Quality of life and care burden among family caregivers of people with severe mental illness: mediating effects of self-esteem and psychological distress.

BACKGROUND: Family caregivers are important allies for healthcare providers in facilitating the recovery process among people with mental illness (PWMI). The present study examined the factors associated with quality of life (QoL) among family caregivers of PWMI. METHODS: A multi-center cross-sectional survey was conducted. Family caregivers of people with schizophrenia, major depressive disorder, and bipolar disorder were recruited using convenience sampling. A survey assessing their QoL, depression, anxiety, and self-esteem was completed with self-rated psychometric scales including the Rosenberg Self-Esteem Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, Beck Anxiety Inventory, and World Health Organization Quality of Life Instrument Short Form. A mediation model was constructed with QoL as the dependent variable, care burden as the independent variable, and psychological distress (including depression and anxiety) with self-esteem as mediating variables. RESULTS: Family caregivers of people with schizophrenia had worse QoL compared with counterparts of people with major depression and bipolar disorder. The sociodemographic of both caregivers and PWMI had less impact on QoL when psychological factors were considered. Caregivers with lower self-esteem, higher levels of psychological distress, and heavier care burdens had poorer QoL. Care burden had a significant total effect on QoL. Both self-esteem and psychological distress were significant mediators. CONCLUSION: The findings indicated that caregivers' psychological health and care burden influenced their QoL. Interventions that target family caregivers' self-esteem and psychological distress may attenuate the effect from care burden, and further improve their QoL.

The Utility of the Screening Tool for Autism in 2-Year-Olds in Detecting Autism in Taiwanese Toddlers Who are Less than 24 Months of Age: A Longitudinal Study.

The present longitudinal study examined the utility of the screening tool for autism in 2-year-olds (STAT) in detecting autism spectrum disorder (ASD) in toddlers who are less than 24 months of age. The study sample, which consisted of 119 toddlers with developmental problems, were assessed when they were between 16 and 24 months of age (Time 1) and after a period of 18 months to finalize the diagnosis (Time 2); 57 children had ASD and 62 children had developmental delays. A cutoff score of 2.5 on the STAT yielded an optimal combination of high sensitivity and specificity. The STAT demonstrated adequate predictive validity in detecting ASD in Taiwanese toddlers who are less than 24 months of age.

Service system and cognitive outcomes for young children with autism spectrum disorders in a rural area of Taiwan.

Chiayi is a rural county located in southwestern Taiwan, and the effectiveness of its early intervention service system for autism spectrum disorders was studied in detail. A total of 71 children with autism spectrum disorders ( n = 35) and developmental delay ( n = 36) aged 2.5 years were referred from the only Early Intervention Reporting and Referral Center in Chiayi and followed up at 4 years. Results showed relatively low and varied services of early intervention for both groups during two time-point periods and a relative lack of specific early intervention programs for children with autism spectrum disorders. It was found, however, that cognitive abilities were increased for autism spectrum disorders and developmental delay groups. Additionally, the Early Learning Score at the initial evaluation could contribute to the high learner autism spectrum disorders subgroup. Parental socio-economic level was also determined to benefit the high learner developmental delay subgroup.

Rasch analysis suggested three unidimensional domains for Affiliate Stigma Scale: additional psychometric evaluation.

OBJECTIVES: To examine the psychometrics of the Affiliate Stigma Scale using rigorous psychometric analysis: classical test theory (CTT) (traditional) and Rasch analysis (modern). Differential item functioning (DIF) items were also tested using Rasch analysis. STUDY DESIGN AND SETTING: Caregivers of relatives with mental illness (n = 453; mean age: 53.29 ± 13.50 years) were recruited from southern Taiwan. Each participant filled out four questionnaires: Affiliate Stigma Scale, Rosenberg Self-Esteem Scale, Beck Anxiety Inventory, and one background information sheet. RESULTS: CTT analyses showed that the Affiliate Stigma Scale had satisfactory internal consistency (α = 0.85-0.94) and concurrent validity (Rosenberg Self-Esteem Scale: r = -0.52 to -0.46; Beck Anxiety Inventory: r = 0.27-0.34). Rasch analyses supported the unidimensionality of three domains in the Affiliate Stigma Scale and indicated four DIF items (affect domain: 1; cognitive domain: 3) across gender. CONCLUSION: Our findings, based on rigorous statistical analysis, verified the psychometrics of the Affiliate Stigma Scale and reported its DIF items. We conclude that the three domains of the Affiliate Stigma Scale can be separately used and are suitable for measuring the affiliate stigma of caregivers of relatives with mental illness.

Predictors of effectiveness of early intervention on children with intellectual disability: a retrospective cohort study.

BACKGROUND: The Taiwanese government has been promoting early intervention to children with intellectual disability for years, but data on its effectiveness are limited. METHODS: We recruited children who were treated for intellectual disability at a teaching hospital and had two IQ tests from 2001 to 2005 and used the difference between the two tests as the indicator of effectiveness. RESULTS: The participants included 23 boys and 13 girls 56.5 ± 5.9 months of age at the first test and 73.4 ± 4.9 months at the second. The IQ increased from 57.0 ± 8.0 to 65.1 ± 12.3 (p < 0.001). Multi-variate regressions showed that a low maternal educational level, male gender, and a younger age at the first test were significant independent predictors of the effectiveness. CONCLUSIONS: Early intervention can improve the IQ of children with intellectual disability, and the earlier the intervention the better. The effectiveness is demonstrable in boys and more prominent in children whose mothers had a low educational level.

Development of T-STAT for early autism screening.

This study's purpose was to modify the Screening Tool for Autism in Two-Year-Olds (STAT) into a Taiwanese version called T-STAT. Study 1 included 15 children with Autism and 15 children with Developmental Delay (DD) or language impairment (LI) aged between 24 and 35 months. Study 2 had 77 young children with Autism, PDD-NOS, or DD/LI as a clinical-based validation sample. In Study 1, the signal detection procedure found that a cutoff score of 2 would yield high sensitivity and specificity in T-STAT. In Study 2, using a score of 2 as a cutoff, the agreement between T-STAT risk and ADOS classification was highly acceptable. Results were promising as a Level 2 screening tool for Autism for ages two to three.