Kelvin M. T. Fung

Self-stigma of people with schizophrenia as predictor of their adherence to psychosocial treatment

OBJECTIVES Treatment non-adherence has frequently been noticed among people with schizophrenia. Self-stigma towards ones mental illness is believed to be a contributing factor undermining adherence. This study aimed at obtaining empirical support regarding the relationship between psychosocial treatment adherence and self-stigma. Other significant predictors of adherence to psychosocial interventions were to be identified. METHODS Eighty-six people with DSM IV diagnoses of schizophrenia were recruited from psychiatric hospitals and community settings in Hong Kong. Their level of stigma, self-esteem, self-efficacy, insight, psychosocial treatment adherence and demographic data were collected. Multiple regression was used to investigate the adjusted relationship between psychosocial treatment adherence and the selected independent variables. RESULTS Higher level of self-stigma, poorer current insight on the social consequences of having mental illness, and living with others were found to be significant predictors of poor psychosocial treatment attendance. Better self-esteem and current insight about the negative social consequences were significant predictors of better psychosocial treatment participation. Self-stigma and self-esteem exhibited the strongest contributions to psychosocial treatment adherence. CONCLUSIONS Self-stigmatization is associated with the level of treatment adherence among people with schizophrenia, and its negative effect was found to intensify along the self-stigmatization process. Further studies to enhance understanding of self-stigma and improve treatment adherence are suggested.

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.

Self-stigma, stages of change and psychosocial treatment adherence among Chinese people with schizophrenia: a path analysis.

ObjectivesMental illness stigma is one of the key causes for poor psychosocial treatment adherence. The objective of this study was to explore the link between self-stigmatization and adherence via path analysis with insight and readiness for change conceptualized as the possible mediators. The direct effects of psychopathology causing non-adherence were also tested.MethodOne hundred and five participants with schizophrenia were recruited from five psychiatric settings in Hong Kong. Data concerning their level of stigma, insight, stages of change, psychopathology, and psychosocial treatment adherence were collected. Path analysis was used to test two hypothetical models.ResultsThe findings supported the direct effects of self-stigma on reducing psychosocial treatment adherence, and its indirect influences mediated by insight and stages of change on treatment adherence. Psychopathology was also found to have a direct effect on undermining adherence. This model showed better model fit than the one which did not consider the direct effects of self-stigmatization and psychopathology.ConclusionTo conclude, this study deepened our understanding on the mechanism explaining how self-stigmatization undermines psychosocial treatment adherence. The findings provide direct implications on ways of formulating a self-stigma reduction program to combat self-stigma and its negative consequences.

Three year follow-up study of an integrated supported employment for individuals with severe mental illness

Objectives: The aim of the present study was to examine and compare the long-term effectiveness of the Integrated Supported Employment (ISE) programme, which consists of individual placement and support (IPS) and work-related social skills training, with the IPS programme on the vocational and non-vocational outcomes among individuals with severe mental illness (SMI) over a period of 3 years. Method: One hundred and eighty-nine participants with SMI were recruited from two non-government organizations and three day hospitals in Hong Kong and randomly assigned into the ISE (n = 58), IPS (n = 65) and traditional vocational rehabilitation (TVR) (n = 66) groups. Vocational and non-vocational outcomes of the ISE and IPS participants were collected by a blind and independent assessor at 7 11, 15, 21, 27, 33 and 39 months after their admission, whereas the TVR groups were assessed only up to the 15th month follow up. Results: After 39 months of service provision, ISE participants obtained higher employment rate (82.8% vs 61.5%) and longer job tenure (46.94 weeks vs 36.17 weeks) than the IPS participants. Only 6.1% of TVR participants were able to obtain employment before the 15th month follow up. Fewer interpersonal conflicts at the workplace were reported for the ISE participants. Advantages of the ISE participants over IPS participants on non-vocational outcomes were not conclusive. Conclusion: The long-term effectiveness of the ISE programme in enhancing employment rates and job tenures among individuals with SMI was demonstrated by this randomized controlled trial.

A Review on Neurobiological and Psychological Mechanisms Underlying the Anti-depressive Effect of Qigong Exercise

Elders with chronic medical conditions are vulnerable to depression. Mainstream interventions for treating their depression is however far from satisfactory which stimulates the interests of researchers to look for alternative therapies to alleviate geriatric depression. Qigong, a Chinese mindful exercise, is demonstrated to have anti-depressive effects. Results of our earlier studies shed light on the psychological mechanism underlying this effect. The neurobiological mechanism remains unclear. This article attempts to review extant evidence and suggests possible neurobiological pathways of the anti-depressive effect of qigong based on the neurotransmitter, neuroendocrine, and neurotropic perspectives. Further research to consolidate its scientific base is suggested.

Psychosocial and socio-demographic correlates of medication compliance among people with schizophrenia

This study examined the medication compliance of people with schizophrenia in relation to their self-stigma, insight, attitude towards medication, and socio-demographic status via a cross-sectional observational design. Eighty-six Chinese adults with schizophrenia were recruited from the psychiatric hospitals and community settings for this study. The findings suggested that stereotype agreement of self-stigmatization and attitude towards medication were moderately correlated with medication compliance. Poor insight and living alone were found to be significant predictors of medication compliance based on regression analysis. Insight was identified to be the strongest predictor on compliance which accounted for 68.35% of the total variance. Although self-stigma is only moderately linked with medication compliance, its effects on medication-induced stigma cannot be ignored.

Psycho-physical and neurophysiological effects of qigong on depressed elders with chronic illness

This randomized controlled trial examined the psychological, physical, and neurophysiological effects of a qigong exercise program on depressed elders with chronic medical illness. The experimental group (n = 21, 80 ± 7 years) was given a 12-week qigong exercise program, while the comparison group (n = 17, 81 ± 8 years) participated in a newspaper reading program with the same duration and frequency. Measurement of depression symptoms, psychosocial functioning, muscle strengths, salivary cortisol, and serum serotonin was conducted. At 12 weeks, the qigong group had significant reduction in depressive symptoms (F = 11.68; p < 0.025). Improvement in self-efficacy (F = 4.30; p < 0.050), self-concept of physical well-being (F = 6.82; p < 0.025), and right-hand grip strength (F = 5.25; p = 0.034) was also found when compared with the comparison group. A change in salivary cortisol level was found marginally insignificant between groups (F = 3.16; p = 0.087). However, a decreasing trend of cortisol level was observed. The results provided preliminary evidence for the hypotheses that the antidepressive effect of qigong exercise could be explained by improvement in psychosocial functioning and possibly down-regulation of hyperactivity of the hypothalamic–pituitary–adrenal axis.

Development and initial validation of Perceived Rehabilitation Needs Questionnaire for people with schizophrenia

PurposeThe Perceived Rehabilitation Needs Questionnaires for people with schizophrenia (PRNQ-S), a culturally relevant and multi-faceted assessment tool for measuring perceived needs of people with schizophrenia, was developed and initially validated.MethodsA total of 43 participants including people with schizophrenia, their caregivers, and mental health professionals were recruited for six rounds of focus group discussion to identify issues pertaining to rehabilitation needs of schizophrenia. Results were then used to develop PRNQ-S. An initial validation study among a convenience sample consisting of 219 people with schizophrenia was conducted to examine its psychometric properties.ResultsExploratory Factor Analysis yielded a seventeen-factor solution accounting for 70.7% of the total variance which resulted in a 75-item PRNQ-S. The instrument had excellent internal consistencies and intra-rater reliability.ConclusionsThe PRNQ-S has been developed and psychometrically tested in Hong Kong. It can be used to assess perceived rehabilitation needs for individuals with schizophrenia in Hong Kong. Upon further validations, it may be applied in other Chinese societies such as Singapore and the mainland. Similar research methodology can also be used for assessing needs in other types of psychiatric disability groups.

A Pilot Evaluation on a Stress Management Programme Using a Combined Approach of Cognitive Behavioural Therapy (CBT) and Complementary and Alternative Medicine (CAM) for Elementary School Teachers

The aim of this study is to explore the efficacy of implementing a stress management programme based on a combined approach using cognitive behavioural therapy and complementary and alternative medicine for elementary school teachers who experienced mild level of stress, anxiety and/or depressive symptoms in Hong Kong. A 12-h programme involving cognitive behavioural therapy, self-management, relaxation techniques (diaphragmatic breathing and progressive muscle relaxation), mindful exercises (qigong and yoga), aromatherapy and acupressure was conducted. A quasi-experimental design was used to compare the intervention groups (n = 47) with the wait-list control groups (n = 46). The primary outcome measures were depression, anxiety and stress. Results indicated that the intervention group had significant reduction in depression [(F = 3.93; degrees of freedom (df) = 2.90; p = 0.023)], anxiety (F = 3.37; df = 2.90; p = 0.039) and stress (F = 3.63; df = 2.89; p = 0.031) when compared with the control group. Participants in both groups demonstrated lowered level of salivary cortisol at the post-assessment. The pilot results provided preliminary support to the multi-component stress management programme in relieving affective symptoms of teachers. The programme may be considered as an initial strategy to empower teachers with the abilities to cope with their affective symptoms. Further evaluation using a better designed randomized study with a larger sample size is warranted. (word: 198; max.: 200).

The Perceived Rehabilitation Needs of People with Schizophrenia in Hong Kong: Perspectives from Consumers and Care-givers

A quantitative survey was conducted to investigate the perceived rehabilitation needs based on people with schizophrenia and their caregivers. A total of 194 persons with schizophrenia and 83 caregivers were recruited by convenience sampling to complete the two newly developed questionnaires for this purpose which included the Perceived Rehabilitation Needs Questionnaire for People with Schizophrenia and the Perceived Rehabilitation Needs Questionnaire for Caregivers towards People with Schizophrenia respectively. The findings deepened the understanding of this area. Some policy and service development suggestions for mental health strategies in Hong Kong and the Asian-Pacific region were made.