Using the health action process approach to predict facemask use and hand washing in the early stages of the COVID-19 pandemic in China.

Personal hygiene including wearing facemask and washing hands are instrumental to reduce transmission of COVID-19. The present study applied the health action process approach (HAPA) to examine the process from intention to protective behaviors in the early stages of the COVID-19 pandemic. A longitudinal online survey study was conducted among 229 individuals (61.6% females; M age = 25.37 years, SD age = 8.34 years) living in Hubei province, China. Action self-efficacy, outcome expectancy, risk perception, intention, planning and action control regarding facemask wearing and hand washing were assessed at baseline (Time 1), and behaviors were assessed a week later (Time 2). Data were collected from 30 January to 16 February 2020. Two structural equation models were specified to test the theory-driven determinants of the facemask wearing and hand washing respectively. The results showed that action self-efficacy predicted intentions to wear facemasks and wash hands. Intention and action control predicted both behaviors at Time 2. Associations between planning and behaviors were mixed. Mediation analyses revealed that action control significantly mediated the relationship between intention and both behaviors (facemask wearing: 90% CI [0.01, 0.12]; hand washing: 95% CI [0.01, 0.21]). Planning did not mediate the relationship between intention and the two behaviors. The findings illustrate that action self-efficacy is positively associated with intention to facemask wearing and hand washing, and action control contributes to bridging intention to behaviors. Both motivational and volitional factors warrant consideration in interventions to improve adherence to facemask wearing and hand washing in COVID-19.

Psychometric Validation of PHQ-9 and GAD-7 in Filipino Migrant Domestic Workers in Macao (SAR), China.

There are 500,000 female Filipino domestic workers worldwide. However, there are no validated instruments to assess common mental disorders in this population. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) are brief measures that could be effective screeners for depression and anxiety in domestic workers. This study aims to establish reliability and validity of the Filipino versions of the PHQ-9 and GAD-7. In Study 1, 131 domestic workers completed the PHQ-9, GAD-7, and other questionnaires with a test-retest interval of 10 days. Convergent validity was examined using measures of posttraumatic stress disorder, direct exposure to traumatic events, and rumination. Discriminant validity was assessed using measures of discrimination, pain, social support, and indirect exposure to traumatic events. In Study 2, criterion validity was established with another sample of domestic workers (N = 100) using clinician-administered Mini International Neuropsychiatric Interviews. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic efficiency. Results showed acceptable and high internal consistency for PHQ-9 and GAD-7, respectively. Both had acceptable test-retest reliability. Convergent and discriminant validity were also established. ROC curve results demonstrated that optimal cut scores for PHQ-9 and GAD-7 are 6 and 7, respectively. The Filipino versions of PHQ-9 and GAD-7 are reliable and valid for use among Filipino domestic workers.

Exploring comorbidity between anxiety and depression among migrant Filipino domestic workers: A network approach.

BACKGROUND: Depression and anxiety are comorbid. From the network model perspective, comorbidity is due to direct interactions between depression and anxiety symptoms. These interacting symptoms are called bridge symptoms, suppression of which is expected to halt other symptoms. This study investigates the network structure of depression, anxiety, and bridge symptoms in a sample of migrant domestic workers, who are among the most vulnerable and marginalized groups of workers. METHOD: Data were collected from 1375 Filipino domestic workers in Macao Special Administrative Region, China. Data from a subsample of 355 consisting of participants who met criteria for depression and anxiety were used in analysis. R software was used to estimate the network. RESULTS: The eight strongest edges were between items from the same disorder. Six were between depression symptoms, like "concentration difficulties" and "psychomotor agitation/retardation," and "psychomotor agitation/retardation" and "thoughts of death." Two were between anxiety symptoms, including "worry too much" and "trouble relaxing." For centrality indices, "fatigue" had highest strength and closeness, and "restlessness" had highest betweenness. Results revealed three bridge symptoms: "fatigue," "depressed mood," and "anhedonia." LIMITATIONS: The results may not generalize to the entire Filipino population. Further, while the centrality index of strength had adequate stability, it was not highly stable. CONCLUSIONS: The current study highlighted critical transdiagnostic bridge symptoms as specific candidates for intervention. "Psychomotor agitation/retardation" was identified as key priority due to its association with suicidal ideation. Systemic multilevel interventions at the person-level (e.g., cognitive therapy and behavioral activation), and at the structural and policy-level to alleviate psychosocial stressors, could be applied to address disorder comorbidity in this population.

Psychometric validation of the PTSD Checklist-5 among female Filipino migrant workers.

Migrant populations are at increased risk for exposure to traumatic life events. Presently, there are no reliable and valid screening instruments for posttraumatic stress disorder (PTSD) among Filipino migrant workers, a population that numbers over 2.3 million worldwide. This study evaluated the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in a sample of female Filipino migrant workers in Macao (SAR), China, in two studies. The first examined the reliability (internal and test-retest), convergent validity (with depression, anxiety, and rumination), and discriminant validity (with pain and social support) in a sample of 131 participants. The second study established criterion validity of the PCL-5 using the PTSD module of the Mini-International Neuropsychiatric Interview (MINI), delivered by a female Filipino psychologist as the criterion, in a sample of 100 participants. Results indicated excellent internal consistency (Cronbach's alpha = 0.95) and moderate 10-day test-retest reliability (ρ = 0.58, p < .001). PCL-5 scores correlated strongly with scores on measures of depression (ρ = 0.71, p < .001), anxiety (ρ = 0.61, p < .001), and rumination (ρ = 0.68, p < .001), supporting convergent validity. Discriminant validity was demonstrated by a weaker association with scores on measures of pain (ρ = 0.33, p < .001) and social support (ρ = -0.11, p = .22). The diagnostic accuracy of the scale was good (AUC = 0.87). The optimal cutoff score of 25 optimized sensitivity (0.89) while maintaining adequate specificity (0.73), with a weighted Kappa of κ[1]) = 0.82. Our results demonstrated that the PCL-5 is a reliable and valid screening instrument for use among female Filipino migrant workers.

Las poblaciones migrantes tienen un mayor riesgo de exposición a eventos traumáticos en la vida. Actualmente, no hay instrumentos de detección fiables y válidos para el trastorno de estrés postraumático (TEPT) entre los trabajadores migrantes filipinos, una población que cuenta con más de 2,3 millones en todo el mundo. Este estudio evaluó las propiedades psicométricas de la Lista de chequeo-5 para TEPT según el DSM-5 (PCL-5) en una muestra de trabajadoras migrantes filipinas en Macao (SAR), China, en dos estudios. El primero examinó la confiabilidad (reevaluación interna y de prueba), la validez convergente (con depresión, ansiedad y rumiación) y la validez discriminante (con dolor y apoyo social) en una muestra de 131 participantes. El segundo estudio estableció la validez de criterio del PCL-5 utilizando el módulo TEPT de la Entrevista Internacional Neuropsiquiátrica Mini (MINI) aplicado por una psicóloga filipina como criterio, en una muestra de 100 participantes. Los resultados indicaron una excelente consistencia interna (alfa de Cronbach 0.95) y moderada fiabilidad de 10 días de prueba-reevaluación (ρ = 0.58, p <0.001). Las puntuaciones de PCL-5 se correlacionaron fuertemente con las puntuaciones en las medidas de depresión (ρ = 0.71, p <0.001), ansiedad (ρ = 0.61, p <0.001) y rumiación (ρ = 0.68, p <0.001), apoyando la validez convergente. La validez discriminante se demostró por una asociación más débil con las puntuaciones en las medidas del dolor (p= 0.33, p<0.001) y apoyo social (p= −0.11, p= 0.22).La precisión diagnóstica de la escala fue buena (AUC = 0.87). El punto de corte óptimo de 25 sensibilidad optimizada (0,89) manteniendo una especificidad adecuada (0,73), con un Kappa ponderado de κ [1]) = 0,82. Nuestros resultados demostraron que el PCL-5 es un instrumento de detección confiable y válido para el uso entre trabajadoras migrantes filipinas.

The association between disaster exposure and media use on post-traumatic stress disorder following Typhoon Hato in Macao, China.

Background: Direct exposure to natural disasters and related losses are associated with post-traumatic stress disorder (PTSD). It is less clear whether indirect media exposure is associated with PTSD. Objective: This study investigated key exposure-related risk factors for PTSD and examined the effect of media exposure on the prevalence of disaster-related PTSD. Method: Typhoon Hato directly hit Macao on 23 August 2017. It was one of the most serious natural disasters ever to strike southern China. One month after the event, 1876 Chinese university students in Macao were recruited into a cross-sectional study (mean age 20.01 years, SD = 2.63; 66.2% female). Self-reported typhoon exposure, media use and exposure to disaster-related content, and PTSD symptoms were collected using an electronic survey. Univariable analyses assessed associations between risk factors and PTSD, which were then included in a series of multivariable logistic regressions. Results: The prevalence of PTSD was 5.1%. Adjusted models demonstrated that being male (vs female) [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI) 1.07-2.63], home damage (aOR = 2.86, 95% CI 1.71-4.78), witnessing people injured (aOR = 2.33, 95% CI 1.36-4.00), and almost drowning during the storm (aOR = 8.99, 95% CI 1.92-41.99) were associated with PTSD. After adjusting for direct exposure, indirect exposure to disaster-related social media content, including information related to drowning victims (aOR = 1.29, 95% CI 1.00-1.67) and residents' emotional reactions (aOR = 1.98, 95% CI 1.44-2.72), was associated with PTSD. Viewing more information about the storm itself (aOR = 0.37, 95% CI 0.28-0.49) and images of heroic acts (aOR = 0.72, 95% CI 0.55-0.94) were significantly associated with lower odds of PTSD. Conclusion: These findings add to the literature demonstrating that some types of media use and certain media content following a natural disaster are associated with PTSD.

Antecedentes: La exposición directa a desastres naturales y las pérdidas relacionadas se asocian con el trastorno de estrés postraumático (TEPT). Lo que está menos claro es si la exposición indirecta a través de los medios está también asociada con el TEPT.Objetivo: Este estudio investigó los factores de riesgo clave relacionados con la exposición para el TEPT y examinó el efecto de la exposición en los medios de comunicación sobre la prevalencia del TEPT relacionado con el desastre.Método: El tifón Hato golpeó directamente a Macao el 23 de agosto de 2017. Fue uno de los desastres naturales más graves de la historia del sur de China. Un mes después del evento, se reclutó una muestra de 1876 estudiantes universitarios chinos en Macao, China en un estudio transversal (edad M = 20.01; SD = 2.63; 66.2% mujeres). El auto-reporte de exposición al tifón, el uso de medios y la exposición a contenidos relacionados con el desastre, y los síntomas del TEPT se recopilaron mediante una encuesta electrónica. Los análisis univariantes evaluaron las asociaciones entre los factores de riesgo y el TEPT, que luego fueron incluidos en una serie de regresiones logísticas multivariantes.Resultados: La prevalencia de trastorno de estrés postraumático fue del 5,1%. Los modelos ajustados demostraron que ser hombre (en comparación con mujer) aOR = 1.68, IC del 95% (1.07­2.63), daño en el hogar aOR = 2.86, IC del 95% (1.71­4.78), ser testigo de personas lesionadas aOR = 2.33, IC del 95% (1.36­4.00) y casi ahogarse durante la tormenta aOR = 8.99, el 95% de IC (1.92­41.99) se asoció con TEPT. Después de realizar el ajuste por exposición directa, la exposición indirecta a contenido de redes sociales relacionadas con desastres, incluyendo información relacionada con víctimas de ahogamiento aOR = 1.29, IC del 95% (1.00­1.67) y reacciones emocionales de los residentes aOR = 1.98, IC del 95% (1.44­2.72), se asoció con TEPT. Ver más información sobre la tormenta en sí aOR = 0,37, IC del 95% (0,28 a 0,49) y ver imágenes de personas siendo heroicas aOR = 0,72, IC del 95% (0,55 a 0,94) se asociaron significativamente con probabilidades más bajas de TEPT.Conclusiones: estos hallazgos se agregan a la literatura que demuestra que algunos tipos de uso de los medios y cierto contenido de los medios después de un desastre natural están asociados con el TEPT.