The Effects of Mindfulness-based Stress Reduction Program on Depressive Symptoms Reduction among Family Caregivers in Hong Kong.

摘要

Introduction: Mindfulness-based stress reduction (MBSR) program has been receiving increasing attention in recent years. However, no questionnaires were validated to measure "mindfulness" in Hong Kong Chinese adults. In addition, few studies have been conducted to examine the effectiveness of MBSR on mental wellbeing of family caregivers.;Subjects and Methods: In the first part of the thesis, 230 community adults and 156 patients with clinical diagnosis of generalized anxiety disorder (GAD) were recruited. Both test-retest and internal consistency reliability were used to examine the reliability of FFMQ-C, while confirmatory factor analyses (CFA) were used to examine the structure validity of FFMQ-C.;In the second part of the thesis, 141 caregivers, who met the inclusion/exclusion criteria, were randomly assigned to either the 8-week MBSR group or the control group (self-learning booklets on mental health and stress management). The Center for Epidemiologic Studies Depression Scale (CESD) was used to measure the depressive symptoms as the primary outcome. A score of CESD above 16 was used to identify the clinically significant depression and a 50% or more reduction in CESD was regarded as clinical improvement. The secondary outcomes included anxiety, self-efficacy, mindfulness and quality of life and so on. All the outcome measures were self-administrated at baseline, post-intervention and 3-month follow-up. Intention-to-treat analyses were used to test the group effects of MBSR on outcome measures.;Results: The test-retest reliability of FFMQ-C was 0.88, and Cronbach's alpha was 0.83 in the community sample and 0.80 in the GAD sample. CFA showed adequate model fit for correlated five-factor structure (NNFI 0.94, CFI 0.95, RMSEA 0.076 (0.063-0.086)). A 20-item FFMQ-SF was developed and showed sufficient reliability, validity and psychometric property.;Objectives: The first part of this thesis aimed to validate the Chinese version of Five Facet Mindfulness Questionnaire (FFMQ-C) in Hong Kong and to develop a short form scale (FFMQ-SF). The second part of the thesis aimed to evaluate the effectiveness of MBSR in reducing depressive symptoms among family caregivers in Hong Kong Chinese adults.;In the second part of the thesis, the MBSR group (n=70) showed significantly lower attrition rate than the control group (n=71) (12.9% vs 26.8%, p= .039). Participants in the MBSR group reported significantly greater reduction in CESD compared to the controls immediately post-intervention (-6.72 +/- 6.38 vs -2.85 +/- 4.82, p= .001) and at 3 months post-intervention (-4.70 +/- 6.32 vs -1.39 +/- 8.52, p=.001). MBSR group had a significantly larger proportion of participants with clinical improvement than the control group immediately post-intervention (35.3% vs 4.7%, OR (2.29, 54.51)) and at 3 months post-intervention (23.5% vs 7.0%, OR (1.00, 16.90)). Significant group effects of MBSR were also shown on the reduction of anxiety symptoms, the improvement in self-efficacy, and the increase in mindfulness.;Conclusions: The FFMQ-C and FFMQ-SF are reliable and valid instruments to measure mindfulness in Hong Kong Chinese adults.;MBSR is a feasible and acceptable program to effectively reduce psychological symptoms, and to improve mindfulness and self-efficacy among adult caregivers in Hong Kong Chinese.