Chow S. Lam

Measuring Self-Stigma of Mental Illness in China and Its Implications for Recovery

This study translated and validated the Chinese Version of the Self-stigma of Mental Illness Scale (CSSMIS), which may be used to measure self-stigma of mental health consumers in China. We also examined its correlation with self-esteem, self-efficacy and psychosocial treatment compliance. A cross-sectional observational study was implemented. Some 51 males and 57 females who suffered from severe mental illness were recruited from psychiatric settings in Hong Kong. They were required to complete the Chinese Version of the Self-stigma of Mental Illness Scale, the Rosenberg Self-esteem Scale and the Self-efficacy Scale. Their level of compliance during psychosocial treatment and their demographic information were recorded by their case managers. Exploratory factor analysis revealed two homologous factors for the four subscales of the CSSMIS. Factor 1 was related to the negative beliefs and consequences of having mental disorders, whereas Factor 2 was related to positive beliefs. The perceived stigma subscale and the three self-stigma subscales were strongly inter-correlated. Significant correlations were also found between almost all subscales of the CSSMIS and the remaining scales. The psychometric properties of the CSSMIS are statistically acceptable. The results also suggest that stigma played a detrimental role in undermining self-esteem, self-efficacy and psychosocial treatment compliance. Implications for recovery of mental health consumers are discussed.

A cross-cultural study of employers' concerns about hiring people with psychotic disorder: implications for recovery

IntroductionEmployment discrimination is considered as a major impediment to community integration for people with serious mental illness, yet little is known about how the problem manifests differently across western and non-western societies. We developed a lay model based on Chinese beliefs and values in terms of Confucianism, Taoism, Buddhism, and folk religions which may be used to explain cross-cultural variation in mental illness stigma, particularly in the arena of employment discrimination. In this study, we tested this lay approach by comparing employers’ concerns about hiring people with psychotic disorder for entry-level jobs in US and China.MethodOne hundred employers (40 from Chicago, 30 from Hong Kong, and 30 from Beijing) were randomly recruited from small size firms and interviewed by certified interviewers using a semi-structured interview guide designed for this study. Content analysis was used to derive themes, which in turn were compared across the three sites using chi-square tests.ResultsAnalyses reveal that employers express a range of concerns about hiring an employee with mental illness. Although some concerns were raised with equal frequency across sites, comparisons showed that, relative to US employers, Chinese employers were significantly more likely to perceive that people with mental illness would exhibit a weaker work ethic and less loyalty to the company. Comparison of themes also suggests that employers in China were more people-oriented while employers in US were more task-oriented.ConclusionCultural differences existed among employers which supported the lay theory of mental illness.

Use of the beck depression inventory-II (BDI-II) with persons with traumatic brain injury: Analysis of factorial structure

Primary objective: To determine the factorial structure of the BDI-II in a TBI sample and possible predictor variables of depression following TBI. Research design: Principle components analysis with orthogonal rotation and linear regression analyses. Methods and procedures: Fifty-one individuals with traumatic brain injury (TBI) participated in this study. The factorial structure of the BDI-II, a 21-item self-report measure of depression, was examined with individuals in the early stages following TBI. Time since injury, severity of injury, location of lesion and previous substance abuse were examined as possible predictors of depression following TBI. Results: A three-factor structure of the BDI-II was found for the TBI sample, which included Negative Self-Evaluation, Symptoms of Depression and Vegetative Symptoms of Depression. Time since injury was the only significant predictor of depression following TBI. Conclusion: Using the BDI-II, symptoms of depression after TBI fall into three key categories. With time since injury being the only significant predictor of depression following TBI, it appears that the depression could be more of a result of psychosocial factors than neurobiological factors. It was concluded that BDI-II can be useful in identifying symptoms of depression in the early stages following TBI.

Describing quality of life and psychosocial outcomes after traumatic brain injury.

Kalpakjian CZ, Lam CS, Toussaint LL, Hansen Merbitz NK: Describing quality of life and psychosocial outcomes after traumatic brain injury. Am J Phys Med Rehabil 2004;83:255–265. Objective To describe the quality of life (QOL) and psychosocial outcomes of a sample of adults with traumatic brain injury in 50 community dwelling adults with traumatic brain injury and examine the associations among these variables. Design Cross-sectional. Results Mean QOL rating was low average. Standardized measures had acceptable internal reliability and normal distributions in this sample. Subjects had significantly lower QOL and social support, higher negative affect, and similar positive affect and spirituality compared with standardization and other nondisabled samples. They also had a significantly higher level of community integration than other traumatic brain injury samples. Regression analyses suggested that social support, community integration, and positive affect make a unique and significant contribution to the QOL variance with R2 of 0.492. The addition of spirituality reduced their respective unique variance, reducing positive affect to nonsignificant levels due to their high intercorrelation. Conclusions Findings suggest that this sample experiences a wide range of QOL. Factors significantly associated with good QOL include community integration, positive affect, and social support; demographic variables had virtually no association with QOL. Evaluation of the sample’s response to standardized scales not designed for a traumatic brain injury population support their use in similar QOL investigations.

Driving after a severe head injury

The driving activities of 50 head-injury survivors were surveyed 6 months or more post-discharge. Of these, 21 (42%) possessed a valid drivers licence, but only 19 (38%) were actually operating motor vehicles at follow-up. Only measures of spatial/perceptual deficits were found to discriminate between groups of drivers and non-drivers. The recommendations of rehabilitation staff did not appear to have much influence on the final decision whether or not the survivor resumed driving activities. Most of the drivers did not report post-injury accidents or traffic violations, perhaps because several participants were restricting their driving activities. The willingness voluntarily to restrict driving behaviours may offer some head-injury survivors the opportunity to continue to enjoy this important daily living activity under selected circumstances.

Differential Attitudes of Chinese Students Toward People With Disabilities: a Cross-Cultural Perspective

The purpose of this study was to examine the attitudes of 338 Chinese secondary school students toward three major disability groups (people who are physically disabled, emotionally disturbed, and mentally retarded) using an adaptation of the American Scale of Attitudes toward Disabled Persons (SADP). We found that physically disabled persons were rated higher across the three subscales of the SADP compared to either emotionally disturbed and mentally retarded individuals, who were rated similarly low by the students. The lack of differentiation between the two men tal handicapping conditions is at variance with contemporary western findings. The overall negative attitudes toward people with mental disabilities may have significant implications for community rehabilitation programming for this population.

Chinese and American Perspectives on Stigma

This paper discusses the Chinese and American perspectives on stigma. We review Chinese lay theories on disability and describe their impact on stigma and stereotype formation. These lay theories are understood on the basis of Chinese beliefs and values: Confucianism, Taoism, Buddhism, shame and guilt, and dialectical thinking. An understanding of these lay theories can help researcher and educators better understand observed differences in cognition and behavior between Chinese and American cultures and, thus, provide a means of comprehending and reducing confusions and conflicts between groups. Research findings on Chinese and American differential attitudes and implications for rehabilitation education and curriculum development are also discussed.

Neuropsychological testing and functional outcome for individuals with traumatic brain injury

The relationship between performance on neuropsychological measures and the vocational and independent living functioning of individuals with traumatic brain injury was examined. The Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQ and Stroop Color and Word Test scores differentiated individuals who required no assistance with activities of daily living from those requiring some level of assistance. Only the Stroop Color and Word Test scores differentiated individuals who were competitively employed or engaged in degree-oriented education from those who were unemployed or in sheltered or supported employment. Wechsler Memory Scale-Revised (WMS-R) scores did not differentiate these groups.

Chinese and American employers’ perspectives regarding hiring people with behaviorally driven health conditions: The role of stigma

Work opportunities for people with behaviorally driven health conditions such as HIV/AIDS, drug abuse, alcohol abuse, and psychosis are directly impacted by employer perspectives. To investigate this issue, we report findings from a mixed method design involving qualitative interviews followed by a quantitative survey of employers from Chicago (U.S.), Beijing (China), and Hong Kong (China). Findings from qualitative interviews of 100 employers were used to create 27 items measuring employer perspectives (the Employer Perspective Scale: EPS) about hiring people with health conditions. These perspectives reflect reasons for or against discrimination. In the quantitative phase of the study, representative samples of approximately 300 employers per city were administered the EPS in addition to measures of stigma, including attributions about disease onset and offset. The EPS and stigma scales were completed in the context of one of five randomly assigned health conditions. We weighted data with ratios of key demographics between the sample and the corresponding employer population data. Analyses showed that both onset and offset responsibility varied by behaviorally driven condition. Analyses also showed that employer perspectives were more negative for health conditions that are seen as more behaviorally driven, e.g., drug and alcohol abuse. Chicago employers endorsed onset and offset attributions less strongly compared to those in Hong Kong and Beijing. Chicago employers also recognized more benefits of hiring people with various health conditions. The implications of these findings for better understanding stigma and stigma change among employers are considered.

Behavioral Dyscontrol Scale Deficits Among Traumatic Brain Injury Patients, Part II: Comparison to Other Measures of Executive Functioning

The clinical utility of the Behavioral Dyscontrol Scale (BDS) was compared to that of verbal fluency, the Trail Making Test, and the Stroop Color-Word Test, as well as measures of processing speed/cognitive efficiency and manual dexterity. The ability of these measures to classify 49 TBI patients into frontal versus nonfrontal and mild to moderate versus severe groups was examined. The results showed that the Fluid Intelligence Factor of the BDS improved classifications above and beyond traditional executive measures, but was particularly successful at classifying patients who sustained mild injuries. In contrast, traditional executive instruments were successful at lesion location classifications only among the patients with severe injuries. Severity classifications were successful both for traditional measures of processing speed/cognitive efficiency and for the Motor Programming Factor of the BDS, but only among patients with nonfrontal injuries. These results demonstrate that severity of injury may be an important moderator of tests’ sensitivity to frontal lobe involvement.