Perceived mental illness stigma among family and friends of young people with depression and its role in help-seeking: a qualitative inquiry.

BACKGROUND: Depressive disorders are a serious public health concern. Left untreated, further clinical distress and impairment in important life domains may arise. Yet, the treatment gap remains large. Prior research has shown that individuals with depressive disorders prefer seeking help from informal sources such as family and friends ahead of formal sources. However, this preference has its disadvantages such as experiencing actual, perceived and internalized stigmatizing responses from them which may delay or deter help-seeking. This paper aimed to determine the role of perceived stigma among family and friends in an individual's help-seeking behavior. METHODS: Data were collected using semi-structured interviews with patients with depressive disorders from a tertiary psychiatric hospital in Singapore to capture individuals' self-reported experience with depression and stigmatization among family and friends. Interviews were audio recorded and transcribed verbatim. Data of 33 young adults (mean age = 26 years, SD =4.6; 18 female, 15 male) were analyzed using thematic analysis. RESULTS: In all, four broad themes were developed: (1) absence of support, (2) provision of unhelpful support, (3) preference for non-disclosure, and (4) opposition towards formal help-seeking. Lack of awareness of depression and perpetuation of stigma manifests as barriers towards help-seeking in the form of absence of support and provision of unhelpful support which subsequently leads to a preference for non-disclosure, as well as opposition by family and friends towards formal help-seeking. CONCLUSIONS: Data from this study can contribute to the development of public health programs aimed at improving awareness and support from family and friends and facilitating earlier help-seeking among young people with depressive disorders.

Positive mental health framework of transdiagnostic protective factors in elucidating the association between adverse childhood experiences and severe mental disorders.

OBJECTIVES: Transdiagnostic risk factors-disrupted processes common to psychopathology-link adverse childhood experiences to severe mental disorders (i.e. major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders); however, transdiagnostic protective factors are understudied. The present study investigated the association between a positive mental health framework of protective intra- and interpersonal resources and severe mental disorders in individuals with adverse childhood experiences. We hypothesized that (1) individuals with adverse childhood experiences will experience more severe mental disorders and poorer intra- and interpersonal resources than those without adverse childhood experiences; (2) intrapersonal (e.g. general coping) and interpersonal resources (e.g. emotional support) will interact to predict severe mental disorders. METHODS: A total of 1929 adults participated in this population-based study. Participants were assessed for adverse childhood experiences, severe mental disorders, and intra- and interpersonal resources (general coping, general affect, emotional support, interpersonal skills, spirituality, and personal growth and autonomy) via structured interviews and self-reports. RESULTS: As hypothesized, individuals with adverse childhood experiences (62.6%) experienced more severe mental disorders and poorer intra- and interpersonal resources than those without adverse childhood experiences. Among those with adverse childhood experiences, emotional support interacted with general coping and general affect to predict severe mental disorders; general coping and general affect were negatively associated with severe mental disorders at high (+1 SD) and low (-1 SD) emotional support, respectively. CONCLUSIONS: The present study identified interactions between specific intrapersonal (i.e. general coping and general affect) and interpersonal resources (i.e. emotional support); knowing among whom and when to intervene are essential for optimal treatment of adverse childhood experiences and severe mental disorders.

The perspectives of healthcare professionals in mental health settings on stigma and recovery - A qualitative inquiry.

BACKGROUND: Mental health stigma is one of the most prominent barriers to recovery, and it is widely known that stigma may manifest differentially in different cultures. Healthcare professionals working closely with persons with mental illnesses (PMI) may provide important insights towards stigma that are otherwise unattainable from caregivers and consumers. However, there is a dearth of literature on healthcare professionals' perspectives on this topic. Thus, this study uses a multilevel approach to explore how stigma affects recovery from the perspectives of healthcare professionals that work closely with PMI in Singapore. METHODS: Semi-structured interviews were conducted with a total of 17 healthcare professionals who were working in mental health settings in Singapore. Participants were recruited via direct email invitation or through snowball sampling. Data collected was analysed with the inductive thematic analysis method. All coding and inter-rater analyses were performed with NVivo. RESULTS: The current study themes identified stigma-related factors that influence PMI's recovery from the perspectives of healthcare professionals working closely with PMI. These factors were organised into three overarching themes in a multilevel structure. The three themes were classified as Micro Factors (e.g., internalised stigma), Meso Factors (e.g., discrimination of people associated with the stigmatised group), and Macro Factors (e.g., structural stigma and stigma within healthcare settings). CONCLUSIONS: The findings of this study gave us a greater understanding of how stigma influences recovery in Singapore, which could be used to guide the development and implementation of future policies and strategies to promote recovery. Importantly, our results suggest that improving mental health literacy, addressing cultural misgivings towards mental illness, implementing recovery-oriented practices, and making insurance more accessible for PMI could mitigate the deleterious impact that stigma has on recovery.

Prevalence and impact of peer victimisation among youth seeking treatment at a tertiary psychiatric institution in Singapore: a cross-sectional study.

BACKGROUND: Peer victimization is common among adolescents and leads to negative consequences. However, few studies have examined the extent of peer-victimization and its correlates among adolescent patients in a psychiatric setting. The current study aimed to examine the prevalence and correlates of peer victimisation among youth with mental illness and to examine its association with depressive symptoms and health-related quality of life (HRQOL). METHODS: A sample of 239 youths aged 15-24 years were recruited from the outpatient clinics of a tertiary psychiatric hospital in Singapore using convenience sampling. All participants were administered the Multidimensional Peer Victimisation Scale (MPVS), Short Form 12 (SF-12) questionnaire and the Patient Health Questionnaire-8 (PHQ-8). The effect of MPVS  total and subscores on depression scores, quality of life subscores and quality of life total scores were examined using multiple linear regression analyses. RESULTS: The majority of the patients reported that they had experienced at least one form of peer victimisation (95.8%, n = 229) during their school years. Higher levels of 'verbal victimisation', 'attacks on property' and higher total MPVS scores were significantly associated with lower social functioning; additionally, higher levels of 'verbal victimisation' were significantly associated with lower mental component summary scores in the quality of life assessment. Higher scores on all four subscales as well as higher total scores on the MPVS were significantly associated with more severe depressive symptoms. CONCLUSIONS: Given the high prevalence of peer victimisation in our sample and its associations with more severe depressive symptoms and lower quality of life, it is vital to implement interventions that prevent peer victimisation in educational and other social settings and to provide youth with strategies to more effectively manage instances of peer victimisation.

Employer and Co-worker Perspectives on Hiring and Working with People with Mental Health Conditions.

The purpose of this study was to understand perspectives towards hiring and working with people with mental health conditions (PMHC). Semi-structured interviews with 25 employers and 20 co-workers were carried out. Thematic analysis was used to analyse the data. The barriers to hiring and working with PMHC identified through the interviews were concerns about safety, incompetence, PMHC not being able to get along with others, requiring more training and supervision as well as medical costs and reputational risks to the hiring organisation. Employers and co-workers suggested that improving mental health literacy of staff, pairing the PMHC with trained work buddies, having access to mental professionals when needed, and providing incentives for hiring PMHC such as tax rebates are likely to improve attitudes towards hiring and working with PMHC. Their suggestions for the additional supports required should be considered when developing initiatives to promote inclusivity of PMHC in workplaces.

A Qualitative Exploration of the Views of Policymakers and Policy Advisors on the Impact of Mental Health Stigma on the Development and Implementation of Mental Health Policy in Singapore.

Few studies have examined the views of policy makers regarding the impact of mental health stigma on the development and implementation of mental health policies. This study aimed to address this knowledge gap by exploring policymakers' and policy advisors' perspectives regarding the impact of mental health stigma on the development and implementation of mental health programmes, strategies, and services in Singapore. In all 13 participants were recruited for the study comprising practicing policymakers, senior staff of organisations involved in implementing the various mental health programmes, and policy advisors. Data was collected through semi-structured interviews, which were transcribed verbatim and analysed using reflexive thematic analysis. Data analysis revealed three superordinate themes related to challenges experienced by the policymakers/advisors when dealing with mental health policy and implementation of programmes. These themes included stigma as a barrier to mental health treatment, community-level barriers to mental health recovery, and mental health being a neglected need. Policymakers/advisors demonstrated an in-depth and nuanced understanding of the barriers (consequent to stigma) to mental healthcare delivery and access. Policymakers/advisors were able to associate the themes related to the stigma towards mental illness with help-seeking barriers based on personal experiences, knowledge, and insight gained through the implementation of mental health programmes and initiatives.

Confirmatory factor analysis and measurement invariance of the English, Mandarin, and Malay versions of the SF-12v2 within a representative sample of the multi-ethnic Singapore population.

BACKGROUND: The Short Form Health Survey (SF-12v2) is an increasingly popular measure of health-related quality of life (HRQoL) in Singapore. In order to examine whether the SF-12v2 was appropriate for use in the population, the factor structure and validity of the English, Mandarin, and Malay versions were assessed in a representative sample of the general population of Singapore. METHODS: 6126 respondents were recruited for the Singapore Mental Health Study 2016 (SMHS 2016), a cross-sectional and population-based survey. Confirmatory factor analyses (CFA) were conducted to examine the fit of a two-factor model for the SF-12v2 within a representative sample and amongst the different language (English, Mandarin, Malay) subgroups. Multiple-group CFAs (MGCFA) were conducted to test measurement invariance across the different languages, ethnicities, and chronic illnesses subgroups. CFA-generated latent factor scores (FSCORE command in MPlus) were also compared with the composite scores derived from the developer's scoring method via correlations. Sociodemographic correlates of the latent physical and mental health scores were explored. RESULTS: CFA results within the full sample supported a two-factor model (RMSEA = 0.044; CFI = 0.991; TLI = 0.988; SRMR = 0.044) in which physical functioning, role physical, bodily pain and general health items loaded onto a latent physical health factor, while role emotional, mental health, social functioning, and vitality items loaded onto a latent mental health factor. Physical and mental health factors were allowed to correlate, unlike the developer's orthogonal scoring method. All standardized loadings were high and statistically significant. Both factors had high internal consistency. CFA within subsamples of English, Mandarin, and Malay languages indicated similar findings. MGCFA results indicate that measurement invariance held across the different languages, ethnicities, and those with and without chronic illnesses. CONCLUSION: The present study identified a two-factor (physical and mental health) structure within the general population and amongst the three different languages and demonstrated the measurement invariance of SF-12v2 across different subgroups. Findings indicate that algorithm-derived PCS and MCS should be interpreted with caution as they may result in inaccurate conclusions regarding the relationships between HRQoL and its correlates. Future studies using the SF-12v2 within the general population of Singapore should consider utilizing the factor structure put forth in the present study to obtain more appropriate estimates of HRQoL.

Advancing research to eliminate mental illness stigma: an interventional study to improve community attitudes towards depression among University students in Singapore.

BACKGROUND: After decades of anti-stigma initiatives, the Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) intervention study is one of the first in Singapore to evaluate the effects of an anti-stigma intervention on attitudes towards depression in university students. METHODS: 390 university students from a local university in Singapore were voluntarily recruited for the study. The ARTEMIS intervention comprises an educational and social contact component, as well as a question and answer (Q&A) session with experts in the area of mental health. The Community Attitudes towards Mental Illness (CAMI) scale was administered at baseline, post-intervention and at 3-months follow-up. A confirmatory factor analysis (CFA) was conducted. RESULTS: The CFA identified a 3-factor model for the CAMI with a decent fit (RMSEA = 0.06, CFI = 0.93, TLI = 0.93, SRMR = 0.06). Favourable shifts in attitudes across the factors were observed immediately after the intervention (p <  0.001). Gender (ß = - 1.19, 95% CI: - 2.10, - 0.27, p = 0.01) and nationality (ß = - 1.23, 95% CI: - 2.35, - 0.11, p = 0.03) were identified as significant correlates for the community mental health ideology (CMHI) factor. Linear effects indicated that having a close social contact with mental illness observed a smaller decrease in authoritarianism scores from pre- to post-intervention (ß = 0.85, 95% CI: 0.18, 1.53, p = 0.01); whereas quadratic effects found a greater decrease in scores from post-intervention to after 3-months for benevolence (ß = - 0.34, 95% CI: - 0.52, - 0.16, p <  0.001) and CMHI (ß = - 0.22, 95% CI: - 0.45, - 0.002, p = 0.048). CONCLUSION: The anti-stigma intervention shows promising short-term results across the CAMI dimensions even after adjusting for sociodemographic correlates. However, the intervention did not observe the sustained attitude shifts after 3-months. Recommendations for future anti-stigma interventions were also considered.

Early age of onset of mood, anxiety and alcohol use disorders is associated with sociodemographic characteristics and health outcomes in adults: results from a cross-sectional national survey.

PURPOSE: This cross-sectional study investigated distribution, sociodemographic correlates, and health outcomes in early versus late age of onset (AOO) of mood, anxiety, and alcohol use disorders in Singapore. METHODS: The Composite International Diagnostic Interview established lifetime diagnoses of major depressive, bipolar, generalized anxiety, obsessive compulsive and alcohol use disorders in a representative sample of residents aged 18 years and over (n = 6126). The AOO of the individual and any mental disorders were classified into early and late onset using median values as cut-offs. Data included socio-demographic and health background, health utility score, and productivity losses. Multivariable logistic regression analysis was conducted to assess sociodemographic correlates of early versus late AOO of any mental disorder while linear regression analysis investigated the associations between AOO of individual disorders with health utility score and productivity loss. RESULTS: Respondents' mean (SD) age was 45.6 (16.5) years, comprising 50.5% women and majority of Chinese ethnicity (75.8%). The median AOO for any of the five studied disorders was 21 years (IQR: 15-29). Lowest AOO was observed for obsessive compulsive disorder (Median: 14, IQR: 11-26). Those aged 35 years and over (versus 18-34) were less likely to have earlier AOO [35-49 years (OR: 0.287; 95% CI: 0.154-0.534); 50-64 years (OR:0.156; 95% CI: 0.068-0.361) and 65 and over (OR:0.112; 95% CI:0.027-0.461)], while Malay ethnicity (versus Chinese) (OR: 2.319; 95% CI: 1.384-3.885) and being never married (versus married) (OR: 2.731; 95% CI: 1.493-4.993) were more likely to have early AOO for any mental disorder. Sample with early (versus late) AOO had a lower health utility score (ß = - 0.06,95% CI: - 0.08 to - 0.03) and higher number of days cut down on the type of work (ß = 1.61,95% CI: 0.12-3.10) in those with any mental disorders. CONCLUSION: This study showed that half of the adults with mood, anxiety or alcohol use disorders in Singapore experienced their illness onset by 21 years of age. Early AOO is associated with sociodemographic background and poor health outcomes. Prevention, early detection, and interventions to improve health outcomes in mental disorders should consider the sociodemographic profile and age at first onset of symptoms in the population.

Roles, Facilitators and Challenges of Employment Support Specialists Assisting Young People with Mental Health Conditions.

Purpose The present study aimed to understand the roles, effective strategies and facilitators, and challenges of employment support specialists (ESS) in assisting young people with mental health conditions (MHCs) gain and sustain employment in Singapore. Methods An interpretative qualitative design using an inductive approach was adopted for this study. Using a semi-structured interview guide, in-depth interviews were conducted with twenty ESS employed with mental health service providers or other community-based centers. Verbatim transcripts of the interviews were thematically analyzed using inductive methods. ESS were broadly classified as "any professionals providing employment-related support to people with MHCs". Results Majority of the ESS were employed at a tertiary psychiatric institute. Participants included vocational and occupational specialists, case managers and other clinical professionals. Three key themes emerged from the data: (i) descriptions of roles undertaken by the ESS depicting a wide range of services and requisite skillsets; (ii) facilitators that benefit young people with MHCs' in terms of job placement, for example, ESS' attitudes and attributes, and their clients' disposition; and (iii) challenges that deter effective job placements, such as factors pertaining to the ESS themselves, their clients, and clients' employers. Under this theme, ESS also proposed ways to improve employment opportunities of people with MHCs. Conclusions This study provided insight into a range of tasks performed and challenges faced by ESS in Singapore while assisting their clients. There is a need to address ESS' challenges and expectations in order to enhance their efficiency and aid reintegration of young people with MHCs into the workforce and the society.

Analysis and Interpretation of Metaphors: Exploring Young Adults' Subjective Experiences With Depression.

The aim of this study was to provide a cross-cultural exploration of how young adults with depression use metaphors to describe their illness experiences. Data were collected in semi-structured interviews, designed to capture rich and detailed descriptions of participants' firsthand narrative experiences of depression and how they make sense of depression. Thirty-three participant interview data were analyzed, using a combination of deductive and inductive approaches. The analysis resulted in extracting five major themes with sub-themes, which detail the diversity and vividness of metaphorical expressions embedded in participants' accounts and produce insights and a richer picture of the depression experience. Metaphors play a pivotal role in providing a rich resource that young adults rely on, to construct meaningful accounts about their illness. This highlights the importance of a metaphor-enriched perspective in research as well as in clinical practice, particularly in a multicultural health care setting.

Help-Seeking Patterns Among the General Population in Singapore: Results from the Singapore Mental Health Study 2016.

This study aimed to establish lifetime mental health service utilisation among the general population of Singapore. The sociodemographic correlates of those seeking help from different service provider groups and changes in lifetime mental health service utilisation between 2010 and 2016 among those with mental disorders were also explored. A population-based cross-sectional epidemiological household survey of the Singapore resident population aged 18 years and above was conducted from 2016 to 2018, using the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0. Data from two cross-sectional population-based studies were used for comparison of lifetime mental health service utilisation in 2010 (n = 6616) and 2016 (n = 6126). Chi square test and multiple logistic regression were used to analyse the data. A total of 6126 respondents completed the study in 2016. Overall 9.3% of the total sample, 32.0% of those with mental disorders, and 5.7% of those not meeting criteria for mental disorders, ever sought help for their mental health issues in their lifetime, from any treatment service sectors. Several sociodemographic characteristics were found to be correlated with different service provider groups. There was no change in mental health service utilisation between 2010 and 2016 for all mental disorders included in this study, with the exception of a significant increase in help sought from professionals in social services, among those with alcohol abuse. Even though the overall help-seeking rates are low, it is encouraging that those seeking help did so from mental health professionals and professionals working in the social services.

Association between sleep quality and domains of quality of life amongst patients with first episode psychosis.

BACKGROUND: There is a lack of studies exploring associations between sleep and quality of life (QOL) among patients with schizophrenia who have limited exposure to antipsychotics and are in the early stage of their illness. Our study investigates the association of poor sleep quality and its components with domains of QOL amongst patients with first episode psychosis (FEP). METHODS: Data was utilized from a longitudinal study that examined sleep, smoking and alcohol use amongst patients with FEP who were enrolled in the Early Psychosis Intervention Programme (EPIP). The data were collected during the patients' baseline visit; i.e., within 3 months of admission into the EPIP. The Pittsburgh Sleep Quality Index (PSQI) was employed to examine sleep quality and its 7 components over the last month. The WHO quality of life-BREF was used to examine QOL and its 4 domains: physical health, psychological, social relationship, and environment. Clinical data such as Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores were obtained from a clinical data base. Linear regression analyses were conducted to investigate the association between poor sleep quality and the domains of QOL. RESULTS: Amongst the 280 recruited patients, 62.9% suffered from poor sleep quality. Poor sleep quality was associated with significantly lower scores in all domains of QOL, despite controlling for socio-demographics and clinical variables. Respondents with higher scores in subjective sleep quality and daytime dysfunction were associated with lower scores in the physical health and social relationship domain. Furthermore, respondents with higher scores in subjective sleep quality, sleep latency and daytime dysfunction were associated with lower scores in the psychological domain of QOL. Finally, respondents with higher scores in subjective sleep quality were associated with lower scores in the environment domain of QOL. CONCLUSIONS: Our findings highlight the importance of monitoring sleep quality amongst patients with FEP to improve their QOL. Clinical programmes should also pay more attention to sleep components in order to maintain satisfactory QOL amongst patients with FEP. Future interventions should focus on improving the relevant sleep components to ensure better treatment outcomes.

Mental illness stigma's reasons and determinants (MISReaD) among Singapore's lay public - a qualitative inquiry.

BACKGROUND: Mental illnesses pose a significant burden worldwide. Furthermore, the treatment gap for mental disorders is large. A contributor to this treatment gap is the perceived stigma towards mental illness. Besides impeding one's help-seeking intentions, stigma also impairs persons with mental illness (PMI) in other aspects of their life. Studies have found that stigma may manifest differentially under different cultural contexts. Thus, this study seeks to elucidate the determinants of stigma towards PMI among lay public in Singapore using a qualitative approach. METHODS: A total of 9 focus group discussions (FGD) were conducted with 63 participants consisting of lay public Singaporeans who were neither students or professionals in the mental health field, nor had they ever been diagnosed with a mental illness. Topics discussed during the FGD were related to the stigma of mental illness. Data collected were analyzed with inductive thematic analysis method. A codebook was derived through an iterative process, and data was coded by 4 different coders. Both coding and inter-rater analysis were performed with NVivo V.11. RESULTS: In total, 11 themes for the determinants of stigma were identified and conceptualized into a socioecological model. The socioecological model comprised 4 levels of themes: 1) Individual level beliefs (fear towards PMI, perceiving PMI to be burdensome, dismissing mental illness as not a real condition), 2) Interpersonal influences (upbringing that instills stigma, intergroup bias, perceived inability to handle interactions with PMI), 3) Local cultural values (elitist mindset among Singaporeans, Chinese culture of "face", Islamic beliefs about spiritual possession and reaction towards PMI), and 4) Shared societal culture (negative portrayal by media, Asian values). CONCLUSIONS: The findings of this study improved our understanding of the various reasons why stigma exists in Singapore. The themes identified in this study concur with that of studies conducted overseas, as some determinants of stigma such as fear towards PMI are quite ubiquitous. Specifically, the themes elitist mindset among Singaporeans and perceived inability to handle interactions with PMI were unique to this study. It is highly recommended that future anti-stigma campaigns in Singapore should incorporate the findings of this study to ensure cultural misgivings and beliefs are addressed adequately.

The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students.

BACKGROUND: The reluctance of young adults to seek mental health treatment has been attributed to poor mental health literacy, stigma, preference for self-reliance and concerns about confidentiality. The purpose of this study was to examine the potential impact of an anti-stigma intervention that includes education about depression, information about help-seeking as well as contact with a person with lived experience, on help seeking attitudes. METHODS: A pre-post study design was employed. Changes in help-seeking attitudes were measured using the Inventory of Attitudes towards Seeking Mental Health Services (IASMHS) immediately post-intervention and after 3 months. Sociodemographic data, information on past experiences in the mental health field and contact with people with mental illness were collated. Three hundred ninety university students enrolled in the study. Linear mixed models were used to examine the effects of the intervention. RESULTS: Scores on all subscales of the IASMHS, Psychological Openness (PO), Help-seeking Propensity (HP) and Indifference to Stigma improved significantly post-intervention and at 3-month follow-up compared to pre-intervention, with HP demonstrating the highest effect size. However, a significant decline was observed on all three scales at 3-month follow-up compared to post-intervention. Gender, having friends/family with mental illness, and previous experience in the mental health field moderated the intervention effects for the PO and HP subscales. CONCLUSION: The study showed that the brief anti-stigma intervention was associated with improvements in help-seeking attitudes among university students with differential effects among certain sub-groups. As the beneficial outcomes appeared to decrease over time, booster sessions or opportunities to participate in mental health-related activities post-intervention may be required to maintain the desired changes in help-seeking attitudes.

A typology of nonsuicidal self-injury in a clinical sample: A latent class analysis.

Nonsuicidal self-injury(NSSI) is a behavioural concern and can present in diverse ways, varying by method, frequency, severity, function and so forth. The possible combinations of these features of NSSI produce an array of profiles that makes evaluation and management of this behaviour challenging. The aim of this study was to build upon previous work that reduces the heterogeneity of NSSI patterns by using latent class analysis (LCA) to identify a typology of NSSI. Participants consisted of 235 outpatients aged 14-35 years attending a tertiary psychiatric hospital in Singapore who had reported at least one NSSI behaviour within the last year. Eight indicators captured using the Functional Assessment of Self-Mutilation were used in the LCA: frequency of NSSI, length of contemplation before engaging in NSSI, usage of more than three NSSI methods, suicidal ideation and four psychological functions of NSSI, that is, social-positive, social-negative, automatic-positive and automatic-negative. The LCA revealed three distinct groups: Class 1-Experimental/Mild NSSI, Class 2-Multiple functions NSSI/Low Suicide Ideation and Class 3-Multiplefunctions NSSI/Possible Suicide Ideation. Multinomial logistic regression analyses were conducted to examine the associations between class membership and sociodemographic variables as well as measures of emotion dysregulation, childhood trauma, depression and quality of life. Females were overrepresented in Class 3. In general, Class 3 had the poorest scores followed by Class 2. Our analyses suggest that different NSSI subtypes require different treatment indications. Profiling patterns of NSSI may be a potentially useful step in guiding treatment plans and strategies.

Living arrangements and cognitive abilities of community-dwelling older adults in Singapore.

AIM: Dementia is a growing public health concern. It is necessary to focus on factors that may help preserve cognitive function in late life. Limited research has examined how living arrangements are associated with cognitive function in older adults. This study aims to further our understanding of this association in community-dwelling older adults in a multi-ethnic Asian population. METHODS: Data were obtained from a cross-sectional population survey of 2548 adults aged 60 and older with standardized instruments. Living arrangements were classified as living with adult children and grandchildren, living with adult children only, living with a spouse/partner only, living alone, living with other relatives, and living with non-relatives. RESULTS: Cognitive function was significantly predicted by living arrangements among community-dwelling older adults. Multivariate linear regression analyses revealed that older adults in multigenerational family households had significantly poorer cognitive function than those living with a spouse/partner (ß = 0.54, P < 0.02) and those living with non-relatives (ß = 1.08, P < 0.02). This association was independent of the influence of age, gender, ethnicity, education, employment status, marital status, depression, disability, chronic health conditions, and self-reported health. CONCLUSION: Older adults living in multigenerational households seem to be disadvantaged in their cognitive function. However, we cannot conclude this based on the evidence because of the cross-sectional nature of the data. Further research is needed to reasonably determine the relationship between living arrangements and cognitive function. Regardless, these findings add to the growing understanding of the complex relationship between living arrangements and cognition in older adults and could provide a basis to design effective strategies to delay cognitive decline in community-dwelling older adults.

Hazardous alcohol use in a sample of first episode psychosis patients in Singapore.

BACKGROUND: Hazardous alcohol use has often been found to be more prevalent amongst psychiatric outpatients than the general population. Additionally, it has also been associated with poorer outcomes. The study aimed to investigate (1) the prevalence and (2) socio-demographic and clinical correlates of hazardous alcohol use, as well as (3) the relationship between hazardous alcohol use and quality of life in an outpatient sample with First Episode Psychosis (FEP) in Singapore. METHODS: Baseline data (N = 280) was extracted from a longitudinal study investigating smoking and alcohol use amongst outpatients with FEP in a psychiatric hospital. Information on socio-demographics, hazardous alcohol use, and quality of life was collected through a self-report survey. Hazardous alcohol use was ascertained by total scores of 8 or higher on the Alcohol Use Disorders Identification Test (AUDIT). Data was analysed using logistic regression and linear regression analyses. RESULTS: The prevalence of hazardous alcohol use over the past 12-month period was 12.9%. Those who had never smoked in their lifetime (vs current smokers) and those with a diagnosis of brief psychotic disorder (vs schizophrenia spectrum disorders) were found to have significantly lower odds of hazardous alcohol use. Hazardous alcohol use was also associated with lower negative symptom scores. Lastly, hazardous alcohol use was found to significantly predict lower scores on the physical health, social relationship and environment domains of quality of life. CONCLUSIONS: The association between hazardous alcohol use and lower negative symptom scores is a surprising finding that needs to be further explored. The significant impact of hazardous alcohol use in reductions in quality of life suggests that early screening and interventions could benefit patients with hazardous alcohol use and comorbid psychosis.

The prevalence of childhood trauma in psychiatric outpatients.

BACKGROUND: The aim of this present study was to compare the prevalence and type of trauma experienced by community sample with the outpatient sample with mental disorders. METHODS: A total of 354 outpatients, aged 14-35 years old, with mood disorders, schizophrenia and other psychotic disorders, adjustment disorder and anxiety disorder were recruited from a tertiary psychiatric hospital. A total of 100 healthy controls were recruited from the Singapore general population by snowballing. The Childhood Trauma Questionnaire-Short Form (CTQ-SF) designed to measure childhood trauma and the severity (e.g., physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect) was administered to participants. Socio-demographic and clinical characteristics were obtained from interviews with the participants and from outpatients' medical records, respectively. Independent sample t tests and Chi-square tests were used to investigate the differences between the outpatient and community samples. RESULTS: Overall the CTQ-SF total and domain scores indicated that outpatient sample experienced higher rate of traumatic life events in childhood than community sample. Two most reported trauma types were emotional abuse (n = 81, 59.1%) and physical neglect (n = 74, 54%) reported by the mood disorder group. In the community sample, emotional neglect (n = 46, 46%) and physical neglect (n = 18, 18%) were the most commonly reported trauma type. Overall outpatient sample (n = 80, 22.6%) and community sample (n = 28, 28%) reported at least one type of trauma. CONCLUSION: The findings indicate higher rates of CTQ-SF total and domain scores in outpatient sample demonstrating a higher rate of traumatic life events in childhood compared to community sample. Further research in childhood trauma is needed to improve the knowledge in psychiatric clinic practices.

The importance of considering differential item functioning in investigating the impact of chronic conditions on health-related quality of life in a multi-ethnic Asian population.

PURPOSE: The present study aims to examine the impact of chronic conditions after adjusting for differential item functioning (DIF) on the various aspects of health-related quality of life (HRQoL) in a multi-ethnic Asian population in Singapore. METHOD: Data on 3006 participants from a nation-wide cross-sectional survey of mental health literacy conducted in Singapore were used. Multiple Indicators Multiple Causes model was used to investigate the effects of chronic medical conditions on various HRQoL dimensions assessed with the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) after adjusting for DIF. RESULTS: Twenty out of 36 items were detected with DIF for chronic conditions including high blood pressure, cardiovascular disorders, diabetes, cancer, neurological disorders and ulcer as well as for a few demographic factors such age, gender and marital status. Twenty significant associations between chronic conditions and SF-36 domains were observed. After controlling for all chronic conditions, socio-demographic and DIF items, a significant association emerged between cardiovascular disorders and physical functioning, while the association between diabetes and ulcer and general health became nonsignificant. All other associations remained statistically significant. CONCLUSION: Our findings provide useful information and important implications of DIF on the impact of chronic conditions on HRQoL. We found the impact of DIF with respect to the impact of chronic conditions on HRQoL to be minimal after accounting for measurement bias in this multiracial Asian population.