How discrimination experiences relate to racial/ethnic identity and mental health across first- and second-generation Vietnamese American adolescents

OBJECTIVES

Racial/ethnic discrimination has been linked to behavioral and emotional problems in youth from marginalized groups. However, the psychological experience associated with discrimination may differ between immigrant and nonimmigrant youth. Race-based discrimination may impact an adolescent's view of their own group (private regard) and/or their sense of how others view their group (public regard). Owing to differences in racialization, immigrant adolescents may be affected differently by experiences of discrimination than their U.S.-born peers. The present study examined whether nativity moderated the paths from racial/ethnic discrimination to private and public regard to mental health problems among Vietnamese American youth.

METHOD

Surveys were completed by 718 Vietnamese American 10th and 11th graders (Mage = 15.54 years, 61.4% female, 38.6% male). In this sample, 21.2% were first-generation (i.e., born outside of the United States) and 78.8% were second-generation (i.e., born in the United States with at least one parent born outside of the United States).

RESULTS

Multigroup path analysis tested the direct and indirect effects of racial/ethnic discrimination on behavioral and emotional problems via private and public regard and whether associations differed for first- versus second-generation youth. Racial/ethnic discrimination was associated with lower public regard, but not private regard, for both first- and second-generation Vietnamese American youth. Public regard was negatively associated with behavioral and emotional problems only among second-generation youth. No indirect effects were significant.

CONCLUSIONS

Findings suggest differences in racialized experiences, as well as opportunities to support second-generation Vietnamese American and other marginalized youth from immigrant families from the mental health impacts of discrimination. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psilocybin and Other Classic Psychedelics in Depression

Psychedelic drugs such as psilocybin and ketamine are returning to clinical research and intervention across several disorders including the treatment of depression. This chapter focusses on psychedelics that specifically target the 5-HT2A receptor such as psilocybin and DMT. These produce plasma-concentration related psychological effects such as hallucinations and out of body experiences, insightful and emotional breakthroughs as well as mystical-type experiences. When coupled with psychological support, effects can produce a rapid improvement in mood among people with depression that can last for months. In this chapter, we summarise the scientific studies to date that explore the use of psychedelics in depressed individuals, highlighting key clinical, psychological and neuroimaging features of psychedelics that may account for their therapeutic effects. These include alterations in brain entropy that disrupt fixed negative ruminations, a period of post-treatment increased cognitive flexibility, and changes in self-referential psychological processes. Finally, we propose that the brain mechanisms underlying the therapeutic effect of serotonergic psychedelics might be distinct from those underlying classical serotonin reuptake-blocking antidepressants.

Mixed-methods needs assessment for development of school-based mental health implementation science capacity in low- and middle-income countries: Vietnam as a case example

Worldwide, the majority of youth reside in low- and middle-income countries (LMIC). School-based mental health (SBMH) services are particularly important in LMIC, in part because of LMIC's limited mental health infrastructure. Among the challenges to developing SBMH in LMIC are limited implementation science (IS) capacity, critical for identifying barriers to evidence-based intervention (EBI) use and dissemination, etc., specific to the local country context. A key step in IS capacity development is conducting a needs assessment, to identify barriers (and their solutions) to IS development itself within the local context. The present study conducted an IS needs assessment focused on SBMH in the Southeast Asian LMIC of Vietnam. Seventy-five Vietnamese mental health professionals in SBMH-related fields participated in a mixed-methods study. Vietnamese SBMH researchers and practitioners most likely to have experience and/or interest in IS were selected for study recruitment. Professionals' formal understanding of and experience with IS as a scientific field was highly limited. However, after reading a brief but detailed description of IS, participants' interest in IS training was high, and their mean rating of its potential utility for Vietnam to develop SBMH was 4.7 on a 1-5 scale. Participants also reported on barriers and potential solutions for EBI use in SBMH in Vietnam. Contrary to expectations, the most frequent and severe barriers were not financial but related to limited stakeholder engagement. Overall, these and other study results provide some suggestions how IS capacity to support SBMH may be most efficiently developed in settings such as Vietnam. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relations between risk perception, perceptions of peers' driving, and risky driving among Cambodian adolescents

Introduction

Traffic accidents are a leading cause of death globally, with substantial economic impact particularly in low-and-middle-income countries (LMIC). Adolescents are at particular risk, partly due to their tendency to engage in risky driving. However, most research designed to identify potential causes of risky adolescent driving has been conducted in Western, high-income countries, which often have substantial cultural differences from LMIC that potentially influence risky adolescent driving.

Methods

The present study, one of the first focused on this topic in Southeast Asia, cross-sectionally assessed 425 adolescent motorbike drivers in the Southeast Asian LMIC Cambodia. Adolescents' (a) beliefs about peers' driving (social norms) and (b) driving risk perception were assessed as predictors of four risky driving behaviors: aggressive driving; distracted driving; intoxicated driving; violating driving laws.

Results

Canonical correlation analysis identified a general relation between (a) beliefs about peers' driving, and (b) all four risky driving behaviors, with R2 = 0.35 indicating over one-third of the variance in risky driving was explained by perceptions of peers' driving. Risk perception was not involved in the significant canonical relation, however. Gender moderated two of the underlying relations, with females showing larger relations between perceptions of friends' driving, and distracted driving and violating driving laws.

Discussion

These findings provide useful directions for future research (e.g., assessing the accuracy of Cambodian adolescents' perceptions of peers' driving) useful for helping stakeholders tailor road safety programs (e.g., providing adolescent drivers with accurate information regarding their peers' actual driving behaviors) for adolescent motorcyclists in Cambodia and similar countries.

Canalization and plasticity in psychopathology

This theoretical article revives a classical bridging construct, canalization, to describe a new model of a general factor of psychopathology. To achieve this, we have distinguished between two types of plasticity, an early one that we call 'TEMP' for 'Temperature or Entropy Mediated Plasticity', and another, we call 'canalization', which is close to Hebbian plasticity. These two forms of plasticity can be most easily distinguished by their relationship to 'precision' or inverse variance; TEMP relates to increased model variance or decreased precision, whereas the opposite is true for canalization. TEMP also subsumes increased learning rate, (Ising) temperature and entropy. Dictionary definitions of 'plasticity' describe it as the property of being easily shaped or molded; TEMP is the better match for this. Importantly, we propose that 'pathological' phenotypes develop via mechanisms of canalization or increased model precision, as a defensive response to adversity and associated distress or dysphoria. Our model states that canalization entrenches in psychopathology, narrowing the phenotypic state-space as the agent develops expertise in their pathology. We suggest that TEMP - combined with gently guiding psychological support - can counter canalization. We address questions of whether and when canalization is adaptive versus maladaptive, furnish our model with references to basic and human neuroscience, and offer concrete experiments and measures to test its main hypotheses and implications. This article is part of the Special Issue on "National Institutes of Health Psilocybin Research Speaker Series".

Concurrent and convergent validity of culture-specific psychopathology syndromes among Cambodian adolescents

Psychopathology is defined in part by its impacts on life functioning (e.g., fulfillment of daily responsibilities at work or school, in family relationships). Relations to life functioning are particularly important in the validation of culture-specific syndromes (patterns of mental health symptoms specific to a particular culture), to demonstrate that culture-specific symptom patterns do in fact represent pathology. The current study's goal was to assess the construct validity of the Cambodian Somatic Symptom and Syndrome Inventory (CSSI). The study focused on the statistically unique effects of the CSSI on life functioning (i.e., effects of the CSSI on life functioning, controlling for Western psychopathology syndromes), to determine whether the CSSI contributes information beyond standard Western measures, which would support CSSI culture-specific convergent validity. Because adolescence is a key period when psychopathology often develops, study participants were 391 high-school students in one urban and one rural area of Cambodia. Participants completed the CSSI, the Western psychopathology surveys Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder questionnaire (GAD-7), and life functioning measures assessing functional impairment, quality of life, and help-seeking. Results indicated strong CSSI concurrent validity (canonical correlation = 0.75) with the PHQ-9 and GAD-7, and CSSI total effects convergent validity on life functioning indicators. All CSSI statistically unique effects (controlling for the PHQ-9 and GAD-7) on life functioning measures were non-significant indicating that the CSSI, shown to be a valid assessment measure in the current study, does not add predictive information beyond standard Western measures. A key limitation that should be considered in interpretation of these results is that the life functioning measures, although reviewed by Khmer psychologists, were Western-based, thus potentially inflating relations with Western psychopathology measures.

Latent profile analyses of disordered eating behaviors and nonsuicidal self-injury among Vietnamese adolescents

OBJECTIVE

Comorbidity of disordered eating (DE) behaviors and nonsuicidal self-injury (NSSI) is linked to increased functional impairment. The present study identified subtypes of DE and NSSI comorbidity in a non-Western, low- and middle-income country where there has been particularly little research in this area.

METHOD

Latent profile analyses (LPA) were conducted to identify patterns of subgroup comorbidity in self-reported DE behaviors and NSSI behaviors, in a sample of Vietnamese high-school students (N = 1451, 51% female). Parallel-process LPA was used to predict NSSI subgroup membership from DE subgroup membership.

RESULTS

A seven-class LPA model was identified for DE: (1) Low frequencies of all DE behaviors; (2) Frequent levels of all DE behaviors; (3) Frequent fasting and purging behaviors; (4) Frequent binge eating only; (5) Moderate binge eating; (6) Moderate fasting and purging behaviors; (7) Exercise and fasting. A two-class (high versus low) model was identified for NSSI. Odds of membership in the high-NSSI class were significantly increased for all DE classes except the class characterized by moderate binge eating. Odds of belonging to the high-NSSI class were highest for those in DE classes involving purging behaviors. Males predominated in classes characterized by high behavior dysregulation.

DISCUSSION

DE and NSSI represent important clinical concerns among Vietnamese youth in urban contexts, and males may show particular vulnerability for certain risk behaviors. The association of classes of DE behaviors to NSSI was particularly strong for classes that involved purging, highlighting the importance of this specific behavior for understanding comorbidity of DE and NSSI.

PUBLIC SIGNIFICANCE

Disordered eating and nonsuicidal self-injury (NSSI; hurting oneself without intending to die) commonly co-occur. There has been less research on disordered eating and NSSI among individuals from non-Western or low/middle-income countries. We examined patterns of these behaviors in a school-based sample of Vietnamese adolescents. We found that patterns of disordered eating distinguished by purging showed particular links to NSSI, which could have implications for screening and treatment.

Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies

BACKGROUND

Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies.

METHODS

Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects.

RESULTS

Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects.

CONCLUSIONS

Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.

Prevalence of adverse childhood experiences among Vietnamese high school students

BACKGROUND

Adverse childhood experiences (ACE) are linked to a range of negative health outcomes. However, the majority of research has been conducted in high-income-countries and little is known about ACE prevalence in low-and-middle-income-countries (LMIC), where the majority of the world's youth reside.

OBJECTIVE

Assess ACE prevalence and demographic correlates in two provinces of the Southeast Asian LMIC Vietnam.

METHODS

Prevalence of ACE were assessed among 644 Vietnamese high-school students, using the WHO Adverse Childhood Experiences-International Questionnaire.

RESULTS

About 74% of participants reported experiencing at least one ACE, with 27% reporting experiencing three or more ACE. Prevalence of sexual abuse was above 10% for both males and females. Sex differences were non-significant, suggesting child protective services should give consideration to both males and females. Factor analysis identified two patterns of ACE: Violence and Aggression in Family and Community, and Family Member Dysfunction. Three ACE (sexual abuse, emotional neglect, physical neglect) did not load on either factor. Thus, at least in our sample, sexual abuse was independent of other ACE, which indicates that it can occur in any context, among children in otherwise well-functioning families, an important consideration for child protective services. The lack of significant sex differences in sexual abuse means that Vietnamese boys need equal consideration for protection and support as girls.

CONCLUSIONS

Results indicate that ACE are a prevalent public health problem in Vietnam. Future research evaluating potential ACE risk factors such as authoritarian parenting may be useful to identify possible targets for prevention programs in Vietnam.

The 'big four' health risk behaviors among Vietnamese adolescents: co-occurrence and socio-cultural risk factors

Background

Health Risk Behaviors (HRBs) represent significant health threats for adolescents. However, there has been relatively little research on multiple HRBs in low-and-middle-income countries (LMIC), where the majority of the world’s youth reside. This study’s objective was to investigate common HRB, their co-occurrence, and socio-demographic risk and protective factors among Vietnamese adolescents.

Methods

A cross-sectional self-report survey examined four major HRBs (tobacco use, alcohol consumption, physical inactivity, unhealthy diet) among 431 adolescents aged 15–17 years in five Vietnam provinces. Key HRB risk and protective factors assessed included perceived social norms, parental monitoring of adolescents’ behavior, and health behavior literacy.

Results

Forty-one percent of participants reported no HRB, 39% reported one, and 20% reported two or more HRBs. The four HRBs appeared to be independent, with an exploratory factor analysis indicating no common factors. The most prevalent HRB was unhealthy diet (45%), the least prevalent smoking (1%). The most frequent co-occurring HRBs were unhealthy diet and physical inactivity. Adolescents’ perceptions of norms regarding HRBs and related healthy behaviors were the most consistent risk factor for the HRB. Diet was the HRB most influenced by the social variables perceived norms, monitoring, and health literacy.

Conclusions

Results highlight the importance of future research identifying the temporal order of co-occurrence of multiple HRB, how differing conceptualizations of socio-cultural roles impact on HRB, and health-related effects of HRB co-occurrence. Such information will be useful for maximizing the efficiency and effectiveness of prevention and intervention programs in LMIC.

A221 CONGENITAL PORTOSYSTEMIC SHUNTS: FROM PRENATAL DIAGNOSIS TO LONG- TERM POSTNATAL OUTCOME

Background

Congenital portosystemic shunts (CPSS) are rare vascular malformations that result in blood bypassing the liver and re-entering the systemic circulation unfiltered. The outcomes of CPSS diagnosed prenatally are unknown. Previously published data is related to patients diagnosed after symptom appearance, including hepatic encephalopathy, liver tumors and portal hypertension.

Aims

To describe a cohort of prenatally diagnosed children with CPSS and report on the natural history and outcomes.

Methods

The study was conducted between 2006 and 2019. Prenatal diagnosis was performed during routine prenatal ultrasound. Patients were followed by the pediatric gastroenterologists’ unit.

Results

32 patients were identified; 28 patients with intrahepatic shunts and four patients with extrahepatic shunts. During follow up, Failure to Thrive (FTT) was observed in three of the patients with one shunt (16.7%), and five of the patients with two shunts or more (55.6%). The difference is significant (p- value=0.037). 24 patients with intrahepatic shunts had their shunts closed spontaneously. Median time for closure of the shunt was seven months (IQR 2–14 months, range 0–35 months). No predicting factor was detected for closure of the shunt before the age of one year. All extrahepatic shunts required surgical closure.

Conclusions

Congenital intrahepatic shunts usually close spontaneously and do not need intervention. All patients in our prenatally diagnosed cohort survived with limited to no sequelae.

Funding Agencies

None

Association between ACTH stimulation test results and clinical signs in dogs with hyperadrenocorticism treated with trilostane

Trilostane is the recommended medical treatment for dogs with hyperadrenocorticicm (HAC). The objective of this study was to investigate the association between ACTH stimulation test (ACTHST) results, and relevant clinical signs, in dogs treated with trilostane. A disease-specific questionnaire was developed, which included the owner's assessment of polydipsia, polyuria, polyphagia, panting, and satisfaction with the treatment, based on a 5-response category rating scale. Forty-nine dogs with HAC were prospectively enrolled. Dogs were grouped according to their recheck appointment (first recheck, 710 days after commencement of treatment or change of trilostane dose; second recheck, 4 weeks after the first recheck; third recheck, performed at 3-6 months intervals once the dog was well controlled). At the recheck appointment, the owner's questionnaire responses were recorded, and an ACTHST was performed, along with urine specific gravity measurement. Linear mixed effects models were used to assess differences among the three recheck time points and to test possible associations between ACTHST results and clinical signs. Significant differences between rechecks were present for stimulated cortisol (first to third recheck, P < 0.001; second to third recheck, P < 0.01), polydipsia (first to second recheck, P = 0.001), polyuria (first to second recheck, P < 0.001; first to third recheck, P = 0.001), and owner satisfaction (first to second recheck, P < 0.001; first to third recheck, P < 0.001). Backward stepwise variable elimination did not identify any significant associations between ACTHST results and clinical signs. Therefore, clinical signs of HAC were not predicted based on the ACTHST results.

Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

Introduction

Starting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.

Methods

Mixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.

Results

Of 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.

Conclusion

Due to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

Interpersonal Psychotherapy-Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process

Although research has identified effective evidence-based depression prevention interventions for diverse youth, little is known about how the intervention process unfolds with immigrant family youth. This study utilized a qualitative approach to explore cultural and clinical differences in the implementation of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) in two schools, one serving youth from primarily immigrant, Asian American families and the second, youth from mostly nonimmigrant, non-Hispanic White families. A total of 131 IPT-AST sessions were audio recorded, transcribed, and coded for presence and patterns of cultural and clinical constructs. Results revealed that sessions with immigrant family youth were more likely to contain discussions of interpersonal problems characterized by estrangement, goals of spending time together with important others, mentions of emotion suppression and academic achievement expectations, conversations about acculturation, differences in value orientation, and discomfort with implementing new intervention skills. Dialogue from interventionist and youth exchanges is presented to illustrate how these themes emerged and were addressed by interventionists in a culturally responsive manner. The study highlights how IPT-AST with immigrant family and Asian American youth may unfold differently compared to youth from nonimmigrant families. Implications of findings for providers are discussed.

Mental health literacy at the public health level in low and middle income countries: An exploratory mixed methods study in Vietnam

PURPOSE

Mental health literacy (MHL) is key for mental health development, particularly in low-and-middle-income countries (LMIC) where mental health resources are limited. MHL development can be thought of as occurring at two levels: the individual person level (via direct contact, with specifically-targeted individuals), and the public health level (via indirect contact through public media, targeting the general public). Each approach has advantages and disadvantages.

METHODS

The present mixed methods study assessed the status of and best approaches for development of mental health literacy in the Southeast Asian LMIC Vietnam. Because there has been relatively little discussion of MHL development at the public health level, this assessment focused on the public health level, although not exclusively. Because mental health professionals generally have the most in-depth understanding of their mental health system, study participants were 82 Vietnamese mental health professionals who completed a quantitative survey, with 48 participating in focus groups.

RESULTS

Most of the professionals viewed MHL in Vietnam as low or very low, and that it was difficult or very difficult for the general public to find effective mental health services. Main barriers underlying these problems and more generally for developing MHL in Vietnam identified in the focus groups were: (a) misinformation in the media regarding mental health and mental illness; (b) lack of licensure for non-medical mental health professionals (e.g., psychologists; social workers); (c) lack of interest in mental health from upper-level leadership.

CONCLUSIONS

To the best of our knowledge, this is the first study assessing professionals' perceptions regarding mental health literacy at both the public health and individual-person levels. Although sampling was restricted to Vietnamese professionals, results may provide initial preliminary guidance for other LMIC considering mental health literacy development at multiple levels.

Psychosocial Influences on Medical Help Seeking for Cancer Symptoms and Treatment in Low- and Middle-Income Countries: A Meta-Analysis and Mixed Methods Systematic Review

PURPOSE

Cancer disproportionately affects people living in low- and middle-income countries (LMICs), partly because of delayed medical help-seeking behavior (HSB). Our mixed-methods systematic review synthesized existing studies in LMICs to understand psychosocial influences on cancer-related medical HSB to inform the development of effective interventions to promote earlier HSB for cancer.

METHODS

We searched peer-reviewed literature databases for quantitative, qualitative, and mixed-methods studies exploring barriers/facilitators to medical HSB for cancer symptoms in adults living in LMICs. Study exclusion criteria were low methodologic quality, non-English language publication, non–peer-reviewed publication, and studies conducted in high-income countries. Study findings were synthesized using meta-analysis, meta-ethnography, and narrative synthesis methods, according to individual study design.

RESULTS

Fifty studies were included. Many studies used nonstandardized measures/designs, which increased the difficulty integrating findings. Preliminary findings indicate that the use of traditional healers is a key barrier to prompt medical HSB in LMICs. Use of traditional healers for cancer symptoms/treatment was influenced by causal beliefs about symptoms, familial pressure, ease of access, affordability, and a preference to avoid biomedical treatment, which was perceived as invasive, ineffective, and expensive. Additional psychosocial barriers included shame and stigma associated with cancer, such as fear of marital rejection/divorce; limited knowledge of cancer and associated symptoms; financial and access barriers associated with travel and appointments; and cultural barriers, such as women needing permission from the family network.

CONCLUSION

Such barriers as low symptom knowledge and negative beliefs about cancer are universal barriers to cancer HSB in high-income countries and LMICs, whereas the use of traditional healers and women needing permission to seek medical help seem to be unique to LMICs. Intervention developers should work with local communities to appropriately tailor cancer awareness interventions in LMICs, taking into account cultural influences on HSB. Future evaluations would benefit from using validated measures and robust study designs.

Urbanization, and child mental health and life functioning in Vietnam: implications for global health disparities

PURPOSE

Urbanization is linked to increased health risks, including mental health. However, the large majority of this research has been conducted in high-income countries, and little is known about effects in low-and-middle-income countries (LMIC) where urbanization is occurring most frequently and most rapidly. Within global mental health, children and adolescents are a critical but understudied population. The present study assessed relations between urbanization factors, and child mental health in Vietnam, a Southeast Asian LMIC.

METHODS

Most studies investigating urbanization and mental health have used geographically based dichotomous urban vs. rural variables. Because of significant limitations with this approach, the present study assessed parent-reported urbanization factors (e.g., pollution, crime). In Sub-study #1 (cross-sectional), 1314 parents from 10 Vietnam provinces completed the Urbanization Factors Questionnaire, Child Behavior Checklist (mental health), and Brief Impairment Scale (life functioning). In Sub-study #2 (longitudinal), 256 parents from one highly urban and one highly rural province completed the same measures, at three timepoints across 12 months.

RESULTS

Cross-sectional canonical correlations identified relatively small (e.g., R² = 0.08) but significant relations between urbanization factors, and child functioning. Parallel analyses using a geographically defined urban vs. rural variable did not produce significant results. The large majority of longitudinal relations between the different urbanization factors and child functioning were non-significant.

CONCLUSIONS

This study, among the first to assess urbanization as a multi-dimensional continuous construct in relation to child psychopathology, highlights the value of the use of an urbanization factors approach. A new "urbanization factors differentials" theory is proposed to suggest how effects of urbanization factors might result in global health disparities.

Adolescents' family obligation and activities in rural and urban Vietnam: Implications for social change

This study examined how urbanisation may modify adolescents' values and activities concerning family obligation by surveying 572 adolescents (M_age  = 15.75, SD = .73) in rural and urban Vietnam. Compared with their rural peers, urban adolescents reported a stronger sense of family obligation but spent less time actually engaging in family assistance, findings that were partly explained by urban households' less financial hardship and higher parental education levels. As expected, stronger family obligation values were associated with greater family assistance activities across rural and urban Vietnam. However, stronger family obligation values were associated with more study hours only in urban Vietnam, indicating that urbanisation may broaden the meaning of family obligation to encompass the academic domain. Additionally, weaker family obligation values were associated with more employment hours only in rural Vietnam, suggesting that rural adolescents with little attachment to the traditional value of family obligation may pursue autonomy through employment outside the home. In traditionally familistic societies undergoing urbanisation, family obligation may take on different meaning depending on adolescents' ecological settings that construct cultural values and behavioural norms.

Effects of Family Obligation Values and Autonomy Support on Internalizing Symptoms of Vietnamese-American and European-American Adolescents

OBJECTIVES

Although negotiation of family relatedness and personal autonomy is a key developmental task of adolescence, what is most adaptive for adolescents may vary across cultures. The purpose of the present study was to examine whether relations between family obligation values and adolescent internalizing symptoms may vary as a function of the level of parental autonomy support perceived by the adolescent, and to assess the extent to which such associations vary by ethnic group.

METHODS

The study included 614 adolescents (Mean age = 15.57 years, 50% male) from Vietnamese-American (55%) and European-American (45%) backgrounds. Adolescents reported their: (a) family obligation values to (a1) respect, (a2) provide current assistance, and (a3) provide future support to the family, (b) perceived maternal and paternal autonomy support, and (c) internalizing symptoms.

RESULTS

Effects of family obligation values differed across the three subdomains as a function of maternal autonomy support and ethnic group. Family obligation values to respect the family (a1, above) were related to lower levels of internalizing symptoms for both Vietnamese- and European-American adolescents who received high levels of maternal autonomy support. Ethnic differences emerged such that only among Vietnamese-American adolescents, there was a negative relation between current assistance values (a2, above) and internalizing symptoms among adolescents with high maternal autonomy support.

CONCLUSIONS

Overall, findings highlight the importance for parents to nurture adolescents' family obligation values while also promoting their autonomy development.

Tobacco Smoking and Antisocial Deviance among Vietnamese, Vietnamese-American, and European-American Adolescents

Tobacco smoking is one of the most significant modifiable behavioral health risk factors worldwide. Although smoking rates in some high-income countries (HIC) have declined, rates in many low-and-middle-income countries (LMIC) remain high. Adolescence is a key developmental risk period for smoking initiation. Research indicates that a major adolescent risk factor for tobacco smoking is antisocial deviance, which includes such behaviors as aggression, risk-taking, and rule-breaking. The linkages between antisocial deviance and smoking suggest that these behaviors and their underlying attitudes can be important targets for smoking prevention programs, but for public health efficiency it is important to target the components of antisocial deviance most closely linked smoking. However, although 80% of smokers live in LMIC, most relevant research has been conducted in HIC and its applicability to LMIC is unclear, given cultural differences between many HIC and LMIC. The purpose of the present study was to assess cross-cultural variations in relations among components of antisocial deviance and self-reported tobacco smoking among 2,724 10th and 11th grade Vietnamese, Vietnamese-American, and European-American students. Within the combined sample the relation between self-reported smoking and overall antisocial deviance was β = 0.33. However, the component of antisocial deviance most strongly related to smoking varied across groups, with Risk-taking most strongly related to smoking for Vietnamese-American (β = 0.37) and Vietnamese (β = 0.36) adolescents, and Rule-breaking Behavior most strongly related to smoking for European-American (β = 0.51) adolescents. These and other findings suggest the possible importance of culturally-tailored foci for smoking prevention programs emphasizing different aspects of antisocial deviance.

Explanatory variables for women's increased risk for mental health problems in Vietnam

PURPOSE

The United Nations Sustainable Development Goals include gender equality for women, including health, as one of seventeen targets. Within this broad domain, a wide range of research indicates that being female is associated with increased risk for mental health problems, particularly in low- and middle-income countries (LMIC). What is less clear are the trans-diagnostic demographic and environmental risk factors in LMIC that may underlie this increased risk. The purpose of the present study was to identify socio-economic and related disadvantages potentially underlying increased risk for women for mental health-related problems in the Southeast Asian LMIC of Vietnam.

METHODS

Nine hundred and seventy-seven adults were randomly selected from five provinces in central coastal Vietnam. Individuals were assessed cross-sectionally for depression (PHQ-9), anxiety (GAD-7), post-traumatic stress disorder symptoms (PDS), somatic syndrome (SCL-90-R), alcohol dependence (ICD-10), functional impairment (PDS life functioning section), and self-perceived general physical health (SF-36). Trans-diagnostic risk factors assessed included financial stress, education level, exposure to traumatic events, and others.

RESULTS

At the multivariate level, gender explained approximately 5% of the variance in mental health symptoms, with women significantly higher in all mental health domains except alcohol dependency. The trans-diagnostic risk factors explained slightly over half of this variance, with financial stress and lower education levels the two strongest individual explanatory variables for women's increased risk for mental health problems.

CONCLUSIONS

These results suggest that support for gender equality including in regard to economic stability and education may be critical for reducing broad gender disparities in mental health functioning.

Cultural variation in temporal associations among somatic complaints, anxiety, and depressive symptoms in adolescence

OBJECTIVE

Different domains of internalizing symptoms (somatic, anxiety, depressive) often occur concurrently, suggesting that they may share common etiology. In longitudinal analyses of internalizing among youth, anxiety is often found to precede depression. However, relatively few studies have also assessed how somatic problems, the third symptom domain, are involved in longitudinal patterns of internalizing. In addition, temporal relations among internalizing symptom domains may vary by cultural group as somatic symptoms are posited to be a more culturally-normative way of communicating or experiencing distress in non-Western, interdependent cultures. Thus, the present study examined longitudinal relations among these three internalizing symptom domains in three ethnocultural adolescent samples.

METHODS

304 European American, 420 Vietnamese American, and 717 Vietnamese adolescents' self-reported internalizing symptoms (somatic, anxiety, depressive) were assessed at three time points, spaced three months apart, using multigroup cross-lagged path analysis.

RESULTS

Anxiety symptoms consistently predicted increases in depressive symptoms in European American adolescents. In contrast, for Vietnamese and Vietnamese American adolescents, the most consistent relation was with somatic complaints predicting increases in anxiety. Anxiety and depressive symptoms bidirectionally predicted each other among the Vietnamese and Vietnamese American adolescents.

CONCLUSIONS

Cultural group differences were evident in the temporal course of internalizing symptoms. The pattern of results have implications for culturally relevant intervention targets, during a developmental period of risk for internalizing disorders.

Longitudinal Relations between Emotion Restraint Values, Life Stress, and Internalizing Symptoms among Vietnamese American and European American Adolescents

Objective: Recent research has documented cultural differences in the extent and manner in which various forms of emotion regulation are linked with psychological well-being. Most of these studies, however, have been cross-sectional, nor have they directly examined the values underlying the use of emotion regulation. The present study examined emotion restraint values and their interactions with life stress in predicting internalizing symptoms across time among Vietnamese American and European American adolescents. The study focused on adolescence as a critical developmental period during which life stress and internalizing symptoms increase significantly. Method: Vietnamese American (n = 372) and European American (n = 304) adolescents' levels of emotion restraint values, internalizing symptoms, and stress were assessed at two timepoints six months apart. Results: Results indicated differential associations between emotion restraint values, stress, and symptoms over time for the two groups. For Vietnamese American adolescents, emotion restraint values did not predict depressive, anxiety, or somatic symptoms. For European American adolescents, emotion restraint values predicted higher somatic symptoms but buffered against the effects of interpersonal stress on anxiety and depressive symptoms. Conclusions: These results provide increased understanding of the role of values related to emotion restraint in shaping adolescent internalizing symptoms and responses to stress across cultural groups. Implications of the findings for guiding intervention efforts are discussed.

Altered T cell receptor beta repertoire patterns in pediatric ulcerative colitis

The antigenic specificity of T cells occurs via generation and rearrangement of different gene segments producing a functional T cell receptor (TCR). High-throughput sequencing (HTS) allows in-depth assessment of TCR repertoire patterns. There are limited data concerning whether TCR repertoires are altered in inflammatory bowel disease. We hypothesized that pediatric ulcerative colitis (UC) patients possess unique TCR repertoires, resulting from clonotypical expansions in the gut. Paired blood and rectal samples were collected from nine newly diagnosed treatment-naive pediatric UC patients and four healthy controls. DNA was isolated to determine the TCR-β repertoire by HTS. Significant clonal expansion was demonstrated in UC patients, with inverse correlation between clinical disease severity and repertoire diversity in the gut. Using different repertoire variables in rectal biopsies, a clear segregation was observed between patients with severe UC, those with mild-moderate disease and healthy controls. Moreover, the overlap between autologous blood-rectal samples in UC patients was significantly higher compared with overlap among controls. Finally, we identified several clonotypes that were shared in either all or the majority of UC patients in the colon. Clonal expansion of TCR-β-expressing T cells among UC patients correlates with disease severity and highlights their involvement in mediating intestinal inflammation.

Culturally Sensitive Assessment of Anxious-Depressive Distress in Vietnam: Avoiding Category Truncation

The present study investigated what complaints are prominent in psychologically distressed Vietnamese in Vietnam beyond standard symptoms assessed by Western diagnostic instruments for anxiety and depression. To form the initial Vietnamese Symptom and Cultural Syndrome Addendum (VN SSA), we reviewed the literature, consulted experts, and conducted focus groups. The preliminary VN SSA was then used in a general survey (N = 1004) of five provinces in Vietnam. We found that the VN SSA items were highly and significantly correlated with a measure of anxious-depressive psychopathology (a composite measure of the General Anxiety Disorder-7; Posttraumatic Diagnostic Scale; and Patient Health Questionnaire-9). The VN SSA item most highly correlated to anxious-depressive psychopathology was "thinking a lot" ( r = .54), reported by 15.8% of the sample. Many other symptoms in the addendum also were prominent, such as orthostatic dizziness (i.e., dizziness upon standing up; r = .41), reported by 22.9% of the sample. By way of comparison, somatic complaints more typically assessed to profile Western anxious-depressive distress, such as palpitations, were less prominent, as evidenced by being less strongly correlated to Western psychiatric symptoms and being less frequent (e.g., palpitations: r = .31, 7.1% of the sample). Study results suggest that to avoid category truncation when profiling anxious-depressive distress among Vietnamese that items other than those in standard psychopathology measures should also be assessed.

Neuroplasticity following short-term strength training occurs at supraspinal level and is specific for the trained task

AIMS

Different modalities of strength training cause performance enhancements, which are specific for the trained task. However, the involved mechanisms are still largely unknown. It has been demonstrated that strength training could induce neuroplasticity, which might underlie the performance improvements during the first training sessions. Thus, we hypothesized to find task-specific neuroplasticity after a short-term strength training of two distinct strength tasks.

METHODS

Young healthy male subjects were exposed to 4 sessions of either maximal isometric explosive (EXPL group, N = 9) or slow sustained (SUS group, N = 10) knee extensions. Pre- and post-training, we measured H-reflexes and motor evoked potentials (MEPs) in the vastus lateralis (VL) at the onset of both strength tasks.

RESULTS

Pre- and post-training, H-reflexes remained unchanged in both groups. MEP areas were lower in the trained task in both groups and remained unchanged in the untrained task.

CONCLUSION

This study demonstrated that short-term strength training induces specific neuroplasticity for the trained task only. The fact that MEPs were lower but H-reflex amplitudes remained unchanged at the onset of the trained tasks suggests that strength training elicited neuroplasticity at supraspinal level that most likely reflect an improved task-specific corticospinal efficiency.

Prospective relations between parent-adolescent acculturation conflict and mental health symptoms among Vietnamese American adolescents

OBJECTIVES

Intergenerational acculturation conflict in immigrant families has been implicated as a risk factor for adolescent maladjustment. However, the directionality and specific family related mediators of this association have not been identified. The present study prospectively examined relations between adolescent reports of perceived acculturation conflict and internalizing and externalizing mental health symptoms. Perceived parent-adolescent relationship strain and perceived parental psychological control were examined as potential mediators.

METHOD

Survey measures were administered to 375 Vietnamese American adolescents (48.8% males; M = 15.55 years, SD = .59) at 3 time points over 6 months.

RESULTS

Using cross-lagged path analysis, perceived acculturation conflict predicted externalizing symptoms, whereas internalizing symptoms predicted perceived acculturation conflict. Perceived maternal psychological control mediated the association between perceived acculturation conflict and later externalizing symptoms, whereas maternal psychological control, parental unresponsiveness, and unmet parent expectations mediated the association between internalizing symptoms and later acculturation conflict.

CONCLUSION

Culturally competent enhancement of parental sensitivity and responsiveness might be targeted as a modifiable protective factor in family-based preventive interventions for at-risk immigrant families. (PsycINFO Database Record

Characteristics of Agencies Providing Support Services for Children with Autism Spectrum Disorders in Vietnam

As in virtually all countries, in Vietnam there has been a general trend towards apparent increased rates of Autism Spectrum Disorder (ASD). To address the needs of families and children with ASD, many agencies providing support services have been opened throughout Vietnam over the last two decades. Although agencies in general appear to strive to provide good quality service, the actual quality of operations is unknown. The present article collected and analyzed secondary data from 68 agencies across Vietnam from different information sources, using the nine criteria published by Tran, Weiss, and Pham (in press) [1] and Nguyen, Hoang, Nguyen, Pham, and Tran (2017) [2] to evaluate agency quality. Results of this review suggest that a significant number of centers do not have appropriate legal status, are not following basic ethical standards, are using non-evidence based intervention methods, and are unclear in regards to the intervention procedures or intervention plans they use. Although the current study has a number of limitations, it provides important initial information regarding the current status of ASD services in Vietnam.

Barriers to global health development: An international quantitative survey

BACKGROUND

Global health's goal of reducing low-and-middle-income country versus high-income country health disparities faces complex challenges. Although there have been discussions of barriers, there has not been a broad-based, quantitative survey of such barriers.

METHODS

432 global health professionals were invited via email to participate in an online survey, with 268 (62%) participating. The survey assessed participants' (A) demographic and global health background, (B) perceptions regarding 66 barriers' seriousness, (C) detailed ratings of barriers designated most serious, (D) potential solutions.

RESULTS

Thirty-four (of 66) barriers were seen as moderately or more serious, highlighting the widespread, significant challenges global health development faces. Perceived barrier seriousness differed significantly across domains: Resource Limitations mean = 2.47 (0-4 Likert scale), Priority Selection mean = 2.20, Corruption, Lack of Competence mean = 1.87, Social and Cultural Barriers mean = 1.68. Some system-level predictors showed significant but relatively limited relations. For instance, for Global Health Domain, HIV and Mental Health had higher levels of perceived Social and Cultural Barriers than other GH Domains. Individual-level global health experience predictors had small but significant effects, with seriousness of (a) Corruption, Lack of Competence, and (b) Priority Selection barriers positively correlated with respondents' level of LMIC-oriented (e.g., weeks/year spent in LMIC) but Academic Global Health Achievement (e.g., number of global health publications) negatively correlated with overall barrier seriousness.

CONCLUSIONS

That comparatively few system-level predictors (e.g., Organization Type) were significant suggests these barriers may be relatively fundamental at the system-level. Individual-level and system-level effects do have policy implications; e.g., Priority Selection barriers were among the most serious, yet effects on seriousness of how LMIC-oriented a professional was versus level of academic global health achievement ran in opposite directions, suggesting increased discussion of priorities between LMIC-based and other professionals may be useful. It is hoped the 22 suggested solutions will provide useful ideas for addressing global health barriers.

Incremental validity of the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ) in Vietnam

OBJECTIVE

Valid but efficient psychiatric assessment is essential for mental health development in Asian low and middle-income countries. This study's objective was to assess the validity of Vietnamese versions of the Child Behavior Checklist (CBCL), and the Strengths and Difficulties Questionnaire (SDQ) in Vietnam.

METHODS

Measures were completed by a community sample of 1314 parents of children 6-16 years old from 10 Vietnamese provinces, and by parents of 208 children recruited from 3 psychiatric facilities in Hanoi.

RESULTS

Internal consistency was in the fair to excellent range for all CBCL scales (.76-.96) and for the SDQ Total Problems scale (.81); SDQ subscale internal consistency was in the poor to fair range (.31-.73). All CBCL and SDQ scales and most individual items significantly discriminated between referred and non-referred children, with referred children scoring in the more pathological direction; the CBCL had significantly larger referral effect sizes than the SDQ for all four pairs of comparable scales. At the item level, the largest referral status effect for the CBCL were #73 (Sexual Problems), #84 (Strange Behavior), and #91 (Talks about suicide), and for the SDQ they were #10 (Constantly fidgeting), #15 (Easily Distracted) and # 25 (Good Attention Span-reverse scored). Five CBCL (#2 Drinks alcohol; #99 Uses tobacco, #32 Has to be perfect; #53 Overeats; #56A Aches and pains) and one SDQ items (#23 Gets along better with adults than children) did not discriminate referral status, suggesting the influence of cultural values on clinical referrability (e.g., that Vietnamese parents may not see use of tobacco as an issue of concern, or related to health).

CONCLUSIONS

There is good support for the reliability and validity of the Vietnamese version of the CBCL, and for the SDQ Total Problems scale. Overall, the CBCL appears to be the stronger measure psychometrically, particularly if in-depth assessment is needed.

Cultural Differences in the Reciprocal Relations between Emotion Suppression Coping, Depressive Symptoms and Interpersonal Functioning among Adolescents

The current study examined the prospective relations between emotion suppression and maladjustment (i.e., depressive symptoms, family stress events, peer stress events, and family and peer support) among Vietnamese American (n = 372) and European American adolescents (n = 304). We found that at baseline Vietnamese Americans adolescents reported greater use of emotion suppression coping than European American adolescents. Multi-group structural equation modeling indicated that for European American teens emotion suppression was significantly related to increased depression symptoms and decreased quality of peer relationships. In contrast, for the Vietnamese Americans teens emotion suppression relations to later maladjustment was either nonsignificant or attenuated relative to the European American. These findings suggest ethnic group differences in both the utilization, and consequences and function of emotion suppression among Vietnamese American and European American adolescents.

Vietnam as a case example of school-based mental health services in low and middle income countries: Efficacy and effects of risk status

The purposes of this study were to (a) assess the efficacy of a universal classroom-based mental health and social skills program for primary school students in Vietnam, and (b) given the universal nature of the intervention, assess outcomes as a function of risk status (high vs. low). RECAP-VN is a semi-structured program that provides students with classroom social skills training, and teachers with in-classroom consultation on program implementation and classroom-wide behavior management. Project data were collected at three time-points across the academic year from 443 2nd grade students in regards to their social skills and mental health functioning, in the Vietnamese cities of Hanoi and Danang. Mental health functioning (emotional and behavioral mental health problems) was the ultimate outcome target (at Time 3), with social skills intermediate (at Time 2) outcomes targeted to improve mental health functioning. Significant treatment effects were found on both social skills and mental health functioning. However, although program effects on mental health functioning were significant for both low and high risk status groups, program effects on social skills were only significant for low risk status students, suggesting that different mechanisms may underlie program effects for high and low risk status students. Overall the results of this study, one of the first to assess directly the effects of a school-based program on mental health functioning in a low or middle income country, provide some support for the value of using school-based programs to address the substantial child mental health treatment gap found in low- and middle-income countries.

Adolescents' stigma attitudes toward internalizing and externalizing disorders: Cultural influences and implications for distress manifestations

OBJECTIVE

This study examined predictors of stigma attitudes toward common youth emotional behavioral problems to test the hypothesis that interdependent cultural values would be associated with differential stigma towards externalizing versus internalizing disorders. Furthermore, we examined whether problem-specific stigma attitudes would predict adolescent's own self-reported manifestations of distress.

METHOD

1224 Vietnamese American and European American adolescents completed measures of social distance stigma attitudes in response to vignettes depicting youth with internalizing (depression, social anxiety, somatization) and externalizing (alcohol use, aggressive behaviors, delinquency) disorders. A subset of 676 youth also provided self-reports on their own adjustment prospectively over six months.

RESULTS

Measurement models revealed clear separation of negatively correlated factors assessing stigma toward externalizing versus internalizing problems. Values related to family interdependence were significantly associated with greater tolerance of internalizing disorders and lower tolerance of externalizing disorders. Stigma towards internalizing disorders was associated with lower concurrent self-reported internalizing symptoms, whereas stigma towards externalizing symptoms was associated with lower concurrent externalizing symptoms and greater decreases in externalizing symptoms over time.

CONCLUSIONS

The results of the study suggest that stigma attitudes are differentiated by problem type and may represent one cultural factor shaping distress manifestations.

Caseness rates and risk factors for depression among Vietnamese cancer patients

OBJECTIVE

Research suggests that rates of depression among general population samples in Asia may be significantly lower than in much of the rest of the world. However, whether this applies to depression among cancer patients is unclear, which is important to determine in order to identify depression treatment needs among cancer patients in this region. The purpose of the present study was to assess caseness rates of serious depression among general cancer patients in the Southeast Asian nation of Viet Nam.

METHOD

A total of 695 adult cancer patients from three hospitals in Da Nang, Viet Nam served as study participants. They were assessed at one time point for (a) demographic and (b) cancer characteristics, and (c) depression symptoms.

RESULTS

The overall caseness rate for serious depression was 28%. Although rates of depression in general population samples usually are significantly higher in women than men, rates of depression among men and women did not differ significantly among our cancer patients. Higher levels of depressive symptoms were found, however, as a function of lower patient income and education, occupation, cancer stage, and type of cancer, but not marital status or age.

CONCLUSIONS

Caseness rates of depression are significantly elevated by a factor of 10-15 among Vietnamese cancer patients relative to general population epidemiological studies in the same region. Although a number of studies have found that rates of depression tend to be lower in Asian as compared to Western general population samples, depression rates among our Vietnamese cancer patients were similar to those reported among Western cancer patients. This suggests that whatever factors are responsible for the relatively low rates of depression observed in Asian general population samples may not be operating in regards to cancer-related depression. Overall, the value of these findings are not only that they provide information for policy makers in Viet Nam to support depression treatment among cancer patients, but also that they suggest that despite the apparent relatively low overall rates of depression it may be useful for cancer and mental health researchers in the region to conduct similar assessments for their policy makers.

Effects of the family schizophrenia psychoeducation program for individuals with recent onset schizophrenia in Viet Nam

OBJECTIVE

Although psychoeducation has been found effective for improving the life functioning of patients with schizophrenia in high income countries, there have been relatively few studies of schizophrenia psychoeducation adapted for low and middle-income countries (LMIC), particularly in Southeast Asia. The present study assessed effects of the Family Schizophrenia Psychoeducation Program (FSPP) among Vietnamese patients and their families on the patients' (1) quality of life and (2) medication non-compliance, and the family and patients' (3) stigma towards schizophrenia, and (4) consumer satisfaction.

METHOD

This intervention study involved 59 patients, and their families, from the Da Nang Psychiatric Hospital, randomly assigned to treatment (n=30) or control (n=29) conditions. Control subjects received services as usual (antipsychotic medication); treatment group subjects received the FSPP as well. Blind-rater assessments were conducted at T1 immediately after project enrollment (prior to participating in the FSPP) and at T2 six months later.

RESULTS

There were significant treatment effects on: (1) quality of life, (2) stigma, (3) medication compliance, and (4) consumer satisfaction, with all effects favoring the treatment group. Effect sizes were moderate to large.

CONCLUSIONS

This psychoeducation program appears to reduce stigma, improve quality of life and medication compliance, and increase consumer satisfaction of Vietnamese patients with schizophrenia and their families, beyond the effects of antipsychotic medication. It involves relatively little cost, and it may be useful for it or equivalent programs to be implemented in other hospitals in Viet Nam, and potentially other low-income Asian countries to improve the lives of patients with schizophrenia.

Mental health, life functioning and risk factors among people exposed to frequent natural disasters and chronic poverty in Vietnam

BACKGROUND

People living in low- and middle-income countries (LMIC) are at increased risk for exposure to major natural disasters, which places them at increased risk for mental health problems. Evidence is less clear, however, regarding the effects of less severe but more frequent natural disasters, which are likely to increase due to global climate change.

AIMS

To examine the mental health and life functioning, and their predictors, of people living in central coastal Vietnam, an area characterized by high risk for natural disasters and poverty.

METHOD

1000 individuals were randomly selected from 5 provinces in central coastal Vietnam. Individuals were assessed cross-sectionally for exposure to major storms and other traumatic events (Post-traumatic Diagnostic Scale; PDS), financial stress (Chronic Financial Stress Scale), depression (PHQ-9), anxiety (GAD-7), PTSD (PDS), somatic syndrome (SCL-90-R), alcohol dependency (ICD-10), self-perceived general physical health (SF 36), and functional impairment (PDS life functioning section); caseness was determined using the various measures' algorithms.

RESULTS

22.7% percent of the sample (n=227) met caseness criteria in one or more mental health domains, and 22.1% (n=221) reported moderate to severe functional impairment. Lifetime exposure to typhoons and other major storms was 99% (n=978), with 77% (n=742) reporting traumatic major storm exposure. Moderate to high levels of financial stress were reported by 30% (n=297). Frequency of exposure to major storms was not associated with increased risk for mental health problems but traumatic exposure to a major storm was. Overall, the strongest predictor of mental health problems was financial stress. Number of traumatic typhoons and other major storms in turn were significant predictors (r² = .03) of financial stress. The primary predictor of alcohol dependency was male gender, highlighting the importance of gender roles in development of alcohol abuse in countries like Vietnam.

CONCLUSIONS

Individuals living in central coastal Vietnam have elevated rates of PTSD, somatic syndrome, and functional impairment but not depression or anxiety. Financial stress was the strongest predictor of mental health problems. Results suggest the importance of conducting broad assessments when providing mental health support for disaster-impacted communities. Study results suggest that one indirect consequence of predicted global climate change may be increased prevalence of mental health problems in communities such as that assessed in the present study, due to increased risk for traumatic storm-related exposure and through indirect effects on financial stress, but not through a general increased risk for major storms. Such results also indicate that when supporting LMIC communities that have experienced natural disasters, it will be important to consider the broader community context including poverty, in addition to the direct effects of the disaster.

Operative Outcomes with Myxomatous Mitral Valve Repair: Experience with 586 Patients

INTRODUCTION

American Heart Association (AHA) guidelines recommend mitral valve repair for myxomatous mitral regurgitation whenever possible to prevent LV dysfunction and early mortality. Here we review our early operative outcomes with mitral valve repair for myxomatous mitral regurgitation.

METHODS

We collected data from 586 consecutive patients that underwent mitral repair for myxomatous disease at the Prince Henry and Prince of Wales Hospitals Sydney between 1997 and 2012. All patients had pre- and postoperative transthoracic echocardiograms.

RESULTS

In the first 30 days postoperatively there were five deaths (0.9%), four strokes (0.7%) and five transient ischaemic attacks (TIAs) (0.9%). Repair involved resection in 55.5%, neochordal reconstruction in 41.6%, and in 2.9% a combination of both. There was increasing use of neochordae since 2006. At discharge 99% had mitral regurgitation (MR) ≤ mild and ≤ trivial in 79.5%. For posterior leaflet disease neochordae had improved MR at discharge compared with resection (85% vs 78%, P<0.05). Preoperative triscupid regurgitation (TR) and pulmonary hypertension > mild were associated with a greater degree of MR at discharge (P<0.05) for reasons that are unclear.

CONCLUSION

We have shown excellent early results for mitral repair with very low operative mortality and excellent freedom from significant MR. Successful mitral repairs with low morbidity have resulted in a pattern of early referral in keeping with the current guidelines.