2.3 Evaluations
Datasets concerning socio-demographic parameters, such as gender, age, marital status, educational and employment details were evaluated through a questionnaire developed by two psychiatrists having a minimum of three years’ clinical and research background.
UHR individuals were enrolled using SIPS(McGlashan, Walsh, & Woods, 2010). SIPS contains five components: Scale of Prodromal Symptoms (SOPS), Presence of psychosis scale (POPS), COPS, Global assessment for functioning of a modified scale (GAF-M), and the schizotypal personality disorder diagnostic criteria. Among them, SOPS assesses the type and severity of at-risk symptoms. The SOPS contains 19 entries and consists of four subscales: positive symptoms (5 bars), negative symptoms (6 bars), disintegration symptoms (4 bars), and general symptoms (4 bars). A diagnosis of psychiatric risk syndrome was made, which was mainly adjudicated according to the positive symptom scale (P1: unusual thought content/delusions; P2: doubtful/harmful ideas; P3: exaggerated thoughts; P4: perceptual abnormalities/hallucinations; P5: disordered speech) scores in SOPS. The criteria of judgment were graded on a scale of 0 to 6, with 0: none, 1 to 5 representing that the positive symptoms were non psychotic, and 6 indicating that the positive symptoms reached the level of psychotic. The SIPS/SOPS scale has good reliability and can be widely used in clinical setting (Woods, Walsh, Powers, & McGlashan, 2019).
Symptomatology was evaluated through Chinese version of positive and negative syndrome scale (PANSS)(Kay, Opler, & Lindenmayer, 1988). The primary aim of the PANSS was to rank abundance in psychiatric symptom manifestation/s together with individual symptom severity, consisting in 30 items, which are scored on a 1-7 scale segregated across three sub-scales: positive (7 items), negative (7 items), together with a scale for general psychopathology (16 items). A higher score reflects more severe symptoms.
Depressive symptoms were defined through the Chinese version for Montgomery-Åsberg Depression Rating Scale (MADRS) (Liu et al., 2009; Montgomery & Asberg, 1979). This scale had 10 items, with individual items graded (0-6). A total score of 12 is used as a cut-off, with a score greater than or equal to 12 indicating depressive symptoms. Raised scorings reflected increased severity of depressive symptoms.
Overall function was evaluated through global assessment for functioning scale (GAF)(Hall, 1995). This scale is based on the assessment tool of Axis II in DSM-III-R, which mainly rates three dimensions of social function, psychological symptoms, and occupational/learning function. The total score is divided into nine grades, ranging from 1-100 points, with higher scores indicating better function.
Coping styles have been extensively studied in the 1970s, but have resulted in a diversity of choice of coping style assessment tools due to differences in research perspectives. Internationally, there is no uniform regulation of coping styles, so there are also a variety of assessment tools. Coping Style Questionnaire (CSQ), commonly used in China, was employed for this investigation. CSQ was developed by Xiao and Xu in 1996 referring to theories and questionnaires used in studies on coping and defense in other countries (Xiao and Xu, 1996). The tool has 62 entries, each with two responses with 1 “yes” and 2 “no”. It consists of 6 subscales, which are problem-solving, self-blame, help seeking, fantasy, repression, and rationalization. Problem-solving as well as help seeking were positive coping styles, whereas self-blame, fantasy together with repression were the negative coping styles, rationalized to be the mixed type of coping styles. This questionnaire has satisfactory robustness and relevance and is widely used in China with regard to the evaluation of coping styles.
Self-esteem was performed through self-esteem scale by Rosenberg (Rosenberg, 1978), which was translated into a Chinese version in 1993 and has been tested for extensive validity . The scale contains 10 items across a 4-point Likert scale (1=very strongly disagreement, 4=very strongly agreement). Total scores reflect overall individual self-esteem, increased scorings reflected increased self-esteem.