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Introduction The nine‐item Patient Health Questionnaire (PHQ‐9) is widely used to determine the severity of depression in adult populations, but its psychometric properties with regard to adolescents has been poorly explored. The present study aims to identify the factor structure and examine the measurement invariance of this instrument across genders and age groups in a Chinese adolescent sample. Methods A large sample of Chinese schoolchildren completed the PHQ‐9 in a cross‐sectional survey in Hong Kong (N = 10 933). A confirmatory factor analysis (CFA) to test the factor structure and a multiple group CFA to test the gender and age invariances of the PHQ‐9 in adolescents were conducted. Cronbach alpha was used to assess the reliability of the questionnaire, and Pearson correlations with anxiety, self‐esteem, and perceived control were used to assess its construct validity. Results The CFA results indicate that a one‐factor model with three pairs of item correlations fitted the PHQ‐9 data well, and measurement invariances by age and gender were supported. The PHQ‐9 also possesses adequate internal consistency (>.84) and is strongly correlated with anxiety (>.77), self‐esteem (<−.57), and perceived control (<−.56) in the expected directions in the overall sample and in the gender and age subsamples. Discussion The results support the claim that the PHQ‐9 is a reliable and valid scale and can be used to assess and compare depressive severity across ages and genders during the period of adolescence.

IntroductionAttendance at emergency departments and unplanned hospital readmissions are common for frail older patients after discharge from hospitals. A virtual ward service was piloted to deliver “hospital-at-home” services by community nurses and geriatricians to frail older patients immediately after their discharge from hospital to reduce emergency services utilization.ObjectivesThis study examined the impacts of the virtual ward service on changes in the patients’ emergency attendance and medical readmissions, and their quality of life (QOL).MethodsA matched-control quasi-experimental study was conducted at four hospitals, with three providing the virtual ward service (intervention) and one providing the usual community nursing care (control). Subjects in the intervention group were those who are at high risk of readmission and who are supported by home carers recruited from the three hospitals providing the virtual ward service. Matched control patients were those recruited from the hospital providing usual care. Outcome measures include emergency attendance and medical readmission in the past 90 days as identified from medical records, and patient-reported QOL as measured by the modified Quality-of-Life Concerns in the End of Life Questionnaire (Chinese version). Wilcoxon signed-rank tests compared the changes in the outcome variables between groups.ResultsA total of 39 patients in each of the two groups were recruited. The virtual ward group showed a greater significant reduction in the number of unplanned emergency hospital readmissions (−1.41±1.23 versus −0.77±1.31; P=0.049) and a significant improvement in their overall QOL (n=18; 0.60±0.56 versus 0.07±0.56; P=0.02), but there was no significant difference in the number of emergency attendances (−1.51±1.25 versus −1.08±1.48; P=0.29).ConclusionThe study results support the effectiveness of the virtual ward service in reducing unplanned emergency medical readmissions and in improving the QOL in frail older patients after discharge.

Internal tension, as experienced by participants reflects the challenges of transition from acute to palliation and end-of-life care, made more complex in CCI, because of its poorly defined terminal stage. Nurses' ability to manage the complex process of supporting hope while gradually providing information to build family understanding of CCI highlights their central role in facilitating what and how prognostic information is given, while managing the emotional implications and family response. To better support nurses do this, we advocate for formal structures enabling nurses to participate in decision-making regarding timing of transitions using palliation and end-of-life care.