Prevalence and Factors Associated with Fear of Falling in Community-Dwelling Thai Elderly.

BACKGROUND: Falls are common in older people. The fear of falling (FOF) can lead elderly persons to restrict their activities which reduces quality of life. We aimed to estimate the prevalence and factors associated with FOF in community-dwelling Thai elderly to improve screening, treatment and prevention policies and practices. OBJECTIVES: We aimed to estimate the prevalence and factors associated with FOF in suburban-dwelling Thai seniors. METHODS: Seniors aged 60-85 years old from 4 suburban communities near Bangkok, Thailand, were interviewed and examined. Questionnaires were used to collect data on the FOF, symptoms of depression, anxiety and balance tests. T tests, χ2 tests, and logistic regressions were used in statistical analysis. RESULTS: 210 subjects were enrolled. The mean age was 70.3, and 74.3% were female. Fifty-three (25.2%) reported a previous history of falls. The prevalence of FOF was 35.8% in the subjects with previous history of falls and 21.7% in subjects without previous history of falls. FOF was associated with female gender, age ≥80, living alone, impaired balance, and functional impairment but not with previous history of falls. CONCLUSION: FOF is associated with balance impairment, anxiety, depression, and functional impairment of daily routine activities.

Depression, quality of life and coping style among Thai doctors before their first year of residency training.

OBJECTIVES: Depression and suicide often affect young physicians coping with the demands of residency training. To support effective prevention programmes, we aim to assess depression, quality of life (QoL) and coping style of doctors prior to beginning residency training. METHODS: A cross-sectional study of physicians prior to their first year of residency training at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, was conducted. Questionnaires including the Thai versions of the Proactive Coping Inventory, Patient Health Questionnaire and the Pictorial Thai Quality of Life (PTQL) scale were emailed to all first-year residents 1 week before the beginning of residency training in 2015. Descriptive statistics, χ2 test, independent-sample t-test and Pearson's correlation test were analysed. RESULTS: Among 277 doctors, 102 (36.8%) responded to the survey. The average age of respondents was 26.8 (range 25-33; SD=1.2) and 69.6% were women. Nearly all (99.0%) had moderate-to-high overall QoL scores. Depression was found in 10 (9.8%) of respondents. Depression severity was negatively correlated with proactive coping and QoL. Proactive coping (r=0.509, p<0.001), reflective coping (r=0.266, p=0.007), strategic planning (r=0.347, p<0.001), preventive coping (r=0.298, p=0.002) and emotional support seeking (r=0.252, p=0.011) were positively correlated with QoL. Furthermore, proactive was correlated with lower depressive symptoms severity (r=-0.303, p=0.002). CONCLUSIONS: Although nearly all doctors reported moderate-to-high QoL, positive screening for depression was observed in 9.8% of doctors which is much higher than the prevalence in Thais (1.2%). Mental health promotion policies are essential to help residents effectively cope with the stress and demands of training.

Quality of life and happiness of the students in the disaster area: 6 years after the Tsunami at Takua Pa District, Phang Nga, Thailand.

BACKGROUND: The Tsunami disaster, which occurred on December 26, 2004 in Thailand, caused enormous damage to life, property and community. Although the tragedy occurred 6 years ago, many children and adolescents still suffer from mental health problems. OBJECTIVE: To determine the quality of life and happiness of students who live in the Tsunami disaster area 6 years after the tragedy. MATERIAL AND METHOD: A cross-sectional study was done on 648 students from three schools in Takua Pa district, Phang Nga. They had been provided with psychological or support by multidisciplinary teams from Queen Sirikit National Institute of Child Health, Siriraj Hospital and Chulalongkorn Hospital. The questionnaires consisted of 3 subsets which were self-report of general information, pediatric quality of life inventory and Thai happiness indicator. RESULTS: The student's quality of life was low 15.1%, moderate 68.7% and high 16.2%. Eighteen percent had good (27-42) score higher, 38% had a fair (27-32) score and 44% had a poor (< 27) score. Females and high school performance were associated with happiness. CONCLUSION: Disasters have long lasting effects on victims, especially in children. Although this group of children had regularly received assistance including welfare, finance, education and health advice, most had fair quality of life scores were fair and poor-is this needed. Nearly half of them had happiness level scores less than average. They still have psychosocial problems and will need long-term monitoring, support and assistance.

Association of adolescent substance use: behavioral problems and family background among school students in Tsunami affected area in southern Thailand.

OBJECTIVE: To study the prevalence of substance use and associated factors in school students in Tsunami affected areas in southern Thailand. MATERIAL AND METHOD: The study was a school-based, cross-sectional, anonymous survey that used a translated questionnaire, ESPAD-03, in 5 schools. Chi-square tests and odds ratios were used to evaluate factors associated with substance use. RESULTS: Two thousand seven hundred and sixteen students (87.8%) were enrolled in the study. Lifetime, last 12 months, and last 30 days prevalence rates of any substance use were 50.3, 33.9, and 24.8%, respectively. Lifetime, last 12 months, and last 30 days prevalence rates of alcohol use were 43.2, 30.1, and 17.5%, respectively. Lifetime and last 30 days prevalence rates of smoking were 21.7 and 12.0%. Fighting, stealing, truancy, running away, unsafe sex, and thought of self-harming were associated with alcohol and substance use. Siblings and friends with alcohol and substance use were risk factors. Close support from parents and friends were protective factors. CONCLUSION: There was a high prevalence of smoking, alcohol, and substance use among school students in Tsunami affected areas. Behavioral problems and psychosocial risk factors were associated with history of smoking, alcohol and substance use. School-based intervention in students with behavioral problems seems to be a worthwhile investment. However, longitudinal studies should be done to confirm the correlation of PTSD and substance use.

Under-recognized alcohol-related disorders in psychiatric outpatient unit.

OBJECTIVE: Problematic alcohol consumption is associated with multiple medical conditions and psychiatric comorbidities. Previous publications reported the under-recognition of alcohol-related problems in the clinical setting. The present study comprises of two objectives, 1) to examine the process use by physicians to recognize alcohol-related problems in psychiatric outpatient units, and 2) to compare the results of a CAGE interview and a written version of the CAGE questionnaire. MATERIAL AND METHOD: The participants were recruited via interview using the alcohol section of the Thai version of Diagnostic Interview for Genetic Studies (Th-DIGS), which included 165 psychiatric outpatients with alcohol dependence and 165 psychiatric outpatients without alcohol-related disorders. The validity of diagnoses provided by psychiatrists and physicians (in the records) compared with the Th-DIGS diagnoses were analyzed. Kappa statistics were applied to compare the agreement of the responses for the written version and the oral CAGE interviews. RESULTS: Compared with the diagnoses using Th-DIGS, the physician specificity and positive predictive value were 100% (95% CI: 97.8-100% and 94.9-100%, respectively). However the sensitivity and negative predictive value were 43% (95% CI: 35.4-51%) and 63.5% (95% CI: 57.5-69.6%), respectively. The Kappa value for the written version of the CAGE questionnaire and the CAGE oral interview was 0.723. CONCLUSION: The results of the present study suggest the need to increase physician awareness regarding alcohol-related problems. A brief and high-sensitivity screening questionnaire, such as the CAGE questionnaire, written versions and oral interview, can be implemented for screening alcohol-related disorders in a clinical setting.

Post-traumatic stress disorder in children after the tsunami disaster in Thailand: a 5-year follow-up.

BACKGROUND: Children may suffer from post-traumatic stress disorder after disaster. There was a severe tsunami following an undersea earthquake off the Sumatra coast of Indonesia. There were 20,000 children in 6 southwestern provinces of Thailand who were possibly affected. OBJECTIVE: To study the prevalence of post-traumatic stress disorder (PTSD) in Thai students in the area affected by the December 26th, 2004 tsunami disaster, Thailand. MATERIAL AND METHOD: One thousand six hundred and fifteen surviving students from two schools in Takua Pa district located in Phang-nga Province, Thailand participated in this longitudinal study. Screening was done by using Pediatric Symptom Checklists part II (PSC-II), Childhood Depressive Intervention (CDI) and the Revised Child Impact of Events Scales (CRIES 8). PTSD was diagnosed by child and adolescent psychiatrists by using criteria of DSM-IV. The intervention included psychological first aid, psycho-education, cognitive-behavioral therapy, medication in severe cases, group support for students, parents and teachers which was done, beginning at 10 days after the tsunami disaster. Data were analyzed by using SPSS version 12.0. RESULTS: The prevalence rates of PTSD in the students facing the tsunami disaster in the study group were 573, 46.1, 31.6, 7.6, 4.5, 3.9 and 2.7% at 6 weeks, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after the disaster, respectively. Female to male ratio was 1.7: 1. The peak age was 9-10 years old. The top five on the list of symptoms in PTSD were distress with cue, intrusive thought, functioning impairment, startled response, terrified and hyper vigilance. Seven cases (3.1%) were diagnosed partial PTSD, still exhibited a wide range of PTSD symptoms but did not fulfill the DSM-IV diagnostic criteria. The top five on the list of symptoms in partial PTSD were avoiding thought/feelings, terrified, avoiding place/activities, distress with cue and startled response. CONCLUSION: The prevalence of PTSD among tsunami victims was 57.3% at 6 weeks after the disaster. It declined sharply at 2 years after the event. Despite receiving financial, rehabilitation and mental health support, 2.7% of the victims continued to suffer from PTSD 5 years after the disaster.

Postgraduate psychiatric training in Thailand.

In Thailand, after medical students graduated from medical schools, the general practitioners have to work for the government for at least three years. Then, they can enroll in postgraduate training program. Postgraduate training usually takes three to four years. All of the psychiatric training programs are supervised and monitored by the board of education of the Royal College of Psychiatrists of Thailand (RCPsychT). One of the missions of all training institutes is to prepare residents to be the high qualified psychiatrists to serve the mental well-being of Thai people. Additionally, they should teach the learners to be the leaders in academic and research fields in psychiatry. Currently, there are nine psychiatric training institutions in Thailand, most of which are running by university programs. The training program core curriculum composes of the compulsory rotations such as general psychiatry, child and adolescent psychiatry, neurology, consultation-liaison psychiatry, mental hospital psychiatry and addiction psychiatry. Moreover, the residents also have three months for elective in each program. The learning process includes practicing in an out-patient and in-patient unit under psychiatric staff supervision, individual and group supervision, case conference, journal club, book club and grand round etc. Research in field of psychiatry and social sciences is also compulsory for board examination. The RCPsychT approved two Certificate Diplomas including Diploma of Thai Board of Psychiatry, and Diploma of Thai Board of Child and Adolescent Psychiatry. There are only nine psychiatric training institutes and only thirty to forty residents enrolled in these programs in each year. The compact and collaboration of all training institutes bring about the benefits in efficiency programs management by regular meeting of representatives from each institute. They keep the standard of training program to progress in the same vision and direction. Furthermore, residents of each training programs can exchange and request for elective rotation at the other institutes.

Prevalence of post-traumatic stress disorder in students 23 months after tsunami.

OBJECTIVE: To study the prevalence of post-traumatic stress disorder (PTSD) in the 4th-9th grade students in an affected school 23 months after tsunami. METHOD: Two-stage screening procedure was used in a diagnostic study designed to identify post-traumatic stress disorder in the 4th-9th grade students in a school in Takaupa district, Phang Nga province, 23 months after the 2004 tsunami. Impact of Events Scale (IES) was used as a screening questionnaire in the first stage. In the second stage, the students were assessed by a psychiatrist to identify PTSD according to DSM-IV criteria. SPSS 10.0, inferential statistics and Chi-square test were used to analyze the data. RESULT: A total of 436 students participated in the study. Forty of them were diagnosed with PTSD. The prevalence of PTSD was 15.1%. The sensitivity, specificity and negative predictive value of IES were 0.75, 0.54 and 0.92 respectively. CONCLUSION: The prevalence of PTSD in students in a school 23 months after tsunami was 15.1%.

Psychiatric disorders in children at one year after the tsunami disaster in Thailand.

BACKGROUND: The tsunami that struck Thailand on 26th December 2004 was the greatest natural disaster in the country's history. It left in its wake unprecedented damage and destruction. Children suffered the loss of parents or guardians, and survivors were left to cope with psychological trauma of the disaster OBJECTIVE: To assess the psychiatric disorders in tsunami victim children at one year after the event. MATERIAL AND METHOD: A cross sectional study was done. One thousand three hundred and sixty-four students from 2 schools were enrolled. Three tests were used according to the students' grades, pediatric symptoms checklist, Childhood Depressive Inventory and the Revised Child Impact of Events scale (CRIES). Psychiatric disorders were diagnosed by child and adolescent psychiatrists, using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV). Analysis data by using SPSS version 10.0 and Chi-square test. The results were presented as percentage and p-value. RESULTS: Psychiatric disorders were found in 142 students or 10.4 percents of all students at one year after the tsunami disaster. Not all the students who had psychiatric disorders developed them as the result of the tsunami disaster However, ninety students or 6.3 percent of all the students did have psychiatric disorders resulting from the tsunami disaster The most common psychiatric problem was post traumatic stress disorder Ten percent of grade 4-6 students and 11 percent of grade 7-9 students had psychiatric disorders. The prevalence was lower in kindergarten and grade 1-3 students of which the percentage was 2.3 and 3.8 respectively. CONCLUSION: The prevalence of psychiatric disorders at 1 year after the tsunami disaster was 10.4 percent of all the students or 33.1 percent of victims. The prevalence of psychiatric disorders in grade 4-6 and 7-9 students was higher than in kindergarten and grade 1-3 students. The most common psychiatric problem is post traumatic stress disorder.

Assessment of psychopathological consequences in children at 3 years after tsunami disaster.

BACKGROUND: At 1 year after the Tsunami disaster, 30% of students in two high risk schools at Takuapa district of Phang Nga Province still suffered from post traumatic stress disorder (PTSD). The number ofpatients was sharply declined after 18 months. The psychological consequences in children who diagnosed PTSD after the event were reinvestigated again at 3 years, as there were reports of significant comorbidity and continuing of subsyndromal post traumatic stress symptoms in children suffered from other disasters. OBJECTIVE: To assess psychological outcomes and factors contributed at 3-year follow up time in children diagnosed PTSD at 1-year after the Tsunami disaster MATERIAL AND METHOD: There were 45 students who were diagnosed PTSD at 1-year after the disaster At 3-year follow up time, clinical interview for psychiatric diagnosis was done by psychiatrists. RESULTS: 11.1% of students who had been diagnosed as PTSD at 1-year after Tsunami still had chronic PTSD and 15% had either depressive disorder or anxiety disorder 25% of students completely recovered from mental disorders. Nearly 50% ofstudents were categorized in partial remission or subsyndromal PTSD group. Factors which influenced long-term outcomes were prior history of trauma and severe physical injury from the disaster. CONCLUSION: Although the point prevalence of PTSD in children affected by Tsunami was declined overtime, a significant number of students still suffer from post traumatic stress symptoms, depressive disorder or anxiety disorder which need psychological intervention.

Estimation of prevalence of DSM-IV and latent class-defined ADHD subtypes in a population-based sample of child and adolescent twins.

The goal of this study is to determine the prevalence and age of onset of Diagnostic and Statistical Manual of Mental Disorders and latent class-derived attention deficit/hyperactivity disorder (ADHD) subtypes in a population-based twin sample of boys and girls. Missouri birth records identified families with a twin pair 7 to 18 years of age. Telephone screening interviews for ADHD symptoms were completed for 5007 families. Diagnostic assessments were administered to 564 families with at least one twin meeting screening criteria, plus 183 control families. Prevalence and age of onset for both ADHD nosologies were calculated by sex and zygosity from parent report data. The prevalence of any DSM-IV ADHD was 6.2% overall, 7.4% in boys and 3.9% in girls. The inattentive subtype was most common in boys; the combined subtype was most common in girls. The mean age of onset of symptoms in children with any DSM-IV ADHD was 3.5 years, with no significant differences between boys and girls. Prevalences of latent class defined ADHD subtypes also varied by sex with the severe inattentive and combined classes more common in boys than girls. The age of onset of symptoms did not differ between boys and girls but were higher than in the DSM-IV subtypes. Findings in this twin sample showed that clinically significant ADHD, defined by either DSM-IV or latent class criterion, has an early age of onset and is more common in boys than girls. As clinical samples are most commonly composed of male combined subtypes, the inattentive subtype of both sexes in the general population is an under-treated segment of the general population.

Discrimination of DSM-IV and latent class attention-deficit/hyperactivity disorder subtypes by educational and cognitive performance in a population-based sample of child and adolescent twins.

OBJECTIVE: Despite the general use of DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes, there is controversy over the optimal phenotyping strategy for this disorder.This report contrasts two ADHD subtyping approaches on the prediction of cognitive function and educational achievement. METHOD: ADHD subtypes were determined using DSM-IV and latent class approaches for a population sample of 1,154 child and adolescent twins using parent report data. Twins completed cognitive and achievement testing and parents reported on school grades, special education placement, and history of being held back in school. RESULTS: The DSM-IV primarily inattentive and combined subtype ADHD groups showed significant deficits in cognitive and achievement testing, worse grades, and increased use of special education resources compared with the primarily hyperactive/impulsive subtype and no-ADHD groups. Clinically relevant and less severe latent class ADHD subtypes were also associated with deficits in cognitive and achievement testing, grades, and special education use. CONCLUSIONS: DSM-IV primarily inattentive and combined subtypes of ADHD have similar significant patterns of cognitive and academic dysfunction in the general population. Latent class-defined ADHD subtypes also have patterns of serious cognitive and achievement deficits.