Depression outcome expectancy in primary care in Singapore: symptom severity as a mediating determinant

Background: Depression has been identified as the most common mental illness in Singapore. To address this growing concern, the current study focused on the population within the primary care setting since depression has been demonstrated to be highly prevalent in these patients. This study examined the possible predictors of outcome expectancy based on illness perception and depression severity. Methods: One hundred and one adult patients with depressive symptoms in primary care were recruited for a cross-sectional study. Positive outcome expectancy was measured using the Depression Change Expectancy Scale, and illness perception was measured using the Illness Perception Questionnaire Mental Health. Depression severity was derived from the Patient Health Questionnaire-9 scores extracted from the participants' medical records. Regression and mediation analyses were applied to explore possible predictors of positive outcome expectancy. Results: Regression analysis demonstrated that symptom severity, and specific dimensions under illness perception (i.e., perception of chronicity, perception of personal control, and perception of treatment control) were the most significant predictors of positive outcome expectancy. Mediation analysis found that symptom severity partially mediated the relationship between perception of chronicity and positive outcome expectancy. Conclusions: Pharmacotherapy, interventions from allied health professionals, and psychotherapeutic interventions (e.g., strategies from positive psychology, solution-focused therapy, and strengths-based cognitive behavioral therapy) that aim to directly alleviate depressive symptoms as well as improve the perceptions of chronicity, personal control, and treatment control could potentially enhance treatment benefits in primary care patients with depression

Patient-defined recovery from depression in primary care in Singapore

Research on consumer-defined recovery from mental illness has been criticised for a lack of quantitative analyses and conceptual clarity. This study aims to address this by statistically testing the possible associations between a major model of the stages of recovery and five postulated processes that have been theorised to drive recovery. Eighty-eight participants, who attended psychological consultation for depression at the National Healthcare Group Polyclinics, were recruited. Questionnaires on recovery stages and the five recovery processes were directly administered, while the measure for depressive symptoms were extracted from case file data. Results showed that the five recovery processes were associated with the recovery stages in a manner that supported this recovery model for patients with depression in primary care. However, most of these associations became nonsignificant when the severity of depression was controlled for. Thus, further research is needed to precisely identify the impact of the severity of depression on the patients’ experience of their recovery journeys

Your perception may predict your anxiety level: a preliminary study in primary care in Singapore

Background: Patients’ perception of their medical illness has been shown to associate with not only their responses to the illness but under certain conditions even outcomes of their illness. While anxiety is prevalent among primary care patients, illness perception studies relating to anxiety in this population are scarce. This study aimed to fill this gap and explore clues for perceptual elements of primary care patients’ effective management of their own anxiety. Methods: Ninety-five adult participants (65% female and 35% male) were recruited in two primary care clinics in this cross-sectional study. The questionnaires administered were Generalized Anxiety Disorder-7 (GAD-7) and Illness Perception Questionnaire Mental Health (IPQ-MH) were used to assess anxiety and illness perception respectively. Data analysis was conducted using Spearman’s rho correlation coefficients and linear regression. Results: Four specific dimensions of the participants’ illness perception (i.e., consequences, personal control, coherence and biology) were found to be significantly correlated with their severity of anxiety. In other words, the participants experienced higher anxiety when they perceived a serious impact of anxiety in their lives, experienced a diminished sense of self-efficacy, had trouble understanding their condition and attributed their anxiety to biological causes (which could presumably be ameliorated only with medication). Conclusion: Attribution to biological factors and personal control were highly significant predictors of severity of anxiety. Clinicians should consider psychological interventions that target patients’ medication adherence as well as their physiological responses to anxiety (e.g., breathing skills). Further, anxiety patients’ experience of personal control should be enhanced which could be facilitated through deliberate assessment and reinforcement of the strengths and resources in the patients’ psychosocial spheres

Predictors of motivation for type 2 diabetes mellitus self management of patients in primary care in Singapore

Background: Diabetes is among the top 10 causes of death in Singapore, which has the second-highest proportion of diabetics among all developed nations. Diabetic patients’ self-management is often driven by their perceptions about their own chronic condition. This study explored specific aspects of patients’ (1) cognitive appraisal, (2) emotional distress and (3) a motivational measure in relation to their diabetic condition and attitude toward self-management. Methods: Seventy adult participants (41 female and 29 male) with type-2 diabetes were recruited in this cross-sectional study from patients who sought psychological consultation at polyclinics. The questionnaires administered were (1) Brief Illness Perception Questionnaire, (2) Diabetes Distress Scale, (3) Generalised Anxiety Disorder-7, (4) Insomnia Severity Index, (5) Patient Health Questionnaire-9, (6) Readiness-to-Change Ruler and (7) Sheehan Disability Scale. Results: Multiple regression analysis showed that severity of insomnia symptoms (β = -.26 , p < .05), emotional distress of diabetes (β = -.48 , p < .05), interpersonal distress of diabetes (β = -.35 , p < .05), total distress of diabetes (β = .58 , p < .05), and perception of personal control over diabetes (β = .-.30, p < .05) were significantly associated with reported motivation for engaging in diabetes self-management (R2 = .26, F(5, 62) = 4.26, p < 0.01). Conclusion: Insomnia, emotional distress and perception of personal control over diabetes significantly predicted patients’ reported motivation for diabetes self-management. It may be more productive for clinicians to focus their interventions on these particular aspects of diabetic patients’ experience in promoting self-management behaviour. Future studies may involve (1) the measurement of actual self-management behaviour beyond participants’ report of their motivation to engage in such desirable behavior and (2) qualitative approaches for understanding subjective dimensions of “insomnia,” “distress” and “personal control” in relation to diabetes self-management

Influence of change expectancy and recovery processes on depression severity

Consumer recovery processes refer to social Connectedness, Hope, Identity, Meaning in life, and Empowerment ("CHIME"). This study examined if expectations of change in depression could mediate the relationship between CHIME recovery processes and depression severity. Participants were patients who consulted clinical psychologists at primary care clinics. Measures of depression change expectancy, CHIME recovery processes, and depression symptoms were administered. Change expectancy partially mediated the relationship between Hope and depression severity. The same was found for Identity, but Identity also mediated the relationship between change expectancy and depression. Thus, Hope may reduce depression by improving change expectancies, whereas Identity and change expectancy may have reciprocal influences that alter depression. Findings suggest that the CHIME recovery processes may facilitate recovery from depression

Cultural Responses to Covid-19 Pandemic:Religions, Illness Perception, and Perceived Stress

Many psychological researchers have proven the deteriorating effects of the coronavirus disease 2019 (Covid-19) pandemic on public mental health. In Malaysia, various Covid-19 clusters were associated with religious gatherings. From a cultural psychology perspective, how ethno-religious groups respond to this crisis originating from their unique rationality and ecological systems. Therefore, this study aimed to explore the illness perceptions of major religious groups (Christian, Muslim, and Buddhist) in Malaysia toward the Covid-19 pandemic, their stress levels, and the relationship between illness perception, stress, and forms of religious expression during the lockdown period. Through an online survey method, 608 Malaysian religious believers were included in this mixed-method empirical study, which adapted standardized instruments [Duke University Religion Index (DUREL), Brief Illness Perception Questionnaire (BIPQ), and Perceived Stress Scale (PSS)]. Statistical analysis showed that all three groups reported moderate levels of stress in average without any significant difference after controlling for age. Both internal and external forms of religious expression had a significant negative relationship with stress levels. Personal control, comprehension, and emotions domains of illness perception accounted for a significant variance in the stress level. Furthermore, religious expression significantly moderated the relationship between some illness perception domains and stress. Qualitative coding revealed that most participants perceived human behavior and attitudes, sociopolitical, and sociological factors as causal factors to the current pandemic. These findings confirmed the relationship between religious expression, illness belief, and stress regulation during the pandemic lockdown. Incidental findings of age as a potential protective factor for Malaysian believers warrants further study. In the conclusion, implications for public health policymakers and religious communities on pandemic prevention and well-being promotion were discussed

Recapitalization of Amphibious Operation and Lift

Includes supplementary material.CAPSTONE PROJECT REPORTSystem Engineering and Analysis Cohort 18A and Temasek Defense Systems InstituteThe aging Whidbey Island and Harpers Ferry class ships, LSD-41 and 49 respectively, comprise just over one third of the amphibious navy. However, a solution to the capability gap created by the loss of these ships is needed to maintain the effectiveness of the amphibious fleet across a broad spectrum of mission areas. This research effort considers future ship designs and fleet architectures to meet the capability gaps left by the decommissioning of the LSD-41 and 49 class ships. With respect to lift capacity, performance capability, cost and a risk assessment, the analysis showed the LPD-17 or a LSD(X) approximately 30% larger than the existing classes to be acceptable replacement classes. This analysis also supports further research to determine the most robust fleet architecture apart from the current eleven LHA or LHD, eleven LPD and eleven LSD paradigm.Approved for public release; distribution is unlimited