Measuring grief following miscarriage: psychometric properties of the Chinese version of the Perinatal Grief Scale.

Grief following miscarriage is a complex psychological response. This study was conducted to examine the psychometric properties of the Chinese version of the Perinatal Grief Scale (PGS). A total of 280 Chinese women completed the PGS immediately following a diagnosis of miscarriage (baseline) and were reassessed at 12 months follow-up. The factor structure of the Chinese PGS was explored. The convergent validity of the PGS was established by examining its correlations with the General Health Questionnaire-12 and Beck Depression Inventory at baseline. The reliability of the Chinese PGS was satisfactory. A two-factor structure accounting for 45% of the variance was identified. The Chinese PGS was positively correlated with General Health Questionnaire-12 and Beck Depression Inventory scores. The Chinese PGS was found to be a reliable and valid tool to measure grief following miscarriage.

Outcome of a postnatal depression screening programme using the Edinburgh Postnatal Depression Scale: a randomized controlled trial.

BACKGROUND: There is a lack of evidence on the effectiveness of postnatal depression (PND) screening programmes in reducing morbidity. The aim of this study was to evaluate the effectiveness of a PND screening programme using Edinburgh Postnatal Depression Scale (EPDS) in improving maternal mental health. METHODS: The randomized controlled trial design was used. Participants were 462 Chinese mothers with 2-month-old babies visiting Maternal and Child Health Centres in Hong Kong. Participants in the intervention group were screened for PND using the EPDS, whereas those in the control group were screened by clinical assessment. In both groups, participants identified with PND were offered follow-up management according to protocol. RESULTS: Participants in the intervention group had better maternal mental health outcome as assessed by EPDS at 6 months (risk ratio: 0.59; 95% confidence interval: 0.39-0.89). The number needed to screen was 25. CONCLUSIONS: A PND screening programme comprising the use of EPDS as the screening tool and the provision of follow-up care had resulted in an improvement in maternal mental health at 6 months.

Detecting postnatal depression in Chinese men: a comparison of three instruments.

Postnatal depression affects both men and women. The detection of postnatal depression is important, yet there are few validated screening tools on Chinese men. The goals of the present study were to compare the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), and the Patient Health Questionnaire - Depression Module (PHQ-9) in screening for postnatal depression among Chinese fathers in Hong Kong. The prevalence of depression at 8 weeks postpartum was also estimated. A prospective cohort of 551 men completed the EPDS, BDI, and PHQ-9 at 8 weeks postpartum. Clinical diagnosis of depression was established with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), non-patient version (SCID-NP). The criterion validity of the instruments was evaluated against this clinical diagnosis. The EPDS was significantly more accurate than the BDI and PHQ-9 in detecting postnatal depression among Chinese men. With a cut-off score of 10 or more, the EPDS has a sensitivity of 91%, specificity of 97%, positive predictive value of 57%, and negative predictive value of 99%. Approximately 3.1% men met the DSM-IV criteria for depression at 8 weeks postpartum. The prevalence rate of postnatal depression in Chinese men is comparable to their Western counterparts. The Chinese EPDS is a valid instrument for detecting postnatal depression in men. It could be applied as a supplementary assessment tool in Chinese fathers who may be reluctant to disclose their depressive symptoms in face-to-face interviews.

Antenatal taboos among Chinese women in Hong Kong.

OBJECTIVE: to identify the antenatal taboos commonly practised by pregnant Hong Kong Chinese women; to explore the health beliefs behind these taboos; and to examine how pregnant women perceived and reacted to the cultural tradition. DESIGN: general ethnography and in-depth interviews, followed by a quantitative self-reported survey. SETTING: Antenatal clinic of a university-affiliated hospital in Hong Kong. PARTICIPANTS: consecutive samples of 60 women for in-depth interviews, and 832 women for the survey. MEASUREMENTS: an inventory on the adherence and attitude towards antenatal taboos, and the Beck Depression Inventory that measures severity of depression. FINDINGS: antenatal taboos were still commonly observed by contemporary Chinese women. Miscarriage, fetus malformation and fetal ill-health were the key cultural fears that drove contemporary Chinese women to observe the traditional taboos. About one-quarter and one-tenth of the women, respectively, felt unhappy and disputed with their families about the taboos. These women had significantly higher levels of depression in late pregnancy and during childbirth. IMPLICATIONS FOR PRACTICE: health-care practitioners should be aware of the benefits and risks of traditional antenatal taboos on maternal health. Although some taboos can be socio-morally protective, the tension created by the observation of cultural tradition in modernity may impair maternal psychological well-being. Health-care providers in Western countries should be vigilant of the complex cultural tension faced by migrant Chinese mothers.

The association between maternal depression and frequent non-routine visits to the infant's doctor--a cohort study.

BACKGROUND: Perinatal depression is common, but women typically do not seek help for it. We studied its association with frequent non-routine physician visits, which may be a form of help-seeking behaviour. METHODS: A prospective cohort study of women in their 34th to 38th week of pregnancy at the outpatient obstetrics clinic at a Singapore tertiary hospital was done. Screening was done using the Edinburgh Postnatal Depression Scale and diagnosis of major or minor depressive disorder was made using the SCID-IV. At 6 to 12 months' post-partum, women were screened and interviewed again for depression and asked to report the frequencies with which they had brought their infants to the doctor on non-routine visits in the preceding 6 weeks. Four hundred and seventy-one of the 559 patients recruited before delivery were re-interviewed. RESULTS: After adjusting for confounders, women who had brought their infants for three or more non-routine visits to the infant's doctor had a significantly higher prevalence of depression (32.6%) than those with fewer visits (13.6%) (OR 2.87, 95% CI 1.41 to 5.85, p=0.004). The relative risk reduction for women who did not bring their infants for frequent non-routine visits was 0.583 (95% CI 0.44 to 0.73, p=0.002). They were also more likely to have poorer perceived emotional support from their families. LIMITATIONS: These included use of self-reported doctor visits, and relatively high educational levels of the participants. CONCLUSIONS: Doctors should have a high index of suspicion for enquiring about depression and emotional support in mothers who bring their infants for frequent non-routine visits.

Rethinking depression: an ethnographic study of the experiences of depression among Chinese.

Relative to studies of patients in the West, little research has focused on the lived experiences of patients with mental illness in non-Western societies. The current understanding of the phenomenology of depression and other psychiatric disorders is almost entirely based on studies of Western populations. The objective of the present study was to examine the experiences of depressive disorders among contemporary Chinese in Guangzhou (Canton), China. A total of 40 patients who had significant depressive symptoms were recruited using quota sampling from the outpatient department of a regional mental health service. The depressive experiences of participants were examined by open-ended, in-depth, ethnographic interviews. The interviews were taped, transcribed, and translated. Content analysis was conducted on both the Chinese and English transcripts. A total of six categories of affective experiences were identified among the participants. Indigenous affective lexicons, embodied emotional experiences, implicit sadness, preverbal pain, distress of social disharmony, and centrality of sleeplessness were regularly observed among the informants. Our findings suggest that psychiatric textbooks and diagnostic systems do not cover the full range of depressive symptoms experienced among contemporary Chinese. More studies are needed to examine how depression is differentially experienced globally--a crucial step in making professional diagnosis, treatment, and research more broadly applicable across cultures.

A database on treating drug addiction with traditional Chinese medicine.

AIMS: Traditional Chinese medicine (TCM) has been used to treat drug addiction for more than 160 years and valuable experiences have been accumulated with regard to patients' detoxification and rehabilitation. The aims of this project were (1) to establish a computerized, bilingual (Chinese-English) database on TCM for drug addiction; (2) to analyse the literature published in this field; and (3) to identify those Chinese herbs commonly used for drug addiction treatment. DESIGN: (1) Paper collection: related papers were collected through electronic databases and hand-searched materials; (2) data computerization: the Microsoft Access program and Delphi language were used as the major data management systems; (3) paper analysis: annual publications from 1989 to 2003 were classified and calculated; and (4) herbal analysis: the frequency of herbs used and herbal function categories were analysed. FINDINGS: (1) A special bilingual database that contained 340 works of professional literature, including 85 patent files on TCM for drug addiction, was established, in which more than 90% of the publications originated from mainland China; (2) the literature classification showed a significant increase in the number of publications on clinical and laboratory researches in this field over the past decade; (3) five functional categorizations of Chinese herbs and the 10 most frequently used Chinese herbs as well as three toxic herbs were identified from more than 200 herbs reported in 150 original research articles and 85 patent files. CONCLUSIONS: For the first time, the published data on TCM in the treatment of drug addiction were analysed systematically by using a new database. The results are invaluable for further laboratory and clinical studies to obtain more direct evidence.

Does social capital enhance health and well-being? Evidence from rural China.

Despite increasing acknowledgement that social capital is an important determinant of health and overall well-being, empirical evidence regarding the direction and strength of these linkages in the developing world is limited and inconclusive. This paper empirically examines relationships between social capital and health and well-being-as well as the suitability of commonly used social capital measures-in rural China, where rapid economic growth coexists with gradual and fundamental social changes. To measure social capital, we adopt a structural/cognitive distinction, whereby structural social capital is measured by organizational membership and cognitive social capital is measured by a composite index of trust, reciprocity, and mutual help. Our outcome measures included self-reported general health, psychological health, and subjective well-being. We adopt multi-level estimation methods to account for our conceptualization of social capital as both an individual- and contextual-level resource. Results indicate that cognitive social capital (i.e., trust) is positively associated with all three outcome measures at the individual level and psychological health/subjective well-being at the village level as well. We further find that trust affects health and well-being through pathways of social network and support. In contrast, there is little statistical association or consistent pattern between structural social capital (organizational membership) and the outcome variables. Furthermore, although organizational membership is highly correlated with collective action, neither is associated with health or well-being. Our results suggest that policies aimed at producing an environment that enhances social networks and facilitates the exchange of social support hold promise for improving the health and well-being of the rural Chinese population. In addition, China may not have fully taken advantage of the potential contribution of structural social capital in advancing health and well-being. A redirection of collective action from economic to social activities may be worth considering.

Postnatal depression: an update.

Apart from causing emotional suffering, postnatal depression strains marriage, undermines the mother's confidence, impairs her social functioning and quality of life, and in serious cases contributes to infant abuses, infanticides and suicidal behaviour. Recent studies also show that postnatal depression adversely affects emotional, behavioural and cognitive development of the newborn. In addition, there is growing awareness that depression can occur during pregnancy, and antenatal depression can adversely affect obstetric and neonatal outcomes. Antenatal depressive symptoms are also the strongest predictor of postnatal depression. This paper reviews the epidemiology, clinical presentation, risk factors, prevention and treatment of perinatal depression. The latest development in research and practice related to this condition are also highlighted.

Charcoal-Burning Suicides and Strategies for Prevention.

This paper examines the emergence of a new method of suicide in Hong Kong by carbon monoxide poisoning generated by the burning of charcoal. In just 6 years, it has become the second most common means of suicide after jumping from heights. The profile of these charcoal-burning suicide victims is different from that of other suicide deaths. It seems that a significant proportion of the increase in the number of suicides for the period is attributable to the charcoal burning. The effect of mass media reporting and strategies on how to contain the contagious effect of charcoal-burning deaths are discussed.

Socio-economic and psychological correlates of suicidality among Hong Kong working-age adults: results from a population-based survey.

BACKGROUND: The global toll of suicide is estimated to be one million lives per year, which exceeded the number of deaths by homicide and war combined. A key step to suicide prevention is to prevent less serious suicidal behaviour to preclude more lethal outcomes. Although 61% of the world's suicides take place in Asia and the suicide rates among middle age groups have been increasing since the economic crisis in many Asian countries, population-based studies of suicidal behaviour among working-age adults in non-western communities are scarce. METHOD: Data from a population-based survey with 2015 participants were used to estimate the prevalence of suicidal ideation and behaviour among the working-age population in Hong Kong, and to study the associated socio-economic and psychological correlates. We focused particularly on potential modulating factors between life-event-related factors and suicidal ideation. RESULTS: Six per cent of the Hong Kong population aged 20-59 years considered suicide in the past year, while 1.4% attempted suicide. Hopelessness, reasons for living, and reluctance to seek help from family and friends had direct association with past-year suicidal ideation. Reasons for living were found to moderate the effect of perceived stress on suicidal ideation. CONCLUSIONS: Suicidality is a multi-faceted problem that calls for a multi-sectored, multi-layered approach to prevention. Prevention programmes can work on modulating factors such as reasons for living to reduce suicidal risk in working-age adults.

Psychological responses of pregnant women to an infectious outbreak: a case-control study of the 2003 SARS outbreak in Hong Kong.

OBJECTIVE: The aim of the present study was to examine the behavioral and psychological responses of pregnant women during the 2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong. METHODS: Ethnographic interviews were first conducted to identify the common psychological and behavioral responses to the outbreak. This was followed by a case-control study of 235 consecutive pregnant women recruited during the SARS epidemic, and a historical cohort of 939 pregnant women recruited a year before the outbreak. Both cohorts completed standardized rating scales on depression, anxiety, and social support. RESULTS: Women in the SARS cohort adopted behavioral strategies to mitigate their risk of contracting infection. However, pregnant women tended to overestimate the risk of contracting SARS and nearly a third of the women were homebound. The anxiety level of the SARS cohort was slightly higher than that of the pre-SARS control. No statistical difference was found between the depression levels of the two cohorts. CONCLUSION: The improved social support experienced by pregnant women during SARS might have buffered the stress associated with an outbreak. However, clinicians should monitor for overestimation of infectious risk among pregnant women.

The effects of a celebrity suicide on suicide rates in Hong Kong.

BACKGROUND: Deaths of celebrities, especially by suicide, can be followed by an increase in population suicide rates, particularly where there is extensive media reporting. We have examined the impact on suicides following the death of a famous Hong Kong pop singer whose death from suicide by jumping from a height, occurred on 1st April 2003, and resulted in extensive and often dramatic media coverage. METHODS: Data on suicides were obtained from the Hong Kong Census and Statistics Department and the Coroner's Court. The numbers of suicides in 2003 before and after the death of celebrity were compared to the same period in 1998-2002. The case files and suicide notes of people who died by suicide in 2003 were also studied qualitatively. RESULTS: There was a significant increase in suicides following the celebrity death, compared with the average over the preceding three months as well as the corresponding monthly average during 1998-2002. It was particularly marked in a subgroup comprising males, aged 25-39 years, many of whom died by jumping. The name of the celebrity was often mentioned in case files and suicide notes. LIMITATIONS: The statistical results in showing the excess of suicides were based on aggregated data only. CONCLUSIONS: This study provides further confirmation of the potential harmful consequences of sensational and excessive reporting of celebrity deaths.

Ethno-psychometric evaluation of the General Health Questionnaire in rural China.

BACKGROUND: Most mental health research tools are developed in Western, urban contexts. Few studies have evaluated the applicability of these research tools in rural populations of non-Western countries. We examined the cultural acceptance and psychometric performance of the 12-item General Health Questionnaire (GHQ) in China's rural villages. METHOD: Ethnographic investigations were conducted to assess the cultural applicability of self-report rating scales among villagers. This was followed by a survey of 1401 rural residents, randomly selected from 48 villages of Shandong province using stratified multistage cluster sampling. The respondents were administered the GHQ and the Composite International Diagnostic Interview (CIDI). RESULTS: The GHQ, when administered by trained interviewers, was culturally acceptable to rural residents. The scale had good psychometric properties in the study population. The area under the curve was 0.86. At a cut-off of 1/2, the sensitivity and specificity were 80.6% and 79.3% respectively. CONCLUSIONS: The ethno-psychometric evaluation showed that the GHQ was both culturally valid and psychometrically sound in the Chinese rural context.

Confinement and other psychosocial factors in perinatal depression: a transcultural study in Singapore.

BACKGROUND: To investigate the prevalence, socio-cultural and psychosocial risk factors for perinatal depression in Singaporean women. METHOD: A prospective cohort of 559 women was interviewed antenatally and at six weeks' postpartum at a tertiary hospital. Women were interviewed for diagnosis of depression using a two-stage design, with a screening questionnaire and diagnostic interview. RESULTS: Postnatally, a negative confinement experience was associated with depression. Other independent factors included poor emotional support, a past history of depression, unplanned pregnancy and perceived potential conflicts with relatives over childcare antenatally and dissatisfaction, poor instrumental support postnatally. The prevalence of depression antenatally and postnatally was 12.2% and 6.8%, respectively. LIMITATIONS: Measures of satisfaction with social support were based on self-report; there were high dropout rates at six weeks' postpartum; and other modulating social factors such as pre-existing interpersonal conflicts were not studied. CONCLUSIONS: Perinatal depression in Singaporean women is common. Contrary to expectations, a negative 'confinement' experience is a significant risk factor for postnatal depression, and is not universally welcomed by women. Depression is modulated by dissimilar sets of psychosocial factors antenatally and postnatally.

Charcoal-burning suicide in post-transition Hong Kong.

BACKGROUND: Charcoal-burning, a new suicide method, emerged in Hong Kong during the latest economic recession. Within 2 months charcoal-burning had become the third most common suicide method. AIMS: To examine the characteristics of suicides by charcoal-burning, and to delineate the pathways linking macro-level economic and social changes with the subjective experiences of those surviving a charcoal-burning suicide attempt. METHOD: Both quantitative and qualitative methods were used. In the coroner's records study, the first 160 cases of suicide by charcoal-burning were compared with a control group. In the ethnographic enquiry, we interviewed 25 consecutive informants who had survived serious suicide attempt using charcoal-burning. RESULTS: People who completed suicide by the charcoal-burning method were more likely to have been economically active and physically healthy, and were less likely to have had pre-existing mental illness. Charcoal-burning suicide was associated with overindebtedness. Media reports were pivotal in linking overindebtedness and financial troubles with charcoal-burning. CONCLUSIONS: The political economy of suicide by charcoal-burning illustrated how historical, socio-economic and cultural forces shaped the lived experience that preceded suicide.

Factors associated with psychosis among patients with severe acute respiratory syndrome: a case-control study.

We observed that a number of patients with severe acute respiratory syndrome (SARS) developed affective psychosis during the acute phase of their illness. We reviewed all SARS-related psychiatric consultations in Hong Kong and investigated the risk factors for psychosis among patients with SARS in a matched case-control study. Patients with SARS-related psychosis received higher total doses of steroids and had higher rates of family history of psychiatric illness. The findings of the present study suggest that steroid toxicity, personal vulnerability, and, probably, psychosocial stressors jointly contributed to the development of psychosis in patients with SARS.

A prevalence study of antenatal depression among Chinese women.

BACKGROUND: There has thus far been no empirical research on the occurrence of antenatal psychiatric morbidity in Chinese population. Epidemiological studies in western societies generally show that depressive episodes occur in 10-20% of pregnant women. Longitudinal studies have demonstrated that antenatal depression is one of the most powerful predictors of postnatal depression. There is also a growing literature that shows that antenatal psychological distress can adversely affect maternal and foetal well being. METHODS: At 38 weeks of pregnancy, 238 consecutive women were invited to return for psychiatric assessment. The participants were interviewed using the non-patient version of the Structured Clinical Interview for DSM-IV (SCID-NP). RESULTS: Seventy women (29%) declined to participate, and another 11 (5%) defaulted the SCID interview. Among the 157 women interviewed, the 1-month prevalence of antenatal depression was 4.4%. The 1-month prevalence of all psychiatric diagnoses was 6.4%. The prevalence of antenatal depression and all psychiatric diagnoses for the entire pregnancy was 6.4% and 8.3%, respectively. LIMITATIONS: About a third of eligible subjects did not participate in the study. CONCLUSIONS: A significant proportion of Chinese women suffer from psychiatric morbidity during pregnancy. Depressive disorders are by far the commonest morbidity in the study population. Given the scope of the morbidity and the potential impact on obstetric and neonatal outcomes, early screening and treatment are warranted.

Screening for post-miscarriage psychiatric morbidity.

OBJECTIVE: The purpose of this study was to evaluate 12-item General Health Questionnaire (GHQ-12) in screening for psychiatric morbidity after miscarriage. STUDY DESIGN: A prospective cohort study was carried out involving 222 patients. Six weeks after miscarriage, the GHQ-12 was applied. Psychiatric "case" or "non-case" was diagnosed by the psychiatrist with use of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-R. The patients were computer randomized into Groups A or B. A receiver operating characteristic (ROC) curve was constructed for Group A. The optimal cutoff value of GHQ-12 was determined, and this value was applied to Group B. The test characteristics were assessed. RESULTS: Twenty-seven patients were found to be psychiatric cases. An ROC with area under curve of 0.93 (95% CI 0.87-0.99, P<.001) was constructed. The best GHQ-12 cutoff score was > or =4 in detecting psychiatric caseness. A sensitivity of 83%, specificity of 90%, positive predictive value of 50%, and negative predictive value of 98% were obtained. CONCLUSION: GHQ-12 is an effective screening tool in detecting psychiatric morbidity after miscarriage.