Risk Factors for Tardive Dyskinesia among Asian Patients with Schizophrenia

Ph.DDOCTOR OF MEDICIN

Trends in Subjective Quality of Life Among Patients With First Episode Psychosis—A 1 Year Longitudinal Study

Quality of life (QoL) is often used as an outcome assessment in programs treating patients with first-episode psychosis (FEP). The aim of this study was to examine the longitudinal trend of subjective QoL among patients with FEP and identify the potential influence of patients' social-demographic/lifestyle factors on the trend of QoL. Two hundred and eighty subjects participated in the study. Patient's demographics and subjective QoL were collected at baseline, 6 months and 1 year follow-up. Data were analyzed with a fixed-effect general linear regression model. Subjective QoL demonstrated significant trends of improvement in all four subdomains (physical health, psychological health, social relationships, and environment). Compared with unemployed participants, employed participants were significantly associated with better social relationships (p = 0.005) and environment (p = 0.029) after adjusting for age and gender. Moderation analysis demonstrated a significant improvement of physical health, social relationships, and environment for participants with a higher level of educational achievement, but not for participants with a lower level of educational achievement. Our results indicate that patients with FEP experienced significant improvement in subjective QoL over a 1 year period. Being employed was associated with overall better social relationships and environment among patients with FEP and higher educational achievement was associated with improvement of physical health, social relationship, and environment. Hence, educational achievement and employment could be considered for future optimization of early psychosis intervention programs

Prevalence of and factors related to the use of antidepressants and benzodiazepines: results from the Singapore Mental Health Study

BACKGROUND: Prescription and use of antidepressants and benzodiazepines are common in the general population. Prescription of psychotropic drugs is a complex process: patient, physician and healthcare characteristics mediate, interact and influence it. The current study aimed to establish the prevalence and factors associated with the use of antidepressants (ADs) and benzodiazepines (BZDs) in Singapore. METHODS: The Singapore Mental Health Study (SMHS) was a nationally representative survey of Singapore Residents aged 18 years and above. Face-to-face interviews were conducted from December 2009 to December 2010. The diagnoses of mental disorders were established using the Composite International Diagnostic Interview version 3.0 (CIDI-3.0). The pharmacoepidemiology section was used to collect information on medication use. RESULTS: The overall prevalence estimates for ADs and BZDs use during the 12 months prior to the interview were 1.1% and 1.2% respectively. In all, 2.0% had used ADs and/or BZDs. ‘Help seeking for emotional or mental health problems’ was the most important predictor for the use of ADs and BZDs—help seekers were much more likely to use ADs (adjusted OR: 31.62, 95% CI: 13.36–74.83) and more likely to use BZDs than non-help seekers in the previous 12 months (adjusted OR: 34.38, 95% CI: 12.97–91.16). Only 27.6% of those with 12-month major depressive disorder (MDD) had sought formal medical help for their problems and ADs were being used by just over a quarter of this ‘help-seeking group’ (26.3%). CONCLUSIONS: We found that the use of ADs and BZDs in our population was relatively low, and ‘help-seeking’ was the most important predictor of the use of ADs and BZDs. In concordance with research from other Western countries, use of ADs was low among those with 12-month MDD

Smoking and Socio-demographic correlates of BMI

Abstract Background The aim of the current study was to examine the associations between Body Mass Index (BMI) and socio-demographic factors and to examine the relationship between BMI, smoking status and ethnicity. Methods The Singapore Mental Health Study (SMHS) surveyed Singapore Residents (Singapore Citizens and Permanent Residents) aged 18 years old and above. BMI was calculated using height and weight which were self-reported by respondents. Socio-demographic characteristics and smoking status were recorded in a standardized data collection form. Results Six thousand and six hundred sixteen respondents completed the study (response rate of 75.9 %) which constituted a representative sample of the adult resident population in Singapore. Ethnicity, gender and education status were associated with obesity. There was an interaction effect between ethnicity smoking status, and BMI. Indian and Malay smokers were less likely to be obese compared to Chinese smokers. The relationship between ethnicity and BMI was thus reversed when smoking was taken into account. Conclusions The study identified certain subgroups and risk factors that are associated with obesity. There is a need for further research to explore and identify genetic, metabolic and ethnic differences that underlie the interaction between ethnicity and smoking status which affects BMI

Hoarding Among Outpatients Seeking Treatment at a Psychiatric Hospital in Singapore

Hoarding symptoms commonly co-occur with other psychiatric disorders, such as major depressive disorder, and have been observed across cultures. Yet, few studies have examined hoarding in other disorders or in an Asian context. The present study aimed to determine: (1) the prevalence of clinically significant hoarding, (2) differences between participants with and without significant hoarding, and (3) predictors of hoarding severity in a Singaporean clinical sample. Five hundred outpatients with anxiety disorders, depressive disorders, schizophrenia, and pathological gambling completed a battery of questionnaires on hoarding, anxiety, depression, functional impairment due to clutter, and quality of life. Thirty percent of our sample reported significant hoarding. However, clutter levels in the hoarding group were low, and hoarding severity was not significantly linked to quality of life, after adjusting for anxiety and depression. In addition, depression - but not anxiety - predicted hoarding severity. Our results provide a cross-cultural perspective on hoarding symptoms, and replicate findings that support a link between depression and hoarding. The differential presentation of hoarding in our sample could be due to true cultural differences in hoarding pathology or to variant psychometric properties of the measures used. Further research evaluating hoarding in Asian contexts with different methodology is needed

Gambling and family: A two-way relationship

Families play an important role in the evolution of gambling and are also adversely affected by the disordered gambling of any one of their members. The aims of this study were to explore both the role families play in gambling initiation, maintenance, and help-seeking, and the harm caused to families by the gambling behavior using a qualitative approach. Methods Regular older adult gamblers were included in the study. In-depth interviews were conducted with 25 older adults to gain an understanding of gambling from their perspective. Older adult gamblers described their lived experience of gambling ranging from initiation to harm and attempts to cut down or limit gambling. Data were analyzed using thematic network analysis. Results The mean age of the 25 participants was 66.2 years. The majority were male (n = 18), of Chinese ethnicity (n = 16), had secondary education (n = 9), were married (n = 20), and currently employed (n = 15). Four organizing themes related to the role of families in initiation and maintenance of gambling, harm caused to family members, and their role in help-seeking were identified. Discussion and conclusions The study emphasizes the role of Asian families in both initiation and maintenance of gambling. Hence, families must be involved in prevention and outreach programs. Family members must be educated, so that they can encourage help-seeking to ensure early treatment and recovery. There is a need for interventional studies for reducing stress and improving coping among family members

Religiosity, Religious Coping and Distress Among Outpatients with Psychosis in Singapore

This study aimed to investigate the prevalence of religious coping and explore the association between religious coping, religiosity, and distress symptoms amongst 364 outpatients diagnosed with psychosis in Singapore. Positive and Negative Religious Coping (PRC and NRC), religiosity (measuring the constructs of Organised Religious Activity (ORA), Non-Organised Religious Activity (NORA), and Intrinsic Religiosity (IR)) and severity of distress symptoms (depression, anxiety and stress) were self-reported by the participants. The majority of participants (68.9%) reported religion to be important in coping with their illness. Additionally, multiple linear regression analyses found that NRC was significantly associated with higher symptoms of distress. In contrast, ORA was significantly associated with lower anxiety symptom scores. Overall, the study indicates the importance of religion in coping with psychosis and the potential value in incorporating religious interventions in mental health care

The positive mental health instrument: development and validation of a culturally relevant scale in a multi-ethnic asian population

<p>Abstract</p> <p>Background</p> <p>Instruments to measure mental health and well-being are largely developed and often used within Western populations and this compromises their validity in other cultures. A previous qualitative study in Singapore demonstrated the relevance of spiritual and religious practices to mental health, a dimension currently not included in exiting multi-dimensional measures. The objective of this study was to develop a self-administered measure that covers all key and culturally appropriate domains of mental health, which can be applied to compare levels of mental health across different age, gender and ethnic groups. We present the item reduction and validation of the Positive Mental Health (PMH) instrument in a community-based adult sample in Singapore.</p> <p>Methods</p> <p>Surveys were conducted among adult (21-65 years) residents belonging to Chinese, Malay and Indian ethnicities. Exploratory and confirmatory factor analysis (EFA, CFA) were conducted and items were reduced using item response theory tests (IRT). The final version of the PMH instrument was tested for internal consistency and criterion validity. Items were tested for differential item functioning (DIF) to check if items functioned in the same way across all subgroups. <b>Results: </b>EFA and CFA identified six first-order factor structure (General coping, Personal growth and autonomy, Spirituality, Interpersonal skills, Emotional support, and Global affect) under one higher-order dimension of Positive Mental Health (RMSEA = 0.05, CFI = 0.96, TLI = 0.96). A 47-item self-administered multi-dimensional instrument with a six-point Likert response scale was constructed. The slope estimates and strength of the relation to the theta for all items in each six PMH subscales were high (range:1.39 to 5.69), suggesting good discrimination properties. The threshold estimates for the instrument ranged from -3.45 to 1.61 indicating that the instrument covers entire spectrums for the six dimensions. The instrument demonstrated high internal consistency and had significant and expected correlations with other well-being measures. Results confirmed absence of DIF.</p> <p>Conclusions</p> <p>The PMH instrument is a reliable and valid instrument that can be used to measure and compare level of mental health across different age, gender and ethnic groups in Singapore.</p

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

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

Exploring views and experiences of the general public’s adoption of digital technologies for healthy lifestyle in Singapore: a qualitative study

ObjectiveLittle is known about the general adult population’s adoption of digital technology to support healthy lifestyle, especially when they are expected to take greater personal responsibility for managing their health and well-being today. The current qualitative study intended to gain an in-depth understanding of determinants of digital technology adoption for healthy lifestyle among community-dwelling adults in Singapore.DesignA qualitative study design, with thematic framework analysis was applied to develop themes from the data.SettingSemi-structured individual interviews were conducted with participants either face-to-face or online through a videoconferencing platform.Participants14 women and 16 men from the general population who were between the ages of 22 and 71 years.ResultsThree major themes were developed: (1) digitally disempowered (2) safety and perceived risks and harm; (3) cultural values and drives. Adoption of technology among the general population is needs-driven, and contingent on individual, technological and other cross-cultural contextual factors.ConclusionOur findings highlight there is no one solution which fits all individuals, emphasizing the challenges of catering to diverse groups to reduce barriers to adoption of digital technologies for healthy lifestyle. Digital guidance and training, as well as social influences, can motivate technological adoption in the population. However, technical problems as well as data security and privacy concerns should first be adequately addressed. This study provides rich cross-cultural insights and informs policy-making due to its alignment with government public health initiatives to promote healthy lifestyle