Hsiu Ju Chang

The mediating and moderating roles of the cognitive triad on adolescent suicidal ideation.

Background: Adolescent suicide has been a major concern in Taiwan and continues to be an important research issue for mental health workers. The cognitive triad, which refers to an adolescents views of the self, the world, and the future, was found previously to be related to both depressive symptoms and suicidal ideation. However, researchers have paid less attention to exploring the roles of mediation and moderation which the cognitive triad plays in the relationship between depressive symptoms and suicidal ideation. Objectives: To test the mediating and moderating effects of the cognitive triad on the relationship between depressive symptoms and suicidal ideation in a sample of school-aged adolescents. Methods: A cross-sectional and correlational design was used in this study. Instruments were administered anonymously to a sample of 1,245 school-aged adolescents recruited from nine middle and high schools of Taipei City. Instruments used included the Childrens Depression Inventory, the Cognitive Triad Inventory for Children, and the Positive and Negative Suicide Ideation. Results: Regression analysis revealed that the cognitive triad significantly mediated and moderated the relationship between depressive symptoms and suicidal ideation. Conclusions: These findings have implications for theoretical development and health policies related to suicide prevention programs in schools.

Pivotal moments and changes in the Bonny Method of Guided Imagery and Music for patients with depression

AIMS To explore pivotal moments and changes during the Bonny Method of Guided Imagery and Music from the perspective of patients with depression. BACKGROUND Depression has been described as an extremely difficult experience for people and is characterised by emotional distress and suffering. As depression progresses, symptoms increase and gradually influence all aspects of the lives of those affected. Few studies have been undertaken into the essence of inner and pivotal experiences during Guided Imagery and Music in patients with depression. DESIGN A qualitative research design and discovery-oriented approach were used as the method of both data gathering and textual analysis. METHODS This study conducted semi-structured interviews with five patients with depression after each of eight sessions of the Bonny Method of Guided Imagery and Music. Each session took place in a music therapy laboratory. Forty transcripts were organised into categories and analysed according to the discovery-oriented approach of Mahrer and Boulet, considering the dimensions of the Bonny Method of Guided Imagery and Music. Results. Nine patients with depression were recruited from a medical centre in southern Taiwan from 2004-2005. Five successfully completed eight Bonny Method of Guided Imagery and Music sessions. There were 141 statements coded into 10 subthemes and three themes describing pivotal moments: pushing aside the barrier, gaining new insight, moving forward. Each category was supported by three-four themes. The analysis also yielded three meaningful moments: releasing mind-body rigidity, awareness and inspiration, acceptance and inner transformation. Patients described personal emotional, cognitive and behavioural transformation during the Bonny Method of Guided Imagery and Music experiences. CONCLUSIONS The discovery-oriented approach fulfilled the aim of gaining a valuable understanding of the psychological growth experiences of patients with depression during the Bonny Method of Guided Imagery and Music. RELEVANCE TO CLINICAL PRACTICE Patients with depression particularly need comfort and caring. It is important that nurses offer interventions as adjuvants to medication. This study supports the feasibility of incorporating the Bonny Method of Guided Imagery and Music into the nursing management of patients with depression. Future studies are suggested to examine the interactive process of music stimulus and the multidimensional nature of imagery.

Effect of an interactive computerized psycho-education system on patients suffering from depression

AIMS The aim of this study was to examine the effect of an Interactive Computerized Psycho-Education System on patients suffering from depression and to compare the use of an Interactive Computerized Psycho-Education System vs. traditional pamphlet education approach. BACKGROUND Depression management depends on pharmacological treatment and psychotherapy and on appropriate and timely patient education. Whilst multimedia learning concepts have been applied in areas such as education, this approach has not been widely used in psychiatric outpatient departments. DESIGN AND METHOD A preliminary pre and post quasi-experimental design with patients with depression was employed at an hospital. Participants in the experimental group (n = 19) received an Interactive Computerized Psycho-Education System intervention programme (Interactive Computerized Psycho-Education System and the educational manual). Participants in the control group (n = 13) were exposed only to the traditional pamphlet education approach (consultation from psychiatrists and information sheets). Primary outcome was depression knowledge scores. Secondary outcomes were scores on the Compliance Behaviour Assessment Scale. RESULTS In the experimental group (n = 19), the time spent working on the Interactive Computerized Psycho-Education System was about 30-180 minutes per session, with an average of 67 minutes. Participants in the experimental group had a considerably decreased incidence of medication non-compliance compared with participants in the control group. Knowledge scores of the experimental group ranged from 30-100, with an average score of 74.7. CONCLUSION The Interactive Computerized Psycho-Education System is acceptable and may be as more effective than a traditional education approach to achieve adherence to medications for depression. RELEVANCE TO CLINICAL PRACTICE Compared with a traditional approach, the combination of the Interactive Computerized Psycho-Education System and a nursing-consulting clinic may assist patients with depression to achieve and maintain better medication compliance in addition to improving their knowledge of depression.

Delay in seeking medical evaluations and predictors of self-efficacy among women with newly diagnosed breast cancer: A longitudinal study

BACKGROUND Delaying a diagnosis of breast cancer directly and positively impacts survival. Self-efficacy has been shown to be a causal mechanism in a wide range of health behaviors, a measurable trait that predicts behavior across domains, which is strong associated with psychological variables. However, factors predicting self-efficacy of women with suspected breast cancer who delayed or did not delay seeking a breast cancer diagnosis over time have not been identified. OBJECTIVES To examine the differences between women who delay and women who did not delay seeking a cancer diagnosis, and key factors predicting self-efficacy over time among women with newly-diagnosed breast cancer. DESIGN Descriptive, longitudinal design over 2 months following breast cancer diagnostic evaluation. SETTING A medical center is located in southern Taiwan. PARTICIPANTS Eighty women with suspected breast cancer were approached and 67 subjects with a positive diagnosis of breast cancer were recruited. METHODS Subjects were categorized into women who delayed their diagnosis and women who did not delay their diagnosis. A battery of 5 standardized questionnaires including self-efficacy, anxiety and depression, personality, spiritual support and hope was completed at the first three clinic visits. RESULTS Stage of cancer, trait extroversion/neuroticism and spiritual support were significantly different between groups (p<0.05). Subjects who did not delay (β=-1.613, p<0.05), and time that histology results were provided (β=-2.4333, p<0.001) had a significantly predicted negative change in self-efficacy compared to the group that delayed. Hope at the first clinic visit contributed to the change in self-efficacy over time (β=0.391, p<0.001). CONCLUSIONS Personal factors affecting a womans delay in obtaining medical assessment of breast cancer confirmation. Hope impacts self-efficacy of women with suspected breast cancer and interventions to enhance hope during the early stages of breast cancer evaluation require further study.

Influential Factors for and Outcomes of Hospitalized Patients with Suicide-Related Behaviors: A National Record Study in Taiwan from 1997–2010

Background Investigating the factors related to suicide is crucial for suicide prevention. Psychiatric disorders, gender, socioeconomic status, and catastrophic illnesses are associated with increased risk of suicide. Most studies have typically focused on the separate influences of physiological or psychological factors on suicide-related behaviors, and have rarely used national data records to examine and compare the effects of major physical illnesses, psychiatric disorders, and socioeconomic status on the risk of suicide-related behaviors. Objectives To identify the characteristics of people who exhibited suicide-related behaviors and the multiple factors associated with repeated suicide-related behaviors and deaths by suicide by examining national data records. Design This is a cohort study of Taiwan’s national data records of hospitalized patients with suicide-related behaviors from January 1, 1997, to December 31, 2010. Participants The study population included all people in Taiwan who were hospitalized with a code indicating suicide or self-inflicted injury (E950–E959) according to the International Classification of Disease, Ninth Revision, Clinical Modification. Results Self-poisoning was the most common method of self-inflicted injury among hospitalized patients with suicide-related behaviors who used a single method. Those who were female, had been hospitalized for suicide-related behaviors at a younger age, had a low income, had a psychiatric disorder (i.e., personality disorder, major depressive disorder, bipolar disorder, schizophrenia, alcohol-related disorder, or adjustment disorder), had a catastrophic illness, or had been hospitalized for suicide-related behaviors that involved two methods of self-inflicted injury had a higher risk of hospitalization for repeated suicide-related behaviors. Those who were male, had been hospitalized for suicide-related behaviors at an older age, had low income, had schizophrenia, showed repeated suicide-related behaviors, had a catastrophic illness, or had adopted a single lethal method had an increased risk of death by suicide. Conclusions High-risk factors should be considered when devising suicide-prevention strategies.

Psychometric properties of the Chinese version of the Life Attitude Schedule (LAS-C) in a sample of Taiwanese adolescents

BACKGROUND Although prior research has proposed that several risk factors are conceptually and positively related to suicidal behavior, researchers have also suggested that suicide may be multifaceted. The Life Attitude Schedule (LAS) measures a broad range of suicide-related behaviors, including life-enhancing and life-threatening behaviors. OBJECTIVE This study aimed to translate the LAS into Chinese and evaluate the psychometric properties of the new version (LAS-C). DESIGN A cross-sectional and descriptive design was used. SETTING Data were collected from high schools in the city of Taipei in northern Taiwan. PARTICIPANTS A convenience sample of 1492 high school students was recruited from five high schools in Taipei. METHODS We used the Multi-Health Systems (MHS) translation policy to guide the translation process. Reliability was evaluated by internal consistency (represented by Cronbachs α coefficients) and test-retest (represented by intraclass correlation). Validity was demonstrated by content, convergent, divergent, concurrent, and contrast group comparison. Confirmatory factor analysis was further used to examine the theoretical model and to support construct validity. RESULTS The Cronbachs α coefficient for the whole scale of the LAS-C and its subscales ranged from 0.70 to 0.91. The Intraclass Correlation Coefficient (ICC) ranged from 0.76 to 0.89 on the whole scale and its subscales, and were all statistically significant, at least at the p<0.05 level, indicating good stability over a three-week period. Validity was supported by a Content Validity Index (CVI) of 0.99, convergent, divergent, current, and contrast group comparison validity. Confirmatory factor analysis supported the theoretical model, further providing solid evidence of construct validity. CONCLUSIONS The LAS-C has proper psychometric properties. Future studies must be conducted to shorten the items to form a briefer version.

Validation and Cross-Cultural Adaptation of a Chinese Version of the Emotional and Social Dysfunction Questionnaire in Stroke Patients

The objectives of this study were to develop a cross-cultural Chinese version of the Emotional and Social Dysfunction Questionnaire (ESDQ-C) and test its validity and reliability among Chinese-speaking stroke patients. Various methods were used to develop the ESDQ-C. A cross-sectional study was used to examine the validity and reliability of the developed questionnaire, which consists of 28 items belonging to six factors, anger, helplessness, emotional dyscontrol, indifference, inertia and fatigue, and euphoria. Satisfactory convergence and known-group validities were confirmed by significant correlations of the ESDQ-C with the Profile of Mood States–Short Form (p < .05) and with the Hospital Anxiety and Depression Scale (p < .05). The internal consistency was represented by Cronbach’s alpha, which was .96 and .79 to .92 for the entire scale and subscales, respectively. Appropriate application of the ESDQ-C will be helpful to identify critical adjustment-related types of distress and patients who experience difficulty coping with such distress.

Development and Validation of the Self-Awareness of Falls in Elderly Scale Among Elderly Inpatients

The objectives of this study were to develop the Self-Awareness of Falls in Elderly (SAFE) scale and test its reliability and validity among elderly inpatients. A cross-sectional study design and convenience sampling were used to test the validity and reliability of the SAFE scale. Explanatory factor analysis and confirmatory factor analysis yielded an acceptable goodness of model fit, confirming the 21 items in the SAFE scale that were distributed among four factors: awareness of activity safety and environment, awareness of physical functions, awareness of medication, and awareness of cognitive behavior. The values of interrater reliability and Cronbach’s alpha were at least .70, indicating that reliability of the SAFE scale was acceptable. The SAFE scale is the first instrument to measure self-awareness of fall risk among high-risk groups. Further management and fall prevention can then be designed to reduce the incidence of falls among elderly people in clinical care.