Yu-Ping Chang

Multi‐dimensional discriminative factors for Internet addiction among adolescents regarding gender and age

Aims:  The aim of the present study was to examine the discriminative effects of sociodemographic, individual, family, peers, and school life factors on Internet addiction in Taiwanese adolescents.

Measures assessing spirituality as more than religiosity: a methodological review of nursing and health-related literature

AIMS This paper is a report of a methodological review conducted to analyse, evaluate and synthesize the rigour of measures found in nursing and health-related literature used to assess and evaluate patient spirituality as more than religiosity. BACKGROUND Holistic healthcare practitioners recognize important distinctions exist about what constitutes spiritual care needs and preferences and what constitutes religious care needs and preferences in patient care practice. DATA SOURCES Databases searched, limited to the years 1982 and 2009, included AMED, Alt Health Watch, CINAHL Plus with Full Text, EBSCO Host, EBSCO Host Religion and Philosophy, ERIC, Google Scholar, HAPI, HUBNET, IngentaConnect, Mental Measurements Yearbook Online, Ovid MEDLINE, Social Work Abstracts and Hill and Hoods Measures of Religiosity text. REVIEW METHODS A methodological review was carried out. Measures assessing spirituality as more than religiosity were critically reviewed including quality appraisal, relevant data extraction and a narrative synthesis of findings. RESULTS Ten measures fitting inclusion criteria were included in the review. Despite agreement among nursing and health-related disciplines that spirituality and religiosity are distinct and diverse concepts, the concept of spirituality was often used interchangeably with the concept religion to assess and evaluate patient spirituality. The term spiritual or spirituality was used in a preponderance of items to assess or evaluate spirituality. CONCLUSIONS Measures differentiating spirituality from religiosity are grossly lacking in nursing and health-related literature.

Decision‐Making Process of Nursing Home Placement Among Chinese Family Caregivers

PURPOSE To understand the process and difficulties that Chinese family caregivers experience when making a nursing home placement decision for their loved ones with dementia. DESIGN AND METHODS Using a grounded theory approach, data were collected through individual interviews with 30 Chinese family caregivers in Taiwan. FINDINGS A stage-based framework was generated that described how caregivers went through the decision-making process, what specific challenges they encountered within the process, and how they overcame difficulties to reach their decisions. PRACTICE IMPLICATIONS By identifying the stages of the decision-making process and various challenges that caregivers experience, clinicians can enhance discussions with caregivers to decrease the decision-making burden. Clinicians might develop family-centered interventions for the decision-making process through the post-placement stage while taking into account cultural influences.

Can older adults with dementia accurately report depression using brief forms? Reliability and validity of the Geriatric Depression Scale.

The Geriatric Depression Scale (GDS) is a commonly used screening tool, but its use in older adults with cognitive impairment has been controversial. This study compared the short forms of the GDS with clinician diagnosis of depression using standard criteria (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision) in people with and without dementia. Sensitivity and specificity were acceptable for all forms of the GDS. These results build evidence for using the short GDS 5- and 15-item versions in populations that include people with mild to moderate dementia, increasing the ease of depression screening so it can be performed more frequently in clinical settings.

Management of chronic pain with chronic opioid therapy in patients with substance use disorders

Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.

Relationship between psychosocial adjustment and executive function in patients with bipolar disorder and schizophrenia in remission: The mediating and moderating effects of insight

OBJECTIVES The aims of this study were to examine the relationships between executive function and psychosocial adjustment, and the mediating and moderating effects of insight on the association between executive function and psychosocial adjustment in patients with bipolar disorder and schizophrenia in clinical remission. METHODS The level of psychosocial adjustment was assessed in 96 subjects with bipolar disorder and 96 subjects with schizophrenia who were in remitted state. The association between executive function and psychosocial adjustment and the mediating and moderating effects of insight were examined by multiple regression analysis models and the Goodman test. RESULTS The results indicated that executive function had direct effect on psychosocial adjustment in both subjects with bipolar disorder and schizophrenia. However, the mediating effect of insight on the association between executive function and psychosocial adjustment was only found in subjects with schizophrenia, but not in subjects with bipolar disorder. No moderating effect of insight on the association between executive function and psychosocial adjustment was found in subjects with schizophrenia or bipolar disorder. CONCLUSIONS The results of this study indicated that executive function has an important role in psychosocial adjustment in both patients with bipolar disorder and schizophrenia. Meanwhile, insight has a different role in the association between executive function and psychosocial adjustment between patients with bipolar disorder and schizophrenia.

Internalizing and externalizing problems in adolescent aggression perpetrators, victims, and perpetrator-victims

The aims of this study were to examine the risks of internalizing and externalizing problems in aggression perpetrators, victims, and perpetrator-victims and their sex differences, and to examine the effects of the level of aggression involvement on internalizing and externalizing problems. Eight thousand eighty-five adolescents in Taiwan completed the questionnaires. The associations of aggression involvement and the level of aggression involvement with internalizing and externalizing problems were examined. Compared with the neutrals, pure aggression perpetrators and perpetrator-victims had higher risks for internalizing and externalizing problems and pure victims had higher risks for internalizing problems and theft. Differences in the risks for internalizing and externalizing problems were found among 3 groups with aggression involvement. Levels of aggression involvement increased the risks for some internalizing and externalizing problems. Sex differences were also found. Internalizing and externalizing problems need to be detected among adolescents involved in aggression, especially among perpetrator-victims, those with high levels of aggression involvements, and females.

Factor structure of the Athens Insomnia Scale and its associations with demographic characteristics and depression in adolescents

The eight‐item Athens Insomnia Scale (AIS‐8) is an instrument that has been used frequently to assess insomnia problems. Previous research on adults has found that the AIS‐8 functioned as a sole component. This study aimed to examine the prevalence rates of insomnia problems on the AIS‐8, the factor structure of the AIS‐8 in adolescents and its associations with demographic characteristics and depression in adolescents. A total of 8319 adolescent students (4334 girls and 3985 boys, mean age = 14.7 years, standard deviation = 1.7 years) in southern Taiwan were recruited into this study and completed the AIS‐8. We performed an exploratory factor analysis to examine the factor structure of the AIS‐8, and used the parallel analysis for making decisions regarding factor retention. We also used multiple regression analysis models to determine the associations between insomnia and demographic characteristics and depression. The results found that a high proportion of adolescents had insomnia problems as measured by the AIS‐8. The AIS‐8 was composed of two different factors when used among a large adolescent population, including insomnia symptoms (factor 1) and subjective sleep and daytime distress (factor 2). While being male, being younger, and having depression were associated positively with the severity of insomnia symptoms (factor 1), being older, living in urban areas, and having depression were associated positively with the severity of subjective sleep and daytime distress (factor 2). Clinicians and researchers should consider the different meanings of the two factors of the AIS‐8 when using this tool to assess insomnia problems in adolescents.

Behavioral Interventions Targeting Chronic Pain, Depression, and Substance Use Disorder in Primary Care

BACKGROUND Patients with chronic pain, depression, and substance use disorder (SUD) are often treated in primary care settings. An estimated 52% of patients have a diagnosis of chronic pain, 5% to 13% have depression, and 19% have SUD. These estimates are likely low when considering the fact that 50% of primary care patients with depression and 65% with SUD are undiagnosed or do not seek help. These three conditions have overlapping neurophysiological processes, which complicate the treatment outcomes of a primary physical illness. Behavioral interventions have been widely utilized as adjunctive treatments, yet little is known about what types of behavioral interventions were effective to treat these comorbidities. This systematic review aimed to identify behavioral interventions targeting chronic pain, depression, and SUD in primary care settings. METHODS The Cumulative Index to Nursing and Allied Health Literature, Medline, PsycInfo, and Google Scholar databases were searched to identify randomized controlled trials, using a behavioral intervention, involving adults with at least two of the three conditions. RESULTS This search yielded 1,862 relevant records, and six articles met final selection criteria. A total of 696 participants were studied. Behavioral interventions varied in content, format, and duration. Mindfulness Oriented Recovery Enhancement (MORE), Acceptance and Commitment Therapy (ACT), Interpersonal Psychotherapy adapted for pain (IPT-P), and Cognitive Behavioral Therapy (CBT) showed promising improvements across all studies, albeit with small to moderate effects. CONCLUSIONS MORE, ACT, and CBT combined with mindfulness and Motivational Interviewing had the most promising results for treating chronic pain, depression, and SUD in various combinations in primary care settings. CLINICAL RELEVANCE The evidence is mounting that behavioral interventions such as mindfulness-based or cognitive-behavioral interventions are effective strategies for managing patients with comorbidities of chronic pain, depression, and SUD in primary care. Integrated delivery of behavioral interventions via group sessions, computers, and smart phones may increase patient access to treatment; save time and cost; reduce stigma, patient distress, family burden, and healthcare fragmentation; and provide a ray of hope to amplify conventional treatments.

The Effect of Motivational Interviewing on Prescription Opioid Adherence Among Older Adults With Chronic Pain

PURPOSE To test the effect of office-based motivational interviewing (MI) on prescription opioid adherence in older adults with chronic pain. DESIGN AND METHODS Pre- and post-design was used. Thirty chronic pain patients participated in a 4-week MI in two outpatient settings. FINDINGS Participants demonstrated a significantly reduced risk of prescription opioid misuse, decreased substance use, increased self-efficacy, increased motivation to change, and decreased depression at both the post-test and 1-month follow-up. PRACTICE IMPLICATION MI can be effectively delivered in outpatient settings for older adults who are at risk for opioid misuse. Clinicians could incorporate MI techniques to enhance prescription opioid adherence.