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Given that the perinatal period is a time of increased risk for pregnant women to manifest mental health problems, the identification of antenatal hypomanic symptoms is particularly important. However, data on antenatal hypomanic symptoms is lacking. The present study was aimed at filling this research gap by investigating the prevalence of hypomanic symptoms, including the "active-elated" and "irritable/risk-taking" sides of hypomanic symptoms at the first trimester, and examining their associations with anxiety and depressive symptoms at the following time points: the first trimester, the second trimester, and up to 6-week postpartum. A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 229 pregnant Chinese women in Hong Kong was assessed. Hypomanic symptoms were assessed with the Hypomania Checklist-32 (HCL-32). Of the sample, 43.6% had elevated levels of hypomanic symptoms in the first trimester. Multiple regression analysis showed that after adjusting for potential confounding factors, irritable/risk-taking symptoms were independently associated with higher anxiety symptoms in the first and second trimesters and in the 6-week postpartum period. Primary healthcare practitioners should be made aware of antenatal hypomanic symptoms in pregnant women to facilitate early identification and intervention for anxiety and depression to improve the well-being of both mothers and infants.

Objective Addiction-like eating (AE) is characterized by food cravings and loss of control over excessive food consumption. This study investigated the associations among emotional factors, personality traits, and AE symptoms in Asian young adults. Method This study included 6,823 Asian university students in South Korea, China, Singapore, Hong Kong/Macao, Japan, and Taiwan. Participants completed the modified Yale Food Addiction Scale (mYFAS) and scales on the Big-Five personality traits, impulsivity, anxiety, and depression. Results 6.2% of the participants met the mYFAS (DSM-IV-TR) food addiction diagnostic threshold. Participants from South Korea (7.9%) had the highest rate of food addiction, while participants from Japan (5.1%) and Taiwan (4.1%) reported the lowest rates. Emotional factors of anxiety and depression were the most robust correlates of AE symptoms, followed by country/region and personality factors of higher impulsivity, higher extraversion, and lower agreeableness. Personality correlates were region-specific. Higher impulsivity was a significant correlate for participants from South Korea and Taiwan, higher extraversion for participants from Singapore and Japan, and lower agreeableness for participants from China and Taiwan. Gender was also a significant correlate for participants from South Korea, Hong Kong/Macao, and Taiwan. Discussion Emotional and personality factors are important correlates of AE symptoms among Asian young adults.

Background Pregnancy is a time of increasing vulnerability to the development of body dissatisfaction, anxiety, and depression. The present study aims to examine associations of body dissatisfaction with anxiety and depression at the following points: 6 months before pregnancy (retrospective report); in the first, second, and third trimesters of pregnancy; and up to 6 weeks postpartum. Methods A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 1,371 Chinese pregnant women in Hong Kong was assessed using standardized instruments at four time points. Results A mixed-effects model with repeated measures revealed that body dissatisfaction and depression symptoms changed across different stages of pregnancy. Hierarchical multiple regressions showed that, after adjusting for the identified risk factors, body dissatisfaction before and during pregnancy were positively associated with antenatal anxiety and depression symptoms. Concurrent body dissatisfaction was positively associated with postpartum depression symptoms. Limitations There was a high attrition rate in the follow-up assessments. Antenatal anxiety symptoms were assessed using the scale for general anxiety, which may not adequately capture the experience of anxiety among pregnant women. Conclusions Primary healthcare practitioners should be made aware of body dissatisfaction among pregnant women in order to facilitate early intervention for anxiety and depression, because untreated psychological disturbance during pregnancy may persist into the postpartum period.

Objective: This study aims to evaluate the reliability and validity of the translated Chinese-Cantonese version of the Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R) in a sample of pregna...

Objectives This study aimed to determine the relative risks of addiction to the Internet, online gaming and online social networking of college students in six Asian countries/regions (Singapore, Hong Kong [HK]/Macau, China, South Korea, Taiwan and Japan) compared with students in the United States (US). It also explored the relative risks of depression and anxiety symptoms among students with Internet-related addictions from these countries/regions. Study design This is a cross-sectional survey. Methods A convenience sample of 8067 college students aged between 18 and 30 years was recruited from seven countries/regions. Students completed a survey about their use of the Internet, online gaming and online social networking as well as the presence of depression and anxiety symptoms. Results For all students, the overall prevalence rates were 8.9% for Internet use addiction, 19.0% for online gaming addiction and 33.1% for online social networking addiction. Compared with the US students, Asian students showed higher risks of online social networking addiction but displayed lower risks of online gaming addiction (with the exception of students from HK/Macau). Chinese and Japanese students also showed higher risks of Internet addiction compared with the US students. In general, addicted Asian students were at higher risks of depression than the addicted US students, especially among Asian students who were addicted to online gaming. Addicted Asian students were at lower risks of anxiety than the addicted US students, especially among Asian students who were addicted to online social networking, and addicted students from HK/Macau and Japan were more likely to have higher relative risks of depression. Conclusions There are country/regional differences in the risks of Internet-related addictions and psychiatric symptoms. It is suggested that country/region-specific health education programmes regarding Internet-related addictions are warranted to maximise the efficiency of prevention and intervention. These programmes should attempt to tackle not only problematic Internet-related behaviours but also mood disturbances among college students.

The effects of psychoeducation on thought–action fusion (TAF) beliefs are understudied. We tested whether adding mock electroencephalography (EEG)-based computer trials that induce cognitive dissonance about TAF beliefs, prior to TAF-specific psychoeducation, would enhance and maintain the reduction of TAF beliefs. An unselected sample of 140 Singaporean undergraduates (89 females, 51 males) was randomly assigned to a combined intervention, TAF-specific psychoeducation-only, or control group. Self-report measures of TAF beliefs and cognitive dissonance about TAF beliefs were administered 4 times in the initial session, and once at 1-month follow-up. Findings included the following: (a) greatest cognitive dissonance about TAF beliefs in the initial session with the combined intervention; (b) greater reduction in TAF beliefs in the initial session in both intervention groups, compared with the control group; and (c) incremental reduction in TAF beliefs in the initial session and maintenance at 1-month follow-up with the combined intervention. Cognitive dissonance should be investigated extensively in other aspects of cognitive behavioral therapy (CBT) procedures for TAF beliefs (e.g., behavioral experiments, exposure, and response prevention) to determine whether it contributes to therapeutic change with these techniques. Our combined intervention procedure should also be examined for relevant psychopathology (e.g., obsessive-compulsive symptoms).

The current study investigated the rates of addictions to Internet use, online gaming, and online social networking as well as their associations with depressive symptoms among young adults in China, Singapore, and the United States. A total of 3267 undergraduate students were recruited. Psychological instruments were used to assess various Internet-related addictions and depressive symptoms. Male students were more addicted to Internet and online gaming whereas female students were more addicted to online social networking. Compared with students in the United States, Chinese and Singaporean students were more addicted to Internet use and online social networking but less to online gaming. The odds of depression among students with addiction to various Internet-related addictions were highest in China. Internet-related addiction is a new public health concern of young adults, especially in the Asia-Pacific regions. It is found to associate with depressive symptoms. Strategies should address this phenomenon with attention to specific needs of gender and region while managing mood disturbances.

Purpose of the research This study aimed to determine the prevalence of addiction to social networking sites/platforms (SNS) and its comorbidity with other behavioral addiction and affective disorder among college students in Singapore. 1110 college students (age: M = 21.46, SD = 1.80) in Singapore completed measures assessing online social networking, unhealthy food intake and shopping addiction as well as depression, anxiety and mania. Descriptive analyses were conducted to investigate the prevalence and comorbidity of behavioral addiction and affective disorder. Chi-square tests were used to examine gender differences. The principal results The prevalence rates of SNS, food and shopping addiction were 29.5%, 4.7% and 9.3% respectively for the total sample. SNS addiction was found to co-occur with food addiction (3%), shopping addiction (5%), and both food and shopping addiction (1%). The comorbidity rates of SNS addiction and affective disorder were 21% for depression, 27.7% for anxiety, and 26.1% for mania. Compared with the total sample, students with SNS addiction reported higher comorbidity rates with other behavioral addiction and affective disorder. In general, females as compared to males reported higher comorbidity rates of SNS addiction and affective disorder. Major conclusions SNS addiction has a high prevalence rate among college students in Singapore. Students with SNS addiction were vulnerable to experience other behavior addiction as well as affective disorder, especially among females.

Past research frequently reports significant relation between workaholism and job burnout, and some studies further indicate workaholism varies across countries. Surprisingly, there is no study that directly examines whether country moderates the workaholism-burnout association. To address this research question, we have collected independent work samples from two culturally diverse countries, namely the People’s Republic of China and the United States. A total of 2243 participants (1243 American respondents and 1000 Chinese respondents) were recruited. Preliminary group comparison suggested that there were statistical differences among participants from different industries on the key variables, including workaholism, job demands, autonomy and emotional exhaustion. Therefore, we have divided our participants into three subsamples [i.e., (1) natural resources, mining and construction industry, (2) manufacturing industry, and (3) service industry] and separate analyses were conducted. In the moderated regression analyses, workaholism significantly predicted two dimensions of job burnout, namely emotional exhaustion and depersonalization, even when job demand and job autonomy were controlled. Finally, although two significant moderating effects were found, there was a lack of consistent empirical support to the hypothesized moderating effect of country on workaholism-burnout association. Implications and limitations were discussed.

Background and aims The addictive nature of compulsive buying implies that mood disturbances, stress, and cognitive biases that underlie compulsive buying might operate in ways similar in both genders. In the current study, we aimed to test hypothetical pathways of mood compensation and irrational cognitions, which may explain compulsive buying tendencies. We also examined potential gender differences in these pathways. Methods Two-hundred and thirty-two male (age: M = 20.30, SD = 1.74) and 373 female Chinese college students (age: M = 19.97, SD = 1.74) in Hong Kong and Macau completed measures assessing compulsive buying, psychological distress, avoidance coping, materialism, and buying-related cognitions. Mediation analyses via a structural equation modeling approach explained by Cheung (2007, 2009) were conducted, with gender as a grouping variable. Results There was a gender difference in the mood compensation pathway; avoidance coping partially mediated the link between psychological distress and compulsive buying severity in females only. On the other hand, the irrational cognitive pathway, in which irrational buying-related cognitions fully mediated the link between materialism and compulsive buying severity, was supported for both genders. There was no gender difference in the extent of mediation within the irrational cognitive pathway, and the mediation effect within the irrational cognitive pathway was larger than that within the mood compensation pathway for both genders. Conclusions Mood compensation processes in compulsive buying might be female specific, and secondary to irrational cognitions, which were gender invariant. Gender-dependent mechanisms and irrational cognitions should be emphasized in compulsive buying treatment.

OBJECTIVE Although eating disorders in pregnancy have been studied extensively, little research attention has been given to disordered eating. The objectives of the present study were to determine the prevalence and levels of disordered eating in the perinatal period, and to identify risk factors and adverse outcomes of disordered eating during pregnancy. METHOD A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 1,470 Chinese pregnant women from hospitals in Hong Kong was assessed using standardized instruments at five time points from the first trimester to 6 months postpartum. RESULTS The levels of disordered eating changed significantly across trimesters. Higher levels of disordered eating in pregnancy were significantly associated with higher levels of disordered eating at 6 weeks and 6 months postpartum, greater anxiety and depressive symptoms, lower 1-min Apgar scores, and abnormal birth weight. DISCUSSION The present study pointed to the need for more research and clinical attention to antenatal disordered eating given that it is associated with anxiety, depression, postpartum disordered eating and obstetric outcomes.

Background: This study extended the stress-vulnerability model in order to understand Internet addiction in Asian countries. A parallel mediation model was proposed to specify that emotional and personality vulnerabilities would mediate the influence of social anxiety on Internet addiction. Methods: A total of 1127 participants (430 males and 697 females) aged from 17 to 28 were recruited from universities in Singapore. Participants completed a paper-and-pencil questionnaire on standardized psychological scales that assessed social anxiety, depression, impulsivity, and Internet addiction. Results: About 9.4% of the participants met the cut-off score for Internet addiction. The bootstrapping procedure was conducted to test the hypothesized parallel mediation model. Results showed that social anxiety had a direct effect on Internet addiction, as well as indirect effects via depression and impulsivity. Depression was found to be a stronger mediator than impulsivity. In particular, high levels of social anxiety were related to high levels of impulsivity and depression, which were in turn related to high levels of Internet addiction. The pathways of the proposed parallel mediation model were similar for males and females. There were no gender differences on the levels of Internet addiction, social anxiety, and impulsivity; but females reported more depression symptoms than males. Conclusions: Internet addiction is common in university students. It is associated with impulsivity and high rates of depression and social anxiety. Prevention and intervention strategies should be designed to address this phenomenon. Assessment and management of social anxiety, depression, and impulsive personality should also be included in the programs that aim to reduce Internet addiction.

The shortage of organs for transplantation in Japan has alerted health professionals to the low organ donation rate among Japanese people. The unique cultural view of death and altruism has been su...

Objectives While patients with systemic lupus erythematosus (SLE) have poorer health-related quality of life (HRQoL) and are more depressed than healthy people, the impact of proinflammatory cytokines, particularly tumour necrosis factor-alpha (TNFα), on these unfavourable psychosocial parameters is unclear. We aim to explore potential relationships between lupus-related proinflammatory cytokines, HRQoL and depressive symptoms in patients with SLE. Methods Patients with SLE and age-matched healthy subjects were assessed for HRQoL and depressive and anxiety symptoms by the Short Form Health Survey-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) respectively. Using multiplex immunoassay, a panel of serum proinflammatory cytokines including TNFα, interleukin (IL)-1β, IL-6, IL-17, IL-23 and IL-33 were determined and compared between both groups. Independent associations between SF-36, serum proinflammatory cytokine levels and HADS scores were studied by regression models. Results In total, 54 patients and 54 healthy controls were studied. Lupus patients had significantly poorer HRQoL ( p Conclusions Higher serum TNFα level is independently associated with poorer HRQoL and more severe depressive symptoms in SLE patients. These associations suggest a potential impact of inflammatory response on depressive symptoms and the quality of life in patients with SLE.

Background There remains a paucity of research on control attribution and depression within Asian populations. This study examines: (1) Success/Failure condition as a moderator between depression and negative affect or shame, and (2) differences in control attribution between patients with depression and healthy controls in Singapore. Methods Seventy one patients with depression and 71 healthy controls went through a digit-span memory task where they were randomized into either the Success or Failure condition. Participants in the Success condition had to memorize and recall 5-digit strings, while participants in the Failure condition did the same for 12-digit strings. They then completed self-report measures of negative affect, shame, and attribution of control. One-way ANCOVA was performed to examine task condition as a moderator of association between mental health status and post-task negative affect or shame. Test of simple effects was carried out on significant interactions. Sign test and Mann-Whitney U test were employed to investigate differences in attribution of control. Results Mental health status and Success/Failure condition had significant effects on reported negative affect and shame. Healthy controls reported less post-task negative affect and shame in the Success than in the Failure condition while patients with depression reported similar levels of post-task negative affect and shame in both conditions. However, these differences were not significant in the test of simple effects. In addition, healthy controls felt a stronger sense of personal control in success than in failure and were more likely to blame external factors in failure than in success. Conversely, patients with depression were more inclined to credit external factors in success than in failure and ascribed greater personal control in failure than in success. Conclusion The results suggest that successful conditions may not necessitate the reduction of negative affect in Asians with depression, indicating possible cultural variation in affective states as a result of control attribution and the importance of attending to these variations in designing psychological intervention for Asians. Further studies are required to gather more evidence on control attributions in different contexts and study other cognitive mechanisms related to depression in the Asian population.

Current HIV prevention interventions for female sex workers (FSWs) have tended to target the cognitive factors in changing their behaviors, yet little attention has been paid to the psychological factors that influence the behavior of women in sex work. This review aimed to explore the associations between the psychological health of FSWs and HIV risk. A total of eight studies published in English before July 2013 were identified and reviewed. FSWs had reported psychological issues, including depression, suicidal thoughts as well as lower quality of life, and the pooled prevalence of probable depression was as high as 62.4%. The majority of studies showed that higher scores in psychological health problems were associated with increased HIV risk behavior, in particular inconsistent condom use, or sexually transmitted infections. Among the five studies which measured symptoms of depression, four documented that higher depression scores were significantly associated with inconsistent condom use among FSWs with their clients and/or partners. Meta-analysis using a fixed-effects model was performed to examine the association between depression and inconsistent condom use and found that higher scores in depression were significantly associated with inconsistent condom use (odds ratio = 2.57, p

This study examined the role of impulsivity and its interplay with gambling correlates in influencing the severity of pathological gambling in Chinese societies. It also investigated the extent to which impulsivity would moderate and/or mediate the relationship between life stress and pathological gambling in 94 Chinese treatment-seeking gamblers. Results of a hierarchical regression analysis showed that years of gambling, life stress, and impulsivity were significant correlates of pathological gambling. Post-hoc analyses of a significant impulsivity x life stress 2-way interaction effect indicated that life stress was significantly associated with pathological gambling among participants with low impulsivity only, whereas pathological gambling remained high regardless of the stress level among participants with high impulsivity. Bootstrapping results also showed that impulsivity partially mediated the influence of life stress on pathological gambling. Findings have implications for gambling treatment programs.

This article presents a study that examined the relationship between involvement in multiple roles and psychological distress among 380 Caucasian and African American women aged 18—60, focusing on women’s roles as paid workers, wives, and mothers. The quality of the mother role was significantly associated with psychological distress, while role occupancy and role quantity were not. Furthermore, the African American and white women appeared to be affected similarly by the quality of their experience in the mother role.

This study examined the influence of immediate social environment on health compromising behaviors (HCB) among 6564 high school students in China. Results showed that physical abuse by parents was a major risk factor that accounted for high rates of HCB. Perceived positive school experience and social support were protective factors associated with low rates of HCB. These two protective factors also buffered the adverse influence of abuse on the practice of individual HCB. In particular, parental abuse was associated with sexual experimentation, non-fatal self-harm, and suicide behaviors only at low levels of protective factors.

BACKGROUND: GPs are often the first contact for injured children and hence play a crucial role in early identification and intervention of child abuse cases in the community. OBJECTIVES: To investigate Hong Kong GPs' attitudes and behaviours towards child abuse reporting and their opinions on the introduction of a mandatory reporting system. METHODS: A cross-sectional survey was conducted in 2006 among GPs who were attending or had attended a local postgraduate family medicine course. RESULTS: One hundred and seventy-one GPs participated in this study, among which only 8.9% received formal child abuse training. Only 35.8% of those GPs who had encountered suspected cases reported every case. GPs who considered reporting could produce more harm than good to the family or child, who concerned about maintaining anonymity and who were reluctant to get involved with legal system were less likely to make a report [odds ratio (OR) 0.21-0.27; 95% confidence interval (CI) 0.06-0.11, 0.67-0.86]. 'Concern on own anonymity' was the only significant independent predictor for reporting (OR 3.47; 95% CI 1.11-10.87). Despite the low satisfaction with the present reporting system, 67.3% would not support the introduction of a mandatory reporting system. Logistic regression showed previous training could predict supportive attitude towards mandatory reporting (OR 4.84, 95% CI 1.01-23.27). CONCLUSIONS: This study shows low reporting behaviour among Hong Kong GPs. The major barriers to report are identified and can only be addressed by education and a carefully designed support system for GPs. Further research engaging a multidisciplinary approach is required to work towards an optimally beneficial system for the children. Language: en

Early in the epidemic, HIV infection and AIDS were rarely diagnosed in women. Today, the HIV/AIDS epidemic represents a growing and persistent health threat to women, especially young women. The purpose of the current study was to conduct an international study with female undergraduate college students to assess knowledge and attitudes about HIV/AIDS, current and future sexual behaviors, and condom use self-efficacy. Participants included several convenience samples of female undergraduate college students from three public universities in the southern region of the United States (n = 112), a large public university in Australia (n = 66), and a public university in Hong Kong (n = 93). This research study utilizes a quantitative survey research design. Seventy-seven percent of American women and 66% of Australian women were sexually active compared with only 21% of Chinese women (χ2 = 67.74, p

A total of 979 Chinese college students were recruited in order to examine the psychometric properties of the Chinese version of the South Oaks Gambling Screen (C-SOGS). The C-SOGS was internally consistent and correlated with gambling-related problems and negative mental health status. Results of likelihood ratios (LRs) and receiver operating characteristic (ROC) curve supported the C-SOGS as a valid screening instrument for probable pathological gambling. Using the DSM-IV criteria for pathological gambling, the conventional cut score of 5 on the C-SOGS showed satisfactory sensitivity, specificity and false negative rates. This cut score identified 85% of the true positives and 95% of the true negatives. In general, the C-SOGS overestimated the number of pathological gamblers relative to DSM-IV criteria. Future research on Chinese gambling should build on current empirical work on the SOGS to refine the C-SOGS for use with Chinese populations.

This study explored age-cohort differences on attitudes and intention toward old age home placement among 186 young, 161 middle-aged, and 185 older Chinese in Hong Kong, who voluntarily participated in this questionnaire survey without monetary reward. Compared to young adults and middle-aged Chinese, older Chinese were more likely to view old age homes positively, to adhere to traditional filial obligations, and to endorse beliefs about individual independence. Middle-aged Chinese reported greater intention, as compared to young adult Chinese, to refer older people to old age homes. Favorable attitudes toward old age homes were the most significant predictor of acceptance of old age home placement in each cohort. Among young Chinese adults, beliefs about independence and positive attitudes toward older people also significantly accounted for intention to refer older family members to old age home care. The findings suggest that old age home placement is not associated with unfilial thinking in contemporary Chinese society. Limitation and implications of the study were also discussed.

Four-hundred-and-thirty-five Chinese married nurses with children were surveyed on their family—work role experience, sense of mastery, and psychological distress. Hierarchical regression analyses showed spillover effects of role experience on psychological health as well as asymmetrical permeability of family and work boundaries. The hypothesis that mastery acted as a moderator between role experience and psychological health was supported. In general, a higher level of mastery augmented positive but mitigated negative influence of role experience on psychological functioning. Findings provide useful information to practitioners and policy makers on issues related to family—work stress and women’s health in contemporary Chinese society.

We examined the reliability, validity, and classification accuracy of the South Oaks Gambling Screen (SOGS) when adopted for use in Chinese. The DSM-IV criteria for pathological gambling served as the standard against which the classification accuracy of the SOGS was tested. A total of 283 Chinese adults in the community and 94 Chinese treatment-seeking gamblers were recruited. The internal reliability of the SOGS was satisfactory for the general sample and acceptable for the gambling sample. The SOGS was correlated with the DSM-IV criteria items as well as psychosocial and gambling-related problems. Relative to the DSM-IV criteria, the SOGS tended to overestimate the number of pathological gamblers in both samples. In general, we were relatively confident that individuals were not pathological gamblers if the SOGS scores were between 0 and 4 and were pathological gamblers if the SOGS were between 11 and 20. There was about 50-50 chance of being pathological gamblers if the SOGS scores were between 8 and 10. However, the probability of individuals being pathological gamblers was about 0.30 if the SOGS scores were between 5 and 7. We proposed a SOGS cut score of 8 to screen for probable pathological gambling in Chinese societies. © 2009 Springer Science+Business Media, LLC., published_or_final_version, Springer Open Choice, 01 Dec 2010

Objective This study investigated the prevalence of child maltreatment as perpetrated by parents, its associated health outcomes, and its resilient factors among high school students in China. Methods A multi-level stratified random school-based survey was conducted in 2005. Twenty four high schools were randomly chosen from eight districts in Guangzhou, South China (three from each district). Two classes were randomly selected from each of Form 1 to Form 3 (aged 12–16) in each selected school. Data from 6,593 students were analyzed. A number of locally validated tools were used to measure various types of maltreatment as well as physical and psychological conditions of students. Results The half-year prevalence of psychological aggression, minor physical maltreatment, severe physical maltreatment, and very severe physical maltreatment were 78.3%, 23.2%, 15.1%, and 2.8% respectively; while the half-year prevalence of sexual abuse was .6%. Maltreated students were more likely to report physical and psychological problems, and a positive relationship was also found between the severity of maltreatment and the likelihood of negative health outcomes. Male gender or having higher levels of social support and life satisfaction were identified as resilient factors to physical health of maltreated students. Conclusions Child maltreatment as perpetrated by parents is common among high school students in Guangzhou, China. More public education programs are needed to raise public awareness of this problem. Intervention programs that target at improving social support and life satisfaction of students are potentially beneficial.

Aims. This study examined the prevalence and correlates of the use of restraint and force in care for older people in the hospital setting in Hong Kong. Background. The use of restraint and force is common in care for older people. Although some knowledge exists on the potential consequences and characteristics of patients where restraint is used, little is known about the profiles of the nursing staff administering restraint. Design. Descriptive cross-sectional study. Method. Data were collected in 2006. A total of 187 nursing staff provided information on their demographic characteristics, coworker emotional support, burnout symptoms, attitudes toward patients with dementia, as well as their perceptions of the use of restraint and force in care for older people and their experiences with it. Results. More than two-thirds (73·8%) of the participants reported using restraint or force in the past three months, with physical restraint endorsed by 69%, the use of force in examination or treatment endorsed by 48·1% and the use of force in activities of daily living endorsed by 46·5% of the participants. Pearson correlation analysis results show that use of physical restraint was negatively correlated with the age of participants (r = −0·44, p 0·05). Conclusion. The use of restraint and force is common among nurses in hospital medical wards in Hong Kong. To reduce restraint use in patient care, steps need to be taken to mitigate feelings of burnout and to foster sense of social support among nurses. Relevance to clinical practice. The hospital administration can take a leading role in restraint reduction by setting standards of care and by formulating institutional policy regarding the use of restraint or force.

This is a two-part study of perimenstrual symptomatology in Chinese women. We developed and validated the Chinese Questionnaire of Perimenstrual Symptoms (CQ-PERI-MS), which was adapted from the Moos Menstrual Distress Questionnaire, and used this instrument to assess the prevalence and nature of perimenstrual symptoms among Chinese women in Hong Kong. The initial CQ-PERI-MS was first administered to a sample of 538 menstruating Chinese women in Hong Kong together with measures of anxiety, depression and neuroticism. Psychometric analyses rendered a 32-item CQ-PERI-MS which demonstrated good reliability, convergent and discriminant validity, and factorial validity. Four factors were yielded, namely, Dysphoria, Somatic distress, Cognitive problems and Arousal. The CQ-PERI-MS was then administered to a separate sample of 339 menstruating Chinese women in Hong Kong for further examination of validity as well as pattern of perimenstrual symptoms. It was found that perimenstrual symptoms were common, with 18.6% and 34.2% of the participants reporting 10 or more premenstrual and menstrual symptoms, respectively. Both premenstrual and menstrual distress were characterised by a combination of emotional and somatic symptoms. Contrary to previous preconceptions, perimenstrual symptoms are commonly experienced by Chinese women, with both overlapping and distinct features when compared with patterns in the West.

Chinese people are consistently reported to be less likely to commit to posthumous organ donation than the Westerners. This study aims at investigating how death anxiety may hinder them from expressing their willingness to donate organs. Among 290 Hong Kong Chinese adults (age plus or minus 25 years), a higher level of death anxiety was associated with a greater expectation of medical neglect and a lower level of self-efficacy. Moreover, a higher level of death anxiety was also correlated with a lower likelihood of donor card signing and discussion of organ donation. The results of regression analyses suggested a mediating role of self-efficacy on the relationship between death anxiety and these behaviors. That is, death anxiety, by lowering one's perceived self-efficacy, reduces his/her likelihood to sign the donor card or to tell his/her donation decision. Findings suggest that death education program should be included in promotion campaigns for Chinese adults.

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services...

The objective of the study was to examine quality of life (QOL) and its age-specific factors in cervical cancer patients at different stages of life.One hundred and seventy-three Chinese patients with cervical cancer were surveyed by telephone. QOL was assessed with the WHO Quality of Life Scale-Chinese/Hong Kong (HK) version (WHOQOL-BREF-HK) and compared across age groups. Using multiple regression analyses, demographic and medical factors that were independently associated with QOL outcomes in each age group were identified.The age groups did not differ in the level of QOL, except for the social relationship domain. Older patients reported poorer social functioning than younger patients. Different factors were associated with QOL outcomes in different age groups. For patients in young adulthood, employment and education level were positively associated with QOL. For patients in midlife adulthood, time since diagnosis and stage of cancer were positively associated with QOL. For patients in aging adulthood, QOL was negatively associated with age, physical morbidity, and a history of termination of pregnancy. However, having a partner and possessing religious belief were positively associated with QOL.Patient's age had a significant impact on the experience of QOL. Older patients had poorer social relationships than younger patients. Religion seemed to have a protective effect against poor social functioning in aging patients.

Two-hundred-and-thirty-one Chinese women were individually interviewed on their HIV-prevention behavior and gender-related psychosocial factors. Compared to women with intact marriages, women with marital disruption endorsed more inaccurate information about HIV/AIDS, had less worry about contracting HIV from their husbands, and were less likely to use condoms in current and future sexual activities. Among sexually active Chinese married women, rates of condom use in the past 6 months were 60% for the intact group and 38% for the disrupted group. Factors that discriminated between condom non-users and users among sexually active women in the disrupted group included: conservative gender attitudes toward sexuality and sexual decision-making, negative attitudes toward condom use, and lack of concern about contracting HIV from their husbands.

s The process of modernization and rapid economic development in China has brought changes in family structure and gender relation. We reviewed empirical literature on intimate partner violence (IPV) in China within the past 20 years to understand the magnitude and nature of the problem. Information was drawn from 19 empirical studies and a total of 49,201 adult respondents. The average lifetime and year prevalence of male-on-female IPV was respectively 19.7% and 16.8% for any type, 42.6% and 37.3% for psychological, 14.2% and 6.7% for physical, and 9.8% and 5.4% for sexual violence. Higher lifetime prevalence of any type of IPV was reported by rural respondents, by studies conducted in healthcare settings, and by studies using standardized scales to assess IPV. Women were at increased risk of IPV when they and/or their partners were of low education and socio-economic status, grew up in rural areas, and exhibited behavior problems of smoking, alcoholism, and illicit drug use. IPV was also related to long duration of marriage, poor marital quality, marital conflicts, sexual jealousy and extramarital affairs, status/power disparity between partners, inadequate social support, and extended family structure. Cultural and societal risk markers included patriarchal beliefs, wife-beating myths, and political/legal sanction of violence.

A total of 952 (841 men and 111 women) Chinese treatment-seeking problem gamblers completed self-report assessment forms. Female in contrast to male gamblers were more likely to be older, married, less educated, and without employment. Female gamblers also started gambling at an older age, had a shorter gambling history, preferred casino and mahjong gambling, and reported more somatic complaints and suicidal thoughts. Male and female gamblers accumulated similar amount of gambling debt and reported an average of 12 gambling-related problems on the Chinese version of the South Oaks Gambling Screen [Lesieur and Blume (Am J Psychiatry 144:1184-1188, 1987)]. Both groups were similarly troubled by their indebtedness, inability to control gambling, and gambling-related interpersonal problems. However, female gamblers had fewer means to pay their gambling debt. Given that significant gender-related differences were observed in Chinese problem gamblers, prevention and treatment services should attend to specific needs of male and female gamblers.

This study investigated the trajectory of traumatic stress symptoms in the aftermath of the 2004 Southeast Asian earthquake-tsunami. A total of 265 adult Thai survivors were assessed at 2 weeks and 6 months following the earthquake-tsunami. The percentages of survivors reporting traumatic stress symptoms were 22% at 2 weeks and 30% at 6 months postdisaster. Four trajectories of traumatic stress symptoms were identified: 12% of survivors presented with chronic stress symptoms, 18% had a delayed onset, 10% showed improvement, and the remaining 60% maintained a stable emotional equilibrium. Among survivors, the chronic group was the oldest, the delayed group reported the lowest level of perceived government support, and the resilient group experienced the fewest postdisaster psychiatric symptoms. Results pointed to the need to broaden the conceptualization of postdisaster stress responding as well as to establish disaster psychiatry and related mental health activities in the region.

Objective This study explored psychosocial factors associated with psychological adjustment among survivors of a severe natural disaster. Methods Two hundred sixty-seven adult Thai survivors of the 2004 Southeast Asian earthquake–tsunami were surveyed. Results At 6 months following the disaster, percentages of survivors who reported positive and negative adjustment were 34% and 40%, respectively. For positive adjustment, best predictors were predisaster employment, increased arousal, and frequent support seeking. Support seeking also partially mediated the association between arousal and positive adjustment. For negative adjustment, infrequent support seeking and increased intrusion and arousal were the best predictors. Arousal was a partial mediator between intrusion and negative adjustment, and support seeking also partially mediated the influence of intrusion and arousal on negative adjustment. Conclusion Mental health programs for survivors of natural disasters should focus on promoting active coping strategies such as support seeking, strengthening of support networks, and management of posttraumatic stress symptoms to facilitate adjustment.

Objective This study aimed to examine rates and associated factors of parent-to-child corporal punishment and physical maltreatment in Hong Kong Chinese families. Method Cross-sectional and randomized household interviews were conducted with 1,662 Chinese parents to collect information on demographic characteristics of parents and children, marital satisfaction, perceived social support, evaluation of child problem behaviors, and reactions to conflicts with children. Descriptive statistics, analyses of variances, and logistic regression analyses were conducted. Results The rates of parent-to-child physical aggression were 57.5% for corporal punishment and 4.5% for physical maltreatment. Mothers as compared to fathers reported higher rates and more frequent use of corporal punishment on their children, but this parental gender effect was insignificant among older parents and those with adolescent children. Boys as compared to girls were more likely to experience higher rates and more frequent parental corporal punishment, especially in middle childhood at aged 5–12. Furthermore, parents perpetrated more frequent physical maltreatment on younger as compared to older children. Results from logistic regression analyses indicated that significant correlates of parental corporal punishment were: children's young age, male gender, and externalizing behaviors as well as parents’ young age, non-employment, and marital dissatisfaction. For parent-to-child physical maltreatment, significant correlates were externalizing behaviors of children and parental marital dissatisfaction. Conclusions Hong Kong Chinese parents commonly used corporal punishment on their children, which was associated with characteristics of children, parents, and family.

Objective: The current longitudinal study explored the prevalence and psychosocial factors of disordered eating among new Chinese mothers in Hong Kong. Method: Self-report questionnaires on bulimic symptoms and pregnancy-related factors were collected at both prenatal and postnatal periods from 131 Chinese women. Results: Participants reported significantly more severe disordered eating in the postnatal than in the prenatal period, with percentages being 19.08% and 8.4%, respectively, using the Eating Disorder Inventory-2. Results revealed that prenatal disordered eating, weak maternal-fetal attachment, a low level of instrumental spousal support during pregnancy, postnatal depressive symptoms, and a poor mother-infant relationship were significantly related to disordered eating at 6 months postchildbirth. Conclusion: Findings suggested that the transition to motherhood is a period of stress that may either precipitate or exacerbate disordered eating. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006.

Seventy-one Chinese social workers and 74 Chinese police officers residing in Hong Kong were surveyed on their gender-role attitudes, endorsement of wife abuse myths, and definitions of wife abuse. Results showed that compared to social workers, police officers held more conservative gender-role attitudes, endorsed more myths about wife abuse, and adopted more restrictive definitions of physical and psychological wife abuse. Hierarchical regression analyses showed that definitions of wife abuse were related to different predictors for these two groups of professionals. Among social workers, egalitarian gender-role attitudes were a significant predictor of broad definitions of physical wife abuse, but no significant predictor was found for psychological wife abuse. Among police officers, significant predictors of definitions of physical wife abuse included marital status, educational attainment, and endorsement of wife abuse myths; gender-role attitudes were the only significant predictor of definitions of psychological wife abuse.

This study examined psychosocial factors associated with the acceptance of long-term placement in old age homes (OAHs) among 185 elderly Chinese in Hong Kong. Participants were recruited from local community centers for elderly people and were individually interviewed on their willingness to enter OAHs, attitudes toward OAHs, perceived mental and physical health status, and beliefs about filial piety and independence. Results showed that only 20% of the participants indicated their willingness to enter OAHs in the coming 6 months. Among depicted services and facilities in OAHs, participants rated the quality of OAH staff as the most important, whereas the choice of food and mealtimes were viewed as the least important. Participants were more willing to enter OAHs if depicted services and facilities were provided at OAHs. Findings of the hierarchical regression analysis revealed that salient correlates of willingness to enter OAHs were positive attitudes toward OAHs, poor perceived physical health, male gender, and a low need for independence. Prior visits to OAHs and filial piety beliefs were unrelated to participants’acceptance of OAH care. Service and policy implications in promoting elderly people’s sense of autonomy and acceptance of OAH care, reducing the cost of placement in OAHs, and ensuring the quality of services and care in OAHs are also discussed.

This study explored how physical and psychosocial factors influenced the practice of health-promoting behaviors among elderly Chinese patients with type-2 diabetes. Individual structured interviews were conducted with 191 elderly Chinese attending an outpatient clinic in Hong Kong. Results showed that demographic and illness characteristics were unrelated to health practices. Participants were more likely to engage in health-promoting behaviors when they were physically well, valued their health, were confident of practicing the behaviors and viewed their illness as controllable by both doctors and themselves. The above factors exerted their respective main effects, instead of interaction effects, in predicting health practices.

This study aimed to establish preliminary estimates and related risk factors for elder abuse among Hong Kong Chinese families. A total of 276 elder Chinese participated in the study, among which 27.5% reported having experienced at least one abusive behavior committed against them by their caregivers during the surveyed year. The most common form of abuse was verbal abuse (26.8%), whereas physical abuse (2.5%) and violation of personal rights (5.1%) were relatively less common. There was no gender difference in the prevalence of elder abuse. Overall and verbal abuse were best predicted by participants' poor visual and memory abilities, dependence on the caregivers, and caregivers' nondependence on them. Physical abuse was best predicted by caregivers' nondependence on the participants as well as participants' dependence on the caregivers. Participants' age was the only significant predictor for violation of personal rights. Results, limitations, and implications of the study were also discussed.

This study examined sexual practices, condom use, and psychosocial correlates of condom use in a convenience sample of 187 Chinese gay men in Hong Kong. Among those who were sexually active and answered the item on condom use (n = 164), 22% never used condoms, 39% were inconsistent condom users, and 39% used condoms every time they engaged in sexual activities in the past 6 months. Compared to inconsistent and noncondom users, consistent condom users had more positive feelings toward condom use, perceived greater vulnerability to STD/AIDS infections, showed greater self-acceptance and disclosure of their homosexual sexual orientation, were more involved with local gay communities, endorsed more favorable attitudes toward coming out, and had a lower level of perceived discrimination because of their homosexual sexual orientation. The two groups did not differ significantly on perceived partner reaction to condom use. Results of a logistic regression analysis showed that positive feelings toward condom use were the most salient correlate of consistent condom use.

Severe acute respiratory syndrome (SARS) was first reported in China, and spread to 29 regions, affecting over 8000 people worldwide. For the general public, the psychological impact of SARS may have been greater than the physical health danger of the disease. The present paper proposes the influence of psychological factors on people's cognitive, affective, and behavioral responses during the SARS outbreak. The various papers in this special issue of the Journal reveal how people have reacted during the SARS outbreak: People's general coping styles may be related to their health behavior during the outbreak. Cultural differences were evident in the perception of SARS, and individuals' perceptual styles may have influenced their ability to cope with the outbreak. The way in which individuals coped with SARS-related stressful events was different from their usual practices of managing daily stress. Individual differences in the adoption of preventive measures were related to the distinct susceptibility to several social-cognitive biases.

Analyses of focus group discussions show that Chinese conceptions of women as legitimate victims of violence are constructed through representations of men as sick or being controlled by their impulses and of women as sex objects or naggers who trigger men's impulses or potential for violence. As women's behaviors are seen as precipitating factors, men are thus excused from their acts of violence and do not have to shoulder full responsibility for their violent behaviors. However, some young and educated Chinese reject various cultural myths, oppose victim-blaming explanations, and disrupt pro-violence social scripts

The purpose of this study was to explore the relationship of family, peer and school factors on the mental health of Chinese male and female at risk adolescents and secondary school students in Hong Kong. Questionnaire surveys based on various standardized assessment scales were conducted with 398 (183 female and 215 male) Chinese at risk adolescents and 320 (160 female and 160 male) Chinese secondary school students between 12 and 18 years of age in Hong Kong. Compared to secondary school students, at risk adolescents had poorer relations with parents, more negative family and peer influence, a more negative school environment, and poorer social functioning. Findings also revealed that female participants had more somatic symptoms, anxiety, and depression compared to males. The importance of environmental factors on the mental health of Chinese adolescents supports previous research in Western countries. Implications for intervention and prevention were discussed from a crosscultural perspective.

This study aims to explore various psychosocial correlates associated with how Chinese react to death and dying. A total of 282 Chinese college students participated in this study. They completed the Death Anxiety Scale, the Revised Death Anxiety Scale, and the Multidimensional Fear of Death Scale, as well as measures on self-efficacy and health locus of control. Results showed that younger as compared with older participants and women as compared with men tended to be more death anxious. Those with low levels of self-efficacy and external health control orientations were more likely to report a high level of death anxiety. Only a weak association was found between internal health locus of control and fear of conscious death. Limitations of the study were also discussed.

This study aimed to explore how Chinese residing in different Chinese societies defined violence against women (VAW). A total of 3,540 Chinese human service professionals residing in Hong Kong, Taiwan, and the People's Republic of China participated in the study. In general, Chinese perception of VAW was best predicted by their gender, educational attainment, attitudes toward women, and the types of criteria that they used to determine VAW. Results also showed that there were regional differences in the perception of whether the depicted behaviors would constitute VAW, criteria in determining behaviors as VAW, and attitudes toward women. Compared to agency professionals, communion professionals had a broader definition of VAW and were more likely to rate the infliction of psychological harm and violation of women's rights as important determining criteria for VAW. Results and limitations of the study were discussed