Journal of the Psychiatric Association of Thailand

Characteristics and Risk Factors of Non-Suicidal Self-Injury Behaviors in Children and Adolescents with Depression at Lamphun Hospital

Korpboon Pavakul — 2026-06-30

Objective: To study the characteristics and risk factors of non-suicidal self-injury behaviors in children and adolescents with depression at Lamphun Hospital, and to examine the differences in non-suicidal self-injury behaviors and risk factors between patients younger than 15 years and those aged 15 years and older.

Methods: A cross-sectional study was conducted among 80 patients aged 11 - 18 years diagnosed with depression according to DSM-5 criteria, with a history of at least one self-injury incident between January and December 2022. Data were collected using the Thai version of the Brief Non-Suicidal Self-Injury Assessment Tool (BNSSI-AT) and a risk factor questionnaire. Descriptive statistics, Fisher’s exact test, and t-test were used for analysis.

Results: Among 80 children and adolescents with depression who engaged in self-injury at Lamphun Hospital, the mean age was 14.9 years, with 88.7% being female. The mean age of first self-injury was 13.1 years. The average frequency of NSSI was 25 times per year. 56.3% used 5 or more different methods, and 87.3% used wrist cutting. 58.7% showed likelihood of repeated self-injury. The most common reasons for NSSI were to relieve stress and pressure and to manage uncomfortable feelings. Most patients were aware that they needed to fight against feelings of wanting to harm themselves and viewed self-injury as a life problem 53.8% perceived that self-injury affected their self-worth and self-esteem. Patients aged 15 years and older significantly viewed self-injury as affecting their clothing choices more than younger patients (p = 0.039), while patients younger than 15 years significantly viewed self-injury as less disruptive to their lives (p = 0.035). The most common risk factors for NSSI were bullying by peers and criticism by family members.

Conclusion: Among children and adolescents with depression at Lamphun Hospital, the most common method of self-harm was cutting the arms. The main reasons for self-harm were to relieve stress and emotional pressure. The most frequently reported risk factors were being bullied by peers and being criticized by family members. Factors that increased patients’ awareness included struggling with urges to self-harm and recognizing that self-harm negatively affects their self-worth and self-esteem.

The Association between Duration of Social Media Use and Quality of Sleep among Thai Adolescents with Attention-Deficit Hyperactivity Disorder at King Chulalongkorn Memorial Hospital

Naiyarat Bandasak — 2026-06-30

Objective: The objective of this study was to examine the prevalence of poor sleep quality in adolescent patients with Attention-Deficit/Hyperactivity Disorder (ADHD) and to investigate the relationship between the duration of social media usage and sleep quality among these patients who were receiving outpatient treatment at the child and adolescent psychiatry outpatient clinic, King Chulalongkorn Memorial Hospital.

Methods: This study was a cross-sectional study with a sample of 134 adolescent patients, aged 13 - 18 years, who were diagnosed with ADHD and receiving outpatient treatment at the child and adolescent psychiatry outpatient clinic, King Chulalongkorn Memorial Hospital. Data was collected using questionnaires. The participants completed self-report questionnaires on demographic data, social media usage, the social-media addiction screening scale (S-MASS), and the Pittsburgh sleep quality index (PSQI). Concurrently, their parents completed the Swanson, Nolan, and Pelham rating scale (SNAP-IV (short form)) to assess the adolescents’ ADHD symptoms. Statistical analysis was performed to evaluate the collected data. Descriptive statistics were used to describe the characteristics of the sample. Univariate analyses, including Pearson correlation, independent 1samples t-test, and one-way ANOVA, were conducted to examine the relationships between various factors. Finally, multiple logistic regression was performed to identify factors independently associated with poor sleep quality. A p-value of less than 0.05 was considered statistically significant.

Results: The study sample comprised 134 participants with a mean age of 14.5 ± 1.5 years. The majority of the sample were male (70.9%). Educational level was predominantly at the lower secondary school level, representing 93 individuals (69.9%). The most common body mass index (BMI) range was 18.5 - 22.9, which accounted for 32.8% of the sample. A high proportion of participants had no comorbid physical illness (82.1%) or psychiatric disorders (58.2%). The prevalence of poor sleep quality was 50.0%. The findings from the multiple logistic regression analysis revealed that: 1) a moderate to high risk of social media addiction was associated with an increased likelihood of poor sleep quality (adjusted OR = 2.98, p = 0.006) 2) spending more than 56 hours on social media in one month was strongly associated with poor sleep quality (adjusted OR = 5.64, p = 0.009) 3) a diagnosis of mood (affective) disorders (F30 - F39) was significantly associated with poor sleep quality (adjusted OR = 7.82, p = 0.008).

Conclusion: The duration of social media usage and the risk of high social media addiction were associated with poor sleep quality in adolescents with attention deficit hyperactivity disorder (ADHD). Increased social media usage time and higher risk of social media addiction contribute to worsening sleep quality.

Development of Positive Parenting Scale (POPS)

Punnapat Thanaariyapaisan — 2026-06-30

Objective: To develop and validate parent and child-reported versions of the Positive Parenting Scales (POPS) as effective tools for evaluating positive parenting skills.

Methods: Two versions of Positive Parenting Scales (POPS) were developed: a self-report version for parents (POPS-P) and a child-report version (POPS-C). Content validity index (CVI) was evaluated by the experts, construct validity was examined through factor analysis, and internal consistency was assessed using Cronbach’s alpha coefficient.

Results: Data were collected from a total of 2,634 parents of students from kindergarten to Grade 12 and 1,912 students from Grade 3 to Grade 12, enrolled in public and private schools in five provinces: Bangkok, Khon Kaen, Chiang Rai, Songkhla, and Ubon Ratchathani. The internal consistency of POPS-P and POPS-C were 0.87 and 0.86 respectively. The factor loadings for the parent and child versions ranged from 0.45 - 0.75 and 0.37 - 0.72, respectively. Content validity, as evaluated by four experts in child and adolescent psychiatry, psychologist, and linguist, showed that content validity index (CVI) scores above 0.87 for the self-report version and 0.75 for the child-report version.

Conclusion: Positive Parenting Scales (POPS), both parent and child-report versions, have good validity and reliability, it suitable for evaluating positive parenting skills.

Exploring Clinical Features of Early Onset Schizophrenia at Somdet Chaopraya Institute of Psychiatry

Chananya Suksawatt — 2026-06-30

Objective: Schizophrenia is a major psychiatric disorder that causes significant functional impairment. When onset occur in childhood or adolescence, it is considered a neurodevelopmental disorder and is associated with greater severity and poor prognosis. This study investigates the clinical features of schizophrenia in adolescents aged 14 to 18 years at the supra-tertiary psychiatric hospital in Bangkok and association between stable versus severe group and clinical variables.

Methods: In a descriptive retrospective study (N = 96), all patients aged 14 to 18 years who received the first diagnosis of schizophrenia at Somdet Chaopraya Psychiatric Institute between 2018 and 2023 were included in the study. Descriptive statistics were used to characterize the sample. Associations between clinical factors and illness severity were analyzed using chi-square or Fisher’s exact tests, and odds ratio (OR) were estimated using univariable logistic regression.

Results: The study included 96 participants who met the inclusion criteria. Among these, 75% were male, with a mean age diagnosis of 16.8 years. Comorbidities were present in 36.6% of the cases, with substance use disorder being the most prevalent. Among this cannabis users were the most frequently reported. Prior to the schizophrenia diagnosis, 54.2% of participants had been diagnosed with other mental health conditions, most frequently substance-induced psychosis. However, no statistically significant associations were observed between the study variables and illness severity (stable vs. severe groups).

Conclusion: Early onset schizophrenia was characterized by predominance of male patients with high rate of comorbid substance use. These findings highlight the importance of substance use prevention policy in Thailand. Behavioral changes were the most common prodromal manifestation, and this information may contribute to earlier detection of the disorder.

The Association between Caregivers’ Mental Health Literacy Levels and the Quality of Life of Psychiatric Patients

Kattaleeya Visessmith — 2026-06-30

Objective: In Thailand, mental health literacy has been emphasized in national policy to improve recognition, help-seeking behavior, and treatment adherence. However, evidence regarding mental health literacy among caregivers of psychiatric patients remains limited. Therefore, this study aimed to assess mental health literacy among caregivers of psychiatric patients, identify associated factors, and examine its association with patients’ quality of life.

Methods: A cross-sectional study was conducted at the psychiatric outpatient department of Phramongkutklao Hospital between January and June 2025. Thirty patient–caregiver dyads were enrolled. Eligible patients were adults aged 18 - 60 years receiving continuous psychiatric treatment for at least six months, and caregivers had provided care for at least six months. Data were collected using the Thai Mental Health Literacy Scale, the WHOQOL-BREF Thai version, the Barthel Activities of Daily Living Index and medical records. Descriptive statistics and logistic regression analyses were performed.

Results: Most caregivers demonstrated a high level of mental health literacy (73.3%). Higher caregiver mental health literacy was significantly associated with caring for patients diagnosed with depression (aOR = 15.84; 95% CI = 1.17 - 214.97; p = 0.038) and with the presence of hallucinations (aOR = 24.82; 95% CI = 1.12 - 551.65; p = 0.042). Most patients reported a moderate level of quality of life (66.7%). In multivariate analysis, the presence of multiple caregivers was the only independent factor associated with better quality of life (aOR = 21.13; 95% CI = 1.44 - 310.94; p = 0.026) No significant association was found between caregiver mental health literacy and patients’ quality of life.

Conclusion: Caregiver mental health literacy was associated with patients’ diagnostic characteristics but was not directly associated with patients’ quality of life. Social support, reflected by having multiple caregivers, appeared to play a more important role in influencing quality of life. Further studies with larger sample sizes are needed to confirm these findings.

Reliability and Validity of the Thai Version of the Work and Social Adjustment Scale in Non-Psychotic Psychiatric Outpatients

Sasipang Chamchuen — 2026-06-30

Objective: To develop and evaluate the reliability, validity, and sensitivity to change of the Thai version of the Work and Social Adjustment Scale (WSAS) in non-psychotic psychiatric outpatients.

Methods: This study used secondary data derived from 159 non-psychotic psychiatric outpatients (age 18 - 65 years) who visited the psychiatric outpatient clinics at Ramathibodi Hospital and Chakri Naruebodindra Medical Institute. The participants completed the WSAS, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and World Health Organization-5 Well-Being Index (WHO-5) at their first visit to the clinics and 6 - 8 weeks later. Internal consistency was assessed using Cronbach’s alpha. Construct validity was assessed using confirmatory factor analysis (CFA). Convergent validity was examined using Spearman’s rank correlations between WSAS and measures of depression (PHQ-9), anxiety (GAD-7), and well-being (WHO-5). Sensitivity to change was evaluated by comparing the changes in WSAS scores between treatment responders, defined as those with ≥50% reduction in PHQ-9 or GAD-7 scores, and non-responders, using the Mann–Whitney U test.

Results: The mean age (standard deviation, SD) of participants was 33.9 (12.8) years. Most were female (73.0%). The WSAS demonstrated excellent internal consistency (Cronbach’s α = 0.897). CFA revealed an excellent fit for a modified one-factor model, allowing correlated errors between Items 3 (social leisure activities) and 5 (close relationship) (χ² (4) = 2.12, p = .714, CFI = 1.000, TLI = 1.010, RMSEA = 0.000 [90% CI: 0.000, 0.089], SRMR = 0.010), and large standardized factor loadings of all 5 items (range: .709 - .838, all ps < .001). The total scores of WSAS were strongly positively correlated with depressive symptoms (PHQ-9: ρ = 0.717, p < .001) and anxiety symptoms (GAD-7: ρ = 0.662, p < .001), and moderately negatively correlated with well-being (WHO-5: ρ = -0.552, p < .001). Assessing sensitivity to changes showed that treatment responders showed greater reductions in WSAS scores from baseline compared with non-responders (p < .001).

Conclusion: The WSAS is a reliable, valid, and clinically sensitive measure of functional impairment in Thai non-psychotic psychiatric outpatients. Its strong psychometric properties and responsiveness to clinical change support its use in routine outcome monitoring and evaluation of treatment-related functional recovery in Thai mental health settings.

Prevalence of Severe Alcohol Withdrawal Syndrome and Its Associated Factors among Alcohol Withdrawal Syndrome Patients Receiving Psychiatric Consultation at The Emergency Department at King Chulalongkorn Memorial Hospital: A Descriptive Study

Thanawat Suharit — 2026-06-30

Objective: To determine the prevalence of severe alcohol withdrawal syndrome and identify factors associated with alcohol withdrawal in patients presenting to the emergency department of a tertiary hospital.

Methods: This retrospective descriptive study included 179 patients diagnosed with Alcohol Withdrawal Syndrome (AWS) at the Emergency Department, King Chulalongkorn Memorial Hospital. Severe AWS was defined by an AWS score >15, delirium tremens, withdrawal seizures, or physician diagnosis. Clinical history and laboratory data were analyzed using univariate analysis and multivariate analysis using Generalized Linear Model (GLM) with a Hierarchical approach to identify factors associated with severe alcohol withdrawal syndrome.

Results: The prevalence of severe AWS among patients receiving psychiatric consultation was 73.7% (n = 132 of 179). Multivariate analysis identified history of alcohol withdrawal seizures as the strongest factor associated with severe AWS (Adjusted Odds Ratio [AOR], 5.50; 95% CI, 1.75 - 24.76). Additionally, significantly inverse associations were identified for bicarbonate levels (AOR, 0.31 per 10 mmol/L increase; 95% CI, 0.13 - 0.69) and Platelets count (AOR, 0.58 per 100,000/μL increase; 95% CI, 0.38 - 0.87), indicating that lower levels of these markers were associated with severe AWS.

Conclusion: The prevalence of severe AWS in this cohort of patients receiving psychiatric consultation was high. History of alcohol withdrawal seizures, bicarbonate levels, and Platelets count were statistically significant factors associated with severe AWS. However, due to the retrospective cross-sectional design, these factors cannot be directly applied as predictors. Prospective studies are needed to confirm the direction of these associations and evaluate their predictive capability.

The Effect of Resilience on the Relationship between Personality and Burden in Caregivers of Patient with Behavioral and Psychological Symptoms of Dementia (BPSD)

Natthanan Chanduang — 2026-06-30

Objective: This study aimed to examine the association between mental resilience and the relationship between caregivers’ personality traits and caregiver burden among caregivers of patients with dementia, and to identify factors associated with caregiver burden.

Methods: A Cross-sectional descriptive study was conducted among 93 caregivers of patients with dementia. The instruments used included the Thai version of the International Personality Item Pool (IPIP) to assess personality traits, the Zarit Burden Interview to measure caregiver burden, and the 20-item Resilience Quotient (RQ) to assess mental resilience. Data were analyzed using descriptive statistics and multivariate analysis with multiple linear regression. Interaction analysis was conducted to examine the moderating role of resilience on the relationship between personality traits and caregiver burden. Linear marginal prediction was conducted to clarify the characteristics of the interaction.

Results: Among the 93 participants, caregiver burden was associated with neuroticism personality trait (ρ = .713, p < .001) and mental resilience (ρ = -.501, p < .001). Multivariate analysis revealed that neuroticism was positively associated with caregiver burden (b = 5.826, 95% CI 4.13, 7.52, p < .001), while the total resilience score (RQ) was negatively associated with caregiver burden (b = -4.447, 95% CI -6.19, -2.71, p < .001). Interaction analysis showed a significant interaction between neuroticism and resilience in predicting burden (interaction effect: b = 1.859, 95% CI 0.21, 3.51, p = .027). Specifically, among caregivers with low neuroticism, those with high resilience had lower predicted burden scores compared to those with low resilience.

Conclusion: A high level of resilience is associated with a lower likelihood of burden among caregivers with a low level of neuroticism, suggesting the role of resilience as a potential target for interventions aiming at preventing caregiver burden.

Association and Factors of Risperidone Induced Hyperprolactinemia

์Namfon Piyatrakul — 2026-06-30

Objective: The primary objective was to study the association between serum prolactin levels and risperidone as well as other factors and to study the association between serum prolactin levels and the clinical symptoms of hyperprolactinemia. The secondary objective was to study the outcomes of prolactin level management in patients receiving risperidone.

Methods: This retrospective analytical study collected data from the electronic medical records of patients receiving risperidone and measurement of prolactin level at Suanprung Psychiatric Hospital, Suansaranrom Hospital, and Prasrimahabhodi Psychiatric Hospital between January 1, 2021, and July 31, 2023. Data were analyzed using descriptive statistics, linear regression, and paired t-test.

Results: A total of 190 patients were included. Most were female (95.3%). The mean risperidone dosage was 2.92 ± 1.92 mg/day, and the mean serum prolactin level was 81.20 ± 57.48 ng/mL. Multivariable linear regression analysis showed that risperidone dosage was positively associated with serum prolactin levels with statistical significance (β = 9.03, 95% CI: 4.85 - 13.21, P < 0.001), as well as educational level at secondary to sub-bachelor education level (P = 0.023). In contrast, the body mass index was negatively associated with serum prolactin levels (P = 0.023). The most common clinical manifestations were menstrual irregularity (74.5%), galactorrhea (50.4%), and gynecomastia (42.3%). However, there was no statistically significant association between the severity of hyperprolactinemia and the clinical symptoms. Management strategies including drug discontinuation, medication switching, and dose reduction of risperidone significantly decreased serum prolactin levels (P < 0.001).

Conclusion: This study demonstrated that risperidone dosage was significantly associated with serum prolactin levels. However, no significant association was observed between prolactin levels and clinical manifestations of risperidone-induced hyperprolactinemia. Discontinuation, switching, or dose reduction of risperidone significantly decreased prolactin levels. These findings may serve as preliminary evidence to inform screening strategies and optimize management of risperidone-induced hyperprolactinemia in routine clinical practice.