Factors associated with mental health of medical students in Vietnam: A national study

This project was the first national study of the health and wellbeing of medical students in Vietnam. Data from over 2,000 students from eight universities indicate that, while the majority are healthy, significant proportions have poor mental and/or physical health and other life adversities. For many students, heavy academic demands were not a major stressor; rather, difficulties within their family, interpersonal relations, dissatisfaction with career choice and housing and financial problems appear to cause the most strain. This study provides evidence that will be useful for the development of professional counseling services in Vietnamese universities.

Factors associated with health risk behavior among school children in urban Vietnam

Background Health risk behavior among young people is a public health problem in Vietnam. In addition, road traffic injuries are the leading cause of death for those aged 15–29 years. The consequences can be devastating for adolescents and their families, and can create a significant economic burden on society. Objective: The aim of this study was to identify protective and risk factors that may influence three health risk behaviors among school children: suicidal thinking (ST), drinking alcohol (DA), and underage motorbike driving (MD). Methods A cross-sectional survey of 972 adolescents (aged 12–15 years) was conducted in two secondary schools in Hanoi, Vietnam. The schools were purposely selected, one each from the inner city and a suburban area, from which classes (grade 6 to 8) were randomly selected. All students attending classes on survey days took part in the survey. The anonymous, self-completed questionnaire included measures of risk behavior, school connectedness, parental bonding, and other factors. Multivariable regression models were used to examine associations between the independent variables and the three health risk behaviors controlling for confounding factors. Results Young people in the inner city school reported a higher prevalence of all three risk behaviors than those in the suburban area (ST: 16.1% [95% confidence interval, or CI, 12.9–19.3] versus 4.6% [95% CI 2.7–6.5], p<0.001; DA: 20.3% [95% CI 16.8–23.8] versus 8.3% [95% CI 5.8–10.8], p<0.001, and MD: 10.1% [95% CI 7.4–12.8] versus 5.7% [95% CI 3.6–7.8], p<0.01). School connectedness and mother and father care appeared to be significant protective factors. For males, bullying in school was associated with suicidal thoughts, whereas for both males and females, school connectedness may be protective against suicidal ideation. Conclusion This study supports findings from other nations regarding suicidal thoughts and alcohol use, and appears to be one of the first to examine risk and protective factors forMD. Health promotion within schools should be introduced to improve students’ feelings of connectedness in combination with communication and education campaigns focusing on parental care and engaging teachers for the promotion of safer, supportive school environments.

Adverse childhood experiences and the health of university students in eight provinces of Vietnam

Recent systematic reviews have emphasized the need for more research into the health and social impacts of adverse childhood experiences (ACEs) in the Asia-Pacific region. This cross-sectional study was conducted with 2099 young adult students in 8 medical universities throughout Vietnam. An anonymous, self-report questionnaire included the World Health Organization ACE-International Questionnaire and standardized measures of mental and physical health. Three quarters (76%) of the students reported at least one exposure to ACEs; 21% had 4 or more ACEs. The most commonly reported adversities were emotional abuse, physical abuse, and witnessing a household member being treated violently (42.3%, 39.9%, and 34.6%, respectively). Co-occurrence of ACEs had dose–response relationships with poor mental health, suicidal ideation, and low physical health–related quality of life. This first multisite study of ACEs among Vietnamese university students provided evidence that childhood adversity is common and is significantly linked with impaired health and well-being into the early adult years

Serendipitous road trips: Enhancing tourists’ experiences through social interaction

Driving can be a lonely activity. While there has been a lot of research and technical inventions concerning car-to-car communication and passenger entertainment, there is still little work concerning connecting drivers. Whereas tourism is very much a social activity, drive tourists have few options to communicate with fellow travellers. The proposed project is placed at the intersection of tourism and driving and aims to enhance the trip experience during driving through social interaction. This thesis explores how a mobile application that allows instant messaging between travellers sharing similar context can add to road trip experiences. To inform the design of such an application, the project adopted the principle of the user-centred design process. User needs were assessed by running an ideation workshop and a field trip. Findings of both studies have shown that tourists have different preferences and diverse attitudes towards contacting new people. Yet all participants stressed the value of social recommendations. Based on those results and a later expert review, three prototype versions of the system were created. A prototyping session with potential end users highlighted the most important features including the possibility to view user profiles, choose between text and audio input and receive up-to-date information. An implemented version of the prototype was evaluated in an exploratory study to identify usability related problems in an actual use case scenario as well as to find implementation bugs. The outcomes of this research are relevant for the design of future mobile tourist guides that leverage from benefits of social recommendations.

Current CAPE-15: A measure of recent psychotic-like experiences and associated distress

Aim Psychotic-like experiences (PLEs) are common in young people and are associated with both distress and adverse outcomes. The Community Assessment of Psychic Experiences-Positive Scale (CAPE-P) provides a 20-item measure of lifetime PLEs. A 15-item revision of this scale was recently published (CAPE-P15). Although the CAPE-P has been used to assess PLEs in the last 12 months, there is no version of the CAPE for assessing more recent PLEs (e.g. 3 months). This study aimed to determine the reliability and validity of the current CAPE-P15 and assess its relationship with current distress. Method A cross-sectional online survey of 489 university students (17–25 years) assessed lifetime and current substance use, current distress, and lifetime and 3-month PLEs on the CAPE-P15. Results Confirmatory factor analysis indicated that the current CAPE-P15 retained the same three-factor structure as the lifetime version consisting of persecutory ideation, bizarre experiences and perceptual abnormalities. The total score of the current version was lower than the lifetime version, but the two were strongly correlated (r = .64). The current version was highly predictive of generalized distress (r = .52) and indices that combined symptom frequency with associated distress did not confer greater predictive power than frequency alone. Conclusion This study provided preliminary data that the current CAPE-P15 provides a valid and reliable measure of current PLEs. The current CAPE-P15 is likely to have substantial practical utility if it is later shown to be sensitive to change, especially in prevention and early intervention for mental disorders in young people.

An imagery-based road map to tackle maladaptive motivation in clinical disorders

There is now a widespread recognition of the importance of mental imagery in a range of clinical disorders (1). This provides the potential for a transdiagnostic route to integrate some aspects of these disorders and their treatment within a common framework. This opinion piece argues that we need to understand why imagery is such a central and recurring feature, if we are to progress theories of the origin and maintenance of disorders. This will aid us in identifying therapeutic techniques that are not simply targeting imagery as a symptom, but as a manifestation of an underlying problem. As papers in this issue highlight, imagery is a central feature across many clinical disorders, but has been ascribed varying roles. For example, the involuntary occurrence of traumatic memories is a diagnostic criterion for PTSD (2), and it has been suggested that multisensory imagery of traumatic events normally serves a functional role in allowing the individual to reappraise the situation (3), but that this re-appraisal is disabled by extreme affective responses. In contrast to the disabling flashbacks associated with PTSD, depressed adults who experience suicidal ideation often report “flash forward” imagery related to suicidal acts (4), motivating them to self-harm. Socially anxious individuals who engage in visual imagery about giving a talk in public become more anxious and make more negative predictions about future performance than others who engage in more abstract, semantic processing of the past event (5). People with Obsessive Compulsive Disorder (OCD) frequently report imagery of past adverse events, and imagery seems to be associated with severity (6). The content of intrusive imagery has been related to psychotic symptoms (7), including visual images of the catastrophic fears associated with paranoia and persecution. Imagery has been argued (8) to play a role in the maintenance of psychosis through negative appraisals of imagined voices, misattribution of sensations to external sources, by the induction of negative mood states that trigger voices, and through maintenance of negative schemas. In addiction and substance dependence, Elaborated Intrusion (EI) Theory (9, 10) emphasizes the causal role that imagery plays in substance use, through its role in motivating an individual to pursue goals directed toward achieving the pleasurable outcomes associated with substance use...

Design thinking using a collaborative model for skin cancer prevention

Physical activity is well recognised as a means to reduce cancer risk; however, outdoor activity can increase sun exposure and consequential skin cancer risk. It is proposed, one of the key potential solutions to promote active lifestyles whilst enhancing protection against skin cancer is design resolution for active apparel that considers Australia’s sub-tropical climate whilst maintaining comfort, aesthetic appeal and performance. Using a design thinking approach, facilitated through collaboration between an NGO and a university, student designers were tasked with developing apparel prototypes to explore this challenge. Through practical ideation of problems, potential design solutions were developed within a modest NGO budget and adherence to specific brand guidelines. This project is novel as it demonstrates a low cost yet effective way of collaboratively creating a product to meet multiple needs, rather than reactively assessing already manufactured sun protection products for endorsement. It is a nimble and unique stepping stone in integrating sun safety considerations into clothing that is appealing to the population and creating cross-industry understandings of how design can better contribute to human health and wellbeing. Outcomes to be shared include empirical insights for updating sun safe clothing guidelines, issues around the aesthetic nature of sun safe apparel, and the role of design education for sun safety.

Suicidal behaviour in bipolar disorder

The Jorvi Bipolar Study (JoBS) is a collaborative ongoing bipolar research project between the Department of Mental Health and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital (HUCH), Espoo, Finland. The JoBS is a prospective, naturalistic cohort study of secondary level care psychiatric out-and inpatients with a new episode of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) bipolar disorder (BD). Altogether, 1630 patients (aged 18-59) years were screened using the Mood Disorder Questionnaire (MDQ) for a possible new episode of DSM-IV BD. 490 patients were interviewed with semi-structured interview [the Structured Clinical Interview for DSM-IV Disorders, research version with Psychotic Screen (SCID-I/P)]. 191 patients with new episode of DSM-IV BD were included in the bipolar cohort study. Psychiatric comorbidity was evaluated using semi-structured interviews. At 6- and 18-month follow-up, the interviews were repeated and life-chart methodology was used to integrate all available information about nature and duration of all different phases. Suicidal behaviour was examined both at intake and follow-up by psychometric scale [Scale for Suicidal Ideation (SSI)], interviewer s questions and medical and psychiatric records. The aim of this thesis was to evaluate prevalence of suicidal behaviour and incidence of suicide attempts, and examine the wide range of risk factors for attempted suicide both, at intake and follow-up, in representative secondary-level sample of psychiatric in- and outpatients with BD. In this study suicidal behaviour was common among psychiatric patients with BD. During the episode when patients were included into cohort study (index episode), 20% of the patients had attempted suicide and 61% had suicidal ideation. Severity of depressive episode and hopelessness were independent risk factors for suicidal ideation, whereas hopelessness, comorbid personality disorder and previous suicide attempt predicted suicide attempts during the index episode. There were no differences in prevalence of suicidal behaviour between bipolar I and II disorder; the risk factors were overlapping but not identical. During the index episode, suicide attempts took place during depressive, mixed and depressive mixed phases. Furthermore, there were marked differences regarding level of suicidal ideation during different phases, with the highest levels during the mixed phases of the illness. Hopelessness was independently associated with suicidal behaviour during the depressive phase. A subjective rating of severity of depression (Beck Depression Inventory) and younger age predicted suicide attempts during mixed phases. During the 18-month follow-up 20% of patients attempted suicide. Previous suicide attempts, hopelessness, depressive phase at index episode and younger age at intake were independent risk factors for suicide attempts during follow-up. Taken altogether, 55% patients attempted suicide before index episode, during index episode or during follow-up. The incidence of suicide attempts was 37-fold during combined mixed and depressive mixed states and 18-fold during major depressive phase as compared with other phases. Prior suicide attempt and time spent in combined mixed phases - mixed and depressive mixed - and depressive phases independently predicted the suicide attempt during follow-up. More than half of the patients have attempted suicide during their lifetime, a finding which highlights the public health importance of suicidal behaviour in bipolar disorder. Clinically, it is crucial to recognize BD and manage the mixed and depressive phases of bipolar patients fast and effectively, as time spent in depressive and mixed phases involves a remarkably high risk of suicide attempts.

Depressive Disorders in Primary Health Care

The Vantaa Primary Care Depression Study (PC-VDS) is a naturalistic and prospective cohort study concerning primary care patients with depressive disorders. It forms a collaborative research project between the Department of Mental and Alcohol Research of the National Public Health Institute, and the Primary Health Care Organization of the City of Vantaa. The aim is to obtain a comprehensive view on clinically significant depression in primary care, and to compare depressive patients in primary care and in secondary level psychiatric care in terms of clinical characteristics. Consecutive patients (N=1111) in three primary care health centres were screened for depression with the PRIME-MD, and positive cases interviewed by telephone. Cases with current depressive symptoms were diagnosed face-to-face with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P). A cohort of 137 patients with unipolar depressive disorders, comprising all patients with at least two depressive symptoms and clinically significant distress or disability, was recruited. The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), medical records, rating scales, interview and a retrospective life-chart were used to obtain comprehensive cross-sectional and retrospective longitudinal information. For investigation of suicidal behaviour the Scale for Suicidal Ideation (SSI), patient records and the interview were used. The methodology was designed to be comparable to The Vantaa Depression Study (VDS) conducted in secondary level psychiatric care. Comparison of major depressive disorder (MDD) patients aged 20-59 from primary care in PC-VDS (N=79) was conducted with new psychiatric outpatients (N =223) and inpatients (N =46) in VDS. The PC-VDS cohort was prospectively followed up at 3, 6 and 18 months. Altogether 123 patients (90%) completed the follow-up. Duration of the index episode and the timing of relapses or recurrences were examined using a life-chart. The retrospective investigation revealed current MDD in most (66%), and lifetime MDD in nearly all (90%) cases of clinically significant depressive syndromes. Two thirds of the “subsyndromal” cases had a history of major depressive episode (MDE), although they were currently either in partial remission or a potential prodromal phase. Recurrences and chronicity were common. The picture of depression was complicated by Axis I co-morbidity in 59%, Axis II in 52% and chronic Axis III disorders in 47%; only 12% had no co-morbidity. Within their lifetimes, one third (37%) had seriously considered suicide, and one sixth (17%) had attempted it. Suicidal behaviour clustered in patients with moderate to severe MDD, co-morbidity with personality disorders, and a history of treatment in psychiatric care. The majority had received treatment for depression, but suicidal ideation had mostly remained unrecognised. The comparison of patients with MDD in primary care to those in psychiatric care revealed that the majority of suicidal or psychotic patients were receiving psychiatric treatment, and the patients with the most severe symptoms and functional limitations were hospitalized. In other clinical aspects, patients with MDD in primary care were surprisingly similar to psychiatric outpatients. Mental health contacts earlier in the current MDE were common among primary care patients. The 18-month prospective investigation with a life-chart methodology verified the chronic and recurrent nature of depression in primary care. Only one-quarter of patients with MDD achieved and maintained full remission during the follow-up, while another quarter failed to remit at all. The remaining patients suffered either from residual symptoms or recurrences. While severity of depression was the strongest predictor of recovery, presence of co-morbid substance use disorders, chronic medical illness and cluster C personality disorders all contributed to an adverse outcome. In clinical decision making, beside severity of depression and co-morbidity, history of previous MDD should not be ignored by primary care doctors while depression there is usually severe enough to indicate at least follow-up, and concerning those with residual symptoms, evaluation of their current treatment. Moreover, recognition of suicidal behaviour among depressed patients should also be improved. In order to improve outcome of depression in primary care, the often chronic and recurrent nature of depression should be taken into account in organizing the care. According to literature management programs of a chronic disease, with enhancement of the role of case managers and greater integration of primary and specialist care, have been successful. Optimum ways of allocating resources between treatment providers as well as within health centres should be found.

Attitudes towards suicide among Master’s degree students: a cross-cultural comparison between China and Finland

Attitudes towards suicide among Master’s degree students in Chang Sha (China) and Helsinki (Finland) were compared in order to explore possible cross-cultural differences. The sample included 206 Master’s degree students, 101 Chinese and 105 Finnish. Data were collected using the 30-item Multi-Attitudes Suicide Tendency Scale (MAST) and a demographic information form. According to the results, both Chinese and Finnish students held positive attitudes towards life, they held contradictory attitudes towards suicide, with Finnish students having more permissive and liberal attitudes towards suicide than their Chinese counterparts. In addition, three socio-demographic characteristics, namely religion, family structure, and economic status, associated with attitudes towards suicide among the Chinese Master’s degree students; meanwhile, all socio-demographic characteristics, including gender, religion, major subject, family structure, economic status, and received social support related to attitudes towards suicide among the Finnish Master’s degree students. However, after examining the interaction effect between socio-demographics and cultural backgrounds on attitudes towards suicide, the attitudes of Chinese students were more related to gender, marital status, family economic status, and received social support, whereas Finnish students were more influenced by religion. These findings suggest that culture plays an important role in shaping country-specific differences in attitudes towards suicide and their association with socio-demographic characteristics. Understanding individual attitudes towards suicide could help in intervention to prevent the development of suicidal ideation and in providing appropriate psychological counseling to reduce mental problems. Therefore, these cross-cultural differences may provide indications on how to conduct suicide prevention programs while considering culture-specific contexts.

BIOCARDS AND LEVEL OF ABSTRACTION

Biocards are formal descriptions of biological phenomena and their underlying functional principles. They are used in bioinspired design to document search results and to communicate the findings for use in the further design process. The present study explored the effect of abstraction level used in biocards. This was done in two workshops conducted with design students in Denmark and India. Students were given a design assignment and instructions for how to perform the BID ideation work. Half of the students were given biocards with abstract descriptions while the other half got biocards with concrete descriptions. The novelty of found solutions was evaluated by the students by rating novelty of each solution on a scale from 1 to 5. Mean values for abstract descriptions were 0,3 higher than for concrete descriptions indicating that more innovative solutions were found when students used biocards with abstract descriptions compared to concrete descriptions. The difference in mean value is significant with a confidence level better than 1%. It seems likely that more abstract descriptions in biocards helps avoiding design fixation in biomimetic design work.

O comportamento suicida e a religiosidade: revisão sistemática de literatura

O papel da religiosidade na determinação do comportamento suicida é controverso, havendo estudos que a consideram um fator protetor e outros um fator de risco. Neste estudo os autores conduziram uma revisão sistemática da literatura para avaliar a relação entre a religiosidade e o comportamento suicida. Dentre os 154 artigos publicados em periódicos científicos inicialmente identificados nas bases Medline, Lilacs, Scielo e PsycInfo, foram selecionados 59 artigos que enfocavam a associação entre religiosidade e comportamento suicida. Para a avaliação dos atributos qualitativos dos artigos foi desenvolvido um Roteiro de Avaliação Qualitativa. Os resultados mostram que grande parte dos artigos encontrados apresentava falta de rigor metodológico na mensuração do conceito de religiosidade, possivelmente devido à característica subjetiva desse constructo. Contudo, verificou-se que o papel protetor contra o comportamento suicida exercido pela religiosidade, sofre variações de acordo com a cultura na qual está inserida, considerando que para algumas culturas o comportamento suicida não é visto com total desaprovação. Porém, a maioria dos estudos reforça a hipótese de que a religiosidade diminui o risco de comportamento suicida nos indivíduos que professam algum tipo de credo e, que participam de algum espaço religioso. Não foram encontrados, nesta pesquisa, estudos que medissem a associação, entre religiosidade e comportamento suicida, em religiões de matriz africana.

中老年危机热线来电者的应激源与自杀危险性

Objective: Psychosocial crisis and psychiatric disorders are two stressors for suicide action. This study will explore the differences on demographic characteristics, severity of depression, and suicidality of middle-aged and elder crisis line callers under the influences of psychosocial crisis or psychiatric disorders or two simultaneously-mixed stressors, in order to develop effective intervention strategies for crisis line. Methods: Analysis data of 1,092 cases selected from national crisis line callers aged 45 and over who were assessed with “Suicide risk assessment” during the period from December, 2002 to December, 2008. The sample were divided into three groups of psychosocial crisis, mental health problems, and mixed-stressors of three types of general callers (48.2%, 32.3%, 19.5%), callers with current suicide ideation (43.7%, 33.0%, 23.3%) and callers attempted suicide 2 weeks prior to the call (33.6%, 42.3%, 24.1%) respectively according to the operators’ judgments of the callers’ claimed difficult situations and classification system of crisis line database. X2 test and Tukey-type and Multinomial Logistic Regression multiple comparison methods are applied to analysis the differences of the three groups. Results: In agreement with previous studies, more females (71.3%, X2=13.45, P<0.001), especially females influenced by relationship stressors (76.8%, X2=25.12, P<0.001) made the call for crisis. Among general callers, the check-out rates of Major Depression Episode of mixed-stressor callers (78.5%, P<0.001) and problem callers (68.7%, P<0.05) were significantly higher than that of crisis callers (57.1%). The check-out rates of suicide ideation of mixed-stressor callers (71.4%) were significantly higher than that in crisis callers (53.8%, P<0.001) and problem callers (60.9%, P<0.05). The check-out rates of prior suicide attempts of mixed-stressor (16.6%, P<0.05) and problem callers (18.5%, P<0.01) were significantly higher than that of crisis callers (9.8%). More than half of the mixed-stressor callers (51.8%) reported over 50% degree of hopelessness, which was significantly higher than that of crisis callers (35.6%, P<0.01) and problem callers (38.2%, P<0.05). Fewer crisis callers sought medical help than problem and mixed-stressor callers among three types of callers (X2=241.35, 146.56, 50.87; P<0.001). Compare to non-compound crisis callers, the proportion of minor, severe depression and prior depression diagnosis (14.0% vs. 17.4%; 54.9% vs. 65.2%; 0 vs. 2.2%; X2=14.35，P<0.01), suicide ideation (51.1% vs. 64.0%, P<0.05) and prior suicide attempts (8.4% vs. 15.0%, P<0.05) in compound crisis callers were significantly higher. There were more compound crisis callers with over 50% hopelessness (51.9% vs. 31.0%，X2=11.96，P<0.01). Conclusion: As predicted, among middle-aged and elderly participants, mixed-stressor and compound crisis callers were higher in degree of severity of depression and suicidality. Intervention strategies should be developed addressing to specific stressor or stressors. The promotions of crisis callers’ medical help seeking behavior need to be emphasized.

Design thinking - a critical analysis.

The latest buzz phrase to enter the world of design research is “Design Thinking”. But is this anything new and does it really have any practical or theoretical relevance to the design world? Many sceptics believe the term has more to do with business strategy and little to do with the complex process of designing products, services and systems. Moreover, many view the term as misleading and a cheap attempt to piggyback the world of business management onto design. This paper seeks to ask is design thinking anything new? Several authors have explicitly or implicitly articulated the term “Design Thinking” before, such as Peter Rowe’s seminal book “Design Thinking” [1] first published in 1987 and Herbert Simon’s “The Sciences of the Artificial” [2] first published in 1969. In Tim Brown’s “Change by Design” [3], design thinking is thought of as a system of three overlapping spaces rather than a sequence of orderly steps namely inspiration – the problem or opportunity that motivates the search for solutions; ideation – the process of generating, developing and testing ideas; and implementation – the path that leads from the design studio, lab and factory to the market. This paper seeks to examine and critically analyse the tenets of this new design thinking manifesto set against three case studies of modern design practice. As such, the paper will compare design thinking theory with the reality of design in practice.

Female frequent internet gamblers: a qualitative study of their gambling, its impact and their views on treatment and policy

Aims: to study the gambling history and stories of participants, motivations, impact and helpseeking. Method: Details were advertised on websites and newspapers. 30 frequent gamblers were interviewed over the telephone for approximately one hour. Verbatim transcriptions were analysed using NVIVO and grounded theory. Results/conclusions: Not all women had gambled before. However, internet accessibility meant prolonged periods were spent gambling to the neglect of other life areas. Some were originally motivated by excitement but others gambled to escape from current difficulties. Depression, anxiety, panic attacks and suicide ideation were common. The women were ambivalent towards their gambling and receiving help.