Peter W. H. Lee

Validating the Beck Depression Inventory-II for Hong Kong Community Adolescents

The primary purpose of this study was to test for the validity of a Chinese version of the Beck Depression Inventory-II (C-BDI-II) for use with Hong Kong community (i.e., nonclinical) adolescents. Based on a randomized triadic split of the data (N = 1460), we conducted exploratory factor analysis on Group1 (n = 486) and confirmatory factor analysis (CFA) within the framework of structural equation modeling on Groups 2 (n = 487) and 3 (n = 487); the second CFA served as a cross-validation of the determined factor structure. Factor analytic results, based on a 4-factor structure that comprised 1 2nd-order general factor of Depression and 3 1st-order factors representing Negative Attitude, Performance Difficulty, and Somatic Elements, replicated those reported previously for Canadian (Byrne & Baron, 1993), Swedish (Byrne, Baron, Larsson, & Melin, 1995), and Bulgarian (Byrne, Baron, & Balev, 1998) nonclinical adolescents. Based on this cross-validated factor structure, findings related to internal consistency reliability, stability over a 6-month time lag, and relations with relevant external criteria provided strong support for the valid use of the C-BDI-II in measuring depressive symptoms for Hong Kong community adolescents.

The use of music to reduce anxiety for patients undergoing colposcopy: A randomized trial

OBJECTIVE The goal of this work was to investigate the impact of music on womens anxiety and perceived pain during colposcopy examination. METHODS This was a prospective randomized study. Two hundred and twenty women referred for colposcopy for the first time were recruited. They were randomized to either the music or no-music group. Before colposcopy examination, each subject completed a Chinese version of the state anxiety questionnaire (STAI) and assessed the anticipated pain for colposcopy with a visual analog scale (VAS). Slow-rhythm music was played during colposcopy examination in the music group. Subjects in the no-music group were examined in the same setting without music. After colposcopy, each subject completed the STAI form again and assessed their pain during examination by the VAS. RESULTS Women in the music group experienced significantly less pain (mean VAS 3.32 [95% CI 2.86-3.78] vs 5.03 [4.54-5.52], P<0.001) and lower anxiety (mean STAI 39.36 [95% CI 37.33-41.39] vs 44.16 [41.82-46.49], P = 0.002) during colposcopy examination than women in the no-music group. On linear regression analysis, the factors significantly affecting anxiety during colposcopy were anxiety score at enrollment, pain score during colposcopy, and whether or not the women had listened to music during the colposcopy examination. The factors significantly affecting the pain scores were whether the women had listened to music during the procedure and the final anxiety scores. CONCLUSIONS Music is a simple, inexpensive, and easily used strategy to minimize anxiety and pain during colposcopy examination.

Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: a qualitative–quantitative study

Objectives: To explore perceptions towards cervical cancer, human papillomavirus (HPV) infection and HPV vaccination and to identify factors affecting the acceptability of HPV vaccination among Chinese adolescent girls in Hong Kong. Methods: Six focus groups were conducted with Chinese adolescent girls (median age 16 years, age range 13–20, n  =  64) in Hong Kong in April 2007. Thematic analysis was employed to identify major themes related to cervical cancer and HPV vaccination. A supplementary questionnaire was administered to all participants before and after group discussion to assess their knowledge, attitudes and intention to be vaccinated and to collect demographic information. Results: Participants’ knowledge on cervical cancer was limited and HPV was largely unheard of. They had difficulty understanding the mechanism linking cervical cancer with HPV infection. Participants held a favourable attitude towards HPV vaccination but the perceived timing of vaccination varied. Barriers to vaccination include high monetary cost, uncertain length of vaccine effectiveness, low perceived risk of HPV infection, no immediate perceived need of vaccination, anticipated family disapproval and fear of the pain of injection. Factors conducive to vaccination include perceived family and peer support and medical reassurance on safety and efficacy of vaccine. The differences on knowledge, attitudes, intention to be vaccinated now and willingness to conform to significant others before and after the discussion were statistically significant, with an increased tendency towards favouring vaccination after the focus group. Conclusions: Participants favoured HPV vaccination despite not feeling an immediate need to be vaccinated. Interventions could focus on providing professional information on HPV vaccination and raising adolescents’ perceived need to take preventive measures against HPV infection.

A follow-up study of infantile autism in Hong Kong

All 87 autistic children referred to the Department of Psychiatry from 1976 to 1986 were included as subjects. Their demographic, family, medical, and psychiatric characteristics were described. Sixty-six (75.9%) were traced for follow-up assessment. There was a striking similarity between the characteristics of our sample and those reported in other countries (e.g., sex ratio, intelligence, language ability, behavioral characteristics, and outcome). The finding of less family history of language delay, epilepsy, and sex difference are discussed.

Bioavailable testosterone is associated with a reduced risk of amnestic mild cognitive impairment in older men

Objective  We investigated the risk of amnestic mild cognitive impairment (aMCI) in relation to serum bioavailable (BT) and total testosterone (TT) levels in older men.

The Beck Depression Inventory-II: Testing for Measurement Equivalence and Factor Mean Differences Across Hong Kong and American Adolescents

Working within the framework of a confirmatory factor analytic (CFA) model, this study adds another dimension to construct validation of both the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) and a Chinese version of the BDI-II (C-BDI-II; Chinese Behavioral Sciences Society, 2000). Specifically, we tested for measurement equivalence of the C-BDI-II with the original BDI-II across Hong Kong (N = 1771) and American (N = 501) adolescents, respectively. Provided with evidence of measurement equivalence, we then tested for differences in the latent factor means (i.e., subscale levels) of three first-order factors of negative attitude, performance difficulty, and somatic elements and one second-order factor of general depression. All procedures were based on analyses of mean and covariance structures (MACS) that took into account both the incompleteness and non-normality of the data. Findings revealed sound evidence of measurement equivalence of the C-BDI-II and BDI-II factorial structures, and latent factor means that pointed to higher levels of depressive symptoms for Hong Kong adolescents than for their American counterparts.

A randomized controlled trial of psychosocial interventions using the psychophysiological framework for Chinese breast cancer patients.

Abstract This study aimed to investigate the psychophysiological outcomes of different psychosocial interventions for breast cancer patients. Participants were randomly assigned into 3 intervention groups, namely, Body-Mind-Spirit (BMS), Supportive-Expressive (SE), and Social Support Self-Help (SS) groups; a no-intervention group was used as control. Salivary cortisol was used as the physiological stress marker. Distress level, mental adjustment, emotional control, and social support were measured. Data were collected at baseline, 4 month, and 8 month. Preliminary results indicated that BMS intervention produced the greatest and the most sustained effects. It enhanced positive social support, reduced psychological distress, emotional control, and negative mental adjustment. Total salivary cortisol was lowered after 8 months. Most participants in SE groups indicated the treatment helpful, but changes in psychophysiological outcomes were not statistically significant. Participants in SS groups seemed less likely to benefit from the intervention. The no intervention control group indicated a reduction in social support. These outcomes suggest that active professional intervention is more likely to yield therapeutic effects. In particular, psychosocial intervention attending to the spiritual dimension contributes to positive outcomes.

The Effects of Radiofrequency Ablation Versus Medical Therapy on the Quality‐of‐Life and Exercise Capacity in Patients with Accessory Pathway‐Mediated Supraventricular Tachycardia: A Treatment Comparison Study

This study aims to evaluate the impact of transcatheter radiofrequency ablation on quality‐of‐life (QOL) and exercise capacity in patients with paroxysmal Supraventricular tachycardia (SVT) on stable medical therapy and the extent of symptomatic benefits of this treatment in patients with SVT of different clinical severity. A total of 55 patients with SVT on stable medications for 3 months were randomly selected for either radiofrequency ablation treatment (46 patients) or continuation of medical therapy (medical control group, 9 patients). Severity of SVT was classified based on the frequency and duration of SVT episodes, hemodynamic disturbance, and the presence of preexcited atrial fibrillation during an episode. Treadmill exercise capacity (Bruce protocol) and QOL (questionnaire study and interview) were assessed before and at 3‐month intervals for 1 year after the radiofrequency procedure and at 3 months in the medical control group. Thirty‐six of 46 patients were successfully ablated in one session, and a QOL measure before and at 3 months after ablation in these patients showed an improvement in total scores for “General Health Questionnaire” (20.3 ± 6.2 vs 16.9 ± 5.3, P < 0.01), “Somatic Symptoms Inventory” (73. 0 ± 6.0 vs 76.1 ± 4.1, P < 0.02), and “Sickness Impact Profile” (12.6 ±1.7 vs 4.9 ± 3.9, P < 0.01). This improvement in QOL was progressive and sustained over a 1‐year period. Major arrhythmia limitations, such as apprehension of strenuous activities and long distance travel, were alleviated after a successful procedure. The extent of improvement in QOL was significant for patients considered to have “mild” or “severe” arrhythmia. Maximum exercise capacity during treadmill exercise increased from 13.1 ± 5.5 to l4.9 ± 4.5 minutes at 3 months after successful ablation (P < 0.002), which was mainly due to suppression of exercise induced SVT. There was no change in QOL or exercise capacity in the medical control group and in patients with an initially unsuccessful radiofrequency ablation. Thus, transcatheter radiofrequency ablation is superior to medical therapy in improving QOL and exercise capacity of patients with SVT of different clinical severity.

Factor structure of the Center for Epidemiological Studies Depression Scale in Hong Kong adolescents.

We present data from the Center for Epidemiological Studies–Depression Scale (CES–D; Radloff, 1977) for 2 samples of Hong Kong community adolescents (combined N = 1,385). The 4 positive affect items related poorly to the remainder of the scale. Using 16 items, the data were consistent with 2 models with highly correlated factors: (a) a 2-factor model, 1 of which merged somatic and affective items, and (b) a 3-factor model separating somatic, depressed, and interpersonal items. Correlations with related constructs provide preliminary support of validity. Hong Kong adolescents are influenced both by traditional concepts of mind-body holism and Western psychological models separating psychological and somatic symptoms.

Suicidality and cultural values among Hong Kong adolescents.

Scholars have proposed that individualistic values resulting from globalization are associated with increasing behavioral and emotional problems among youth in modernizing cultures. This study examined specific individualistic and traditional values in the context of suicidal ideation and behaviors in Hong Kong among community adolescent youths (N=2427) ages 14-18 years. Participants indicated the extent to which self-direction/independence and obedience/respect for elders were important to them. They also reported on four progressive levels of suicidality: whether in the last year they had experienced suicidal ideation, made plans for a suicide attempt, attempted suicide, and (for attemptors) made a serious attempt requiring medical attention. After controlling for quality of family relationships and depressive symptoms, at least one of the values predicted suicidality at all but the highest level. There were sex-specific associations between values and suicidality. In general, endorsement of self-direction was correlated with reduced risk of suicidality for boys and was irrelevant to girls. In contrast, traditional emphases on obedience and respect for elders were more frequently protective against suicidality for girls and were inconsistent predictors for boys. The relationship between values and suicidality was generally independent of the effect of family relationships and depressive symptoms. Thus, values were associated with adolescent suicidality, but not consistently in the direction predicted by some theorists, and the association depended upon the adolescents sex.