1
|
Wei SY, Tsai TH, Tsai TY, Chen PS, Tseng HH, Yang YK, Zhai T, Yang Y, Wang TY. The Association between Default-mode Network Functional Connectivity and Childhood Trauma on the Symptom Load in Male Adults with Methamphetamine Use Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:105-117. [PMID: 38247417 PMCID: PMC10811392 DOI: 10.9758/cpn.23.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/25/2023] [Accepted: 08/14/2023] [Indexed: 01/23/2024]
Abstract
Objective : The relationship between adverse childhood experiences and methamphetamine use disorder (MUD) has been shown in previous studies; nevertheless, the underlying neural mechanisms remain elusive. Childhood trauma is associated with aberrant functional connectivity (FC) within the default-mode network (DMN). Furthermore, within the DMN, FC may contribute to impaired self-awareness in addiction, while cross-network FC is critical for relapse. We aimed to investigate whether childhood trauma was associated with DMN-related resting-state FC among healthy controls and patients with MUD and to examine whether DMN-related FC affected the effect of childhood trauma on the symptom load of MUD diagnosis. Methods : Twenty-seven male patients with MUD and 27 male healthy controls were enrolled and completed the Childhood Trauma Questionnaire. DMN-related resting-state FC was examined using functional magnetic resonance imaging. Results : There were 47.1% healthy controls and 66.7% MUD patients in this study with adverse childhood experiences. Negative correlations between adverse childhood experiences and within-DMN FC were observed in both healthy controls and MUD patients, while within-DMN FC was significantly altered in MUD patients. The detrimental effects of adverse childhood experiences on MUD patients may be attenuated through DMN-executive control networks (ECN) FC. Conclusion : Adverse childhood experiences were negatively associated with within-DMN FC in MUD patients and healthy controls. However, DMN-ECN FC may attenuate the effects of childhood trauma on symptoms load of MUD.
Collapse
Affiliation(s)
- Shyh-Yuh Wei
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Han Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Yu Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huai-Hsuan Tseng
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Tianye Zhai
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Tzu-Yun Wang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
2
|
Chang HM, Chen C, Lu ML, Jou S, Santos VHJ, Goh KK. The interplay of childhood trauma, oxytocin, and impulsivity in predicting the onset of methamphetamine use. CHILD ABUSE & NEGLECT 2024; 147:106579. [PMID: 38048654 DOI: 10.1016/j.chiabu.2023.106579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Childhood trauma is associated with substance use disorders, including methamphetamine use disorder (MUD). Oxytocin, involved in social bonding, stress regulation, and reward processing, may influence addiction vulnerability and impulsivity in individuals with a history of childhood trauma. OBJECTIVE To investigate the relationships among childhood trauma, oxytocin levels, impulsivity, and the age of first methamphetamine use in individuals with MUD. PARTICIPANTS AND SETTING The study included 298 male participants (148 individuals with MUD and 150 healthy controls) from both probation offices and psychiatric clinics. METHODS Childhood trauma was assessed using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), impulsivity with the Barratt Impulsiveness Scale-11 (BIS-11), and plasma oxytocin levels were obtained. RESULTS Individuals with MUD exhibited higher levels of childhood trauma, impulsivity, and lower plasma oxytocin levels compared to healthy controls. Childhood trauma was associated with a younger age of first methamphetamine use, higher impulsivity, and lower oxytocin levels among individuals with MUD. Plasma oxytocin levels partially mediated the relationship between childhood trauma and both the age of first methamphetamine use and impulsivity. Serial mediation analysis demonstrated that oxytocin levels and impulsivity sequentially mediated the relationship between childhood trauma and the age of first methamphetamine use. CONCLUSIONS The findings reveal the complex interplay among childhood trauma, oxytocin, impulsivity, and methamphetamine use, emphasizing the importance of considering these factors in prevention and intervention strategies for MUD. Future research should explore oxytocin and impulsivity-focused interventions to mitigate the effects of childhood trauma and reduce MUD development risk.
Collapse
Affiliation(s)
- Hu-Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chenyi Chen
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Mind, Brain and Consciousness, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; The Innovative and Translational Research Center for Brain Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Susyan Jou
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate School of Criminology, National Taipei University, Taipei, Taiwan
| | - Vitor Hugo Jesus Santos
- Department of Psychiatry and Mental Health, Faculty of Health Sciences (FCS-UBI), Cova da Beira University Hospital Center, Covilhã, Portugal
| | - Kah Kheng Goh
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; The Innovative and Translational Research Center for Brain Consciousness, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
3
|
Li D, Wang D, Ren H, Tian Y, Chen J, Zhu R, Li Y, Wang L, Zhang XY. Association between rumination and drug craving in Chinese male methamphetamine use disorder patients with childhood trauma. CHILD ABUSE & NEGLECT 2023; 144:106357. [PMID: 37459735 DOI: 10.1016/j.chiabu.2023.106357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/18/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND In China, males make up the majority of methamphetamine (MA) dependent individuals and the majority of treatment seekers. Childhood trauma (CT) and rumination are associated with an increased risk of MA use. However, the association between CT, rumination, and drug craving remains largely unknown. OBJECTIVE The present study aims to explore the association between rumination and drug craving in methamphetamine use disorder (MAUD) patients with CT. PARTICIPANTS AND SETTING This study recruited 404 male participants with MAUD from a male drug rehabilitation center in Southwest China. METHODS Patients with CT were identified by the short form of Childhood Trauma Questionnaire (CTQ-SF). Rumination and drug craving were assessed by the Ruminative Responses Scale (RRS) and the Obsessive Compulsive Drug Use Scale (OCDUS), respectively. RESULTS 188 patients (46.5 %) experienced CT. Patients who had experienced CT showed significantly higher RRS symptom rumination score and OCDUS total score than those who had not. In patients with CT, RRS total and all subscale scores were positively associated with OCDUS interference of drug. Furthermore, the RRS brooding (β = 0.34, p < 0.001) and total scores (β = 0.38, p < 0.001) were determined to be separate contributors to the OCDUS total score in patients with CT. CONCLUSIONS Our study suggests that CT is common in male MAUD patients, and those who have suffered CT may exhibit higher levels of rumination and drug craving. Moreover, CT may play an influential role in the association between rumination and drug craving in patients with MAUD.
Collapse
Affiliation(s)
- Deyang Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Hengqin Ren
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| |
Collapse
|
4
|
Yang M, Sheng X, Ge M, Zhang L, Huang C, Cui S, Yuan Q, Ye M, Zhou R, Cao P, Peng R, Zhou X, Zhang K. Childhood trauma and psychological sub-health among Chinese adolescents: the mediating effect of Internet addiction. BMC Psychiatry 2022; 22:762. [PMID: 36471293 PMCID: PMC9721004 DOI: 10.1186/s12888-022-04384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/11/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The factors related to psychological sub-health (PSH) have been widely described, but the research on the mechanism behind the complex relationship between childhood trauma and PSH is limited. This study investigated the current situation and risk factors of PSH among Chinese adolescents. And further, explore whether Internet addiction (IA) plays a potential mediating effect in childhood trauma and PSH. METHODS The study was conducted in October 2020 in Anhui Province, China. The PSH state of 866 adolescents was investigated, including demographic information such as gender, age, and grade. Childhood trauma, IA, and PSH were measured by the Childhood Trauma Questionnaire Short Form (CTQ-SF), Young's Internet Addiction Test (IAT), and the Multidimensional Sub-health Questionnaire of Adolescents (MSQA). The mediating effect is further verified by the structural equation model (SEM). RESULTS In this study, 866 adolescents were selected as subjects, and the proportion of male and female is roughly equal. The prevalence of PSH in adolescents was 25.8%, and left-behind children, boarding, or adolescents who have had non-suicidal self-injury (NSSI) are more likely to have PSH. Through the mediation test, the direct effect of childhood trauma on PSH was 0.23 (95% CI [4.91,9.00],p <0.001), and the mediating effect of IA on childhood trauma and PSH was 0.07 (95% CI [1.42, 3.32],p <0.001). and the proportion of them is 75.14% and 24.86% respectively. CONCLUSIONS Childhood trauma has direct and indirect effects on PSH, and IA plays a mediating effect in the indirect effect. Therefore, clarifying these relationships helps formulate and implement effective interventions to improve psychological health (PH) in Chinese adolescents.
Collapse
Affiliation(s)
- Meng Yang
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Xuanlian Sheng
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Menglin Ge
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Ling Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Cui Huang
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Shu Cui
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Qiuyu Yuan
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Mengting Ye
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Ruochen Zhou
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Panpan Cao
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Ran Peng
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006 Anhui China
| | - Xiaoqin Zhou
- School of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China. .,Department of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006, Anhui, China. .,Anhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006, Anhui, China.
| | - Kai Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China. .,Department of Psychiatry, Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006, Anhui, China. .,Anhui Psychiatric Center, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238006, Anhui, China.
| |
Collapse
|
5
|
Wiss DA, Prelip ML, Upchurch DM, von Ehrenstein OS, Tomiyama AJ, Shoptaw SJ. Perceived social support moderates the association between household dysfunction adverse childhood experiences (ACEs) and self-reported drug use among men who have sex with men in Los Angeles, California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103899. [PMID: 36334318 DOI: 10.1016/j.drugpo.2022.103899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been shown to be associated with drug use in adulthood. The single ACE of household substance use history (part of the household dysfunction category) has frequently been associated with drug use. Resilience factors such as perceived social support appear to buffer the association between ACEs and drug use and may be particularly relevant for urban men who have sex with men (MSM). The current study of low-income mostly Black and Latino MSM aims to investigate whether the cumulative ACE score predicts self-reported drug use in a dose-response manner and whether this potential association differs by perceived social support. METHODS Data was utilized from a longitudinal study of MSM (mean age=34; SD=7.1) with varied substance use behaviors (n = 321) collected between August 2014 and April 2022. Cumulative, household dysfunction ACEs, and the single ACE of household substance use history were investigated as predictors of self-reported drug use (methamphetamine, ecstasy, cocaine/crack, heroin/fentanyl, party drugs [GHB, special K, mushrooms, LSD/acid], other drugs [bath salts, PCP]) during the past six months in mixed-effects logistic regression models, with moderation analyses by perceived social support (measured by the Multidimensional Scale of Perceived Social Support) across all models using stratified analysis and one model of multiplicative interaction. RESULTS There was no suggestion of a dose-response relationship between the number of ACEs and the predicted probability of self-reported drug use. Cumulative ACEs did not predict the outcome overall (aOR=1.99; 95% CI: 0.86-4.59), however, a positive association was estimated for individuals reporting lower levels of perceived social support (aOR=2.80; 95% CI: 0.97-8.06). The dimension of household dysfunction had a positive association with drug use (aOR=1.32; 95% CI: 1.00-1.74) whereas the dimension of childhood maltreatment did not. The association between household dysfunction and drug use was moderated by the perception of social support, with those reporting lower levels having greater odds of reporting drug use (aOR=2.94; 95% CI: 1.04-8.31). The association between household substance use history and self-reported drug use was similarly moderated by perceived social support in a multiplicative interaction model (p = .02). CONCLUSION Perceived social support emerged as a potential buffering factor for any reported drug use, particularly for the single ACE of household substance use history. Given that the association between ACEs and drug use was weak among those with higher levels of perceived social support, promotion of social ties in the community may help reduce the burden of substance use among MSM exposed to ACEs.
Collapse
Affiliation(s)
- David A Wiss
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA.
| | - Michael L Prelip
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA
| | - Ondine S von Ehrenstein
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA
| | - A Janet Tomiyama
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA 90095, USA
| | - Steven J Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, 10880 Wilshire Blvd., Los Angeles, CA 90024, USA
| |
Collapse
|
6
|
Oxytocin as an adolescent treatment for methamphetamine addiction after early life stress in male and female rats. Neuropsychopharmacology 2022; 47:1561-1573. [PMID: 35581382 PMCID: PMC9206013 DOI: 10.1038/s41386-022-01336-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/02/2022] [Accepted: 04/27/2022] [Indexed: 11/08/2022]
Abstract
Early life stress (ELS) is associated with perturbed neural development and augmented vulnerability to mental health disorders, including addiction. How ELS changes the brain to increase addiction risk is poorly understood, and there are no therapies which target this ELS-induced vulnerability. ELS disrupts the oxytocin system, which can modulate addiction susceptibility, suggesting that targeting the oxytocin system may be therapeutic in this ELS-addiction comorbidity. Therefore, we determined whether adolescent oxytocin treatment after ELS could: (1) reduce vulnerability to anxiety, social deficits, and methamphetamine-taking and reinstatement; and (2) restore hypothalamic oxytocin and corticotropin-releasing factor expressing neurons and peripheral oxytocin and corticosterone levels. Long Evans pups underwent maternal separation (MS) for either 15 min or 360 min on postnatal days (PND) 1-21. During adolescence (PNDs 28-42), rats received a daily injection of either oxytocin or saline. In Experiment 1, adult rats were assessed using the elevated plus-maze, social interaction procedure, and methamphetamine self-administration procedure, including extinction, and cue-, methamphetamine- and yohimbine-induced reinstatement. In Experiment 2, plasma for enzyme immunoassays and brain tissue for immunofluorescence were collected from adult rats after acute stress exposure. Adolescent oxytocin treatment ameliorated ELS-induced anxiety and reduced methamphetamine- and yohimbine-induced reinstatement in both sexes, and suppressed methamphetamine intake and facilitated extinction in males only. Additionally, adolescent oxytocin treatment after ELS restored oxytocin-immunoreactive cells and stress-induced oxytocin levels in males, and attenuated stress-induced corticosterone levels in both sexes. Adolescent oxytocin treatment reverses some of the ELS effects on later-life psychopathology and vulnerability to addiction.
Collapse
|
7
|
He H, Zhou S, Peng C, Ran W, Tong S, Hong L, Cai F, Jin W, Jiang Y, Li M, Wang X, Luo M, Wang W, Zhao K. Effects of resilience on impulsivity, cognition and depression during protracted withdrawal among Chinese male methamphetamine users. BMC Psychiatry 2022; 22:414. [PMID: 35729547 PMCID: PMC9215047 DOI: 10.1186/s12888-022-04041-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methamphetamine (METH) dependence is a complex and dynamic public health problem. Long-term abuse of METH can increase numerous risks of mental and physical problems. Currently, the methods to reduce METH dependence and improve the withdrawal symptoms are limited and ineffective. Resilience is seen as a multidimensional and dynamic capability to recover or bounce back from stressful events and is also generally considered as a protective factor against mental dysfunction. METHODS One hundred thirty-four males with METH dependence were consecutively recruited from Huanglong Compulsory Isolated Detoxification Center between 2019 and 2021, of whom 112 were into the group. The Connor-Davidson Resilience Scale (CD-RISC), Self-rating depression scale (SDS), Self-rating anxiety scale (SAS), Barratt Impulsiveness Scale-11(BIS-11), and the Repeatable Battery for the Assessment of Neuropsychological Status (Rbans) were used to evaluate resilience, depression, anxiety, impulsivity, and cognition respectively. RESULTS The results mainly indicated that high resilience group showed lower SDS, SAS and BIS-11 scores than low resilience group (all p < 0.05). Besides, the total scores of Rbans were higher in high resilience groups than low resilience group (both p < 0.05). Moreover, linear regression results showed that resilience may be influenced by the scores of SDS and SAS. CONCLUSIONS Resilience is negatively correlated with impulsivity and depression. Besides, it is also positively associated with cognitive function. Drug users with higher resilience may have a strong ability to mobilize psychological resources to create a good psychological environment, which may have a positive effect on the relief or improvement of symptoms.
Collapse
Affiliation(s)
- He He
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Siyao Zhou
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Chenhui Peng
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Wang Ran
- grid.13402.340000 0004 1759 700XThe Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Siyu Tong
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Lan Hong
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Fangfang Cai
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Wei Jin
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Yile Jiang
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Mengjia Li
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Xuanping Wang
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Mengdan Luo
- grid.268099.c0000 0001 0348 3990School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000 China
| | - Wei Wang
- School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000, China. .,The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Ke Zhao
- School of Mental Health, Wenzhou Medical University, Chashan Higher Education Park, Ouhai District, Wenzhou, 325000, China. .,The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China. .,School of Mental Health, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
8
|
Wang D, Deng Q, Ross B, Wang M, Liu Z, Wang H, Ouyang X. Mental health characteristics and their associations with childhood trauma among subgroups of people living with HIV in China. BMC Psychiatry 2022; 22:13. [PMID: 34986834 PMCID: PMC8729148 DOI: 10.1186/s12888-021-03658-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV (PLWH) carry a high risk for mental health problems, which has been extensively reported in the literature. However, an understanding of mental health characteristics in different subgroups of PLWH is still limited. In the present study, we conducted a cross-sectional survey to explore mental health characteristics and their associations with childhood trauma in two major subgroups of PLWH in China. METHODS A total of 533 PLWH (213 prisoners in the prison system, and 320 outpatients) were assessed using the 8-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P8), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Childhood Trauma Questionnaire (CTQ). RESULTS From the total sample, 22.0% PLWH frequently experienced psychotic-like experiences (PLEs), 21.8% had clinically significant anxiety syndrome, 34.0% had clinically significant depressive syndrome, and 63.6% experienced at least one type of traumatic exposure during their childhood, with physical neglect being the most common. Compared to outpatients with HIV, prisoners living with HIV reported more severe mental health problems and a higher frequency of childhood trauma, with childhood trauma in turn predicting higher risk for mental health problems. Similarly, among outpatients living with HIV, both childhood emotional and sexual abuse had predictive effects on all the three mental health problems. CONCLUSIONS The study suggests that PLWH have higher risk of anxiety, depression and PLEs, and childhood trauma could serve as predicting factors for such risks. In addition, childhood trauma may play distinct roles in predicting the risk for the mental health problems, depending on different subgroup of PLWH.
Collapse
Affiliation(s)
- Dongfang Wang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China ,grid.263785.d0000 0004 0368 7397School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Qijian Deng
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Brendan Ross
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine, McGill University, Montreal, QC Canada
| | - Min Wang
- grid.508008.50000 0004 4910 8370Institute for HIV/AIDS, the First Hospital of Changsha, Changsha, China
| | - Zhening Liu
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Honghong Wang
- grid.216417.70000 0001 0379 7164Xiangya Nursing School, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011, China.
| |
Collapse
|
9
|
Gupta A, Shebl FM, Tong Y, Wagner K, Bassett IV, Page K, Winstanley EL. Association of co-occurring mental health problems with hepatitis C status among young people who inject drugs in rural New Mexico, 2016-2018. Addict Sci Clin Pract 2022; 17:58. [PMID: 36266666 PMCID: PMC9583516 DOI: 10.1186/s13722-022-00340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Injection drug use (IDU) remains the strongest risk factor for hepatitis C virus (HCV) in the United States. HCV rates are increasing in rural areas among young adult people who inject drugs (PWID). People with HCV and PWID have disproportionate rates of mental health problems; however, it is unclear whether risky injection behaviors mediate the association between mental health problems and HCV. We examined the association between mental health problems and HCV in a rural cohort of young adult PWID, with the goal of informing rural service delivery. METHODS We conducted a secondary analysis of cross-sectional data from a convenience sample of young adult PWID in 2 rural counties in New Mexico. Participants were recruited from 2 community venues between September 2016 and May 2018. Associations between mental health problems and HCV were examined using bivariate (Fisher's exact) and multivariable modified Poisson regression analyses (with robust standard errors). Using structural equation modeling (SEM), we assessed duration of IDU and receptive syringe sharing (RSS) as mediators of this relationship. RESULTS A total of 263 patients were enrolled, with a median age of 26.1 years. The majority were male (66.3%) and Hispanic/Latino (a) (87.6%). The median age first injected was 19 years, and over half reported having ever engaged in RSS (53.4%). At least one mental health problem was reported by 60.1% of participants, with post-traumatic stress disorder (PTSD) being the most prevalent condition (42.2%). A majority (60.9%) tested positive for HCV antibody, and just under half (45.7%) of all participants tested positive for HCV ribonucleic acid. In SEM, PTSD had a significant total effect on HCV (τ = 0.230, P = 0.05), and this relationship was partially mediated by duration of IDU (αβ = 0.077, P = 0.03). The association between mental health problems and HCV was partially mediated by duration of IDU and the sequential mediation of duration of IDU and RSS (αβ + αββ = 0.091, P = 0.05). CONCLUSIONS High HCV rates among young adult PWID in rural New Mexico may be partly explained by mental health problems, duration of IDU and RSS. Mental health services for young adult PWID in rural areas may help decrease HCV transmission in rural areas. Trial Registration N/A.
Collapse
Affiliation(s)
- Akash Gupta
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA.
| | - Fatma M. Shebl
- grid.32224.350000 0004 0386 9924Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114 USA
| | - Yao Tong
- grid.32224.350000 0004 0386 9924Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114 USA
| | - Katherine Wagner
- grid.266832.b0000 0001 2188 8502University of New Mexico, Albuquerque, NM USA
| | - Ingrid V. Bassett
- grid.32224.350000 0004 0386 9924Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114 USA
| | - Kimberly Page
- grid.266832.b0000 0001 2188 8502University of New Mexico, Albuquerque, NM USA
| | - Erin L. Winstanley
- grid.268154.c0000 0001 2156 6140West Virginia University, Morgantown, WV USA
| |
Collapse
|
10
|
Huang C, Yuan Q, Ge M, Sheng X, Yang M, Shi S, Cao P, Ye M, Peng R, Zhou R, Zhang K, Zhou X. Childhood Trauma and Non-suicidal Self-Injury Among Chinese Adolescents: The Mediating Role of Psychological Sub-health. Front Psychiatry 2022; 13:798369. [PMID: 35222116 PMCID: PMC8866574 DOI: 10.3389/fpsyt.2022.798369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
The factors associated with non-suicidal self-injury (NSSI) of adolescents have been widely researched. However, the underlying mechanism of the relationship between childhood trauma and NSSI is limited. This study aimed to explore the risk factors for NSSI among Chinese adolescents. Our hypothesis was that psychological sub-health (PSH) played a mediating role between childhood trauma and NSSI. The Childhood Trauma Questionnaire, the Multidimensional Sub-health Questionnaire of Adolescent, and the self-report NSSI were used to measure childhood trauma, PSH, and NSSI. Structural equation model (SEM) was performed to verify our hypothesis. The results showed that 33.9% of the participants in our survey had engaged in NSSI in the past year. Adolescents who were left-behind children or in primary schools were more likely to engage in NSSI. Additionally, 56.2% of the participants had moderate to severe childhood trauma, and 26.1% of the participants had PSH. Furthermore, childhood trauma and PSH would increase the risk of NSSI by 2 times (B = 0.79, p < 0.01) and 5 times (B = 1.64, p < 0.01), respectively. SEM was established (p = 0.512) and the goodness-of-fit indices were examined (CMIN/DF = 0.892; GFI = 0.997; AGFI = 0.992; NFI = 0.991; RFI = 0.980; IFI = 1.00; TLI = 1.00; CFI = 1.00; RMSEA < 0.001). The SEM indicated that childhood trauma positively predicted NSSI both directly and indirectly through PSH. PSH has been confirmed to have partial mediating effects between childhood trauma and NSSI. The assessment of PSH may be an operable and effective method to screen and predict NSSI. Meanwhile, the intervention of childhood trauma and PSH may effectively prevent and reduce the occurrence of NSSI among adolescents.
Collapse
Affiliation(s)
- Cui Huang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Qiuyu Yuan
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Menglin Ge
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xuanlian Sheng
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Meng Yang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Shengya Shi
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Panpan Cao
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Mengting Ye
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Ran Peng
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Ruochen Zhou
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Kai Zhang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xiaoqin Zhou
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| |
Collapse
|
11
|
Wahab S, Sivarajah R, Azmi AD, Chemi N, Mahadevan R. Association between childhood trauma, intimate partner violence, and perceived parental competence among women abusing amphetamine-type stimulant. Front Psychiatry 2022; 13:994324. [PMID: 36684009 PMCID: PMC9845574 DOI: 10.3389/fpsyt.2022.994324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION This cross-sectional study examines the correlation between childhood trauma, intimate partner violence (IPV), and parenting self-efficacy among women who reported using amphetamine-type stimulants (ATS) in an institutional drug rehabilitation center. METHODS A total of 106 participants were recruited by purposive sampling, of which 88 were mothers. Questionnaires were used to collect sociodemographic data and study variables. RESULTS Most of these women had experienced emotional abuse, sexual abuse, and physical neglect in their childhood. IPV assessments revealed that 70.5% (n = 74) and 30.5% (n = 32) had experienced physical and sexual violence, respectively. In terms of parenting competency, they scored 79.5% for self-efficacy and 54.4% for parenting satisfaction. Childhood emotional abuse significantly increases the odds of individuals experiencing sexual violence by 20.9%. DISCUSSION We found that childhood trauma and IPV did not have a significant relationship with parenting efficacy. Conversely, childhood emotional abuse and physical abuse were negatively correlated to parenting satisfaction. It is imperative that any form of childhood abuse be recognized and stopped early to reduce the harm it brings to women later in life.
Collapse
Affiliation(s)
- Suzaily Wahab
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Malaysia
| | - Rubini Sivarajah
- Department of Psychiatry, Hospital Kajang, Bandar Kajang, Selangor, Malaysia
| | - Amirul Danial Azmi
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Malaysia
| | - Norliza Chemi
- Department of Psychiatry, Hospital Kajang, Bandar Kajang, Selangor, Malaysia
| | - Raynuha Mahadevan
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Malaysia
| |
Collapse
|