Ray C. Hsiao

Differentiating Adolescent Self-Injury from Adolescent Depression: Possible Implications for Borderline Personality Development

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.

The relationships between body mass index and television viewing, Internet use and cellular phone use: the moderating effects of socio-demographic characteristics and exercise.

OBJECTIVE This study aimed to examine the relationships between body mass index (BMI) and television viewing, Internet use and cellular phone use and the moderators for these relationships in adolescents. METHOD The relationship between BMI and the time spent on three kinds of sedentary activities and the moderators for these relationships were analyzed among 9,278 Taiwanese adolescents. The different relationships between BMI and various Internet and cellular phone-related activities were analyzed. RESULTS High television viewing and high Internet use were associated with increased BMI in adolescents. Exercising had a moderating effect on the relationship between BMI and television viewing. Several Internet and cellular phone-related activities were associated with increased BMI. DISCUSSION The results support the relationships between adolescent BMI and television viewing and Internet use. The moderating effect of exercise and various Internet and cellular phone-related activities should be considered when developing intervention strategies for overweight adolescents.

Emotion dysregulation and dyadic conflict in depressed and typical adolescents: Evaluating concordance across psychophysiological and observational measures

Many depressed adolescents experience difficulty in regulating their emotions. These emotion regulation difficulties appear to emerge in part from socialization processes within families and then generalize to other contexts. However, emotion dysregulation is typically assessed within the individual, rather than in the social relationships that shape and maintain dysregulation. In this study, we evaluated concordance of physiological and observational measures of emotion dysregulation during interpersonal conflict, using a multilevel actor-partner interdependence model (APIM). Participants were 75 mother-daughter dyads, including 50 depressed adolescents with or without a history of self-injury, and 25 typically developing controls. Behavior dysregulation was operationalized as observed aversiveness during a conflict discussion, and physiological dysregulation was indexed by respiratory sinus arrhythmia (RSA). Results revealed different patterns of concordance for control versus depressed participants. Controls evidenced a concordant partner (between-person) effect, and showed increased physiological regulation during minutes when their partner was more aversive. In contrast, clinical dyad members displayed a concordant actor (within-person) effect, becoming simultaneously physiologically and behaviorally dysregulated. Results inform current understanding of emotion dysregulation across multiple levels of analysis.

Tattooing among high school students in southern Taiwan: The prevalence, correlates and associations with risk-taking behaviors and depression

This study aims to examine the prevalence and sociodemographics, family and peer correlates of tattooing among high school students in southern Taiwan, and to examine the associations between tattooing and a variety of adolescent risk‐taking behaviors and depression. A total of 9755 high school students (grades 7 to 12) in southern Taiwan were recruited into this study and completed the questionnaires. The prevalence of tattooing among the adolescents was calculated. The responses were analyzed using the logistic regression analysis models. It was found that 1% of high school students in southern Taiwan had 1 or more tattoos on their bodies. The older students who were perceived to have low family monitoring and who had friends who drink regularly, used illicit drugs, had a criminal record or were in a gang were more likely to have a tattoo. Tattooing was also found to be associated with violence, weekly alcohol consumption, illicit drug use, dropping out of school, unprotected sex, suicidal ideation/attempt, and depression. The results indicate that several demographics, family and peer factors are associated with adolescent tattooing. Tattooing may be an indicator of risk‐taking behaviors in high school students.

Body Weight Statuses and Their Sociodemographic Correlates Among Adolescents in Southern Taiwan: Results Using Two Sets of Cutoff References

PURPOSE To examine the differences in the prevalence of overweight and obesity based on the cutoff references established by the International Obesity Task Force (IOTF) and the Working Group on Obesity in China (WGOC), the prevalence of underweight on the IOTF reference, and the sociodemographic correlates of body weight statuses in Taiwanese adolescents. METHODS Overweight and obesity in 10,371 Taiwanese adolescents were determined by the IOTF and WGOC cutoff references for body mass index (BMI). Underweight was determined by the IOTF. The prevalence of overweight and obesity using the IOTF standard were compared to those using the WGOC standard. Associations of body weight statuses with gender, age, residential status, and parental education level were also examined. RESULTS Using the IOTF standard, 3.4% were underweight, 15.2% were overweight, and 6.1% obese, whereas 14.1% were considered overweight and 8.7% were obese by the WGOC standard. For both genders, more adolescents were classified as overweight by the IOTF standard and as obese by the WGOC standard. Although females were more likely to be underweight than males, males were more likely to be overweight or obese than females. For both genders, although older age increased the risk of being underweight, younger age increased the risk of being overweight or obese. For males, living in urban areas was associated with being overweight, and low paternal education level was associated with being obese. CONCLUSIONS The prevalence of overweight and obesity may differ depending on the reference standard consulted. Paternal education level and urbanicity were associated with gender differences in the proportion of adolescents who were overweight or obese.

The Relationship between Overweight/Obesity and Self-esteem in Adolescents: The Moderating Effects of Socio-demographic Characteristics, Family Support, Academic Achievement and Peer Interaction

Objectives: The aims of this cross-sectional study were to examine the relationship between adolescent overweight/obesity and self-esteem, and the moderating effects of socio-demographic characteristics, family support, academic achievement, and peer interaction on its relationship. Methods: We recruited 9,885 adolescent students in southern Taiwan into this study to complete the questionnaires. We examined the relationship between overweight/obesity and self-esteem as well as the moderating effects of socio-demographic characteristics, family support, academic achievement, and peer interaction with logistic regression analyses. Results: The results of this study found that after adjusting for other important variables, overweight or obese adolescents were more likely to have low self-esteem (p＜0.05). Meanwhile, age (p＜0.05) and family support (p＜0.05) showed significant moderating effects on the relationship between low self-esteem and overweight/obesity. Conclusions: The results of this study showed that low self-esteem was an important clinical issue in overweight or obese adolescents, and that the relationship between overweight/obesity and self-esteem differed significantly for the adolescents with various groups of age and family support. We suggest that further studies are needed to confirm the findings of this study.

Relationship between psychological inflexibility and experiential avoidance and internet addiction: Mediating effects of mental health problems

Internet addiction became a major mental health problem in college student. Our objective was to examine the relationship between psychological inflexibility and experiential avoidance (PIEA) and Internet addiction (IA) and the mediating effects of mental health problem indicators. 500 college students (238 men and 262 women) participated in this study. The level of PIEA was examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The levels of depression, anxiety, interpersonal sensitivity, and hostility were evaluated using the Symptom Checklist-90 item-Revised Scale. The relationship among PIEA, mental health problems, and IA was examined using structural equation modeling. The severity of PIEA was positively associated with the severity of IA as well as positively associated with the severity of mental health problems. In addition, the severity of mental health problem indicators was positively associated with the severity of IA. These results provide the severity of PIEA is directly related to the severity of IA and indirectly related to the severity of IA through increasing the severity of mental health problems. The PIEA should be one of the target objectives when administer cognitive-behavioral therapy to college students with IA and mental health problems.

Substance abuse in early onset psychotic disorders

ABSTRACT Objectives: To examine patterns of substance use in youths with schizophrenia or other early onset psychotic disorders. Methods: Youths with psychotic disorders (onset before age 18 years) were assessed annually over two years using standardized diagnostic and symptom rating measures, including the Structured Clinical Interview for DSM-IV (SCID). Subjects with psychosis solely due to substance use were excluded. Subjects were between the ages of 6 and 17 years at study entry, with a mean age of 14.8 ± 2.2 years. Results: Thirty-nine percent of the 69 subjects met criteria for schizophrenia. Forty-five percent of the subjects met criteria for substance use disorders (i.e., substance abuse or dependence), and another 7% tried illicit substances without meeting criteria for abuse or dependence. Substance use disorders (SUDs) were not significantly associated with the type of psychotic illness, gender, ethnicity, socioeconomic status, severity of positive or negative symptoms at baseline, or other hypothesized risk factors (e.g., disruptive behavior disorders, familial substance abuse, and maltreatment). Subjects with SUDs had a significantly older age of entry into the study (p < .001). Subjects with co-occurring schizophrenia and SUDs used substances prior to the onset of psychosis and had a significantly older age of onset of psychosis (p < .021). Only 26% of youths with SUDs had received specific chemical dependency treatment. Conclusions: Substance abuse is a very significant and under-treated problem in this sample of youths with early onset psychosis. Efforts to identify specific risk factors and effective intervention strategies are needed.

Differences in mental health among young adults with borderline personality symptoms of various severities

PURPOSE This study examined the differences in mental health and behavioral problems among young adults with borderline personality symptoms of various severities. METHODS 500 college students participated in this study. Borderline personality symptoms were evaluated using the Taiwanese version of the Borderline Symptom List (BSL-23). Mental health problems were assessed using the Symptom Checklist-90-Revised Scale. Suicidality and other behavioral problems were assessed using questions from the epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia and BSL-23 Supplement. According to the distribution of BSL-23 scores at the 25th, 50th, and 75th percentiles, the participants were divided into 4 groups: No/Mild, Moderate, Severe, and Profound. Analysis of variance and the chi-square test were used to compare mental health and behavioral problems among the 4 groups. RESULTS All mental health problems differed significantly among the 4 groups. The severity of nearly all mental health problems increased with that of borderline personality symptoms. The proportions of most behavioral problems differed significantly among the 4 groups. The Profound group was more likely to have behavioral problems than the other 3 groups. CONCLUSION Young adults who had more severe borderline personality symptoms had more severe mental health and behavioral problems.

Insight into Alcohol Consumption-Related Problems and Its Correlates Among Taiwanese Alcoholic Hepatogastroenterological Clinic Patients

1Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan 2Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan 3Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan 4Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan 5Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan 6Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA 7Department of Psychiatry, Children’s Hospital and Regional Medical Center, Seattle, Washington, USA