Association of Grip Strength, Upper Arm Circumference, and Waist Circumference with Dementia in Older Adults of the WiSE Study: A Cross-Sectional Analysis

OBJECTIVE

We examined the associations of handgrip strength, upper arm circumference, and waist circumference with dementia among Singapore older adults.

DESIGN

Cross-sectional epidemiological study.

SETTING

Residential homes, day care centres, nursing homes and institutions.

PARTICIPANTS

2,565 men and women aged 60 years and above who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013.

MEASUREMENTS

Socio-demographic correlates, dietary habits, health behaviours, grip strength, upper arm circumference, and waist circumference were collected. Grip strength was measured using a hand dynamometer with the dominant hand. Upper arm circumference was measured using a measuring tape around the thickest part of the upper arm while waist circumference measured in centimetres was measured at the narrowest part of the body between the chest and hips for women, and measured at the level of the umbilicus for men. Dementia was diagnosed using the 10/66 dementia diagnostic criteria.

RESULTS

Mean grip strength was 13.07 kg (SE=0.60) for people with dementia and 21.98 kg (SE=0.26) for people without dementia. After adjusting for all factors, grip strength remained significantly associated with dementia (p <0.0001). Upper arm circumference was associated with dementia (p <0.0001) but this association was only significant in the univariate analysis. Waist circumference was not significantly associated with dementia.

CONCLUSIONS

Lower grip strength was independently associated with dementia in the older adult population in Singapore. Further research needs to be done to ascertain whether this association exists for specific types of dementia and look into the relationship of other anthropometric measurements with dementia in Singapore.

Retrospective observation of mental disorders during postpartum period: Results from the Singapore mental health study

Background

The perinatal period has been identified as a period of vulnerability for various disorders (particularly anxiety and depressive disorders), which have been associated with negative outcomes for both mother and infant. The current study utilized data from the Singapore Mental Health Study (SMHS) to examine the temporal relationship between mental disorders and the perinatal period, as well as associated risk factors.

Methods

Life table estimation method was used to derive the estimated hazard rate for any mood or anxiety disorders following pregnancy. Multivariate logistic regression was used to examine the association between socio-demographic factors and onset of mental disorders after the first pregnancy.

Results

Among women with children (n = 2278), 1.5 % were found to have an onset of any mental disorder (i.e., mood disorders, anxiety disorders, alcohol use disorders), within 2 years after pregnancy. A peak in hazard rate was noted at approximately 1 year following pregnancy for anxiety disorders but not mood disorders. Women who were married, employed and physically healthy were less likely to have had developed any mental disorder.

Conclusions

The prevalence of mental disorders during pregnancy and postpartum was found to be low among women with children in our community sample, with increased vulnerability following delivery. The results offer some insight into the occurrence of mental disorders during the perinatal period among women in Singapore.

Perspectives on Smoking Initiation and Maintenance: A Qualitative Exploration among Singapore Youth

Studies among adolescents have shown that several important interpersonal, intrapersonal and environmental factors are associated with smoking behaviour. The current qualitative research project aimed to explore the determinants of smoking initiation and maintenance, from a youth perspective, among young people who smoked, living in a multi-ethnic Asian country. Focus group discussions (FGDs) were conducted with youths in Singapore in youth-friendly and accessible locations. Young people, from a variety of social contexts-varying on age, gender, ethnicity and educational level, were included in the study. All FGDs were conducted in English and participants were recruited using a mix of network and purposive sampling. All FGDs were audio recorded and transcribed verbatim. The data were analyzed using qualitative content analysis, allowing themes to emerge from the data with the goal of answering the research question. Ninety-one youth smokers (54 males, 37 females), aged between 14 to 29 years, participated in the study. The majority were males (59%) and of Chinese ethnicity (52%). Participants identified multiple personal, social, and familial influences on young adults' smoking behaviors. Peer and family influences, as well as risk minimization, played a key role in smoking initiation and maintenance. While young people were aware of policies that restricted smoking, these did not directly affect their decision to start smoking. The theory of triadic influence provided a promising theoretical framework to understand smoking initiation and maintenance in a sample of young adult smokers from a multi-ethnic Asian country. It also provides actionable information for initiatives to prevent smoking in young people, which includes their perspectives and emphasizes an inclusive approach without stigmatizing those who smoke.

Patterns and Predictors of Dropout from Mental Health Treatment in an Asian Population

INTRODUCTION

Studies examining mental health treatment dropout have primarily focused on Western populations and less so on Asian samples. The current study explored the prevalence and correlates of mental health treatment dropout across the various healthcare sectors in Singapore.

MATERIALS AND METHODS

Data was utilised from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among an adult population (n = 6616) aged 18 years and above. Statistical analyses were done on a subsample of respondents (n = 55) who had sought treatment from the various treatment providers (i.e. mental health, medical, social services and religious healers) in the past 12 months. The World Mental Health (WMH) Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to determine diagnoses of mental disorders, chronic medical disorders and service utilisation.

RESULTS

Of those who had received treatment, 37.6% had ended treatment prematurely, 23.2% had completed treatment and 39.2% were still in treatment. The religious and spiritual sector (83.1%) had the highest dropout, followed by the general medical sector (34.6%), mental health services sector (33.9%) and the social services sector (30%). Marital status emerged as the only sociodemographic factor that significantly predicted treatment dropout-with those who were married being significantly less likely to drop out than those who were single.

CONCLUSION

The overall dropout rate across the various healthcare sectors was comparable to past studies. While the small sample size limits the generalisability of findings, the current study provides useful insight into treatment dropout in an Asian population.

Functioning and quality of life in hoarding: A systematic review

Hoarding, the acquisition and inability to let go of a large number of possessions, has been found to be associated with high levels of impairment that can compromise functioning and quality of life (QoL). Yet few studies have specifically investigated the relationship between hoarding and functioning/QoL. The present review aimed to summarize the current status of research on functioning and QoL in hoarding as well as identify knowledge gaps in the extant literature. We conducted systematic searches in ProQuest, PsycINFO, PubMed and ScienceDirect, and identified 37 relevant articles for inclusion. There was much evidence to indicate that hoarding has a significant impact on various aspects of functioning and that functioning can improve with treatment, though findings on the relationship between hoarding and QoL were more tenuous. The limitations of previous studies and implications of our findings are discussed.

Culture and age influences upon gambling and problem gambling

Objective

This study aimed to (i) examine the prevalence and types of gambling, (ii) establish prevalence of ‘pathological’ gambling, (iii) explore the correlates of gambling, and (iv) establish psychiatric and physical comorbidity in a sample of older adult gamblers (≥ 60 years) in contrast to younger gamblers in a representative population sample in Singapore.

Method

This paper reports the results of a secondary analysis of data from a representative community survey of 6616 participants, of which 2252 had engaged in gambling activities at least once in their lifetime.

Results

48.9% of older adults reported lifetime gambling. Older gamblers were more likely to be males, married or widowed (vs. never married), with pre-primary, primary and secondary education (vs. university), economically inactive (vs. employed) and had personal annual income of SGD $19,999 and below (vs. SGD $50,000 and above). Older gamblers had significantly higher rates of betting on horses, playing numbers or betting on lotteries, and playing Mahjong. After adjusting for demographic variables in multiple logistic regression analyses, gamblers aged 60 years and older had significantly lower odds of having pathological gambling than those in the younger age group (OR = 0.4). Older gamblers had significantly higher odds of having diabetes (OR = 3.2), hypertension (OR = 4.9), and any comorbid chronic physical condition assessed in this study.

Conclusions

For the majority of older adults, gambling remains a recreational activity that is entertaining and a way of socialization. However, one must remain cognizant of the possible risks for some to develop disordered gambling.

•

48.9% of older adults in Singapore reported lifetime gambling.

•

Older gamblers were more likely to be males, married or widowed, and had lower education.

•

Older gamblers had significantly lower odds of having pathological gambling.

Prevalence of Chronic Mental and Physical Disorders, Impact on Work Productivity and Correlates of Alcohol Use Disorders and Nicotine Dependence across Occupations

INTRODUCTION

This study assessed occupational differences in the prevalence of mental and physical disorders in an employed general population sample in Singapore and investigated the impact of these disorders on work productivity losses in terms of work-loss days and work-cutback days. The association of occupation with alcohol use disorders (AUD) and nicotine dependence (ND) was also investigated.

MATERIALS AND METHODS

Data from a population-based mental health survey of a representative sample of multi-ethnic residents aged 18 years and above were used. The World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI) was administered to establish the lifetime diagnosis of key mental disorders. Self-report on sociodemographic characteristics, productivity loss, ND, and lifetime physical conditions were obtained. Nine occupational groups were included in this analysis.

RESULTS

The sample comprised 4361 participants with a mean (SD) age of 42.2 (11.9) years, ranging between 19 to 80 years. 'Associate professionals and technicians' (26.2%), 'Services and sales workers' (17.7%) and 'Professionals' (15.4%) were the 3 predominant occupational categories. Sociodemographic characteristics differed significantly across occupations (P <0.001). The lifetime prevalences of having 'any mental disorder' and 'any physical disorder' were 13.0% and 37.9%, respectively; major depressive disorder was the most prevalent mental disorder (5.9%) and hypertension was the most common physical disorder (15.6%). There were no significant differences in work productivity loss across occupations. Sociodemographic and occupational correlates for AUD and ND were identified.

CONCLUSION

Sociodemographic and health disparities exist in the major occupational categories in Singapore. The strength of the associations between occupation and AUD and ND are significant, indicating the need for preventative measures in select occupations.

Prevalence and determinants of gambling disorder among older adults: a systematic review

AIMS

This paper aims to systematically review studies on the prevalence of gambling disorder among older adults aged 60years and above and to summarize the evidence on the determinants, risk factors as well as the comorbidities associated with it.

METHODS

A systematic search was conducted for peer-reviewed, journal articles between 1st January 1995 and 1st May 2013. Only original studies which were published in English, included participants older than 60years of age and provided prevalence figures specifically among them, and where participants were assessed to have a gambling disorder by a validated instrument in non-treatment seeking/non-clinical setting were included.

RESULTS

25 eligible studies were identified from the literature. The prevalence of lifetime gambling disorder ranged from 0.01% to 10.6% across studies. Prevalence of gambling disorder is higher among the younger age groups (of older adults) and among males as compared to females. Those with gambling disorder were more likely to be single or divorced/separated. Findings indicate that older adults may gamble more in an effort to ameliorate negative emotional states; they may have limited access to other exciting activities or they may be unable to participate in activities that they were previously able to and they might attempt to fill this gap with gambling.

CONCLUSIONS

Gambling disorder among older adults is a significant problem. Fixed incomes and limited prospects of future earnings make them an extremely vulnerable group. There is an urgent need to understand the phenomenon of gambling disorder in older adults.

Refining the latent structure of neuropsychological performance in schizophrenia

BACKGROUND

Elucidating the cognitive architecture of schizophrenia promises to advance understanding of the clinical and biological substrates of the illness. Traditional cross-sectional neuropsychological approaches differentiate impaired from normal cognitive abilities but are limited in their ability to determine latent substructure. The current study examined the latent architecture of abnormal cognition in schizophrenia via a systematic approach.

METHOD

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were carried out on a large neuropsychological dataset including the Brief Assessment of Cognition in Schizophrenia, Continuous Performance Test, Wisconsin Card Sorting Test, Benton Judgment of Line Orientation Test, and Wechsler Abbreviated Scale of Intelligence matrix reasoning derived from 1012 English-speaking ethnic Chinese healthy controls and 707 schizophrenia cases recruited from in- and out-patient clinics.

RESULTS

An initial six-factor model fit cognitive data in healthy and schizophrenia subjects. Further modeling, which accounted for methodological variance between tests, resulted in a three-factor model of executive functioning, vigilance/speed of processing and memory that appeared to best discriminate schizophrenia cases from controls. Factor analytic-derived g estimands and conventionally calculated g showed similar case-control discrimination. However, agreement analysis suggested systematic differences between both g indices.

CONCLUSIONS

Factor structures derived in the current study were broadly similar to those reported previously. However, factor structures between schizophrenia subjects and healthy controls were different. Roles of factor analytic-derived g estimands and conventional composite score g were further discussed. Cognitive structures underlying cognitive deficits in schizophrenia may prove useful for interrogating biological substrates and enriching effect sizes for subsequent work.

Hoarding in an Asian Population: Prevalence, Correlates, Disability and Quality of Life

Introduction: Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value. The objectives of the study were to establish the prevalence of hoarding behaviour among the general population and among individuals with obsessive-compulsive disorder (OCD) in a cross-sectional study conducted in Singapore. Materials and Methods: The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older, living in households. The diagnoses of mental disorders were established using Version 3.0 of Composite International Diagnostic Interview (CIDI 3.0). Differences between 3 groups i.e. those diagnosed with lifetime/12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) OCD with hoarding, those diagnosed with lifetime/12-month DSM-IV OCD without hoarding and those with lifetime hoarding behaviour without diagnosis of DSM-IV OCD were determined. Results: The weighted prevalence of lifetime hoarding behaviour was 2% and that of hoarding among those with OCD was 22.6%. Those who met the criteria for hoarding behaviour alone were associated with lower odds of having obsessions of contamination, harming, ordering as well as compulsions of ordering and other compulsions than those who met criteria for both OCD and hoarding. Conclusion: Hoarders without OCD were less impaired, in terms of comorbid psychopathology, than those with OCD with and without hoarding, and had a higher quality of life versus those with both OCD and hoarding, though still lower than that of the general population. Keywords: Obsessive-compulsive disorder, Singapore, Survey

Population norms for the EQ-5D index scores using Singapore preference weights

PURPOSE

To provide norms for the EQ-5D index scores based on Singapore preference weights according to age, sex, ethnicity, and language version and compare the EQ-5D index scores for respondents with and without psychiatric disorders and chronic medical conditions.

METHODS

The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of the resident (citizens and permanent residents) population in Singapore. The diagnoses of psychiatric disorders were established using the World Mental Health Composite International Diagnostic Interview version 3.0 (CIDI 3.0). Index scores were derived using the Singapore preference weights.

RESULTS

In general, the mean EQ-5D index score using Singapore preference weights decreased with increased age. The EQ-5D Malay version reported lower mean EQ-5D index than the English version. In multivariate analysis, the mean EQ-5D index for respondents with MDD, dysthymia, bipolar disorder, GAD, OCD, diabetes, hypertension, arthritis or rheumatism, neurological condition, stroke or major paralysis, heart attack, back problems, stomach ulcer, kidney failure, migraine headaches, and chronic lung disease was significantly lower than those without these conditions.

CONCLUSIONS

These findings support the use of the Singapore preference weights for EQ-5D valuations when measuring health-related quality of life and comparing the health burden of psychiatric and chronic physical conditions among adults in Singapore.

Hoarding in an Asian population: prevalence, correlates, disability and quality of life

INTRODUCTION

Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value. The objectives of the study were to establish the prevalence of hoarding behaviour among the general population and among individuals with obsessive-compulsive disorder (OCD) in a cross-sectional study conducted in Singapore.

MATERIALS AND METHODS

The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older, living in households. The diagnoses of mental disorders were established using Version 3.0 of Composite International Diagnostic Interview (CIDI 3.0). Differences between 3 groups i.e. those diagnosed with lifetime/12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) OCD with hoarding, those diagnosed with lifetime/12-month DSM-IV OCD without hoarding and those with lifetime hoarding behaviour without diagnosis of DSM-IV OCD were determined.

RESULTS

The weighted prevalence of lifetime hoarding behaviour was 2% and that of hoarding among those with OCD was 22.6%. Those who met the criteria for hoarding behaviour alone were associated with lower odds of having obsessions of contamination, harming, ordering as well as compulsions of ordering and other compulsions than those who met criteria for both OCD and hoarding.

CONCLUSION

Hoarders without OCD were less impaired, in terms of comorbid psychopathology, than those with OCD with and without hoarding, and had a higher quality of life versus those with both OCD and hoarding, though still lower than that of the general population.

Proof-of-concept randomized controlled trial of pregnenolone in schizophrenia

RATIONALE

Preclinical and clinical data suggest that pregnenolone may be a promising therapeutic in schizophrenia. Pregnenolone is neuroprotective and enhances learning and memory, myelination, and microtubule polymerization. Treatment with pregnenolone elevates allopregnanolone (a neurosteroid that enhances GABAA receptor responses) and pregnenolone sulfate (a positive NMDA receptor modulator). Pregnenolone could thus potentially mitigate GABA dysregulation and/or NMDA receptor hypofunction in schizophrenia via metabolism to other neurosteroids.

OBJECTIVE

The objective of this study is to conduct a randomized controlled trial of adjunctive pregnenolone in schizophrenia.

METHODS

Following a placebo lead-in, 120 participants were randomized to pregnenolone or placebo for 8 weeks (Institute for Mental Health, Singapore). Primary endpoints were changes in MATRICS Consensus Cognitive Battery (MCCB) composite scores (cognitive symptoms), UCSD Performance-based Skills Assessment-Brief (UPSA-B) composite scores (functional capacity), and Scale for Assessment of Negative Symptoms (SANS) total scores (negative symptoms). A modified intent-to-treat analysis approach was utilized.

RESULTS

No significant changes compared to placebo were demonstrated in composite MCCB scores. In contrast, participants randomized to pregnenolone (n = 56) demonstrated greater improvements in functional capacity (UPSA-B composite changes) compared to placebo (n = 55), p = 0.03. Pregnenolone was also superior to placebo in the communication subscale of the UPSA-B (p < 0.001). Serum pregnenolone changes post-treatment were correlated with UPSA-B composite score changes in females (r s = 0.497, p < 0.042, n = 17) but not in males. Mean total SANS scores were very low at baseline and did not improve further post-treatment. Pregnenolone was well-tolerated.

CONCLUSIONS

Pregnenolone improved functional capacity in participants with schizophrenia, but did not improve cognitive symptoms over an 8-week treatment period. Neurosteroid changes correlated with functional improvements in female participants. Neurosteroid interventions may exhibit promise as new therapeutic leads for schizophrenia.

Suicidal Ideation, Suicidal Plan and Suicidal Attempts Among Those with Major Depressive Disorder

Introduction: The aims of the study were to identify the prevalence and sociodemographic and clinical correlates of suicidal behaviours using data from a cross-sectional survey among those with major depressive disorder (MDD) in Singapore. Materials and Methods: The Singapore Mental Health Study (SMHS) was a cross-sectional epidemiological study that surveyed Singapore residents (Singapore citizens and permanent residents) aged 18 years and above. The assessment of mental disorders was established using version 3.0 of the Composite International Diagnostic Interview (CIDI 3.0). For the purposes of this study, suicidal behaviour was assessed by questions which were asked to respondents who answered positively to the screening questions in the CIDI 3.0 “Depression” module. Results: The prevalence of suicidal ideation, plan and attempt among those with lifetime MDD was 43.6%, 13.7% and 12.3%, respectively. We found that suicidal ideation, plan and attempt were significantly associated with ethnicity, education and income. The rate of those who had sought some professional help was higher among those with suicidal plan (71.7%) and attempt (72.3%) as compared to those with suicidal ideation (48.7%) and those with MDD but no suicidal behaviour (29%). Conclusion: Individuals with MDD and suicidal behaviour do differ from their non-suicidal counterparts as they have a different sociodemographic and clinical profile. There is a need for more research and a better understanding of this population which in turn could lead to the development and implementation of relevant interventions. Key words: Composite International Diagnostic Interview, Depression, Prevalence, Singapore Mental Health Study, Suicidal behaviour

Suicidal ideation, suicidal plan and suicidal attempts among those with major depressive disorder

INTRODUCTION

The aims of the study were to identify the prevalence and sociodemographic and clinical correlates of suicidal behaviours using data from a cross-sectional survey among those with major depressive disorder (MDD) in Singapore.

MATERIALS AND METHODS

The Singapore Mental Health Study (SMHS) was a cross-sectional epidemiological study that surveyed Singapore residents (Singapore citizens and permanent residents) aged 18 years and above. The assessment of mental disorders was established using version 3.0 of the Composite International Diagnostic Interview (CIDI 3.0). For the purposes of this study, suicidal behaviour was assessed by questions which were asked to respondents who answered positively to the screening questions in the CIDI 3.0 "Depression" module.

RESULTS

The prevalence of suicidal ideation, plan and attempt among those with lifetime MDD was 43.6%, 13.7% and 12.3%, respectively. We found that suicidal ideation, plan and attempt were significantly associated with ethnicity, education and income. The rate of those who had sought some professional help was higher among those with suicidal plan (71.7%) and attempt (72.3%) as compared to those with suicidal ideation (48.7%) and those with MDD but no suicidal behaviour (29%).

CONCLUSION

Individuals with MDD and suicidal behaviour do differ from their non-suicidal counterparts as they have a different sociodemographic and clinical profile. There is a need for more research and a better understanding of this population which in turn could lead to the development and implementation of relevant interventions.

Single Mothers Have a Higher Risk of Mood Disorders

Introduction: Previous research has shown single mothers to be at greater risk for both physical and mental health disorders as compared to married mothers. Psychiatric disorders, in particular depression, have been shown to be more prevalent in single mothers than married mothers. This study was aimed at comparing the prevalence of depression, other mood, and anxiety disorders in single and married mothers in a multiethnic Asian society. Materials and Methods: The Singapore Mental Health Study (SMHS) was a cross-sectional survey of the representative population of Singapore. The survey targeted Singapore residents aged 18 years and above. Trained interviewers established the diagnoses of mental disorders using the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). Physical illnesses, social support and sociodemographic correlates were established using structured interviews. For the purpose of this study, single mothers were defined as unmarried, divorced/separated/widowed mothers who had children aged 21 years and below. Results: Face-to-face interviews were completed with 6616 respondents from December 2009 to December 2010. After controlling for sociodemographic correlates in multiple logistic regression model, single mothers had significantly higher odds of having mood disorders (OR = 5.28) as compared to married mothers. Conclusion: Our study found that single mothers in Singapore across ethnicities, experienced a higher risk for mood disorders as elsewhere in the world. Single motherhood was also associated with lower age and education. Our study identifies young, single mothers as a vulnerable group associated with mental illnesses that must be targeted with specific interventions to improve mental health and well-being. Key words: Anxiety disorder, Major depressive disorder, Single mother, Social support

Single mothers have a higher risk of mood disorders

INTRODUCTION

Previous research has shown single mothers to be at greater risk for both physical and mental health disorders as compared to married mothers. Psychiatric disorders, in particular depression, have been shown to be more prevalent in single mothers than married mothers. This study was aimed at comparing the prevalence of depression, other mood, and anxiety disorders in single and married mothers in a multiethnic Asian society.

MATERIALS AND METHODS

The Singapore Mental Health Study (SMHS) was a cross-sectional survey of the representative population of Singapore. The survey targeted Singapore residents aged 18 years and above. Trained interviewers established the diagnoses of mental disorders using the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). Physical illnesses, social support and sociodemographic correlates were established using structured interviews. For the purpose of this study, single mothers were defined as unmarried, divorced/separated/widowed mothers who had children aged 21 years and below.

RESULTS

Face-to-face interviews were completed with 6616 respondents from December 2009 to December 2010. After controlling for sociodemographic correlates in multiple logistic regression model, single mothers had significantly higher odds of having mood disorders (OR = 5.28) as compared to married mothers.

CONCLUSION

Our study found that single mothers in Singapore across ethnicities, experienced a higher risk for mood disorders as elsewhere in the world. Single motherhood was also associated with lower age and education. Our study identifies young, single mothers as a vulnerable group associated with mental illnesses that must be targeted with specific interventions to improve mental health and well-being.

Latent structure of psychosis in the general population: results from the Singapore mental health study

BACKGROUND

Few studies have examined the latent construct of psychotic symptoms or distinguished between the latent construct and its manifest indicators. The current study aimed to investigate the latent structure of psychotic symptoms using factor mixture modeling (FMM) and to use the best-fitting model to examine its sociodemographic and clinical correlates.

METHOD

The Singapore Mental Health Study (SMHS) was based on an adult representative sample of the Singapore population. Psychotic symptoms were assessed by using the Psychosis Screen section of the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). FMM analyses were applied to determine the latent construct of psychotic symptoms. Sociodemographic and clinical correlates of the latent structure of psychosis symptoms were examined using multiple linear and logistic regression analyses.

RESULTS

The overall weighted lifetime prevalence of any psychotic experience was 3.8% in the SMHS after excluding subthreshold experiences. The FMM analysis clearly supported the dimensional model of the latent structure of psychotic symptoms. On deriving the total score for 'psychosis symptoms' in accordance with the one latent trait model, and correlating it with sociodemographic factors, we found that female gender, vocational education, current and past smokers were positively associated with the 'psychosis' total score.

CONCLUSIONS

There is a need for an increased understanding of, and research into, this intermediate state of 'psychosis symptoms' that do not meet diagnostic criteria for psychosis. It is also important to learn more about the group of individuals in the community who may have preserved functioning to elucidate the protective factors that prevent transition to psychosis.

Peptic ulcer disease and mental illnesses

OBJECTIVE

We evaluated the association between self-reported doctor-diagnosed peptic ulcer disease (PUD) and mental disorders in a representative cross-sectional study conducted in 2010 in Singapore.

METHOD

The sample comprised 6616 community-dwelling individuals. Participants were asked about a previous history of doctor-diagnosed PUD. Assessment of mental disorders was performed using the World Mental Health Composite International Diagnostic Interview version 3.0. Quality of life was assessed using the EuroQoL 5D.

RESULTS

The weighted prevalence of PUD was 1.58% (95% CI=1.13-2.02). In adjusted analyses, PUD was more common among people with anxiety disorders [obsessive compulsive disorders (OR 4.22, 95% CI 1.59-11.21), Generalized Anxiety Disorders (OR 9.25, 95% CI 2.43-35.17), any anxiety disorders (OR 4.41, 95% CI 1.82-10.61)] and with any mood disorders (OR 2.66, 95% CI 1.08-6.53). PUD was associated with alcohol abuse and alcohol dependence, but not with smoking or nicotine dependence. Adjustment for nicotine and alcohol use attenuated the association of mood disorders with PUD, but not that of anxiety disorders. PUD was associated with reduced quality of life as measured on EuroQoL 5D, with further reduction in those with concomitant mental disorders.

CONCLUSION

PUD was associated with anxiety disorders, and this association is not attenuated with adjustment for nicotine dependence or alcohol use disorder.

Development, validity and reliability of the short multidimensional positive mental health instrument

PURPOSE

The 47-item positive mental health (PMH) instrument measures the level of PMH in multiethnic adult Asian populations. This study aimed to (1) develop a short PMH instrument and (2) establish its validity and reliability among the adult Singapore population.

METHODS

Two separate studies were conducted among adult community-dwelling Singapore residents of Chinese, Malay or Indian ethnicity where participants completed self-administered questionnaires. In the first study, secondary data analysis was conducted using confirmatory factor analysis (CFA) to shorten the PMH instrument. In the second study, the newly developed short PMH instrument and other scales were administered to 201 residents to establish its factor structure, validity and reliability.

RESULTS

A 20-item short PMH instrument fulfilling a higher-order six-factor structure was developed following secondary analysis. The mean age of the participants in the second study was 41 years and about 53% were women. One item with poor factor loading was further removed to generate a 19-item version of the PMH instrument. CFA demonstrated a first-order six-factor model of the short PMH instrument. The PMH-19 instrument and its subscales fulfilled criterion validity hypotheses. Internal consistency and test-retest reliability of the PMH-19 instrument were high (Cronbach's α coefficient = 0.87; intraclass correlation coefficient = 0.93, respectively).

CONCLUSIONS

The 19-item PMH instrument is multidimensional, valid and reliable, and most importantly, with its reduced administration time, the short PMH instrument can be used to measure and evaluate PMH in Asian communities.

The Longitudinal Youth at Risk Study (LYRIKS)--an Asian UHR perspective

Numerous studies have been published on the psychosis prodrome and have explored a wide array of its many aspects. However, the set of risk factors identified by these various efforts is not homogenous across studies. This could be due to unique population factors or relatively small sample sizes. Only few studies were conducted on Asian populations, whose socio-cultural characteristics differ - in some cases remarkably - from those in western populations. Singapore is a highly dense city-state in South-east Asia, with low rates of substance abuse. The Longitudinal Youth at Risk Study (LYRIKS) commenced in Singapore in 2008, designed to comprehensively assess a group of ultra high risk (UHR) individuals and identify clinical, social, neuropsychological and biological risk factors unique to the local population. 173 UHR individuals were recruited from this single-site study over 4 years. Here, we detail aspects of the study methodology and report on the baseline social and clinical characteristics of the sample population. 78% of the UHR sample suffered from a psychiatric disorder, with Major Depressive Disorder present in more than half of the sample. The mean Global Assessment of Functioning (GAF) score was 57.4, which indicated a moderate level of impairment. Although the recruited sample did not differ significantly by social and clinical characteristics when compared to previously published reports, the conversion rate to psychosis was 3.5% (n=6) at 6 months. Follow-up measures are currently underway to assess longitudinal incidence of psychosis and impact of risk factors on cognition, functioning and remission.