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This study investigated how relocation patterns affect disaster survivors' psychological stress on the diverse durations and spaces of relocation. It analyzed a 10-year data set of 1,236 families affected by 2009's Typhoon Morakot in Taiwan, identifying six relocation patterns through dynamic time warping (DTW). A hierarchical linear model was utilized, revealing the discernible impacts of environmental factors, sociocultural factors, and family-level socioeconomic factors on psychological stress. The study revealed that survivors who quickly found stable residences after the disaster initially experienced lower stress levels, but in the long term, their stress increased. Conversely, those with unstable residences experienced higher initial stress but lower long-term stress. Comparing similar patterns, we found that survivors who had more time for preparation and who sought opportunities, coped, or adapted to secondary stressors before long-distance relocation faced lower stress levels. These findings suggest that relocation patterns have a greater impact on the psychosocial stress of disaster survivors than time or relocation distance.

Suicidal risk has been a significant mental health problem. However, the predictive ability for repeated self-harm (SH) has not improved over the past decades. This study thus aimed to explore a potential tool with theoretical accommodation and clinical application by employing traditional logistic regression (LR) and newly developed machine learning, random forest algorithm (RF). Starting with 89 items from six commonly used scales (i.e., proximal suicide risk factors) as preliminary predictors, both LR and RF resulted in a better solution with much fewer items in two phases of item selections and analyses, with prediction accuracy 88.6% and 79.8%, respectively. A combination with 12 selected items, named LR-12, well predicted repeated self-harm in 6-month follow-up with satisfactory performance (AUC = 0.84, 95% CI: 0.76-0.92; cut-off point by 1/2 with sensitivity 81.1% and specificity 74.0%). The psychometrically appealing LR-12 could be used as a screening scale for suicide risk assessment., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The COVID-19 pandemic has induced traumatic and fear responses globally. Time attitudes, which refer to one's feelings toward the past, present and future, may have certain effects on psychological adaptations during this crisis period. This study employed a person-centered approach and a two-wave prospective design to investigate how people with different time attitude profiles change differently in their PTSD symptoms and COVID-19-related fears from a low-risk stage to the first big COVID-19 outbreak in Taiwan. Participants were 354 adults with a mean age of 27.79 years. The result provided support for the theoretical six-factor structure of the traditional Chinese Adolescent and Adult Time Inventory-Time Attitudes Scale (AATI-TA). Four clusters of time attitude profiles were identified (Positives, Negatives, Past Negatives and Pessimists). At both waves, Positives had lower levels of PTSD severity and COVID-19-related fears than most of the other groups, and the reverse was noted for Negatives. As for time effects, people across all profiles were significantly affected during the outbreak, but Negatives showed a greater increase in PTSD severity than other groups. In conclusion, mental health services should put efforts into early identification of those with highly negative time attitudes and implement interventions that nudge people toward a more balanced or positive attitude in each temporal frame, especially during adversity such as the COVID-19 pandemic., Competing Interests: Competing interestsThe authors have no competing interests to declare., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The widely used Centrality of Event Scale (CES) measures the extent that a traumatic event serves as a central component of self-identity, a reference point, and a turning point in an individual's life story. The present study aimed to develop a Chinese version of the CES and assess its reliability, criterion validity, and factor structure. Data were collected from three samples of trauma-exposed Taiwanese individuals (N = 939), including 420 earthquake survivors, 300 trauma-exposed community adults, and 219 trauma-exposed undergraduate students. We conducted an exploratory factor analysis and confirmatory factor analysis and compared the resulting models with a one-factor model and the originally proposed model. The results indicated that a new three-factor model, S-Bχ 2 (167, N = 519) = 687.01, p < .001, CFI = .95, IFI = .95, NNFI = .94, RMSEA = .078, SRMR = .047, might better represent the construct compared to the one-factor or originally proposed model. Furthermore, the Chinese CES demonstrated excellent internal consistency, Cronbach's αs = .89-.94; adequate 1-month reliability, rs = .54-.64, and 6-month temporal stability, rs = .52-.67; and good concurrent and predictive validity. The findings indicate that the Chinese version of the CES demonstrates good psychometric properties with a three-factor structure, and it could be used to assess event centrality among nonclinical trauma-exposed Taiwanese adults., (© 2022 International Society for Traumatic Stress Studies.)

Mental health is as crucial as physical health, but it is underappreciated by mainstream biomedical research and the public. Compared to the use of AI or robots in physical healthcare, the use of AI or robots in mental healthcare is much more limited in number and scope. To date, psychological resilience-the ability to cope with a crisis and quickly return to the pre-crisis state-has been identified as an important predictor of psychological well-being but has not been commonly considered by AI systems (e.g., smart wearable devices) or social robots to personalize services such as emotion coaching. To address the dearth of investigations, the present study explores the possibility of estimating personal resilience using physiological and speech signals measured during human-robot conversations. Specifically, the physiological and speech signals of 32 research participants were recorded while the participants answered a humanoid social robot's questions about their positive and negative memories about three periods of their lives. The results from machine learning models showed that heart rate variability and paralinguistic features were the overall best predictors of personal resilience. Such predictability of personal resilience can be leveraged by AI and social robots to improve user understanding and has great potential for various mental healthcare applications in the future.

The Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) is an updated DSM-5 version of the PDS, a widely used measure for PTSD. The PDS-5 has recently been shown to possess sound psychometric properties and awaits cross-cultural validation. The present study aimed first, to evaluate the psychometric properties of the Chinese version of the PDS-5; second, to evaluate alternative factor models of DSM-5 PTSD symptoms with multiple trauma samples. Data were collected from five samples of Taiwanese trauma-exposed individuals (total N = 903): 138 burn injury survivors, 403 earthquake survivors, 181 trauma-exposed young adults, 91 trauma-exposed undergraduates, and 90 female domestic violence survivors. The Chinese PDS-5 possessed excellent internal consistency (α s = .94-.95) and satisfactory five-week (r = .80) and one-year temporal stability (r = 0.76). Convergent, concurrent, and discriminant validity were also established. Consistent with recent studies, confirmatory factor analyses demonstrated the best fit of a seven-factor Hybrid model, followed by a six-factor Anhedonia model across multiple trauma samples., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification., Methods: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated., Results: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms., Conclusions: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression., (© 2019 Association for Child and Adolescent Mental Health.)

Objectives : The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes the diagnostic criteria for Internet gaming disorder (IGD). This study evaluated (1) the screening, diagnostic, and prevalence-estimated cutoff points of the Chen Internet Addiction Scale-Gaming Version (CIAS-G) for IGD in the DSM-5; and (2) the differences in the CIAS-G and subscale scores among individuals with IGD, regular gamers (RGs), and other control subjects. Methods: We recruited 69 participants with IGD, 69 RGs, and 69 healthy participants based on diagnostic interviews conducted by a psychiatrist according to DSM-5 IGD criteria. All participants completed the CIAS-G and were assessed using the clinical global impression scale. Results: The optimal screening and diagnostic cutoff points were 68 or more (sensitivity, 97.1%; specificity, 76.8%) and 72 or more (sensitivity, 85.5%; specificity, 87.0%) for IGD based on DSM-5 criteria, respectively. The 76 or more cutoff point had the highest number needed to misdiagnose and was the optimal prevalence estimated cutoff point. Conclusions: The screening cutoff point could be used to identify individuals with IGD for further diagnostic interviewing to confirm the diagnosis in the clinical setting or for two-stage epidemiological evaluation. The diagnostic cutoff point provides a provisional diagnosis of IGD when diagnostic interviewing is unavailable. The prevalence-estimated cutoff point could be used to estimate the prevalence of IGD in large-scale epidemiological investigations when further diagnostic interviewing is impractical. The clinical and epidemiological utility of CIAS-G warrants further study.

Insecure attachment cognitions, emotion recognition biases, and their interaction are important contributors to depression susceptibility. The present study, with a prospective longitudinal design, investigated the role of negative emotion recognition in moderating the linkage from insecure attachment cognitions to elevated depressive symptoms. A sample of 96 depression-prone individuals completed measures for attachment anxiety and attachment avoidance, depression symptom severity, and a computerized facial and prosodic emotion recognition task twice with a four-week interval. Results revealed that the interaction between attachment avoidance and fearful prosodic emotion recognition significantly predicted subsequent depressive symptoms. More specifically, greater attachment avoidance with lower accuracy of fearful prosodic emotions at baseline predicted an increase of depressive symptoms over four-week interval. However, no moderating role of emotion recognition in the linkage from attachment anxiety to depression persistence was noted. The present study demonstrates that attachment avoidance and negative emotion recognition may together contribute to the maintenance of depression. The findings may be pertinent to attachment avoidance-related deactivating strategy that appears to be a specific cultural forbearance way for emotion regulation in collectivistic societies. Potential applications and future research are then suggested., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Based on emotional processing theory, preexisting negative cognitions may contribute to the development of posttraumatic stress disorder (PTSD) symptoms. The present study prospectively examined the association between preexisting PTSD-related cognitions and subsequent acute PTSD symptoms, and the potential mediators of this association. We also compared the effect of preexisting depressive cognitions and preexisting PTSD-related cognitions on PTSD symptoms. In the current study, 810 Taiwanese undergraduates completed a baseline survey (T1), of which 73.1% (n = 592) participated in a second survey two months later (T2). Of those who completed both surveys, 97 experienced a trauma at least one week before T2; this group comprised the final sample. Hierarchical regression showed that preexisting PTSD-related cognitions (β = .38, p < .001, sr 2 = .117), but not preexisting depressive cognitions (β = .11, p = .315, sr 2 = .011), were a significant and substantial predictor of acute PTSD symptoms after we controlled for established pretrauma risk factors (i.e., gender, prior trauma, and prior psychological problems). Multiple mediation analysis revealed that negative appraisal of symptoms (a 1 b 1 = 0.90, 95% CI [0.16, 2.18], P M = .251) and trauma-related rumination (a 3 b 3 = 1.23, 95% CI [0.23, 2.86], P M = .341), but not trauma memory disorganization (a 2 b 2 = 0.65, 95% CI [-0.17, 1.92], P M = .182), significantly mediated between preexisting PTSD-related cognitions and acute PTSD symptoms. Our findings highlight the role of preexisting negative cognitions in acute PTSD symptomatology. The development of PTSD symptoms is likely determined by the interaction of risk factors before and after trauma., (Copyright © 2018 International Society for Traumatic Stress Studies.)

European and Northern American healthcare authorities increasingly encourage the use of Patient Reported Outcome Measures (PROMs) that complement clinical and laboratory assessments to help holistically evaluate reconstructive outcomes. This is the first study to evaluate PROMs in cleft lip/palate patients who have, or have not, undergone secondary alveolar bone grafting (SABG).A PROMs study was conducted; 40 consecutive consenting cleft lip/palate children between 8 and 14 years old were included. Twenty patients did, and 20 patients did not, have SABG. PROMs scores from children and parents in the 2 groups were compared.Forty patients completed the trial. No significant differences in total score from the Chang Gung Short Form-15 (CGSF-15) were found between children and their parents. Children with SABG reported no more oral-nasal regurgitation than children without SABG, but tended to report more nasal obstruction. There were no statistically significant differences in parent reported outcomes between the 2 groups.Cleft lip/palate patients who underwent SABG reported significantly less nasal regurgitation and more nasal obstruction compared to those patients who did not undergo SABG., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Greater risk of post-traumatic stress disorder (PTSD) is seen in individuals exposed to interpersonal traumatic events. Based on an attachment perspective, interpersonal trauma exposure may activate one's attachment insecurity system and disrupt affect, behaviour and interpersonal function, which may in turn create more difficulties to cope with interpersonal traumas and exacerbate PTSD symptomatology. The present study examined whether attachment anxiety relative to attachment avoidance would be a stronger predictor of greater PTSD symptoms following interpersonal traumas versus impersonal traumas in a Taiwanese sample. One hundred and sixty-two trauma-exposed Taiwanese young adults completed the measures of symptoms of depression, anxiety and PTSD, and attachment anxiety and attachment avoidance. In this Taiwanese study, higher attachment anxiety was observed in individuals who were exposed to interpersonal traumas. The interpersonal trauma group reported greater PTSD symptoms than did the impersonal trauma group. Specifically, after controlling for age, occurrence of trauma and distress of trauma, attachment anxiety, but not attachment avoidance, predicted more PTSD total severity and avoidance symptoms in the interpersonal trauma group. The findings may be pertinent to attachment anxiety-related hyperactivating strategies, as well as specific cultural values and a forbearance strategy applied to regulate traumatic distress in a collectivist society. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Introduction: Patients with social anxiety disorder (SAD) have a cognitive preference to negatively evaluate emotional information. In particular, the preferential biases in prosodic emotion recognition in SAD have been much less explored. The present study aims to investigate whether SAD patients retain negative evaluation biases across visual and auditory modalities when given sufficient response time to recognise emotions., Methods: Thirty-one SAD patients and 31 age- and gender-matched healthy participants completed a culturally suitable non-verbal emotion recognition task and received clinical assessments for social anxiety and depressive symptoms. A repeated measures analysis of variance was conducted to examine group differences in emotion recognition., Results: Compared to healthy participants, SAD patients were significantly less accurate at recognising facial and prosodic emotions, and spent more time on emotion recognition. The differences were mainly driven by the lower accuracy and longer reaction times for recognising fearful emotions in SAD patients. Within the SAD patients, lower accuracy of sad face recognition was associated with higher severity of depressive and social anxiety symptoms, particularly with avoidance symptoms., Conclusion: These findings may represent a cross-modality pattern of avoidance in the later stage of identifying negative emotions in SAD. This pattern may be linked to clinical symptom severity.

Smartphone addiction is considered a form of technological addiction that has attracted increasing attention. The present study developed and validated the short-form Smartphone Addiction Inventory (SPAI-SF) and established cutoff point for screening smartphone addiction based on diagnostic criteria established by psychiatric interview. A total of 268 participants completed an online survey that collected demographic data, smartphone use behaviours, and responses to the 26-item SPAI. Each participant also completed a psychiatric interview. Confirmatory factor analysis (CFA) revealed that the 10-item SPAI-SF replicated the structure of original 26-item SPAI accurately, yielding a four-factor model consisting of compulsive behaviour, functional impairment, withdrawal, and tolerance. For maximal diagnostic accuracy, a cutoff point of 24/25 best discriminated cases of smartphone addiction from diagnostic negatives. The present findings suggest that both the 26-item SPAI and SPAI-SF manifest the four constructs of behavioural addiction and the characteristics of smartphone addiction. The cutoff point determined by psychiatrists' diagnostic interview will be useful for clinical screening and epidemiologic research., (Copyright © 2016 John Wiley & Sons, Ltd.)

Background & Problems: Incontinence associated dermatitis (IAD) is a common skin disorder in critical patients who suffer from fecal incontinence. Symptoms of IAD include pain, redness, swelling, and, in some cases, secondary infections. IAD is thus a major problem faced in critical nursing care. The incidence of incontinence associated dermatitis averaged 34.72% at the intensive care unit in our hospital from October to December 2013. The factors that we identified as associated with IAD included: (1) Nurses: incorrect nursing care and insufficient IAD-related knowledge among nurses; (2) DEVICES: lack of skin barrier products and the use of diapers with poor air ventilation; (3) Regulations: lack of IAD care standards and lack of auditing oversight; (4) Patient problems: skin edema, incontinence, and medication use., Purpose: To decrease the incidence of IAD from 34.72% to 22%., Methods: The authors searched the Cochrane, PubMed, CINAHI, and Nursing Reference Center databases for relevant articles that were published from 2000 to 2014. Fifty studies were identified and four evidence-based references were selected for follow-up assessment. Levels of evidence were at levels 2 and 3. We designed an intervention that: (1) set a high-risk notice to increase awareness; (2) held six in-service training programs; (3) developed nursing standards and designed e-learning education lessons that specifically targeted reducing the incidence of IAD; (4) established a regular audit system., Result: The incidence of IAD decreased from 34.72% pretest to 19.8% posttest (posttest period: April - October 2014)., Conclusion: This project effectively reduced the incidence of IAD in high-risk patients in our intensive care unit. The authors established evidence-based interventions that significantly improved patient outcomes.

A growing number of studies indicate that posttraumatic cognitions play a crucial role in the development and maintenance of posttraumatic stress disorder (PTSD). However, the effects of posttraumatic cognitions on general psychopathology beyond PTSD remain unclear. The current study aimed to validate the Chinese version of the Child Posttraumatic Cognitions Inventory (CPTCI-C) and to investigate the relationship between posttraumatic cognitions and psychopathology. A community sample of 285 school-aged children and adolescents (aged 9-17, 160 [56.1 %] female) reported their trauma-related cognitions on the CPTCI-C and completed measures of symptoms of PTSD, depression, and generalized anxiety. Parents reported their children's internalizing and externalizing problems. We validated a revised version of the CPTCI-C based on the results of confirmatory factor analyses. The resulting evidence suggests that this revised CPTCI-C possesses good internal consistency, fair 6-week temporal stability, and good concurrent validity. In addition to significant correlations between posttraumatic cognitions and internalizing and externalizing psychopathology, after controlling for age, gender, and trauma types, both the revised CPTCI-C subscale scores conveyed unique contributions to psychological distress while only the maladaptive appraisals of the trauma remained weakly associated with externalizing problems. Structural equation modeling analysis showed that maladaptive appraisals of the trauma had a direct longitudinal impact on chronic PTSD severity. No mediation effect of posttraumatic cognitions on the relationship between acute and chronic PTSD activity was observed. The implications of our findings are discussed for the specificity of posttraumatic cognitions to posttraumatic internalizing psychopathology and cognitive interventions that target negative trauma-related cognitions.

This longitudinal study investigated the prevalence, predictors, and related factors for Internet addiction among elementary and junior high school students in Taiwan. A convenient sample of grades 3, 5, and 8 students (n = 1153) was recruited from six elementary and one junior high schools. They were assessed during the beginning and the end of the spring semester of 2013. Internet addiction was examined by the Chen Internet Addiction Scale (CIAS). Other factors were screened using the Chinese version of the Autism Spectrum Quotient (AQ) for autistic trait, the Parental Bonding Instrument (PBI) for parenting, the Family APGAR for family support, the Social Adjustment Inventory for Children and Adolescents for social function, and the Swanson, Nolan, and Pelham, version IV scale (SNAP-IV) for ADHD symptoms. The prevalence of Internet addiction decreased from 11.4% to 10.6%. Male, low family support, poor social adjustment, and high ADHD-related symptoms were related to Internet addiction. However, there was an inverse relationship between autistic traits and Internet addiction. Further, its predictivity could be accounted by poor academic performance, male, and protective parenting style. Internet addiction is not uncommon among youths in Taiwan. The predictors identified in this study could be the specific measures for the development of a prevention program for Internet addiction in the youth population., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Posttraumatic growth (PTG) is viewed as a positive psychological change resulting from a struggle with trauma. A number of trauma-related factors have been proven effective in predicting PTG; however, the effects of pretrauma psychological factors on PTG have not been adequately evaluated (e.g., using a prospective design). This prospective study examined the effects of pretrauma psychological factors (e.g., coping styles, prior trauma) on PTG. In total, 810 Taiwanese undergraduate students were recruited for a baseline survey (Time 1), among whom 592 completed a survey 2 months later (Time 2). Data from 110 participants who had experienced trauma between Time1 and Time 2 were used for analysis. Among the pretrauma factors examined at baseline, only rumination and distractive style were positively correlated with PTG. The posttrauma factors based on Calhoun and Tedeschi's model (i.e., core belief challenge, deliberate rumination, and social support) were also positively correlated with PTG. A hierarchical regression analysis showed that pretrauma coping styles had an incremental effect on PTG beyond posttrauma predictors. Deliberate rumination signifciantly mediated the relationship between pretrauma rumination and PTG. These findings highlight the role of pretrauma psychological factors in PTG and present further support for Calhoun and Tedeschi's model of PTG., ((PsycINFO Database Record (c) 2015 APA, all rights reserved).)

Aims: Attribution theory claims that people who are stigmatized experience more negative emotional and behavioral reactions from others when they are thought to be responsible for their problems. Accordingly, this study proposed a neurobiology-based psychoeducational intervention, which attempted to reduce people's blameworthy attitudes toward and social distance from depressed individuals., Methods: One hundred and thirty-two college students were randomly assigned to an experimental and control group. Participants in the experimental group received a 30-min lecture on neurobiology-based psychoeducation for depressive disorders, and were asked to fill out questionnaires before and 2 weeks after the intervention. The control group, with no intervention, also filled out the same questionnaires before and 2 weeks after the experiment. The main contents of the neurobiology-based psychoeducation concerned the neurotransmission processes and biological mechanisms of depression, in order to emphasize the biological attribution of depression., Results: An ancova indicated that the neurobiology-based psychoeducational intervention significantly elevated the biological attribution of depression and reduced the social distance from depressed individuals. Psychological blameworthy attitudes toward depression, however, did not significantly change., Conclusions: Through a brief psychoeducation program about depression, knowledge of neuroscience could lead to positive benefits. Public awareness that depression can be effectively prevented and treated may be a way in which people can accept depressed individuals. Further studies are needed to certify the mechanisms of the effect of neurobiology-based psychoeducation., (© 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.)

Objective: The aim of this study was to develop a self-administered scale based on the special features of smartphone. The reliability and validity of the Smartphone Addiction Inventory (SPAI) was demonstrated., Methods: A total of 283 participants were recruited from Dec. 2012 to Jul. 2013 to complete a set of questionnaires, including a 26-item SPAI modified from the Chinese Internet Addiction Scale and phantom vibration and ringing syndrome questionnaire. There were 260 males and 23 females, with ages 22.9 ± 2.0 years. Exploratory factor analysis, internal-consistency test, test-retest, and correlation analysis were conducted to verify the reliability and validity of the SPAI. Correlations between each subscale and phantom vibration and ringing were also explored., Results: Exploratory factor analysis yielded four factors: compulsive behavior, functional impairment, withdrawal and tolerance. Test-retest reliabilities (intraclass correlations  = 0.74-0.91) and internal consistency (Cronbach's α = 0.94) were all satisfactory. The four subscales had moderate to high correlations (0.56-0.78), but had no or very low correlation to phantom vibration/ringing syndrome., Conclusion: This study provides evidence that the SPAI is a valid and reliable, self-administered screening tool to investigate smartphone addiction. Phantom vibration and ringing might be independent entities of smartphone addiction.

The DSM-5 proposed the diagnostic criteria of Internet gaming disorder (IGD) and suggested that more evidence is necessary before it is included as a standard disorder in the DSM system. The aims of this study were to: 1) evaluate the diagnostic validity of individual criteria of IGD in the DSM-5 and the criteria of craving and irritability; 2) determine the optimal cut-off point for the IGD criteria in the DSM-5. We recruited 75 subjects with IGD, 75 without IGD, and 75 in remission from IGD based on the Diagnostic Criteria of Internet Addiction for College Students (DC-IA-C). All participants underwent a diagnostic interview based on the diagnostic criteria of IGD in the DSM-5 and completed the CIAS and QGU-B. Except for the "deceiving" and "escape" criteria, all criteria of IGD had diagnostic accuracy ranging from 77.3% to 94.7% to differentiate university students with IGD from remitted students. The criterion of craving had diagnostic accuracy of 88% and the criteria of irritability had an accuracy of 68.7%. Fulfilling 5 or more criteria of IGD in the DSM-5 was the best cut-off point to differentiate young adults with IGD from healthy or remitted users., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Patients with schizophrenia perform significantly worse on emotion recognition tasks than healthy participants across several sensory modalities. Emotion recognition abilities are correlated with the severity of clinical symptoms, particularly negative symptoms. However, the relationships between specific deficits of emotion recognition across sensory modalities and the presentation of psychotic symptoms remain unclear. The current study aims to explore how emotion recognition ability across modalities and neurocognitive function correlate with clusters of psychotic symptoms in patients with schizophrenia., Methods: 111 participants who met the DSM-IV diagnostic criteria for schizophrenia and 70 healthy participants performed on a dual-modality emotion recognition task, the Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version (DANVA-2-TW), and selected subscales of WAIS-III. Of all, 92 patients received neurocognitive evaluations, including CPT and WCST. These patients also received the PANSS for clinical evaluation of symptomatology., Results: The emotion recognition ability of patients with schizophrenia was significantly worse than healthy participants in both facial and vocal modalities, particularly fearful emotion. An inverse correlation was noted between PANSS total score and recognition accuracy for happy emotion. The difficulty of happy emotion recognition and earlier age of onset, together with the perseveration error in WCST predicted total PANSS score. Furthermore, accuracy of happy emotion and the age of onset were the only two significant predictors of delusion/hallucination. All the associations with happy emotion recognition primarily concerned happy prosody., Discussion: Deficits in emotional processing in specific categories, i.e. in happy emotion, together with deficit in executive function, may reflect dysfunction of brain systems underlying severity of psychotic symptoms, in particular the positive dimension.

This study explored how individuals in Taiwan perceive the risk of earthquake and the relationship of past earthquake experience and gender to risk perception. Participants (n= 1,405), including earthquake survivors and those in the general population without prior direct earthquake exposure, were selected and interviewed through a computer-assisted telephone interviewing procedure using a random sampling and stratification method covering all 24 regions of Taiwan. A factor analysis of the interview data yielded a two-factor structure of risk perception in regard to earthquake. The first factor, "personal impact," encompassed perception of threat and fear related to earthquakes. The second factor, "controllability," encompassed a sense of efficacy of self-protection in regard to earthquakes. The findings indicated prior earthquake survivors and females reported higher scores on the personal impact factor than males and those with no prior direct earthquake experience, although there were no group differences on the controllability factor. The findings support that risk perception has multiple components, and suggest that past experience (survivor status) and gender (female) affect the perception of risk. Exploration of potential contributions of other demographic factors such as age, education, and marital status to personal impact, especially for females and survivors, is discussed. Future research on and intervention program with regard to risk perception are suggested accordingly., (© 2012 Society for Risk Analysis.)

Objective: This study aimed to investigate child physical abuse (CPA) while taking into account the more rigorous definitions of CPA in the Chinese societies. The prevalence of CPA and CPA-related PTSD were estimated, together with the examination of peri-traumatic subjective reactions and their impacts on PTSD., Methods: In a Taiwanese sample of 1966 4th to 8th graders, the Chinese version of UCLA PTSD Reaction Index for DSM-IV (Steinberg, Brymer, Decker, & Pynoos, 2004) was used to investigate the lifetime exposure to CPA. A sub-sample of 236 traumatized CPA victims was examined with respect to related PTSD symptoms., Results: Thirty-four percent of the children had been exposed to CPA. The estimated current prevalence of full and partial PTSD was 13.6% and 16.9%, respectively., Conclusions: The current CPA prevalence was found to be higher than the Western countries, but lower than the previous findings in other East Asian societies. The full PTSD prevalence was close to the findings in the Western countries, whereas sub-clinical PTSD was less observed in Taiwan. Peri-traumatic subjective reactions, that is, Criterion A2 and perceived threat, were shown to be major predictors of PTSD symptom severity. The role of attitudes of child discipline in the Chinese societies in the prevalence of CPA and CPA-related PTSD is discussed., Practice Implications: By providing explicit epidemiological information of CPA and CPA-related PTSD in Taiwan, the current study extends our understanding of CPA and CPA-related PTSD more broadly from Western countries to the Eastern societies. By separately investigating CPA relating to different perpetrators, cross-study comparison is enhanced. In the current study, the significance of considering cultural background in defining CPA and examining CPA-related PTSD was pointed out. Meanwhile, the role of victims' subjective reactions in the psychopathology of PTSD is highlighted. The findings and discussions could contribute for generating a more sophisticated clinical practice, especially with Asian or Chinese cases., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This prospective longitudinal study examined two competing models, a traditional social support model and a supportive and detrimental social relations model, to clarify the association of PTSD symptoms with supportive and detrimental social relations. Seven-hundred five adolescents living near the epicenter of the Taiwan Chi-Chi Earthquake participated in the study. The models were evaluated and cross-validated using structural equation modeling. The supportive and detrimental social relations model appeared to be a better fit. After further evaluation of three nested versions of the supportive and detrimental social relations model, detrimental social relations was found to partially mediate the relationship between PTSD symptoms 1 and 2 years following the earthquake. The findings suggest that helping adolescents deal with detrimental social relations can contribute to postdisaster adjustment.

Introduction: Facial affect recognition deficits may represent specific deficits and contribute to social dysfunction in patients with schizophrenia. Whether their impacts on social dysfunction are independent to those caused by deficits in basic neurocognition and clinical symptoms needs to be further delineated., Method: Association patterns between affect recognition and basic neurocognitive abilities in 40 acute and 33 stable patients with schizophrenia were compared to explore whether their interrelationships changed across clinical stages. The independent contribution of affect recognition deficits to social dysfunction was explored by multivariate models controlling for general intellectual ability, basic neurocognition, and clinical symptoms., Results: Affect recognition deficits were associated with social role performances, self-care, and contributed independently to global social functioning in stable patients but not in acute patients. Conversely, affect recognition deficits were associated with impaired basic neurocognitions in acute patients but not in stable patients., Conclusion: In stabilized community patients with schizophrenia, affect recognition deficits were relatively independent to basic neurocognition and had significant social functional consequences.

The aims of this study were to develop diagnostic criteria of Internet addiction for college students (DC-IA-C) with diagnostic interviews and to establish the optimal cutoff points of the Chen Internet Addiction Scale (CIAS) for the purposes of screening for and making the diagnosis of Internet addiction. A total of 216 college students (132 male and 84 female) were recruited in the study. The results demonstrated that 5/6 cutoff points of criteria A in DC-IA-C had the best diagnostic accuracy (95.9%). Besides, 63/64 and 67/68 cutoff points of the CIAS were evaluated to be the best screening and diagnostic cutoff points, respectively. The DC-IA-C can provide health care professionals with a means to diagnose and communicate about Internet addiction among college students, and the screening and diagnostic cutoff points of CIAS could provide a screening instrument or a discriminative instrument in surveys for Internet addiction among college students.

The posttraumatic cognitions inventory (PTCI) is a 33-item self-report measure assessing dysfunctional beliefs following trauma. This study reported the factor structure and psychometric properties of the Chinese version of the PTCI (PTCI-C), as well as its relationship with PTSD symptoms. Study participants consisted of 240 traumatized college students in Taiwan. Confirmatory factor analyses indicated adequate replication of the original three-factor structure of the PTCI after eliminating four cross-loaded items. The 29-item PTCI-C was thus developed and its psychometric data were evaluated. This measure displays good internal consistency, test-retest stability, concurrent validity, and discriminative validity. The study findings are discussed in terms of intercultural differences in attribution style and the possible contribution of negative cognitions to PTSD development.

Aims: The aim of the present study was to compare psychiatric symptoms between adolescents with and without Internet addiction, as well as between analogs with and without substance use., Methods: A total of 3662 students (2328 male and 1334 female) were recruited for the study. Self-report scales were utilized to assess psychiatric symptoms, Internet addiction, and substance use., Results: It was found that Internet addiction or substance use in adolescents was associated with more severe psychiatric symptoms. Hostility and depression were associated with Internet addiction and substance use after controlling for other symptoms., Conclusions: This result partially supports the hypothesis that Internet addiction should be included in the organization of problem behavior theory, and it is suggested that prevention and intervention can best be carried out when grouped with other problem behaviors. Moreover, more attention should be devoted to hostile and depressed adolescents in the design of preventive strategies and the related therapeutic interventions for Internet addiction.

Background: Orthognathic surgery has been increasingly performed in the authors' country. To ascertain the increased satisfaction that comes with surgery, it is necessary to evaluate the patient's motivation for surgery., Methods: Seventy-four female patients were evaluated before surgery. The control group consisted of 124 female patients. All participants completed the measures of perception of appearance, body image, stigma, and quality of life on an individual basis. These measures were tested, with satisfactory reliability and validity., Results: Patients scored significantly lower than the control group on the measures for perception of appearance, stigma of surgery, and quality of life, but higher on appearance orientation and stigma of deformity. Correlation analyses revealed various patterns of intercorrelations of subscales of stigma and body image in both groups. Regression analysis yielded three significant predictors for surgery motivation (i.e., satisfaction of facial areas, stigma of surgery, and appearance orientation), altogether accounting for 46.2 percent of the total variance., Conclusions: Given the broadly known importance of body image in seeking surgery, it may be equally important to take stigma into consideration of the patient's motivation. Further investigations are needed.

The aim of the study is to examine the differences in the diversity of family factors between adolescents with and without Internet addiction and substance use experience. A total of 3662 students (2328 boys and 1334 girls) were recruited from seven junior high schools, six senior high schools, and four vocational high schools in southern Taiwan. Internet addiction and substance experience were classified according to the score of Chen Internet Addiction Scale Questionnaires for Experience of Substance use. The family factors assessed included perceived family satisfaction, family economic status, parents' marriage status, care-givers, the frequency of intra-family conflict, families' habitual alcohol use, and perceived parents' or care givers' attitude toward adolescents' substance use. This study demonstrated that the characteristics of higher parent-adolescent conflict, habitual alcohol use of siblings, perceived parents' positive attitude to adolescent substance use, and lower family function could be used develop a predictive model for Internet addiction in the multiple logistic regression analysis. The former three family factors were also sufficient in themselves to develop a predictive model for substance use experience. The results revealed that adolescent Internet addiction and substance use experience shared similar family factors, which indicate that Internet addiction and substance use should be considered in the group of behavioral problem syndromes. A family-based preventive approach for Internet addiction and substance use should be introduced for adolescents with negative family factors.

Obsessive-compulsive and impulsive behaviors co-occur in certain psychiatric conditions. Some have suggested that these disturbances constitute a spectrum of altered psychologies and behaviors that share an underlying neuropathology. We investigate here whether obsessive-compulsiveness and impulsivity reflect related psychological dimensions in a non-clinical adolescent population. Out of 720 high-school students, 672 and 682 completed a questionnaire interview with a Chinese version of the Maudsley Obsessive-Compulsive Inventory (MOCI) and the Barratt Impulsiveness Scale (BIS-11), respectively. Both MOCI and BIS-11 demonstrated good overall internal consistency, each with three major factors identified with Principal Component Analysis. In the 638 participants who completed both questionnaires, the total MOCI and BIS-11 scores did not correlate with each other. However, the MOCI factor "repetitive checking and attention to details" correlated negatively with the BIS-11 factor "inability to plan and look ahead" for all participants, and for males and females separately. The same MOCI factor also correlated negatively with the BIS-11 factors "lack of perseverance and self-control" and "novelty-seeking and acting without thinking" for all participants, and for females but not for males. The MOCI factor "doubt and intrusive thoughts" correlated positively with the BIS-11 factor "lack of perseverance and self-control" for all participants, and for males but not for females. These results suggested that the relationship between obsessive-compulsiveness and impulsivity as measured by the MOCI and the BIS-11 is complicated, with gender playing an important modulatory role. We discuss the relevance of these findings to developing a conceptual scheme to characterize and study the neurobiological basis of obsessive-compulsive and impulsive behaviors.

Background: The etiological factors and interrelations of juvenile delinquents, with psychiatric morbidity and substance abuse have been continuously debated. Cloninger's Tridimensional Theory of Temperament has been reported to predict patterns of substance abuse and comorbidity. In the current study, we aimed to examine the usability of the theory in predicting juvenile delinquency and substance abuse., Methods: Sixty consecutive and newly incarcerated male delinquents with history of substance abuse were recruited from a juvenile correctional facility in northwestern Taiwan from January 2002 through December 2003. All subjects were assessed of their temperament, behavioral problems, and psychiatric disorders on an individual base., Results: The juvenile delinquent subjects with childhood history of attention deficit and hyperactivity disorder (ADHD) were significantly younger, consumed less betel nuts, and had more siblings with history of drug abuse., Conclusion: Consistent with the results of Cloninger's studies, novelty seeking positively correlated to the amount of substance abuse, while harm avoidance inversely correlated in juvenile delinquents. Endemic trend of choice of substance abuse needs to be taken into consideration in future research projects.

Objective: This study aimed to examine the differences in personality characteristics between adolescents with and without Internet addiction and substance use experience as defined by the Tridimensional Personality Questionnaire (TPQ), and to compare personality characteristics among groups of adolescents with both Internet addiction and substance use experience (comorbid group), those with only Internet addition (Internet addiction group), those with only substance use experience (substance experience group), and those without Internet addiction or substance use experience (control group)., Method: In the cross-sectional investigation, we recruited 3662 students (2328 boys and 1334 girls) from high schools in southern Taiwan. Our investigation was conducted using the TPQ, the Chen Internet Addiction Scale, and Questionnaires for Experience in Substance Use., Results: Adolescents with Internet addiction were more likely to have substance use experience. High novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) predicted a higher proportion of adolescents with Internet addiction. High NS, low HA, and low RD predicted a higher proportion of adolescents with substance use experience. Of the 4 groups, the Internet addiction group had the highest HA scores and the comorbid group had the lowest HA scores., Conclusion: Adolescents with high NS and low RD should be provided with effective strategies for preventing Internet addiction and substance use. In addition, the Internet addiction group and the comorbid group should be provided with different preventative strategies focused on HA.

Existing literature shows that the level of biological attribution and stigma of depression influences willingness to seek help. However, no study has used experimental methods to explore the question whether increasing biological attribution and decreasing blameworthy attitude towards depression will enhance willingness to seek help. In so doing, 299 college students were randomly assigned to biological, destigmatization, combined, and control groups. The measures included the Biological Attribution Scale, Psychological Blame Scale, and Help-Seeking Willingness Scale. The data were analyzed by a 2 x 2 ancova (with or without biological attribution education x with or without destigmatization education) on willingness to seek professional help which was assessed 2 weeks later, with adjusting for help-seeking willingness at baseline. Results showed that biological education had a significant main effect to elevate help-seeking willingness, but destigmatization education did not. In addition, no interaction effect existed between the two independent variables. The authors suggested that biological education makes people legitimize depression as a disease entity, so that it would be a practical approach to increase people's motivation to solve their emotional afflictions, especially in societies that emphasize emotional constraints. In contrast, although destigmatization information reduces people's negative appraisals to the depressed individuals, it does not go a step further to increase people's motivation to seek professional help. Further studies are needed to clarify the mechanisms of educational effects.

The aim of this study was to establish the optimal cut-off points of the Chen Internet Addiction Scale (CIAS), to screen for and diagnose Internet addiction among adolescents in the community by using the well-established diagnostic criteria of Internet addiction. This survey of 454 adolescents used screening (57/58) and diagnostic (63/64) cut-off points of the CIAS, a self-reported instrument, based on the results of systematic diagnostic interviews by psychiatrists. The area under the curve of the receiver operating characteristic curve revealed that CIAS has good diagnostic accuracy (89.6%). The screening cut-off point had high sensitivity (85.6%) and the diagnostic cut-off point had the highest diagnostic accuracy, classifying 87.6% of participants correctly. Accordingly, the screening point of the CIAS could provide a screening function in two-stage diagnosis, and the diagnostic point could serve as a diagnostic criterion in one-stage massive epidemiologic research.

The aims of the present study were to develop diagnostic criteria of Internet addiction for adolescents and to examine the discriminating potential and validity of diagnostic criteria by an empirical community study among adolescent populations. We developed 13 candidate diagnostic criteria for characteristic symptoms of Internet addiction in adolescents. A total of 468 adolescents completed the Chen Internet Addiction Scale (CIAS) and were systematically assessed for Internet-using behaviors by seven psychiatrists using the diagnostic interview schedule. The sensitivity, specificity, and diagnostic accuracy of the 13 candidate diagnostic criteria were analyzed with references to the interviewers' global clinical impressions and CIAS results. The cutoff point of the diagnostic criteria to differentiate the Internet-addicted subjects with nonaddicted ones was then determined by the best diagnostic accuracy and the receiver operating characteristic curve. This study selected nine of the 13 candidate diagnostic criteria to construct the diagnostic criteria of Internet addiction for adolescents, which were composed of three main criteria: characteristic symptoms of Internet addiction, functional impairment secondary to Internet use, and exclusive criteria. The diagnostic criteria had high diagnostic accuracy, specificity, negative predictive value, accepted sensitivity, and accepted positive predictive rate. The validity of the diagnostic criteria proposed in this study was further confirmed by comparing the demographic and Internet-using characteristics between those with and without Internet addiction. The diagnostic criteria for Internet addiction can provide health care professionals with a means to communicate and make comparisons of clinical cases.

The aim of this study was to evaluate the extent to which gender and other factors predict the severity of online gaming addiction among Taiwanese adolescents. A total of 395 junior high school students were recruited for evaluation of their experiences playing online games. Severity of addiction, behavioral characteristics, number of stressors, and level of satisfaction with daily life were compared between males and females who had previously played online games. Multiple regression analysis was used to explore gender differences in the relationships between severity of online gaming addiction and a number of variables. This study found that subjects who had previously played online games were predominantly male. Gender differences were also found in the severity of online gaming addiction and motives for playing. Older age, lower self-esteem, and lower satisfaction with daily life were associated with more severe addiction among males, but not among females. Special strategies accounting for gender differences must be implemented to prevent adolescents with risk factors from becoming addicted to online gaming.

We explore the temporal attention function in a non-clinical sample of adolescents varying in impulsivity, as assessed with the Barratt Impulsiveness Scale. In a Rapid Serial Visual Presentation task, in which two targets (T(1) and T(2)) were presented in close temporal proximity among distractors, participants tried to identify T(1) and detect T(2) in one (dual-task) experiment and only to detect T(2) in a second, control (single-task) experiment. The sensitivity of T(2) detection was analyzed using signal detection theory. The attentional blink -- the impairment in T(2) detection following the identification of T(1) -- was increased in magnitude and protracted in adolescents with high impulsivity, compared with those with low impulsivity. Moreover, a few more participants with high impulsivity appeared to have a blink temporally weighing toward a later time, an observation also made in children with attention deficit hyperactivity disorder (ADHD) in an earlier study. Taken together, these findings suggest impairment in temporal attention in adolescents with high impulsivity. As in ADHD children, a gating deficit may play a central role in this attention impairment.

Background: It is often difficult to predict the timing and frequency of asthma attacks. In addition to interrupting the daily life of both the affected child and his/her family, asthma can also pose sudden danger to a child. Based on clinical observations, many asthma-affected children and their parents must constantly adjust themselves to the uncertainty of the disease, which leads to increased stress on the family. The use of care maps has demonstrated increased efficiency and effectiveness in the care of asthma patients from a variety of settings., Objective: We designed this study to construct and evaluate a care map for asthmatic children in Taiwan. Specific attention was placed on comparing the study and control subjects by parental knowledge of asthma, medication used for asthma, hospital readmission, and health care resource usage., Subjects and Methods: The care map was constructed by in-depth interviews with eight sets of parents of children with asthma. Forty-four parents of 42 asthma children were randomized into two groups in the Allergic Clinic of the Chang Gung Children's Hospital. The experimental group of 22 parents received individual instruction and training sessions in addition to the regular care provided to the control group of 22 parents., Results: Forty-two children with asthma were surveyed in this study. To examine the reliability and validity of a care map for children with asthma, a quantitative survey was conducted with 42 outpatient parents with asthmatic children. There was less emergency room attending rate in experimental group (6/month; p<0.05) The understanding of the disease was much improved in parents of experimental group (13.85+/-1.04 vs. 10.91+/-2.14; p<0.01). Furthermore, parents acquired a more positive attitude to asthma, and almost all of the control group had irregular follow-ups by a physician and had irregular use of medication., Conclusion: This study emphasizes that a care map in children with asthma (CACM) can be used to educate parents in how to provide the best treatment plan for their children. This study also shows how a CACM can help parents train their children in the best behaviors during asthma attacks. Empathetic assessment and elimination of cultural barriers, a well-designed educational program, and a mutually developed treatment plan could significantly improve the quality of life for families and specific asthma outcomes.

Children with cancer face both physical and psychosocial challenges. However, there is not enough empirical evidence in Taiwan regarding how they and their families cope with their illness. The purpose of the present study was to explore the psychosocial impact of cancer on target children and their families as well as the degree of depression experienced by these children. Twenty-four pediatric cancer patients, aged 8 through 17 years, completed the Chinese version of Children Depression Inventory (CDI). Both these patients and 18 parents completed questionnaires about their psychosocial adjustment since the diagnosis of cancer. The results showed: (i) patients did not perceive significant changes in their psychosocial adjustment, whereas parents indicated significantly lower mood of patients and a slight decrease in the number of friends; (ii) both parents and siblings showed positive adjustment; and (iii) there was neither significant difference on the CDI scores between the pediatric cancer patients and a normative group, nor significant relationships between patients' CDI scores and demographic characteristics of both patients and their parents, parenting attitudes, as well as variables related to the illness. Lastly, the results are discussed in terms of issues of methodology and instruments. Possible direction for further investigations is suggested.