Mapping the PHQ-8 to EQ-5D, HUI3 and SF6D in patients with depression.

BACKGROUND: There is limited evidence of mapping clinical instruments to a generic preference-based instrument in Asian patient populations. The current study aims to map the eight-item Patient Health Questionnaire depression scale (PHQ-8) onto the EuroQol Five-Dimension (EQ-5D), the Health Utilities Index Mark 3 (HUI3) and the Short Form Six-Dimension (SF-6D) which helps to inform future cost-utility analyses of treatments for depression. METHODS: A total of 249 participants who had completed PHQ-8, EQ-5D, SF-6D and HUI3 questionnaires were included in the analyses. A beta regression mixture model was used to map the utility scores as a function of PHQ-8 total scores, PHQ-squared, age and gender. The predictive accuracy of the models was examined using mean absolute error and root mean square error. RESULTS: The results were compared against two common regression methods including Ordinary Least Square (OLS) and Tobit regression models. The mean age of the sample was 36.2 years (SD = 11.1). The mean EQ-5D-3L, EQ-5D-5L, HUI3 and SF-6D utility scores were 0.615, 0.709, 0.461 and 0.607, respectively. The EQ-5D-3L, EQ-5D-5L and SF-6D utility scores were best predicted by the beta mixture regression model consisting of PHQ-8 total sores, PHQ-squared, and covariates including age and gender. The HUI3 was best predicted by the OLS regression model. CONCLUSIONS: The current study provides important evidence to clinicians and researchers about the mapping algorithms that can be used in economic evaluation among patients with depression.

The association between caregiver burden, distress, psychiatric morbidity and healthcare utilization among persons with dementia in Singapore.

BACKGROUND: Caregivers of persons with dementia (PWD) face high caregiving burden, distress related to responsive behaviours, and psychiatric morbidity. The present paper examines how these are associated with healthcare utilization of the PWD in Singapore. METHODS: The data of 399 caregiver-PWD dyads were extracted from a national cross-sectional survey. PWD completed the Client Service Receipt Inventory, which provided information on their healthcare utilization (i.e. emergency service use, hospital admission, length of stay in hospital, and number of outpatient visits) within a frame of 3 months. The Zarit Burden Interview  (ZBI), Neuropsychiatric Inventory Questionnaire (NPI-Q), and Self Reporting Questionnaire (SRQ-20) were administered to caregivers. Information on severity of dementia, physical multimorbidity of the PWD, household composition, and caregivers' sociodemographic characteristics such as age, gender, and education were collected. Variables significantly associated with healthcare utilization in the univariate analyses were selected and included in the final regression models. Emergency service use and hospital admission were investigated using logistic regression analyses, whilst negative binomial models were utilized for length of stay in hospital and number of outpatient visits. RESULTS: After adjusting for significant correlates such as dementia severity and multimorbidity, only caregiver distress from responsive behaviours was positively associated with emergency room utilization, while caregiver burden was positively associated with length of hospital stay in the final regression model. Psychiatric morbidity was associated with healthcare utilization outcomes at the univariate level but did not reach statistical significance in final models. CONCLUSION: The study identifies caregiver variables associated with the healthcare utilization of PWD. Policy makers and healthcare professionals should provide interventions to ease burden and distress amongst caregivers of PWD.

Understanding the relationships between mental disorders, self-reported health outcomes and positive mental health: findings from a national survey.

BACKGROUND: The link between mental illness and mental health is gaining focus in research and practice. This study aimed to investigate the association of mental disorders with positive mental health (PMH), overall health and quality of life. In addition, the role of PMH in mediating the relationships between mental disorders and health outcomes was assessed. METHODS: The study sample comprised 2270 residents aged 18 years and above who participated in a nationally representative, cross-sectional survey estimating the lifetime prevalence of mood, anxiety and alcohol use disorders, and health outcomes (self-reported overall health, quality of life and PMH) in Singapore. The Positive Mental Health Instrument was used to estimate the level of Total PMH among the respondents with and without mental disorders. Associations between mental disorders and health outcomes were assessed through regression models. Path analyses were conducted to investigate mediating role of PMH. RESULTS: Total PMH (Mean ± SD) was significantly lower among individuals having any of the studied lifetime mental disorders (4.23 ± 0.64 versus 4.50 ± 0.67 among those without these disorders). Although having a mood or anxiety disorder was associated with significantly lower Total PMH even after controlling for socio-demographic characteristics, similar relationship was not observed for alcohol use disorders. History of any mental disorders was also associated with lower overall health and quality of life. Total PMH mediated the relationships between mental disorders and overall health and quality of life by reducing the effect sizes for the associations between mental disorders and these health outcomes. CONCLUSIONS: Mental disorders were associated with poor health outcomes in affected individuals. This study showed that PMH can mediate the relationships between mental disorders and health outcomes, and act as an underlying mechanism to improve overall health and quality of life in individuals with mental disorders. Findings thus highlight the significance of incorporating mental health promotion and interventions in clinical populations.

Development and validation of the Rapid Positive Mental Health Instrument (R-PMHI) for measuring mental health outcomes in the population.

BACKGROUND: The multidimensional Positive Mental Health Instrument (PMHI) has 47 items and six subscales. This study aimed to develop and validate a short unidimensional version of the PMHI among Singapore's adult resident population. METHODS: Using pooled data from three earlier studies (n = 1050), PMHI items were reduced by Partial Credit Rasch Model (PCRM) runs in a random split-half sample, while psychometric properties of the resulting measure were tested through confirmatory factor analysis (CFA), item response theory-graded response model and internal consistency reliability in the other half. Its reliability, construct and concurrent validity, agreement with the original scale, floor and ceiling effect, and scale estimates were further investigated in an external representative general population sample (n = 1925). RESULTS: The average age of the participants was around 41 years. Four PCRM re-runs for item selection resulted in a 6-item unidimensional Rapid PMHI (R-PMHI). CFA confirmed the unidimensional structure of the R-PMHI in the internal (RMSEA = 0.075, CFI = 0.985, TLI = 0.974) and external (RMSEA = 0.051, CFI = 0.992, TLI = 0.987) validation samples. In the external validation sample, the R-PMHI met concurrent validity criteria, showing high agreement with the 47-item version with intra-class correlation coefficient of 0.872 (95% CI: 0.861 to 0.882) and low floor and ceiling effects. Weight-adjusted mean (SE, 95% CI) R-PMHI score in the population was 4.86 (0.2, 4.82-4.90). CONCLUSION: The unidimensional 6-item R-PMHI offers brevity over the original multidimensional measure while appropriately representing the positive mental health construct. Prospective studies are needed to assess its responsiveness and test-retest reliability.

Sleep beliefs and attitudes and the association with insomnia among psychiatric outpatients.

Background: While it has been demonstrated that dysfunctional sleep beliefs can contribute to sleep disturbances, less is known about it in psychiatric patients and the role these beliefs play in influencing sleep.Aims: To examine maladaptive sleep cognition among psychiatric patients and to assess its association with insomnia.Method: Participants were outpatients (n = 400) recruited from a tertiary psychiatric hospital. The Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) scale was administered to examine sleep-related cognitions in different domains. Clinical insomnia was assessed using the Insomnia Severity Index. Factors associated with DBAS were explored using linear regression and the association between DBAS scores and insomnia was tested using logistic regression.Results: Among psychiatric patients, factors associated with the DBAS domains were ethnicity, educational attainment, psychiatric comorbidity, and consumption of sleep medication. Higher dysfunctional sleep beliefs were associated with insomnia. The association was particularly prominent in the mood disorder diagnostic group.Conclusions: Dysfunctional sleep beliefs were associated with insomnia among psychiatric patients. Addressing these maladaptive cognitions is critical in alleviating sleep problems in psychiatric patients.

Mapping the Positive and Negative Syndrome Scale scores to EQ-5D-5L and SF-6D utility scores in patients with schizophrenia.

OBJECTIVE: The current study aims to map the Positive and Negative Syndrome Scale (PANSS) onto the five-level EuroQol five-dimensional (EQ-5D-5L) and Short Form six-dimensional (SF-6D) utility scores for patients with schizophrenia. METHODS: A total of 239 participants with schizophrenia spectrum disorder were recruited from a tertiary psychiatric hospital in Singapore. Ordinary least squares (OLS), censored least absolute deviations and Tobit regression methods were employed to estimate utility scores from the EQ-5D-5L and SF-6D. Model selection of the 18 regression models (three regression methods × six model specifications) was primarily determined by the smallest mean absolute error and mean square error, and the largest R2 and adjusted R2. RESULTS: The mean age of the sample was 39.7 years (SD = 10.3). The mean EQ-5D-5L and SF-6D utility scores were 0.81 and 0.68, respectively. The EQ-5D-5L utility scores were best predicted by the OLS regression model consisting of three PANSS subscales, i.e. positive, negative and general psychopathology symptoms, and covariates including age and gender. The SF-6D was best predicted by OLS regression model consisting of five PANSS subscales, i.e. positive, negative, excitement, depression and cognitive subscales. CONCLUSION: The current study provides important evidence to clinicians and researchers on mapping algorithms for converting PANSS scores into utility scores that can be easily applicable for cost-utility analysis when EQ-5D-5L and SF-6D data are not available for patients with schizophrenia spectrum disorder in Singapore.

Subjective quality of life among patients with schizophrenia spectrum disorder and patients with major depressive disorder.

BACKGROUND: The goal of clinicians and healthcare workers providing treatment to patients with psychiatric disorders, has shifted over time from focusing on the symptoms alone towards functional improvement. In this study, we aimed to compare the subjective quality of life (QoL) among patients with schizophrenia spectrum disorders and major depressive disorder (MDD). METHODS: QoL scores were collected using 36-item Short Form Survey Instrument. QoL scores were compared between 203 outpatients with schizophrenia spectrum disorders and 185 outpatients with MDD using analysis of covariance. The Positive and Negative Syndrome Scale was administered to assess the severity of psychiatric symptoms among patients with schizophrenia and Personal Health Questionnaire-8 items was utilized to assess the severity of depressive symptoms among patients with MDD. The correlation coefficient (r) of socio-demographic factors and core psychiatric symptoms with QoL were analyzed using multiple linear regression. RESULTS: As compared to patients with MDD, patients with schizophrenia reported better health scores in all QoL subdomains, except for physical function (PF). Among patients with schizophrenia, old age was correlated with better mental health (MH, r = 0.35) and PF (r = 0.37). Compared to those of Chinese ethnicity, those of Malay, Indian and other ethnicity were correlated with worse PF (r = - 0.43 for Malays; r = - 0.30 for Indians and r = - 0.34 for other ethnicities). Longer duration of mental illness was correlated with worse MH (r = - 0.30), worse PF (r = - 0.38) and worse scores on role limitations due to physical health problems (RP, r = - 0.30). Among patients with MDD, older age was correlated with worse PF (r = - 0.33) and patients without comorbid physical illness reported less bodily pain (r = 0.45) and better general health (r = 0.34). Moreover, all psychiatric symptoms among patients with schizophrenia were negatively correlated with QoL, but the strength of the correlation was less than that between depressive symptoms and QoL among patients with MDD. CONCLUSION: Patients with schizophrenia generally reported better QoL as compared to patients with MDD. The correlates of QoL differed between patients with schizophrenia and patients with MDD. This study adds to the understanding of QoL among patients with mental illnesses and may aid in better management of these patients with different psychiatric diagnoses.

Clinical effectiveness and speed of response of electroconvulsive therapy in treatment-resistant schizophrenia.

AIM: Although electroconvulsive therapy (ECT) has been shown to be efficacious for patients with treatment-resistant schizophrenia, there has been limited evidence on the rate of response, cognition, and quality-of-life outcomes. The primary aims of the present study were thus to examine the effectiveness and speed of response to ECT in a naturalistic retrospective cohort in patients with treatment-resistant schizophrenia. METHODS: We performed a retrospective database analysis. The primary effectiveness outcome was defined as an improvement of ≥40% from pretreatment scores based on the Brief Psychiatric Rating Scale (BPRS) Psychotic Symptom subscale. Data were included for analysis for all patients with a primary DSM-5 diagnosis of schizophrenia that was treatment-resistant and who had had an acute course of ECT initiated for the treatment of schizophrenia between 1 July 2016 and 1 December 2016. RESULTS: A total of 50 inpatients were included for analysis. The present study revealed that 50% of patients showed at least a 40% reduction in BPRS Psychotic Symptom subscale scores after completion of ECT and that 16.7% of patients responded after the first three sessions, 39.3% after six sessions, 46.4% after nine sessions, and 50% after 12 sessions. The greatest improvement in BPRS scores was between the third and sixth ECT sessions. BPRS scores, Clinical Global Impression, Montreal Cognitive Assessment, and Global Assessment of Functioning showed significant improvement. There was no significant difference in quality-of-life outcomes. CONCLUSION: Utilizing modern techniques in treatment-resistant schizophrenia, this study demonstrates the real-world effectiveness and rate of response of patients receiving ECT.

Attitudes towards psychiatry amongst medical and nursing students in Singapore.

BACKGROUND: A shortage of specialists in psychiatry, both in terms of psychiatrists and psychiatric nurses is evident worldwide. While there are multiple factors leading to an individual's decision to specialize in psychiatry, the individual's perceptions and attitudes towards psychiatry tend to play an essential role. This study thus aimed to explore attitudes towards psychiatry amongst medical and nursing students in Singapore and examine factors associated with these attitudes. METHODS: The present cross-sectional study used an online web survey tool to assess attitudes towards psychiatry amongst 502 medical and 500 nursing students in Singapore using the Attitudes towards Psychiatry (ATP-18) scale. Descriptive statistics and multiple linear regressions were used to examine associated factors (sociodemographic and education). RESULTS: The majority of students in this population endorsed favourable attitudes towards the following aspects of psychiatry: challenges within psychiatry, importance of psychiatry and psychiatric skills, treatment efficacy and view towards psychiatrists, but had generally unfavourable attitudes towards psychiatric patients. Male participants (compared to female; ß = - 1.190, p < 0.05), participants in the middle income group (compared to higher income group; ß = - 0.945, p < 0.05), participants who rated average for psychiatry lecture course and psychiatry clinical placement course (compared to above average; ß = - 1.654, p < 0.05; ß = - 1.181, p < 0.05) had a less favourable attitude to psychiatry. Not surprisingly, participants who were more likely to specialize in psychiatry (ß = 2.053, p < 0.001) had a more favourable attitude towards psychiatry compared to those who were less likely to specialize in psychiatry. CONCLUSIONS: The majority of students in this study endorsed unfavourable attitudes towards patients in the psychiatric setting. The present psychiatry curriculum could be improved to nurture the development of empathetic attitudes towards people with mental illness. De-stigmatization strategies could also be integrated into other curricula besides psychiatry.

Direct and moderating effects of personality on stigma towards mental illness.

BACKGROUND: While many studies have explored the concept and correlates of stigma towards individuals with mental illness, few have investigated the role of personality in this process. In the current study, we firstly examined the relationship between personality and stigma towards mental illness; and then explored the moderating effects of personality traits on the relationship between contact experience/s and stigma. METHODS: Participants were recruited from public medical (N = 502) and nursing schools (N = 500) from April to September 2016 in Singapore for this cross-sectional survey, and they were randomly assigned to a vignette describing one of the following mental disorders: major depressive disorder, obsessive compulsive disorder, alcohol abuse, schizophrenia, and dementia. Stigma was measured by the 'Personal and Perceived scales of the Depression Stigma Scale' and the 'Social Distance Scale'. These scales together had a 3-factor structure based on a previous national study in Singapore, namely 'weak-not-sick', 'dangerous/unpredictable' and 'social distance'. Personality was measured by the 20-item short form of the International Personality Item Pool-five factor model measure. RESULTS: Regression suggested agreeableness and openness to experience were negatively associated with all three domains of stigma. 'Weak-not-sick' and extraversion were positively associated; and 'social distance' was positively associated with higher scores on conscientiousness and neuroticism. Both close- and non-close contact were associated with more positive attitudes towards mental illness among the participants. Openness to experience moderated the relationships of close contact experience with 'weak-not-sick' and 'dangerous/unpredictable', but in different directions. The association between close contact and 'social distance' were moderated by agreeableness. CONCLUSIONS: Unlike non-close contact experience, close contact with people with mental illness worked differently on stigma for individuals with different personality traits. Future studies are needed to further explore the underlying mechanisms for such differences.

Psychometric properties of the short Warwick Edinburgh mental well-being scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders.

BACKGROUND: To establish the validity and reliability of the Short Warwick Edinburgh Mental Well-being Scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders in Singapore and estimate SWEMWBS scores across socio-demographic and the three psychiatric diagnostic groups in the sample. METHODS: This secondary analysis was conducted using data from a study among outpatients of a tertiary psychiatric hospital. In addition to the SWEMWBS, socio-demographic data and current psychiatric diagnosis were collected. Service users were also administered the Global Assessment of Functioning (GAF), Patient Health Questionnaire (PHQ)-8, Generalised Anxiety Disorder (GAD)-7, Satisfaction with Life Scale (SWLS) and the Positive Mental Health (PMH) instrument. The SWEMWBS was tested for factorial validity, reliability and convergent and divergent validity. RESULTS: In total, 350 service users with a mean (SD) age of 39.1 (11.1) years were included in this study of which 39.4%, 38.9% and 21.7% had schizophrenia, depression and anxiety spectrum disorders, respectively. The single factor structure of the SWEMWBS was confirmed by confirmatory factor analysis (CFI = 0.969, TLI = 0.954, RMSEA = 0.029). The internal consistency reliability was high (Cronbach's alpha = 0.89). The convergent and divergent validity testing revealed that the SWEMWBS scores had significant moderate to high positive correlations with GAF, SWLS and PMH scores and moderate negative correlations with (PHQ)-8 and (GAD)-7 scores. SWEMWBS scores were higher in married participants (22.2 (5.4) versus never married: 20.7 (5.3) and divorced/separated/widowed: 20.4 (5.1), p = 0.049) and among those with schizophrenia (22.8 (5.5) versus depression:19.6 (4.7) and anxiety spectrum disorders 20.9 (5.2), p < 0.001). CONCLUSION: These results demonstrate adequate validity and reliability of the SWEMWBS in people with schizophrenia, depression and anxiety spectrum disorders in Singapore.

Gender differences in positive mental health among individuals with schizophrenia.

OBJECTIVE: This article aims to investigate the gender differences in positive mental health among outpatients with schizophrenia. METHODS: 142 outpatients (aged 21-65 years) with schizophrenia spectrum disorders were recruited from a tertiary psychiatric hospital. They were administered the following instruments: The Positive Mental Health (PMH) instrument, Patient Health Questionnaire (PHQ)-8 and Generalized Anxiety Disorder (GAD)-7, and the Global Assessment of Functioning (GAF) scale. Socio-demographic and clinical characteristics were gathered from interviews with the participants as well as from their medical records. Independent t-tests and chi-square tests were performed to investigate the gender differences in PMH total and domain-specific scores. Association of socio-demographic and clinical characteristics with PMH was furthered explored in men and women independently using multiple linear regression analyses using backward stepwise method. RESULTS: PMH total score and Emotional Support (ES) and Global Affect (GA) sub-scale scores were significantly higher among women vs men (PMH = 4.41 vs 4.07, p value = 0.01 and domains ES = 4.56 vs 3.84, p value < 0.01 and GA = 4.44 vs 4.02, p value = 0.01), given that the men and women samples did not differ significantly in their socio-demographic and clinical profiles. After adjusting for all covariates, men with no formal/ primary education were significantly associated with lower PMH total score than those with higher (secondary, A level, pre-university) education. Men belonging to Malay ethnic group had significant higher PMH total score compared to men of Chinese ethnicity. Among the women samples, those with depression as measured by PHQ-8 had significantly lower scores in the PMH total score and higher GAF score was associated with significantly higher scores in PMH total score. CONCLUSIONS: This study identified gender differences in PMH of patients with schizophrenia spectrum disorders whereby women had higher PMH total score and domain scores than men. The study also identified factors associated with PMH which can aid in designing gender appropriate mental health interventions.

Behavioral and psychological symptoms of dementia: prevalence, symptom groups and their correlates in community-based older adults with dementia in Singapore.

BACKGROUND: This study assessed the prevalence and factor structure of behavioral and psychological symptoms of dementia (BPSD) in a community-based sample of older adults with dementia and identified their correlates. METHODS: Data collected from 399 Singapore residents with dementia aged 60 years and above, interviewed along with a family/friend during a national survey, were used for this analysis. Neuropsychiatric Inventory Questionnaire assessed older adults' BPSD. Other data included socio-demographics, dementia severity, cognition, chronic physical conditions, disability, and caregivers' burden. Exploratory factor analysis assessed BPSD sub-groups, factor scores of which were used to identify socio-demographic, and clinical correlates. RESULTS: Prevalence of BPSD was 67.9% and 30% of the population had experienced three or more BPSD in the past month. Two distinct and moderately correlated symptom groups representing "psychosis and behavior dysregulation" and "mood disturbance and restlessness" were identified. As factor scores for both the groups increased with older age, poor cognition and caregiver burden, the former was also related to being never married and having no formal education. CONCLUSIONS: Study provides evidence of two distinct groups of BPSD and their important correlates. Clinicians treating BPSD should consider their age and cognitive impairment and be cognizant of their caregivers' burden.

Hand-grip strength among older adults in Singapore: a comparison with international norms and associative factors.

BACKGROUND: Hand-grip strength (HGS) serves as a proxy measure for muscle function and physical health. Studies have shown that low HGS is associated with common age-related disorders including frailty and sarcopenia. The aim of the present study was to establish the normative values of HGS among older adults in Singapore and to compare it with data from Western and other Asian countries. The study also aimed to explore the sociodemographic and anthropometric correlates of HGS. METHODS: Data were collected from 2043 men and women aged 60 years and above who took part in the Well-being of the Singapore Elderly study in 2013. HGS was obtained using a Jamar Plus + digital hand dynamometer. Normative data were stratified by; 5-year age groups, sex and ethnicity. Relationships between the HGS with various sociodemographic and anthropometric correlates were examined using multiple linear regression analysis. RESULTS: The mean HGS demonstrate a decreasing trend with increased age across all ethnic groups and sexes. HGS among Singapore older adults were relatively low compared to Western and other Asian countries. Males in the youngest age group (60-64) and of Chinese ethnicity attained greater HGS values than their counterparts. When the regression analysis was stratified for sex, significant associations were found between height, upper arm circumference with HGS in the males sample, and between height, weight, waist circumference and HGS in the females sample. CONCLUSIONS: Older adults in Singapore have a relatively weak HGS compared to other countries. Greater height and weight, and smaller waist circumference are independently associated with greater HGS in females but not males. These results facilitate the interpretation of HGS conducting using Jamar digital-type dynamometers among the older adults in Singapore.

Psychometric properties of the positive mental health instrument among people with mental disorders: a cross-sectional study.

BACKGROUND: The Positive Mental Health (PMH) instrument was developed and validated to assess the level of PMH and its six dimensions in a multi-ethnic general population sample. This cross-sectional study examines the psychometric properties of the instrument for assessing the level of PMH among help-seeking patients with mental disorders. METHODS: The PMH instrument was tested among 360 out-patients with schizophrenia, depression or anxiety spectrum disorders, seeking treatment at a tertiary psychiatric hospital and its affiliated clinics in Singapore. All participants completed the PMH instrument along with measures of life satisfaction, mental and overall health and happiness. Reliability (internal consistency), construct (Exploratory Structural Equation Modeling (ESEM)) and criterion (convergent and divergent) validity of the PMH instrument were tested in this population. Items were also tested for item response theory and differential item functioning (IRT-DIF). RESULTS: ESEM on the PMH instrument showed good fit with the model reflecting six factors (general coping, personal growth and autonomy, spirituality, interpersonal skills, emotional support, and global affect). Internal consistency was high (Cronbach's alpha >0.85) for the instrument and its six subscales. The PMH instrument fulfilled expected correlations with related constructs and demonstrated adequate item discrimination and difficulty estimates; however, significant DIF was noted for few items for age, gender and ethnicity groups. CONCLUSIONS: The PMH instrument is a reliable and valid instrument for measuring PMH dimensions in patients with mental disorders. Further studies in larger samples are needed to assess the impact of DIF on PMH scores. The implications for the shift in focus from just the negative aspects of mental disorders to including positive components in the assessment of patients with mental disorders are immense, and can be applied in routine mental health practice and policy making.

Psychiatric morbidity and its correlates among informal caregivers of older adults.

OBJECTIVE: This present study estimated the psychiatric morbidity among informal caregivers of older adults and investigated its association with their socio-demographic factors and older adult's health status, including dementia, depression and physical health conditions. METHODS: Data from a national cross-sectional survey were used. For each participating older adult, an informal caregiver who 'knew the older adult best' and was aware of their health condition, was also interviewed to collect information on the older adults' care needs, and behavioral and psychological symptoms of dementia (BPSD). Data from 693 pairs was used. Informal caregivers were administered the Self Reporting Questionnaire (SRQ)-20 and psychiatric morbidity was defined as those with a total SRQ score of ≥8. Measures included informal caregivers' socio-demographic characteristics, assessment of dementia and depression in the older adults and self-report on their lifetime and current physical conditions. The association of socio-demographic characteristics, health conditions, care assistance and BPSD was investigated using backward stepwise logistic regression analysis where psychiatric morbidity (total SRQ score

Positive mental health in psychotherapy: a qualitative study from psychotherapists' perspectives.

BACKGROUND: There is growing evidence in the literature on the use of positive mental health (PMH) interventions among clinical samples. This qualitative study aims to explore the definitions of PMH from psychotherapists' perspectives, and to examine views and attitudes related to the construct. METHODS: Focus group discussions were conducted with psychotherapists at a tertiary psychiatric institute. Focus group sessions were transcribed verbatim and transcripts were analyzed using an inductive thematic approach. RESULTS: Five themes related to psychotherapists' definition of PMH were identified: (1) acceptance; (2) normal functioning and thriving in life; (3) resilience; (4) positive overall evaluation of life; (5) absence of negative emotions and presence of positive emotion states. Themes related to views and attitudes towards PMH were: (1) novel and valuable for psychotherapy; (2) reservations with terminology; (3) factors influencing PMH. CONCLUSION: PMH in psychotherapy is a multidimensional concept that means more than symptom management and distress reduction in clients. There is potential value for its application in psychotherapy practice, though some concerns need to be addressed before it can be well integrated.

Social Media-Driven Routes to Positive Mental Health Among Youth: Qualitative Enquiry and Concept Mapping Study.

BACKGROUND: Social media influence almost every aspect of our lives by facilitating instant many-to-many communication and self-expression. Recent research suggests strong negative and positive impacts of social media exposure on youth mental health; however, there has been more emphasis on harmful relationships. OBJECTIVE: Given the limited research on the benefits of social media for mental health, this qualitative study explored the lived experiences of youth to understand how social media use can contribute to positive mental health among youth. METHODS: Using an interpretivist epistemological approach, 25 semistructured interviews and 11 focus group discussions were conducted with male and female youth of different ethnicities (aged 15 to 24 years) residing in Singapore, who were recruited through purposive sampling from the community. We conducted inductive thematic analysis and concept mapping to address the research aims. RESULTS: We found that youth engaged in a wide range of activities on social media from connecting with family and friends to participating in global movements, and these served as avenues for building positive mental health. Based on participants' narratives, our analysis suggested that positive mental health among youth could be influenced by 3 features of social media consumption (connection with friends and their global community, engagement with social media content, and the value of social media as an outlet for expression). Through these, pathways leading to the following 5 positive mental health components were identified: (1) positive relationships and social capital, (2) self-concept, (3) coping, (4) happiness, and (5) other relevant aspects of mental health (for example, positivity and personal growth). CONCLUSIONS: The study results highlight the integral role of social media in the lives of today's youth and indicate that they can offer opportunities for positive influence, personal expression, and social support, thus contributing to positive mental health among youth. The findings of our research can be applied to optimize engagement with youth through social media and enhance the digital modes of mental health promotion.

A qualitative study on negative experiences of social media use and harm reduction strategies among youths in a multi-ethnic Asian society.

PURPOSE: This study aimed to expand and inform the emerging body of research on the negative experiences of social media use among youths and how youths deal with them, in an Asian setting, using a qualitative approach. METHODS: Data were collected using 11 focus group discussions (FGDs) and 25 semi-structured interviews (SIs) among youths aged 15 to 24 years residing in Singapore who were recruited via purposive sampling. Data were analysed using thematic analysis. RESULTS: The salient negative effects mentioned by participants include the development of negative reactions and feelings from upward comparisons with others (e.g., others' achievements and lifestyle), receiving hurtful comments, exposure to controversial content (e.g., political events and social movements), as well as the perpetuation of negative feelings, behaviours, and sentiments (e.g., rumination, unhealthy eating behaviour, and self-harm). Participants also described strategies which they have employed or deemed to be useful in mitigating the negative effects of social media use. These include filtering content and users, taking breaks from social media, cognitive reframing, and self-affirmation, where they identify and change stress-inducing patterns of thinking by setting realistic social, physical, and lifestyle expectations for themselves, and focusing on self-development. CONCLUSION: The current results highlight that while youths experience negative effects of social media use, they have high media literacy and have employed strategies that appear to mitigate the negative effects of social media use. The findings can inform various stakeholders involved in helping youths navigate the harms of social media use or provide directions for intervention studies aimed at reducing the harms of social media use.