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Objective: To examine the clinical profile of Chinese eating disorder patients at a tertiary psychiatric clinic in Hong Kong from 1987 to 2007. Method: Data on 195 consecutive patients were retrieved from a standardized intake interview by an eating disorder specialist. Patients seen between 1987–1997 (n = 67) and 1998–2007 (n = 128) and fat-phobic (n = 76) and nonfat-phobic (n = 39) anorexic patients were compared. Results: Patients were predominantly single (91.8%), female (99.0%), in their early-20s and suffered from anorexia (n = 115; 59.0%) or bulimia (n = 78; 40.0%) nervosa. The number of patients increased twofold across the two periods. Bulimia nervosa became more common while anorexia nervosa exhibited an increasingly fat-phobic pattern. Nonfat-phobic anorexic patients exhibited significantly lower premorbid body weight, less body dissatisfaction, less weight control behavior, and lower EAT-26 scores than fat-phobic anorexic patients. Discussion: The clinical profile of eating disorders in Hong Kong has increasingly conformed to that of Western countries. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [ABSTRACT FROM AUTHOR]

Objective: Previous studies of atypical depression have been conducted in Western communities. There has been no community-based epidemiological study of atypical depression that covers the entire spectrum of bipolar disorders. The aim of the present study was to examine the 12 month prevalence of atypical depression and the differences in demographic and clinical profiles between depressed patients with and without atypical symptoms in the Chinese adult population of Hong Kong. Method: A random sample of 3016 Chinese adults completed a telephone-based structured interview that examined their 12 month prevalence of major depressive episode. Atypical depression was defined as major depressive episode with hypersomnia and increased weight or appetite. Major depressive episode with and without atypical symptoms were compared on sociodemographic variables, number of depressive and manic/hypomanic symptoms, proportion of having lifetime mania/hypomania, suicidality, family psychiatric history, help-seeking behaviour, level of distress and role impairment. Results: The 12 month prevalence of atypical depression was 1.3%. Compared to non-atypical depression, atypical depression was associated with female gender, soft (subthreshold) bipolar II disorder, family psychiatric history, higher suicidality, more help-seeking from psychiatrists, and more depressive and manic/hypomanic symptoms. There was no difference in levels of distress or impairment. Conclusions: Although limited by the lack of detailed information on comorbidity, bipolar family history, and age of onset, the findings support the hypothesis that atypical depression among Chinese people in Hong Kong exhibited prevalence and correlates similar to those found in Western epidemiological and clinical studies. Further research is warranted to examine its association with hypomania and how atypical depression may occupy a nosological position between typical unipolar depression and bipolar spectrum disorders. [ABSTRACT FROM AUTHOR]

Aims: To examine the patterns of drinking, the relationship between binge drinking, alcohol abuse, and dependence, and the sociodemographic factors associated with problem drinking among Hong Kong Chinese. Method: An anonymous, random telephone survey was conducted on 9860 Hong Kong Chinese adults from April to June, 2006. Results: The age-adjusted prevalence amongst men for binge drinking was 14.4% with 5.3% of males being alcohol abusers and 2.3% dependent on alcohol. The corresponding figures for women were all lower at 3.6%, 1.4%, and 0.7%, respectively. Younger age groups showed the highest prevalence of these drinking problems. Among male binge drinkers, 18.7% were also alcohol abusers and 12.3% were alcohol dependent. Among female binge drinkers, 16% reported alcohol abuse and 9.9% reported dependence. Male binge drinkers were less likely to be older, less likely to be students but more likely to be employed in the service industry. Female binge drinkers were less likely to be over 60 years of age or married but more likely to be smokers. In both genders, smoking was significantly associated with the likelihood of binge drinking (OR = 3.6-12.3), alcohol abuse (OR = 3.0-12.1), and dependence (OR = 5.2-20.6). Conclusions: Although binge drinking has been well tolerated in Chinese culture, it is strongly associated with alcohol abuse and dependence in both genders in Hong Kong. Our findings suggest that prevalence of problematic alcohol consumption warrants greater promotion of alcohol harms awareness. Higher rates of heavy drinking in younger-aged individuals may reflect changing lifestyle behaviors and herald higher future levels of alcohol-related health and social problems. [ABSTRACT FROM AUTHOR]

Studies on the relationship between stress and specific mental disorders in particular occupational groups during major reforms have been limited, especially in Chinese communities. Using a strictly implemented telephone survey, this study examines standardized diagnoses of generalized anxiety disorder (GAD) and major depressive episode (MDE), and the association between risks of disorders and stressors faced by a random and representative sample of 2,004 Chinese teachers (aged 21-65 years) in Hong Kong. Both job-specific and general stressors were studied. Results show that the six-month prevalence rates of GAD (11.3%) and MDE (12.8%) were higher than those of the general population. Job-specific stressors were more commonly endorsed than general stressors and were related to higher risks of both GAD and MDE. Those classified as having comorbid GAD and MDE reported more sick-leave days than those classified GAD only and those without any diagnosis. Teachers exhibited a moderately high level of recognition of mental disorders but only 8.5% of those with disorders sought help from mental health professionals because of concern over stigma. Although cross-sectional and time-limited, the telephone survey method may be a cost-effective and non-stigmatizing method for studying the relationship between mental disorders and stress of specific occupational groups. [ABSTRACT FROM AUTHOR]

Objective: We examined the psychometric properties of the Eating Disorder Diagnostic Scale (EDDS) in a community sample of Hong Kong school children. Method: Participants (359 boys and 387 girls), aged 12 to 19 years, were assessed on the EDDS on two occasions, one month apart. Factor structure, internal consistency, test-retest reliability, and validity against the Eating Disorders Examination–Questionnaire (EDE-Q) and Center for Epidemiological Studies-Depression (CES-D) were investigated. Results: Four groupings emerged on exploratory factor analysis: body dissatisfaction, bingeing behaviors, bingeing frequency, and frequency of compensatory behaviors. Items loaded on the same factors for boys and girls. Internal consistency for these factors was acceptable. Test-retest reliability was high for body dissatisfaction factor but weak to moderate for other factors and for diagnoses. High concurrent validity with the EDE-Q, and correlation with the CES-D was shown. Conclusion: We offer preliminary reliability and validity evidence to support the further development of the EDDS as a screening instrument to assess eating disturbances in Hong Kong youth. © 2007 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background. This is the first study to examine variation across cohorts in lifetime risk of DSM-IV mental disorders in metropolitan China.Method. Face-to-face household interviews of 2633 adults in Beijing and 2568 adults in Shanghai were conducted from November 2001 to February 2002 using a multi-stage household probability sampling method. The Chinese World Mental Health (WMH) Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used for assessment.Results. Lifetime prevalence of any disorder was 13·2%. Alcohol abuse (4·7%), major depressive disorder (3·5%), and specific phobia (2·6%) were the most common disorders. The median age of onset was later for mood (43 years) than anxiety (17 years) and substance use (25 years) disorders. Compared to observed lifetime prevalence, the projected lifetime risk as of age 75 years increased by 106% for major depressive disorder (7·2%), and was uniformly higher for all disorders. Relative odds of any lifetime disorder were 4·7 in the most recent cohorts (ages 18–34) compared to the eldest cohorts (ages ?65).Conclusions. The findings of this cross-sectional study tally with the view that rapid socioeconomic changes may bring about increasing incidence of mental disorders in China. However, prospective longitudinal studies are needed to confirm if the increase is real. Because of the huge size of the Chinese population, any increase in projected lifetime risk of mental disorders represents an enormous increase in the number of affected individuals. [ABSTRACT FROM AUTHOR]

Background. Psychiatric epidemiological surveys in China have repeatedly found much lower prevalence estimates than in most other parts of the world.Method. Face-to-face household interviews of 5201 subjects (2633 in Beijing and 2568 in Shanghai respectively) were conducted from November 2001 to February 2002 using a multistage household probability sampling method. A Chinese version of the World Health Organization Composite International Diagnostic Interview (CIDI) was used for assessment.Results. Twelve-month prevalence of any DSM-IV mental disorder in metropolitan China is estimated to be 7·0%, with major depressive disorder (2·0%), specific phobia (1·9%), and intermittent explosive disorder (1·7%) the most common disorders. Of these, 13·9% are classified as serious, 32·6% moderate, and 53·5% mild. Only 3·4% of respondents with any disorder sought treatment within the previous 12 months.Conclusions. Although the general pattern of disorders, risk factors, and unmet need for treatment are similar to those in other countries, a low prevalence of mental disorders is found in metropolitan China. Resolving methodological problems that cause downward bias in estimates, such as stigma-related under-reporting and diagnostic incongruity with a somatopsychic mode of symptom presentation may lead to more accurate and probably higher prevalence estimates in future epidemiological studies. As a low prevalence still translates into an enormous number of people in China, measures are urgently needed to address the huge unmet need for treatment of mental disorders. [ABSTRACT FROM AUTHOR]

Objective: The authors determined the intermediate-term outcome of anorexia nervosa for Chinese patients in Hong Kong. Method: A consecutive series of 88 patients who fulfilled DSM-III-R criteria for typical (i.e., fat phobic [N = 63]) and atypical (i.e., no fat phobia [N = 25]) anorexia nervosa were contacted at least 4 years after onset of their illness for semistructured and self-rated assessments of outcome. Results: Three patients (3.4%) died; the mortality ratio for this group against the expected standard for subjects of similar age and gender was 10.5 to 1. Eighty (94.1%) of the remaining 85 patients were successfully traced 9.0 years after onset of their illness. Good, intermediate, and poor outcomes were seen in 61.8%, 32.9%, and 5.3% of the subjects, respectively. Anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified was exhibited by 55.0% of the subjects (N = 44). Lifetime depressive (81.6%) and anxiety (27.6%) disorders were common. Older age at onset and the presence of fat phobia independently predicted poor outcome. Patients with atypical anorexia nervosa were symptomatically stable, less likely to demonstrate bulimia, and had a better eating disorder outcome than patients with typical anorexia nervosa. Conclusions: The outcome profile of Chinese patients supported the cross-cultural disease validity of anorexia nervosa. The cultural fear of fatness not only shaped the manifest content but also added to the chronicity of the illness. [ABSTRACT FROM AUTHOR]

Presents a study on patients with eating disorders using the Eating Attitude Test (EAT) in Hong Kong, China. Prevalence of eating disorders in high-income societies; Details on the pathological EAT profile of bulimic patients; Attributions of the starvation of anorexic patients.

This study aims to identify themes from the treatment of Chinese families with an adolescent or an adult member suffering from anorexia nervosa (AN), through a multiple case study. This study reveals that self-starvation may be regarded as a cultural metaphor. Four major themes emerged at the family level: self-starvation as an expression of love and control, coalition of the AN daughter with the mother, family loyalty, and the powerlessness and helplessness of the mother. The themes identified are narrative accounts of the Hong Kong Chinese families, rather than causal explanations proposed by Western literature. The emerging themes are believed to be constructed and legitimized by traditional Chinese cultural values, with females being subordinated to and dependent on males and the self being subjugated to or sacrificed for the collective. Treatment implications are discussed. [ABSTRACT FROM AUTHOR]

Examines the prevalence and experience of psychiatric morbidity among primary care patients with chronic fatigue in Hong Kong, China. Demographics; Prevalence of weakness of nerves, neurasthenia and chronic fatigue syndrome; Differences between subgroups.

Explores the perceptions of anorexia nervosa among 842 Chinese undergraduates who had little biomedical exposure to the condition in Hong Kong, China. Anorexia as a chronic psychiatric condition of severe weight loss; Symptoms of anorexia; Resemblance between lay and professional epistemologies; Interdependence of lay and professional ethnopsychiatric theories and lived anorexia experience.

Evaluates the validity of Eating Disorder Inventory among patients in Hong Kong. Clinical assessment of patients with bulimia nervosa; Comparison of results with Canadian patients with eating disorders; Similarity in profile of patients.

In contrast to the West, bulimic disorders are rarer than anorexia nervosa in Hong Kong. Four female normal-weight bulimic patients with mostly typical clinical features and conspicuous morbidity are reported. The case histories support the hypothesis that binge-eating is used to regulate unpleasant affect. [ABSTRACT FROM AUTHOR]

Anorexia nervosa is a geographically distinct psychiatric disorder; it is rapidly increasing in incidence in Western countries, while being virtually unreported in China, or in the Chinese community of Hong Kong. This is surprising when the Chinese preoccupation with food and their reported readiness to somatise dysphoria are considered. Three Chinese anorectics born and living in Hong Kong and exhibiting mostly typical clinical features are reported. The rarity of the disorder in the East could be related to protective biological and socio-cultural factors specific to the Chinese, and while it may become more common, anorexia nervosa is unlikely to reach Western proportions. [ABSTRACT FROM AUTHOR]

Objectives: This community-based study examined perceived barriers to the initiation of mental health treatment among individuals with anxiety, mood, and alcohol use disorders. Methods: Face-to-face interviews were conducted with 5,201 respondents in Beijing and Shanghai using the World Mental Health Composite International Diagnostic Interview. Perceived barriers to initiating treatment from various health practitioners were examined among 211 individuals who met criteria for 12-month DSM-IV disorders and did not receive treatment. Results: Most respondents (92%) with DSM-IV disorders perceived a low need for treatment. Among respondents who perceived a need, 47% reported structural barriers and 83% reported attitudinal barriers. Respondents who had severe mental disorders and perceived a need reported more structural barriers (72%) than attitudinal barriers (65%). Lack of knowledge about service availability was the most common structural barrier. Conclusions: Future studies should examine the reasons for perceived low need for treatment and other ' treatment barriers among people with mental disorders. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article by Michael Phillips and colleagues about mental illness in China.