Smoking Cessation Rate and Its Predictors among Heavy Smokers in a Smoking-Free Hospital in Taiwan.

Smoking poses critical risks for heart disease and cancers. Heavy smokers, defined as smoking more than 30 pack-year, are the most important target for smoking cessation. This study aimed to obtain the cessation rate and its predictors among heavy smokers. We collected data from heavy smokers who visited a smoking-free hospital in Taiwan during 2017. All patients were prescribed either varenicline or nicotine replacement therapy (NRT) for smoking cessation, and their smoking status was followed for six months. Successful smoking cessation was defined by self-reported no smoking over the preceding seven days (7-day point abstinence). In total, 280 participants with a mean aged of 53.5 years were enrolled, and 42.9% of participants successfully stopped smoking in 6 months. The results revealed that quitters were older, with hypertension, fewer daily cigarettes, and being prescribed with varenicline. Multiple logistic regressions analyses identified that fewer daily cigarettes and being prescribed with varenicline were predictors of successful smoking cessation. Therefore, we suggest that varenicline use may help heavy smokers in smoking cessation.

The effectiveness of Culturally Sensitive Collaborative Treatment of depressed Chinese in family medicine clinics: A randomized controlled trial.

OBJECTIVE: To investigate whether the Culturally Sensitive Collaborative Treatment (CSCT) would improve outcomes for patients with major depression who were managed in family medicine clinics in Taiwan. METHOD: A single-blinded randomized trial was conducted in 26 family medicine clinics. Patients with major depressive disorder were consecutively randomized to either CSCT or treatment as usual (TAU). The primary outcome was the severity of depression. Secondary outcomes included treatment response, treatment remission, quality of life, and medication adherence. Outcomes were compared using hierarchical linear models (mixed-effects models) from baseline to 26-week follow-up assessments. RESULTS: Of the 280 patients, 141 were randomized to TAU and 139 to CSCT. Hierarchical linear modeling revealed that the CSCT group displayed significantly greater improvement in depressive symptoms over the study period when compared to the TAU group (B=-2.60, P<0.001). The odds of achieving the response, remission, and medication adherence were significantly greater for the CSCT group compared to the TAU group (odds ratio=4.65, 4.12, and 2.06, respectively; all Ps<0.05). However, both groups did not differ significantly in quality of life. CONCLUSION: CSCT is effective in improving treatment outcomes for major depression in family medicine clinics in Taiwan.

Self-harm and its association with internet addiction and internet exposure to suicidal thought in adolescents.

BACKGROUND/PURPOSE: Self-harm (SH) is a risk factor for suicide. We aimed to determine whether internet addiction and internet exposure to confided suicidal ideation are associated with SH in adolescents. METHODS: This study was a cross-sectional survey of students who self-completed a series of online questionnaires including a sociodemographic information questionnaire, questionnaire for suicidality and SH, Chen Internet Addiction Scale (CIAS), Patient Health Questionnaire (PHQ-9), multi-dimensional support scale (MDSS), Rosenberg self-esteem scale (RSES), Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and questionnaire for substance abuse. RESULTS: A total of 2479 students completed the questionnaires (response rate = 62.1%). They had a mean age of 15.44 years (range 14-19 years; standard deviation 0.61), and were mostly female (n = 1494; 60.3%). The prevalence of SH within the previous year was 10.1% (n = 250). Among the participants, 17.1% had internet addiction (n = 425) and 3.3% had been exposed to suicidal content on the internet (n = 82). In the hierarchical logistic regression analysis, internet addiction and internet exposure to suicidal thoughts were both significantly related to an increased risk of SH, after controlling for gender, family factors, exposure to suicidal thoughts in the real life, depression, alcohol/tobacco use, concurrent suicidality, and perceived social support. However, the association between internet addiction and SH weakened after adjusting for the level of self-esteem, while internet exposure to suicidal thoughts remained significantly related to an increased risk of SH (odds ratio = 1.96; 95% confidence interval: 1.06-3.64). CONCLUSION: Online experiences are associated with SH in adolescents. Preventive strategies may include education to increase social awareness, to identify the youths most at risk, and to provide prompt help.

Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan.

PURPOSE: The aim of this study was to determine the reliability and validity of a Chinese version of the Patient Health Questionnaire (PHQ-9) for the purpose of screening major depressive disorder (MDD) among primary care patients in Taiwan. METHOD: A total of 1954 primary care patients completed the PHQ-9. Patients (n = 1532) were interviewed using the Schedule for Clinical Assessments in Neuropsychiatry and 17-item of Hamilton Rating Scale. Subsample cases were retested within 2 weeks. RESULTS: The PHQ-9 had a good internal consistency (α = .80) and test-retest reliability (intraclass correlation coefficient = 0.87). A principal component factor analysis yielded 1-factor structure, which accounted for a total of 42.0% of the variance. The PHQ-9 was significantly correlated with the external validators such as the 17-item of Hamilton Rating Scale and the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire (P < .001). Using the Schedule for Clinical Assessments in Neuropsychiatry interview as the criterion standard, a PHQ-9 score of 10 or higher had a sensitivity of 0.86 and a specificity of 0.94 for recognizing MDD. The screening accuracy of the 2 items version, PHQ-2, was also satisfactory (scores ≥ 2: sensitivity 0.88; specificity 0.82). The single-question screen, PHQ-1 (depressed mood), was 78% sensitive and 93% specific for detecting MDD (score ≥ 2). CONCLUSION: The PHQ-9 and its 2 subscales, PHQ-2 and PHQ-1, seem reliable and valid for detecting MDD among Chinese primary care patients.

Controlled trial of problem-solving therapy and consultation-liaison for common mental disorders in general medical settings in Taiwan.

OBJECTIVE: Common mental disorders (CMD) are prevalent high-impact illnesses seen in general medical settings worldwide. There has been no investigation on the efficacy of enhanced care in Chinese societies. The aim of this study was to compare the outcome of three interventions for treating CMD: usual care (UC), problem-solving therapy plus UC (PST-UC), and psychiatric consultation plus UC (PC-UC). METHOD: The sample for this randomized controlled trial consisted of 254 patients with CMD being managed in general medical care settings. Clinical and functional assessments were done at baseline and at 16 weeks. RESULTS: Two hundred six patients had complete data at 16 weeks (66 in the UC group, 63 in the PST-UC group, 77 in the PC-UC group). All patients had significant improvement on all scales over time, with no significant differences among the three treatment groups. CONCLUSION: This trial failed to demonstrate the efficacy of enhanced care with consultation-liaison by mental health professionals for patients with CMD in general medical settings in Taiwan. Improved outcomes may require more integrated interventions.

Identification of common mental disorders by general medical doctors in Taiwan.

The aims of the study were to examine the detection rate of common mental disorders (CMD) by general medical doctors and which patient-related factors associated with increased chances of detection in Taiwan. A two-phase case-identification using the Chinese Health Questionnaire and the Revised Clinical Interview Schedule (CIS-R) was carried out among a sample of consecutive new attenders (n=990) in community and hospital-based clinics. Physicians completed a checklist of the problems that they identified during each consultation. General medical doctors missed more than 85% of the CIS-R cases of defined mental disorder. Physicians performed better identification of CMD among attenders with a higher socioeconomic status, without physical illness, having psychological presentation or attribution, suffering from more serious common mental disorders, or having a longer duration of illness. The very low identification rate of CMD has strongly implied the need to improve postgraduate training in psychiatry for general medical doctors in Taiwan. Simply adding one or two questions about mood and attributions of presenting symptoms might help physicians to identify CMD.