Developing a new multi-dimensional depression assessment scale

Depression is a global risk factor of mental health. Empirical studies (e.g. Beck, 1967, 1976) and clinical observations (APA, 1996, 2000) showed that it has symptoms in 4 domains-, emotional, cognitive, somatic and interpersonal. A good depression assessment instrument makes clinicians more effective in screening out non-depressed people and choosing the appropriate treatment. However, commonly used depression assessment scale such as BDI-II, Hamilton depression rating scale, and CES-D put little attention on evaluating interpersonal symptoms. Only three per cent of the total items in all depression scales were on interpersonal domain. Therefore, a new depression assessment scale, aiming to evaluate all 4 domains of depressive symptom, was developed. In Study 1, an 85-item questionnaire containing all the possible depressive symptoms was distributed to 87 participants from mental health professions. Based on their clinical experience and knowledge, they rated how typical each symptom was on a 5-point Likert scale in which 5 represented the most typical symptom and 1 as the least typical symptom. The mean score for each item was calculated and ranked. Items with strong correlations were excluded. Finally, forty-eight Items with the highest mean scores were put into the new multidimensional depression assessment scale, which aimed to assess the severity and symptom pattern of depression. The new depression assessment scale contained 52 items, 48 from the first study and 4 from psychiatrists after checking the validity of the scale. It consisted of 4 subscales, emotional, cognitive, somatic and interpersonal. One hundred mentally healthy participants finished the questionnaire, as well as BDI-II. Reliability analysis and Pearson correlation gave high Cronbach's alpha (>0.8) for each subscale and good correlation (>0.7) between the new scale, its subscales, and BDI-II. All the evidence indicated that the new depression scale had good psychometric characteristics. It was found to be reliable and valid for the use of assessing depression severity and symptoms

Nature of depression in Chinese populations within and outside of pregnancy: a study in Inner Mongolia

Depression poses a global threat for mental health (Murray & Lopez, 1996). However, in China, national studies of depression epidemiology are very few. Only from 2011 have Chinese researchers began to adopt internationally recognized diagnostic criteria and standardized interview instruments in psychiatric epidemiological surveys (Guo et al., 2011), and previous studies generated inconsistent results of depressive prevalence. As the largest ethnic group in the world, the Chinese account for 18.9% of the world’s population (National Bureau of Statistics of China, 2015). Yet most research on depression is based on Western samples and may not accurately characterize depression as experienced by Chinese populations. This thesis examines depression in non-pregnant and pregnant women in Inner Mongolia, who are under the influence of cultural values of collectivism and social factors specific to China. Chinese society adheres firmly to traditional values (Whyte, 2005), while market reform, birth-control policy, together with high parental investment in childcare and rearing construct a unique and sometimes unfavorable environment for Chinese women that may influence their depression expression. This thesis includes a series of three linked studies. The first study validated the 52- item New Multidimensional Depression Scale (MDAS) with clinically depressed individuals in Inner Mongolia. The aims were to assess whether the MDAS demonstrated good psychometric properties in clinically depressed Chinese patients for the scale to be factor analysed on a Chinese construct of depression symptomatology to show cultural characteristics in China. This aim was achieved by carrying out Exploratory and Confirmatory factor analysis in separate studies. One hundred and seventy-one clinically depressed participants were recruited in Inner Mongolia. They were given the MDAS and Beck Depressive Inventory (BDI) and other scales to complete. The psychometric properties of the MDAS were tested regarding reliability and validity. Following which an Exploratory factor analysis (EFA) was run on MDAS. Several findings emerged in the study. First, the first factor extracted comprised of core psychological and affective symptoms conceptualized in the Western construct of depression. An interpersonal-cognitive factor was extracted as the second factor, followed by a third somatic factor in the cluster of symptoms. The results suggested that core affective and cognitive symptoms for diagnosis are universal across cultures, while Chinese individuals express interpersonal symptoms that characterized their collectivistic culture that emphasizes interpersonal harmony. Study 2 examined depressive symptoms in the antenatal period in Inner Mongolia women. Two-hundred and thirty-four women, mostly in their third trimester, were recruited in an antenatal hospital in Inner Mongolia. They completed the MDAS, Beck Depression Inventory (BDI) and Edinburgh Postpartum Depression Scale (EPDS). In exploring how depression in its item content is expressed and experienced by pregnant Chinese women, the study also searched for the best-fit model of MDAS on pregnant women in Inner Mongolia. It compared three factor models: the three-factor structure of MDAS from study 1, the hypothesized four-factor model corresponding to each subscale (emotional, cognitive, somatic and interpersonal), and the one-factor model corresponding to a unidimensional structure of the MDAS. A best-fit model was found for the four-factor model, supporting using the four hypothesized subscales of MDAS on pregnant women. In a subsequent step, the MDAS was validated and its psychometric properties were tested to show illustrated results. The findings supported measuring interpersonal symptoms in self-report measurements to measure different aspects of depressive severity in Chinese pregnant women. In particular, somatic symptoms should be considered with caution in screening and primary care. The finding has significant implications for assessing with self-report questionnaires, which are widely used in clinical settings. Study 3 was based on the same sample as study 2 and investigated risk factors associated with antenatal depression in China. China has undergone drastic socio-economic and political transformation in the last twenty years. Unfortunately, market reform is creating less favourable employment conditions, and the traditional value of male dominance still stands firmly in the society. Women are facing more financial insecurity and a tight birth control policy and growing stress in work-and-family balance. All these create an environment that could contribute to their depression that could be expressed in a different way from Western populations. Depression may also be underlined by different risk factors related to the social and cultural environment. This study measured demographic characteristics (including age, education, employment, week of gestation, first pregnancy), social support, social activity, work stress, and work-family balance and their relationship with depression. It included three parts. In part 1 participants were classified into depressed and non-depressed groups using EPDS>10 as the cut-off point for depression. The two groups were compared on demographic variables using the Chi-square test and on psychosocial risk factors using the Mann-Whitney U test. No significant demographic variable was found to distinguish the two groups, whereas self-esteem, work stress and social activities differed significant between depressed and non-depressed pregnant women. Bivariate correlations between psychosocial risk factors and depressive scales (MDAS, BDI and EPDS) gave rise to significant correlations between risk factors and each scale. In the third part hierarchical multiple linear regression analysis examined associations between social and demographic risk factors and depression. The results showed that work stress, work-and-family balance, social activity and social support were significantly associated with depressive severity in overall severity of depression (total MDAS score) and each domain of depressive severity (each subscale of MDAS). In conclusion, the three studies together provide novel insight into our understanding of depression within and outside of pregnancy in Chinese women, in terms of symptoms and risk factors. The Western conceptualization of depression possesses great validity across cultures, that the core symptoms of depression remain universal for diagnosis. Chinese cultural values and social environment are reflected in the cultural expressions of depressive symptoms especially in depressed individuals but less affective in pregnant women. As hypothesized, Chinese society influenced risk factors related to education and work-family balance in pregnant women. The result supported using a scale with a comprehensive interpersonal symptom checklist because it potentially captures Chinese expression and experience, which could be characterized by an interpersonal style of illness presentation. In addition, the best-fit four-factor model supported including interpersonal symptoms in self-report measures and they are also related to different risk factors from other domains of depressive symptoms. This could be linked to some unfavourable social and cultural influence pregnant Chinese women experience. The thesis gives rise to implications for potential clinical applications. The advancement of cultural characteristics in symptom contents in both clinical and pregnant population facilitates a better symptom checklist for assessing depression severity. In particular, it helps to modify existing self-report questionnaires with culturally sensitive symptoms for better discrimination of individuals

Validation of Chinese Multidimensional Depression Assessment Scale (MDAS) in Inner Mongolia pregnant women and risk factors of antenatal depression in Inner Mongolia in the era of one-child policy

BACKGROUND:Pregnancy involves physiological changes in reproductive and endocrine systems, and social role changes that can increase the risk of mental health problems. In China, greater emphasis has been given to postpartum depression and its negative impact on infant development. This study examined depression in pregnant women in Inner Mongolia, who are under the influence of cultural values of collectivism and social factors specific to China. Chinese society adheres firmly to traditional values, while market reform, birth-control policy, together with high parental investment in childcare and rearing construct a unique and sometimes unfavorable environment for Chinese women that may influence their depression expression. THE AIMS OF THIS STUDY ARE TWOFOLD:First, it validated the Chinese Multidimensional Depression Assessment Scale (MDAS), a holistic self-report questionnaire measuring depression severity in four domains of depression-emotional, somatic, cognitive and interpersonal in pregnant women in Inner Mongolia; second, it examined the influences of demographic characteristics (including age, education and employment), pregnancy characteristics (week of gestation, first pregnancy), self-esteem, social support, social activity, work stress, and work-family balance on depression. METHODS:A total of 234 pregnant women, mostly in their third trimester, were recruited in an antenatal hospital in Inner Mongolia and self-reported questionnaires were completed. RESULTS:Using Confirmatory factor analysis (CFA), MDAS gave rise to a best-fit four-factor model corresponding to each subscale when it was first developed. MDAS also reported high Cronbach's alpha (0.96) and good convergent validity. Using hierarchical multiple linear regressions with significant demographic variables controlled for, self-esteem, work-family conflict, and social support were found to be significant predictors for depression. CONCLUSIONS:MDAS is a valid scale to be used with Chinese pregnant women, especially in more collectivistic geographical areas. Risk factors specific to the Chinese context add insights to the experience of antenatal depression in China and contribute to understanding depression in from a global mental health perspective

Remarkable link between projected uncertainties of Arctic sea-ice decline and winter Eurasian climate

We identify that the projected uncertainty of the pan-Arctic sea-ice concentration (SIC) is strongly coupled with the Eurasian circulation in the boreal winter (December–March; DJFM), based on a singular value decomposition (SVD) analysis of the forced response of 11 CMIP5 models. In the models showing a stronger sea-ice decline, the Polar cell becomes weaker and there is an anomalous increase in the sea level pressure (SLP) along 60°N, including the Urals–Siberia region and the Iceland low region. There is an accompanying weakening of both the midlatitude westerly winds and the Ferrell cell, where the SVD signals are also related to anomalous sea surface temperature warming in the midlatitude North Atlantic. In the Mediterranean region, the anomalous circulation response shows a decreasing SLP and increasing precipitation. The anomalous SLP responses over the Euro-Atlantic region project on to the negative North Atlantic Oscillation–like pattern. Altogether, pan-Arctic SIC decline could strongly impact the winter Eurasian climate, but we should be cautious about the causality of their linkage.publishedVersio

Prevalence and impact of clinical violence towards nursing students in Hong Kong: a cross-sectional study

Objectives: Studies of violence towards nursing students (NSs) have been scattered mainly in the West and Middle East, but to date there have been no studies in Eastern countries. Differences in nursing education systems and cultures might have contributed to variations in incidences of clinical violence. The purpose of this study was to investigate the prevalence, associated factors and impact of clinical violence to NSs.Methods: This was a cross-sectional survey study. Convenience sampling was used to recruit university NSs from March to June 2012 in classroom settings in Hong Kong. A valid and reliable questionnaire was used to collect the data. 1297 questionnaires were distributed and 1017 NSs completed questionnaires, with a response rate of 78.41%.Results: Of the 1017 NSs, 37.3% (n=379) reported having experienced clinical violence during their nursing studies. The prevalence of verbal abuse (30.6%) was significantly greater than that of physical violence (16.5%). The perpetrators of verbal abuse were predominantly patients (66.8%), hospital staff (29.7%), university supervisors (13.4%) and patients’ relatives (13.2%). Patients (91.0%) were the greatest source of physically violent assaults. Compared with those who had experienced physical violence, the NSs who had experienced verbal abuse were more likely not to take action, and not to stop or report the incident, but were also more likely to tell their friends/families. Although the negative effects on emotions, clinical performance and the extent to which they were disturbed by the violence were significantly greater for verbal abuse than that for physical violence, their intention to leave the nursing profession after experiencing either verbal or physical violence was significantly higher after than before the experience (p<0.001).Conclusions: Our results found a moderately high prevalence of clinical violence among NSs. Provision and/or reinforcement of appropriate training about clinical violence in the nursing curricula is necessary

Brief advice and active referral for smoking cessation services among community smokers: a study protocol for randomized controlled trial

Abstract Background Most smokers do not use smoking cessation (SC) services although it increases successful quits. Passive referral providing SC information to smokers is commonly used in SC studies. Little was known about active referral in the community setting. This study aims to motivate community smokers to quit by brief SC advice using a validated AWARD model (Ask, Warn, Advise, Refer and Do-it-again) that adjunct with active referral of smokers to various SC services in Hong Kong. Methods/Design This is a single-blinded, parallel three-armed cluster randomized controlled trial (RCT) with two treatment groups of (1) brief SC advice using the AWARD model, active referral to SC services plus a referral card and a health warning leaflet (active referral group) and (2) brief SC advice using AWARD model and health warning leaflet (brief advice group) and a control group receives general very brief advice with a self-help booklet. A total of 1291 smokers will be recruited from 66 clusters (recruitment sessions) with 22 will be allocated to each of the two intervention and one control groups. SC ambassadors will be trained for delivering the interventions and conducting telephone follow-up. The primary outcomes are self-reported 7-days point prevalence (PP) abstinence at 3 and 6 months follow-up. Intention-to-treat principle and multi-level regressions will be used for data analysis. Discussion This is the first RCT on assessing a model combining brief advice and active referral to SC services among community smokers. The results will inform the practices of SC services and intervention studies. Trial registration NCT02539875 (ClinicalTrials.gov registry; registered retrospectively on 22 July 2015

Sport-specific balance ability in Taekwondo practitioners

ABSTRACT Fong SSM, Cheung CKY, Ip JY, Chiu JHN, Lam KLH, Tsang WWN. Sport-specific balance ability in Taekwondo practitioners. J. Hum. Sport Exerc. Vol. 7, No. 2, pp. 520-526, 2012. Taekwondo is a combat sport emphasizing on kicking techniques and dynamic footwork. Specialized balance ability is crucial for Taekwondo practitioners. This study aimed to compare (1) the postural stability during turning, and (2) the forward lunge distance between adolescent TKD practitioners and non-practitioners. Nineteen TKD practitioners (12 males, 7 females; Mean age ± SD: 15.58 ± 1.07 years) and nineteen control participants (13 males, 6 females; Mean age ± SD: 16.21 ± 0.98 years) were recruited in the study. Balance performance was assessed by the Forward Lunge Test and Step/Quick Turn Test with the NeuroCom Balance Master system. Forward lunge distance, turn time and turn sway were measured. TKD practitioners were found to turn faster by 35.37% (p=0.004) and sway less during turning by 15.23% (p=0.034) than non-practitioners. The forward lunge distance in TKD practitioners was 5.67% shorter than that in control participants (p=0.046). This study shows that TKD practitioners might have sport-specific balance ability. The findings of this study inspire the exploration of the longitudinal training effect of TKD so as to develop the evidence base for this exercise option to improve the postural control of adolescents with balance problems

Perceived social support, perceived stress, and quality of sleep among COVID-19 patients in Iran: assessing measurement invariance of the multidimensional scale of perceived social support across gender and age

BackgroundPerceived social support (PSS) plays a considerable role in mental health. The Multidimensional Scale of Perceived Social Support (MSPSS) is one of the most widely used scales, leading to much research evidence. The present study investigated its measurement model, equivalence across gender (male and female) and age groups (older patients= above 60 and non-older patients= below 60), and concurrent validity.MethodsA cross-sectional survey was conducted between March and October 2020, on patients hospitalized due to COVID-19 in Tehran, Iran. The scales were administered to 328 COVID-19 patients (54.6% male, aged 21 to 92) from two general hospitals; participants completed MSPSS (including friends, family, and significant others subscales), Pittsburgh Sleep Quality Index (PSQI, include sleep latency, subjective sleep quality, habitual sleep efficiency, sleep duration, use of sleep medication, daytime dysfunction, and sleep disturbances subscales), and the Perceived Stress Scale-10 (PSS-10, to assess patients’ appraisal of stressful conditions).ResultsThe MSPSS three-factor structure was confirmed among COVID-19 patients by Confirmatory Factor Analysis (CFA). The results support the MSPSS internal consistency and configural, metric, and scalar invariance across gender and age groups. Nevertheless, small but significant differences were found across ages based on the latent factor mean of the MSPSS from friends, with a lower mean level in older patients. The coefficients of Cronbach’s alpha (ranging from.92 to.96), the ordinal theta (ranging from.95 to.98), and Omega (ranging from.93 to.97) suggested high internal consistency of MSPSS. The concurrent validity of MSPSS was evidenced by its significant negative correlation with PSS-10 (τb = -.13, p &lt;.01) and also subjective sleep quality (τb = -.22, p &lt;.01), sleep disturbances (τb = -.26, p &lt;.001), and daytime dysfunction (τb = -.26, p &lt;.001).ConclusionsThe MSPSS was valid and reliable for measuring individuals’ perception of social support between males and females and older and non-older COVID-19 patients

O-GlcNAc Modification: Friend or Foe in Diabetic Cardiovascular Disease

O-Linked β-N-acetyl glucosaminylation (O-GlcNAcylation) is a dynamic post-translational modification that occurs on serine and threonine residues of cytosolic and nuclear proteins in all cell types, including those involved in the cardiovascular system. O-GlcNAcylation is thought to act in a manner analogous to protein phosphorylation. O-GlcNAcylation rapidly cycles on/off proteins in a time scale similar to that for phosphorylation/dephosphorylation of proteins. Several studies indicate that O-GlcNAc might induce nuclear localization of some transcription factors and may affect their DNA binding activities. However, at the cellular level, it has been shown that O-GlcNAc levels increase in response to stress and augmentation of this response suppresses cell survival. Increased levels of O-GlcNAc have been implicated as a pathogenic contributor to glucose toxicity and insulin resistance, which are major hallmarks of type 2 diabetes and diabetes-related cardiovascular complications. Thus, O-GlcNAc and its metabolic functions are not yet well-understood; focusing on the role of O-GlcNAc in the cardiovascular system is a viable target for biomedical investigation. In this review, we summarize our current understanding of the role of O-GlcNAc on the regulation of cell function and survival in the cardiovascular system