Helen Fung Kum Chiu

Objective: To establish the norms of the Hong Kong Brief Cognitive Test (HKBC) among Chinese older adults and to examine its utility for differentiating neurocognitive disorders from cognitively normal controls.Methods: Two thousand three hundred twelve participants aged 40 years and above were recruited from six regions of China as the norm construction sample. 93 normal participants and 246 cognitive impairment patients were included for diagnostic test of HKBC. Based on the multinomial regression model, which analyzed the relationship between HKBC score and demographic information, the norm of HKBC score and converted T score (HKBC‐T) were constructed. The ROC curve of HKBC‐T was depicted to calculate the optimal cutoff value of screening cognitive impairment.Results: The results showed that HKBC score was negatively correlated with age (SE = −5.48, p < 0.001) and positive correlation with education (SE = 1.53, p < 0.001), with no significant association with gender and living area. The AUC value of HKBC‐T is 0.85 in distinguishing cognitive impairment and normal older adults. The optimal cutoff value was 45.79 points, achieving a sensitivity of 91.4% and a specificity of 66.7%.Conclusion: Age and education must be adjusted when creating the HKBC norms. The HKBC‐T is promising in detecting cognitive impairment at the population level.

Psychotic-like experiences (PLEs) may be important antecedents of psychosis and other mental disorders. To investigate distinct longitudinal trajectories of the frequency of PLEs and their relationship to subsequent development of mental disorders. A longitudinal study of self-reported PLEs and concurrent traumatic experiences was conducted among 6,198 adolescents through annual classroom assessments over 3 years (2014-2016) using the Community Assessment of Psychic Experiences and the Trauma History Questionnaire. Diagnoses of mental disorders were based on the Mini-International Neuropsychiatric Interview in the final year. Growth mixture modeling was used to identify distinct growth trajectories in the frequency of PLEs. Logistic regression was then used to explore relationships between different PLE trajectories and emergence of psychiatric disorders, taking account of sociodemographic characteristics and childhood antecedents. Two different PLE trajectories were identified, one characterized by stable low levels of PLE frequency and the other by progressively increasing PLE frequency. Transition to mental disorder occurred in 3.39% of the increasing-frequency group and 1.28% of the stable low-level group. The increasing-frequency group had a significantly higher risk of transition to any psychiatric disorder (OR = 2.7; 95% CI, 1.56-4.66), to a psychotic disorder (OR = 22.14; 95% CI, 2.30-213.25), and to a nonpsychotic psychiatric disorder (OR = 2.28; 95% CI, 1.27-4.10). Besides increasing PLEs (OR = 3.33; 95% CI, 1.55-7.19), other risk factors for any psychiatric disorder included childhood trauma (OR = 1.17; 95% CI, 1.01-1.36), family divorce (OR = 2.86; 95% CI, 1.24-6.61), and minority ethnicity (OR = 2.91; 95% CI, 1.18-7.20). The pattern of increasing PLEs predominates in predicting emergent mental disorder, particularly psychosis, along with minority status, trauma, and family divorce, suggesting potential targets for preventive intervention.

Objective: To examine the attitude toward suicide (ATS) and its influence on nonfatal suicidal behaviors of Chinese rural‐to‐urban migrant workers (MWs).Method: Altogether, 3031 MWs completed the positive ATS Scale and structured questions regarding lifetime suicide ideation, plan, and attempt. Mental health help‐seeking behaviors of MWs were also investigated.Results: Overall, MWs held a more negative ATS than the Chinese general population. The lifetime prevalence of suicide ideation, plan, and attempt was 5.5%, 1.3%, and 1.1%, respectively. After controlling for lifetime depressive disorders and other covariates, a negative ATS was still significantly associated with lower risk of lifetime suicide ideation (OR = 0.32), plan (OR = 0.22), and attempt (OR = 0.26). MWs with a negative ATS were more likely to talk to others and seek help by online/telephone consultation for their mental health and suicidal problems (p < .05). A more positive ATS was significantly associated with male gender, low education level, ethnic minority of Miao, low monthly income, and originating from western China.Conclusions: The majority of MWs hold a negative ATS, which significantly contributes to their relatively low risk of nonfatal suicidal behaviors. The more help‐seeking from others and online/telephone consultation in MWs with a negative ATS may lower their risk of nonfatal suicidal behaviors.

Objectives: To develop and examine the validity of a new brief cognitive test with less educational bias for screening cognitive impairment.Methods: A new cognitive test, Hong Kong Brief Cognitive Test (HKBC), was developed based on review of the literature, as well as the views of an expert panel. Three groups of subjects aged 65 or above were recruited after written consent: normal older people recruited in elderly centres, people with mild NCD (neurocognitive disorder), and people with major NCD. The brief cognitive test, Mini‐Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA), were administered to the subjects. The performance of HKBC in differentiating subjects with major NCD, mild NCD, and normal older people were compared with the clinical diagnosis, as well as the MMSE and MoCA scores.Results: In total, 359 subjects were recruited, with 99 normal controls, 132 subjects with major NCD, and 128 with mild NCD. The mean MMSE, MoCA, and HKBC scores showed significant differences among the 3 groups of subjects. In the receiving operating characteristic curve analysis of the HKBC in differentiating normal subjects from those with cognitive impairment (mild NCD + major NCD), the area under the curve was 0.955 with an optimal cut‐off score of 21/22. The performances of MMSE and MoCA in differentiating normal from cognitively impaired subjects are slightly inferior to the HKBC.Conclusions: The HKBC is a brief instrument useful for screening cognitive impairment in older adults and is also useful in populations with low educational level.

Rural-to-urban migrant workers (MWs) are a large vulnerable population in China and, recently, the new-generation MWs (those born in 1980 or later) have become the majority of this population. Examining difference in the epidemiology of poor mental health between the new- and old-generation (those born before 1980) MWs would facilitate mental health promotion efforts. However, very few related studies are available and they produced conflicting findings. This study investigated intergenerational difference in prevalence and correlates of psychological distress (PD) in MWs. A total of 3031 MWs (691 old- and 2340 new-generation MWs) completed a standardized questionnaire containing socio-demographic, migration-related, and work-related variables and the Chinese 12-item General Health Questionnaire (GHQ-12). A GHQ-12 score of 3 or higher was used to denote PD. PD was more prevalent in the new- than old-generation MWs (36.2% versus 28.2%, P < 0.001). The elevated risk of PD in the new- versus old-generation remained significant after controlling for potential confounders (OR=1.51, P < 0.001). For the new-generation, correlates for PD included low monthly income, recent two-week physical morbidity, migrating alone, poor Mandarin proficiency and long working hours; while for the old-generation, correlates for PD included low education, recent two-week physical morbidity, and having worked in many cities. The new-generation MWs are at higher risk for PD than the old-generation MWs. Mental health services for addressing the generation-specific needs may be an effective way to prevent or reduce PD of MWs.