by examining the psycho-social effects of the sense of community in mediating between WHO domains of age-friendliness and the life satisfaction of older adults. Data were obtained from 898 participants in Hong Kong. Path analysis was conducted. Two AFC domains, Social Participation as well as Community Support and Health Services, were found to be associated with life satisfaction. Sense of community was found to mediate between these two domains and life satisfaction. The implications of these findings are discussed with reference to developing opportunities in social participation of older adults and enhancing community/health support services in the context of developing sustainability in the community.

The effectiveness of nonpharmacological interventions for informal dementia caregivers: An updated systematic review and meta-analysis.

This systematic review and meta-analysis compared the effects of 131 randomized controlled trials, published between 2006 and mid-2018, for dementia caregivers with community-dwelling care-recipients. A new classification of interventions was proposed to enable a more detailed examination of the effectiveness of psychological interventions; 350 postintervention effect sizes in 128 studies and 155 follow-up effect sizes in 55 studies were computed. Postintervention effects were significant for all outcomes when all interventions are pooled together. Follow-up effects were found for all outcomes, except physical health and positive aspects of caregiving. Educational programs with psychotherapeutic components, counseling/psychotherapy, and mindfulness-based interventions had the strongest effects on reducing depressive symptoms. Multicomponent and miscellaneous interventions had the largest effects on reduction of burden/stress. Multicomponent and mindfulness-based interventions had the largest effects on enhancing subjective well-being. It should be noted that mindfulness and counseling/psychotherapy studies generally had small samples, and studies with smaller sample sizes tended to report larger effects. Metaregression analyses revealed that, overall, younger caregivers benefited more from the interventions. Although the majority of studies were from North America and Europe, there were a growing number from Asia and other parts of the world. Recommendations were made, including developing new theoretical models that address caregivers' changing needs over time; development of interventions that can be flexibly administered and individually "tailored," and assessing positive as well as negative aspects of caregiving to encourage development of greater resilience. We conclude with observations on the global health significance of improving the impact of psychosocial interventions on caregivers' lives. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Reminiscing to teach others and prepare for death is associated with meaning in life through generative behavior in elderlies from four cultures.

Objectives: Reminiscence is considered an important aspect of successful ageing. Prominent reminiscence functions in old age are to pass on important experiences (Teach/Inform) and to prepare for death (Death Preparation). These reminiscence functions were hypothesized to be associated with generative behavior which in turn was hypothesized to be associated with meaning in life. Thus, we tested an indirect effect of reminiscence functions on meaning in life mediated by generative behavior.Method: Elderly participants provided information on reminiscence functions, generative behavior, and meaning in life. Participants were recruited in Cameroon, China (Hong Kong), the Czech Republic, and Germany, to test the generalizability of findings.Results: The assumed indirect effect was identified: Reminiscence functions were associated with meaning in life via generative behavior. This pattern was found for all cultural samples.Conclusion: Albeit results have to be interpreted with caution as they are based on cross-sectional data, findings suggest that these reminiscence functions motivate generative behavior and thus indirectly affect meaning in life in elderlies from all four cultural contexts. In future studies, this effect needs to be replicated with a broader age range and a more fine-grained measure of generative behavior to account for potential differences in culturally appropriate generative outlets.

Telephone-based behavioral activation intervention for dementia family caregivers: Outcomes and mediation effect of a randomized controlled trial.

OBJECTIVES: The study examined the effects of a telephone-administered psycho-education with behavioral activation intervention (TBA) for family caregivers of person's with Alzheimer's dementia to reduce levels of depressive symptoms and burden and to enhance relationship satisfaction with the care-recipient METHODS: A double-blinded randomized trial compared TBA with telephone-based psycho-education with general monitoring (TGM). Ninety-six dementia caregivers were randomized. Both conditions received four weekly psycho-education sessions led by a social worker. TBA participants then received eight bi-weekly behavioral activation practice sessions delivered by paraprofessionals. TGM participants received eight bi-weekly monitoring sessions by paraprofessionals. RESULTS: As compared to TGM, TBA participants reported significantly larger reductions in depressive symptoms and burden and larger improvement in relationship satisfaction. Self-efficacy for controlling upsetting thoughts was found to have a partial meditation effect between TBA and the reduction of depressive symptoms. Qualitative feedback suggested that TBA participants expressed unique gains in awareness and developing new ways of reappraising the caregiving situation. CONCLUSION: TBA was an effective intervention to reduce depressive symptoms and burden as well as to enhance relationship satisfaction in dementia caregivers. PRACTICE IMPLICATIONS: The use of telephone and trained paraprofessionals can enhance the accessibility and sustainability of behavioral activation intervention for dementia family caregivers.

Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned.

With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver's ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, the use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts has received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined.

Validating the Revised Scale for Caregiving Self-Efficacy: A Cross-National Review.

BACKGROUND AND OBJECTIVES: This article reviews an instrument used in cross-national research with dementia family caregivers-the Revised Scale for Caregiving Self-Efficacy (RSCSE). Although the RSCSE has been translated into multiple languages, few studies have examined scale performance across samples. We examine congruence of psychometric, reliability, and validity data to inform research and practice. METHODS: We conducted citation searches using Scopus, Google Scholar, Web of Science, and PsycINFO. Identified dementia caregiving studies cited the original RSCSE article and described results of English and/or non-English translations of the scale. RESULTS: Peer-reviewed published studies (N = 58) of dementia family caregivers included data for Arabic, Chinese, English, French, Italian, and Spanish translations of the RSCSE; the majority (72%) reported use of non-English translations. Studies utilizing confirmatory factor analytic approaches reported findings consistent with the original development study. Internal consistency, convergent/discriminant validity, and criterion validity indices were congruent across diverse cross-national caregiving samples assessed with different translations. Data supported the RSCSE's sensitivity to change following specific psychosocial caregiving interventions. DISCUSSION: The reliability and validity of different translations of the RSCSE support continued use with cross-national samples of dementia family caregivers. Limitations of the scale point to the need for further self-efficacy measurement development within caregiving domains. Consistent with Bandura's discussion of social cognitive theory in cultural contexts, personal agency for caregiving challenges remains generalizable to cross-national populations. This review discusses the implications for cross-cultural research and practice.

Treating Subthreshold Depression in Primary Care: A Randomized Controlled Trial of Behavioral Activation With Mindfulness.

PURPOSE: We undertook a randomized controlled trial to assess the efficacy of group-based behavioral activation with mindfulness (BAM) for treating subthreshold depression in primary care in Hong Kong. METHODS: We recruited adult patients aged 18 years or older with subthreshold depression from public primary care clinics and randomly assigned them to a BAM intervention group or a usual care group. The BAM group was provided with eight 2-hour weekly BAM sessions by trained allied health care workers. Patients in the usual care group received usual medical care with no additional psychological interventions. The primary outcome was depressive symptoms measured by the Beck Depression Inventory-II at 12 months. Secondary outcomes included incidence of major depressive disorder at 12 months. We assessed quality of life, activity and circumstances change, functional impairment, and anxiety at baseline, end of intervention, 5 months, and 12 months. RESULTS: We randomly allocated 115 patients to the BAM intervention and 116 patients to usual care. At 12 months, compared with usual care peers, BAM patients had a slightly more favorable change in levels of depressive symptoms on the Beck Depression Inventory-II (between-group mean difference in score = -3.85; 95% CI, -6.36 to -1.34; Cohen d = -0.46, 95% CI, -0.76 to -0.16). Incidence of major depressive disorder was lower with BAM (10.8% vs 26.8%, P = .01), whereas groups did not differ significantly on other secondary outcomes at 12 months. CONCLUSIONS: Group BAM appears to be efficacious for decreasing depressive symptoms and reducing the incidence of major depression among patients with subthreshold depression in primary care, although generalizability of our findings may be limited.

Adapting an attention-deficit hyperactivity disorder parent training intervention to different cultural contexts: The experience of implementing the New Forest Parenting Programme in China, Denmark, Hong Kong, Japan, and the United Kingdom.

The New Forest Parenting Programme (NFPP) is a parenting program developed for parents who have a child with attention-deficit hyperactivity disorder (ADHD). It is a manualized program that is delivered in a parent's home over 8 weeks, or in a group format, or through a self-help manual. Three randomized controlled trials have been carried out in the United Kingdom. The NFPP group has adapted the program according to feedback from parents and therapists, and for use with different populations, both within the United Kingdom and internationally. The first international trial took place in New York, United States. Trials in Denmark, Hong Kong, and Japan followed. More recently, a trial of the self-help manual has been carried out in mainland China. This paper will outline the adaptions that were needed in order to be able to deliver the program in different countries with their own expectations of parenting, culture, and language. Training had to be differently focused; manuals and handouts had to be revised, translated and back-translated; and supervision had to be delivered at a distance to maintain the fidelity of the program. The international group will outline their experience of running trials in their own countries with the NFPP in a face-to-face format (Denmark), a group format (Hong Kong and Japan), and a self-help format (mainland China).

Predictors of quality of life and depression in older people living in temporary houses 13 months after the Wenchuan earthquake in western China: A cross-sectional study.

In this study, we explored the predictors of quality of life and depressive features in older people living in temporary housing 13 months after the Wenchuan earthquake in western China. Anonymous data were collected via questionnaires in a cross-sectional survey of 189 older people living in temporary housing 13 months after the earthquake. To explore the predictors of the outcomes of interest, Pearson correlation and multiple linear regression analysis were used. The results indicated that interests/hobbies, subjective support, and family function were positive predictors of quality of life, whereas instrumental activities of daily living and depressive symptoms were its negative predictors. In addition, we found that a higher level of instrumental activities of daily living predicted a greater likelihood of depression. These results suggested that developing strategies to decrease the instrumental activities of daily living score of these people helps improve their quality of life and depression. To enhance the quality of life of these individuals, healthcare providers should also focus on developing their interests/hobbies and provide them with adequate social support, especially subjective support.

Age-Friendliness and Life Satisfaction of Young-Old and Old-Old in Hong Kong.

Age-friendliness, promoted by the World Health Organization (WHO), aims to enable and support individuals in different aspects of life for fostering life satisfaction and personal well-being as they age. We identified specific aspect(s) of age-friendliness associated with life satisfaction and examined similarities and differences in age-friendliness and life satisfaction in young-old and old-old adults. Six hundred and eighty-two ageing adults were asked to complete a survey questionnaire consisting of the Age-friendly City Scale, Satisfaction with Life Scale, and sociodemographic variables. Multiple linear regression analysis was used to examine the effects of various domains of age-friendliness on life satisfaction among the young-old adults (aged 65 to 74, n = 351) and the old-old adults (aged 75 to 97, n = 331). Common domains associated with life satisfaction in both young-old and old-old groups were transportation and social participation. Community and health services were associated with life satisfaction for the young-old group only. On the other hand, civic participation and employment was significantly associated with the old-old group only. Social participation is important for the young-old and the old-old. Ageing older adults can be a resource to the society. Implications for promoting and implementing age-friendliness were discussed in the context of successful and productive ageing and the need for a more refined taxonomy of social activities.