Acceptance of healthy lifestyle nudges in the general population of Singapore

Background

In recent years, behaviourally driven policies such as nudges have been increasingly implemented to steer desired outcomes in public health. This study examines the different nudges and the socio-demographic characteristics and lifestyle behaviours that are associated with public acceptance of lifestyle nudges.

Methods

The study used data from the nationwide Knowledge, Attitudes and Practices study (KAP) on diabetes in Singapore. Three types of nudges arranged in increasing order of intrusiveness were examined: (1) information government campaigns, (2) government mandated information and (3) default rules and choice architecture. Acceptance was assessed based upon how much respondents ‘agreed’ with related statements describing heathy lifestyle nudges. Multivariable linear regressions were performed with socio-demographics and lifestyle behaviours using scores calculated for each nudge.

Results

The percentage of respondents who agreed to all statements related to each nudge were: 75.9% (information government campaigns), 73.0% (government mandated information), and 33.4% (default rules and choice architecture). Respondents of Malay/Others ethnicity (vs. Chinese) were more likely to accept information government campaigns. Respondents who were 18 – 34 years old (vs 65 years and above), female, of Malay/Indian ethnicity (vs Chinese), were sufficiently physically active, and with a healthier diet based on the DASH (Dietary Approach to Stop Hypertension) score were more likely to accept nudges related to government mandated information. Respondents of Malay/Indian ethnicity (vs Chinese), and who had a healthier diet were more likely to accept default rules and choice architecture.

Conclusion

Individuals prefer less intrusive approaches for promoting healthy lifestyle. Ethnicity and lifestyle behaviours are associated with acceptance of nudges and should be taken into consideration during the formulation and implementation of behaviourally informed health policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13668-x.

The Recovering Quality of Life 10-item (ReQoL-10) scale in a first-episode psychosis population: Validation and implications for patient-reported outcome measures (PROMs)

AIM

This study aimed to examine the psychometric performance of the Recovering Quality of Life scale 10-item version (ReQoL-10) using a sample from a Singapore first-episode psychosis intervention program, to explore its clinical and sociodemographic correlates, and to discuss its utility as a patient-reported outcome measure (PROM).

METHODS

Sociodemographic data, duration of untreated psychosis (DUP), and diagnosis were collected from 300 participants. Clinical data, which included baseline and current scores on the Patient Health Questionnaire 9-item version, EuroQoL-5 Dimension 3-level version, Positive and Negative Syndrome Scale, and Global Assessment of Functioning scale, were extracted. The ReQoL-10 was tested for structural validity, internal consistency, and construct validity, and a multiple linear regression determined if any of the baseline factors were statistically significant predictors of the total ReQoL-10 scores.

RESULTS

The mean (SD) total ReQoL-10 score of the sample was 27.8 (7.8). Confirmatory factor analysis confirmed the bifactor model structure of the ReQoL-10. The instrument demonstrated good internal consistency and adequate construct validity. Being older was associated with higher total ReQoL-10 scores, while being married, having a highest educational level of vocational/diploma, longer DUP, and a diagnosis of affective psychosis were associated with lower total ReQoL-10 scores.

CONCLUSIONS

This study has validated the ReQoL-10 as suitable for routine use to measure recovery-specific quality of life in a psychiatric setting among patients with first-episode psychosis, and is a potential tool to initiate recovery conversations. As a PROM, it can facilitate shared decision making, in line with efforts to evaluate and improve quality of care.

Extended network analysis: from psychopathology to chronic illness

BACKGROUND

Understanding complex associations between psychopathology and chronic illness is instrumental in facilitating both research and treatment progress. The current study is the first and only network-based study to provide such an encompassing view of unique associations between a multitude of mental and physical health-related domains.

METHODS

The current analyses were based on the Singapore Mental Health Study, a cross-sectional study of adult Singapore residents. The study sample consisted of 6616 respondents, of which 49.8% were male and 50.2% female. A network structure was constructed to examine associations between psychopathology, alcohol use, gambling, major chronic conditions, and functioning.

RESULTS

The network structure identified what we have labeled a Cartesian graph: a network visibly split into a psychopathological domain and a physical health domain. The borders between these domains were fuzzy and bridged by various cross-domain associations, with functioning items playing an important role in bridging chronic conditions to psychopathology.

CONCLUSIONS

Current results deliver a comprehensive overview of the complex relation between psychopathology, functioning, and chronic illness, highlighting potential pathways to comorbidity.

Development, reliability, and validity of the case management quality of care scale (CMQS) among clients with first episode psychosis

This paper describes the development and validation of the Case Management Quality Scale (CMQS) to measure the quality of care provided by case managers in an early intervention service for clients with first episode psychosis. A total of 300 client participants from the Singapore Early Psychosis Programme completed a self-administered survey comprising 52 items measuring case management, the Client Satisfaction Questionnaire 8-item version (CSQ-8), Recovery Self-Assessment - person in recovery version (RSA-R), and Working Alliance Inventory - long form client version (WAI-C), and Recovering Quality of Life 10-item version (ReQoL-10). Exploratory factor analysis was conducted on the 52-item scale and the items were reduced using criterion validity. Psychometric properties of the 25-item CMQS were tested using internal consistency and concurrent validity. A 2-factor structure of the CMQS was established comprising two subscales - Therapeutic alliance and Care and empowerment. The test of normality for CMQS and subscales was largely found to be within the acceptable range. The Cronbach's alpha for the CMQS scale was high (0.97) and in terms of convergent validity, the CMQS and the two subscales had a moderate correlation with the CSQ-8, RSA-R, and WAI-C (r ranging from 0.596-0.711) and a mild correlation with the ReQoL-10. In conclusion, the CMQS is a user-friendly, and psychometrically sound instrument that is potentially useful for measuring case manager-client therapeutic alliance, and the level of care and empowerment in a case management service.

Prevalence and correlates of bipolar spectrum disorders in Singapore: Results from the 2016 Singapore Mental Health Study (SMHS 2016)

BACKGROUND

Prevalence estimates of Bipolar Spectrum Disorders (BSD) remain scant in Southeast Asia. This study aims to investigate the prevalence of BSD, its correlates with sociodemographic factors, and the associations between the BSD subgroups and clinical severity, impairment, and disability in Singapore.

METHODS

This study utilizes data gathered from the second Singapore Mental Health Study (SMHS)- a nationwide cross-sectional survey conducted between 2016 and 2018 (response rate: 69.5%). Respondents were randomly selected and administered, in a single visit, interviewer-led surveys of the World Health Organization Composite International Diagnostic Interview version 3.0 (CIDI 3.0) in their preferred language (i.e. Chinese, Malay, Tamil, or English). A total of 6126 residents completed the study.

RESULTS

The lifetime weighted prevalence of BSD, Bipolar I, II, and subthreshold bipolar disorder was 3.1%, 1.5%, 0.03%, and 1.6% respectively. A higher prevalence of Bipolar Disorders (BPD) was significantly associated with younger age, being divorced or separated, and being unemployed. Lifetime comorbidity of BSD with at least one other psychiatric or physical condition was 45% and 51% respectively. BSD was most comorbid with Obsessive Compulsive Disorder (psychiatric condition) and Chronic pain (physical condition).

LIMITATIONS

This study relies on self-report data which may be subject to unintended response biases leading to the under or over-reporting of results.

DISCUSSION

In addition to the high prevalence of BPD, there is also a concerning shift and increase in the proportion of those who experience severe symptoms of mania/hypomania and depression. Subthreshold bipolar disorder is found to be clinically significant and cross-culturally valid in a multi-cultural setting.

Comorbidities within mental illnesses in a multiethnic urban population

The prevalence and patterns of comorbidities among mental illnesses including substance misuse have been rarely documented in urban communities. In this study, we aimed to examine the prevalence, diagnostic patterns, common risk factors and functioning associated with comorbid mental illness among community residents in an urban population. Using data from Singapore Mental Health Study (SMHS) 2010 (n = 6616) and SMHS 2016 (n = 6126), we investigated the changes in the overall prevalence of comorbid mental illness and the diagnostic patterns of multiple affective disorders, affective disorder comorbid with substance misuse and multiple substance misuse. The most common diagnostic pair of comorbid affective disorder was major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) (0.4 % at 2010 and 0.7 % at 2016). Among comorbid substance misuse, comorbidity of MDD and alcohol related disorder (ARD) was most frequent (0.5 % and 0.7 % respectively), while comorbidity of nicotine dependence (ND) with ARD decreased from 0.5 % to 0.1 %. Logistic regression was utilized to identify the associations of socio-demographics/clinical characteristics with patterns of comorbid mental illness and the associations of number of comorbid mental illness with impaired functioning. The risk profileassociated with comorbid mental illnesses differed among various comorbidity groups. Moreover, in SMHS 2016, higher number of comorbidities within mental illness was associated with higher odds of functioning impairment. The increase in the prevalence of comorbid mental illnesses indicates the need for early diagnosis and integrated disease management. Moreover, certain subgroups in the general population are more at risk of comorbid mental illnesses.

Obsessive-Compulsive Disorder in Singapore: Prevalence, Comorbidity, Quality of Life and Social Support

Introduction: Using data from Singapore Mental Health Study 2016 (SMHS 2016), we examined the prevalence of lifetime and 12-month obsessive-compulsive disorder (OCD),its sociodemographics correlates and association with comorbid psychiatric disorders and physical conditions, perceived social support and quality of life. Materials and Methods: The World Mental Health Composite International Diagnostic Interview (version 3.0) was administered by trained interviewers to 6126 residents aged ≥18 years old to assess OCD prevalence and that of other select psychiatric disorders. Details on sociodemographics, perceived social support and health-related quality of life were obtained. Results: Lifetimeand 12-month prevalence of OCD was 3.6% and 2.9%, respectively. Adjusted regression analysis showed that those with OCD had significantly higher odds of major depressive disorder (odds ratio [OR], 5.4), bipolar disorder (OR, 8.9), generalised anxiety disorder (OR, 7.3) and alcohol abuse (OR, 2.7). OCD was significantly associated with suicidal ideation and suicidality (OR, 5.1). OCD subjects also had higher odds of chronic pain (OR, 2.4) and diabetes (OR, 3.1). Finally, OCD subjects had lower mean mental composite summary scores than controls (respondents without any of the psychiatric disorders and physical conditions included in SMHS 2016) and those with other lifetime psychiatric disorders and physical conditions. Conclusion: OCD prevalence in Singapore is high. Most people with OCD do not seek treatment despite experiencing significant comorbidity and loss of quality of life. Key words: Composite International Diagnostic Interview, Epidemiology, Multi-ethnic, Psychiatric disorder, Survey

Obsessive-Compulsive Disorder in Singapore: Prevalence, Comorbidity, Quality of Life and Social Support

INTRODUCTION

Using data from Singapore Mental Health Study 2016 (SMHS 2016), we examined the prevalence of lifetime and 12-month obsessive-compulsive disorder (OCD), its sociodemographic correlates and association with comorbid psychiatric disorders and physical conditions, perceived social support and quality of life.

MATERIALS AND METHODS

The World Mental Health Composite International Diagnostic Interview (version 3.0) was administered by trained interviewers to 6126 residents aged ≥18 years old to assess OCD prevalence and that of other select psychiatric disorders. Details on sociodemographics, perceived social support and health-related quality of life were obtained.

RESULTS

Lifetime and 12-month prevalence of OCD was 3.6% and 2.9%, respectively. Adjusted regression analysis showed that those with OCD had significantly higher odds of major depressive disorder (odds ratio [OR], 5.4), bipolar disorder (OR, 8.9), generalised anxiety disorder (OR, 7.3) and alcohol abuse (OR, 2.7). OCD was significantly associated with suicidal ideation and suicidality (OR, 5.1). OCD subjects also had higher odds of chronic pain (OR, 2.4) and diabetes (OR, 3.1). Finally, OCD subjects had lower mean mental composite summary scores than controls (respondents without any of the psychiatric disorders and physical conditions included in SMHS 2016) and those with other lifetime psychiatric disorders and physical conditions.

CONCLUSION

OCD prevalence in Singapore is high. Most people with OCD do not seek treatment despite experiencing significant comorbidity and loss of quality of life.

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.

A narrative synthesis of possible causes and risk factors of hoarding behaviours

BACKGROUND

Hoarding is a disorder characterized by excessive acquisition and persistent difficulty in discarding possessions. The behaviour has adverse emotional, physical, social, financial, and legal outcomes for the person with the disorder and family members, and might pose a significant public health problem. Hoarding has been included as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM-5). The prevalence of hoarding disorder is approximately 2-6% globally. The current state of the evidence does not offer clear understanding of the causes of hoarding behaviours. A systematic review of the extant literature was carried out to determine the possible causal factors of hoarding behaviours.

METHODS

This review is conducted in line with PRISMA guidelines. The following electronic databases: Medline through Ovid, EMBASE and PsycINFO were searched for relevant articles published between January 2000 and November 2018. Only articles published in English language were included. Two reviewers independently scrutinized the studies and included them in this review.

RESULTS

Our search strategy returned a total of 396 references. Preliminary findings suggest that individuals with hoarding behaviours may have a genetic susceptibility; abnormal neural activity in the fronto-temporal, para-hippocampal gyrus and insular parts of the brain has also been identified. Traumatic life experiences have also been posited to predispose individuals to hoard.

CONCLUSION

Although the understanding of hoarding disorder hasgrown in recent years, greater efforts are still needed to clarify the etiology and mechanisms of hoarding disorder as these may help in planning of more holistic interventions to treat the problem.

Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population

STUDY OBJECTIVES

With the introduction of insomnia disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), greater emphasis has been placed on the diagnosis and treatment of sleep disorder even in the presence of a coexisting mental disorder. The current study seeks to explore the clinical picture of insomnia in the context of psychiatric disorders commonly associated with sleep complaints by assessing the prevalence and correlates of DSM-5 insomnia disorder, and examining the extent to which insomnia symptoms have been addressed in this population.

METHODS

Four hundred treatment-seeking outpatients suffering from depressive, bipolar affective, anxiety, and schizophrenia spectrum disorders were recruited. DSM-5 insomnia was established using the modified Brief Insomnia Questionnaire. Differences in sociodemographic factors, clinical status, impairment outcomes, and mental health services utilization were compared. Information on patients' help-seeking experiences for insomnia-related symptoms was collected to determine the treatment received and treatment effectiveness.

RESULTS

Almost one-third of our sample (31.8%) had DSM-5 insomnia disorder. Those with insomnia disorder had significantly higher impairment outcomes than their counterparts but no group difference was observed for mental health services utilization. Findings based on past treatment contact for sleep problems suggest that diagnosis and treatment of insomnia is lacking in this population.

CONCLUSIONS

With the new calling from DSM-5, clinicians treating psychiatric patients should view insomnia less as a symptom of their mental illnesses and treat clinical insomnia as a primary disorder. Patients should also be educated on the importance of reporting and treating their sleep complaints. Nonmedical (cognitive and behavioral) interventions for insomnia need to be further explored given their proven clinical effectiveness.

The correlates of slow gait and its relation with social network among older adults in Singapore

OBJECTIVES

This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status.

METHODS

Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample.

RESULTS

The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score.

CONCLUSION

Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.

Employment status among the Singapore elderly and its correlates

AIM

It has been hypothesized that working beyond retirement age may have a protective effect on various aspects of well-being in the elderly. This paper aims to examine the relationship between employment status of elderly Singaporeans and indicators of well-being.

METHODS

As part of the Well-being of the Singapore Elderly study, data relating to sociodemographics, social networks, medical history, physical activity, cognitive function, and disability were collected from 2534 participants aged 60 years and older. Participants included full-time workers (n = 483), part-time workers (n = 205), the unemployed (n = 32), homemakers (n = 808), and retirees (n = 1006). The data were analyzed by multiple logistic regression.

RESULTS

Likelihood of being employed decreased with age, and employment was higher among men. Paid workers had significantly higher levels of physical activity, more extensive social networks, better cognitive function, less disability, and lower risk of dementia than retirees and homemakers. Paid workers had significantly lower chronic disease burden than retirees and rated their health to be better than retirees and the unemployed.

CONCLUSIONS

These findings show that meaningful employment is associated with better psychological and physiological well-being among the elderly, highlighting the importance of studying likely protective effects of employment and creating employment opportunities for elderly Singaporeans.

Prevalence and correlates of sleep problems among elderly Singaporeans

BACKGROUND

The current study examined the prevalence and correlates of sleep problems among elderly Singaporeans.

METHODS

Data were taken from the Well-being of Singapore Elderly study, a cross-sectional, epidemiological survey conducted among Singapore residents aged 60 years and above (n = 2565). Respondents were screened for sleep problems through a series of questions in the Geriatric Mental State examination. Details on sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression were also collected. Logistic regression analysis was used to explore significant associations between sleep problems, sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression.

RESULTS

Overall, 13.7% (n = 341) of older adults reported at least one sleep problem. Of those who reported sleep problems, 69.4% experienced sleep interruption at night, 48.9% reported having difficulty falling asleep, 22.3% reported early morning awakening, and 11.4% had all three problems. Elderly with sleep problems were significantly more likely to have a range of chronic physical conditions and depression and were also significantly less likely to be physically active. Older adults with at least one sleep problem reported significantly greater disability compared to those with no sleep problems.

CONCLUSION

The high probability of comorbid chronic conditions as well as higher disability among those with sleep problems makes this an important area of research.

Diagnosis of dementia by medical practitioners: a national study among older adults in Singapore

OBJECTIVES

Dementia is inevitably associated with an ageing population which has tremendous public health, social and economic implications. Yet the extant evidence suggests that the diagnosis of dementia in general is neither timely nor accurate. The aim of this present study was to establish the prevalence of dementia as diagnosed by medical practitioners in Singapore and its associated factors.

METHOD

The analysis is based on a national epidemiological study of older adults in Singapore which had established the prevalence of dementia using the 10/66 protocol. It was a community based survey, and face-to-face interviews were conducted with 2565 respondents (a response rate of 66%) and 2421 informants.

RESULTS

In all, 3% of the respondents were diagnosed by a medical practitioner to have dementia of which 11.5% were diagnosed by general practitioners. Only 30.3% were prescribed medications specifically for dementia. Those with comorbid depression were more likely to be diagnosed to have dementia.

CONCLUSION

The apparent low rate of diagnosis by medical practitioners is in line with studies done in the West. There is a need to elucidate the reasons underlying this under-diagnosis in order to better address this gap.

Hoarding symptoms among psychiatric outpatients: confirmatory factor analysis and psychometric properties of the Saving Inventory - Revised (SI-R)

BACKGROUND

The growing interest in problematic hoarding as an independent clinical condition has led to the development of the Saving Inventory-Revised (SI-R) to assess hoarding phenomenology. The SI-R is one of the most widely used instruments to measure hoarding symptoms; however, it lacks validation in non-Western samples.

METHODS

The current study examined the construct, convergent, and discriminant validity of the SI-R among 500 outpatients at a psychiatric hospital in Singapore. The three-factor structure solution of the SI-R was fitted in a confirmatory factor analysis.

RESULTS

The final model achieved mediocre fit (χ2 = 1026.02, df = 186; RMSEA = 0.095, SRMR = 0.06; CFI = 0.86; NNFI = 0.85). Two reverse-coded items (items 2 and 4) were removed due to insufficient factor loadings, resulting in the modified 21-item SI-R (SIR-21). Our findings indicate the need to further examine the construct validity of the SI-R, particularly in non-Western samples. Nonetheless, correlations with other hoarding-related constructs, such as anxiety (Beck Anxiety Inventory) and depression (Beck Depression Inventory-II), supported the convergent and discriminant validity of the SIR-21 in our sample.

CONCLUSIONS

Findings in our current majority Chinese sample were consistent with previous observations from other Chinese samples. Implications were discussed from a cross-cultural perspective, such as cultural emphasis on saving for future use and overlap between the concepts of discarding and acquiring in Chinese samples. Future studies should also examine differences among other ethnic groups (e.g., Malay, Indian).

Screening for Drinking Problems in the Elderly in Singapore Using the CAGE Questionnaire

INTRODUCTION

Given that past research on drinking problems has focused primarily on younger samples, the present study sought to examine the prevalence and correlates of alcohol use among the elderly in Singapore.

MATERIALS AND METHODS

Data were extracted from the Well-being of the Singapore Elderly (WiSE) study, a cross-sectional, epidemiological survey conducted among a nationally representative sample of Singapore residents (n = 2565) aged 60 years and above. Variables assessed include drinking problems, depression and anxiety symptoms, obesity, smoking status, chronic physical disorders and disability.

RESULTS

The weighted prevalence of drinking problems (CAGE score ≥2) in our sample was 4.2%. Male sex, Indian ethnicity, and being divorced or separated were associated with a significantly higher likelihood of drinking problems. Participants with drinking problems were also more likely to have subthreshold depression. There were no significant differences in disability among those with drinking problems, those without drinking problems and non-drinkers, after adjusting for demographic variables.

CONCLUSION

Our findings contribute to the body of research that indicates an association between drinking problems and depressive symptoms among the elderly. Thus, screening for depressive symptoms in the elderly with drinking problems may be useful in identifying such comorbidities in order to aid treatment planning.

Prevalence and predictors of tobacco use in the elderly

OBJECTIVE

Smoking is a well-established public health issue, which has not been examined previously among the elderly in Singapore. This paper describes and identifies the current prevalence and predictors of tobacco use among the older resident population.

METHODS

Data were derived from the Well-being of the Singapore Elderly study, a cross-sectional epidemiological study of the elderly in Singapore. Sociodemographic data from 2565 Singapore residents aged 60 years and above were collected through face-to-face interviews. Multinomial logistic regression analyses identified predictors of tobacco use.

RESULTS

A total of 236 respondents were current tobacco users (9.5%). The majority of older tobacco users were men (88.1%). Significant predictors of tobacco use were gender, marital status, and education level. Younger age (60-74 years old) was associated with more tobacco use, and the completion of tertiary education with lower rates of use.

CONCLUSIONS

Smoking prevalence among the elderly was lower than that of the Singapore general adult population (16%). However, the rate is still high and is of concern given the likelihood of a higher rate of physical disorders, which could be worsened with tobacco use. The identification of those at risk enables them to be targeted for smoking cessation programs and other interventions. Copyright © 2015 John Wiley & Sons, Ltd.

Body mass index, waist-hip ratio and risk of chronic medical condition in the elderly population: results from the Well-being of the Singapore Elderly (WiSE) Study

BACKGROUND

The aim of the current study was to establish the prevalence and relationship of Body Mass Index (BMI) and Waist-Hip Ratio (WHR) with chronic health conditions and their associated socio-demographic correlates in the elderly population of Singapore.

METHODS

The data was extracted from the Well-being of the Singapore Elderly (WiSE) study, a comprehensive single phase, cross-sectional, population-based, epidemiological study conducted in 2013 among Singaporean residents (n = 2565) aged 60 years and above with a mean age of 72.7 years (range 60 to 105, SD = 9.53). The respondents were assessed with anthropometric measurements including height, weight, BMI, waist circumference, hip circumference and WHR. Participants provided information on their socio-demographic details and chronic health conditions.

RESULTS

Prevalence of those who were obese, overweight, normal and underweight based on BMI was 8.7 %, 33.4 %, 52.5 % and 5.5 % respectively. Malays were more likely to be overweight compared to Chinese and Indians, while Malays and Indians were more likely to be obese compared to Chinese. Participants who were never married were less likely to be overweight compared to married. Participants aged 85 years and above were more likely to be underweight compared to those aged 60-75 years. Prevalence of high WHR (above 0.90 for men and 0.80 for women) was 79.8 % and this was more pervasive amongst Indians. Participants who were homemakers were more likely to have high WHR while those with tertiary education tended to have low WHR. Being overweight was associated with hypertension and heart problems, while obesity was associated with hypertension and diabetes, and a high WHR was associated with hypertension and diabetes. There were no significant differences in the other chronic conditions in this elderly population.

CONCLUSIONS

This study demonstrates the importance of anthropometric measurements in the elderly and its association with certain chronic physical conditions, indicating their utility in the clinical management of these conditions in the elderly.

Prevalence and Correlates of Pain in People Aged 60 Years and above in Singapore: Results from the WiSE Study

Background. Although pain is experienced among people of all ages, there is a need to study its risk factors and impact among older adults. Aims. The study sought to determine the prevalence, sociodemographics, and clinical correlates of pain along with association of pain with disability among older adults in Singapore. Methods. The WiSE study was a comprehensive cross-sectional, single phase, epidemiological survey conducted among the elderly aged 60 years and above and used a nationally representative sample of three main ethnic groups in Singapore: Chinese, Malays, and Indians. The survey administered 10/66 protocol pain questionnaire, sociodemographic questionnaire, health status questionnaire, World Health Organization Disability Assessment Scale (WHODAS 2.0), and Geriatric Mental State (GMS) examination. Results. A total of 2565 respondents completed the study giving a response rate of 65.5%. The prevalence of pain among the elderly aged 60 years and above is 19.5 %. Females, incomplete primary education Indians, and those diagnosed with any chronic health condition were associated with risk of pain and disability. Conclusion. Study findings showed that disability related to pain among the elderly is considerable making it a priority to reduce the morbidity and disability among the elderly with pain.

Qualitative study of Singaporean youths' perception of antismoking campaigns: what works and what does not

Background

Youths are more likely to rebel against messages perceived to inhibit their independence. In order for antismoking campaigns to be effective with this population, adopting evidence-based strategies is crucial. In this study, we examined youths’ reaction to past and ongoing antismoking campaigns, and delineate effective and ineffective components of campaigns as identified by them.

Methods

12 focus group discussions were conducted with 91 youth smokers aged 15–29 years. Data were analysed using qualitative content analysis. A codebook was derived through an iterative process. The data were coded systematically by three coders, using Nvivo V.10.

Results

Fear appeals that had no immediate relevance to youths, and campaigns involving humour or sports/dance activities that distracted youths from the antismoking messages, were deemed ineffective. In contrast, elements identified to be efficacious were: positive tone, low-fear visual images, ‘low-controlling language’ and a genuine spokesperson. Youth tended to favour campaigns circulating on social media platforms. Importantly, youths voiced a lack of tangible support for their efforts to quit smoking.

Conclusions

Participants expressed a preference towards antismoking messages that were less authoritative, and perceived a distinct lack of support for their intentions to quit smoking. There is room for incorporating suggestions by participants in future antismoking campaigns. Future research is needed to identify barriers to accessing available support.

Factors Influencing Attitudes Towards Seeking Professional Psychological Help: Findings From A Multi-Ethnic Asian Population-Based Study

Introduction

Various socio-demographic variables have been shown to influence attitudes towards seeking professional psychological help (ATSPPH), while negative ATSPPH can act as a barrier to mental healthcare, resulting in under-utilization of psychological services.

Aims and objectives

To explore the factor structure of the ATSPPH scale and determine whether any significant socio-demographic differences exist in relation to ATSPPH among a nationally representative sample.

Methods

Data was extracted from a population-based, cross-sectional survey conducted between March 2014 and March 2015 among Singapore Residents aged 18-65 years (n = 3006). Respondents completed the 10-item ATSPPH scale and also provided socio-demographic information. Exploratory factor analysis (EFA) was performed to establish the factor structure of the ATSPPH scale. Multivariable linear regression analyses were conducted to examine socio-demographic factors associated with ATSPPH.

Results

EFA revealed that the ATSPPH scale formed three distinct dimensions comprising “Openness to seeking professional help”, “Value in seeking professional help” and “Preference to cope on your own”. Higher “Openness to seeking professional help” scores were significantly associated with 18-34-year-olds and unmarried respondents, whilst Malay ethnicity and lower education were significantly associated with lower openness scores. Malays, Indians and lower education were significantly associated with lower “Value in seeking professional help” scores, whereas higher “Preference to cope on your own” scores were significantly associated with lower education.

Conclusion

Population subgroups including those with lower educational levels and different ethnic groups have more negative ATSPPH. Tailored, culturally appropriate educational interventions which reduce negative ATSPPH are needed, which effectively target these populations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

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.

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.

Lifetime and twelve-month prevalence of heavy-drinking in Singapore: results from a representative cross-sectional study

Background

The study aimed to establish the prevalence of heavy drinking, evaluate correlations between heavy drinking and socio-demographic factors, physical and psychiatric conditions, and assess the impact of heavy drinking on quality of life and days of work-loss.

Methods

Data from a nationally-representative cross-sectional sample were used. The sample comprised 6616 community-dwelling Singaporeans & Singapore Permanent Residents. The main instruments used were the World Mental Health Composite International Diagnostic Interview and EuroQol 5D. Heavy drinking was defined as consumption of 4 or more drinks, or 5 or more drinks in a day in women and men respectively.

Results

12.6% of all adult Singapore residents reported heavy drinking in the last 12 months, and 15.9% reported lifetime heavy-drinking. Strong gender, ethnic, age and income differences were seen. Heavy drinking was positively associated with major depression, the presence of any mood disorder, and with chronic pain. It was also strongly associated with alcohol dependence, alcohol abuse, and nicotine dependence. Heavy-drinkers reported lower quality of life compared to non-heavy drinkers, measured using the EuroQol 5D Visual Analogue Scale.

Conclusions

Singapore has a relatively high prevalence of 12-month heavy drinking of 12.6%, and lifetime heavy drinking of 15.9%. Heavy drinking was positively associated with both physical and mental health conditions, and with declines in quality of life. Continued monitoring of heavy drinking behavior and sustained efforts to mitigate the risks associated with heavy drinking is needed.

Prevalence and correlates of alcohol use disorders in the Singapore Mental Health Survey

AIMS

  To establish the prevalence, correlates, comorbidity and treatment gap of alcohol use disorders in the Singapore resident population.

DESIGN

  The Singapore Mental Health Study is a cross-sectional epidemiological survey.

SETTING

  A nationally representative survey of the resident (citizens and permanent residents) population in Singapore.

PARTICIPANTS

  A total of 6616 Singaporean adults aged 18 years and older.

MEASUREMENTS

  The diagnoses were established using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) diagnostic modules for life-time and 12-month prevalence of selected mental illnesses including alcohol use disorders.

FINDINGS

  The life-time prevalence of alcohol abuse and alcohol dependence was 3.1% and 0.5%, while the 12-month prevalence of alcohol abuse and alcohol dependence was 0.5% and 0.3%, respectively. The life-time and 12-month prevalence of alcohol use disorders was 3.6% and 0.8%, respectively. Those with alcohol use disorder had significantly higher odds of having major depressive disorder [odds ratio (OR) 3.1] and nicotine dependence (OR 4.5). Compared to the rest of the population, those with an alcohol use disorder had significantly higher odds of having gastric ulcers (OR 3.0), respiratory conditions (OR 2.1) and chronic pain (OR 2.1). Only one in five of those with alcohol use disorder had ever sought treatment.

CONCLUSIONS

  The prevalence of alcohol use disorders is relatively low in the Singapore adult population. Comorbidity with mental and physical disorders is significant, emphasizing the need to screen people with alcohol use disorders for these comorbidities.

The Singapore Mental Health Study: an overview of the methodology

The Singapore Mental Health Study (SMHS) is a population-based, cross-sectional, epidemiological study on the Singapore multi-ethnic adult population. This article provides an overview of the research design and methods used which took into consideration the unique characteristics of the country and its multi-ethnic population. A face-to-face household survey of Singapore residents aged 18 years and above was undertaken from 2009 to 2010. The nationally representative probability sample was derived using a disproportionate stratified sampling method. In order to increase precision for subgroup estimations the design was stratified with over-sampling of Malays, Indians and those aged 65 years and above. Respondents were assessed using the English, Chinese (computerized) and Malay (paper and pencil based) version of the Composite International Diagnostic Interview (CIDI) 3.0 to establish lifetime and 12-month prevalence of mental disorders, the current use of mental health services (both Western and traditional services), the treatment gaps and loss of role functioning.

Comparing effectiveness of risperidone with first-generation antipsychotic medications in patients with schizophrenia-spectrum disorders

This naturalistic retrospective study aims to compare effectiveness of a second-generation antipsychotic medication, risperidone, with first-generation antipsychotic medications (haloperidol and trifluoperazine) in an Asian population with first-episode schizophrenia-spectrum disorders. A total of 261 patients were assessed for time to discontinuation for any reason and specific reasons of discontinuation, controlling for baseline differences between groups. Some 90% of patients discontinued their antipsychotic medications before 18 months. Median time to discontinuation for any reason in risperidone was 69 days versus first-generation antipsychotic medications of 27 days. Specifically, the risperidone group had a longer time to discontinuation for any reason than haloperidol (HR = 0.61, p = 0.005) and trifluoperazine groups (HR = 0.63, p = 0.03), as well as a longer time to discontinuation due to intolerability of side effects than haloperidol (HR = 0.50, p = 0.008) and trifluoperazine groups (HR = 0.26, p = 0.001). There were no significant differences between medications for time to discontinuation due to lack of efficacy, patient's/family's decisions or other reasons. We conclude that there is a very high rate of discontinuation of the initial antipsychotic medications for various reasons, with risperidone having an overall longer time to discontinuation compared with first-generation antipsychotic medications.

Mental Health Professionals’ Perceived Barriers and Benefits, and Personal Concerns in Relation to Psychiatric Research

Aim: Mental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals’ perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatric hospital. Materials and Methods: Self-administered questionnaire was employed to collect socio-demographic data and opinions on research. Likert scale was used for the responses and descriptive statistics and ordinal regression were used for data analysing. Results: 93.8% respondents perceived “contribution to medical knowledge/ public health” to be a major benefit of conducting research. 86.7% respondents felt that “learning experience” was important. “Prestige/publication” (52.7%) and “financial gain” (76%) were perceived to be unimportant. “Clinical load of patients”, “lack of skilled personnel to assist in research” and “insufficient funding” were identified as important barriers by 72.4%, 70.6% and 68.9% respondents. “Time constraints”, “patient and family readiness to research participation”, “insufficient training” and “concerns about patient welfare” are major concerns while conducting research. Conclusion: To the study team’s best knowledge, this is the only study of mental health professionals’ perceptions on psychiatric research. It is useful for strategising research planning and enhancing the research culture in the hospital. Key words: Healthcare professionals, Mental health research, Research planning strategies

Mental health professionals' perceived barriers and benefits, and personal concerns in relation to psychiatric research

AIM

Mental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals' perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatric hospital.

MATERIALS AND METHODS

Self-administered questionnaire was employed to collect socio-demographic data and opinions on research. Likert scale was used for the responses and descriptive statistics and ordinal regression were used for data analysing.

RESULTS

93.8% respondents perceived "contribution to medical knowledge/public health" to be a major benefit of conducting research. 86.7% respondents felt that "learning experience" was important. "Prestige/publication" (52.7%) and "financial gain" (76%) were perceived to be unimportant. "Clinical load of patients", "lack of skilled personnel to assist in research" and "insufficient funding" were identified as important barriers by 72.4%, 70.6% and 68.9% respondents. "Time constraints", "patient and family readiness to research participation", "insufficient training" and "concerns about patient welfare" are major concerns while conducting research.

CONCLUSION

To the study team's best knowledge, this is the only study of mental health professionals' perceptions on psychiatric research. It is useful for strategising research planning and enhancing the research culture in the hospital.