Longitudinal Patterns and Predictors of Depression Trajectories Related to the 2014 Occupy Central/Umbrella Movement in Hong Kong.

OBJECTIVES: To examine the longitudinal patterns and predictors of depression trajectories before, during, and after Hong Kong's 2014 Occupy Central/Umbrella Movement. METHODS: In a prospective study, between March 2009 and November 2015, we interviewed 1170 adults randomly sampled from the population-representative FAMILY Cohort. We used the Patient Health Questionnaire-9 to assess depressive symptoms and probable major depression. We investigated pre-event and time-varying predictors of depressive symptoms. RESULTS: We identified 4 trajectories: resistant (22.6% of sample), resilient (37.0%), mild depressive symptoms (32.5%), and persistent moderate depression (8.0%). Baseline predictors that appeared to protect against persistent moderate depression included higher household income (odds ratio [OR] = 0.18; 95% confidence interval [CI] = 0.06, 0.56), greater psychological resilience (OR = 0.63; 95% CI = 0.48, 0.82), more family harmony (OR = 0.68; 95% CI = 0.56, 0.83), higher family support (OR = 0.80; 95% CI = 0.69, 0.92), better self-rated health (OR = 0.28; 95% CI = 0.16, 0.49), and fewer depressive symptoms (OR = 0.59; 95% CI = 0.43, 0.81). CONCLUSIONS: Depression trajectories after a major protest are comparable to those after major population events. Health care professionals should be aware of the mental health consequences during and after social movements, particularly among individuals lacking social support.

Direct Participation in and Indirect Exposure to the Occupy Central Movement and Depressive Symptoms: A Longitudinal Study of Hong Kong Adults.

Despite the extensive history of social movements around the world, the evolution of population mental health before, during, and after a social movement remains sparsely documented. We sought to assess over time the prevalence of depressive symptoms during and after the Occupy Central movement in Hong Kong and to examine the associations of direct and indirect exposures to Occupy Central with depressive symptoms. We longitudinally administered interviews to 909 adults who were randomly sampled from the population-representative FAMILY Cohort at 6 time points from March 2009 to March 2015: twice each before, during, and after the Occupy Central protests. The Patient Health Questionnaire-9 was used to assess depressive symptoms and probable major depression (defined as Patient Health Questionnaire-9 score ≥10). The absolute prevalence of probable major depression increased by 7% after Occupy Central, regardless of personal involvement in the protests. Higher levels of depressive symptoms were associated with online and social media exposure to protest-related news (incidence rate ratio (IRR) = 1.28, 95% confidence interval (CI): 1.06, 1.55) and more frequent Facebook use (IRR = 1.38, 95% CI: 1.12, 1.71). Higher levels of intrafamilial sociopolitical conflict was associated with more depressive symptoms (IRR = 1.05, 95% CI: 1.01, 1.09). The Occupy Central protests resulted in substantial and sustained psychological distress in the community.

Normative data and psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) and the abbreviated version (CD-RISC2) among the general population in Hong Kong.

PURPOSE: To examine whether the two-item version (CD-RISC2) of the Connor-Davidson Resilience Scale (CD-RISC) has adequate internal consistency and construct validity, as well as significant correlation with the full scale, and to provide normative data for the CD-RISC and the CD-RISC2 in a Chinese general population in Hong Kong. METHODS: In total, 10,997 randomly selected participants aged ≥20 years completed the Chinese version of the CD-RISC (including the 2 items of the CD-RISC2), the Patient Health Questionnaire, Family Harmony Scale, Family APGAR, and CAGE Questionnaire. Internal consistency and convergent and discriminant validity of the CD-RISC and CD-RISC2 were assessed. RESULTS: Cronbach's α for CD-RISC and CD-RISC2 was 0.97 and 0.79, respectively. CD-RISC2 was associated with the 25-item version of the CD-RISC (r = 0.88), depressive symptoms (r s = -0.18), family harmony (r = 0.20), family functioning (r = 0.27) and was not associated with alcohol consumption (r = 0.05). The mean score for the CD-RISC and CD-RISC2 was 59.99 (SD = 13.92) and 5.03 (SD = 1.37), respectively. Men, younger individuals, and those with higher education or higher household income reported higher resilience levels. CONCLUSIONS: The Chinese version of the CD-RISC2 was demonstrated to be a reliable and valid measure in assessing resilience among the general population in Hong Kong.

Structure and validity of Family Harmony Scale: An instrument for measuring harmony.

Culture plays a role in mental health, partly by defining the characteristics that are indicative of positive adjustment. In Chinese cultures, positive family relationships are considered central to well-being. The culturally emphasized characteristic of family harmony may be an important factor associated with psychopathology. This article presents the development and psychometric examination of the Family Harmony Scale (FHS), an indigenously developed 24-item instrument tapping family harmony in 17,461 Hong Kong residents from 7,791 households. A higher-order model with 1 second-order factor and 5 first-order factors fit the data well and showed factorial invariance across sex and participants in different family roles. A 5-item short form (FHS-5) was also developed, with 1 item from each first-order factor. The short scale showed, as expected, a single-factor structure with good fit. Both scales demonstrated high internal consistency, acceptable test-retest reliability, and good convergent and discriminant validity. The 24-item FHS was negatively associated with depressive symptoms after accounting for individual risk factors and general family function. Family harmony moderated the relationship between life stress and depressive symptoms such that those individuals who reported low family harmony had stronger associations between life stress and depressive symptoms. This study adds to the literature a systematically developed, multidimensional measure of family harmony, which may be an important psychological protective factor, in a large urban Chinese sample. The FHS-5 minimizes operational and respondent burdens, making it an attractive tool for large-scale epidemiological studies with Chinese populations in urban settings, where over half of China's 1.4 billion people reside.

Transmissibility of the Ice Bucket Challenge among globally influential celebrities: retrospective cohort study.

OBJECTIVES: To estimate the transmissibility of the Ice Bucket Challenge among globally influential celebrities and to identify associated risk factors. DESIGN: Retrospective cohort study. SETTING: Social media (YouTube, Facebook, Twitter, Instagram). PARTICIPANTS: David Beckham, Cristiano Ronaldo, Benedict Cumberbatch, Stephen Hawking, Mark Zuckerberg, Oprah Winfrey, Homer Simpson, and Kermit the Frog were defined as index cases. We included contacts up to the fifth generation seeded from each index case and enrolled a total of 99 participants into the cohort. MAIN OUTCOME MEASURES: Basic reproduction number R0, serial interval of accepting the challenge, and odds ratios of associated risk factors based on fully observed nomination chains; R0 is a measure of transmissibility and is defined as the number of secondary cases generated by a single index in a fully susceptible population. Serial interval is the duration between onset of a primary case and onset of its secondary cases. RESULTS: Based on the empirical data and assuming a branching process we estimated a mean R0 of 1.43 (95% confidence interval 1.23 to 1.65) and a mean serial interval for accepting the challenge of 2.1 days (median 1 day). Higher log (base 10) net worth of the participants was positively associated with transmission (odds ratio 1.63, 95% confidence interval 1.06 to 2.50), adjusting for age and sex. CONCLUSIONS: The Ice Bucket Challenge was moderately transmissible among a group of globally influential celebrities, in the range of the pandemic A/H1N1 2009 influenza. The challenge was more likely to be spread by richer celebrities, perhaps in part reflecting greater social influence.

Effects of depressive symptoms and family satisfaction on health related quality of life: the Hong Kong FAMILY study.

OBJECTIVE: To examine the effect of depressive symptoms and satisfaction with family support (FS) on physical and mental Health Related Quality of Life (HRQoL). METHODS: Data were obtained from the Hong Kong FAMILY Project baseline survey in 2009-2011, which included 16,039 community residents (age ≥ 20). The FS was measured using the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR, range 0-10) Questionnaire. HRQoL were assessed using the SF-12 version 2. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived neighborhood cohesion were also assessed. RESULTS: In a multilevel regression model, socio-demographic and behavioral variables explained 21% and 19% of the variance in physical and mental HRQoL. The presence of depressive symptoms (PHQ-9 score ≥ 10, standardized coefficients, ß of -1.73) and high FS (APGAR score 7-10, 1.15) were associated with mental HRQoL, after adjustment for age, education, household monthly income, drinking status, physical activity, chronic conditions, life stress and neighborhood cohesion. Not FS but the presence of depressive symptoms (ß of -0.88) was associated with physical HRQoL. The presence of depressive symptoms in women than men were more associated with a poorer physical HRQoL (p<0.01) while depressive symptoms in men were associated with a decrease in mental HRQoL (p<0.001). The interaction between FS and depressive symptoms was nonsignificant in relation to HRQoL. Among those with depressive symptoms, high FS was associated with a better mental HRQoL (41.1 vs. 37.9, p<0.001) in women but not contribute to variance in men. CONCLUSIONS: Higher FS and presence of depressive symptoms were significantly associated with HRQoL in general population in Hong Kong. Among those with depressive symptoms, high FS was associated with a favorable mental HRQoL in women but not men.

A prospective study of stage of change for general health promotion action and health-related lifestyle practices among Chinese adults.

In a previous study we proposed the notion of general health promotion action (GHPA) defined as "a general intention and actual practices to take action aimed to promote health." GHPA is a subjective measure of health-promoting lifestyle which may reflect practices aimed to promote health and practices which are taken for non-health reasons but which nonetheless have health benefits. The present prospective study aimed to examine whether baseline stage of change for GHPA predicted health-related lifestyle practices at 24-month follow-up in a representative community-based cohort of 3129 Hong Kong Chinese adults. Overall, 37% of the subjects remained in the same stage, 43% had progressed to later stages, and 20% had regressed to earlier stages of change at follow-up. Baseline maintainers were the most likely to report desirable lifestyle practices at follow-up. They were significantly more likely to have exercised in the past month, consumed at least 2 portions of fruit a day, consumed at least 3 portions of vegetable a day, consumed at least 5 portions of fruit or vegetable a day, have had no episodes of binge drinking in the past month, and have had a dental examination at least once a year. The association remained significant after adjusting for age, gender, education, income and baseline level of respective lifestyle practices, with significantly increasing trends from precontemplation to maintenance stage. We conclude that the predictive validity of stage of change for GHPA was supported from these longitudinal findings, and further research on how GHPA can guide health promotion strategies is warranted.