Decision-making capacity of inpatients with schizophrenia in Hong Kong

This is a prospective study examining decision-making abilities in Chinese schizophrenia patients in Hong Kong. We interviewed patients before their discharge from hospital after a psychotic relapse, examining their decision regarding whether or not they would take maintenance neuroleptic treatment. Decision-making abilities were assessed by the MacArthur Competence Assessment Tool-Treatment, a semistructured questionnaire. We examined their relationships with demographic, clinical, and cognitive variables, measured by standardized instruments. Eighty-one participants were seen. Weaknesses were noted in a range of relevant decision-making abilities. Positive and negative schizophrenic symptoms, specifically lack of judgment and insight, difficulty in abstract thinking, unusual thought content, and conceptual disorganization, were found to be correlated with performance in decision-making abilities, as were cognitive deficits. Verbal working memory was a moderate predictor of the ability to understand treatment information. Decision-making impairments and negative treatment attitude were related to the decision not to adhere to medication. Copyright © 2005 by Lippincott Williams & Wilkins.link_to_subscribed_fulltex

Web-based survey of depression, anxiety and stress in first-year tertiary education students in Hong Kong

Objective: The mental health of tertiary education students is an area of increasing concern worldwide. The objective of this study is to examine the prevalence of depression, anxiety and stress in first-year tertiary education students in Hong Kong. Method: Depression, anxiety and stress were measured by the 42-item Depression Anxiety Stress Scales, completed on the web by participating students anonymously. Results: A total of 7915 students completed the survey, yielding a response rate of 27.5%. Depression, anxiety and stress levels of moderate severity or above were found in 21%, 41% and 27% of our respondents, respectively. Conclusions: The web-based survey methodology was well accepted by our sample group of tertiary education students. We found high rates of psychological morbidity in first-year tertiary education students in Hong Kong. The high prevalence of depression, anxiety and stress symptoms in the first year of college life is alarming. It illustrates the need for primary and secondary prevention measures, with development of adequate and appropriate support services for this group. © 2006 The Authors; Journal compilation © 2006 The Royal Australian and New Zealand College of Psychiatrists.link_to_subscribed_fulltex

Cultivating psychological well-being in Hong Kong's future doctors

There has been much recent attention on psychological well-being and pastoral care for medical students. This study examines psychological morbidity (depression, anxiety and stress) in Hong Kong medical students, as well as their concerns, coping mechanisms and their help-seeking. Medical students in Hong Kong reported a higher level of psychological morbidity as compared with other tertiary education students. Their main concerns include examinations, stress, career, adjusting to the new medical curriculum and commitment to the course. The coping skills adopted were largely adaptive. Maladaptive coping skills like 'denial;, 'self-blame' and 'behavioural disengagement' were highly correlated with depression, anxiety and stress scores. Most of the students concerned wanted support services that were specifically tailored to their needs and at least partly provided by people who had been through medical training themselves. The faculty at the University of Hong Kong is establishing a Programme for Effective Transition and Student Support (PETSS) to provide a multi-faceted support system for its medical students. The findings in this study help to ensure that the services provided will be relevant, accessible and acceptable to the students. © 2005 Taylor & Francis.link_to_subscribed_fulltex

An instrument to assess mental patients' capacity to appraise and report subjective quality of life

Quality of life (QOL) is increasingly recognized as an important outcome measure in treatment studies and service evaluation. However, patients or service users may sometimes lack the capacity to either evaluate or express their subjective QOL, for example due to cognitive impairment, communication disorders, symptom distress or burden of completing the assessment itself. This paper describes the development of an instrument, the capacity to report subjective quality of life inventory (CapQOL), which evaluates the ability of patients to appraise their subjective QOL and to complete related measures. The CapQOL is a simple and brief screening tool, designed for use in people with a wide range of mental disabilities. It helps researchers to identify individuals who are unable to appraise or report their subjective quality of life. We administered the CapQOL to 442 patients with early psychosis. About 89% of the participants were assessed to be able to complete a subjective QOL measure. The CapQOL demonstrated satisfactory psychometric properties. Further validation studies in people with psychosis as well as other mental disabilities are indicated. © Springer 2005.link_to_subscribed_fulltex

Stress and psychological impact on SARS patients during the outbreak

Objective: To examine stress and psychological impact in severe acute respiratory syndrome (SARS) patients during the 2003 outbreak. SARS is a novel, highly infectious pneumonia, and its psychological impact is still unclear. Method: At the peak of the outbreak, SARS patients (n = 79) and healthy control subjects (n = 145) completed the Perceived Stress Scale (PSS) and documented a range of psychological responses. Groups were balanced for age, sex, education, and living circumstances. Results: Stress was significantly higher in SARS patients than in healthy control subjects. Stress correlated significantly with negative psychological effects. Of SARS patients, 39% (n = 30) were infected health care workers; these individuals reported significantly more fatigue and worries about health than did other patients. Of patients, 25% (n = 20) requested psychological follow-up. Conclusions: General stress and negative psychological effects are increased in SARS patients, particularly among infected health care workers. This may increase the risk of mood and stress-related disorders. Functional impairment is apparent in the postrecovery phase.link_to_subscribed_fulltex

Psychological effects of the SARS outbreak in Hong Kong on high-risk health care workers

Objective: To quantify stress and the psychological impact of severe acute respiratory syndrome (SARS) on high-risk health care workers (HCWs). Method: We evaluated 271 HCWs from SARS units and 342 healthy control subjects, using the Perceived Stress Scale (PSS) to assess stress levels and a structured list of putative psychological effects of SARS to assess its psychological effects. Healthy control subjects were balanced for age, sex, education, parenthood, living circumstances, and lack of health care experience. Results: Stress levels were raised in both groups (PSS = 18) but were not relatively increased in the HCWs. HCWs reported significantly more positive (94%, n = 256) and more negative psychological effects (89%, n = 241) from SARS than did control subjects. HCWs declared confidence in infection-control measures. Conclusions: In HCWs, adaptive responses to stress and the positive effects of infection control training may be protective in future outbreaks. Elevated stress in the population may be an important indicator of future psychiatric morbidity.link_to_subscribed_fulltex