Poor mental health among Taiwanese people experiencing the public debates on and referendums for same-sex marriage: A Facebook online survey.

BACKGROUND/PURPOSE: Public debates on legalization of same-sex marriage occurred in Taiwan since the latter half of 2016. Taiwanese people voted on same-sex marriage referendums on November 24, 2018. The aim of this Facebook online study was to examine the changes in rates of poor mental health status among Taiwanese people during the 23-month period of public debates on and referendums for legalizing same-sex marriage. METHODS: A two-wave internet survey was conducted using Facebook to gather information regarding mental health and attitudes toward same-sex marriage among 3286 participants (1456 heterosexual and 1830 nonheterosexul) in Wave 1 (one week after the first reading of the Marriage Equality Bill) and 1370 participants (540 heterosexual and 830 nonheterosexul) in Wave 2 survey (one week after the referendum of same-sex marriage). The five-item Brief Symptom Rating Scale was used for assessing mental health status. RESULTS: The rate of poor mental health status significantly increased from the Wave 1 to Wave 2 surveys in heterosexual, lesbian, gay and bisexual (LGB) participants. In nonherterosexual groups, the rates of poor mental health status increased in LGB and female and male nonheterosexual participants of all age. The rates of poor mental health status also increased in heterosexual participants who were female, were young, and supported same-sex marriage. CONCLUSION: The rates of poor mental health status increased in both heterosexual and nonheterosexual people during the period of public debates on and the referendums for same-sex marriage. Heterosexual people who were female, were young, and supported same-sex marriage had also increased rates of poor mental health state during the same period.

Role of mental health in the attitude toward same-sex marriage among people in Taiwan: Moderating effects of gender, age, and sexual orientation.

PURPOSE: The aims of the study were to examine the role of mental health in peoples' attitude toward same-sex marriage in Taiwan, as well as the moderating effects of gender, age, and sexual orientation on the association between mental health and attitude toward same-sex marriage. METHODS: In total, 3235 participants were recruited through a Facebook advertisement. Each participant completed a questionnaire assessing attitude toward same-sex marriage and a 5-item Brief Symptom Rating Scale (BSRS-5). Multiple regression analysis was performed to investigate the association between mental health and attitude toward same-sex marriage. RESULTS: Poor mental health was significantly associated with a low level of support for same-sex marriage. Age and sexual orientation moderated the association between mental health state and support for same-sex marriage. A significant association between poor mental health and a low level of support for same-sex marriage was observed only in older participants but not in younger participants. Moreover, a significant association between poor mental health and a low level of support for same-sex marriage was indicated only in heterosexual participants but not in non-heterosexual participants. CONCLUSION: Our findings suggest that poor mental health was significantly associated with opposition to same-sex marriage. This relationship is more pronounced among older and heterosexual people.

Relationships between traditional and cyber harassment and self-identity confusion among Taiwanese gay and bisexual men in emerging adulthood.

BACKGROUND: Harassment victimization is prevalent among gay and bisexual men and may negatively impact the victims' mental health. AIMS: To examine the relationships between traditional and cyber harassment and self-identity confusion among Taiwanese gay and bisexual men in emerging adulthood. PROCEDURES: A total of 305 gay or bisexual men (age, 20-25 years) in Taiwan were recruited. Participants' self-identity confusion and the experiences of traditional and cyber harassment were assessed. The relationships of experiences of harassment victimization, number of places at which traditional harassment occurred, and type of harassment victimization with self-identity confusion were examined using multiple regression analysis. RESULTS: Both victims of verbal ridicule and relational exclusion and victims of physical aggression and theft of belongings had higher levels of disturbed identity and lack of identity than did non-victims. Those who experienced traditional harassment at multiple places had higher levels of unconsolidated identity and lack of identity than did those who experienced traditional harassment at only one place. Those who experienced multiple types of harassment had higher levels of unconsolidated identity than those who experienced only one type of harassment. DISCUSSIONS: Victimization of traditional harassment and multisite and multitype harassments were significantly related to self-identity confusion in gay and bisexual men.

Associations between callous-unemotional traits and various types of involvement in school bullying among adolescents in Taiwan.

PURPOSE: This study examined associations between callous-unemotional (CU) traits and involvement in school bullying among 613 Taiwanese adolescents. METHODS: CU traits were determined using the self-reported Chinese versions of the Inventory of Callous and Unemotional Traits (C-ICUT) and the School Bullying Experience Questionnaire (C-SBEQ). The study used logistic regression analysis to assess associations between CU traits and types of involvement in school bullying, with controls for the effect of age, sex, and residential background. RESULTS: Higher levels of the callous trait were positively associated with greater risk of being a victim of physical bullying and belongings snatch, or a perpetrator of verbal, relational and physical bullying and belongings snatch. Higher levels of the unemotional trait were positively associated with greater risk of being a victim of verbal and relational bullying. The uncaring trait had no significant associations with any type of bullying involvement. CONCLUSION: The role played by CU traits should, therefore, be examined when developing programs to detect and prevent school bullying.

Intention to care for gay and lesbian patients and knowledge about homosexuality: A comparison of Taiwanese nurses in 2005 and in 2017.

OBJECTIVE: To examine the differences in the levels of intention to care for gay and lesbian patients and knowledge regarding homosexuality among Taiwanese nurses between 2005 and 2017 and the moderators of these differences. DESIGN AND SAMPLE: This two-wave survey study was conducted on nurses in 2005 (N = 1,176; Survey 2005) and 2017 (N = 1,519; Survey 2017) recruited from three hospitals. MEASUREMENTS: An anonymous self-report questionnaire was used. RESULTS: In Survey 2017, the nurses expressed both a higher intention to care for gay and lesbian patients and degree of knowledge regarding homosexuality than did those in Survey 2005. The experience of providing care for gay or lesbian patients moderated the association between the time of the survey and intention to care for gay and lesbian patients. Moreover, having gay or lesbian friends or relatives moderated the association between the time of the survey and knowledge about homosexuality. CONCLUSIONS: Nurses' intention to care for gay and lesbian patients and knowledge regarding homosexuality in Taiwan significantly increased from 2005 to 2017. The experience of providing care for gay and lesbian patients and having gay or lesbian friends or relatives moderated the increase of nurses' intention to care and knowledge.

Physical Child Abuse and Teacher Harassment and Their Effects on Mental Health Problems Amongst Adolescent Bully-Victims in Taiwan.

This study compared physical child abuse and teacher harassment of bully-victims with other groups and examined their associations with mental health problems in bully-victims. For 6,160 adolescents, experiences of physical child abuse, teacher harassment, peer bullying, and six mental health problem indicators were assessed. Adolescents that had experienced physical child abuse and teacher harassment were more likely to be bully-victims but not neutral or pure victims. Adolescents who reported physical child abuse were more likely to be bully-victims but not pure bullies. Bully-victims that had experienced teacher harassment exhibited more severe depression and insomnia than did those without teacher harassment. Gender had moderating effects on the difference in physical child abuse between bully-victims and neutrals and on the association between physical child abuse and suicidality in bully-victims. Physical child abuse and teacher harassment should be considered when preventive and intervention programs are developed for adolescents.

Mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems among adolescents in Taiwan.

BACKGROUND: This study aimed to examine the mediating effects of depression and anxiety on the relationships of bullying victimization and perpetration with pain among adolescents in Taiwan. METHOD: A total of 4976 students of junior and senior high schools completed the questionnaires. Bullying victimization and perpetration, pain problems, depression, and anxiety were assessed. The mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems and the moderating effects of sex on the medicating roles of depression and anxiety were examined by structural equation model. RESULTS: Both depression and anxiety were significant mediators of the relationship between bullying victimization and pain problems among adolescents. Depression was also a significant mediator of the relationship between bullying perpetration and pain problems among adolescents. Sex had no moderating effect on the mediating role of depression/anxiety on the association between bullying involvement and pain problems. CONCLUSIONS: Medical and educational professionals should survey and intervene in depression and anxiety when managing pain problems among adolescents involved in bullying.

The association of Internet addiction symptoms with anxiety, depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder.

BACKGROUND: The aims of this study were to examine the associations of the severity of Internet addiction symptoms with various dimensions of anxiety (physical anxiety symptoms, harm avoidance, social anxiety, and separation/panic) and depression symptoms (depressed affect, somatic symptoms, interpersonal problems, and positive affect) and self-esteem among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan. METHOD: A total of 287 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. Their severity of Internet addiction symptoms was assessed using the Chen Internet Addiction Scale. Anxiety and depression symptoms and self-esteem were assessed using the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T), the Center for Epidemiological Studies Depression Scale (CES-D), and the Rosenberg Self-Esteem Scale (RSES), respectively. The association between the severity of Internet addiction symptoms and anxiety and depression symptoms and self-esteem were examined using multiple regression analyses. RESULTS: The results indicated that higher physical symptoms and lower harm avoidance scores on the MASC-T, higher somatic discomfort/retarded activity scores on the CES-D, and lower self-esteem scores on the RSES were significantly associated with more severe Internet addiction symptoms. CONCLUSIONS: Prevention and intervention programs for Internet addiction in adolescents with ADHD should take anxiety, depression, and self-esteem into consideration.

Child-Mother Agreement on Experiences of School Bullying Involvement in Children With ADHD.

Objective: To examine the levels of agreement between the reports of 452 children and their mothers on children's experiences of bullying involvement at school and investigate the factors influencing the levels of agreement in children with ADHD. Method: The levels of agreement between children's and mothers' reports were examined. The influence of age, sex, ADHD symptoms, and psychiatric comorbidities on the levels of agreement was also examined. Results: The results indicated low agreement on the experiences of bullying involvement in child-mother ADHD dyads. Age and hyperactivity-impulsivity, oppositional, depressive, and anxiety symptoms significantly influenced the levels of agreement on the victimization of physical bullying. Age significantly influenced the levels of agreement on the perpetration of physical bullying. Conclusion: Multiple sources of information are required when clinicians assess the experiences of bullying involvement at school in children with ADHD. The factors influencing the levels of agreement should be considered.

Relationship between Difficulty in Emotion Regulation and Internet Addiction in College Students: A One-Year Prospective Study.

This prospective study evaluated the predictive effect of difficulty in emotion regulation on the occurrence and remission of Internet addiction (IA) and determined whether IA has a role in changing emotion regulation among college students during a follow-up period of 1 year. A total of 500 college students (262 women and 238 men) were recruited. In baseline and follow-up investigations, the levels of IA and difficulty in emotion regulation were evaluated using the Chen Internet Addiction Scale and the Difficulties in Emotion Regulation Scale (DERS), respectively. The results indicated that the subscale of impulse control difficulties on the DERS predicted the incidence of IA during the follow-up period of 1 year in male participants (t = -2.875, p = 0.005), whereas no subscale on the DERS predicted the remission of IA. IA did not predict the change in difficulties in emotion regulation. The subscale of impulse control difficulties on the DERS predicted the occurrence of IA in the college students and warrants early intervention.

Role of School Bullying Involvement in Depression, Anxiety, Suicidality, and Low Self-Esteem Among Adolescents With High-Functioning Autism Spectrum Disorder.

This study aimed to compare the severities of psychopathologies and the level of self-esteem among 219 adolescents with high-functioning autism spectrum disorder (ASD) who were classified into pure perpetrators, pure victims, perpetrator-victims, and neutrals in Taiwan. The experiences of school bullying involvement in the previous 1 year were measured using the Chinese version of the School Bullying Experience Questionnaire. The severities of depression, anxiety, and suicidality were measured using the Center for Epidemiological Studies Depression Scale, the Multidimensional Anxiety Scale for Children, and the 5-item questionnaire from the epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. The level of self-esteem was measured using the Rosenberg Self-Esteem Scale. The results indicated that compared with the self-reported neutrals, the self-reported perpetrator-victims and pure victims had more severe depression and anxiety. No difference in depression, suicidality, anxiety, and self-esteem was found among the four groups of various parent-reported bullying involvement experiences. Mental health problems in adolescents with ASD who experienced bullying victimization should be routinely surveyed.

Quality of life of gay and bisexual men during emerging adulthood in Taiwan: Roles of traditional and cyber harassment victimization.

This study examined factors related to the quality of life (QOL) of gay and bisexual men during emerging adulthood in Taiwan. The factors included traditional harassment (e.g., verbal ridicule, relational exclusion, physical aggression, and theft of belongings), cyber harassment, sex- and gender-related factors (e.g., sexual orientation, age at initial identification of sexual orientation, self-reported level of gender nonconformity, and perceived social acceptance toward homosexuality and bisexuality), and demographic characteristics. In total, 305 Taiwanese gay and bisexual men, aged 20-25 years, were recruited. Their QOL, traditional harassment, and cyber harassment data were collected using the World Health Organization Questionnaire on Quality of Life: Short Form, School Bullying Experience Questionnaire, and Cyberbullying Experiences Questionnaire, respectively. In total, 60.3%, 34.4%, 28.2%, and 29.5% of the participants reported experiencing traditional harassment, cyber harassment, traditional harassment across multiple contexts, and harassment in multiple forms, respectively. Both traditional and cyber harassment were significantly associated with lower QOL. Individuals who experienced traditional harassment across multiple contexts and harassment in multiple forms had lower QOL in nearly all domains than did individuals who had experienced traditional harassment in a single context and harassment of a single form. However, the QOL did not significantly differ between individuals who had experienced traditional harassment in a single context and nonvictims nor between individuals who had experienced harassment of a single form and nonvictims. Lower education level, older age at initial identification of sexual orientation, higher perception of gender nonconformity, and lower perceived social acceptance toward homosexuality and bisexuality were significantly associated with lower QOL. Clinical and public health professionals should consider these factors when developing programs to enhance the QOL of gay and bisexual men.

Correlations of Internet Addiction Severity With Reinforcement Sensitivity and Frustration Intolerance in Adolescents With Attention-Deficit/Hyperactivity Disorder: The Moderating Effect of Medications.

Background: Deviations in reinforcement sensitivity and frustration-related reactions have been proposed as components of the biopsychosocial mechanisms, which explained the high vulnerability to internet addiction (IA) among individuals with attention-deficit/hyperactivity disorder (ADHD). There is currently limited knowledge on the relationship of IA symptoms with reinforcement sensitivity and frustration intolerance, as well as factors moderating those correlations in this population. Objective: The aims of this study were (1) to examine the associations of IA symptoms severity with reinforcement sensitivity and frustration intolerance and (2) identify the moderators of these associations among adolescents diagnosed with ADHD in Taiwan. Methods: A total of 300 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. Their levels of IA severity, reinforcement sensitivity, and frustration intolerance were assessed using the Chen Internet Addiction Scale, behavioral inhibition system (BIS) and behavioral approach system (BAS), and Frustration Discomfort Scale, respectively. The associations of IA severity with reinforcement sensitivity and frustration intolerance were examined using multiple regression analysis. Possible moderators, including medications for ADHD, were tested using the standard criteria. Results: Higher fun seeking on the BAS (p = .003) and higher frustration intolerance (p = .003) were associated with more severe IA symptoms. Receiving medication for treating ADHD moderated the association between fun seeking on the BAS and severity of IA symptoms. Conclusion: Fun seeking on the BAS and frustration intolerance should be considered as targets in prevention and intervention programs for IA among adolescents with ADHD.

Pain, Bullying Involvement, and Mental Health Problems Among Children and Adolescents With ADHD in Taiwan.

OBJECTIVE: The aim of this study was to examine the relationships of pain and pain-induced functional impairment with bullying involvement, as well as the relationships between pain and mental health problems among 474 children and adolescents with ADHD. METHOD: The levels of pain, pain-induced functional impairment, involvement in bullying, depression, anxiety, ADHD symptoms, and sleep quality were assessed. RESULTS: Both victims of verbal and relational bullying and victims of physical bullying were more likely to have pain and pain-induced functional impairment than nonvictims. The perpetrators of verbal and relational bullying were more likely to have pain than the nonperpetrators. Participants with pain and pain-induced functional impairment experienced more severe depression and anxiety and worse sleep quality than did those without pain or pain-induced functional impairment. CONCLUSION: Clinical and educational professionals should consider the possibility of involvement in bullying and comorbid depression, anxiety, and poor sleep quality among ADHD children and adolescents with pain problems.

Self-Reported and Parent-Reported School Bullying in Adolescents with High Functioning Autism Spectrum Disorder: The Roles of Autistic Social Impairment, Attention-Deficit/Hyperactivity and Oppositional Defiant Disorder Symptoms.

The aim of this study was to examine the prevalence of self-reported and parent-reported bullying victimization, perpetration, and victimization-perpetration and the associations of autistic social impairment and attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms with bullying involvement in adolescents with high functioning autism spectrum disorder (ASD). A total of 219 adolescents with high functioning ASD participated in this study. The associations of sociodemographic characteristics, parent-reported autistic social impairment, and parent-reported ADHD and ODD symptoms with self-reported and parent-reported bullying victimization, perpetration, and victimization-perpetration were examined using logistic regression analysis. The results found that the agreement between self-reported and parent-reported bullying involvement was low. Compared with bullying involvement experiences reported by adolescents themselves, parents reported higher rates of pure bullying victimization (23.7% vs. 17.8%) and victimization-perpetration (28.8% vs. 9.1%) but a lower rate of pure bullying perpetration (5.9% vs. 9.1%). Deficit in socio-communication increases the risk of being pure victims and victim-perpetrators. Parent-reported victim-perpetrators had more severe ODD symptoms than did parent-reported pure victims.

Cyberbullying Victimization and Perpetration in Adolescents with High-Functioning Autism Spectrum Disorder: Correlations with Depression, Anxiety, and Suicidality.

The present study examined the associations between cyberbullying involvement and sociodemographic characteristics, autistic social impairment and attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD) symptoms in 219 adolescents with high-functioning autism spectrum disorder (ASD). Moreover, the associations between cyberbullying involvement and depression, anxiety, and suicidality were also examined. Adolescents self-reported higher rates of being a victim or perpetrator of cyberbullying than were reported by their parents. Increased age and had more severe ODD symptoms were significantly associated with being victims or perpetrators of cyberbullying. Being a victim but not a perpetrator of cyberbullying was significantly associated with depression, anxiety, and suicidality. Cyberbullying victimization and perpetration should be routinely surveyed in adolescents with high-functioning ASD.

Bullying Victimization and Perpetration and Their Correlates in Adolescents Clinically Diagnosed With ADHD.

OBJECTIVE: To examine the prevalence rates of bullying involvement and their correlates in adolescents diagnosed with ADHD in Taiwan. METHOD: Bullying involvement, family and ADHD characteristics, the levels of behavioral inhibition system (BIS) and behavioral approach system (BAS), and psychiatric comorbidity were assessed in 287 adolescents with ADHD. The multiple regression analysis was used to examine the correlate of bullying victimization and perpetration. RESULTS: The prevalence rates of the pure victims, pure perpetrators, and victim-perpetrators were 14.6%, 8.4%, and 5.6%, respectively. Young age, a high BIS score, autism spectrum disorders, and low satisfaction with family relationships were associated with severe bullying victimization. A high score of fun seeking on the BAS and low satisfaction with family relationships were associated with severe bullying perpetration. CONCLUSION: A high proportion of adolescents with ADHD are involved in bullying. Multiple factors are associated with bullying involvement in adolescents with ADHD.

Effects of theory of mind performance training on reducing bullying involvement in children and adolescents with high-functioning autism spectrum disorder.

Bullying involvement is prevalent among children and adolescents with autism spectrum disorder (ASD). This study examined the effects of theory of mind performance training (ToMPT) on reducing bullying involvement in children and adolescents with high-functioning ASD. Children and adolescents with high-functioning ASD completed ToMPT (n = 26) and social skills training (SST; n = 23) programs. Participants in both groups and their mothers rated the pretraining and posttraining bullying involvement of participants on the Chinese version of the School Bullying Experience Questionnaire. The paired t test was used to evaluate changes in bullying victimization and perpetration between the pretraining and posttraining assessments. Furthermore, the linear mixed-effect model was used to examine the difference in the training effect between the ToMPT and SST groups. The paired t test indicated that in the ToMPT group, the severities of both self-reported (p = .039) and mother-reported (p = .003) bullying victimization significantly decreased from the pretraining to posttraining assessments, whereas in the SST group, only self-reported bullying victimization significantly decreased (p = .027). The linear mixed-effect model indicated that compared with the SST program, the ToMPT program significantly reduced the severity of mother-reported bullying victimization (p = .041). The present study supports the effects of ToMPT on reducing mother-reported bullying victimization in children and adolescents with high-functioning ASD.

Relationship between borderline personality symptoms and Internet addiction: The mediating effects of mental health problems.

Aim To examine the relationship between borderline personality symptoms and Internet addiction as well as the mediating role of mental health problems between them. Methods A total of 500 college students from Taiwan were recruited and assessed for symptoms of Internet addiction using the Chen Internet Addiction Scale, borderline personality symptoms using the Taiwanese version of the Borderline Symptom List and mental health problems using four subscales from the Symptom Checklist-90-Revised Scale (interpersonal sensitivity, depression, anxiety, and hostility). Structural equation modeling (SEM) was used to test our hypothesis that borderline personality symptoms are associated with the severity of Internet addiction directly and also through the mediation of mental health problems. Results SEM analysis revealed that all paths in the hypothesized model were significant, indicating that borderline personality symptoms were directly related to the severity of Internet addiction as well as indirectly related to the severity of Internet addiction by increasing the severity of mental health problems. Conclusion Borderline personality symptoms and mental health problems should be taken into consideration when designing intervention programs for Internet addiction.

Social skills deficits and their association with Internet addiction and activities in adolescents with attention-deficit/hyperactivity disorder.

Background and aims The aims of this study were to examine the association between social skills deficits and Internet addiction and activities in adolescents with attention-deficit/hyperactivity disorder (ADHD) as well as the moderators for this association. Methods A total of 300 adolescents, aged between 11 and 18 years, who had been diagnosed with ADHD participated in this study. Their Internet addiction levels, social skills deficits, ADHD, parental characteristics, and comorbidities were assessed. The various Internet activities that the participants engaged in were also examined. Results The associations between social skills deficits and Internet addiction and activities and the moderators of these associations were examined using logistic regression analyses. Social skills deficits were significantly associated with an increased risk of Internet addiction after adjustment for the effects of other factors [odds ratio (OR) = 1.049, 95% confidence interval (CI) = 1.030-1.070]. Social skills deficits were also significantly associated with Internet gaming and watching movies. The maternal occupational socioeconomic levels of the participants moderated the association between social skills deficits and Internet addiction. Conclusions Social skills deficits should be considered targets in prevention and intervention programs for treating Internet addiction among adolescents with ADHD.