Mapping the schizophrenia quality of life scale to EQ-5D, HUI3 and SF-6D utility scores in patients with schizophrenia

OBJECTIVES

The current study aimed to map the disease-specific Schizophrenia Quality of Life Scale (SQLS) onto the three- and five-level EuroQol five-dimension (EQ-5D-3 L and EQ-5D-5 L), Health Utility Index Mark 3 (HUI3) and Short Form six-dimensional (SF-6D) preference-based instruments to inform future cost-utility analyses for treatment of patients with schizophrenia.

METHODS

Data from 251 outpatients with schizophrenia spectrum disorders was included for analysis. Ordinary least square (OLS), Tobit and beta regression mixture models were employed to estimate the utility scores. Three regression models with a total of 66 specifications were determined by goodness of fit and predictive indices. Distribution of the original data to the distributions of the data generated using the preferred estimated models were then compared.

RESULTS

EQ-5D-3 L and EQ-5D-5 L were best predicted by the OLS model, including SQLS domain scores, domain-squared scores, age, and gender as explanatory predictors. The models produced the best performance index and resembled most closely with the observed EQ-5D data. HUI3 and SF-6D were best predicted by the OLS and Tobit model respectively.

CONCLUSION

The current study developed mapping models for converting SQLS scores into generic utility scores, which can be used for economic evaluation among patients with schizophrenia.

Psychotherapists’ perspective of the use of eHealth services to enhance positive mental health promotion

Objective

Keyes’s two-continua model of mental health proposes that mental illness and positive mental health are two separate, correlated, unipolar dimensions. eHealth services have been used to deliver mental health care, though the focus remained largely on symptom reduction and management of negative aspects of mental health. The potential of eHealth services to promote positive mental well-being, however, has not been tapped sufficiently. The present study aims to explore psychotherapists’ perspective on the feasibility of eHealth services to enhance positive mental health promotion.

Methods

Seven focus group discussions were conducted among professionals ( n = 38) who delivered psychotherapy to examine positive mental health in their practice. Responses related to the use of e-psychotherapy to promote mental well-being were extracted for use in a secondary analysis of data in this study. Thematic analysis of data via inductive approach was conducted to allow emergence of common themes.

Results

Three main themes related to psychotherapists’ perspective on the feasibility of eHealth intervention in enhancing positive mental health were identified: (1) use of eHealth to educate and improve positive mental health; (2) concerns on incorporating psychotherapy into online services; (3) other factors that affect uptake or effectiveness of eHealth intervention for positive mental health.

Conclusions

The study generally found support among psychotherapists for the feasibility of eHealth intervention in promoting positive mental health among clients. Potential difficulties in implementation and practicality concerns were discussed.

A Qualitative Approach to Understanding the Holistic Experience of Psychotherapy Among Clients

Background: The study of the experience of clients across multiple service encounters (or touchpoints) is important from the perspective of service research. Despite the availability of effective psychotherapies, there exists a significant gap in the optimal delivery of such interventions in the community. Therefore, the aim of this study was to explore the experience of psychotherapy among clients integrating the before-during-after service encounters using a qualitative approach. Methods: A total of 15 clients of outpatient psychotherapy were interviewed, and data saturation was reached. The topics included pathways and reasons to seeking psychotherapy, aspects of the therapy process that have been helpful or unhelpful, and perceived change after receiving psychotherapy. Information was analyzed using the inductive thematic analysis method. Emergent themes pertaining to pre-psychotherapy encounters were mapped onto major components that were identified in Andersen's Health Service Utilization Model. Results: Mental health stigma and the lack of understanding about psychotherapy were the predisposing factors that impeded service use while the preference for non-pharmacological intervention promoted its use. Enabling factors such as affordability and service availability were also of concern, along with perceived and evaluated needs. The attributes of therapists, application of techniques, and the resistance of the client were found to impact the therapeutic alliance. While the majority of the clients experienced positive change or had engaged in self-help strategies after receiving psychotherapy, some cited limited impact on the recovery of symptoms or problematic self-coping without the therapists. Conclusion: This study proposes to expand on Andersen's Behavioral Model by including therapy-related factors so as to provide a more holistic understanding of the use of psychotherapy among the clients. More importantly, the study identified several barriers to access and negative experiences or outcomes, which should be addressed to promote uptake of the psychotherapy intervention.

Association of adverse childhood experiences with diabetes in adulthood: results of a cross-sectional epidemiological survey in Singapore

OBJECTIVES

Several studies have linked diabetes mellitus to adverse childhood experiences (ACEs). While a number of studies have examined the association between ACEs and diabetes in Western populations, few have done it in Asian populations. The current study aimed to examine (1) the association between ACEs and diabetes, including the association after age stratification, and (2) the association of comorbid depression, resource use and health-related quality of life (HRQoL) among those with diabetes and ACEs in Singapore.

SETTINGS

Participants were surveyed in their homes or any other preferred venue of their choice.

PARTICIPANTS

6126 individuals aged 18 years and above were randomly selected among Singapore residents.

DESIGN

Cross-sectional nationwide epidemiological study.

RESULTS

Exposure to any ACE was not associated with increased odds of diabetes; however, those who had experienced parental separation, death or divorce of a parent had higher odds of diabetes. In addition, we observed significant interaction between age and ACEs in relation to odds of diabetes. ACEs were significantly associated with higher odds of diabetes mainly in the younger age group. The prevalence of major depressive disorder was significantly higher among those with diabetes and ACEs than those with diabetes alone (3.7% and 0.3% respectively).

CONCLUSIONS

Efforts to promote regular exercise and healthy lifestyles both in the population and among those with diabetes must continue for the prevention and management of diabetes. The findings emphasise the need to create more awareness of both the prevalence and impact of ACEs among those treating chronic diseases.

A Scoping Review on Cue Reactivity in Methamphetamine Use Disorder

The experience of craving via exposure to drug-related cues often leads to relapse in drug users. This study consolidated existing empirical evidences of cue reactivity to methamphetamine to provide an overview of current literature and to inform the directions for future research. The best practice methodological framework for conducting scoping review by Arkey and O'Malley was adopted. Studies that have used a cue paradigm or reported on cue reactivity in persons with a history of methamphetamine use were included. Databases such as Medline, EMBASE, PsycINFO and CINAHL were searched using key terms, in addition to citation check and hand search. The search resulted in a total of 32 original research articles published between 2006 to 2020. Three main themes with regard to cue reactivity were identified and synthesized: (1) effects of cue exposure, (2) individual factors associated with cue reactivity, and (3) strategies that modulate craving or reactivity to cues. Exposure to methamphetamine-associated cues elicits significant craving and other autonomic reactivity. Evidence suggests that drug cue reactivity is strongly associated with indices of drug use and other individual-specific factors. Future studies should focus on high quality studies to support evidence-based interventions for reducing cue reactivity and to examine cue reactivity as an outcome measure.

Independent and combined associations of sleep duration and sleep quality with common physical and mental disorders: Results from a multi-ethnic population-based study

Sleep duration and sleep quality are often linked to increased risk of mortality and morbidity. However, national representative data on both sleep duration and sleep quality and their relationship with chronic health problems are rarely available from the same source. This current study aimed to examine the independent and combined associations of sleep duration and sleep quality with physical and mental disorders, using data from the Singapore Mental Health Study 2016. 6,126 residents aged ≥18years participated in this epidemiological, cross-sectional survey. Sleep measures were assessed using the Pittsburg Sleep Quality Index while lifetime or 12-month medical and psychiatric diagnoses were established using the Composite International Diagnostic Interview 3.0. Both short sleep (<6hrs compared to 7-8hrs) and poor sleep were found to be independently associated with chronic pain, obsessive compulsive disorder and any mental disorder while poor sleep was additionally associated with major depressive disorder, bipolar disorder, generalized anxiety disorder and any physical disorder, when adjusted for confounders. Poor sleep combined with short sleep (≤6hrs/day vs 7-8hrs/day) was associated with the highest number of comorbidities among other sleep combinations. Sleep duration and sleep quality, when adjusted for each other, remained independently associated with both physical and mental disorders. Affective disorders may be more closely related to poor sleep quality compared to abnormal sleep duration. Our findings suggest sleep quality to be a more important indicator for psychological and overall health compared to sleep duration.

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.

Psychiatry as a career choice among medical students: a cross-sectional study examining school-related and non-school factors

OBJECTIVES

Given the low recruitment to psychiatry worldwide, the current study aimed to examine how premedical and intramedical school factors, perception of career aspects, attitudes towards psychiatry, stigma towards mental illness and personality traits may affect the likelihood of psychiatry as a career choice.

DESIGN

Cross-sectional online study.

PARTICIPANTS

502 medical students from two public medical institutions in Singapore.

METHODS

We critically examined existing literature for factors identified to influence psychiatry as a career choice and explored their effects in a group of medical students in Singapore. To avoid overloading the regression model, this analysis only included variables shown to have significant association (p<0.05) with the outcome variable from the initial Χ² test and independent t-test analyses.

RESULTS

A considerable number of non-medical school factors such as preschool influence and interest, personality traits and importance of a high status specialty in medicine were found to affect students' choice of psychiatry as a career. Among medical school factors, attending a psychiatry/mental health club was the only influential factor. Negative attitudes towards psychiatry, but not stigma towards people with mental illness, significantly predicted the likelihood of not choosing psychiatry as a career.

CONCLUSIONS

Improving educational environment or teaching practice in psychiatric training may aid in future recruitment for psychiatrists. While the changing of premedical school influences or personality factors may be infeasible, medical schools and psychiatry institutes could play a more critical role by enhancing enrichment activities or clerkship experience to bring about a more positive attitudinal change towards psychiatry among students who did consider a career in psychiatry.

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.

Identifying the best sleep measure to screen clinical insomnia in a psychiatric population

BACKGROUND

Insomnia symptoms are highly prevalent among patients with psychiatric disorders, and this mandates the need to identify the best self-administered sleep measure to screen for clinical insomnia among them.

METHODS

A total of 400 psychiatric outpatients completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index (ISI), Epworth Sleepiness Scale, Flinders Fatigue Scale, Functional Outcomes of Sleep Questionnaire, and Dysfunctional Beliefs and Attitudes about Sleep Scale in a cross-sectional study. The sensitivity, specificity, positive, and negative predictive values of these six sleep scales were assessed and compared in relation to both ICD-10 and DSM-5 insomnia disorder status established using the interviewer-administered Brief Insomnia Questionnaire.

RESULTS

Receiver operator characteristic curves with the area under the curve (AUC) revealed the ISI to be the most accurate measure to discriminate cases and non-cases on both ICD-10 (AUC = 0.88, 95% CI = 0.84-0.92) and DSM-5 (AUC = 0.82, 95% CI = 0.78-0.86) criteria with "good" accuracy. The cut-off scores of ≥14 and ≥ 11 for the ISI provided optimal sensitivity and specificity for the detection of ICD-10 and DSM-5 insomnia, respectively.

DISCUSSION

With the new calling from DSM-5 to treat sleep symptoms in the presence of a co-existing mental condition, early detection of psychiatric patients with clinically significantly insomnia using a simple but accurate self-report sleep measure becomes important. Our study suggests that the ISI could be used as a potential screening tool for comorbid insomnia disorder in patients with mental disorders.

Correct recognition and continuum belief of mental disorders in a nursing student population

BACKGROUND

The current study aimed to explore the correct recognition of mental disorders across dementia, alcohol abuse, obsessive compulsive disorder (OCD), schizophrenia and depression, along with its correlates in a nursing student population. The belief in a continuum of symptoms from mental health to mental illness and its relationship with the non-identification of mental illness was also explored.

METHODS

Five hundred students from four nursing institutions in Singapore participated in this cross-sectional online study. Respondents were randomly assigned to a vignette describing one of the five mental disorders before being asked to identify what the person in the vignette is suffering from. Continuum belief was assessed by rating their agreeableness with the following statement: "Sometimes we all behave like X. It is just a question of how severe or obvious this condition is".

RESULTS

OCD had the highest correct recognition rate (86%), followed by depression (85%), dementia (77%), alcohol abuse (58%) and schizophrenia (46%). For continuum belief, the percentage of respondents who endorsed symptom continuity were 70% for depression, 61% for OCD, 58% for alcohol abuse, 56% for dementia and 46% for schizophrenia. Of concern, we found stronger continuum belief to be associated with the non-identification of mental illness after controlling for covariates.

CONCLUSIONS

There is a need to improve mental health literacy among nursing students. Almost a quarter of the respondents identified excessive alcohol drinking as depression, even though there was no indication of any mood symptom in the vignette on alcohol abuse. Further education and training in schizophrenia may need to be conducted. Healthcare trainees should also be made aware on the possible influence of belief in symptom continuity on one's tendency to under-attribute mental health symptoms as a mental illness.

A systematic review on comorbid post-traumatic stress disorder in schizophrenia

Post-traumatic stress disorder (PTSD) appears to commonly co-occur with schizophrenia, which is widely considered the most disabling mental illness. Both conditions share neurological risk factors, and present with symptoms that are superficially similar, complicating diagnostic accuracy. The presence of comorbid PTSD is also of concern as additional diagnoses tend to worsen functioning and quality of life. In the current review, EMBASE, Medline, and PsycINFO were searched for articles pertaining to PTSD comorbidity in schizophrenia spectrum disorders. Articles went through two stages of review prior to inclusion - one at the abstract level and another at the full-text level. Thirty-four articles were ultimately included in the present review. Prevalence of PTSD in schizophrenia ranged from 0 to 57%, likely due to study heterogeneity. Findings generally indicated that comorbid PTSD was associated with higher levels of positive symptoms, general psychopathology, and neurocognitive impairment, as well as worse functioning and quality of life. As such, it is important for clinicians to differentiate between psychotic and PTSD symptoms, and to pay attention to the associated features of comorbid PTSD in order to provide the most appropriate intervention. Unfortunately, epidemiological and longitudinal studies in this area are lacking.

Positive mental health in outpatients with affective disorders: Associations with life satisfaction and general functioning

BACKGROUND

Positive mental health (PMH) is an integral and essential component of health that encompasses emotional, psychological and social well-being. The Keyes' two continua model of mental health and illness posits that mental health status is not merely the absence of mental health problems, and it can be enhanced regardless of a diagnosis of mental illness. The present study hypothesized that mentally ill patients with higher levels of PMH would be associated with better life satisfaction and general functioning.

METHODS

218 outpatients with affective disorders at a tertiary psychiatric hospital were recruited and administered the multidimensional Positive Mental Health instrument, which was validated and developed in Singapore to measure PMH. Depression and anxiety severity were also assessed. Associations of positive mental health with life satisfaction and general functioning were investigated in linear regression models.

RESULTS

PMH scores varied largely within patients with depressive and anxiety disorders but did not differ statistically across the two diagnoses, except for emotional support. PMH was associated with both life satisfaction and general functioning with little evidence of confounding by sociodemographic and clinical status.

LIMITATIONS

The cross-sectional design of the study could not examine causal relationships. Findings may be restrictive to treatment-seeking population with specific affective disorders.

CONCLUSION

Our study provides evidence to support the notion that a good mental health state is not simply the absence of a mental disorder. Mentally ill patients can also have high levels of PMH that possibly have a moderating or mediating effect on the relationship between patients' clinical symptoms and life satisfaction or general functioning.

Sleep disturbance among people with major depressive disorders (MDD) in Singapore

BACKGROUND

Sleep problems are common with major depressive disorder (MDD), which has been identified as the most pervasive mental disorder in Singapore.

AIMS

This study aimed to establish the prevalence of sleep disturbance among adults with lifetime and 12-month MDD, as well as its socio-demographic and clinical correlates.

METHOD

Data were collected from the Singapore Mental Health Study, a cross-sectional epidemiological survey of the local residential population aged ≥18 years. Using the CIDI 3.0, 417 and 181 respondents with lifetime and 12-month MDD were included in the analysis.

RESULTS

The prevalence of insomnia-related sleep disturbance among those with lifetime and 12-month MDD was 90.9% and 91.4%, respectively. Multiple logistic regression analyses revealed ethnicity, education and the number of depressive episodes as well as clinical comorbidities such as obsessive compulsive disorder, diabetes and hypertension to be significantly associated with sleep disturbance among those with lifetime MDD. However, only 28.6% of those with sleep disturbance sought help from a professional.

CONCLUSIONS

The proportion of Singaporeans with MDD who have sleep disturbance is high, with increased risk for mental and physical health problems. Given the low rate of treatment contact, individuals with MDD must be screened and treated for sleep disturbance.