The Effectiveness of a Community Psychiatric Rehabilitation Program Led by Laypeople in China: A Randomized Controlled Pilot Study.

Background: Community psychiatric rehabilitation has proven effective in supporting individuals and their families in recovering from mental illness. The delivery of evidence-based community rehabilitation services, however, requires health care workers to possess a set of specially trained knowledge and skills. Most developing countries, including China, do not have specially trained mental health personnel. The purpose of this study was to test the feasibility and efficacy of a community psychiatric rehabilitation program delivered by laypeople. Method: We conducted a randomized controlled study. Patients at two sites in Chengdu, China, were randomly assigned to either the laypeople-delivered (LPD) community psychiatric rehabilitation group (N = 49) or the drop-in center control group (N = 45). The outcomes were changes in symptoms, social functioning, and family functioning over 6 months, as measured by the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance Scale (PSP), the Family Burden Scale of Disease (FBS), and the Family APGAR index. Results: The number of sessions received over the 12-week period of treatment ranged from 20 to 100%, with a mean completion rate of 77.32% for all 12 sessions. Statistically significant interactions between group and time were found for the total PANSS [F (2, 94) = 12.51, p < 0.001] and both the Negative PANSS [F (2, 94) = 5.89, p < 0.01] and Positive PANSS [F (2, 94) = 6.65, p < 0.01] as well as the PSP [F (2, 94) = 3.34, p < 0.05], FBS [F (2, 94) = 5.10, p < 0.01], and Family APGAR index [F (2, 94) = 4.58, p < 0.01]. The results showed that the experimental group outperformed their counterparts in symptom management, personal social functioning, family care burden, and coherence. Conclusion: These results support the feasibility and efficacy of having laypeople deliver psychiatric rehabilitation services. A discussion and limitations of the study have been included.

Family Decision Making and Self-Determination Among Consumers With Schizophrenia in China: Cross-Cultural Implications.

OBJECTIVES: Self-determination is viewed as an important ingredient of successful recovery in psychiatric rehabilitation. The concept of autonomy, a key component of self-determination, may be of less importance in Chinese cultures, whereby an individual's choices may be in conflict with the family's expectations. This study aimed to develop an instrument to measure opinions about self-determination among Chinese consumers and their family members. METHODS: A 27-item questionnaire, the Consumer and Family Decision Making Scale (CFDMS), was constructed to measure consumers' and family members' views of self-determination in various aspects of daily life. A total of 364 (182 consumers of psychiatric services with a diagnosis of schizophrenia and 182 of their family members) participated in the study. RESULTS: The CFDMS was found to possess good psychometric properties and appears to be a reliable and valid instrument for assessment of consumers' decision making. (The Cronbach's alphas of psychiatric care and treatment factor, personal and social function factor, community and daily living factor, and money management factor were as follows: .86, .89, .87 and .76. The respective test-retest reliabilities were as follows: .81, .89, .80, and .88). Chinese consumers preferred autonomous decision making in regard to personal and social functioning and community and daily living but preferred to defer decisions regarding psychiatric care and treatment and money management to others. Family members and consumers had similar views. CONCLUSIONS: Deferring decisions to family members is common in Chinese families. The emphasis on autonomy in Western health care may need to be reconsidered in the treatment of Chinese consumers. Chinese families have a strong influence on treatment decisions, and providers must respect this style and remain nonjudgmental when dealing with situations or decisions that may be contradictory to their own culture and values.

Effectiveness RCT of a CBT intervention for youths who lost parents in the Sichuan, China, earthquake.

OBJECTIVE: Many children who lost parents in the 2008 earthquake in Sichuan Province, China, experienced symptoms of posttraumatic stress disorder (PTSD) and depression. This randomized controlled study compared the treatment effectiveness of short-term cognitive-behavioral therapy (CBT) with a general supportive intervention and with a control group of nontreatment. METHODS; Thirty-two Chinese adolescents were randomly assigned to three treatment groups. Participants were compared for psychological resilience (Connor-Davidson Resilience Scale), symptoms of PTSD (Children's Revised Impact of Events Scale), and depression (Center for Epidemiologic Studies Depression Scale) at baseline, after treatment, and three-month follow-up. RESULTS: CBT was effective in reducing PTSD and depressive symptoms and improved psychological resilience. General support was more effective than no intervention in improving psychological resilience. CONCLUSIONS: Short-term CBT group intervention seems to be a robust intervention for natural disaster victims. Short-term CBT group intervention was more effective than the general supportive intervention and the no-treatment group in enhancing psychological resilience and reducing PTSD and depression among adolescents who had lost parents in the earthquake. The general supportive intervention was effective only in improving psychological resilience.

Chinese and American employers' perspectives regarding hiring people with behaviorally driven health conditions: the role of stigma.

Work opportunities for people with behaviorally driven health conditions such as HIV/AIDS, drug abuse, alcohol abuse, and psychosis are directly impacted by employer perspectives. To investigate this issue, we report findings from a mixed method design involving qualitative interviews followed by a quantitative survey of employers from Chicago (U.S.), Beijing (China), and Hong Kong (China). Findings from qualitative interviews of 100 employers were used to create 27 items measuring employer perspectives (the Employer Perspective Scale: EPS) about hiring people with health conditions. These perspectives reflect reasons for or against discrimination. In the quantitative phase of the study, representative samples of approximately 300 employers per city were administered the EPS in addition to measures of stigma, including attributions about disease onset and offset. The EPS and stigma scales were completed in the context of one of five randomly assigned health conditions. We weighted data with ratios of key demographics between the sample and the corresponding employer population data. Analyses showed that both onset and offset responsibility varied by behaviorally driven condition. Analyses also showed that employer perspectives were more negative for health conditions that are seen as more behaviorally driven, e.g., drug and alcohol abuse. Chicago employers endorsed onset and offset attributions less strongly compared to those in Hong Kong and Beijing. Chicago employers also recognized more benefits of hiring people with various health conditions. The implications of these findings for better understanding stigma and stigma change among employers are considered.

Assessing readiness to work from a stages of change perspective: implications for return to work.

The Lam Assessment on Stages of Employment Readiness (LASER) was developed to assess welfare recipients' employment readiness. The LASER consists of 14 items corresponding to Prochaska's stages of change model (Prochaska, DiClemente and Norcross, 1992). A sample of 149 welfare recipients from a work training program participated in the study. The Confirmatory Factor Analysis (CFA) supported the three factors structure corresponding to Prochaska's Pre-Contemplation, Contemplation, and Action stages. A cluster analysis classified the sample into three groups according to their LASER scores. A six months follow-up on employment outcomes showed that those who were in Pre-contemplation stage had the poorest employment outcome (25%), those who were in the Action stage had the best outcome (56%) and those in the Contemplation stage were in between (38%). Implications for work rehabilitation and treatment matching were discussed.

Social support and quality of life among Latinos with mental illness.

We examine the degree of social support and quality of life (QOL) among 60 Latinos with mental illness from a Community Mental Health Center of a large metropolitan Midwestern city. Additionally, we assess the relationship of both the quality and quantity of social support, and control for demographic factors as they all relate to QOL. Latinos had an average network of 3 contacts. Despite their small network, participants were satisfied with the quality of support they received. Their QOL was mixed, comparable to reports from non-Latinos with mental illness, and from the general population. Having better quality of social support being male and younger were associated with a higher QOL. Community treatment programs for Latinos with mental illness could benefit from focusing on nurturing existing networks, fostering social skills, and providing additional forms of support for those Latinos in need.

Examining the cross-cultural validity of the english short-form McGill Pain Questionnaire using the matched moderated regression methodology.

OBJECTIVES: Pain is identified as the third largest health problem in the world, impacting sleep, physical functioning, and psychologic functioning. Pain has been viewed as a multidimensional experience influenced by biology, psychology, cultural conditioning, expectancies, and social contingencies. The aims of this study were to examine the psychometric properties and the differential item functioning (DIF) of the short-form McGill Pain Questionnaire (SF-MPQ) to test the cultural differences in verbally based pain expression. METHODS: Data were drawn from the medical records of 134 Hispanic and 134 non-Hispanic White patients with pain. Cases were matched on total SF-MPQ score, sex, and age. Estimates of reliability and validity were assessed. Using a traditional moderated regression approach, each of the 15 items on the SF-MPQ was analyzed for DIF using matched moderated regression methodology. RESULTS: Internal consistency was high: Hispanics 0.90 and non-Hispanics 0.89. Factor analysis revealed 2 components for each ethnic group. DIF analyses revealed statistically significant group differences for the 5 items (ie, throbbing, gnawing, aching, tiring-exhausting, and sickening) potentially due to cultural-linguistic factors. The remaining 10 items revealed no significant differences. Group differences were not accounted for by sex, age, marital status, education, pain location, or pain duration. DISCUSSION: Test bias was relatively small (0.74) given the entire scale of the SF-MPQ (0 to 45), indicating that this measure seems to be used equivalently across these 2 groups. This study shows 1 method in evaluating the cross-cultural validity of pain assessment instruments, and contributes to the understanding of cross-cultural variability in item reporting on the SF-MPQ.

Competence of people with intellectual disabilities on using human-computer interface.

We investigated the task processes which hinder people with intellectual disabilities (ID) when using the human-computer interface. This involved testing performance on specific computer tasks and conducting detailed analyses of the task demands imposed on the participants. The interface used by Internet Explorer (IE) was standardized into 16 tasks (161 subtasks). A total of 57 people with ID completed all the tasks. The task demands of each subtask were analyzed and rated by an expert panel review. Results indicated that the 16 identified tasks to have varied levels of difficulty. Participants' performances were differentiated by two tasks: general motor functions and use customized bookmark. The majority of the tasks required visual acuity, vigilance, orientation, and basic sensori-motor abilities. The more difficult tasks were associated with higher levels of working memory and recognition of Chinese words. The model of identification, response, and execution was useful for analyzing the IE tasks. Successful IE performances appeared to be determined by the match between the participants' abilities and the task demands. The findings shed light on the use of task-specific screening tests and on the design of ability-specific training programs that enhance the computer competency of people with ID.

A long-term cross-sectional study on gastric bypass surgery: impact of self-reported past sexual abuse.

BACKGROUND: This study examined differences in gastric bypass surgical outcomes by comparing two groups of female patients: those with a history of sexual abuse (SA) and those without a history of sexual abuse (NSA). METHODS: Participants who agreed to participate in the study were assessed at either 6-18 months or 19-40 months postsurgery. Outcome measures included body mass index (BMI), level of depression as measured through the Beck Depression Inventory, level of self-esteem as measured through the Rosenberg Self-esteem Scale, and BISS as measured through the Body Image State Scale. Two-by-two analyses of variance (ANOVAs) were conducted for each of the four outcome variables. RESULTS: ANOVA results revealed that BMI was the only variable to be found statistically significant among the four dependent measures. At 6-18 months postsurgery, the SA group had significantly higher BMI than the NSA group. Compared BMI during the two postsurgery time periods, the SA group had a significantly lower BMI at 19-40 months than the SA group at 6-18 months postsurgery. CONCLUSION: The results suggest that females with a history of sexual abuse did not differ from their counterparts with regard to depression, self-esteem, and body dissatisfaction at baseline, as well as years after surgery. Given the improvement in BMI from the sexual abuse group at 6-18 months postsurgery to 19-40 month postsurgery, patients may not be as concerned with maintaining excess weight as a defense against potential future abuse as originally proposed.

Disability and work-related attitudes in employers from Beijing, Chicago, and Hong Kong.

Employers are primary and necessary agents in the return of people with disabilities to the work force. In this study, employment attitudes about two key constructs for vocational rehabilitation are examined: hiring the person with a disability and accommodating the person with disabilities at work. One hundred employers from Beijing, Hong Kong, and Chicago were surveyed regarding their attitudes. Results showed employers from Beijing were less likely to endorse hiring people with disabilities compared with those from Chicago and Hong Kong. In addition, people with psychiatric disabilities were less likely to be hired compared with those with physical disabilities. No clear pattern by city emerged for accommodations. Reasons why this pattern of attitudes emerged are discussed. Implications of these findings for attitude change are also considered.

Measuring self-stigma of mental illness in China and its implications for recovery.

This study translated and validated the Chinese Version of the Self-stigma of Mental Illness Scale (CSSMIS), which may be used to measure self-stigma of mental health consumers in China. We also examined its correlation with self-esteem, self-efficacy and psychosocial treatment compliance. A cross-sectional observational study was implemented. Some 51 males and 57 females who suffered from severe mental illness were recruited from psychiatric settings in Hong Kong. They were required to complete the Chinese Version of the Self-stigma of Mental Illness Scale, the Rosenberg Self-esteem Scale and the Self-efficacy Scale. Their level of compliance during psychosocial treatment and their demographic information were recorded by their case managers. Exploratory factor analysis revealed two homologous factors for the four subscales of the CSSMIS. Factor 1 was related to the negative beliefs and consequences of having mental disorders, whereas Factor 2 was related to positive beliefs. The perceived stigma subscale and the three self-stigma subscales were strongly inter-correlated. Significant correlations were also found between almost all subscales of the CSSMIS and the remaining scales. The psychometric properties of the CSSMIS are statistically acceptable. The results also suggest that stigma played a detrimental role in undermining self-esteem, self-efficacy and psychosocial treatment compliance. Implications for recovery of mental health consumers are discussed.

Rehabilitation of injured workers with chronic pain: a stage of change phenomenon.

OBJECTIVE: This study was designed to explore the stages of change involved in return to work (RTW) for a group of workers who had been suffering from chronic pain. METHOD: The participants were 67 (mean age = 42.67) injured workers who participated in a six-week RTW program. Assessments of the participants on various measures were conducted before and during the program, and at the end of the follow-up period (3 months post-program). RESULTS: The overall RTW rate of the participants was 65.7%. Most importantly, the participants' RTW outcomes were found to be significantly predicted by their readiness for RTW (action) at the baseline. In the third week, their RTW was significantly predicted by their confidence in returning to work and their readiness for RTW (action). By the sixth week, their RTW outcomes were predicted by their readiness for RTW (pre-contemplation). CONCLUSION: The results enable us to better understand the stage-of-change factors that might influence injured workers' resumption of a productive work role and the rehabilitation process of RTW.

A cross-cultural study of employers' concerns about hiring people with psychotic disorder: implications for recovery.

INTRODUCTION: Employment discrimination is considered as a major impediment to community integration for people with serious mental illness, yet little is known about how the problem manifests differently across western and non-western societies. We developed a lay model based on Chinese beliefs and values in terms of Confucianism, Taoism, Buddhism, and folk religions which may be used to explain cross-cultural variation in mental illness stigma, particularly in the arena of employment discrimination. In this study, we tested this lay approach by comparing employers' concerns about hiring people with psychotic disorder for entry-level jobs in US and China. METHOD: One hundred employers (40 from Chicago, 30 from Hong Kong, and 30 from Beijing) were randomly recruited from small size firms and interviewed by certified interviewers using a semi-structured interview guide designed for this study. Content analysis was used to derive themes, which in turn were compared across the three sites using chi-square tests. RESULTS: Analyses reveal that employers express a range of concerns about hiring an employee with mental illness. Although some concerns were raised with equal frequency across sites, comparisons showed that, relative to US employers, Chinese employers were significantly more likely to perceive that people with mental illness would exhibit a weaker work ethic and less loyalty to the company. Comparison of themes also suggests that employers in China were more people-oriented while employers in US were more task-oriented. CONCLUSION: Cultural differences existed among employers which supported the lay theory of mental illness.

The Word Accentuation Test - Chicago.

A reading test for Spanish speakers in the United States was developed called the Word Accentuation Test-Chicago. The construction and validation of this 40 item test was modeled after reading tests developed in Spain and Argentina, and is based on irregular accentuation of words. The Word Accentuation Test-Chicago was validated on 45 community participants using the Wechsler Adult Intelligence Scale-III in Spanish. Better reading performance was associated with higher intelligence test performance, with an additional 5% of the variation in intelligence score accounted for by reading performance after controlling for age and education. These results indicate that the Word Accentuation Test-Chicago is a psychometrically sound measure of Spanish reading ability that is robustly related to general cognitive ability.

Use of the Beck Depression Inventory-II (BDI-II) with persons with traumatic brain injury: analysis of factorial structure.

PRIMARY OBJECTIVE: To determine the factorial structure of the BDI-II in a TBI sample and possible predictor variables of depression following TBI. RESEARCH DESIGN: Principle components analysis with orthogonal rotation and linear regression analyses. METHODS AND PROCEDURES: Fifty-one individuals with traumatic brain injury (TBI) participated in this study. The factorial structure of the BDI-II, a 21-item self-report measure of depression, was examined with individuals in the early stages following TBI. Time since injury, severity of injury, location of lesion and previous substance abuse were examined as possible predictors of depression following TBI. RESULTS: A three-factor structure of the BDI-II was found for the TBI sample, which included Negative Self-Evaluation, Symptoms of Depression and Vegetative Symptoms of Depression. Time since injury was the only significant predictor of depression following TBI. CONCLUSION: Using the BDI-II, symptoms of depression after TBI fall into three key categories. With time since injury being the only significant predictor of depression following TBI, it appears that the depression could be more of a result of psychosocial factors than neurobiological factors. It was concluded that BDI-II can be useful in identifying symptoms of depression in the early stages following TBI.

Describing quality of life and psychosocial outcomes after traumatic brain injury.

OBJECTIVE: To describe the quality of life (QOL) and psychosocial outcomes of a sample of adults with traumatic brain injury in 50 community dwelling adults with traumatic brain injury and examine the associations among these variables. DESIGN: Cross-sectional. RESULTS: Mean QOL rating was low average. Standardized measures had acceptable internal reliability and normal distributions in this sample. Subjects had significantly lower QOL and social support, higher negative affect, and similar positive affect and spirituality compared with standardization and other nondisabled samples. They also had a significantly higher level of community integration than other traumatic brain injury samples. Regression analyses suggested that social support, community integration, and positive affect make a unique and significant contribution to the QOL variance with R of 0.492. The addition of spirituality reduced their respective unique variance, reducing positive affect to nonsignificant levels due to their high intercorrelation. CONCLUSIONS: Findings suggest that this sample experiences a wide range of QOL. Factors significantly associated with good QOL include community integration, positive affect, and social support; demographic variables had virtually no association with QOL. Evaluation of the sample's response to standardized scales not designed for a traumatic brain injury population support their use in similar QOL investigations.

Behavioral Dyscontrol Scale deficits among traumatic brain injury patients, part I: Validation with nongeriatric patients.

The Behavioral Dyscontrol Scale is a measure of executive abilities initially designed to predict functional independence in geriatric populations. The current study examined the utility of two Behavioral Dyscontrol Scale (BDS) scoring systems in a nongeriatric sample. The BDS was administered to 49 TBI patients undergoing inpatient and outpatient rehabilitation. The results demonstrate slightly greater utility of the BDS-II scoring system, and support clinical utility of the instrument with nongeriatric patients. Specifically, the Motor Programming Factor and Environmental Independence Factor were more impaired among patients with severe, as compared to mild to moderate, TBIs. In contrast, the Fluid Intelligence Factor was more impaired among patients with frontal, as compared to nonfrontal, injuries. However, when patients were categorized by severity, lesion location differences on the BDS total score and factors were found only for patients with mild to moderate injuries. Similarly, when patients were categorized by lesion location, severity effects were only present among the nonfrontal group. Receiver Operating Characteristic curves demonstrated sensitivity and specificity rates that ranged from 60% to 100% for clinically meaningful cutting scores.

Behavioral Dyscontrol Scale deficits among traumatic brain injury patients, part II: Comparison to other measures of executive functioning.

The clinical utility of the Behavioral Dyscontrol Scale (BDS) was compared to that of verbal fluency, the Trail Making Test, and the Stroop Color-Word Test, as well as measures of processing speed/cognitive efficiency and manual dexterity. The ability of these measures to classify 49 TBI patients into frontal versus nonfrontal and mild to moderate versus severe groups was examined. The results showed that the Fluid Intelligence Factor of the BDS improved classifications above and beyond traditional executive measures, but was particularly successful at classifying patients who sustained mild injuries. In contrast, traditional executive instruments were successful at lesion location classifications only among the patients with severe injuries. Severity classifications were successful both for traditional measures of processing speed/cognitive efficiency and for the Motor Programming Factor of the BDS, but only among patients with nonfrontal injuries. These results demonstrate that severity of injury may be an important moderator of tests' sensitivity to frontal lobe involvement.

Conceptualization and identification of depression in adults with brain damage by clients and rehabilitation clinical staff.

PRIMARY OBJECTIVE: To explore reasons used by staff and clients to identify depression and examine how each group differs. RESEARCH DESIGN: A between group comparison on both quantitative and qualitative data. METHODS AND PROCEDURE: Thirty-seven individuals with brain injury and 18 non-psychologist rehabilitation professionals participated in this study. The Inventory for Depressive Symptomatology (IDS), a 28-item instrument of client self-report and clinician ratings was used for comparison. Additionally, qualitative data on presence and reason for identification of depression were collected from both parties. RESULTS: There is substantial disagreement between clinicians and clients with regard to overall identification of depression. However, both groups based diagnoses on mood/cognitive symptoms rather than anxiety or vegetative symptoms. CONCLUSION: The results point to a discrepancy in client and clinician identification and understanding of depression after brain injury, indicating a potential need for education for both groups.