Wing S. Wong

The differential mediating effects of pain and depression on the physical and mental dimension of quality of life in Hong Kong Chinese adults

ObjectiveThe impact of pain and depression on health-related quality of life (QoL) is widely investigated, yet the pain-depression interactions on QoL remain unclear. This study aims to examine the pain-depression-QoL mediation link.MethodsPain severity were assessed in a sample of Chinese professional teachers (n = 385). The subjects were also assessed on depressive symptoms and QoL. Regression models were fitted to evaluate the pain-depression-QoL relationships.ResultsAbout 44% of the sample had 3-5 painful areas in the past 3 months. Shoulder pain (60%) and headache (53%) were common painful areas. The results of regression analyses showed that pain mediated the effects of depression on the mental aspect of QoL (standardized β = -0.111; Sobel test: z = -3.124, p < 0.005) whereas depression mediated the effects of pain on the physical aspect of QoL (standardized β = -0.026; Sobel test: z = -4.045, p < 0.001).ConclusionsOur study offered tentative evidence that pain and depression impacted differently on the mental and physical aspect of QoL. As these findings were based on a Chinese teacher sample, future studies should employ more representative samples across cultures to verify the present data.

The effects of insomnia and internet addiction on depression in Hong Kong Chinese adolescents: an exploratory cross-sectional analysis.

The negative association of insomnia and internet addiction with mental health is widely documented in the literature, yet little is known about their inter‐relationships. The primary aim of this study was to examine the inter‐relationships between insomnia, internet addiction and depression. A total of 719 Chinese adolescents in Hong Kong participated in this school‐based cross‐sectional study. Participants completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), the Chinese Internet Addiction Scale (CIAS), the 12‐item version of General Health Questionnaire (GHQ‐12) and questions assessing internet use pattern and sociodemographic characteristics. The classification of internet addiction and insomnia was based on the CIAS cutoff global score >63 and PSQI cutoff global score >5, respectively. Multiple regression analyses tested the effects of insomnia and internet addiction on depression. Among students with internet addiction (17.2%), 51.7% were also identified as insomniacs. Internet addicts scored significantly poorer on all PSQI components, except sleep duration, than their non‐addicted counterparts. After adjustment for gender and internet use time, both internet addiction (β = 0.05; Sobel test Z = 6.50, P < 0.001) and insomnia (β = 0.59; Sobel test Z = 4.49, P < 0.001) demonstrated a significant association with depression. Overall, there is high comorbidity between internet addiction and insomnia. Both insomnia and internet addiction emerged as significant explanatory factors, but they exerted differential effects on depression. Future research should be directed at determining the causal relationship between internet addiction and insomnia, and its underlying mechanism with depression.

Prevalence of insomnia among Chinese adults in Hong Kong: a population-based study

Prevalence estimates of insomnia in western general populations are well documented, but population‐based epidemiological data on insomnia in Chinese adults are scarce. The aims of the present study were to determine the prevalence of insomnia in the general population of Hong Kong, compare components of sleep disturbances and lifestyle factors stratified by sex, and identify risk factors for insomnia. Using a population‐based cross‐sectional design, a total of 5001 Chinese adults aged ≥18 years completed a telephone interview on the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS) and measures of quality of life (QoL) indexed by Medical Outcomes Study 12‐item Short‐Form Health Survey (SF12), lifestyle and sociodemographic details. Insomnia was defined by a PSQI global score >5. The resultant weighted prevalence of insomnia was 39.4%, equivalent to 2.2 million affected adults in Hong Kong. Women reported significantly poorer component and global sleep quality (all P < 0.05). Fully adjusted stepwise regression analyses identified non‐full‐time employment status, existing long‐term health problems, alcohol consumption four to seven times per week, higher HADS scores, poor mental health component of QoL and low self‐perceived health were associated significantly with insomnia (all P < 0.05). Our results suggest that insomnia is highly prevalent among Hong Kong Chinese adults and is associated with frequent use of alcohol, poor mental health and QoL.

Prevalence and Characteristics of Chronic Pain in the General Population of Hong Kong

UNLABELLED Western studies document the prevalence of chronic pain in the general adult population to be between 2 and 55%. Knowing the prevalence of chronic pain among Chinese populations provides important comparative perspective: To determine the prevalence of chronic pain in the general population of Hong Kong; evaluate the relationship of chronic pain with sociodemographic and lifestyle factors; and describe the pain characteristics among chronic pain sufferers. A total of 5,001 adults aged ≥ 18 years (response rate 58%) drawn from the general population of Hong Kong completed the Chronic Pain Grade (CPG) questionnaire, providing information on chronic pain and sociodemographic status using telephone interviews. Overall 34.9% reported pain lasting more than 3 months (chronic pain), having an average of 1.5 pain sites; 35.2% experienced multiple pain sites, most commonly of the legs, back, and head with leg and back being rated as the most significant pain areas among those with multiple pain problems. The CPG criteria classified 21.5% of those with chronic pain symptoms as Grade III or above. Fully adjusted stepwise regression analyses identified being female, older age, divorced/separated, having part-time employment, existing long-term health problems, higher HADS Anxiety scores, poor QoL (mental health component), and low self-perceived health to be significantly associated with chronic pain. PERSPECTIVE Our data evidenced that chronic pain is common in the general population of Hong Kong, and the prevalence is highest among women and middle-aged adults.

The association between patient satisfaction and quality of life in Chinese lung and liver cancer patients.

Background:Patient satisfaction has been accorded increased importance in evaluating the quality of health care. However, only a few studies have examined factors associated with patient satisfaction in cancer populations, with no data currently available in Chinese oncology populations. Objectives:We sought to examine the longitudinal course of the relationship between patient satisfaction and quality of life (QoL) in Chinese cancer patients. Methods:A total of 253 liver cancer patients and 334 lung cancer patients were assessed during their first outpatient visit (baseline) and at 2 follow-up interviews (FU1 and FU2). QoL was measured by the Chinese version of the Functional Assessment of Cancer Therapy-General Scale [FACT-G (Ch)]. Patient satisfaction was assessed by the Nine-Item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) and the cognitive subscale of the Medical Interview Satisfaction Scale (MISS-Cog). Linear mixed effects (LME) models were fitted to identify predictors of patient satisfaction and QoL. Results:Results of LME analyses showed no significant between-group differences in psychosocial, satisfaction, and QoL measures over time (all P > 0.05). Age [β = −0.001, 95% confidence interval (CI): −0.03 to 0.00, P < 0.05] and optimism (β = 0.20, 95% CI: 0.10 to 0.30, P < 0.001) predicted MISS-Cog and ChPSQ-9, respectively. After adjusting for sociodemographic and psychosocial variables, only ChPSQ-9 (β = 0.12, 95% CI: 0.06 to 0.18, P < 0.001) predicted QoL scores. No significant association between MISS-Cog and QoL was found. Conclusions:General emotional support from health professionals (ChPSQ-9) was a more effective predictor of QoL than was a measure of informational support (MISS-Cog) among these patients. Because expectations of clinical care likely vary by culture, and nature and stage of disease, measures of patient satisfaction that address both informational and care expectations are important.

Prevalence of chronic fatigue among Chinese adults in Hong Kong: A population-based study

BACKGROUND Epidemiologic data is available on chronic fatigue for Western, but not for Chinese populations. The aims of the present study were to determine the prevalence of chronic fatigue in the general population of Hong Kong, compare health and lifestyle characteristics of non-chronic fatigue and chronic fatigue cases, and identify risk factors for chronic fatigue. METHODS We performed telephone interviews on 5001 randomly selected Chinese adults aged ≥18 years administering the Chinese version of Chronic Fatigue Scale (ChCFS), the Hospital Anxiety and Depression Scale (HADS), and quality of life (QoL) indexed by Medical Outcomes Study 12-item Short-Form Health Survey (SF12). Lifestyle, and sociodemographic data were also collected. Chronic fatigue was defined according to Fukuda et al.s (1994) criteria and case criterion was a ChCFS total scores ≥4. RESULTS The weighted prevalence of chronic fatigue was 10.7%, which was equivalent to 0.6 million adults in Hong Kong. Higher prevalence rates were found in females, older age groups, and low socioeconomic status. Fully adjusted stepwise regression analyses identified older age, retirees, housewife, existing long-term health problems, higher HADS scores, poor QoL, and low self-perceived health to be significantly associated with increased risk of chronic fatigue, whereas regular exercise was associated with decreased risk of chronic fatigue (all p<0.05). LIMITATIONS The cross-sectional design did not allow determination of the time course and causal relationship between chronic fatigue and associated factors. CONCLUSIONS Our data evidenced that chronic fatigue is common in the general population of Hong Kong, and the prevalence increased with age and was higher in the women and lower socioeconomic population.

The Fear-Avoidance Model of Chronic Pain: Assessing the Role of Neuroticism and Negative Affect in Pain Catastrophizing Using Structural Equation Modeling

BackgroundPrevious research on the fear-avoidance model (FAM) of chronic pain suggests that the personality traits of neuroticism and negative affect (NA) influence pain catastrophizing. However, the mechanisms of their influence on pain catastrophizing remain unclear.PurposeThis study examined four possible models of relationships between neuroticism, NA, and pain catastrophizing within the FAM framework using structural equation modeling.MethodA total of 401 patients with chronic musculoskeletal pain completed measures of neuroticism, NA, three core FAM components (pain catastrophizing, pain-related fear, and pain anxiety), and adjustment outcomes (pain-related disability and depression).ResultsRegression analyses refuted the possibility that neuroticism and NA moderated each other’s effect on pain catastrophic thoughts (p > 0.05). Results of structural equation modeling (SEM) evidenced superior data-model fit for the collapsed models in which neuroticism and NA were two secondary traits underlying a latent construct, negative emotion (disability: comparative fit index (CFI) = 0.93; depression: CFI = 0.91).ConclusionThe results offer preliminary evidence that patients presenting with more neurotic symptom and heightened NA probably elicit more catastrophic thoughts about pain.

The co-morbidity of chronic pain, insomnia, and fatigue in the general adult population of Hong Kong: Prevalence and associated factors

OBJECTIVES Although research suggests there is considerable overlap among chronic pain, fatigue, and sleep disturbances, no research to date has concurrently examined their interrelationships. This study estimates the co-occurrence of these three conditions in terms of prevalence and associated factors in the general adult population. METHODS In a population-based, cross-sectional telephone survey, 5001 adults aged ≥18 years drawn from the Hong Kong general population completed the Chronic Pain Grade (CPG) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Chronic Fatigue Scale (CFS), Hospital Anxiety and Depression Scale (HADS), and socio-demographic questions. RESULTS The overall prevalence of reporting all three chronic conditions was 5.6% (95% CI: 4.9-6.4) and increased with age, being higher in women, and those in lower income and education level groups. Individuals with multiple symptoms also reported poorer mental health, and self-perceived health. Results of multi-ordinal regression analyses identified female, divorced/separated, having part time employment, retirees, unemployment, housewives, existing long-term health problems, higher HADS scores, and low self-perceived health to be significantly associated with reporting all three symptoms. CONCLUSION This study has shown that the co-occurrence of chronic pain, fatigue, and sleep disturbances was common in the general adult population. Multiple symptoms are comorbid of psychological distress.

The differential effects of gratitude and sleep on psychological distress in patients with chronic pain

This study aimed to examine the possible cross-sectional mediating role of sleep in the relationship of gratitude with depression and anxiety in patients with chronic pain. A total of 224 patients with chronic pain completed structured questionnaires assessing chronic pain, depression and anxiety symptoms, gratitude, and sleep disturbances. Results of multiple regression analyses yielded a modest mediating effect for sleep on the gratitude–depression link whereas a stronger mediating effect was found for sleep on the gratitude–anxiety link. These data show much of the effect of gratitude on depression was direct whereas sleep exerted a stronger mediating effect on the gratitude–anxiety link.

FEAR OF MOVEMENT/(RE)INJURY IN CHINESE PATIENTS WITH CHRONIC PAIN: FACTORIAL VALIDITY OF THE CHINESE VERSION OF THE TAMPA SCALE FOR KINESIOPHOBIA

OBJECTIVE To assess the factor structure of the Chinese version of the Tampa Scale for Kinesiophobia (TSK). DESIGN Chinese patients with chronic pain attending either orthopaedic specialist services (n = 216) or multidisciplinary specialist pain services (n = 109) participated in this study. METHODS Subjects completed the Chinese version of TSK, The Chronic Pain Grade Questionnaire, Hospital Anxiety and Depression Scale, and questions assessing socio-demographic characteristics. Confirmatory factor analyses were used to compare hierarchical and correlated models of 5 different factor solutions previously reported in patients with chronic pain in the West. RESULTS Confirmatory factor analyses demonstrated inequality of the TSK factor structure, in that the TSK11 for the orthopaedics sample was best represented by a two-factor correlated model (S-Bchi2 = 49.593; comparative fit index (CFI) = 0.93; normed filt index (NFI) = 0.911; root mean square error of approximation (RMSEA) = 0.025) comprising 2 first-order factors, Somatic Focus (TSK11-SF) and Activity Avoidance (TSK-AA). The pain clinic sample showed a one-factor structure as best representing the TSK4s underlying dimensions (CFI = 0.971; NFI = 0.912; RMSEA = 0.048). There was no evidence to support a single overarching concept of kinesiophobia. CONCLUSION The TSK appears to have utility in Chinese chronic pain populations. Elucidation of the TSKs psychometrics properties in other Chinese/Asian pain populations with different diagnoses and presentations of pain problems is warranted.