Background

A number of factors, such as demographics, cognitive function, personality and interpersonal relationship) play a role in late-life depression. This study investigates the influence of social inhibition on the inverse emotional stability (neuroticism) and depressive symptoms found in elderly Thai people.

Methods

In total, 123 elderly Thais aged 60 years of age or older were tested using the 64-item Inventory of Interpersonal Problems, Symptom Checklist-90, and the 16 Personality Factors Questionnaire. Hierarchical regression and path analyses were performed in order to identify the relationships among these variables.

Results

The age of the participants ranged from 60 to 93 years old (mean = 71.7; SD = 6.2), and out of the group, 51.2% were male, 56.1% were married and 61.8% were on a low income. The average number of years spent in education among the participants was 7.6 (SD = 5.1). The variables found to be significantly associated with depression were age, intellect, social inhibition and possession of inverse emotional stability (neuroticism). Low levels of emotional stability were most strongly associated with depressive symptoms (standardized regression coefficients −0.29), but this effect was found to be reduced (mediated, to −0.26) by social inhibition. In total, 30% of the total variance could be explained by this model, and there was an excellent statistical fit.

Conclusions

The variables found to be significantly associated with depression were a younger age, as well as lower levels of intellectual skill, social inhibition and inversed emotional stability (neuroticism). It was found that a lack of emotional stability is, along with a younger age, the strongest predictor of depressive symptoms, but can be mediated by social inhibition.

Aim:

This study seeks to investigate the psychometric properties of the short version of the revised ‘Experience of Close Relationships’ questionnaire, comparing non-clinical and clinical samples.

Methods:

In total 702 subjects participated in this study, of whom 531 were non-clinical participants and 171 were psychiatric patients. They completed the short version of the revised ‘Experience of Close Relationships’ questionnaire (ECR-R-18), the Perceived Stress Scale-10(PSS-10), the Rosenberg Self-Esteem Scale (RSES) and the UCLA Loneliness scale. A retest of the ECR-R-18 was then performed at four-week intervals. Then, confirmatory factor analyses were performed to test the validity of the new scale.

Results:

The ECR-R-18 showed a fair to good internal consistency (α 0.77 to 0.87) for both samples, and the test-retest reliability was found to be satisfactory (ICC = 0.75). The anxiety sub-scale demonstrated concurrent validity with PSS-10 and RSES, while the avoidance sub-scale showed concurrent validity with the UCLA Loneliness Scale. Confirmatory factor analysis using method factors yielded two factors with an acceptable model fit for both groups. An invariance test revealed that the ECR-R-18 when used on the clinical group differed from when used with the non-clinical group.

Conclusions:

The ECR-R-18 questionnaire revealed an overall better level of fit than the original 36 item questionnaire, indicating its suitability for use with a broader group of samples, including clinical samples. The reliability of the ECR-R- 18 might be increased if a modified scoring system is used and if our suggestions with regard to future studies are followed up.

This study examines the Thai version of the Multidimensional Scale of Perceived Social Support (MSPSS) for its psychometric properties.

Methods:

In total 462 participants were recruited - 310 medical students from Chiang Mai University and 152 psychiatric patients, and they completed the Thai version of the MSPSS, the State Trait Anxiety Inventory (STAI), the Rosenberg Self-Esteem Scale (RSES) and the Thai Depression Inventory (TDI). Test-retest reliability was conducted over a four week period.

Results:

Factor analysis produced three-factor solutions for both patient (PG) and student groups (SG), and overall the model demonstrated adequate fit indices. The mean total score and the sub-scale score for the SG were statistically higher than those in the PG, except for ‘Significant Others’. The internal consistency of the scale was good, with a Cronbach’s alpha of 0.91 for the SG and 0.87 for the PG. After a four week retest for reliability exercise, the intra-class correlation coefficient (ICC) was found to be 0.84. The Thai-MSPSS was found to have a negative correlation with the STAI and the TDI, but was positively correlated with the RSES.

Conclusion:

The Thai MSPSS is a reliable and valid instrument to use.

Background

Delirium is a common illness among elderly hospitalized patients. However, under-recognition of the condition by non-psychiatrically trained personnel is prevalent. This study investigated the performance of family physicians when detecting delirum in elderly hospitalized Thai patients using the Thai version of the Confusion Assessment Method (CAM) algorithm.

Methods

A Thai version of the CAM algorithm was developed, and three experienced Thai family physicians were trained in its use. The diagnosis of delirium was also carried out by four fully qualified psychiatrists using DSM-IV TR criteria, which can be considered the gold standard. Sixty-six elderly patients were assessed with MMSE Thai 2002, in order to evaluate whether they had dementia upon admission. Within three days of admission, each patient was interviewed separately by a psychiatrist using DSM-IV TR, and a family physician using the Thai version of the CAM algorithm, with both sets of interviewers diagnosing for delirium.

Results

The CAM algorithm tool, as used by family physicians, demonstrated a sensitivity of 91.9% and a specificity of 100.0%, with a PPV of 100.0% and an NPV of 90.6%. Interrater agreement between the family physicians and the psychiatrists was good (Cohen's Kappa = 0.91, p < 0.0001). The mean of the time the family physicians spent using CAM algorithm was significantly briefer than that of the psychiatrists using DSM-IV TR.

Conclusions

Family physicians performed well when diagnosing delirium in elderly hospitalized Thai patients using the Thai version of the CAM algorithm, showing that this measurement tool is suitable for use by non-psychiatrically trained personnel, being short, quick, and easy to administer. However, proper training on use of the algorithm is required.

Background

Among the stress instruments that measure the degree to which life events are perceived as stressful, the Perceived Stress Scale (PSS) is widely used. The goal of this study was to examine the psychometric properties of a Thai version of the PSS-10 (T-PSS-10) with a clinical and non-clinical sample. Internal consistency, test-retest reliability, concurrent validity, and the factorial structure of the scale were tested.

Methods

A total sample of 479 adult participants was recruited for the study: 368 medical students and 111 patients from two hospitals in Northern Thailand. The T-PSS-10 was used along with the Thai version of State Trait Anxiety Inventory (STAI), the Thai Version of the Rosenberg Self-Esteem Scale (RSES), and the Thai Depression Inventory (TDI).

Results

Exploratory Factor Analysis (EFA) yielded 2 factors with eigenvalues of 5.05 and 1.60, accounting for 66 percent of variance. Factor 1 consisted of 6 items representing "stress"; whereas Factor 2 consisted of 4 items representing "control". The item loadings ranged from 0.547 to 0.881. Investigation of the fit indices associated with Maximum Likelihood (ML) estimation revealed that the two-factor solution was adequate [χ2 = 35.035 (df = 26, N = 368, p < 0.111)]; Goodness-of-Fit Index (GFI) = 0.981; Root Mean Square Residual (RMR) = 0.022; Standardized Root Mean square Residual (SRMR) = 0.037, Comparative Fit Index (CFI) = 0.989; Normed Fit Index (NFI) = 0.96, Non-Normed Fit Index (NNFI) = 0.981, Root Mean Square Error of Approximation (RMSEA) = 0.031. It was found that the T-PSS-10 had a significant positive correlation with the STAI (r = 0.60, p < 0.0001), and the TDI (r = 0.55, p < 0.0001); and was significantly negatively correlated with the RSES (r = -0.46, p < 0.0001, N = 368). The overall Cronbach's alpha was 0.85. The ICC was 0.82 (95% CI, 0.72 and 0.88) at 4 week-retest reliability.

Conclusions

The Thai version of the PSS-10 demonstrated excellent goodness-of-fit for the two factor solution model, as well as good reliability and validity for estimating the level of stress perception with a Thai population. Limitations of the study are discussed.

Background

It has been reported for over the past decade that the use of selective serotonin reuptake inhibitors (SSRI's) may associate with the emergence of apathy. The authors hypothesized that depressed patients treated with SSRI's would show more signs of apathy than patients treated with non-SSRI antidepressants. This case control study was conducted to investigate the possibility of the association between SSRI use and the occurrence of apathy.

Methods

Baycrest Centre for Geriatric Care's Day Hospital Database of elderly depressed patients who received antidepressants was divided into 2 groups depending on antidepressant use at discharge: SSRI user group-SUG, and non-SSRI user group-NSUG. Apathy scales developed by the authors were selected from the Geriatric depression Scale (GDS) and the Hamilton Rating Scale for Depression (HAMD), and were titled as GDS-apathy subscale (GAS) and HAMD-apathy subscale (HAS). Demographic data, baseline apathy, underlying medical conditions and medication use were studied. Proportion, analysis of variances, Chi-square test, odds ratio with 95% confidence interval were reported.

Results

Among 384 patients (160 SUG and 224 NSUG), mean GDS and HAM-D at discharge were 12.46 and 10.61 in SUG, and were 11.37 and 9.30 in NSUG, respectively. Using GAS for apathy assessment, 83.7% of patients in SUG and 73.4% in NSUG stayed apathetic at discharge. As evaluated by HAS, 44.2% of patients in SUG and 36.5% in NSUG stayed apathetic. SSRI use was not a predictor of apathy at admission, while it was at discharge, p = 0.029. The SUG showed more patients with apathy than that found in NSUG (adjusted OR = 1.90 (1.14–3.17). Age 70–75 years tended to be a predictor for the apathy (p = 0.058). Using HAS, age 70–75 years and living situation were associated with apathy at discharge, p = 0.032 and 0.038 respectively.

Conclusion

Even though depression was improved in elderly patients receiving antidepressants, apathy appeared to be greater in patients who were treated with SSRI than that found in patients who were not. Frontal lobe dysfunction due to alteration of serotonin is considered to be one of the possibilities.