Resilience and associative stigma among mental health professionals in a tertiary psychiatric hospital: a cross-sectional study in Singapore

OBJECTIVES

The mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to 'bounce back' from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma.

DESIGN

Observational study-cross-sectional design.

SETTING

Tertiary psychiatry hospital in Singapore.

PARTICIPANTS

The study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital.

MEASURES

Resilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness.

RESULTS

Mean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores.

CONCLUSION

The present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential.

N-Methyl-D-Aspartate(NMDA) Receptor and Voltage-Gated Potassium Channel (VGKC) Antibody-Associated Encephalitides Presenting as First Episode Acute Psychosis

Aim: Acute psychosis is not an uncommon presenting feature in immune-mediated encephalitides. Most patients improve if properly diagnosed and treated expediently with immunotherapy. Our study aimed to describe the frequency, clinical spectrum, and long-term outcomes in patients presenting with acute psychosis who have anti-N-methyl-D-aspartate (NMDA) receptor or anti-voltage-gated potassium channel (VGKC) encephalitis. Method: We recruited patients aged 16-50 years presenting with less than 1 month of psychotic and neurological symptoms including cognitive dysfunction, seizures, abnormal movements, and/or autonomic dysfunction. Results: Between September 2011 and October 2013, 60 patients with first episode acute psychosis were screened; 15 were recruited and included for analyses. Four (26.7%) patients were diagnosed with anti-NMDA receptor encephalitis and 1 (6.7%) with anti-VGKC encephalitis. We found that the mean serum white blood cell (WBC) count (12.8 × 109/L ± 4.8 vs. 7.9 × 109/L ± 2.6; p = 0.05) and cerebrospinal fluid WBC count (106 cells/µl ± 101 vs. 8.5 cells/µl ± 18.9; p = 0.05) were higher in positive cases. Certain prodromal features such as fever, headache, confusion, facial dyskinesia, and hypersalivation were also more likely to be present in positive cases. Patients with autoimmune encephalitis also tended to be more unwell, with the majority requiring intensive care, had lower global assessment of functioning scores (30 ± 10 vs. 53.7 ± 21.2, p = 0.09), and were not well enough to complete standard psychiatric and cognitive assessments at presentation. Conclusion: Autoimmune encephalitis is not uncommon in patients with acute psychosis. Elevated WBC counts, certain prodromal features, and a more severe illness at presentation should prompt appropriate evaluation.

Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population

BACKGROUND

The co-occurrence of two or more chronic medical conditions in an individual is defined as multimorbidity. Lifestyle factors, including poor dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption are key modifiable risk factors that play a role in the development of chronic medical conditions and potentially multimorbidity. The current study aimed to examine the level of physical activity among those with multimorbidity and its association with socio-demographic factors, clinical parameters, and health-related quality of life (HRQoL) among community-dwelling adults attending a primary care clinic in Singapore.

METHODS

This cross-sectional study was conducted among patients with multimorbidity between August 2014 and June 2016. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) Short Form. HRQoL was measured using the EuroQol-5 Dimension (EQ-5D-3 L). Data on clinical parameters including hemoglobin A1c (HbA1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure were collected from patient records. Multivariable logistic regression analysis and linear regression were performed to determine the association between IPAQ and clinical health outcomes, as well as HRQoL measures, respectively.

RESULTS

In all, 932 respondents with multimorbidity were recruited for the study. Of these, 500 (53.8%) had low physical activity, 325 (35.0%) had moderate physical activity, while 104 (11.2%) had high physical activity. Respondents who were insufficiently active had significantly higher odds of being overweight/ obese (OR: 1.5, 95% confidence interval [CI]: 1.1-1.9, p = 0.01) as compared to those who were sufficiently physically active. The multiple linear regression model revealed that insufficient activity level was negatively associated with EQ-5D index score (β = - 0.05, p <  0.001) and the visual analogue scale (β = - 4.4, p <  0.001) measuring HRQoL as compared to sufficient activity levels in respondents with multimorbidity.

CONCLUSIONS

The low levels of physical activity among patients with multimorbidity, and its association with overweight status and poorer HRQoL emphasizes the importance of increasing physical activity in this population. Family physicians treating patients with chronic diseases need to continue encouraging and helping individuals to initiate and maintain appropriate physical activity levels.

Motivations to quit smoking and challenges faced during cessation among individuals with first episode psychosis in Singapore

AIMS

The prevalence of smoking has been noted to be higher among individuals with mental illness, particularly among those with schizophrenia and related psychosis than in the general population. The present paper sought to examine the motivations and challenges to quit smoking among first episode psychosis patients (N = 281) enrolled in the Early Psychosis Intervention Programme (EPIP) in Singapore.

METHODS

Questionnaires were used to collect details on an individual's smoking status, cessation attempts, motivations to quit, and challenges to stop smoking. Using baseline data, multiple linear regressions were conducted to examine the socio-demographic correlates of motivations and challenges of smoking cessation behaviour.

RESULTS

Of the study sample, 59.4% reported to have never smoked while 39.9% were currently smoking or had attempted smoking. Health reasons and cost were the most highly endorsed motivations to stop smoking; whereas cravings, stress, and boredom were highly endorsed as challenges to stop smoking. Socio-demographic factors such as age, educational level, and marital status were also found to be associated with the motivations to stop smoking and challenges faced during smoking cessation.

CONCLUSIONS

The present study highlights the most highly endorsed motivations and challenges reported among individuals with first episode psychosis (FEP) in an Asian population. Given that the literature examining motivations and challenges to quit smoking has predominantly focused on the general population, results from the current study have implications for the formulation of smoking cessation programmes targeted at individuals with mental illness, particularly those with FEP.

Prevalence and correlates of smoking and nicotine dependence: results of a nationwide cross-sectional survey among Singapore residents

BACKGROUND

Since the Singapore Mental Health Study in 2010 which reported a 16.0% prevalence rate for current smokers and 4.5% for nicotine dependence, new anti-smoking strategies have been implemented. The aim of this study was to compare smoking trends from the 2010 study with the second Singapore Mental Health Study in 2016 (SMHS 2016).

METHODS

A survey of 6126 individuals aged 18 years and above randomly selected among Singapore residents was conducted using the same methodology as the 2010 study. The measures used in this analysis were sociodemographic questions, the Composite International Diagnostic Interview which assessed for psychiatric disorders, the Fagerstrom Test for Nicotine Dependence and a list of chronic physical conditions that were prevalent in Singapore. Logistic regression analyses were used to test for associations between smoking/nicotine-dependence and other measures.

RESULTS

In the SMHS 2016, 16.1% were current smokers and 3.3% were nicotine-dependent. As compared with non-smokers, current smokers were more likely to be younger, male gender, of ethnic minority and had lower/vocational education level. Younger age, male gender, lower/vocational education and psychiatric disorders (major depression, bipolar disorder and alcohol use disorders) predicted nicotine dependence. No associations were found between nicotine dependence and any of the chronic conditions.

CONCLUSION

The prevalence of current smokers in the population has plateaued while that of nicotine dependence has decreased from 2010. However, the study did not investigate the use of e-cigarettes. Inequalities in smoking and nicotine dependence continue to pervade the population particularly among those of ethnic minority, lower/vocational education and the mentally ill.

Confirmatory Factor Analysis and Measurement Invariance of the Multidimensional Scale of Perceived Social Support in Young Psychiatric and Non-Psychiatric Asians

INTRODUCTION

Studies of the 3-factor (family, friends and significant others) Multidimensional Scale of Perceived Social Support (MSPSS) have shown mixed results in non-Western and/or psychiatric populations due to factorial inconsistencies in its structure. Our study aimed to replicate and expand previous findings of MSPSS through confirmatory factor analysis (CFA) and measurement invariance analysis in a young Asian population of psychiatric and non-psychiatric subjects.

MATERIALS AND METHODS

Data on 209 subjects were examined. The majority were Chinese (66.5%) followed by Malays (17.2%), Indians (14.4%) and other ethnicities (1.9%). Subjects in the non-psychiatric group (n = 100) did not report any psychiatric illnesses. Subjects in the psychiatric group (n = 109) were outpatients of a tertiary hospital in Singapore who had been diagnosed with depressive disorders.

RESULTS

The 3-factor models of MSPSS showed better fit indices than the 2-factor models (friends/significant others and family, or family/significant others and friends) which indicated that the 3-factor structure of MSPSS was valid. Multigroup CFA demonstrated metric invariance, indicating MSPSS scores can be compared across groups. In the psychiatric group, descriptive and weighted univariate analyses revealed significantly lower levels of perceived social support in every domain of MSPSS.

CONCLUSION

The 3-factor model of MSPSS can be used to compare psychiatric and non-psychiatric subjects locally. Since psychiatric patients reported lower MSPSS scores, future research could examine the causative factors that contribute to lower perceived social support in young adults seeking psychiatric intervention.

Subjective quality of life among patients with schizophrenia spectrum disorder and patients with major depressive disorder

BACKGROUND

The goal of clinicians and healthcare workers providing treatment to patients with psychiatric disorders, has shifted over time from focusing on the symptoms alone towards functional improvement. In this study, we aimed to compare the subjective quality of life (QoL) among patients with schizophrenia spectrum disorders and major depressive disorder (MDD).

METHODS

QoL scores were collected using 36-item Short Form Survey Instrument. QoL scores were compared between 203 outpatients with schizophrenia spectrum disorders and 185 outpatients with MDD using analysis of covariance. The Positive and Negative Syndrome Scale was administered to assess the severity of psychiatric symptoms among patients with schizophrenia and Personal Health Questionnaire-8 items was utilized to assess the severity of depressive symptoms among patients with MDD. The correlation coefficient (r) of socio-demographic factors and core psychiatric symptoms with QoL were analyzed using multiple linear regression.

RESULTS

As compared to patients with MDD, patients with schizophrenia reported better health scores in all QoL subdomains, except for physical function (PF). Among patients with schizophrenia, old age was correlated with better mental health (MH, r = 0.35) and PF (r = 0.37). Compared to those of Chinese ethnicity, those of Malay, Indian and other ethnicity were correlated with worse PF (r = - 0.43 for Malays; r = - 0.30 for Indians and r = - 0.34 for other ethnicities). Longer duration of mental illness was correlated with worse MH (r = - 0.30), worse PF (r = - 0.38) and worse scores on role limitations due to physical health problems (RP, r = - 0.30). Among patients with MDD, older age was correlated with worse PF (r = - 0.33) and patients without comorbid physical illness reported less bodily pain (r = 0.45) and better general health (r = 0.34). Moreover, all psychiatric symptoms among patients with schizophrenia were negatively correlated with QoL, but the strength of the correlation was less than that between depressive symptoms and QoL among patients with MDD.

CONCLUSION

Patients with schizophrenia generally reported better QoL as compared to patients with MDD. The correlates of QoL differed between patients with schizophrenia and patients with MDD. This study adds to the understanding of QoL among patients with mental illnesses and may aid in better management of these patients with different psychiatric diagnoses.

Medication adherence in first-episode psychosis patients in Singapore

AIM

Early intervention programmes for first episode psychosis (FEP) aim to reduce the duration of untreated psychosis (DUP) and improve functional outcomes. The sustained maintenance of improved outcomes depends largely on patients' adherence to prescribed treatment. This paper examines the prevalence of non-adherence in a cohort of patients with FEP and the sociodemographic and clinical factors associated with non-adherent behaviour.

METHODS

The sample included consecutive patients accepted from 2007 to 2012 into the Early Psychosis Intervention Programme (EPIP) in Singapore. Sociodemographic variables as well as DUP, insight, severity of psychopathology and clinical diagnoses were collected. Patients were assessed at baseline and 1 year with the PANSS and Global Assessment of Functioning Scale (GAF). Medication adherence was grouped into 3 categories: no-adherence, partial adherence and regular adherence.

RESULTS

Of the 445 patients included, 51% were male with a mean age of 26.3 years, 74.6% had schizophrenia spectrum and delusional disorders, 14% had affective psychosis and 11.3% had brief psychotic disorder or psychotic disorder not otherwise specified. At 1 year follow up, 65.5% reported regular adherence, 18.7% were partially adherent and 15.8% were non-adherent. Non-adherence was correlated with male gender, living alone and having poorer judgement and insight. Partial adherence was associated with Malay ethnicity and having undergone national service.

CONCLUSION

Medication adherence is prevalent in FEP and associated with a variety of factors. This study supports the use of culturally appropriate interventions in addressing barriers to adherence. Further studies would need to be done to address specific factors affecting adherence outcomes.

Prevalence and correlates of generalized anxiety disorder in Singapore: Results from the second Singapore Mental Health Study

The aim of this paper is to report findings on the epidemiology of generalized anxiety disorder (GAD) using data from the Singapore Mental Health Study (SMHS) 2016, and draw comparisons with results from the first SMHS in 2010. Singapore residents aged 18 years and above participated in the household survey where the WHO Composite International Diagnostic Interview 3.0 was administered to assess the prevalence of GAD and other mental health conditions. The findings revealed that the lifetime prevalence of GAD was 1.6% among the Singapore general population in 2016, an increase from the 0.9% in 2010. More lifetime GAD cases were reported across several sociodemographic groups including age and employment status. Lifetime GAD was significantly associated with higher odds of several comorbid psychiatric conditions (OR = 3.8-9.3, p < 0.05). Treatment seeking behavior did not differ significantly when compared to SMHS 2010 and there was still a considerable treatment gap among individuals with GAD. Future intervention programs to reduce anxiety and encourage help-seeking behavior could be implemented at institutes of higher learning and workplace settings to reach the targeted audience.

Associative stigma among mental health professionals in Singapore: a cross-sectional study

OBJECTIVES

(1) Investigate and explore whether different classes of associative stigma (the process by which a person experiences stigmatisation as a result of an association with another stigmatised person) could be identified using latent class analysis; (2) determine the sociodemographic and employment-related correlates of associative stigma and (3) examine the relationship between associative stigma and job satisfaction, among mental health professionals.

DESIGN

Cross-sectional online survey.

PARTICIPANTS

Doctors, nurses and allied health staff, working in Singapore.

METHODS

Staff (n=462) completed an online survey, which comprised 11 associative stigma items and also captured sociodemographic and job satisfaction-related information. Latent class analysis was used to classify associative stigma on patterns of observed categorical variables. Multinomial logistic regression was used to examine associations between sociodemographic and employment-related factors and the different classes, while multiple linear regression analyses were used to examine the relationship between associative stigma and job satisfaction.

RESULTS

The latent class analysis revealed that items formed a three-class model where the classes were classified as 'no/low associative stigma', 'moderate associative stigma' and 'high associative stigma'. 48.7%, 40.5% and 10.8% of the population comprised no/low, moderate and high associative stigma classes, respectively. Multinomial logistic regression showed that years of service and occupation were significantly associated with moderate associative stigma, while factors associated with high associative stigma were education, ethnicity and occupation. Multiple linear regression analyses revealed that high associative stigma was significantly associated with lower job satisfaction scores.

CONCLUSION

Associative stigma was not uncommon among mental health professionals and was associated with sociodemographic factors and poorer job satisfaction. Associative stigma has received comparatively little attention from empirical researchers and continued efforts to address this understudied yet important construct in conjunction with future efforts to dispel misconceptions related to mental illnesses are needed.

Clinical effectiveness and speed of response of electroconvulsive therapy in treatment-resistant schizophrenia

AIM

Although electroconvulsive therapy (ECT) has been shown to be efficacious for patients with treatment-resistant schizophrenia, there has been limited evidence on the rate of response, cognition, and quality-of-life outcomes. The primary aims of the present study were thus to examine the effectiveness and speed of response to ECT in a naturalistic retrospective cohort in patients with treatment-resistant schizophrenia.

METHODS

We performed a retrospective database analysis. The primary effectiveness outcome was defined as an improvement of ≥40% from pretreatment scores based on the Brief Psychiatric Rating Scale (BPRS) Psychotic Symptom subscale. Data were included for analysis for all patients with a primary DSM-5 diagnosis of schizophrenia that was treatment-resistant and who had had an acute course of ECT initiated for the treatment of schizophrenia between 1 July 2016 and 1 December 2016.

RESULTS

A total of 50 inpatients were included for analysis. The present study revealed that 50% of patients showed at least a 40% reduction in BPRS Psychotic Symptom subscale scores after completion of ECT and that 16.7% of patients responded after the first three sessions, 39.3% after six sessions, 46.4% after nine sessions, and 50% after 12 sessions. The greatest improvement in BPRS scores was between the third and sixth ECT sessions. BPRS scores, Clinical Global Impression, Montreal Cognitive Assessment, and Global Assessment of Functioning showed significant improvement. There was no significant difference in quality-of-life outcomes.

CONCLUSION

Utilizing modern techniques in treatment-resistant schizophrenia, this study demonstrates the real-world effectiveness and rate of response of patients receiving ECT.

Validation of the World Health Organization Disability Assessment Schedule 2.0 among older adults in an Asian country

INTRODUCTION

As populations age globally and the burden of chronic illnesses increases, valid measures of disability are needed for assessment in the older adult population. The aim of the current analysis was to explore the psychometric properties and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an epidemiological survey of older adults in Singapore.

METHODS

The study comprised secondary data analysis of the Well-being of the Singapore Elderly study. Inclusion criteria for the study were Singapore residents (Singapore citizens and permanent residents) aged 60 years and above. The 12-item interviewer-administered version of the WHODAS 2.0 was used to assess disability in the study. Data on cognition, health status and sociodemographic information were collected. Depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy.

RESULTS

The study found a one-factor model solution for WHODAS 2.0 with a high internal consistency of all items. The internal consistency for the overall scale was 0.92. The WHODAS 2.0 score positively correlated with multimorbidity, perceived overall health status, depression and subsyndromal depression. There was a significant inverse association between the WHODAS 2.0 score and the cognitive status. After adjustment for all sociodemographic variables in the multiple linear regression analysis, these measures remained significantly associated with the WHODAS 2.0 score.

CONCLUSION

WHODAS 2.0 was found to be a valid measure of disability among older adults. However, further research is required to determine its usefulness as a responsive instrument that can detect change following interventions.

Exploring Singapore's consumption of local fish, vegetables and fruits, meat and problematic alcohol use as risk factors of depression and subsyndromal depression in older adults

Background

Depression is a chronic mental disorder that severely impacts the older adult population globally. Nutritional psychiatry is an approach that has gained traction over the years. Exploring locally relevant consumption of common types of fish, vegetables and fruits (V&F), meat and problematic alcohol use (PAU) as risk factors associated with depression and subsyndromal depression (SSD) could reveal modifiable factors that could be targeted in the local older adult population in Singapore.

Methods

Data collected from the Well-being of the Singapore Elderly (WiSE) study, a cross-sectional population-based epidemiological study of Singapore’s older adult population was analysed for the purposes of this study. Two thousand five hundred sixty-five participants were recruited and comprised of Singapore citizens and permanent residents aged ≥60 years. Data on fish, meat, and V&F consumption were collected using the sociodemographic and risk factor questionnaire. The CAGE (Cut, Annoyed, Guilt, and Eye-opener) questionnaire was used to determine PAU. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) was used to obtain participants’ diagnosis of depression or SSD. A multinomial logistic regression was used to explore the relationship between depression and dietary factors.

Results

Consumption of V&F in the last 3 days was less likely to be associated with depression and SSD. Frequent consumption of specific species of fish was associated with depression and SSD. PAU and the frequent consumption of Himantura gerrardi (stingray) were more likely to be associated with SSD. Finally, meat consumption was more likely to be associated with depression and SSD.

Conclusions

The preliminary findings of the study support a need for healthy eating for the older adult population in Singapore. Further directions include a more thorough health and nutrition survey to capture accurate diets among the older adults in Singapore.

Case management in early psychosis intervention programme: Perspectives of clients and caregivers

AIM

This qualitative study explored the perspectives of clients and caregivers on case management provided by the Singapore Early Psychosis Intervention Programme (EPIP), with the intent to understand the salient aspects of case management from their perspective.

METHODS

Clients and their caregivers were recruited from the EPIP outpatient clinics. Focus group discussions (FGDs) were conducted at a community centre outside the hospital with 47 clients and 19 caregivers. Facilitators were experienced researchers who were not involved in the care of the clients and trained in qualitative research methodologies. All FGDs were audio recorded and transcribed verbatim with all participants' identifiers omitted to protect confidentiality. Qualitative data analysis was conducted using thematic analysis.

RESULTS

There were 11 themes that emerged from the FGDs: therapeutic alliance, holistic monitoring, collaborative role with other care providers, counselling and guidance, crisis management, bridging role, client-centred care, client empowerment and strength building, psychoeducation/education on illness, support and problem solving. "Problem solving" surfaced only from the client FGDs; the remaining themes were common to both groups.

CONCLUSIONS

The voices of clients and caregivers are important to EPIP case management service. This study has provided insights into their perspectives, understandings and lived experiences of case management and its impact on clients and caregivers.

Social support network typologies and their association with dementia and depression among older adults in Singapore: a cross-sectional analysis

OBJECTIVES

To examine the social support network type and its associations with depression and dementia among older adults in Singapore.

DESIGN

This study is a cross-sectional analysis of data from the Well-being of the Singapore Elderly study. The Practitioner Assessment of Network Type was used to identify five social support network types. Odds Ratios (OR) of dementia and depression were estimated with logistic regression and multinomial logistic regression, respectively, adjusted for sociodemographic variables.

SETTING

Singapore.

OUTCOME MEASURES

10/66 criteria and Automated Geriatric Examination for Computer Assisted Taxonomy computer algorithm.

PARTICIPANTS

2421 older adults aged 60 years and above, and their informants.

RESULTS

Logistic regression revealed that as compared with participants in the family dependent social support network type, those in the locally integrated social support network type were negatively associated with dementia. It was observed that it is the older adults' perception of the quality of social interaction that influences the likelihood of depression.

CONCLUSION

The social support network typology presents knowledge about the older adults' social network profile and their cognitive functioning-ability which would help stakeholders better identify older adults who might be at risk of cognitive decline or experiencing delay in diagnosis of dementia.

A comparison of the reliability and validity of SF-6D, EQ-5D and HUI3 utility measures in patients with schizophrenia and patients with depression in Singapore

There is limited evidence of a direct comparison of the psychometric performance of generic preference-based measures in patients with mental illness in an Asian patient population. The current study aimed to compare the test-retest reliability, convergent and known-group validity and magnitude of change in scores of the EuroQol Five-Dimension, Health Utility Index Mark 3 (HUI3) and Short-Form Six-Dimension (SF-6D) measures in patients with depression and patients with schizophrenia spectrum disorder. 500 patients were recruited from a tertiary psychiatric institution in Singapore. The Schizophrenia Quality of Life Scale (SQLS), 8-item Patient Health Questionnaire, Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Positive and Negative Syndrome Scale were also included. In the schizophrenia sample, the SF-6D was found to have higher test-retest validity, convergent validity with SQLS domain scores, known-group validity and magnitude of change in scores over 6-month follow up than other measures. In the depression sample, the HUI3 was found to have higher test-retest reliability, convergent validity with Q-LES-Q, known group validity and magnitude of change in scores than other measures. Results suggest that the SF-6D and HUI3 to be more suitable as a utility measure for patients with schizophrenia and depression in an Asian patient population.

Comparing disease-specific and generic quality of life measures in patients with schizophrenia

The current study aimed to compare the use of a disease-specific and a generic quality of life (QOL) measure in a group 251 outpatients with a schizophrenia spectrum disorder by examining their relationships with symptoms of schizophrenia, psychiatric and medical comorbidities, and other factors, as well as to determine which of these factors will be associated with the measurement discrepancy between the two measures. QOL was assessed with the generic Healthy Utility Index Mark 3 (HUI3) and disease-specific Schizophrenia Quality of Life Scale (SQLS), and symptom severity was determined using the Positive and Negative Syndrome Scale (PANSS). Symptom severity predicted both SQLS and HUI3, while psychiatric comorbidity predicted only the HUI3. Ethnicity, employment and PANSS depression factor were significantly associated with the measurement discrepancy. Using domain scores of the two QOL measures, the HUI3 appears to be superior in discriminating PANSS cognitive factor scores and medical comorbidity status compared to SQLS. Although the use of disease-specific QOL is generally preferred to track treatment progress in clinical settings, the two types of instruments measure non-overlapping aspects of QOL and the generic scales may better reflect QOL impairment due to overall clinical presentation.

Clarifying pathways to poor psychological health: The mediating role of psychosocial factors in the relationship between general psychopathology and quality of life impairment in patients diagnosed with schizophrenia

Objectives

The present study examines the latent factor structure of general psychopathology and investigates the mediating role of unmet psychosocial concerns, motivation, and medication side effects in the relationship between general psychopathology and quality of life (QOL) impairment in patients with schizophrenia.

Methods

A total of 251 patients completed self‐report measures of unmet psychosocial concerns, motivation, medication side effects, and physical/mental QOL impairment. The severity of schizophrenia was assessed on the Positive and Negative Syndrome Scale.

Results

Exploratory factor analysis revealed one latent factor (emotional distress) of general psychopathology. Mediation path analyses controlling for confounding variables revealed significant indirect effects of unmet psychosocial concerns, motivation, and medication side effects on emotional distress and physical/mental QOL impairment.

Conclusions

Our findings suggest that identifying optimal methods of managing co‐occurring emotional distress as well as secondary psychosocial factors on psychological health may improve QOL among patients diagnosed with schizophrenia.

Evaluating Singapore's CHAT Assessment Service by the World Mental Health Organisation (WHO) "Youth-Friendly" Health Services Framework

Young people experience high rates of mental health issues. However, many do not seek professional help. In order to encourage help-seeking behavior among young people, it is important to ensure that services are youth-friendly. This study aims to evaluate the Community Health Assessment Team (CHAT)'s mental health assessment service model using the World Health Organization (WHO) youth-friendly health service framework of accessibility, acceptability, and appropriateness (AAA), and to ascertain the extent to which the CHAT service model is youth-friendly. Three hundred young people aged 16-30 years, who had gone through CHAT mental health assessments, completed a 27-item questionnaire. Majority rated the items in the questionnaire favorably. Our results suggest that majority of the young people who accessed CHAT mental health assessment service found it to be youth-friendly.

Direct and moderating effects of personality on stigma towards mental illness

BACKGROUND

While many studies have explored the concept and correlates of stigma towards individuals with mental illness, few have investigated the role of personality in this process. In the current study, we firstly examined the relationship between personality and stigma towards mental illness; and then explored the moderating effects of personality traits on the relationship between contact experience/s and stigma.

METHODS

Participants were recruited from public medical (N = 502) and nursing schools (N = 500) from April to September 2016 in Singapore for this cross-sectional survey, and they were randomly assigned to a vignette describing one of the following mental disorders: major depressive disorder, obsessive compulsive disorder, alcohol abuse, schizophrenia, and dementia. Stigma was measured by the 'Personal and Perceived scales of the Depression Stigma Scale' and the 'Social Distance Scale'. These scales together had a 3-factor structure based on a previous national study in Singapore, namely 'weak-not-sick', 'dangerous/unpredictable' and 'social distance'. Personality was measured by the 20-item short form of the International Personality Item Pool-five factor model measure.

RESULTS

Regression suggested agreeableness and openness to experience were negatively associated with all three domains of stigma. 'Weak-not-sick' and extraversion were positively associated; and 'social distance' was positively associated with higher scores on conscientiousness and neuroticism. Both close- and non-close contact were associated with more positive attitudes towards mental illness among the participants. Openness to experience moderated the relationships of close contact experience with 'weak-not-sick' and 'dangerous/unpredictable', but in different directions. The association between close contact and 'social distance' were moderated by agreeableness.

CONCLUSIONS

Unlike non-close contact experience, close contact with people with mental illness worked differently on stigma for individuals with different personality traits. Future studies are needed to further explore the underlying mechanisms for such differences.

Positive Caregiving Characteristics as a Mediator of Caregiving Burden and Satisfaction With Life in Caregivers of Older Adults

BACKGROUND

Satisfaction with life is recognized to be a factor in alleviating burden in stressful caregiving duties. However, the mechanism underlying this relationship is indistinct. Positive aspects of caregiving (PAC) may help to regulate caregiving burden among caregivers of older adults. The study aims to examine whether positive caregiving characteristics mediate the effect between satisfaction with life and burden of care.

METHODS

Participants were 285 caregivers of older adults (aged 60 and above) in Singapore and were recruited in a cross-sectional, self-report study (mean [M] = 47.0 years; 64.6% females). Measures included in the study were the Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), and the Satisfaction with Life Scale (SWLS). Mediation analyses were used to study the indirect effects of life satisfaction on caregiver burden through features of PAC.

RESULTS

Mean scores for the ZBI, PAC, and SWLS scales were M = 23.15 (standard deviation [SD] = 15.98), M = 34.55 (SD = 8.19), and M = 23.56 (SD = 6.62) respectively. Results from the mediation analysis revealed that the association between life satisfaction and caregiving burden was significantly mediated by the PAC ( P < .001).

DISCUSSION

Positive aspects of caregiving may be a mechanism that links satisfaction with life and caregiver burden. Findings may represent attempts to manage caregiving duties as well as maintaining a positive attitude toward their responsibilities.