Association of family function and suicide risk in teenagers with a history of self-harm behaviors: mediating role of subjective wellbeing and depression.

Background: A history of self-harm behaviors is closely associated with subsequent suicide death. Although many factors associated with suicide have been identified, it remains unclear how these factors interact to influence suicide risk, especially among teenagers with a history of self-harm behaviors. Methods: Data were collected from 913 teenagers with a history of self-harm behaviors through a cross-sectional study. The Family Adaptation, Partnership, Growth, Affection, and Resolve index was used to assess teenagers' family function. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 were used to evaluate depression and anxiety in teenagers and their parents, respectively. The Delighted Terrible Faces Scale was used to assess teenagers' perception of subjective wellbeing. The Suicidal Behaviors Questionnaire-Revised was used to evaluate teenagers' suicide risk. Student's t-test, one-way ANOVA, multivariate linear regression, Pearson's correlation, and a structural equation model (SEM) were applied to data analysis. Results: Overall, 78.6% of teenagers with a history of self-harm behaviors were at risk for possible suicide. Female gender, severity of teenagers' depression, family function, and subjective wellbeing were significantly associated with suicide risk. The results of SEM suggested that there was a significant chain mediation effect of subjective wellbeing and depression between family function and suicide risk. Conclusion: Family function was closely associated with suicide risk in teenagers with a history of self-harm behaviors, and depression and subjective wellbeing were sequential mediators in the association between family function and suicide risk.

Prevalence and correlates of post-traumatic stress disorder and its symptomatology in tornado-affected rural residents.

Experiencing a serious natural disaster may place survivors at particularly high risk for post-traumatic stress disorder (PTSD); however, very limited data are available on the prevalence and clinical characteristics of PTSD among survivors of a tornado disaster. The present study examined the prevalence of PTSD and correlates and clinical symptoms of possible PTSD in survivors 1.5 months after a tornado disaster. A total of 237 survivors were recruited and administered the Structured Clinical Interview for DSM-V (SCID) to measure the prevalence of PTSD and the Essen Trauma Inventory (ETI) to measure the incidence of symptoms in each dimension. Survivors'demographic information and characteristics of exposure to the tornado were collected via self-report questionnaires. Thirty-two of the survey respondents were diagnosed with PTSD (13.6%, total =237). Correlates of PTSD in survivors were being female (OR=3.62, P = 0.023), living in an area severely affected by the tornado (OR = 3.94, P = 0.032), and having severe property damage (OR = 3.72, P = 0.010). Less common symptoms mainly focused on the avoidance dimension and included feeling alienated or distant from the people around oneself (21.90%), not being able to recall important parts of the event (28.10%), being emotionally numb (31.20%), and feeling like one's plans for the future and hopes will not come true (37.50%). In the sample of rural residents, nearly two-thirds of people with PTSD were not willing to seek psychological help; increasing the accessibility of mental health services and administering more active mental health services are necessary for this vulnerable population, whether or not they claim to need help.

Early Intervention of Perioperative Delirium in Older Patients (>60 years) with Hip Fracture: A Randomized Controlled Study.

OBJECTIVE: To explore the effect of early intervention for perioperative delirium in older (> 60 years) hip fracture patients. METHODS: This prospective study enrolled hip fracture patients aged ≥60 years who were admitted into our hospital between July 2011 and August 2019. Hip fractures were classified according to the Arbeitsgemeinschaft für Osteo-synthesefragen (AO) classification. This study included patients with isolated hip fracture and excluded patients with pathological or peri prosthetic fracture or patients with multiple traumatic injuries and high-energy trauma. They were randomized to receive conventional orthopedic care group (n = 65) or comprehensive orthopedic care group including preoperative psychological counseling and preventative risperidone (n = 63). Daily assessment was based on patient interview with the CAM-CR, and delirium was diagnosed by the Delirium Rating Scale (DRS-R-98). The rate, severity and duration of perioperative delirium and the length of postoperative stay were analyzed. RESULTS: Totally 200 patients were screened for eligibility. Twenty patients were excluded due to alcohol abuse and 40 were excluded because of brain lesions on head CT. In addition, 12 patients were excluded because of impaired cognition. Finally 128 patients were enrolled. Their mean age was 75.3 ± 2.2 years for the comprehensive orthopedic care group and 73.5 ± 6.1 years for the conventional orthopedic care group, and 53.9% of the patients were female. Sixty-eight (53.1%) patients had intertrochanteric fracture, 39.8% patients had femoral head fracture, and 7.0% patients had subtrochanteric fracture. In addition, 58.6% patients underwent internal fixation and 41.4% patients received arthroplasty. In this study, 63 patients were randomized to the comprehensive orthopedic care group and 65 patients to the conventional orthopedic care group. The two groups were comparable in demographic and baseline characteristics (P > 0.05). The rate of perioperative delirium was significantly lower in the comprehensive care group vs the conventional care group (15.9% vs. 30.8%; P < 0.05). The comprehensive care group had significantly reduced length of postoperative hospital stay vs the conventional care group (11.3 ± 2.5 days vs. 14.2 ± 2.2 days, P < 0.01). The mean DRS-R-98 score was 7.1 ± 2.7 for the comprehensive care group, and was significantly lower than that of the conventional orthopedic care group (11.2 ± 3.0; P < 0.05). CONCLUSIONS: Our early intervention may reduce the incidence of perioperative delirium in elderly hip fracture patients (>60 years).

The relationship between father absence and hostility among Chinese depressed youths: A serial mediation model and the role of self-esteem and frustration tolerance.

Background: While the association between father absence and youth hostility has been well-documented among depressed youths, there is a lack of research on the potential mechanism underlying such an association. This study aimed to test a serial mediation model of self-esteem and frustration tolerance on the link between father absence and youth hostility. Methods: A total of 137 Chinese youths with major depressive disorder were recruited from Wuhan Mental Health Center. They completed a survey including the Father Absence Questionnaire to measure father absence, the Chinese Hostility Inventory (CHI) to measure hostility, the Psychological Endurance Questionnaire to measure frustration tolerance, and the Self-esteem Scale (SES) to measure self-esteem. A series of multiple linear regression models were employed to assess the associations among father absence, self-esteem, frustration tolerance, and hostility. Results: Although father absence was modestly associated with hostility (r = 0.30, p < 0.001), subsequent serial mediation analysis showed that father absence was not directly related to hostility (ß = 0.06, p = 0.29) when self-esteem and frustration tolerance were included in the model. High levels of father absence had an adverse effect on levels of self-esteem, which decreased levels of frustration tolerance, and thus higher levels of hostility among depressed youths. The indirect effects of father absence on hostility through self-esteem, frustration tolerance, as well as through self-esteem and frustration tolerance serially accounted for 28%, 24%, and 24% of the total effect, respectively. Conclusion: Our study tested a serial mediation model of self-esteem and frustration tolerance as mediators between father absence and hostility among depressed youths. The findings strengthened our understanding of the potential mechanism underlying the association between self-esteem and frustration tolerance, which may provide useful guidance for future intervention programs.

Efficacy and safety of modified electroconvulsive therapy for the refractory depression in older patients.

OBJECTIVE: We explored the clinical efficacy and safety of modified electroconvulsive therapy (ECT) in the treatment of elderly patients with refractory depression. METHODS: A total of 43 older patients with refractory depression were enrolled in our study from March 2014 to February 2015, with the average age of 65 ± 4.8 years old. Modified electroconvulsive therapy (ECT) was performed in these patients after physical examinations and anesthesia procedures. Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to assessing the efficacy of ECT, and Wechsler Memory Scale (WMS) and mini-mental state examination (MMSE) were used to evaluate the memory ability and cognitive function. RESULTS: The rate of efficacy was calculated as 67.44% after 4 weeks of ECT treatment. Our results showed that HAMA and HAMD scores after 2 weeks of ECT treatment were significantly lower than pretreatment, and the differences were more significant after 4 weeks of ECT treatment. Compared with pretreatment, the scores of memory quotient and immediate memory of WMS decreased significantly after 1 week of treatment. However, these events were not be presented with the progress of treatment, except for after 2 weeks of treatment. Our results demonstrated that compared with pretreatment, the scores of MMSE significantly increased after 4 weeks of treatment. CONCLUSION: ECT is an effective, well-tolerated, and safe method for the treatment of older patients with refractory depression. ECT can be recommended for the treatment of these patients after conducting effective risk control of comorbid somatic diseases.

Reliability and validity of the Chinese version of the Childhood Trauma Questionnaire-Short Form for inpatients with schizophrenia.

BACKGROUND: The evaluation of childhood trauma is essential for the treatment of schizophrenia. The short form of Childhood Trauma Questionnaire (CTQ-SF) is a widely used measure of the experience of childhood trauma in the general population. Nevertheless, data regarding the psychometric property of CTQ-SF for assessing childhood trauma of patients with schizophrenia are very limited. METHODS: Two hundred Chinese inpatients with schizophrenia completed the Chinese CTQ-SF, the Child Psychological Maltreatment Scale (CPMS), the Impact of Events Scale-Revised (IES-R), and the Dissociative Experiences Scale-II (DES-II). To assess test-retest reliability of the CTQ-SF, all patients completed the CTQ-SF again two weeks later. Concurrent and convergent validity was assessed by analyzing Pearson bivariate correlation coefficients between CTQ-SF and CPMS, IES-R, and DES-II. RESULTS: The Cronbach's α coefficient of the Chinese CTQ-SF was 0.81, and the two-week re-test reliability was 0.81 (P<0.01). The criterion-related validity coefficients of CTQ-SF with the CMPS, IES-R and DES-II were 0.61, 0.41, and 0.51, respectively. CONCLUSION: The Chinese CTQ-SF has satisfactory psychometric properties to measure childhood abuse or neglect in Chinese inpatients with schizophrenia.

Significantly more intense pain in methadone-maintained patients who are addicted to nicotine.

Pain and cigarette smoking are very common in heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT) and both have substantial negative effects on HDPs' physical and mental health. Nevertheless, very few studies have assessed the relationship between the two in HDPs. This study examined the association between pain intensity and smoking in Chinese methadone-maintained HDPs. A total of 603 HDPs were consecutively recruited from three MMT clinics in Wuhan, China, and administered with a socio-demographic and drug use questionnaire, a smoking questionnaire concerning average number of cigarettes smoked daily and Heaviness of Smoking Index, and Zung's Self-rating Depression Scale. We used a five-point Verbal Rating Scale to rate the intensity of pain. To determine whether pain's associations with smoking and nicotine dependence were independent, an analysis of covariance was adopted to control for the potential confounding effects of socio-demographic variables, drug use characteristics, and depressive symptoms. Net of potential confounders, in methadone-maintained HDPs, pain intensity was significantly higher in smoker than non-smokers (F = 11.836, P = 0.002) but the pain intensity did not differ significantly across patients with various levels of cigarette consumption (F = 1.992, P = 0.137), while the pain intensity significantly differed across patients with different levels of nicotine dependence (F = 3.252, P = 0.013). Pain is significantly associated with smoking in HDPs receiving MMT, this phenomenon may be explained by the association between nicotine dependence and pain.

Effects of preemptive analgesia with parecoxib sodium on haemodynamics and plasma stress hormones in surgical patients with thyroid carcinoma.

BACKGROUND: To investigate the effects of preemptive analgesia with parecoxib sodium on haemodynamics and plasma stress hormones in surgical patients with thyroid carcinoma. MATERIALS AND METHODS: Fifty-seven patients with thyroid carcinoma who underwent thyroidectomy selectively in Laiwu Hospital Affiliated to Taishan Medical University and Binzhou People's Hospital were selected and randomly divided into three groups, 19 cases in each group. The control group was intravenously injected 0.9% sodium chloride injection before anesthesia induction; trial group I was intravenously injected with parecoxib sodium 20 min before anesthesia induction; based on trial group I, trial group II was injected with parecoxib sodium again 12 h after surgery. The levels of plasma norepinephrine (NE), cortisol (Cor) and blood glucose before, 12 and 24 h after surgery and changes of haemodynamics before surgery, at the end of surgery and 12, 24 and 48 h after surgery were compared in the three groups. Besides, visual analogue scale (VAS) scores were recorded 4, 8, 12 and 24 h after surgery. RESULTS: 12 and 24 h after surgery, the levels of plasma NE and Cor in three groups rose dramatically (P<0.05 or (P<0.01); The levels of plasma NE and Cor in trial groups I and II were evidently lower than in control group (P<0.05 or P<0.01), and those in trial group II slightly lower than in trial group I. 12 h after surgery, the heart rates (HR) and systolic pressures (SBP) in trial groups I and II increased obviously by comparison to surgery before (P<0.05 or P<0.01), but gradually returned to the preoperative level. HR, SBP and diastolic pressures (DBP) in trial groups I and II at the end of surgery and 12 h after surgery were all lower than in the control group, and significant differences were present (P<0.05 or (P<0.01). At 4, 8, 12 and 24 h after surgery, VAS scores in trial groups I and II were markedly lower than in the control group ((P<0.05 or (P<0.01), the scores in trial group II being the lowest. CONCLUSIONS: Combined application of parecoxib sodium for preemptive analgesia before anesthesia and after surgery can effectively reduce the levels of plasma stress hormones and improve analgesic effects in surgical patients with thyroid carcinoma, and without conspicuous impact on haemodynamics.

[Study on the use of benzodiazepine among middle school students in Wuhan City].

OBJECTIVE: In order to understand the status of benzodiazepine (BZD) use in middleschool students from Wuhan city. METHODS: In the Wuhan city zone, twenty-eight middle-schools were chosen randomly to the even numbers, with students from grade 8 to 12 had been studied. Altogether, 258 classes were investigated with 12 345 questionnaires were filled in by the subjects anonymously. SPSS 10.0 was used for data analysis. RESULTS: Rate of BZD use in Wuhan middle school students was 4.0% with the rate of dependence as 4.1per thousand. There were differences in gender and grade: male students tend to be higher than females (P< 0.01), and senior higher than junior's (P < 0.01). More commonly used drugs would include Diazepam (59%) and Surazepam (29.7%). Among students who used drugs, 43.3% used for 1-7 day and 8.2% of them used 6 tablets or more. 57.6% used 1 tablet once a day (46.2%) before bed time (40.8%). The major reason for using drug was insomnia (43%), followed by pressure from school. The reasons for BZD abuse were: relief of anxiety (14.1%), curiosity (13.3%), peer pressure (10.8%), and fun seeking (9.85%), etc. The source of drugs was from their families (29%). By Multinomial logistic regression, the risk factors of abuse BZD were: ignorance of drug prescription, sex, regular alcohol intake, knowing that BZD use can bring amusement regular, smoking cigarettes, relationship with parents, mother's way of providing education, schooling of fathers, relationship between parents. CONCLUSION: Difference was seen in the use of BZD between gender and age of the students. Multiple factors showed that: personal, family and social factors were related to the use of BZD.