Effectiveness of educational interventions in reducing the stigma of healthcare professionals and healthcare students towards mental illness: A systematic review and meta-analysis.

AIM: To examine the effectiveness of educational interventions in reducing stigma among healthcare professionals and students towards people with mental illness. DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster RCTs. DATA SOURCES: Articles published from database inception to October 2023 were systematically searched from seven databases (CINAHL, Embase, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS: Random-effect meta-analyses were conducted. Heterogeneity was evaluated using the I2 statistics and Cochran's Q chi-squared test. A quality appraisal conducted at the study level used the Cochrane risk of bias tool and an outcome-level quality assessment utilized the Grades of Recommendation, Assessment, Development and Evaluation Approach. Publication bias was assessed using the funnel plot. RESULTS: Twenty-five articles were included in this review. Meta-analysis reported statistically significant medium and small effect sizes for attitudes towards mental illness and attitudes towards people with mental illness respectively, showing the association between educational interventions and improved attitudes among healthcare professionals and students. However, a statistically non-significant effect was reported for knowledge of mental illness. Subgroup analyses indicated that face-to-face and contact-based interventions were particularly effective at reducing stigma. Notably, single-session interventions were just as effective as multiple sessions, suggesting a potential for resource-efficient approaches. CONCLUSION: Educational interventions demonstrate promise in fostering more positive attitudes towards mental health issues. Future research should aim to determine the long-term effects of these interventions and include patient feedback on the stigmatizing behaviours of healthcare professionals and students, to holistically evaluate the effect of interventions. NO PATIENT OR PUBLIC CONTRIBUTION: This study is a secondary review and does not require relevant contributions from patients or the public. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Face-to-face contact-based educational sessions have proven to be the most effective. Reinforcing learning may be achieved through a series of repeated single-session interventions.

A qualitative systematic review of adolescent's perceptions of sleep: Awareness of, barriers to and strategies for promoting healthy sleep patterns.

AIMS: To consolidate adolescents' perspectives regarding various aspects of sleep and offer insights to promote healthier sleep habits during their critical developmental years. METHODS/DATA SOURCES: Six electronic databases (PubMed, CINAHL, Embase, Scopus, PsycINFO and Web of Science) were searched from their inception dates to June 2023. Data were extracted and meta-summarised using Sandelowski and Barroso's approach and synthesised using Thomas and Harden's thematic analysis framework. RESULTS: Meta-synthesis from 11 peer-reviewed published studies identified four main themes: (1) Awareness and understanding of sleep's significance, (2) The shadows and radiance of slumber, (3) Traversing the sleepscape: trouble bubbles and (4) Illuminating the path: Guiding lights to enhanced sleep. CONCLUSION/IMPLICATIONS: Our review findings suggest a lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Identified barriers to adequate sleep encompass various factors, including overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. Strategies to improve adolescents' sleep health involve multiple sleep strategies, including sleep education, workshops/seminars, parental involvement, incorporating digital well-being practices, the promotion of relaxation techniques and the provision of essential resources. Prioritising sleep health and implementing targeted interventions are key steps to empower adolescents, create supportive environments and shape a healthier future generation. Future research endeavours should focus on evaluating the effectiveness of interventions and exploring the influence of cultural factors. IMPACT: There exists a notable lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Barriers to achieving adequate sleep among adolescents include overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. The collaboration between healthcare institutions, professionals and educational institutions is crucial to facilitate (1) the implementation of sleep education workshops/seminars targeting adolescents, (2) increased parental involvement and role-modelling to instil good sleep practices among adolescents and (3) enhanced integration of digital well-being practices, the promotion of relaxation techniques and accessibility to essential sleep hygiene resources. REPORTING METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. TRIAL AND PROTOCOL REGISTRATION: This review was registered on the Prospective Register of Systematic Reviews (CRD42023403775).

The impact of gardening on mental resilience in times of stress: A case study during the COVID-19 pandemic in Singapore.

To curb the spread of Covid-19, Singapore, like other cities, had to impose movement restriction and social distancing measures that may affect the well-being of its residents. In this paper, we assessed the potential benefits of gardening on the mental well-being of Singapore residents, based on the concept of mental resilience. We hypothesized that gardening activities promote mental resilience. A survey was administered on 8,786 participants of a "Gardening with Edibles" programme, measuring their mental resilience status, engagement in gardening activities and socio-demographic information. The mental resilience scores of participants who engaged in weekly gardening were compared with the scores derived from another survey conducted during the pandemic on an online community comprising demographically representative respondents with an interest on Covid-19 related community care. The results showed that the mental resilience of those who gardened was statistically significantly higher than the online community. Within the gardening group, those with less than one hour of weekly gardening time had significantly lower scores in their total mental resilience, and five out of seven resilience factors, "emotional regulation", "relationship", "confidence", "positive thinking" and "spirituality", compared to those with more weekly gardening time, showing that the efficacy of the mediating effects may peak at a weekly gardening time of between one to four hours. Home gardening may be an effective way for people living in densely populated cities to interact with nature and build mental resilience during the pandemic.

AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation.

BACKGROUND: The impact that the COVID-19 pandemic has had on health care workers' mental health, in particular, cannot be ignored. Not only did the pandemic exacerbate mental health challenges through elevated stress, anxiety, risk of infection, and social isolation, but regulations to minimize infection additionally hindered the conduct of traditional in-person mental health care. OBJECTIVE: This study explores the feasibility of using Wysa, an artificial intelligence-led mental health app, among health care workers. METHODS: A national tertiary health care cluster in Singapore piloted the use of Wysa among its own health care workers to support the management of their mental well-being during the pandemic (July 2020-June 2022). The adoption of this digital mental health intervention circumvented the limitations of in-person contact and enabled large-scale access to evidence-based care. Rates and patterns of user engagement were evaluated. RESULTS: Overall, the opportunity to use Wysa was well-received. Out of the 527 staff who were onboarded in the app, 80.1% (422/527) completed a minimum of 2 sessions. On average, users completed 10.9 sessions over 3.80 weeks. The interventions most used were for sleep and anxiety, with a strong repeat-use rate. In this sample, 46.2% (73/158) of health care workers reported symptoms of anxiety (Generalized Anxiety Disorder Assessment-7 [GAD-7]), and 15.2% (24/158) were likely to have symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]). CONCLUSIONS: Based on the present findings, Wysa appears to strongly engage those with none to moderate symptoms of anxiety. This evaluation demonstrates the viability of implementing Wysa as a standard practice among this sample of health care workers, which may support the use of similar digital interventions across other communities.

Reaching hidden youth in Singapore through the Hidden Youth Intervention Program: A biopsychosocial approach integrating mental health and social work interventions.

Hidden youth are youth who withdraw from society for at least 6 months, physically isolating within their homes or rooms. There has been a steady rise in this phenomenon across many developed countries, and this trend is expected to continue. As hidden youths often present with complex psychopathology and psychosocial issues, multi-factorial intervention approaches are recommended. To reach this isolated population and address gaps in services, a community mental health service and a youth social work team collaborated to develop the first specialized intervention for hidden youth in Singapore. This pilot intervention combines components from Hikikomori treatment models from Japan and Hong Kong, and a treatment program for isolated individuals diagnosed with Internet Gaming Disorder. This paper describes the development of the pilot intervention model- a four-stage biopsychosocial intervention targeting the complex needs of hidden youth and their families- and illustrates its implementation and challenges faced through a case study. Based on 2 years of service delivery to 25 youths, good practices such as utilizing novel outreach strategies and the importance of involving and caring for caregivers are also highlighted. Preliminary outcomes of this ongoing pilot intervention indicate reductions in social withdrawal behavior and increased engagement in school or work, especially for youth at the final stage of intervention. Strengths of the program include its multi-disciplinary and flexible nature, and the whole-family approach. Limitations of this program included a lack of information on Singaporean hidden youth and the lack of quantitative outcome data of this pilot program. In future, we aim to further enhance program elements through collaboration with international and local partners, and to develop an evaluative framework to determine program effectiveness.

Risk and protective factors associated with adolescent depression in Singapore: a systematic review.

Introduction: Adolescent depression is prevalent, and teen suicide rates are on the rise locally. A systemic review to understand associated risk and protective factors is important to strengthen measures for the prevention and early detection of adolescent depression and suicide in Singapore. This systematic review aims to identify the factors associated with adolescent depression in Singapore. Methods: A systematic search on the following databases was performed on 21 May 2020: PubMed, EMBASE and PsycINFO. Full texts were reviewed for eligibility, and the included studies were appraised for quality using the Newcastle Ottawa Scale. Narrative synthesis of the finalised articles was performed through thematic analysis. Results: In total, eight studies were included in this review. The four factors associated with adolescent depression identified were: (1) sociodemographic factors (gender, ethnicity); (2) psychological factors, including childhood maltreatment exposure and psychological constructs (hope, optimism); (3) coexisting chronic medical conditions (asthma); and (4) lifestyle factors (sleep inadequacy, excessive internet use and pathological gaming). Conclusion: The identified factors were largely similar to those reported in the global literature, except for sleep inadequacy along with conspicuously absent factors such as academic stress and strict parenting, which should prompt further research in these areas. Further research should focus on current and prospective interventions to improve mental health literacy, targeting sleep duration, internet use and gaming, and mitigating the risk of depression in patients with chronic disease in the primary care and community setting.

Temperament, parenting, mental disorders, life stressors and help-seeking behavior of Asian adolescent suicide attempters: A case control study.

Purpose: The need to elucidate risk factors for adolescent suicide is urgent, as suicide consistently ranks among the top causes of death globally. Understanding suicide risk factors could inform more effective interventions. Previous studies have identified certain risk factors associated with suicide, but there is a paucity of research among adolescent and multi-ethnic Asian populations. Materials and methods: This case-control study sampled 13-to-19-year-old Asian adolescents who had attempted suicide (N = 60) and controls (N = 58) matched by age, ethnicity and gender at group-level (73.7% female). Life stressors, temperament, parenting style, mental health conditions and help-seeking behavior were examined. Results: All domains of life stress apart from emerging adult responsibility were higher among cases than controls, especially home life, peer pressure and romantic relationships. Suicide attempters tended to avoid new situations, be less adaptable to changes, have a negative outlook and irregular sleep-wake cycle. Additionally, they perceived their parents to be significantly more aggressive, neglecting, rejecting and cold, while parents' perceptions of their own parenting were only significantly different in the domain of parental neglect. Cases were more likely to exhibit disorders of disruptive behavior, eating, mood, anxiety, symptoms of schizophrenia and experience of disturbing events. Significant differences were also found for 10 out of 12 Axis II disorders, particularly borderline, depressive, and avoidant personality disorder traits. No significant case-control differences were found regarding overall rates of help-seeking. Conclusion: Findings from this study may help in suicide prevention efforts through more tailored interventions.

Hikikomori Phenomenon in East Asia: Regional Perspectives, Challenges, and Opportunities for Social Health Agencies.

Hikikomori, which originated in Japan, refers to the condition where youths withdraw into the home and do not participate in society for an extended period of time. Recent updates on hikikomori presentation within the region were exchanged at a Hikikomori Round Table and Regional Symposium (HRTRS) discussion late 2017, leading to this perspective paper. Hikikomori presents as an overall homogeneous construct, while diversity in clinical presentation exists across East Asian countries. We examined the various presentations, risk factors, theoretical frameworks, and classification issues about hikikomori. In particular, specific risk factors have emerged to some degree across the region, while some are more locale specific. We propose that hikikomori youths have differential onset and developmental patterns, potentially resulting in heterogeneous presentation. We briefly summarized existing interventions in the East Asian region. Intervention strategies need to be tailored to different subtypes. A multicomponent approach would address complexity, multifactorial onset, and development of the condition. The HRTRS presented to participating countries the opportunity to collectively work toward a more universal definition of the hikikomori condition and explored innovative ways to shape existing service structures. Opportunities for participating countries described pertain to early detection of cases, adoption of assessment tools, and improved intervention services.

Academy of Medicine-Ministry of Health clinical practice guidelines: attention deficit hyperactivity disorder.

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Prevalence of autism spectrum disorders among children in China: a systematic review.

BACKGROUND: There are no reliable estimates of the prevalences of autism and autism spectrum disorders (ASD) in China. OBJECTIVE: Combine results across studies to estimate the prevalences of autism and ASD among Chinese children under the age of 18, and assess variations in the prevalences with respect to gender, ethnicity, and urban versus rural residence. METHODS: Based on pre-defined inclusion and exclusion criteria, studies were identified by searching the following databases: Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, Chinese Biological Medical Literature Database, Pubmed, and Web of Science. Statistical analysis was conducted using R-2.15.2 software. RESULTS: The 24 studies meeting inclusion criteria included 5 registry studies from Taiwan and Hong Kong (covering a total of 14570 369 children) and 19 community-based screening and diagnostic studies from mainland China (with a combined sample of 771 413 children). The annually reported prevalence of autism in the registry studies ranged from 1.8 to 424.6 per 10 000. A meta-analysis of 18 of the studies from mainland China (excluding a large nationwide study with the lowest prevalence of autism) with a range in rates from 2.8 to 30.4 per 10 000 generated an estimated pooled prevalence of autism of 12.8 per 10 000 (95%CI, 9.4 to 17.5). The pooled prevalence of ASD estimated from 5 of these studies (which had a range in rates from 7.3 to 75.3 per 10 000) was 24.5 per 10000 (95%CI, 10.4 to 57.4). The reported prevalence of autism varied substantially by gender, location of residence, date of publication, and source of the sample. CONCLUSION: The huge difference between the rates for autism reported from registry systems in Hong Kong and Taiwan (a 200-fold difference) and the large differences in rates reported from community-based screening studies in mainland China (a 10- to 15-fold difference) highlight the urgent need for establishing standardized methods for estimating the prevalences of autism and ASD. Until these methodological improvements have been made, it will not be possible to develop evidence-based prevention and treatment strategies for the management of these uncommon but seriously disabling conditions.

Autism spectrum disorder in Chinese populations: a brief review.

This review summarizes the published work on the prevalence and incidence rates of autism spectrum disorder (ASD) in Chinese populations. The authors searched MEDLINE, Web of Science and the PsycINFO database and identified seven studies that were published in the English language. In mainland China, Li and colleagues reported an autism prevalence rate of 2.38/10,000 but admitted the possibility of underestimation. A higher prevalence of 11/10,000 was reported by Zhang and Ji based on a survey that was conducted in Tianjin, China. In Taiwan, Chien and colleagues reported that the cumulative prevalence of ASD increased from 1.79 to 28.72/10,000 from 1996 to 2005 and the annual incidence rate increased from 0.91 to 4.41/10,000 per year from 1997 to 2005. Another study based on the Taiwan national health insurance database reported a high prevalence rate of 122.8/10,000 for the year 2007. Two studies based on the Taiwan national disability registry data reported an increasing trend of ASD for the period 2000-2007 and 2004-2010, respectively. In Hong Kong, Wong and colleagues estimated that the incidence of ASD was 5.49/10,000 and the average prevalence over the 1986-2005 period was 16.1/10,000. We identified 12 studies through the searching of Chinese databases. The prevalences among these studies varied from 2.8 to 29.5/10,000. While existing data appear to suggest, it remains unclear whether there is a true rise in the prevalence of ASD in ethnic Chinese population across geographic sites. More collaborative research on this topic should be conducted in the future.

Suicidal and help-seeking behavior in Xiamen, south China.

INTRODUCTION: The aim of this study is to examine the association between suicidal behavior and mental health status of south Chinese people, and explore the mediating effect of help-seeking behaviors. METHODS: The study participants were 10,757 persons aged 18 years and older from the mental health survey of Xiamen city. Data on suicidal behavior and help-seeking behavior were collected by trained psychiatric nurses through face-to-face interviews. Mental health status was assessed using the 12-item General Health Questionnaire (GHQ-12). Multiple logistic regression and general linear model were used in statistical analysis. RESULTS: In the entire study sample, 236 study participants reported suicide ideation (2.19%, 95% CI: 1.92-2.47%), and 59 reported at least one suicide attempt (0.55%, 95% CI: 0.41-0.69%). Individuals with suicide attempt and suicide ideation had higher GHQ scores than those without suicidal behavior. The majority of study participants with suicide ideation or suicide attempt did not seek any help (77.5% and 79.7%, respectively). Among participants with suicidal behavior, seeking help from mental health professional was associated with a better mental health status (OR = 4.04, 95%CI: 1.17-10.16). DISCUSSION: Only a small proportion of individuals with suicide behavior in south China had ever sought help. Seeking help was associated with a better mental health status.