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Abstract Background Anxiety and depressive disorders, characterized by high incidence and functional impairments, are emotional disorders with shared etiological and maintenance mechanisms. Dialectical behavior therapy (DBT) is a promising approach for the transdiagnostic treatment of emotional disorders. Developing a brief DBT intervention can facilitate the adoption of evidence-based therapy. Methods This protocol is for a 3-year single-blinded, two-arm randomized controlled trial. Individuals with depressive or anxiety disorder will be randomly allocated to a modified DBT–informed transdiagnostic psychotherapy group or a treatment-as-usual group. The intervention group will receive DBT individual therapy for 15 weeks. Power analyses revealed that the cohort should include a minimum of 250 participants. Preintervention, postintervention, and follow-up (after 3 months) assessments will be conducted. Primary outcomes will be severities of depression and anxiety rated by blind assessors. Intent-to-treat and per-protocol analyses will be conducted using the hierarchical linear model. Effect sizes will be estimated using Cohen’s d. Result To the best of our knowledge, the proposed study will be the first randomized controlled trial to evaluate the efficacy of a modified DBT intervention in managing transdiagnostic emotional disorders in Chinese individuals. Conclusion This intervention is expected to improve clinical outcomes, daily functioning, and quality of life. The trial will enrich the empirical evidence for transdiagnostic interventions, facilitating the implementation of evidence-based therapy and reducing the high prevalence and challenges (e.g., disability) of emotional disorders in the Chinese population. Trial registration number NCT05989451

Abstract Background The short form of the Borderline Symptom List (BSL-23) is a self-rated instrument developed from the initial 95-item German version of the Borderline Symptom List (BSL-95). It is widely used among Chinese adults, but its applicability, factor structure and validity remain uncertain in adolescents. This study aimed to evaluate the psychometric properties of the Chinese Mandarin version of the BSL-23 in a sample of suicidal adolescents. Methods The Chinese Mandarin BSL-23 was given to 279 outpatient adolescents with self-injurious thoughts or behaviors. The factor structure, reliability, convergent validity, criterion-related validity and cut-off value were investigated. Results The Chinese Mandarin version of the BSL-23 demonstrated a one-factor structure and replicated the original version. The scale had high reliability and good test-retest stability. The Chinese Mandarin BSL-23 was correlated with depression, hopelessness, impulsivity, emotional dysregulation, self-esteem, loneliness, childhood trauma and parental bonding patterns evaluated with a variety of scales. The measure showed good criterion-related validity and predictive accuracy (AUC = 0.87) for self-injurious and suicidal adolescents with borderline personality disorder (BPD) at a cut-off point of 60/61 (mean score 2.60/2.65), with a sensitivity of 0.76 and specificity of 0.83. Conclusions The Chinese Mandarin version of the BSL-23 is a reliable and valid self-reported instrument to assess BPD symptomatology among suicidal adolescents.

Background: Data on self-harm (SH) repetition in non-Western adolescents are limited; this study is to survey the predictors. Methods: A total of 5879 adolescents (mean age 16.02 years) in Northern Taiwan were recruited. The participants filled in online questionnaires about their sociodemographic data, suicidality, depressive symptoms, self-esteem, social support, family discord, impulsivity, and alcohol and tobacco use at baseline (T1) and at the 1 year follow-up (T2). We used logistic regression analysis to examine the predictors of SH continuation. Generalized structural equation modeling (GSEM) was then estimated to analyze the treatable variables for both years and to investigate their relationships and mediating effects. Results: A total of 125 students were identified as being in the SH continuation group; while 470 students were identified as being in the SH stop group. The SH continuation rate was 21%; no significant gender difference was found. Logistic regression analysis showed that the predictors of SH continuation were low school ranking, poor quality of listening from relatives, use of the cutting method for SH, and a suicide plan in the past year at T1, and more depressed mood, use of the cutting method for SH, more suicide ideation and plans at T2. Similar predictors were found by GSEM; self-esteem at T1 and depressed mood at T2 were found to be mediators in the pathways. Conclusion: The continuation rate of SH was similar to that reported in Western countries. These predictors should be included in the treatment plan to prevent SH continuation.

Background: We designed this open-pilot study to investigate the efficacy and feasibility of incorporating the Interpersonal Effectiveness skills from Dialectical Behavior Therapy (DBT-IE) into a 3-h clinical communication workshop for registered nurses. Method: A convenience sample of registered nurses were invited. The Professional Fulfillment Index, Perceived Stress Scale, Empathy Index, the Interpersonal Reactivity Index, and measures regarding quality of life, anxiety, depression, and insomnia were completed. A subgroup of participants received the Objective Structured Teaching Examinations (OSTE). Pre- and post-workshop assessments were conducted to identify the most empathetic or validated responses from case scenarios and to assess the self-rated levels of confidence regarding the capability to select the best answer. The satisfaction of the participants with respect to the workshop content, process, and the lecturer were also collected. Paired t-test was used for statistical analysis. Results: Among the 164 participants of the clinical communication workshop, 72 consented and their pre- and post-results were analyzed. Post-workshop assessment revealed significant improvement in professional fulfillment (p = 0.014), interpersonal coping ability (p = 0.038), and decrease in dysfunctional coping style (p

IntroductionThe treatment effect of bright light therapy (BLT) on major depressive disorder (MDD) has been proven, but the underlying mechanism remains unclear. Neuroimaging biomarkers regarding disease alterations in MDD and treatment response are rarely focused on BLT. This study aimed to identify the modulatory mechanism of BLT in MDD using resting-state functional magnetic resonance imaging (rfMRI).Materials and methodsThis double-blind, randomized controlled clinical trial included a dim red light (dRL) control group and a BLT experimental group. All participants received light therapy for 30 min every morning for 4 weeks. The assessment of the Hamilton Depression Rating Scale-24 (HAMD-24) and brain MRI exam were performed at the baseline and the 4-week endpoint. The four networks in interest, including the default mode network (DMN), frontoparietal network (FPN), salience network (SN), and sensorimotor network (SMN), were analyzed. Between-group differences of the change in these four networks were evaluated.ResultsThere were 22 and 21 participants in the BLT and dRL groups, respectively. Age, sex, years of education, baseline severity, and improvement in depressive symptoms were not significantly different between the two groups. The baseline rfMRI data did not show any significant functional connectivity differences within the DMN, FPN, SN, and SMN between the two groups. Compared with the dRL group, the BTL group showed significantly increased functional connectivity after treatment within the DMN, FPN, SN, and SMN. Graph analysis of the BLT group demonstrated an enhancement of betweenness centrality and global efficiency.ConclusionBLT can enhance intra-network functional connectivity in the DMN, FPN, SN, and SMN for MDD patients. Furthermore, BLT improves the information processing of the whole brain.Clinical trial registrationThe ClinicalTrials.gov identifier was NCT03941301.

Background: Cigarette smoking and alcohol drinking are the most common types of substance use and misuse (SUM) among adolescents. This study aimed to estimate the prevalence and psychosocial factors associated with current cigarette smoking and hazardous alcohol drinking among adolescents in Taiwan. Methods: Data were collected via self-administered questionnaires on computers from students at 14 senior high schools in Taipei, Taiwan. Hierarchical multiple regression strategies were used to determine the risk factors for SUM. Results: A total of 5879 participants were recruited, the majority of whom were female (56.7%). The prevalence rates of current smoking and hazardous alcohol drinking were 3.84% and 7.38%, respectively. Risk factors associated with current smoking were similar to those for hazardous alcohol drinking, including male gender, low school ranking, and depression. In addition, current smoking was associated with increasing age, hazardous alcohol drinking, and fewer parents with whom they can talk, whereas hazardous alcohol drinking was associated with current smoking, not living with both biological parents, and more peers with whom they can talk. Conclusion: The potential coexistence of adolescent SUM and common psychosocial correlates demands an integrated approach. Health professionals should provide corresponding intervention programs and coordinate with parents and teachers to develop an anti-SUM environment, especially for males and high-risk schools. Preventive psychiatric services as an integral part of anti-SUM strategies for adolescents targeting to depression may be useful in reducing the risk.

Self-harm (SH) is a risk factor for suicide. We aimed to determine whether internet addiction and internet exposure to confided suicidal ideation are associated with SH in adolescents. Methods: This study was a cross-sectional survey of students who self-completed a series of online questionnaires including a sociodemographic information questionnaire, questionnaire for suicidality and SH, Chen Internet Addiction Scale (CIAS), Patient Health Questionnaire (PHQ-9), multi-dimensional support scale (MDSS), Rosenberg self-esteem scale (RSES), Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and questionnaire for substance abuse. Results: A total of 2479 students completed the questionnaires (response rate = 62.1%). They had a mean age of 15.44 years (range 14–19 years; standard deviation 0.61), and were mostly female (n = 1494; 60.3%). The prevalence of SH within the previous year was 10.1% (n = 250). Among the participants, 17.1% had internet addiction (n = 425) and 3.3% had been exposed to suicidal content on the internet (n = 82). In the hierarchical logistic regression analysis, internet addiction and internet exposure to suicidal thoughts were both significantly related to an increased risk of SH, after controlling for gender, family factors, exposure to suicidal thoughts in the real life, depression, alcohol/tobacco use, concurrent suicidality, and perceived social support. However, the association between internet addiction and SH weakened after adjusting for the level of self-esteem, while internet exposure to suicidal thoughts remained significantly related to an increased risk of SH (odds ratio = 1.96; 95% confidence interval: 1.06–3.64). Conclusion: Online experiences are associated with SH in adolescents. Preventive strategies may include education to increase social awareness, to identify the youths most at risk, and to provide prompt help.

Background: Informal caregivers for dementia are vulnerable to psychological distress. Researches have shown the inconsistent results in the efficacy of various psychosocial interventions for burden of informal caregivers for patients with dementia. The aim of this study was to provide further understanding for the relative efficacy of psychosocial interventions in lessening the burden of caregivers. Methods: This research was a prospective, longitudinal, one-group pretest–posttest design to measure the effectiveness of 32-h psycho-educational training program for family caregivers in Taiwan. The Chinese version Zarit Burden Interview (ZBI), the 12-item version of General Health Questionnaire (GHQ-12), and Medical Outcome Study 36-item Short-Form Health Survey (SF-36) were assessed at pre-intervention, 3-month post-intervention, 6-month post-intervention, and 9-month post-intervention. Pre–post comparisons were made using general estimate equations (GEE) to confirm the longitudinal effects of the intervention for caregivers. Results: A total of 53 caregiver–patient dyads met the study criteria, of whom 34 (64.2%) dyads completed total assessments. There were significant improvements of the overall effects on ZBI (p

Stigma of major depressive disorder (MDD) is an important public health problem. This study aimed to examine the level of perceived stigma and its associated factors in MDD patients in five Asian countries, including China, Korea, Malaysia, Singapore, and Thailand. A total of 547 outpatients with MDD were included from Asian countries. We used the stigma scale of the Explanatory Model Interview Catalogue (EMIC) to assess stigma. The Montgomery–Asberg Depression Rating Scale (MADRS), Symptoms Checklist 90-Revised (SCL-90-R), Fatigue Severity Scale (FSS), Sheehan Disability Scale (SDS), 36-Item Short-Form Health Survey (SF-36), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess symptoms, clinical features, functional impairment, health status, and social support. The stigma scores of patients under 55 years old were significantly higher than those equal to or greater than 55 years old (P < 0.001). The stigma scores exhibited significant negative correlation with age; MSPSS scores of family, friends, and others; and SF-36 subscale of mental health, but significant positive correlation with MADRS, FSS, SDS, and SCL-90-R subscale scores of depression, interpersonal sensitivity, obsession–compulsion, psychoticism, and somatization. Multivariate regression analysis revealed that age, SCL-90-R interpersonal sensitivity, obsession–compulsion, psychoticism, MSPSS scores of friends and others, and SF-36 of mental health were significantly associated with the level of perceived stigma. These findings suggest that MDD patients who are young, have a high degree of interpersonal sensitivity and psychoticism, have low health-related quality of life, and have low social support are the target population for stigma interventions in Asia.

Background: This study aimed to assess the reliability, validity, and factor structure of the Patient Health Questionnaire-9 (PHQ-9) and its two subscales (PHQ-2, PHQ-1) for screening major depression disorder (MDD) in primary care elderly patients in Taiwan. Method: A total of 634 participants aged ≥60 years were enrolled from the primary care settings. They completed PHQ-9, and Short Form of Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). After that, they were interviewed by using Schedule for Clinical Assessments in Neuropsychiatry (SCAN) and 17-item of Hamilton Rating Scale (HAMD-17). Result: The PHQ-9 demonstrated acceptable internal consistency (α = 0.77), test-retest reliability (intraclass correlation coefficient = 0.79), and concurrent validity with HAMD-17 (r = 0.66; p

Children with attention-deficit/hyperactivity disorder (ADHD) often have problems in social interactions. We investigated the social and behavioral effects of providing both social skill training and parent training to school-aged children with ADHD in Taiwan. Methods: Seven consecutive 8-week behavioral-based social skill training (SST) group sessions were held for 48 children with ADHD; parallel 8-week parent group sessions were provided simultaneously. Fifty-five children with ADHD were recruited as a control group. All children took medication as prescribed by their doctors. The effects were assessed using the teacher and parent version of the Chinese version of Swanson, Nolan, and Pelham, version IV scale (SNAP-IV), the Chinese version of the Child Behavior Check List (CBCL-C), child and teacher version of the modified Social Skill Rating System (SSRS-C and SSRS-T), at baseline, post-treatment, and 4 months from baseline. The doses of methylphenidate and drug compliance were controlled during the analysis. Results: The mixed-effects model demonstrated the main effect of group sessions on the Oppositional subscale of SNAP-P, the Anxious/Depressed subscale of CBCL-C, the Self Control subscale of SSRS-C, and the Active Participation subscale of SSRS-T, all in favor of the experimental group. However, the improvement on the Oppositional subscale of SNAP-P and the Self Control subscale of SSRS-C were noted only between baseline and post-treatment period and were not sustained at the end of the follow-up period. Conclusion: Our study demonstrated that children with ADHD could benefit from this low intensity psychosocial program, although some improvements were not maintained at follow-up assessment.

The goal of this study is to investigate associations between subjective memory complaint and objective cognitive performance in older people with previous major depression-a high-risk sample for cognitive impairment and later dementia. A cross-sectional study was carried out in people aged 60 or over with previous major depression but not fulfilling current major depression criteria according to DSM-IV-TR. People with dementia or Mini-Mental State Examination score less than 17 were excluded. Subjective memory complaint was defined on the basis of a score ≧4 on the subscale of Geriatric Mental State schedule, a maximum score of 8. Older people aged equal or over 60 without any psychiatric diagnosis were enrolled as healthy controls. Cognitive function was evaluated using a series of cognitive tests assessing verbal memory, attention/speed, visuospatial function, verbal fluency, and cognitive flexibility in all participants. One hundred and thirteen older people with previous major depression and forty-six healthy controls were enrolled. Subjective memory complaint was present in more than half of the participants with depression history (55.8%). Among those with major depression history, subjective memory complaint was associated with lower total immediate recall and delayed verbal recall scores after adjustment. The associations between subjective memory complaint and worse memory performance were stronger in participants with lower depressive symptoms (Hamilton Depression Rating Scale score

Mental health promotion campaigns require a good understanding of public attitudes and mental health literacy. Few studies have investigated changes in these two aspects over time. We aimed to examine such changes and their associations with help-seeking preference in Taiwan. Methods: Data were extracted from the Taiwan Social Change Survey (1990, 1995, and 2000) based on national representative samples. Each wave of the surveys included four questions about attitudes toward severe mental illness, a case vignette describing depressive and anxiety symptoms to evaluate respondents' mental health literacy, and their preference of medical and/or informal help-seeking if they develop such symptoms. Mental and physical health statuses measured using the Chinese Health Questionnaire and self-reported chronic physical illnesses were included as covariates. Results: There were 2531, 2075, and 1892 respondents in the three waves of the surveys, respectively. During the 1990s, approximately one in four to five Taiwanese held some misconceptions toward mental illness. The attitudes toward mental illness were generally not associated with medical or informal help-seeking preference after statistical adjustment. However, respondents viewing symptoms in the vignette as physical or mental in origin were more willing to seek help than those who saw these symptoms as not being an illness. Conclusion: Attribution of depressive and anxiety symptoms appeared to be more likely to influence help-seeking behaviors than attitudes toward mental illness. Enhancing public mental health literacy toward depression may help facilitate help-seeking in response to potential mental illness.

Depression is a major health concern, often treated by non-psychiatrists. This study assessed self-reported knowledge, attitudes and treatment practices of non-psychiatric physicians in the recognition and management of depression. Methods: Survey questionnaires were given to non-psychiatric physicians who attended a depression training program. We asked physicians about their current clinical practice, knowledge, confidence, attitudes and perceived barriers to care regarding recognition and management of patients with depression. Results: Of 524 eligible non-psychiatric physicians, 375 (72%) completed surveys. The majority of physicians held a strong sense of responsibility for managing depression, although they provided treatment to only a small proportion of depressed patients. Most of them were not confident treating depressed patients, and they reported that incomplete knowledge and training were major barriers that limited their involvement. The patient and organization barriers were not related to reported management, but the physician barriers (lack of skills and knowledge in managing depression) were related to reported rate of treatment. Age, prior depression training, and education were major contributing factors to domains of knowledge, attitude and behavior, in terms of the number of domains involved. Family physician orientation was associated with higher score on knowledge scale, but not with other variables of attitude and behavior. Conclusion: Our study suggests that non-psychiatrists may also play a role in the care of depression, but identifying and managing depression can be a challenge to them. Attitudinal barriers, confidence, and knowledge of treatment may compromise the physician's ability to manage depression. Future interventions and educational efforts need to address each of these issues.

ObjectiveDespite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample.MethodUsing nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates.ResultsA total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder.ConclusionsIn this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.

Elderly patients are vulnerable to the adverse neurological effects of antipsychotics, particularly Parkinsonian symptoms and tardive dyskinesia. This vulnerability in the elderly becomes complex and unpredictable when aripiprazole is prescribed to replace other second-generation or first-generation antipsychotics. This report describes a 69-year-old female schizophrenic patient, who received aripiprazole after using a few antipsychotics, including the first- and second-generation ones. The tardive dyskinesia developed 6 weeks after switching to aripiprazole but subsided 4 weeks later when stopping the concurrent amantadine and decreasing the dosage of trihexyphenidyl. However, Parkinsonian symptoms developed insidiously thereafter, which remitted after the dosage of trihexyphenidyl was increased again. The possible mechanisms of the alternated adverse neurological events after a switch to aripiprazole in the chronic elderly psychosis are discussed.

Objectives The aim of this study was to investigate differences and similarities in risk factors for deliberate self-harm (DSH) and suicidal attempt (SA), and the role of impulsivity among a group of community adolescents. Setting This is a cross-sectional study conducted at high schools in Northern Taiwan. Data and participants We recruited grade 1 students from 14 high schools. A total of 5879 participants (mean age 16.02 years, female adolescents: 57.7%) completed the online assessment. Outcome measures Participants completed online questionnaires about sociodemographic data, suicidality, history of DSH and SA, depressed mood, self-esteem, social support, family discord, impulsivity (Barratt Impulsiveness Scale Version 11 (BIS-11)) and the use of alcohol, tobacco and illicit drugs. A subsample was interviewed about lifetime SA, and the results were compared with those from the online questionnaires. Results In our sample, 25% of the students had lifetime DSH and 3.5% had lifetime SA. Two hundred and seventy-two students received face-to-face interviews. The concordance between the online questionnaires and interviews in terms of ascertaining cases of SA was moderate (concordance rate 82.76%; kappa value 0.59). Similar risk factors for DSH/SA among the whole sample included female gender, lower academic performance, depression, substance use (tobacco and alcohol) and low self-esteem. The BIS-11 score was correlated with DSH. Factor 3 score of the BIS-11 (novelty seeking) was correlated with DSH in both boys and girls, whereas factor 2 score (lack of self-control) was correlated with SA in boys. Social support was a protective factor against SA among the female adolescents. Gender modulated the association of impulsivity and DSH/SA. Associations between impulsivity and DSH and SA were particularly strong among boys. Conclusions Risk factors for DSH and SA were similar, but not identical. Early identification of those at risk and appropriate interventions may be helpful. [ABSTRACT FROM AUTHOR]

Background Past and repeated self-harm are long-term risks to completed suicide. A brief rating scale to assess repetition risk of self-harm is important for high-risk identification and early interventions in suicide prevention. The study aimed to examine the validity of the Chinese version SAD PERSONS Scale (CSPS) and to evaluate its feasibility in clinical settings. Methods One hundred and forty-seven patients with self-harm were recruited from the Emergency Department and assessed at baseline and the 6th month. The controls, 284 people without self- harm from the Family Medicine Department in the same hospital were recruited and assessed concurrently. The psychometric properties of the CSPS were examined using baseline and follow-up measurements that assessed a variety of suicide risk factors. Clinical feasibility and applicability of the CSPS were further evaluated by a group of general nurses who used case vignette approach in CSPS risk assessment in clinical settings. An open-ended question inquiring their opinions of scale adaptation to hospital inpatient assessment for suicide risks were also analyzed using content analysis. Results The CSPS was significantly correlated with other scales measuring depression, hopelessness and suicide ideation. A cut-off point of the scale was at 4/5 in predicting 6-month self-harm repetition with the sensitivity and specificity being 65.4% and 58.1%, respectively. Based on the areas under the Receiver Operating Characteristic curves, the predictive validity of the scale showed a better performance than the other scales. Fifty-four nurses, evaluating the scale using case vignette found it a useful tool to raise the awareness of suicide risk and a considerable tool to be adopted into nursing care. Conclusions The Chinese SAD PERSONS Scale is a brief instrument with acceptable psychometric properties for self-harm prediction. However, cautions should be paid to level of therapeutic relationships during assessment, staff workload and adequate training for wider clinical applications. [ABSTRACT FROM AUTHOR]

Background: Although suicide has been postulated as a result of social breakdown, relatively little attention has been paid to the association between social relationships and non-fatal self-harm. We sought to investigate the extent to which social factors correlate with self-harm in this case-control study. Methods: The primary outcome was self-harm with hospital presentation. Cases of self-harm from the Emergency Department in a general hospital in Northern Taiwan were recruited, and individually age-and-gender-matched control participants were recruited from non-psychiatric outpatient clinics at the same hospital. The Close Persons Questionnaire was administered and its social support and social network subscales were used to measure social relationships in the 12 months prior to the interview. Other covariates, comprising sociodemographic factors, major life events, physical and mental health, were adjusted in conditional logistic regression models. Results: A total of 124 case-control pairs were recruited. The mean (standard deviation) age of the case group was 34.7 (12.8) years and 80.6% were female. Higher social isolation score remained significantly associated with selfharm after adjustment (adjusted odds ratio per standard deviation increase 2.92, 95% confidence interval 1.44-5.95) and household size was negatively associated with the outcome (adjusted odds ratio per unit increase 0.54, 95% CI 0.32-0.94). Conclusions: More limited social networks were associated with self-harm after adjustment for potential confounders. Enhancing social structure and effective networking of people with self-harm to community resources may be important for self-harm management in Asian societies and elsewhere. [ABSTRACT FROM AUTHOR]

Analyzing given medical databases provide valuable references for classifying other patients symptoms. This study presents a strategy for discovering fuzzy decision trees from medical databases, in particular Harbeman's Survival database and the Blood Transfusion Service Center database. Harbeman's Survival database helps doctors treat and diagnose a group of patients who show similar past medical symptoms and the Blood Transfusion Service Center database advises individuals about when to donate blood. The proposed data mining procedure involves neural network based clustering using Adaptive Resonance Theory 2 (ART2), and the extraction of fuzzy decision trees for each homogeneous cluster of data records using fuzzy set theory. Besides, another objective of this paper is to examine the effect of the number of membership functions on building decision trees. Experiments confirm that the number of erroneously clustered patterns is significantly reduced compared to other methods without preprocessing data using ART2. [ABSTRACT FROM AUTHOR]

Objective: To assess whether non-psychiatric physicians would benefit from a national depression training program and explore associated factors. Method: Attending physicians were asked to complete survey questionnaires of confidence, attitude, knowledge, and their willingness to implement new strategies to improve care, before and after training. Paired Mest and multiple regression analysis were used to determine the differences and explore factors associated with the domains of confidence, attitude, and knowledge. McNemar's test was used to compare the difference between the physicians' intention to change depression management before and after training. Results: Of 524 eligible physicians, 307 (59%) completed the pre- and post-program assessments. These physicians showed significantly increased knowledge score and willingness to implement new treatment strategies, as well as more positive attitude toward and confidence in treating depression. The lower corresponding baseline score was associated with greater improvement in domains of knowledge, confidence, and attitude. Completion of the training was associated with an improvement in knowledge and becoming less helpless and avoidant attitude. Other factors including non-family-medicine physicians, post-graduate education, and female gender are associated with greater improvements in various domains. Conclusions: Our study shows that even a brief educational program can positively influence the physicians' knowledge, attitudes, and confidence in treating depression. Further work is needed to monitor whether the effects of training are long-term, and can be translated into behavioral change in practice. [ABSTRACT FROM AUTHOR]

Background: Lower concentrations of n-3 PUFAs have been reported to be associated with cognitive impairment and dementia, but also with depression-itself a potential risk factor for cognitive decline. Objective: The aims of this study were to investigate associations between n-3 PUFA concentrations in erythrocyte membrane or plasma and cognitive function in an at-risk sample of older people with previous major depression and to explore specificity with respect to cognitive domains. Design: A cross-sectional sample of 132 eligible participants who had recovered from major depression (mean ± SD age: 67.8 ± 6.6 y) were enrolled from outpatient psychiatric services. A series of cognitive tests and a structured questionnaire were administered. Fasting blood samples were collected for n-3 PUFA measurements. Results: Higher EPA and total n-3 PUFA concentrations and a lower ratio of arachidonic acid to EPA in erythrocyte membranes were associated with a higher cognitive composite score: independent of age and sex, but no longer significant after adjustment for education. No associations were found with plasma concentrations of any fatty acid. Considering individual cognitive tests, the strongest and most consistent correlations were found between immediate recall and concentrations of total n-3 PUFAs and α-linolenic acid (ALA) in erythrocytes, which were observed only in participants with recurrent depression. Conclusions: Total erythrocyte n-3 PUFA concentrations are positively associated with cognitive function, particularly immediate recall, in older people with previous depression. Lower concentrations of n-3 PUFAs or ALA in erythrocyte membranes may be good predictors for cognitive impairment in older people with previous recurrent depression. [ABSTRACT FROM AUTHOR]

This study aimed to understand the current inclinations toward depression and compulsion for members of four different religious groups, and to predict religious beliefs along the suicide path through analyzing the lifetime prevalence of suicidal ideation and suicide attempts for members of these religious groups. Participants in this cross-sectional study, which adopted purposive sampling, were members of Christianity, Catholicism, Buddhism, and Taoism in northern Taiwan. In the case of suicide experiences, suicides among people one knows, and tendency toward compulsion and depression, there are statistical differences between the four religions. According to the results, some people with suicidal tendency will attend religious activities; therefore, we predict that religious beliefs play an important role in suicide prevention. [ABSTRACT FROM AUTHOR]

Objectives: Microelectronic engineers are considered valuable human capital contributing significantly toward economic development, but they may encounter stressful work conditions in the context of a globalized industry. The study aims at identifying risk factors of depressive disorders primarily based on job stress models, the Demand-Control-Support and Effort-Reward Imbalance models, and at evaluating whether depressive disorders impair work performance in microelectronics engineers in Taiwan. Methods: The case-control study was conducted among 678 microelectronics engineers, 452 controls and 226 cases with depressive disorders which were defined by a score 17 or more on the Beck Depression Inventory and a psychiatrist's diagnosis. The self-administered questionnaires included the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, demography, psychosocial factors, health behaviors and work performance. Hierarchical logistic regression was applied to identify risk factors of depressive disorders. Multivariate linear regressions were used to determine factors affecting work performance. Results: By hierarchical logistic regression, risk factors of depressive disorders are high demands, low work social support, high effort/reward ratio and low frequency of physical exercise. Combining the two job stress models may have better predictive power for depressive disorders than adopting either model alone. Three multivariate linear regressions provide similar results indicating that depressive disorders are associated with impaired work performance in terms of absence, role limitation and social functioning limitation. Conclusions: The results may provide insight into the applicability of job stress models in a globalized high-tech industry considerably focused in non-Western countries, and the design of workplace preventive strategies for depressive disorders in Asian electronics engineering population. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to validate the Mandarin Chinese version of different screening instruments and compare their performances for identifying hazardous drinkers in Taiwan. Methods: We compared the performance of the Mandarin Chinese versions of AUDIT, AUDIT-C (AUDIT items 1, 2 and 3), AUDIT-4 (AUDIT items 1, 2, 3 and 10), AUDIT-3 (AUDIT item 3), TWEAK, SMAST and CAGE to detect hazardous drinking in hospitalized patients in Taiwan. The results of the test instruments were blindly compared with the reference standard Schedule for Clinical Assessments in Neuropsychiatry (SCAN). Results: Of 404 patients evaluated, 100 were identified as having a hazardous drinking pattern. All screening instruments showed acceptable sensitivities (ranging from 85 to 93%) and specificities (ranging from 72 to 92%), but AUDIT and its short forms performed consistently better than the other instruments. Conclusions: The Mandarin Chinese versions of AUDIT and its derivatives perform well in screening hospitalized Taiwanese patients for hazardous drinking. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of dementia is expected to increase in Chinese society in the next 40 years. Family members remain the primary caregivers and bear a heavy burden. The present study aims to examine the reliability and validity of the Chinese version of the Zarit Burden Interview (CZBI). Method: One hundred eighty-one patient-caregiver dyads were recruited. Caregivers completed the measures of the CZBI, Caregiver Activity Survey (CAS) and 12-item Chinese Health Questionnaire (CHQ-12). Mini-Mental State Examination and Clinical Dementia Rating Scale were used to assess the patients' condition. Results: Overall reliability of CZBI was good, with the internal consistency and test-retest reliability being high. The CZBI was highly correlated with the scores of the CAS and CHQ-12, which provides evidence of concurrent validity. Factor analysis found five factors, which accounted for 60% of variance. Conclusion: The CZBI is feasible for measuring feelings of burden of caregivers for Taiwanese patients with dementia. [ABSTRACT FROM AUTHOR]

Objective: To identify the midlife risk factors for subtypes of dementia newly developed later in life. Methods: A nested case-control study was conducted on 157 demented cases and 628 comparison cases selected from 40,636 men and women who were enrolled from 1982 to 1992. Four comparison cases were frequency-matched on age, time at enrollment (within 6 months), gender, and residential township. Midlife risk factors included vascular risk factors (body mass index [BMI], total cholesterol, total triglycerides, blood glucose, cerebro vascular accident [CVA] history, diabetes mellitus history, and hypertension history), cigarette smoking, and alcohol consumption. Dementia assessments were ascertained through the computerized data linkage from National Health Insurance Database from 2000 to 2002 and clinically confirmed by neurologists or psychiatrists. Conditional logistic regression analysis was used to estimate the matched odds ratio (OR) and its 95% confidence intervals (CI) for each risk factor. Results: A J-shaped relationship was observed between BMI (kg/m²) and dementia. The multivariate-adjusted ORs (95% CI) of developing dementia were 1.84 (1.02-3.33), 1.87 (1.08 -3.23) and 2.44 (1.39- 4.28), respectively, for BMIs of <20.5, 23.0 -25.4, ≥25.5 compared with a BMI of 20.5 -22.9 as the referent group (OR = 1.0). Similar findings were observed for Alzheimer disease (AD) and vascular dementia (VaD). The association between obesity (BMI ≥25.5) and both AD and VaD was statistically significant among cigarette smokers but not among nonsmokers. Additionally, history of CVA was a significant risk factor for VaD, but not for AD. Conclusion: Being underweight, being overweight, and a cerebrovascular accident in midlife may increase the risk of dementia in late life. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the detection, treatment, and outcome by general medical physicians (GPs) of common mental disorders (CMDs) in Taiwan. Methods: A total of 285 patients with CMDs were recruited using a two-stage design from 1,009 consecutive patients seeing their GP. Subjects were assessed by psychiatrists at the outset and again after 1 year using the Chinese version of the Revised Clinical Interview Schedule (CISR), List of Threatening Experiences, and Brief Disability Questionnaire. Records of diagnosis and treatment of CMD were also obtained from the treating GP. Results: 167 patients completed the 1-year follow-up evaluation. The GPs had detected CMD in only 14.5% of patients. They also under-treated CMD: antidepressants were given to 7.9% (3/38) of patients with depressive disorders and to 4.8% (3/63) of patients with mixed anxiety-depressive disorders. The 1-year remission rate of CMD was 63.5% (1061167). The outcome was relatively independent of the GP's detection and treatment. The poorest outcomes were significantly associated with a higher baseline CISR score, greater physical disability on follow-up, and major life events within 6 months of the final assessment. Conclusions: This study found that GPs in northern Taiwan detected and treated only a small proportion of patients with CMDs. The outcome of CMDs was not associated with either detection or treatment by GPs. [ABSTRACT FROM AUTHOR]

Background Alcohol use disorders (AUDs) among the Yami aborigines in Taiwan were investigated and compared with four other Taiwanese aboriginal groups. Method A sample survey was conducted using a semi-structured clinical interview for AUDs among 252 subjects. aged 15 and above, from two Yami villages on Orchid Island. Results The prevalences of DSM - Ill - R and DSM - IV alcohol use disorders were 13.1% and 0.3% by one year. and 175% and 15,2% by lifetime, respectively, with a male excess. The risk for AUDs miami men was significantly associated with a lower educational level, a non-married status, and the length of stay in mainland Taiwan. A protective effect of Christian belief was evident for lifetime risk for AUDs. Conclusions The lower prevalences of AUDs in Yami than in other aboriginal groups in Taiwan might be explained by social isolation of the former, and differences in drinking tradition, availability of alcohol, biological vulnerability, and the extent of acculturation between these groups. [ABSTRACT FROM AUTHOR]