Behavioral activation for dementia caregivers: scheduling pleasant events and enhancing communications.

BACKGROUND: Dementia caregiving is often associated with increase in depressive symptoms and strained relationships. This study tested whether telephone-delivered psychoeducation combined with an enhanced behavioral activation (BA) module had a better effect on the well-being of Alzheimer's caregivers than psychoeducation alone. The focus is on enhancing the competent use of coping skills via BA. The program is delivered by telephone to increase accessibility and sustainability for caregivers. Senior citizens are trained as paraprofessionals to deliver the BA module to increase the potential for sustainability of the program. METHODS AND SUBJECTS: The study compared two telephone interventions using a 4-month longitudinal randomized controlled trial. For the first 4 weeks, all participants received the same psychoeducation program via telephone. Then for the following 4 months, eight biweekly telephone follow-up calls were carried out. For these eight follow-up calls, participants were randomized into either one of the two following groups with different conditions. For the psychoeducation with BA (PsyED-BA) group, participants received eight biweekly sessions of BA practice focused on pleasant event scheduling and improving communications. For the psychoeducation only (PsyED only) group, participants received eight biweekly sessions of general discussion of psychoeducation and related information. A total of 62 family caregivers of persons living with dementia were recruited and 59 (29 in the PsyED-BA group and 30 in the PsyED only group) completed the whole study. RESULTS: As compared to the group with psychoeducation and discussion, the group with enhanced BA had decreased levels of depressive symptoms. The study had a low attrition rate. CONCLUSION: Results suggested that competence-based training could be effectively administered through the telephone with the help of senior citizens trained and engaged as paraprofessionals. Results contribute to the present literature by offering some framework for developing effective, accessible, sustainable, and less costly interventions.

The Temporal Experience of Pleasure Scale (TEPS): exploration and confirmation of factor structure in a healthy Chinese sample.

BACKGROUND: The Temporal Experience of Pleasure Scale (TEPS) is a measure specifically designed to capture the anticipatory and consummatory facets of pleasure. However, few studies have examined the structure of the measure in non-Western samples. The current study aimed to evaluate the factor structure and psychometric properties of the TEPS in a Chinese sample. METHODS: We administered the Chinese version of the TEPS to 2275 healthy Chinese college students. They were randomly split into two sub-samples. The first sub-sample was used for exploratory factor analysis (EFA) to examine the structure of the TEPS in a Chinese sample. The second sub-sample was used as a validation sample for the identified structure from the EFA and confirmatory factor analysis (CFA) was adopted. RESULTS: Results of the EFA suggested a four-factor model (consummatory contextual, consummatory abstract, anticipatory contextual, and anticipatory abstract factors) instead of the original two-factor model (consummatory and anticipatory factors) ascertained from Western samples in the United States. The CFA results confirmed these results in the second sub-sample. Internal consistency and test-retest stability of the TEPS factors were good. CONCLUSIONS: The TEPS has four factors among Chinese participants. Possible reasons for cultural difference and potential applications of the TEPS for cross-cultural comparison are discussed.

Smoking is associated with poor self-rated health among adolescents in Hong Kong.

INTRODUCTION: To investigate the association between smoking and self-rated health (SRH) among adolescents in Hong Kong. METHODS: Form 1 (U.S. Grade 7) to 5 students (N = 36,225) from 85 randomly selected secondary schools were surveyed using anonymous, self-administered questionnaires to collect information about smoking, SRH, secondhand smoke exposure, drinking, illicit drug use, physical activities, medical services use, health complaints, and sociodemographic characteristics. Logistic regression yielded adjusted odds ratios (AORs) for poor SRH due to smoking in boys and girls. RESULTS: Compared with never-smoking, smoking experimentation, ex-smoking, and current smoking were associated with AORs (95% CI) for poor SRH of 1.22 (1.07-1.40), 1.43 (1.12-1.83), and 1.31 (1.13-1.53), p for trend <.001, in boys and 1.26 (1.10-1.39), 1.42 (1.08-1.85), and 1.75 (1.53-2.00, p for trend <.001, in girls. The AOR of poor SRH for current smoking was higher in girls than boys, p for interaction <.001. Current and experimental smoking but not ex-smoking were significantly associated with poor SRH among healthy students who had no health complaints or recent medical consultations. Increasing cigarette consumption, years of smoking, and smoking urge were also significantly associated with poor SRH. CONCLUSIONS: Smoking was associated with poor SRH among Chinese adolescents, especially girls. This finding is useful for discouraging smoking initiation and motivating quitting in adolescent smokers.

Exploratory study on the base-rate of paranoid ideation in a non-clinical Chinese sample.

Recent findings from several large-scale community surveys suggest that delusions tend to occur in non-clinical samples as a continuous phenotype rather than as an all-or-none phenomenon. However, the majority of studies on the prevalence of delusions and paranoid ideation are limited to Western samples. The present study aims to examine the phenomenon and base-rate of paranoid ideation in a Chinese non-clinical sample. A total of 4951 undergraduates (65.9% male) completed a checklist for paranoid ideation and the Schizotypal Personality Questionnaire (SPQ). Participants were classified into individuals with and without schizotypal personality disorder (SPD) features based on the SPQ. For the frequency subscale, 2.1-18.2% of the participants without SPD features experienced certain types of paranoid ideation at least once a week during the survey. The prevalence rate even elevated to a higher proportion in conviction and distress dimensions. For the conviction subscale, 9.3-53.5% of the participants somewhat believed of the ideations. For the distress subscale, 14.7-31.3% of the participants felt somewhat distressing in the experienced paranoid ideation. Participants with SPD features reported significantly higher prevalence in most items across these three dimensions. Findings indicate a high base-rate of attenuated forms of psychotic-like symptoms in a non-clinical Chinese sample, and provide further evidence for the continuity of psychotic phenomenon in non-clinical samples.

Social support and well-being in dementia family caregivers: the mediating role of self-efficacy.

OBJECTIVES: The study investigated self-efficacy as a possible mediator of the relationship between the social support and depressive symptoms of primarily informal caregivers, mainly family members, of patients with dementia in Hong Kong. METHOD: One hundred and thirty-four caregivers were interviewed. Path analyses were conducted using a self-efficacy scale that consists of three subscales assessing three domains of caregiving self-efficacy. Self-efficacy for obtaining respite, responding to disruptive patient behaviours, and controlling upsetting thoughts about caregiving were measured. RESULTS: Results showed that self-efficacy acted as a partial mediator between social support and depressive symptoms of these caregivers. CONCLUSION: Findings suggest that self-efficacy may function as a mechanism through which social support influences depressive symptoms, and the importance of this self-efficacy mechanism can be domain-specific.

Depressive symptoms and smoking among Hong Kong Chinese adolescents.

AIMS: To examine associations among depressive symptoms, smoking, smoking trajectories and quitting smoking in Hong Kong. DESIGN: Prospective longitudinal design, with wave 1 at baseline (T1) and wave 2 (T2) 12 months later. SETTING AND PARTICIPANTS: Form 1 (equivalent to 7th grade in the United States) students, mean age = 12.7 years, n = 1894. MEASUREMENTS: Self-reported smoking status, attempts to quit and depressive symptoms. FINDINGS: At both waves, current as well as ex-smokers had higher depressive symptoms than never smokers. T1 smoking predicted T2 depressive symptoms among those with low baseline depressive symptoms. Depressive symptoms at T1 predicted smoking at T2 among non-smokers at T1. Trajectories were defined by separating participants who were never smokers at both waves ('non-smokers'), those who smoked at both waves ('persistent smokers'), those who smoked at one time but were not smoking at either wave ('past smokers), and those who had never smoked at T1 but reported smoking a year later ('new smokers'). Persistent, past and new smokers had higher depressive symptoms at both waves than non-smokers. Smokers who reported not wanting or trying to quit and those who had been unsuccessful at quitting had higher depressive symptoms at T2 than those who successfully quit. CONCLUSION: Our results suggest that depressive symptoms promote tobacco use in Asian adolescents by making it more likely that an adolescent will begin smoking and less likely that she or he will quit. These findings elucidate risk factors in Hong Kong for two important public health concerns for adolescents: smoking and depression.

Perceived peer smoking prevalence and its association with smoking behaviours and intentions in Hong Kong Chinese adolescents.

BACKGROUND: Among the many personal, social and environmental risk factors of adolescence smoking, normative beliefs stand out for their potential to be modified with factual information on smoking prevalence. AIMS: To study the perceived peer smoking prevalence and its association with smoking behaviours in Hong Kong Chinese adolescents. DESIGN AND SETTING: Cross-sectional territorial-wide school-based survey conducted in 64 randomly selected secondary schools in Hong Kong. PARTICIPANTS: A total of 13,280 forms 1-3 students (equivalent to grades 7-9 in the United States) aged 12-16 years. MEASUREMENTS: Perceived peer smoking prevalence, smoking status, intention to smoke in future, other smoking-related factors and demographic information. FINDINGS: Overestimation of peer smoking prevalence was observed regardless of gender and smoking status, and was more common in girls (69.4%) than boys (61.0%), and in experimental (74.3%) and current smokers (85.4%) than in never smokers (60.7%). Boys who overestimated and grossly overestimated (over two times) peer smoking were more likely to be current smokers, with adjusted odds ratios and 95% confidence intervals (95% CI) of 1.95 (1.24-3.07) and 3.52 (2.37-5.24) (P for trend <0.001). Similarly, boys who grossly overestimated peer smoking were 76% (95% CI: 41-120%) more likely to have ever smoked. CONCLUSION: Overestimation of peer smoking prevalence was common in Hong Kong Chinese boys and girls, and was associated with current and ever smoking in boys. These findings have important implications on normative education in adolescence smoking prevention programmes.