Pandemic fatigue and depressive symptoms among college students in the COVID-19 context: indirect effects through sense of control and intolerance of uncertainty.

Pandemic fatigue, the state of weariness, exhaustion, and demotivation to engage in protective behaviors during the coronavirus disease 2019 (COVID-19) pandemic, have been linked with depressive symptoms. However, the mechanism underlying this association remains unclear. Based on the stress process model, the present study examined the indirect effects of pandemic fatigue on depressive symptoms through the indirect roles of sense of control and intolerance of uncertainty. Data were collected from 1,162 Chinese undergraduate and postgraduate students (Mage = 21.61 years old, SD = 2.81, 64.29% women) through electronic questionnaires. The pandemic fatigue scale, the personal mastery scale, the short version of the Intolerance of Uncertainty Scale, and the Depression subscale of the Depression-Anxiety-Stress Scales were employed. Indirect effects were analyzed using structural equation modeling. The results revealed that pandemic fatigue related to COVID-19 was positively associated with depressive symptoms through (a) sense of control; (b) intolerance of uncertainty; and (c) a sequential pathway from sense of control to intolerance of uncertainty. The findings expand the application of the stress process model to the context of COVID-19 and deepen the understanding of pandemic fatigue-depressive symptoms link with considering the indirect roles of sense of control and intolerance of uncertainty. Psychological distress in the context of COVID-19 could be alleviated by the interventions on strengthening sense of control and tolerance of uncertainty and lessening the adverse effects of pandemic fatigue.

Comparison of stigmatizing views towards COVID-19 and mental disorders among adolescent and young adult students in China.

Objective: Infectious diseases including COVID-19 and mental disorders are two of the most common health conditions associated with stigma. However, the comparative stigma of these two conditions has received less attention in research. This study aimed to compare the prevalence of stigmatizing views toward people with COVID-19 and mental disorders and the factors associated with these views, among a large sample of adolescent and young adult students in China. Methods: A total of 9,749 adolescents and young adults aged 15-24 years completed a survey on stigmatizing attitudes toward COVID-19 and mental disorders, as well as mental health-related factors, including general mental health status and symptoms of depression, anxiety, insomnia, and post-traumatic stress disorder (PTSD). Multivariable linear regression analyses were conducted to identify factors associated with stigmatizing views. Findings: The prevalence of COVID-19 and mental disorders-related stigma was 17.2% and 40.7%, respectively. COVID-19-related stigma scores were significantly higher among male students (ß = 0.025, p < 0.05), those without quarantine experience (ß = 0.035, p < 0.001), those with lower educational level (p < 0.001), those with lower family income (p < 0.01), and those with higher PTSD symptoms (ß = 0.045, p < 0.05). Mental disorder-related stigma scores were significantly higher among individuals with average and lower-than-average levels of family income (p < 0.01), depression symptoms (ß = 0.056, p < 0.001), anxiety symptoms (ß = 0.051, p < 0.001), and mental health problems (ß = 0.027, p < 0.05). Conclusion: The stigma of mental disorders is higher in the youth population than the stigma of COVID-19. Factors associated with stigmatizing attitudes toward people with COVID-19 and mental disorders varied across the youth. Stigma-reduction interventions among the youth should be targeted specifically to COVID-19 or mental disorders conditions.

Association between self-compassion and cyber aggression in the COVID-19 context: roles of attribution and public stigma.

Self-compassion is negatively associated with aggressive behaviors. However, the association between self-compassion and cyber aggression toward stigmatized people (e.g., people infected with COVID-19) has not been investigated in the COVID-19 context and the mechanism underlying this association remains underexplored. On the basis of emotion regulation theory and attribution theory, this study examined the indirect effects of self-compassion on cyber aggression toward people infected with COVID-19 through attribution and public stigma of COVID-19. Data were collected from 1162 Chinese college students (415 male, mean age = 21.61 years). Participants completed an online questionnaire including measurement of the key variables and basic demographic information. Results indicated that self-compassion was negatively associated with cyber aggression through the lower attribution of COVID-19 and lower public stigma of COVID-19. A sequential pathway from the attribution of COVID-19 to public stigma of COVID-19 was identified in the relationship between self-compassion and cyber aggression. Our findings are consistent with emotion regulation theory and attribution theory, which posit that emotion regulation strategies are associated with interpersonal mistreatment through cognitive pathways. These findings suggest that emotional self-regulation strategies can be used to reduce cyber aggression toward stigmatized people by reducing attribution and public stigma in the COVID-19 context. Self-compassion improvement could be target for the interventions aiming at alleviating public stigma and interpersonal mistreatment toward stigmatized people.

Affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia in rural China.

BACKGROUND: Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China. AIMS: This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China. METHODS: A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden. RESULTS: Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden. CONCLUSIONS: The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services.

Quality of life among family caregivers of people with schizophrenia in rural China.

PURPOSES: To investigate quality of life (QoL) of family caregivers of people with schizophrenia and examine the influencing factors of the QoL in a Chinese rural area. METHODS: This study included people with schizophrenia (n = 269) and their family caregivers (n = 269) from Xinjin district, Chengdu, China. Family caregivers' QoL was measured by the World Health Organization Quality of Life-Brief Form and its influencing factors was analyzed by the multivariate regression. RESULTS: Family caregivers of people with schizophrenia had very poor QoL across four domains. The regression analysis showed that physical domain of QoL was significantly associated with age, psychiatric symptoms of people with schizophrenia, and caregiving burden of family caregivers (p < 0.05). Psychological domain of QoL was significantly related to family caregivers' affiliate stigma, caregiving burden, and psychiatric symptoms of people with schizophrenia (p < 0.05). Social domain of QoL was significantly associated with age and psychiatric symptoms of people with schizophrenia, and affiliate stigma of family caregivers (p < 0.05). Environmental domain of QoL was significantly related to age and psychiatric symptoms of people with schizophrenia, and family caregivers' caregiving burden (p < 0.05). CONCLUSION: Family caregivers of people with schizophrenia had poor QoL in rural China. Family caregivers' QoL is significantly impacted by age and psychiatric symptoms of people with schizophrenia, caregivers' affiliate stigma and caregiving burden. Providing social support and psychosocial interventions for family caregivers of people with schizophrenia might be crucial to improve their QoL and caregiving.

Effectiveness of enhancing contact model on reducing family caregiving burden and improving psychological wellbeing among caregivers of persons with schizophrenia in rural China.

BACKGROUND: It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS). METHODS: We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively. RESULTS: Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 (p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 (p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 (p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 (p = 0.0160 and 0.0486, respectively). CONCLUSIONS: This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM's effectiveness in various population.

Medication non-adherence and its influencing factors in persons with schizophrenia in rural China.

BACKGROUND: Few studies have been conducted to explore medication non-adherence in persons with schizophrenia (PWS) and its influencing factors in rural China. This study aimed to investigate the medication non-adherence and its influencing factors among PWS in rural China. METHODS: A total of 269 PWS and their family caregivers in Xinjin district, Chengdu, China were investigated on medication adherence and related factors. Logistic regression was employed to identify the influencing factors. RESULTS: The results showed that 37.6% of PWS had medication non-adherence. PWS living with family caregivers had significantly lower rate of medication non-adherence (34.7%) than those not living with family caregivers (60.0%) (p < 0.01). Family caregivers' affiliate stigma of mental illness, knowledge of mental illness and self-esteem were significantly related to patients' medication non-adherence (p < 0.05). PWS' employment status, living with family caregiver, present mental status and social support were significantly related to medication adherence. CONCLUSION: This study shows medication non-adherence is severe among PWS in rural China. Both patient- and family-related factors affect patients' medication adherence seriously. Except improving patients' treatment and mental status, development of family caregiving, social support network and intervention on reducing stigma of mental illness should be crucial for enhancing PWS' medication adherence.

Effectiveness of enhancing contact model on reducing stigma of mental illness among family caregivers of persons with schizophrenia in rural China: A cluster randomized controlled trial.

Background: Contact-based intervention has been documented and proved effective on reducing stigma of mental illness in high-income countries, but it is still unclear about the effectiveness of the contact-based intervention among family caregivers of persons with schizophrenia (FCPWS) in low- and middle-income countries including rural China. Methods: We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin district of Chengdu city in Southwest China. The FCPWS in these townships were randomly allocated to the Enhancing Contact Model (ECM), Psychoeducational Family Intervention (PFI), or Treatment as Usual (TAU) group. FCPWS in three groups were provided specific interventions and follow-ups. By using a mixed-effect model, our goal was to examine the differences in affiliate self-stigma scale (ASSS) scores among three groups with the data collected at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up timepoints, respectively. This trial is registered with ChiCTR, number ChiCTR2000039133. Findings: In April 2019, 253 FCPWS from 8 townships were randomly assigned to receive either ECM (cluster=3, n=90), PFI (cluster=2, n=81), or TAU (cluster=3, n=82). Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower ASSS scores at 9-month follow-up (estimated parameter [EP]= -5.51, 95% CI -10.27 to -0.74, p=0.02). There were no statistically significantly different ASSS scores at 9-month follow up between ECM and PFI groups. Compared with participants in the PFI group, younger (<60 years old), with higher monthly income and other caregiver (e.g., parent, sibling, child) participants in the ECM group had statistically significantly lower ASSS scores in the 3-month follow-up (EP = -5.66, 95% CI -10.13 to -1.19, p<0.01; EP = -7.82, 95% CI -11.87 to -3.78, p<0.001; EP = -6.79, 95% CI -10.69 to -2.90, p<0.001, respectively). Interpretation: This first trial in rural China shows that ECM intervention, a new anti-stigma intervention model, is a promising method for reducing affiliate stigma among FCPWS. The ECM intervention is more effective and stable than the PFI on reducing affiliate stigma among FCPWS. Further research needs to explore whether a long-term intervention could produce a more positive anti-stigma outcome trajectory. Funding: General Research Fund, University Grants Committee, Hong Kong SAR (GRF, Grant No. 17605618, 2018-2021, PI: Dr. M.S. Ran).

Affiliate stigma of mental illness in family caregivers of persons with mental illness in Hong Kong.

BACKGROUND: Affiliate stigma of family caregivers may severely influence family caregiving, early treatment, and recovery of people with mental illness (PMI), and it may be impacted by the knowledge of mental illness and contact with PMI. However, little is known about the correlation between affiliate stigma of family caregivers of PMI and contact in Hong Kong. AIMS: This study aimed to investigate affiliate stigma and its influencing factors among family caregivers of PMI in Hong Kong. METHODS: A total of 106 family caregivers in Hong Kong participated in the study. The measurements included affiliate stigma, contacts (quantity, quality, and level), knowledge, prejudice, and discriminatory behaviors. Multiple regression analyses were employed. RESULTS: The mean score of affiliate stigma scale (ASS) in family caregivers was 2.17 (SD = 0.65). In regression analyses, the results showed that contact quantity and contact level were significantly associated with higher affiliate stigma and its cognitive domain, while contact quality (e.g. positive contact) were significantly associated with lower affiliate stigma and its all domains among family caregivers. The positive relationship between prejudicial attitudes and affiliate stigma was also found. CONCLUSIONS: Affiliate stigma is severe among family caregivers of PMI in Hong Kong. The results of this study indicate that contact, especially positive contact, contributes to reducing affiliate stigma among family caregivers of PMI. The results of this study are important for development of health policy on reducing stigma in family caregivers of PMI. The effectiveness of Enhancing Contact Model (ECM) should be examined in future anti-stigma interventions.

The impacts of COVID-19 outbreak on mental health in general population in different areas in China.

BACKGROUND: This study aimed to explore the impacts of COVID-19 outbreak on mental health status in general population in different affected areas in China. METHODS: This was a comparative study including two groups of participants: (1) general population in an online survey in Ya'an and Jingzhou cities during the COVID-19 outbreak from 10-20 February 2020; and (2) matching general population selected from the mental health survey in Ya'an in 2019 (from January to May 2019). General Health Questionnaire (GHQ-12), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were used. RESULTS: There were 1775 participants (Ya'an in 2019 and 2020: 537 respectively; Jingzhou in 2020: 701). Participants in Ya'an had a significantly higher rate of general health problems (GHQ scores ⩾3) in 2020 (14.7%) than in 2019 (5.2%) (p < 0.001). Compared with Ya'an (8.0%), participants in Jingzhou in 2020 had a significantly higher rate of anxiety (SAS scores ⩾50, 24.1%) (p < 0.001). Participants in Ya'an in 2020 had a significantly higher rate of depression (SDS scores ⩾53, 55.3%) than in Jingzhou (16.3%) (p < 0.001). The risk factors of anxiety symptoms included female, number of family members (⩾6 persons), and frequent outdoor activities. The risk factors of depression symptoms included participants in Ya'an and uptake self-protective measures. CONCLUSIONS: The prevalence of psychological symptoms has increased sharply in general population during the COVID-19 outbreak. People in COVID-19 severely affected areas may have higher scores of GHQ and anxiety symptoms. Culture-specific and individual-based psychosocial interventions should be developed for those in need during the COVID-19 outbreak.

Mental health-related stigma and attitudes toward patient care among providers of mental health services in a rural Chinese county.

BACKGROUND AND AIMS: The increasing prevalence of mental illness and low treatment rate presents a pressing public health issue in China. Pervasive stigma is a significant barrier to mental health recovery and community inclusion. In particular, stigmatizing or supportive attitudes held by healthcare providers could either perpetuate or mitigate self-stigma of people with mental illness. Moreover, mental health resources are unevenly distributed in China, with most of them concentrated in urban centers and provincial capitals. This study explores healthcare providers' attitudes toward mental illness and the challenges they faced at work in a rural Chinese county. METHOD: Four focus groups were conducted with 36 healthcare providers from a three-tier mental healthcare system in a rural county in southwestern China. Focus group discussions were recorded and transcribed verbatim. The team employed a conventional content analysis approach for data analysis. All transcripts were double-coded by three bilingual team members who are native Chinese speakers. Coding discrepancies were resolved by consensus. RESULTS: Healthcare providers recruited from the county, township, and village levels varied in educational background, professional qualification, and experience of working with people with mental illness. Five thematic categories identified across four groups include (1) barriers to mental healthcare delivery, (2) keys to mental health recovery, (3) providers' attitudes toward providing care, (4) providers' perception toward patients and family members, and (5) providers' perception of training needs. CONCLUSIONS: This is a unique study that included healthcare providers from a three-tier healthcare system. Findings signal the importance of understanding healthcare practitioners' experiences and views to inform the design of training initiatives in rural or low-resource communities.

Knowledge, contact and stigma of mental illness: Comparing three stakeholder groups in Hong Kong.

BACKGROUND: It remains unknown what the impacts of multiple dimensions of contact (e.g. level, quantity and quality) are on the stigma of mental illness. AIMS: To explore the relationship between the multiple dimensions of contact and stigma of mental illness among family members (FM), mental health workers (MHW) and community residents (CR) in Hong Kong. METHODS: The stigma, contact and knowledge were measured in FM, MHW and CR in Hong Kong. Multiple regression analyses were used. RESULTS: MHW (n = 141) had higher knowledge, more contact and lower stigma of mental illness than CR (n = 95) or FM (n = 62). Knowledge and contact quality were significantly associated with lower stigma of mental illness in the three groups. However, contact level and contact quantity were not significantly associated with most stigma components. The contact level was positively associated with stigma of mental illness among FM and CR. CONCLUSIONS: The results of this study highlight the differences in knowledge, contact and stigma of mental illness among different stakeholder groups. This study suggests that positive contact (e.g. equal, supportive, voluntary and pleasant contact) reduces stigma of mental illness, while negative contact (e.g. unfriendly, unsupportive, unpleasant contact) may increase stigma. The Enhancing Contact Model (ECM) should be tested in future anti-stigma interventions.

A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: a call to action.

Infectious diseases, including COVID-19, are crucial public health issues and may lead to considerable fear among the general public and stigmatization of, and discrimination against, specific populations. This meta-analysis aimed to estimate the pooled prevalence of stigma in infectious disease epidemics. We systematically searched PubMed, PsycINFO, Embase, MEDLINE, Web of Science, and Cochrane databases since inception to June 08, 2021, and reported the prevalence of stigma towards people with infectious diseases including SARS, H1N1, MERS, Zika, Ebola, and COVID-19. A total of 50 eligible articles were included that contributed 51 estimates of prevalence in 92722 participants. The overall pooled prevalence of stigma across all populations was 34% [95% CI: 28-40%], including enacted stigma (36% [95% CI: 28-44%]) and perceived stigma (31% [95% CI: 22-40%]). The prevalence of stigma in patients, community population, and health care workers, was 38% [95% CI: 12- 65%], 36% [95% CI: 28-45%], and 30% [95% CI: 20-40%], respectively. The prevalence of stigma in participants from low- and middle-income countries was 37% [95% CI: 29-45%], which is higher than that from high-income countries (27% [95% CI: 18-36%]) though this difference was not statistically significant. A similar trend of prevalence of stigma was also observed in individuals with lower education (47% [95% CI: 23-71%]) compared to higher education level (33% [95% CI: 23-4%]). These findings indicate that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging effects of the infodemics during infectious disease epidemics, including COVID-19, and reduce infectious disease-related stigma.

Public Stigma of COVID-19 and Its Correlates in the General Population of China.

This study aimed to examine the profile of COVID-19-related public stigma and its correlates in the general population of China. A cross-sectional online survey was conducted in China from 7 May to 25 May in 2020. A total of 1212 participants from the general population completed the survey measuring their stigmatizing attitudes towards COVID-19, as well as knowledge and causal attributions of COVID-19. Univariate and multivariate analyses were performed to examine the correlates of COVID-19-related public stigma. A total of 31.8% of participants endorsed stigmatization towards people with COVID-19. Those who were of older age (t = -3.97, p < 0.001), married (F = 3.04, p < 0.05), had a lower level of education (F = 8.11, p < 0.001), and a serious psychological response (F = 3.76, p < 0.05) reported significantly higher scores of public stigma. Dangerousness (B = 0.047, p < 0.001), fear (B = 0.059, p < 0.001), anger (B = 0.038, p < 0.01), and responsibility (B = 0.041, p < 0.001) were positively associated with public stigma. This study shows that public stigma related to COVID-19 is prevalent in the general population of China. Actions against public stigma need to contain the spread of misinformation about COVID-19, alter inappropriate attributions, alleviate unfavorable reactions, and provide psychosocial support for the public.

Stigma of mental illness and cultural factors in Pacific Rim region: a systematic review.

BACKGROUND: Although cultural factors play a crucial role in experience of stigma, there is scant review on the impact and importance of culture on stigma of mental illness across Pacific Rim Region. This study aims to investigate: 1) the cultural factors related to stigmatizing beliefs about mental illness in Pacific Rim region, and 2) culture-specific measures and interventions on stigma of mental illness. METHODS: A systematic search of papers was conducted in the MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, Cochrane Library and Google scholar through January 2003 to April 2019. RESULTS: Forty-one studies in Pacific Rim region which met the inclusion criteria were included in the study. The rate of stigma of mental illness (e.g., public stigma: from 25.4 to 85.2%) was relatively high in Pacific Rim region. Culture factors (e.g., Collectivism, Confucianism, face concern and familism, religion and supernatural beliefs) contributed to people's stigmatizing behaviors and attitudes toward persons with mental illness, their relatives and mental health professionals. Certain measurements were developed and employed to assess different type of cultural factors related to stigma of mental illness. CONCLUSIONS: Cultural factors play an important role in influencing the rate and performance of stigma of mental illness. Further research on stigma of mental illness and culture-specific interventions to reduce the stigma should be conducted in the Pacific Rim region.

Peer-to-peer contact, social support and self-stigma among people with severe mental illness in Hong Kong.

BACKGROUND: Self-stigma exerts a range of adversities for persons with severe mental illness (SMI), however, little is known about the association between peer contact, social support and self-stigma. AIMS: This study aimed to explore the mediating role of social support on the relationship between peer contact and self-stigma among persons with SMI in Hong Kong. METHODS: A total of 159 persons with SMI (schizophrenia and mood disorder) in community service centres participated in the study through completing a survey on self-stigma, social functioning, social support, perception of peer contact and mass media. Logistic regression was utilised to explore the influencing factors of self-stigma among the participants. RESULTS: The results showed that 81.1% of participants reported moderate to severe levels of self-stigma. Self-stigma was significantly associated with diverse factors (e.g. social functioning). Importantly, positive peer contact was significantly associated with lower self-stigma of persons with SMI. Social support acted as a mediator between peer contact and self-stigma. CONCLUSION: The results of this study suggest that contact-based interventions, such as enhancing positive peer-to-peer contact, should be conducted for reducing self-stigma among persons with SMI.

The mediating role of knowledge on the contact and stigma of mental illness in Hong Kong.

BACKGROUND: Although knowledge is a crucial component in contact theory delineating how prejudice changes toward out-groups with stigmatized conditions, little is known about the mediating role of knowledge on contact, stigmatizing attitudes, and behaviors toward mental illness. AIM: This study aimed to examine the mechanism underlie contact and stigma change by knowledge. METHODS: A total of 366 participants including family members (FM), mental health providers (MHP), and community residents (CR) recruited across communities in Hong Kong and completed measures of contact level, contact quantity, contact quality, mental health related knowledge, prejudice, and discriminatory behaviors. Structural equation modeling was adopted to test the association among the key variables. RESULTS: Higher level of contact was significantly correlated with better knowledge, less prejudice, and less discriminatory behaviors. Knowledge was directly and negatively correlated with prejudicial attitudes but was not significantly related to discriminatory behaviors. Furthermore, lower levels of prejudice were associated with less discriminatory behaviors. CONCLUSION: Enhancement of contact may increase understanding toward people with mental illness (PMI) and diminish stigmatizing attitudes and behaviors. Although prejudicial attitudes may be reduced by broadening mental health knowledge, increasing knowledge only might not ameliorate discriminatory behaviors. Future research should test mediators on contact and stigma by using longitudinal data.

Treatment Status of Elderly Patients With Severe Mental Disorders in Rural China.

This study was performed to compare the treatment status between older (≥65 years) and younger adults (18-64 years) with severe mental illness (SMI) and explore factors associated with treatment status in rural China. Persons with SMI were identified in one mental health survey in 2015 in 6 townships of Xinjin County, Chengdu, China. Logistic regressions were conducted to explore factors associated with treatment status. Older adults with SMI, especially major depressive disorder, reported significantly lower rates of treatment than younger group. Older age, longer duration of illness, and poor mental status were risk factors for never-treated status in these patients. Never-treated status (46.3%) and poor treatment status in these older patients are serious issues. Different treatment statuses in these patients had various influencing factors. It is crucial to develop culture-specific, community-based mental health services to improve early identification, diagnosis, treatment, and recovery of older adults with SMI in rural China.

Perception of social support and psychotic symptoms among persons with schizophrenia: A strategy to lessen caregiver burden.

BACKGROUND: Improving patients' perception of social support is significant not only for their re-adaptation to life but also for alleviating caregivers' burden. AIM: This study aims to examine an integrated model regarding social support, psychotic symptoms and caregiver burden. METHODS: Persons with schizophrenia (N1 = 300) and their family caregivers (N2 = 300) in Xinjin County, Chengdu, China, completed the survey to report their demographics, patients' perception of social support (Duke Social Support Index), psychotic symptoms (Positive and Negative Syndrome Scale) and caregiver burden (Burden Scale for Family Caregivers, Short Version). Structural equation modelling was utilised to test the proposed model. RESULTS: The degree of caregiver burden differed significantly within subgroups of patients' gender and education, as well as caregivers' gender, education and employment. Caregiver burden was negatively related to patients' age and household income. Social interaction partially mediated the relationship between instrumental and subjective social support (total effect = 0.451, p < .01). Subjective social support fully mediated the impact of social interaction on psychotic symptoms (total effect = -0.099, p < .05). In the final model, instrumental social support was positively associated with social interaction (p < .001) and increased subjective social support (p < .05). Increased subjective social support showed correlation with a lower degree of psychotic symptoms (p < .01), which was related to a lower level of caregiver burden (p < .001). CONCLUSION: This study shows the associations of patients' social support with psychotic symptoms and caregiver burden. Culture-specific psychosocial interventions should be provided for both patients and caregivers to enrich external support and reduce psychotic symptoms and caregivers' burden within the health care environment.