Shih-Cheng Liao

Development and verification of validity and reliability of a short screening instrument to identify psychiatric morbidity.

BACKGROUND AND PURPOSE The accurate identification of minor mental disorders associated with depression and anxiety in non-psychiatric medical settings is an important component of mental health care. The present study aimed to develop a reliable and valid short screening tool to improve the identification of psychiatric morbidity. METHODS Data from the 50-item Brief Symptom Rating Scale (BSRS-50) obtained from 721 medical inpatients were used to develop a short screening tool (BSRS-5) to identify psychiatric morbidity. The BSRS-5 comprises 5 symptom items, selected from the BSRS-50, each of which has the highest correlation with the corresponding subscale score of Anxiety, Depression, Hostility, Interpersonal Sensitivity and Additional Symptoms in the BSRS-50. Various types of reliability and validity of the BSRS-5 were assessed in different populations, including 253 human immunodeficiency virus-1 infected outpatients, 257 psychiatric outpatients, 56 psychiatric inpatients, 100 rehabilitation outpatients with chronic low back pain, 2915 university freshmen, and 1090 community members. RESULTS Internal consistency (Cronbach alpha) coefficients of the BSRS-5 ranged from 0.77 to 0.90. The test-retest reliability coefficient was 0.82. Concurrent validity coefficients between the sum score of BSRS-5 and the General Severity Index of BSRS-50 ranged from 0.87 to 0.95. Choosing 6+ as the cut-off score for psychiatric cases, the rate of accurate classification of BSRS-5 was 76.3% (78.9% sensitivity, 74.3% specificity, 69.9% positive predictive value, 82.3% negative predictive value). The BSRS-5 could differentiate the severity of illness in psychiatric outpatients based on psychiatrists ratings using the Clinical Global Impression scale, severity of psychopathology of psychiatric inpatients between admission and discharge, levels of pain indicated by 4 dimensions of the Dallas Pain Questionnaire for outpatients with chronic low back pain, and the severity of psychopathology between university students and community members with and without suicidal ideation. CONCLUSION The BSRS-5 can be used to identify psychiatric morbidity in both medical practice and the community.

Comparative analysis between psychological and endoscopic profiles in patients with gastroesophageal reflux disease: A prospective study based on screening endoscopy

Background:  Associations between psychological and endoscopic profiles are not clearly validated among the heterogeneous patients with gastroesophageal reflux disease (GERD). The purpose of the present paper was therefore to identify any associations by means of cross‐sectional study.

Suicide by charcoal burning in Taiwan, 1995-2006.

BACKGROUND We sought to identify risk factors and trends that might underlie the greatly increased incidence of charcoal-burning suicide in Taiwan and to learn whether the increasing accessibility of a single suicide method can increase overall suicide rates. METHODS Data from a national mortality register for subjects who committed suicide during 2001 to 2006 and who were 15 years old or older when they died was analyzed. A review of available evidence and comparisons with historical cases were also performed. RESULTS From 1995 to 2006, 68% of suicides in Taiwan involved males, and suicide rates for men increased from 9.5 to 26.7 per 100,000 population; suicide rates for women rose from 5.6 to 11.7 per 100,000 population. The sex ratio (M:F) increased from 1.69:1 to 2.28:1. The greatest increase in suicide rates occurred among those 25-44 years of age. The incidence of charcoal-burning suicide was 0.22 per 100,000 in 1999 but reached 6.48 per 100,000 in 2006. Age, gender, marital status, and year of committing suicide were significant predictors for suicide by charcoal burning. This single suicide method accounted for 33.5% of suicide deaths in Taiwan in 2006. LIMITATIONS The number of suicides by charcoal burning may be under- or overestimated, and life events of the suicide subjects were not analyzed. CONCLUSIONS Romanticizing suicide by charcoal burning by the media and cultural influences may have contributed to the increased suicides. Prohibiting sale of charcoal in convenience stores, enforcing media guidelines, and setting up carbon monoxide detectors may help prevent suicide by charcoal burning.

Prevalence of Suicidal Ideation and Associated Risk Factors in the General Population

BACKGROUND/PURPOSE Suicide is an important public health problem and one of the leading causes of death worldwide. The present study investigated the prevalence of suicidal ideation (SI) and its associated risk factors in the general population. METHODS A nationwide community survey was conducted using a computer-aided telephone interview system with residents aged >or= 15 years, who were selected by a stratified, proportional randomization method. The questionnaire comprised demographic variables, five items of psychopathology selected from the Brief Symptom Rating Scale (BSRS-5) and questions about personal experience with suicide. In total, 2054 respondents, 1002 male (48.8%), and 1052 female (51.2%), completed the survey. RESULTS The weighted prevalence of SI was 2.84% in the past week, 5.50% in the past year, and 18.49% during a lifetime. Significant risk factors for SI in the last week included presence of SI over the past year [odds ratio (OR) =1763.6], SI during the lifetime (OR =267.6), psychiatric morbidity (OR = 30.3), depression (OR =26.1), inferiority (OR =11.2), hostility (OR = 10.9), anxiety (OR = 10.5), insomnia (OR =6.7), history of seeking help for psychological distress (OR = 7.9), divorce (OR =6.4), unemployment (OR = 5.0) and having suicidal behavior in relatives or friends (OR =3.8). Stepwise multiple regression analysis demonstrated that the five symptom items of BSRS-5 and unemployment significantly predicted 25.3% of the variance of SI. Using the BSRS-5 score 3 or 4 as a cut-off to predict SI, the rate of accurate classification was 85.88%, with sensitivity of 0.83 and specificity of 0.86. CONCLUSION A telephone interview survey containing the BSRS-5 items is an efficient way to identify determinants of SI in the general population.

Teachers' knowledge, beliefs and attitudes concerning schizophrenia- a cross-cultural approach in Japan and Taiwan.

Abstract.Background:Mental health literacy of the general public is essential for the effective promotion of society’s mental health. However, there has been no investigation of the general public’s mental health literacy with Japanese and Taiwanese socio-cultural backgrounds.Methods:A total of 129 Japanese and 150 Taiwanese elementary school teachers were surveyed about knowledge, beliefs and attitudes concerning schizophrenia by means of a questionnaire with a vignette describing a case of the disease. Identification of the case, cause of the disease, coping behavior for the case, and perception of stigmatizing and supporting attitudes by parents and neighbors of the case were investigated.Results:As a common finding with the studies in Western countries, only small percentages of the Japanese and Taiwanese respondents were able to make a correct identification. A further common finding was the emphasis on psychosocial factors as a cause of schizophrenia, as was the rejection of psychotropic medication, although future study is required to determine to what extent the respondents know about therapeutic procedures utilized by psychiatrists. Significantly stronger stigma perception was shown in the Japanese respondents than in the Taiwanese, which may be attributable to the high institutionalization rate in Japan.Conclusions:Japanese and Taiwanese teachers’ knowledge, beliefs and attitudes regarding schizophrenia were similar to those found in the general public in Western societies. Although the present study is limited in sampling and the components of the mental health literacy investigated, several working hypotheses have been extracted from it to be tested in future investigations on the Japanese and Taiwanese and other Asian general public’s mental health literacy.

Multidimensional assessments of impulsivity in subjects with history of suicidal attempts

OBJECTIVE This study aimed to examine whether subjects with history of suicidal attempts had higher impulsivity as measured by neurocognitive tests and self-report questionnaires. The interrelationships among different impulsivity measures were also explored. METHODS Fifty-four nonpsychotic psychiatric inpatients, including 24 subjects with previous history of suicidal attempts and 30 comparison subjects without previous suicidal attempts, completed the self-report Barratt Impulsiveness Scale-11-Chinese version (BIS-11-CH) and 2 neuropsychologic tests of impulsivity: the immediate memory task/delayed memory task (IMT/DMT) and the single key impulsivity paradigm (SKIP). RESULTS The results indicated that subjects with previous suicidal attempts exhibited higher BIS-11-CH factor 2 (lack of self-control/attentional impulsivity) subscore (P = .02) and more commission errors in IMT (P = .03). However, BIS-11-CH scores and performance indices of IMT/DMT and of SKIP did not correlate with each other. CONCLUSIONS Our findings supported that subjects with previous suicidal attempts had higher impulsivity, which could be revealed by both self-report and neurocognitive measures. However, there is no correlation among self-report, IMT/DMT, and SKIP measures, indicating that they might be measuring different dimensions of impulsivity.

Low prevalence of major depressive disorder in Taiwanese adults: possible explanations and implications

BACKGROUND This study examined the prevalence of major depressive disorder (MDD), and the correlations and co-morbid conditions associated with MDD, in the adult Taiwanese population, which a previous estimate in the 1980s had found to be at the lower end of the spectrum worldwide. Possible explanations for the reported low prevalence of MDD were evaluated. METHOD As part of a survey of common psychiatric disorders in a nationally representative sample of individuals aged ≥ 18 years who were non-institutionalized civilians in Taiwan, a face-to-face interview using the paper version of the World Mental Health Survey of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI) was conducted between 2003 and 2005. Functional impairment and help-seeking behaviors were compared between Taiwanese subjects with MDD and their counterparts in the USA. RESULTS Among the 10 135 respondents, the lifetime prevalence of MDD was 1.20% [standard error (S.E.)=0.2%]. Individuals who were divorced or widowed, aged ≤ 40 years, and female were at increased risk, whereas rural residents were at lower risk for MDD. The proportion of MDD cases co-morbid with other psychiatric disorders in this study was much lower than in the US study. Only one-third of Taiwanese individuals with MDD sought help despite having twice the number of lost workdays compared with the US sample. CONCLUSIONS Despite the low prevalence of MDD in Taiwanese adults, the pattern of low help-seeking behavior and profound functional impairment indicates much room for improvement in the early detection of and intervention in major depression in this population.

Validity of the five-item brief symptom rating scale among subjects admitted for general health screening

BACKGROUND AND PURPOSE Hospital-based general health screening plays an important role in the early detection of mental disorders. The present study examined the validity of the 5-item Brief Symptom Rating Scale (BSRS-5) in subjects admitted for a 2-day general health screening program. METHODS A cross-sectional survey with a modified 2-phase design was conducted at a medical center in Taipei. A total of 283 consecutive subjects who received health screening in a 1-month period completed the BSRS-5 in the first phase. There were 172 (60.8%) males and 111 (39.2%) females with a mean age of 54.4+/-12.0 years. 115 subjects received a standard psychiatric interview with the Mini International Neuropsychiatric Interview-Plus in the second phase. RESULTS In this hospital-based sample, the internal consistency (Cronbach alpha) coefficient for the BSRS-5 was 0.84 and the area under the receiver-operating characteristic curve was 0.91 [95% confidence interval (CI), 0.86-0.95]. The optimal cut-off point was 5/6. The rate of accurate classification was 82.2% (82.6% sensitivity, 81.8% specificity, 81.9% positive predictive value, 82.5% negative predictive value). The estimated prevalence of minor psychiatric morbidity in this sample was 27.2% (95% CI, 22.2-32.4%). CONCLUSION The BSRS-5 is an effective screening instrument for the identification of psychiatric morbidity in hospital-based health screening settings.

Risk predictors for hypnosedative-related complex sleep behaviors: a retrospective, cross-sectional pilot study.

OBJECTIVE To explore the risk predictors for complex sleep-related behaviors (CSBs) in subjects with a DSM-IV-diagnosed depressive disorder, anxiety disorder, adjustment disorder, somatoform disorder, or sleep disorder taking hypnosedative drugs. METHOD One hundred twenty-five subjects using hypnosedatives were enrolled from the psychiatric outpatient clinics of a medical center in Taiwan from May 2006 to July 2006. All subjects completed a questionnaire that included demographic data, current and childhood sleep habits, and CSBs after taking hypnosedatives. Complex sleep-related behaviors were defined as somnambulism with object manipulation, sleep-related eating, and other amnestic sleep-related behaviors. Demographic and clinical variables were compared in those with CSBs and those without. Then multiple logistic regression analyses were performed in order to identify significant risk predictors for CSBs. RESULTS Of the 125 subjects, 19 (15.2%) reported CSBs, all of whom took zolpidem. Among a total of 67 subjects taking zolpidem, those with CSBs were significantly more likely to be younger (P = .023), to be female (P = .011), to take a higher dose of zolpidem (> 10 mg/d; P < .001), and to not go to sleep immediately after taking zolpidem (P = .047). Multiple logistic regression analyses showed that a higher dose of zolpidem (> 10 mg/d) was the only significant predictor of CSBs (OR = 13.1; 95% CI, 2.6-65.9; P = .002). CONCLUSIONS This pilot study suggests that a higher dosage of zolpidem (> 10 mg/d) is the key risk predictor for CSBs.

Quality of life in adults with congenital heart disease: biopsychosocial determinants and sex-related differences

Objectives To assess the quality of life (QoL) in adults with congenital heart disease (ACHD) and to explore the sex-related differences and biopsychosocial determinants in an Asian cohort. Design Prospective cross-sectional clinical study. Setting One tertiary medical centre in Taiwan. Patients and methods The QoL of ACHD (≥20 years) was investigated using the Taiwanese version of the QoL questionnaire designed by the WHO, which assesses four domains of QoL (physical, psychological, social and environmental). Personality, psychological distress and family support were assessed using the Maudsley Personality Inventory, Brief Symptom Rating Scale, and the Family APGAR score, respectively. Results A total of 289 patients (age 33.2±10.6 years; 36% men) were studied. ACHD women had significantly lower QoL scores in the physical and psychological domains compared to the age-matched general population, whereas no differences were observed between ACHD men and the general population. Multivariate analysis showed that female gender was associated with poorer physical QoL; the sex difference in the psychological QoL was mediated by psychological distress. Interaction analysis showed that the effect of family support on the psychological domain of QoL may be different by sex. The determinants of QoL varied between different domains. Extroversion personality trait, psychological distress and family support were common determinants of most domains of QoL. Conclusions In ACHD, female gender was associated with poor physical and psychological QoL. The common denominators for QoL were primarily personality trait, psychological distress and family support, but not disease severity.