Development and validation of the caregiver needs and resources assessment.

Introduction: Existing caregiver assessment tools were long criticized for focusing on the needs and burden while neglecting the importance of the resources. The current study aimed to develop a multidimensional and time-effective assessment tool that measures both needs and resources of non-paid family caregivers of older adults for screening and service-matching purposes. Methods: Items of the Caregiver Needs and Resources Assessment (CNRA) were developed from extensive literature reviews and focus group interviews of family caregivers and social workers in the field. In addition, we collected 317 valid responses from family caregivers of older adults from local non-government organizations in examining the psychometric properties of the CNRA. Results: The results revealed a 12-factor structure that fitted nicely into the conceptual frame of needs and resources domains. Need factors were positively associated with mental health symptoms, while resource factors were positively associated with peace in mind, meaning-making, and personal gain measures. The 36-item CNRA revealed good internal reliability and convergent validity. Discussion: The CNRA has the potential to be used as a compact yet balanced assessment tool for understanding both the needs and resources of caregivers for human service professionals.

Filicide as a cultural practice in Ghana: The qualitative understanding of a family tragedy and its implications for child protection practice.

BACKGROUND: Contrary to evidence from the Western literature, cases of filicide in Ghana are mostly unreported because they are rooted in cultural practices and hidden from the general public. OBJECTIVE: The purpose of this study was to explore the cultural context of filicide in a rural community. Particularly, to provide an understanding of the spirit child (SC) phenomenon, how the killing of a SC is performed and to provide a general understanding of filicide within a particular context. PARTICIPANTS AND SETTING: Four relatives of a family that engaged in a filicide incident took part in the study. The interviews were conducted in a rural community in Ghana where the incident occurred. METHODS: Short written narratives were used to explore the experiences and perceptions of relatives whose family engaged in filicide. RESULTS: Children with severe deformities are likely to be associated with matters of divinity which gives way for the conceptualization of the SC and its attendant filicide. The findings highlight the critical role of traditional healers in rural communities and the consequences of strong community beliefs and expectations that influence parents to commit filicide. CONCLUSION: The study provides directions for child protection workers to address the stigma parents face for having children with severe deformities and to provide education on child welfare legislation.

Family caregiving during the COVID-19 pandemic: factors associated with anxiety and depression of carers for community-dwelling older adults in Hong Kong.

BACKGROUND: The COVID-19 pandemic disrupts the daily routine and increases the caregiving load of the family carers of older adults. This study examined how the pandemic may impact mental health and investigated the prevalence of anxiety and depressive symptoms in family carers of older people. METHODS: Two hundred and thirty-six family carers of older adults participated in this cross-sectional survey study. Outcome measures included their symptoms of anxiety and depression, pandemic-related psychosocial factors, external factors, and the practice of preventive behaviours. RESULTS: Caseness prevalence of anxiety and depression among family carers was 25 and 56% respectively. Working carers were more depressed than non-working, while younger carers reported more anxiety and depression symptoms than older. Hand hygiene and getting drugs from the hospital positively predicted depression while healthy lifestyle negatively predicted depression. These variables, together with perceived risk and severity and the worry of getting infected, predicted anxiety. CONCLUSIONS: The prevalence of mental health symptoms was alarming. Telemedicine practice, including online pharmaceutical services and the Internet Hospital plus Drug Delivery platform, could be a solution in alleviating the burden and worry of infection of family carers. Tailored-made interventions by age and working status of the family carers are recommended.

Regulating the traditional kinship care practice in Ghana: Reflections from young people with kinship care experience.

BACKGROUND: Kinship care has become a favourable alternative care option for orphans and vulnerable children without adequate parental care in Ghana. However, kinship care practices in Ghana are considered informal cultural practices without formal regulations. The absence of formal regulations could have consequences on the health and development of children due to the lack of proper supervision and empirical assessment of children's needs. In line with recent policy discussions on mechanisms to regulate informal kinship care practices, this study aimed to identify how the State could be involved in improving kinship care experience for children. METHODS: Qualitative in-depth interviews were conducted with 22 young persons (aged 18-23) who had been received into kinship care to share their experiences on how the State could be involved in improving kinship care experience for children. Narratives from the young people were analysed following the constructivist grounded theory approach. RESULTS: Introduction of a welfare scheme for kinship caregivers, policy on child care, provision of start-up capital and training for caregivers, were measures suggested by the young people to improve kinship care practice. Providing start-up capital to kinship caregivers was identified to mitigate caregivers' unemployment challenges, which could have ripple effects on the well-being of children by escalating caregiver stress. CONCLUSION: The study's findings suggest that the State has a significant role to ensure that caregivers are equipped with the needed resources to provide adequate care for children. Regulating kinship care practices should embrace a strength-based empowerment model that builds on the capacity of the caregivers to ensure better outcomes for children. Studies that explore the views of policy makers and caregivers in a larger sample may yield promising results to complement the current findings.

Relationship of Anxiety and Depression with Respiratory Symptoms: Comparison between Depressed and Non-Depressed Smokers in Singapore.

The rising prevalence of smokers in the community, specifically psychiatric patients, necessitates smoking cessation as an important strategy for reducing the harmful effects of tobacco. This study aims to compare the profiles of depressed and non-depressed smokers and evaluate how psychiatric symptoms influence respiratory symptoms. A cross-sectional survey was administered to 276 non-depressed adult smokers in the community and 69 adult smokers who had been formally diagnosed with depression in the outpatient clinic of a University Hospital in Singapore. Participants were administered questionnaires on smoking attitudes and perceptions, psychiatric symptoms, and respiratory symptoms. Correlations and multiple regression analyses were conducted. The mean age of smokers in the study was 35.32 ± 13.05 years. Smokers in the community and psychiatric samples were largely similar on all of the sociodemographic factors, except that fewer depressed people were employed (χ² = 8.35, p < 0.01). Smokers with depression also reported more attempts to quit smoking (χ² = 7.14, p < 0.05), higher mean depressive, anxiety, and stress symptom (DASS) scores (t = -10.04, p < 0.01), and endorsed more respiratory symptoms than smokers in the community (t = -2.40, p < 0.05). The DASS scores, number of cigarettes smoked daily, years of smoking, general perception of smokers getting heart disease, and presence of lung disease were positively and significantly correlated with respiratory symptoms. On multiple regression, only anxiety symptoms (ß = 0.26, p < 0.05) and the presence of lung disease (ß = 0.22, p < 0.001) were significantly correlated with respiratory symptoms. Depressed smokers reported greater difficulty in quitting tobacco use, and they perceived more severe respiratory symptoms compared to non-depressed counterparts. Anxiety symptoms were positively associated with the severity of respiratory symptoms. Smoking cessation campaigns need to specifically target psychological symptoms in smokers and focus more psychoeducation on the risk of cardiovascular disease in the middle-aged population.

Development and Validation of the Marital Metaphor Questionnaire (MMQ-10) for Urban Chinese Women.

Metaphors have long been applied to marital counseling and couple therapy. This pioneering study measures marital conceptualization through metaphors. It reports the validation of the Marital Metaphor Questionnaire (MMQ-10), designed to measure the marriage conceptualization of Chinese women through marital metaphors. The MMQ-10 was found to have favorable psychometric properties including reliable internal consistency, a good discriminative prediction of marriage at risk and moderate correlation with a Chinese indigenous multidimensional marital satisfaction inventory. Factor analysis reveals that the MMQ-10 is composed of three dimensions: conjugal relationship, marital anguish, and marital conviction. The MMQ-10 appears to be suitable for the use with Chinese women in premarital or marital counseling sessions. The present researchers hope that this study may support the use of metaphors in future research and clinical practice in other nations and cultures.

Caregiving Experience for Children with Intellectual Disabilities among Parents in a Developing Area in China.

BACKGROUND: By utilizing grounded theory methodology, this study attempted to fill a gap whereby little research explored family caregiving perspectives in China where public support is insufficient and familial responsibility is highly valued. METHODS: Data were collected through the qualitative methods of interviews and observations among a purposive sample of 15 parents of children with intellectual disabilities in central China. RESULTS: The central idea emerging from the data encompassed five broad categories of caregiving experiences: (i) unavoidable caregiving responsibility and (ii) uncertain future as the greatest worries which are the perception towards the recipient; (iii) compromising quality of life and (iv) positive roles of caregiving tasks which focus on the self; and (v) community support which is the perceived support from the external system. CONCLUSION: A recursive relationship existed among these categories. Chinese culture and traditional beliefs dominated throughout these issues. The implications and limitations of this study were discussed.

Empowering caregivers: impact analysis of FamilyLink Education Programme (FLEP) in Hong Kong, Taipei and Bangkok.

BACKGROUND: Education and support for caregivers is lacking in Asia and the peer-led FamilyLink Education Programme (FLEP) is one of the few provisions to address this service gap. This study aims to evaluate quantitatively its efficacy in reducing subjective burdens and empowering the participants. METHOD: One hundred and nine caregiver participants in three Asian cities were successfully surveyed at pre-intervention, post-intervention and six-month intervals with a number of standard inventories. Mixed analysis of variance (ANOVA) procedures showed significant programme impact over time intervals for all sites, and subsequently an empowerment measurement model was tested. RESULTS: FLEP was found effective in reducing worry and displeasure, significantly improving intra-psychic strain, depression and all empowerment measures. The measurement model had an acceptable good fit. Baseline difference showed no interference with the programme efficacy. CONCLUSIONS: Apart from the initial support for FLEP, the current study also provides some hindsight on the empowerment practice in mental health for Asia, whose sociocultural political contexts are vastly different from that of the developed countries. It remains to be seen whether qualitative data or more stringent research design will yield consistent results and whether FLEP can also work in rural areas.

Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modelling analysis.

OBJECTIVE: The Substance Abuse and Mental Health Services Administration (SAMHSA) National Consensus Statement on Mental Health Recovery proposed 10 recovery components as guiding principles for fostering recovery among people with severe mental illness. Although researchers have recognized a close association between patient-oriented recovery and health-related quality of life (HRQOL), the relation between the recovery components and patients' self-reported HRQOL is still unknown. The purpose of the present study was therefore to use structural equation modelling to predict HRQOL of schizophrenia outpatients from the recovery components proposed by SAMHSA. METHODS: The recovery status of 201 outpatients with schizophrenia, schizophreniform, or schizoaffective disorder was measured using 12 variables that indicate the outcome of 10 recovery components. Canonical correlation analysis was applied to screen variables that are highly correlated with HRQOL. Valid variables were then used to build a structural model that predicted individuals' HRQOL as indicated by the World Health Organization Quality of Life Measure Abbreviated (WHOQOL-BREF (HK)). RESULTS: The bestfit model was able to explain 80.7% of the variance in WHOQOL-BREF outcome. The model demonstrated significant direct and indirect effects of five recovery components on HRQOL. The effect of psychosocial symptoms on HRQOL was highest (total beta = -0.64), followed by sense of personal agency (total beta = 0.58), sense of optimism (total beta = 0.54), perceived support (total beta = 0.47), and internal stigma (total beta = -0.42). CONCLUSION: The recovery components proposed by the SAMHSA consensus statement provided a useful framework to explain HRQOL of outpatients with schizophrenia. The present model indicated a moderate to large effect of five major recovery components on HRQOL. It showed that patients' perceptions of support, optimism, and personal agency were influenced by psychosocial symptoms and internal stigma. This empirical study supported the use of recovery principles, such as resilience building or mastery-based intervention to improve the QOL of community dwellers with schizophrenia.

Operationalization of the SAMHSA model of recovery: a quality of life perspective.

PURPOSE: To test empirically the Substance Abuse and Mental Health Services Administration (SAMHSA) recovery model. METHODS: Two hundred and four attendants aged 18-60, with schizophrenia spectrum disorder, from two participating outpatient clinics were interviewed with a number of inventories, including health-related quality of life measure (WHOQOL-BREF (HK)). Canonical correlation analysis was performed on two sets of variables (SAMHSA recovery components and QoL domain scores). RESULTS: There were significant correlations between most recovery components proposed in the SAMHSA recovery statement and the health-related quality of life measure. Age, duration of untreated psychosis, the degree of social support, the interaction of singlehood and the number of confidants, engagement in competitive careers, and the duration of participation in community support services were all found to be important predictors. CONCLUSIONS: The SAMHSA consensus statement appeared to contain valid concepts for Chinese subjects. It presented new challenges for psychiatric rehabilitation and reminded the policy makers that there is much more psychiatric rehabilitation can achieve beyond symptom control and patient management. It also demonstrated that resolve and the commitment of resources to combat stigma, develop resilience, and foster patient empowerment were very much needed in Hong Kong and perhaps in Asia and elsewhere.

Intent to remarry among Chinese elderly widowers: an oasis or an abyss?

To investigate the intent to remarry and the predictors for such intent with psychosocial variables, this study used male interviewers to interview 180 Chinese elderly widowers. A structured questionnaire on singlehood and intent to remarry, which developed out of a pilot in-depth focus-group study, was used. Data were analyzed with nonparametric tests and logistic regression. The intent to remarry was predicted by younger age, inability to meet sexual needs, and dissatisfaction with widowhood. A total of 40% of these widowers who wanted a partner considered finding one from Mainland China. The sex-related findings were very different from previous studies on Chinese men. They showed that there should be professional support to help them to better adjust to late-life marriage. In addition, the study uncovered the need to expand the scope and enhance the sensitivity of current general practitioners and geriatric services to address issues beyond medical concerns.

Community attitudes towards discriminatory practice against people with severe mental illness in Hong Kong.

BACKGROUND: The existing literature on community attitudes towards people with severe mental illness (SMI) tends to be rather general and impressionistic, with apparently conflicting findings which have yet to be adequately understood. AIMS: This article undertakes to examine the community's level of tolerance towards discriminatory practice against people with SMI in three domains: family relations, employment and health care. METHODS: Structured interviews with a representative sample of 507 citizens were carried out using the computer-assisted telephone interview system (CATI). RESULTS: Our survey reveals some expected common misunderstandings about mental illness, with the older age group showing the greatest toleration towards discrimination. However, respondents showed a strong objection to discriminatory behaviour which people with SMI commonly face in health care and employment, whereas greater toleration towards discrimination was found in the family domain. CONCLUSIONS: The coexistence of misunderstandings about mental illness and public rejection of discriminatory practice against people with SMI suggests that community attitudes are multi-dimensional and more amendable than expected. The findings of this study call for target-specific educational strategies for community education, as well as accompanying policy initiatives to end discriminatory practice, if people with SMI are to be truly taken as our fellow citizens.

Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong.

This research examines the experience of stigma associated with psychiatric treatment among Chinese patients with schizophrenia in Hong Kong. In focus groups patients described stigma experiences related to clinic visits and the side effects of antipsychotic medications. Additionally, they revealed various adverse treatment experiences during hospitalization which point to the presence of structural discrimination. Based on the focus group findings, a questionnaire was developed and completed by 320 and 160 patients with schizophrenia and diabetes mellitus, respectively. Results showed that patients with schizophrenia were more likely to anticipate stigma, conceal illness, and default on clinic visits than patients with diabetes. Medication-induced stigma occurred in 48% of patients with schizophrenia. It brought about the unwelcome disclosure of illness, workplace difficulties, family rejection, and treatment non-adherence. Adverse experiences during hospitalization were reported by 44% of patients with schizophrenia. They included negative staff attitudes, excessive physical/chemical restraints, inadequate information/complaint systems, and limited rights. We conclude that stigma, at both individual and structural levels, represents a central experience of the treatment of schizophrenia in Hong Kong. Because inequitable health policy, resource allocation, and service organization privilege service providers' control over users, treatment-related stigma may be a prime example of the social production of stigma and discrimination based on power difference between the stigmatizers and the stigmatized. To examine this critically we need to redirect stigma research to tractable clinical circumstances and structural mechanisms that produce and maintain stigmatizing and discriminatory psychiatric practice. Destigmatization programs must be evaluated not only by change in public attitudes but also by how much they reduce structural stigma and improve patients' lives.

Experience of social stigma by people with schizophrenia in Hong Kong.

BACKGROUND: Research on stigma often focuses on general public attitudes and overlooks patients' subjective experiences of everyday stigma arising from significant others. AIMS: To document and compare the interpersonal experiences of stigma in patients with schizophrenia and patients with diabetes mellitus in Hong Kong. METHOD: Four focus groups were conducted to generate a self-report questionnaire. Data were collected from out-patients with schizophrenia (n=320) and diabetes (n=160). RESULTS: Significantly more patients with schizophrenia (>40%) than diabetes (average 15%) experienced stigma from family members, partners, friends and colleagues. Over 50% anticipated stigma and about 55% concealed their illness. Dysphoria occurred in over half. CONCLUSIONS: Interpersonal (especially intrafamilial) stigma was pervasive, hard to avoid and devastating to patients with schizophrenia. Family support had to be realised rather than assumed, despite the emphasis on relationship bonds in Chinese society. Programmes that build the family as a rehabilitative resource should start early to reduce the development and adverse impacts of stigma.