Fei-Hsiu Hsiao

Playful bottle: a mobile social persuasion system to motivate healthy water intake

This study of mobile persuasion system explores the use of a mobile phone, when attached to an everyday object used by an everyday behavior, becomes a tool to sense and influence that behavior. This mobile persuasion system, called Playful Bottle system, makes use of a mobile phone attached to an everyday drinking mug and motivates office workers to drink healthy quantities of water. A camera and accelerometer sensors in the phone are used to build a vision/motion-based water intake tracker to detect the amount and regularity of water consumed by the user. Additionally, the phone includes hydration games in which natural drinking actions are used as game input. Two hydration games are developed: a single-user TreeGame with automated computer reminders and a multi-user ForestGame with computer-mediated social reminders from members of the group playing the game. Results from 7-week user study with 16 test subjects suggest that both hydration games are effective for encouraging adequate and regular water intake by users. Additionally, results of this study suggest that adding social reminders to the hydration game is more effective than system reminders alone.

A longitudinal study of cortisol responses, sleep problems, and psychological well-being as the predictors of changes in depressive symptoms among breast cancer survivors

OBJECTIVE This study examined whether the changes in sleep problems, attachment styles, meaning in life, and salivary cortisol over the course of 14 months were the predictors of changes in depressive symptoms in women with breast cancer at post-treatment stage. METHODS The study included 76 participants who completed active breast cancer treatment with longitudinal data collected at five points, including baseline assessment (T0) and the four follow-ups after baseline: T1 (in the 2nd month), T2 (in the 5th month), T3 (in the 8th month), and T4 (in the 14th month). The self-reported questionnaires included the Medical Outcomes Study Sleep (MOS-Sleep) scale; the Beck Depression Inventory-II (BDI-II); the Experiences in Close Relationships-Revised (ECR-R) scale for measuring anxiety and avoidance dimensions of attachment style; and the Meaning in Life Questionnaire (MLQ), consisting of the MLQ-Presence scale and the MLQ-Search scale. The participants collected their salivary cortisol at home at six time points: upon waking, 30 and 45 min after waking, and at 1200 h, 1700 h, and 2100 h. RESULTS Higher scores on for anxiety-related attachment style and the sleep problems index at baseline were associated with more severe initial depressive symptoms after the age, BMI, cancer, and treatment variables were controlled. The presence of meaning in life at baseline was negatively correlated with initial depressive symptoms. Moreover, the decreases in the presence of meaning in life over the course of 14 months predicted more severe depressive symptoms. In addition, the persistent increases of cortisol level at 2100 h across 14-month follow-ups predicted worsening depressive symptoms. CONCLUSIONS Lacking presence of meaning in life as a predictor for severe depressive symptoms demonstrates that breast cancer survivors who lack psychological well-being are more likely to be depressed. The persistent elevation of cortisol levels at night also indicates breast cancer survivors to be at high risk of depression.

Patient-Related Barriers to Fatigue Communication in Cancer Patients Receiving Active Treatment

OBJECTIVE To explore barriers to reporting fatigue in cancer patients receiving active treatment and the significant factors associated with those barriers from fatigue characteristics (i.e., intensity, duration, and interference with daily life), to demographic characteristics and disease/treatment variables. METHODS Patients with various types of cancer (n = 288) were recruited from an outpatient chemotherapy center, and from seven oncology and hematology units in a teaching hospital in northern Taiwan. Data were collected using the Fatigue Management Barriers Questionnaire to explore barriers to fatigue communication. RESULTS Fear of distracting the doctor was rated as the highest barrier of reporting fatigue. The degree of fatigue interference with daily life by patients was associated with the willingness to report fatigue. Patients with gastrointestinal cancer experienced more barriers to reporting fatigue than those with hematological cancer. Patients without religion perceived the highest level of barriers to fatigue communication. Outpatients had higher levels of concern than inpatients. CONCLUSIONS Discussion with patients about their high level of perceived fatigue barriers before implementing patient education is recommended. Assessing fatigue interference with daily life and identifying factors associated with barriers to reporting fatigue (i.e., type of cancer, religion, and the setting for receiving treatment) are suggested in order to provide better fatigue management in clinical settings.

The effect of psychotherapy added to pharmacotherapy on cortisol responses in outpatients with major depressive disorder.

The present study examined the changes of depressive symptoms and salivary cortisol responses in 36 outpatients with major depression. These patients were randomly assigned to receive combination therapy (CT), consisting of antidepressants and body-mind-spirit group psychotherapy, or monotherapy (MT), consisting of antidepressants only. The results indicated that CT and MT had similar effects on reducing depressive symptoms. Nevertheless, the results revealed that cortisol levels at night appeared to have a greater reduction in CT than in MT, indicating a downward trend in CT but an upward trend in MT. Moreover, a steeper diurnal pattern of cortisol—a larger deviation in cortisol levels between 30 and 45 minutes postwaking and evening—was more likely associated with CT than MT. The findings suggest that CT produced a protective effect on outpatients with major depression, preventing the increased night salivary cortisol levels and the flatter diurnal cortisol pattern that tended to occur in MT.

The Long-Term Effects of Psychotherapy Added to Pharmacotherapy on Morning to Evening Diurnal Cortisol Patterns in Outpatients with Major Depression

Background: Psychotherapy added to pharmacotherapy results in greater improvement in clinical outcomes than does pharmacotherapy alone. However, few studies examined how psychotherapy coupled with pharmacotherapy could produce a long-term protective effect by improving the psychobiological stress response. Methods: The researchers recruited 63 subjects with major depressive disorder (MDD) in an outpatient department of psychiatry at a general hospital. The randomly assigned subjects formed 2 groups: 29 in combined therapy (COMB) and 34 in monotherapy (MT). The COMB included 8 weekly body-mind-spirit group psychotherapy sessions added to pharmacotherapy. MT consisted of pharmacotherapy only. The outcome measures, collected at the subjects’ homes, included the Beck Depression Inventory II (BDI-II), the State Trait Anxiety Inventory (STAI) and salivary cortisol on awakening, 45 min after awakening, and at 12.00, 17.00 and 21.00 h. Evaluation of outcome measures was at baseline condition, and at months 2 (end of additional psychotherapy), 5 and 8. Results: While the decreases in symptoms of depression were similar between COMB and MT (p > 0.05), the reductions in anxiety state were greater in COMB than in MT during the 8-month follow-up (p < 0.05). A steeper diurnal cortisol pattern more likely occurred in COMB than in MT in the 3 follow-up periods (p < 0.05, p <0.001 and p < 0.01). Conclusions: The superior outcomes of group psychotherapy added to pharmacotherapy for MDD outpatients could relate to decreasing the anxiety state and to producing long-term impacts on positive stress endocrine outcomes seen as a steeper diurnal cortisol pattern.

Efficacy of psychotherapy on diurnal cortisol patterns and suicidal ideation in adjustment disorder with depressed mood

AIMS The aims were to examine the effects of psychotherapy on depressive and anxiety symptoms, the occurrence of suicidal ideations and diurnal cortisol patterns in patients with adjustment disorder (AD) with depressed mood. METHODS Participants recruited from an outpatient department of psychiatry at a general hospital were randomly assigned to one of two groups: 34 in psychotherapy group and 37 in control group. The control group consisted of one-session psychoeducation. Psychotherapy included the eight-weekly body-mind-spirit (BMS) group psychotherapy. Measures included Beck Depression Inventory-II and State Trait Anxiety Inventory. Salivary cortisol samples were collected from the patients at their homes on awakening; 30 and 45 min after awakening; and at 1200, 1700 and 2100 h. Measurements were taken at baseline and at months 2 (end of intervention), 5, 8 and 14. RESULTS There was no differential change over time between the BMS and control groups in self-reported depression or anxiety symptoms. However, suicidal ideation appeared to be reduced in the psychotherapy group. Changes in diurnal cortisol patterns were also significantly different in group × time interactions, in favor of BMS group. CONCLUSIONS Psychotherapy likely provides improvements in psychobiological stress responses and decreases the occurrence of suicidal ideation in patients with AD.

Habitual sleep–wake behaviors and lifestyle as predictors of diurnal cortisol patterns in young breast cancer survivors: A longitudinal study

OBJECTIVE This study aimed to identify predictors of changes in diurnal cortisol patterns during the 8-month follow up period for young breast cancer survivors. Among the potential predictors were tumor size, lymph node metastasis, changes in sleep problems, habitual time of awakening and bedtime, physical activity levels, body mass index (BMI), and depressive levels across 8 months. METHODS The participants were 62 breast cancer women who were aged 40 years and below, and had completed active breast cancer treatment. The longitudinal data were collected at four points: baseline assessment (T0) and three follow-ups after baseline: T1 (in the 2nd month), T2 (in the 5th month), and T3 (in the 8th month). The participants collected their salivary cortisol at home at six time points: upon waking, 30 and 45min after waking, and at 1200h, 1700h, and 2100h. They also completed several questionnaires: the Medical Outcomes Study Sleep scale; the Beck Depression Inventory-II, physical activity levels on a 10-point scale, time of going to bed, time of awakening, and total sleep hours. RESULTS This study found that the main predictors of changes toward flatter diurnal cortisol patterns during the 8-month follow ups were greater tumor sizes, increases of BMI scores, and habitually later times of awakening. CONCLUSIONS While greater tumor sizes represent biological vulnerability of disruption of cortisol circadian rhythm, maintaining an appropriate BMI and good sleep habits could be a protective factor for normal cortisol regulation, which likely helps to reduce early mortality in young breast cancer survivors.

Prenatal Care Visits and Associated Costs for Treatment-Seeking Women With Depressive Disorders

OBJECTIVES This study aimed to determine whether a history of depressive disorders is associated with use and costs of prenatal care among pregnant women in Taiwan. METHODS Participants were mothers with singleton births between 2004 and 2006 (N=23,290), some of whom (N=614) had received care for depression in the year before conception but not during pregnancy. RESULTS The mean number of prenatal care visits was 8.50 and associated costs were

The partner's insecure attachment, depression and psychological well-being as predictors of diurnal cortisol patterns for breast cancer survivors and their spouses.

NT 51,187 for pregnant women with a history of depressive disorders and 9.17 visits and

Factors Associated with Parents’ Perceptions of Parental Smoking in the Presence of Children and Its Consequences on Children

NT 27,998, respectively, for those without such a history. After adjustment for age, monthly income, medical conditions, and obstetric complications, mothers with a history of depression were significantly less likely to receive prenatal care (relative risk=.94, 95% confidence interval=.92-.97, p<.001). However, women with a history of depression had