Linking cohort-based data with electronic health records: a proof-of-concept methodological study in Hong Kong.

OBJECTIVES: Data linkage of cohort-based data and electronic health records (EHRs) has been practised in many countries, but in Hong Kong there is still a lack of such research. To expand the use of multisource data, we aimed to identify a feasible way of linking two cohorts with EHRs in Hong Kong. METHODS: Participants in the 'Children of 1997' birth cohort and the Chinese Early Development Instrument (CEDI) cohort were separated into several batches. The Hong Kong Identity Card Numbers (HKIDs) of each batch were then uploaded to the Hong Kong Clinical Data Analysis and Reporting System (CDARS) to retrieve EHRs. Within the same batch, each participant has a unique combination of date of birth and sex which can then be used for exact matching, as no HKID will be returned from CDARS. Raw data collected for the two cohorts were checked for the mismatched cases. After the matching, we conducted a simple descriptive analysis of attention deficit hyperactivity disorder (ADHD) information collected in the CEDI cohort via the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale (SWAN) and EHRs. RESULTS: In total, 3473 and 910 HKIDs in the birth cohort and CEDI cohort were separated into 44 and 5 batches, respectively, and then submitted to the CDARS, with 100% and 97% being valid HKIDs respectively. The match rates were confirmed to be 100% and 99.75% after checking the cohort data. From our illustration using the ADHD information in the CEDI cohort, 36 (4.47%) individuals had ADHD-Combined score over the clinical cut-off in the SWAN survey, and 68 (8.31%) individuals had ADHD records in EHRs. CONCLUSIONS: Using date of birth and sex as identifiable variables, we were able to link the cohort data and EHRs with high match rates. This method will assist in the generation of databases for future multidisciplinary research using both cohort data and EHRs.

Psychometric evaluation of the Adjustment Disorder New Module-20 (ADNM-20): A multi-study analysis.

The Adjustment Disorder New Module (ADNM) is a self-report instrument for assessing Adjustment disorder (AjD), but uncertainties remain in evaluating factor structure and psychometric properties of ADNM in previous studies. Three studies were conducted to examine the factor structure, psychometrics properties, and clinical utility of the 20-item version of ADNM (ADNM-20) and 4-item version (ADNM-4) among samples of Hong Kong Chinese (N = 1,415). Confirmatory factor analysis demonstrated good model fitness with a bifactor model. Statistical indices indicated unidimensionality of AjD. The model-based reliability showed that the total score of ADNM-20 should be used in scoring and interpretation for capturing the construct of AjD. ADNM-4 model demonstrated full invariance between women and men and partial invariance between age groups. Receiver operating characteristic analysis revealed a cutoff score of 10 for probable AjD. The prevalence of probable AjD was 20.5 % excluding cases with probable depression among a population-representative sample of Hong Kong Chinese amid civil unrest in Hong Kong in July 2019. Cutoff scores of ADNM-20 (49) and ADNM-4 (9) were established for clinically significant common psychiatric conditions, namely PTSD, depression, and anxiety. Both ADNM-20 and ADNM-4 were reliable and valid to assess probable AjD. Implications for clinical research and practice are discussed.

Effects of social support and depression on problematic drinking among trauma-exposed Chinese adults: A population-based study.

BACKGROUND: Alcohol consumption is prevalent and alcohol-related problems are a considerable social issue in China. Over 17% of Chinese consume alcohol regularly. Exposure to potentially traumatic events (PTE) is associated with increased alcohol-related problems. Social support often buffers this association. This study examined the relationship between exposure to PTE and alcohol misuse and explored the moderating effect of social support on this relationship in a Chinese context. METHODS: Data were collected through face-to-face computer assisted interviews in a stratified cluster sample of 753 Chinese adults living in Guangzhou, China. The Life Events Checklist-5 (LEC-5), World Health Organization Alcohol Use Disorders Identification Test (WHO-AUDIT), and Social Support Rating Scale (SSRS) were used to measure trauma exposure, problematic alcohol use, and social support. RESULTS: Univariable logistic regression analyses indicated that trauma exposure (OR = 3.18; compared to non-exposure), increased depression (OR = 1.06), and perceived friend support (OR = 1.21), were associated with higher odds of problematic drinking. Multivariable models adjusting for potential confounders demonstrated that PTE and depression were associated with problematic drinking, but this was not the case for perceived friend support. Perceived friend support modified the effect of trauma exposure and was associated with increased odds of problematic drinking among those who reported high levels of depressive symptoms. CONCLUSION: Social support may not always be a beneficial resource among those who experienced PTEs in a Chinese context. Further research is needed to better understand the role and function of different types of support, and for whom these associations are beneficial.

Barriers and Facilitators of Rapid HIV and Syphilis Testing Uptake Among Filipino Transnational Migrants in China.

Transnational migrant workers are known to be at high risk for HIV/STIs. This study estimated the point prevalence of HIV/syphilis and examined correlates of HIV/syphilis testing uptake among female migrant domestic workers in Macao, China. Data was obtained from 1363 female Filipino domestic workers who were offered free rapid HIV and syphilis testing. A mixed methods analysis was undertaken to examine correlates of testing and themes about reasons for not testing. Among 1164 women tested, there were no cases of HIV/syphilis observed and 199 (14.6%) refused HIV/syphilis testing. Greater social integration (aOR 1.12; 95% CI 1.02-1.24), having more than one sexual partner (aOR 1.65; 95% CI 1.02-2.65), and longer working hours on the testing day (aOR 0.97; 95% CI 0.94-1.00), were associated with testing uptake. Among those who tested, the majority (> 70%) had never tested before, suggesting the need to improve testing outreach. Qualitative themes about reasons for not testing included low perceived need and insufficient time. Individual and structural testing barriers should be reduced to optimize HIV/STI testing in migrant populations.

Psychometric Validation of PHQ-9 and GAD-7 in Filipino Migrant Domestic Workers in Macao (SAR), China.

There are 500,000 female Filipino domestic workers worldwide. However, there are no validated instruments to assess common mental disorders in this population. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) are brief measures that could be effective screeners for depression and anxiety in domestic workers. This study aims to establish reliability and validity of the Filipino versions of the PHQ-9 and GAD-7. In Study 1, 131 domestic workers completed the PHQ-9, GAD-7, and other questionnaires with a test-retest interval of 10 days. Convergent validity was examined using measures of posttraumatic stress disorder, direct exposure to traumatic events, and rumination. Discriminant validity was assessed using measures of discrimination, pain, social support, and indirect exposure to traumatic events. In Study 2, criterion validity was established with another sample of domestic workers (N = 100) using clinician-administered Mini International Neuropsychiatric Interviews. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic efficiency. Results showed acceptable and high internal consistency for PHQ-9 and GAD-7, respectively. Both had acceptable test-retest reliability. Convergent and discriminant validity were also established. ROC curve results demonstrated that optimal cut scores for PHQ-9 and GAD-7 are 6 and 7, respectively. The Filipino versions of PHQ-9 and GAD-7 are reliable and valid for use among Filipino domestic workers.

Psychometric validation of the PTSD Checklist-5 among female Filipino migrant workers.

Migrant populations are at increased risk for exposure to traumatic life events. Presently, there are no reliable and valid screening instruments for posttraumatic stress disorder (PTSD) among Filipino migrant workers, a population that numbers over 2.3 million worldwide. This study evaluated the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in a sample of female Filipino migrant workers in Macao (SAR), China, in two studies. The first examined the reliability (internal and test-retest), convergent validity (with depression, anxiety, and rumination), and discriminant validity (with pain and social support) in a sample of 131 participants. The second study established criterion validity of the PCL-5 using the PTSD module of the Mini-International Neuropsychiatric Interview (MINI), delivered by a female Filipino psychologist as the criterion, in a sample of 100 participants. Results indicated excellent internal consistency (Cronbach's alpha = 0.95) and moderate 10-day test-retest reliability (ρ = 0.58, p < .001). PCL-5 scores correlated strongly with scores on measures of depression (ρ = 0.71, p < .001), anxiety (ρ = 0.61, p < .001), and rumination (ρ = 0.68, p < .001), supporting convergent validity. Discriminant validity was demonstrated by a weaker association with scores on measures of pain (ρ = 0.33, p < .001) and social support (ρ = -0.11, p = .22). The diagnostic accuracy of the scale was good (AUC = 0.87). The optimal cutoff score of 25 optimized sensitivity (0.89) while maintaining adequate specificity (0.73), with a weighted Kappa of κ[1]) = 0.82. Our results demonstrated that the PCL-5 is a reliable and valid screening instrument for use among female Filipino migrant workers.

Las poblaciones migrantes tienen un mayor riesgo de exposición a eventos traumáticos en la vida. Actualmente, no hay instrumentos de detección fiables y válidos para el trastorno de estrés postraumático (TEPT) entre los trabajadores migrantes filipinos, una población que cuenta con más de 2,3 millones en todo el mundo. Este estudio evaluó las propiedades psicométricas de la Lista de chequeo-5 para TEPT según el DSM-5 (PCL-5) en una muestra de trabajadoras migrantes filipinas en Macao (SAR), China, en dos estudios. El primero examinó la confiabilidad (reevaluación interna y de prueba), la validez convergente (con depresión, ansiedad y rumiación) y la validez discriminante (con dolor y apoyo social) en una muestra de 131 participantes. El segundo estudio estableció la validez de criterio del PCL-5 utilizando el módulo TEPT de la Entrevista Internacional Neuropsiquiátrica Mini (MINI) aplicado por una psicóloga filipina como criterio, en una muestra de 100 participantes. Los resultados indicaron una excelente consistencia interna (alfa de Cronbach 0.95) y moderada fiabilidad de 10 días de prueba-reevaluación (ρ = 0.58, p <0.001). Las puntuaciones de PCL-5 se correlacionaron fuertemente con las puntuaciones en las medidas de depresión (ρ = 0.71, p <0.001), ansiedad (ρ = 0.61, p <0.001) y rumiación (ρ = 0.68, p <0.001), apoyando la validez convergente. La validez discriminante se demostró por una asociación más débil con las puntuaciones en las medidas del dolor (p= 0.33, p<0.001) y apoyo social (p= −0.11, p= 0.22).La precisión diagnóstica de la escala fue buena (AUC = 0.87). El punto de corte óptimo de 25 sensibilidad optimizada (0,89) manteniendo una especificidad adecuada (0,73), con un Kappa ponderado de κ [1]) = 0,82. Nuestros resultados demostraron que el PCL-5 es un instrumento de detección confiable y válido para el uso entre trabajadoras migrantes filipinas.

The effect of discrimination on depression and anxiety symptoms and the buffering role of social capital among female domestic workers in Macao, China.

Foreign migrant domestic workers experience an increased burden of mental disorders. Discrimination contributes to this burden. Social resources may buffer migrants from the effects of this discrimination. The present study explored the relationship between discrimination and common mental disorder (CMD) symptoms, anxiety and depression, and examined whether social capital (cognitive and structural) modified this association. A total of 131 female migrant Filipina domestic workers in Macao, China (Mage = 39.7) were sampled using snowball methods. Self-report data were obtained using tablet devices. Correlation analyses demonstrated that discrimination was significantly associated with depression (rs = 0.43) and anxiety (rs = 0.42). Mulitvariable regressions showed that cognitive, but not structural, social capital was significantly negatively associated with depression (ß = -0.30) and anxiety (ß = -0.32). Cognitive social capital modified the association between discrimination and depression (ß = 0.39) and anxiety (ß = 0.53). Contrary to predictions, as discrimination increased, compared to those with no cognitive social capital, those with moderate or high levels of cognitive social capital experienced worsening CMD symptoms. This finding provides greater nuance to our understanding of how and under what circumstances social resources are protective for mental health for migrant workers.

Correlates of expected eMental Health intervention uptake among Filipino domestic workers in China.

BACKGROUND: Transnational migrant populations face critical barriers to mental health service utilization that perpetuate mental health disparities globally. Overseas Filipino workers (OFWs) number over 2 million globally and 25% are female domestic workers. Structural barriers prevent equitable access to mental health services for this population. Electronic mental health (eMental Health) intervention is a scalable alternative to face-to-face treatment. The current study sought to identify key correlates of intention to use eMental Health within a community of female Filipino domestic workers living and working in Macao (SAR), China. METHODS: Respondent-driven sampling implemented at a community field site was used to reach a sample of 1364 female domestic workers. A multivariable adjusted partial proportional-odds (PPO) model was used to assess relevant correlates of intent to use eMental Health. RESULTS: The majority (62.8%) reported being likely to utilize eMental Health. The adjusted PPO model showed that younger age (18-25, 26-35, 36-45 v. over 55), longer time as an OFW, being likely (v. neutral and unlikely) to seek professional services, willingness to pay for services (v. not), belief that mental health services are a priority (v. low priority), having access to Wi-Fi outside the employer's home (v. not), and higher levels of social support were associated with increased odds of intent to use eMental Health. CONCLUSIONS: eMental Health is a promising intervention with high potential for uptake among OFWs. The majority of the study population owned a smartphone and were able to connect to the Internet or Wi-Fi. Future work will rigorously evaluate eMental Health programs for use among OFWs.