Marcus Yu-Lung Chiu

Operationalization of the SAMHSA model of recovery: a quality of life perspective

PurposeTo test empirically the Substance Abuse and Mental Health Services Administration (SAMHSA) recovery model.MethodsTwo hundred and four attendants aged 18–60, with schizophrenia spectrum disorder, from two participating outpatient clinics were interviewed with a number of inventories, including health-related quality of life measure (WHOQOL-BREF (HK)). Canonical correlation analysis was performed on two sets of variables (SAMHSA recovery components and QoL domain scores).ResultsThere were significant correlations between most recovery components proposed in the SAMHSA recovery statement and the health-related quality of life measure. Age, duration of untreated psychosis, the degree of social support, the interaction of singlehood and the number of confidants, engagement in competitive careers, and the duration of participation in community support services were all found to be important predictors.ConclusionsThe SAMHSA consensus statement appeared to contain valid concepts for Chinese subjects. It presented new challenges for psychiatric rehabilitation and reminded the policy makers that there is much more psychiatric rehabilitation can achieve beyond symptom control and patient management. It also demonstrated that resolve and the commitment of resources to combat stigma, develop resilience, and foster patient empowerment were very much needed in Hong Kong and perhaps in Asia and elsewhere.

Recovery Components as Determinants of the Health-Related Quality of Life Among Patients with Schizophrenia: Structural Equation Modelling Analysis

Objective: The Substance Abuse and Mental Health Services Administration (SAMHSA) National Consensus Statement on Mental Health Recovery proposed 10 recovery components as guiding principles for fostering recovery among people with severe mental illness. Although researchers have recognized a close association between patient-oriented recovery and health-related quality of life (HRQOL), the relation between the recovery components and patients’ self-reported HRQOL is still unknown. The purpose of the present study was therefore to use structural equation modelling to predict HRQOL of schizophrenia outpatients from the recovery components proposed by SAMHSA. Methods: The recovery status of 201 outpatients with schizophrenia, schizophreniform, or schizoaffective disorder was measured using 12 variables that indicate the outcome of 10 recovery components. Canonical correlation analysis was applied to screen variables that are highly correlated with HRQOL. Valid variables were then used to build a structural model that predicted individuals’ HRQOL as indicated by the World Health Organization Quality of Life Measure Abbreviated (WHOQOL-BREF (HK)). Results: The bestfit model was able to explain 80.7% of the variance in WHOQOL-BREF outcome. The model demonstrated significant direct and indirect effects of five recovery components on HRQOL. The effect of psychosocial symptoms on HRQOL was highest (total β = −0.64), followed by sense of personal agency (total β = 0.58), sense of optimism (total β = 0.54), perceived support (total β = 0.47), and internal stigma (total β = −0.42). Conclusion: The recovery components proposed by the SAMHSA consensus statement provided a useful framework to explain HRQOL of outpatients with schizophrenia. The present model indicated a moderate to large effect of five major recovery components on HRQOL. It showed that patients’ perceptions of support, optimism, and personal agency were influenced by psychosocial symptoms and internal stigma. This empirical study supported the use of recovery principles, such as resilience building or mastery-based intervention to improve the QOL of community dwellers with schizophrenia.

Predictors of Dating Violence Among Chinese Adolescents: The Role of Gender-Role Beliefs and Justification of Violence

In Chinese societies, violence among adolescent dating partners remains a largely ignored and invisible phenomenon. The goal of this study is to examine the relationships among gender-role beliefs, attitudes justifying dating violence, and the experiences of dating-violence perpetration and victimization among Chinese adolescents. This study has used self-reporting measures to collect data from a probability sample of 976 adolescents (mean age = 15.9) in three Chinese societies: Taiwan, Hong Kong, and Shanghai. Research results reveal a high prevalence of dating violence (including physical violence, sexual violence, and controlling behavior) among Chinese adolescents with dating experience: the perpetration rate is 27.3% and the victimization rate is 39%. Study results demonstrate that adolescents who endorse traditional gender-role beliefs tend to view dating violence as acceptable behavior. Boys’ endorsement of traditional gender roles, boys’ attitudes justifying boy-on-girl violence, and boys’ attitudes against girl-on-boy violence predict boys’ actual sexual-violence behavior. Moreover, boys’ attitudes justifying boy-on-girl dating violence is the strongest predictor of boys’ perpetration of physical and sexual dating violence. This study also shows that boys’ hostility is a significant predictor of boys’ controlling behavior. Programs for preventing dating violence should include components designed to challenge traditional gender-role beliefs and attitudes justifying dating violence.

Caregiving of children with intellectual disabilities in China – an examination of affiliate stigma and the cultural thesis

BACKGROUND While caregivers of children with intellectual disabilities are burdened in every part of the world, it is suspected that particular contexts may make the situation worse. There is little literature on caregivers in China, where familial and clan responsibility rather than individual effort is emphasised, and where communal support, while treasured, is often lacking. METHOD A total of 211 caregivers in two cities, one with and the other without randomised design, participated in a survey study that assessed affiliated stigma, loss of face, anxiety, mental health and empowerment. RESULTS A proportion of 60.6% of participants were found to be conspicuous cases with mental disturbance of a level which required further professional attention. Participants with better resource appeared to have coped better, enjoying lower psychological distress, lower anxiety and a higher level of personal empowerment. Multiple regression analysis revealed that mental health is related to the affective dimension of affiliated stigma, loss of face and anxiety level. This was found to account for more than half the variance (55%). DISCUSSION The subjective burden of care occurs not in isolation but in a cultural field. Chinese caregiving is characterised by a lack of formal support, and such cultural concerns as loss of face and strong affiliated stigma. This socio-political context makes caregiving all the more challenging. The situation has to be addressed by both practitioners and policy makers if family caregiving is to be valued and made sustainable.

Empowering caregivers: Impact analysis of FamilyLink Education Programme(FLEP) in Hong Kong, Taipei and Bangkok

Background: Education and support for caregivers is lacking in Asia and the peer-led FamilyLink Education Programme (FLEP) is one of the few provisions to address this service gap. This study aims to evaluate quantitatively its efficacy in reducing subjective burdens and empowering the participants. Method: One hundred and nine caregiver participants in three Asian cities were successfully surveyed at pre-intervention, post-intervention and six-month intervals with a number of standard inventories. Mixed analysis of variance (ANOVA) procedures showed significant programme impact over time intervals for all sites, and subsequently an empowerment measurement model was tested. Results: FLEP was found effective in reducing worry and displeasure, significantly improving intra-psychic strain, depression and all empowerment measures. The measurement model had an acceptable good fit. Baseline difference showed no interference with the programme efficacy. Conclusions: Apart from the initial support for FLEP, the current study also provides some hindsight on the empowerment practice in mental health for Asia, whose sociocultural political contexts are vastly different from that of the developed countries. It remains to be seen whether qualitative data or more stringent research design will yield consistent results and whether FLEP can also work in rural areas.

Community Attitudes Towards Discriminatory Practice Against People with Severe Mental Illness in Hong Kong

Background: The existing literature on community attitudes towards people with severe mental illness (SMI) tends to be rather general and impressionistic, with apparently conflicting findings which have yet to be adequately understood. Aims: This article undertakes to examine the communitys level of tolerance towards discriminatory practice against people with SMI in three domains: family relations, employment and health care. Methods: Structured interviews with a representative sample of 507 citizens were carried out using the computer-assisted telephone interview system (CATI). Results: Our survey reveals some expected common misunderstandings about mental illness, with the older age group showing the greatest toleration towards discrimination. However, respondents showed a strong objection to discriminatory behaviour which people with SMI commonly face in health care and employment, whereas greater toleration towards discrimination was found in the family domain. Conclusions: The coexistence of misunderstandings about mental illness and public rejection of discriminatory practice against people with SMI suggests that community attitudes are multi-dimensional and more amendable than expected. The findings of this study call for target-specific educational strategies for community education, as well as accompanying policy initiatives to end discriminatory practice, if people with SMI are to be truly taken as our fellow citizens.

Personal Tragedy or System Failure: A Qualitative Analysis of Narratives of Caregivers of People with Severe Mental Illness in Hong Kong and Taiwan

Background: Most studies agree that mental illness brings a heavy objective and subjective burden of care on the family and especially the caregivers. However, very little attention has been paid to the wider context in which this burden is shaped and sustained. Material: In-depth interviews were conducted with 11 caregivers in Hong Kong and Taiwan and subsequent analysis identified four major themes: mystical knowledge beyond understanding, persistent self-blame and lay explanation, inertia of caregivers and non-responsive service system, and unsatisfying encounters with medical staff. Discussion: The results of the study indicate that these families did not get the services they needed. In spite of recounting many system failures, most respondents attributed their situation to tragedy and misfortune at personal and family levels. Such a discourse is closely connected to a wider context of health and social care. The Hong Kong subjects complained more, felt more helpless, and had more persistent self-blame and lay explanation than the Taiwanese subjects. Conclusions: To reduce such experiences, this paper calls for inclusive policies for the family, new education strategies and reflections on the roles of mental health professionals in empowerment and advocacy beyond conventional treatment, counseling and education.

The mediating effect of affective stigma between face concern and general mental health - The case of Chinese caregivers of children with intellectual disability.

An earlier study revealed that the mental health of caregivers of children with intellectual disability is related to the affective dimension of affiliated stigma, loss of face and anxiety level. However, how cultural values such as face concern interplay with stigma remains largely unknown. This extended study goes further to test the mediating role of affective stigma on two slightly different pathway models between the face concern and the mental health outcome of 211 caregivers in two Chinese cities, against the required standards and procedure of being a mediator. The mediating effect of affective stigma is confirmed by meeting Baron and Kennys required standards. Two viable path models are worked out: one model with anxiety as a co-mediating variable successfully accounts for 17% more of the variance on the outcome than another model without anxiety, explaining a total of 56% of the variance. This provides empirical evidence for the first time that cultural values such as face value do not influence directly ones mental health; but works through the experience of real stigma or anticipated stigma situations, to induce anxiety and worsen mental health. Practitioners may need to employ anti-stigma and anxiety reduction strategy in promoting better mental health and to explore cultural elements that can be tapped on for better coping.

The Politics of Citizenship Formation: Political Participation of Mental Health Service Users in Hong Kong

In Hong Kong as elsewhere, there have been calls for an active and inclusive notion of citizenship to empower people affected by mental illness service users (hereinafter users) in addition to conventional altruistic or non-discrimination principles in policy initiatives. In this paper we take a somewhat different perspective to consider how the users may contribute individually and collectively to empower themselves, and how political participation might help to re-assert the status and practice of citizenship. It shows that participation matters in the formation of citizenship for the users. We further assume that political participation is attributable to individual resources, motivations for getting involved and the presence of advocacy agencies to facilitate participation. We then proceed to analyse the level of political participation by the users and the general public based on data from two comparable surveys. We argue that voter empowerment is the most essential factor in bringing about a stronger sense of citizenship among the users. The findings will be discussed in the light of the practice of citizenship and the implications for public policy development.

Modeling self-agency among people with schizophrenia: empirical evidence for consumer-based recovery.

Background: Self-agency - the awareness of ones own capacity to make decisions and to engage in deliberate action - is often interfered with or lost during the course of severe mental illness. Most existing literature on self-agency is either of experimental or qualitative nature, and empirical evidence is scanty. Sampling and Methods: This paper draws on a subset of empirical data from a larger recovery study that involved 204 people with schizophrenia in the community. Structural equation models are built to contrast the models with and without the contribution of self-agency. Results: The self-agency factor loads significantly on variables from five major areas of recovery (hope, empowerment, resilience, self-responsibility and self-mastery). Structural equation models show that the incorporation of this self-agency construct has vastly improved the modeling of the adverse effect of stigma on the quality of life of these subjects. The model with self-agency fitted the criteria better, and explained more total variance (increased from 56 to 80%) for the quality of life of these subjects. Conclusions: Cross-sectional empirical findings appear to support the claim that self-agency is an important construct that cuts through many dimensions of recovery. Initial discussions are made on the nature and function of self-agency, and its relations with recovery concepts and components.