Association of state-level prescription drug monitoring program implementation with opioid prescribing transitions in primary care in Australia.

AIMS: This study aimed to evaluate whether voluntary and mandatory prescription drug monitoring program (PDMP) use in Victoria, Australia, had an impact on prescribing behaviour, focusing on individual patients' prescribed opioid doses and transition to prescribing of nonmonitored medications. METHODS: This was a retrospective cross-sectional study using routinely collected primary healthcare data. A 90-day moving average prescribed opioid dose in oral morphine equivalents was used to estimate opioid dosage. A Markov transition matrix was used to describe how patients prescribed medications transitioned between opioid dose groups and other nonopioid treatment options during 3 transition periods: transition between 2 control periods prior to PDMP implementation (T1 to T2); during the voluntary PDMP implementation (T2 to T3); and during mandatory PDMP implementation (T3 to T4). RESULTS: Among patients prescribed opioids in our study, we noted an increased probability of transitioning to not being prescribed opioids during the mandatory PDMP period (T3 to T4). This increase was attributed mainly to the ceasing of low-dose opioid prescribing. Membership in an opioid dose group remained relatively stable for most patients who were prescribed high opioid doses. For those who were only prescribed nonmonitored medications initially, the probability of being prescribed opioids increased during the mandatory PDMP when compared to other transition periods. CONCLUSION: The introduction of PDMP mandates appeared to have an impact on the prescribing for patients who were prescribed low-dose opioids, while its impact on individuals prescribed higher opioid doses was comparatively limited.

Validation of the OWLS, a Screening Tool for Measuring Prescription Opioid Use Disorder in Primary Care.

OBJECTIVE: The OWLS is a screening tool for prescription opioid use disorder designed for use in primary care. This study aimed to confirm the optimal wording, scoring methods, and cutoff for the OWLS. DESIGN AND SETTING: Cross-sectional analysis of an online sample. SUBJECTS: Participants comprised those with chronic noncancer pain who regularly used prescription opioids. METHODS: Eligible participants self-completed an online version of the OWLS prescription opioid use disorder screening tool and the Composite International Diagnostic Interview Substance Abuse module. Receiver operating characteristics were calculated for three scoring methods for the OWLS, and these were compared with DSM-5 classification of any use disorder and moderate to severe opioid use disorder. RESULTS: Among the sample (N = 324), utilizing scoring method (i) (i.e., positive endorsement ≥ response option "a little bit") and a cutoff of 3 increased the percentage of correctly classified participants, with concurrent increases in specificity and decreases in false discovery rate, and false positive rate. CONCLUSION: OWLS utilizing scoring method (i) with a cutoff of 3 was shown to be the optimal version and scoring method of this tool. This represents a time-efficient, simple scoring method, allowing for quick and accurate screening for opioid use disorder to occur.

Validity and Reliability of the Computer-Administered Routine Opioid Outcome Monitoring (ROOM) Tool.

OBJECTIVE: The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool. DESIGN AND SETTING: Cross-sectional analysis of an online sample. SUBJECTS: Participants comprised those with chronic noncancer pain who regularly used prescription opioids. METHODS: Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time. RESULTS: A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55-0.73) with their longer counterparts. Test-retest reliability was fair (0.58-0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored. CONCLUSION: The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.

Development of a Brief Patient-Administered Screening Tool for Prescription Opioid Dependence for Primary Care Settings.

OBJECTIVE: To develop a short, patient-administered screening tool that will allow for earlier assessment of prescription opioid dependence (often referred to as addiction) in primary care settings. DESIGN AND SETTING: Cross-sectional analysis (N = 1,134) from the two-year time point of the Pain and Opioids IN Treatment (POINT) cohort was used in the scale development. SUBJECTS: Participants who completed two-year interviews in the POINT study, a prospective cohort study that followed people with chronic noncancer pain over a five-year period, and who were prescribed strong opioids for a minimum of six weeks at baseline. METHODS: An advisory committee provided advice on wording and content for screening in primary care settings. Univariate logistic regression identified individual items that were significantly associated with meeting ICD-11 criteria for prescription opioid dependence. Exploratory and confirmatory factor analysis (EFA and CFA) were conducted, and items were reduced to identify a small item set that were discriminative and shared a simple underlying structure. RESULTS: Sixty-four variables associated with ICD-11 criteria for prescription opioid dependence were initially identified. Four rounds of EFA were performed, resulting in five items remaining. CFA identified two possible four-item combinations, with the final combination chosen based on greater item endorsement and the results of goodness-of-fit indices. CONCLUSIONS: Addressing prescription opioid dependence is an important part of the global public health challenge surrounding rising opioid-related harm. This study addresses an important initial requisite step to develop a brief screening tool. Further studies are required to validate the tool in clinical settings.

The hidden patient: chronic physical morbidity, psychological distress, and quality of life in caregivers of older adults.

AIM: Increasing demands for care provision to older adults require good physical and mental health among caregivers. Few studies have examined the health status and correlates of quality of life among caregivers of older adults. The present study therefore sought to examine the prevalence of chronic physical conditions, psychological distress, and correlates of physical and mental quality of life among caregivers of older adults (≥60 years) in Singapore. METHODS: Participants were 285 informal caregivers who were providing care to an older relative. Participants were recruited at the Institute of Mental Health, Singapore, and they completed self-report measures on chronic physical morbidity, psychological distress, and physical and mental quality of life. Multiple regression models were constructed to examine correlates of physical and mental quality of life. RESULTS: More than half of the caregivers had at least one chronic physical condition (58.6%) and psychological distress (52.6%). Chronic physical morbidity, psychological distress, and secondary education status were associated with lower physical quality of life. Psychological distress, younger age, primary education status, and more time spent caregiving were associated with lower mental quality of life. CONCLUSION: Poor physical and mental health among caregivers may impair their ability to provide adequate care to older adults with progressive medical needs. It is important for medical practitioners not to neglect the physical and mental health of caregivers through continued assessment of chronic physical morbidity, psychological distress, and quality of life.

A Non-Parametric Item Response Theory Evaluation of the CAGE Instrument Among Older Adults.

BACKGROUND: The validity of the CAGE using item response theory (IRT) has not yet been examined in older adult population. OBJECTIVE: This study aims to investigate the psychometric properties of the CAGE using both non-parametric and parametric IRT models, assess whether there is any differential item functioning (DIF) by age, gender and ethnicity and examine the measurement precision at the cut-off scores. METHODS: We used data from the Well-being of the Singapore Elderly study to conduct Mokken scaling analysis (MSA), dichotomous Rasch and 2-parameter logistic IRT models. The measurement precision at the cut-off scores were evaluated using classification accuracy (CA) and classification consistency (CC). RESULTS: The MSA showed the overall scalability H index was 0.459, indicating a medium performing instrument. All items were found to be homogenous, measuring the same construct and able to discriminate well between respondents with high levels of the construct and the ones with lower levels. The item discrimination ranged from 1.07 to 6.73 while the item difficulty ranged from 0.33 to 2.80. Significant DIF was found for 2-item across ethnic group. More than 90% (CC and CA ranged from 92.5% to 94.3%) of the respondents were consistently and accurately classified by the CAGE cut-off scores of 2 and 3. CONCLUSIONS: The current study provides new evidence on the validity of the CAGE from the IRT perspective. This study provides valuable information of each item in the assessment of the overall severity of alcohol problem and the precision of the cut-off scores in older adult population.

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.

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.

Responsible gambling among older adults: a qualitative exploration.

BACKGROUND: Responsible gambling (RG) is defined as gambling for pleasure and entertainment but with an awareness of the likelihood of losing, an understanding of the associated risks and the ability to exercise control over one's gambling activity. The current study describes a qualitative approach to explore RG among older adults (aged 60 years and above) in Singapore and reports on the cognitive and behavioural strategies employed by them to regulate their gambling. METHODS: Inclusion criteria included Singapore residents aged 60 years and above, who could speak in English, Chinese, Malay or Tamil and were current or past regular gamblers. Participants were recruited using a combination of network and purposive sampling. Socio-demographic information on age, age of onset of gambling, gender, ethnicity, marital status, education and employment was collected. The South Oaks Gambling Screen (SOGS) was used to collect information on gambling activities and problems associated with gambling behaviour. Qualitative interviews were conducted with 25 older adults (60 years and above) who currently gambled. The data was analyzed using thematic network analysis. RESULTS: This global theme of RG comprised two organising themes: self -developed strategies to limit gambling related harm and family interventions to reduce gambling harm. The basic themes included delayed gratification, perception of futility of gambling, setting limits, maintaining balance, help-seeking and awareness of disordered gambling in self or in others. Family interventions included pleading and threatening, compelling help-seeking as well as family exclusion order. CONCLUSIONS: The study highlights the significant role that families play in Asian societies in imposing RG. Education of family members both in terms of the importance of RG, and communication of the ways in which older adults can incorporate RG behaviours including the use of exclusion in specific scenarios is important.

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.

Prevalence and correlates of traumatic brain injury (TBI) in older adults: results from the Well-being of the Singapore Elderly (WiSE) study.

BACKGROUND: Older adults are among the most susceptible to sustain traumatic brain injury (TBI). The study aimed to determine the (1) prevalence of TBI among older adults in Singapore, and (2) socio-demographic, lifestyle, and clinical correlates of TBI. METHODS: Data were extracted from the cross-sectional, Well-being of the Singapore Elderly (WiSE) study. The study included 2,565 participants aged 60 years and above (Mean = 72.75, SD = 9.54). Information on TBI, socio-demographic, and lifestyle factors were collected using participant self-report and verified with the informant report where necessary. Disability was measured using the World Health Organization - Disability Assessment Schedule 2.0 (WHO-DAS 2.0). Data were analyzed using logistic regression analysis. RESULTS: The prevalence of TBI was 3.6%. Being female (vs. male) was found to be associated with decreased odds of having TBI. Having completed secondary education or lower (vs. tertiary education) was found to be associated with increased odds of having TBI. A history of fainting and diabetes were associated with the presence of TBI. Those with TBI were associated with higher disability scores on the WHO-DAS 2.0 than those without TBI. CONCLUSIONS: The current study provides information on the prevalence and associated factors of TBI in the older adult population in Singapore. Since TBI was associated with older adults with diabetes, they must be cautioned about fall risk. Also, given the association with disability, older adults with TBI are likely to require support and rehabilitative care to ensure good quality of life.

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.

Validation of the short version of the 10/66 dementia diagnosis in multiethnic Asian older adults in Singapore.

BACKGROUND: To validate the short version of the 10/66 dementia diagnosis against the standard version of the 10/66 dementia diagnosis and clinical diagnosis and examine concurrent validity with the World Health Organisation Disability Assessment schedule and care needs in a multiethnic Asian older adult population in Singapore. METHODS: Data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older Singapore Resident population aged 60 years and above was used. The validity of the short version of the 10/66 dementia diagnostic criteria derived from the Community Screening Instrument for Dementia, the modified Consortium to Establish a Registry of Alzheimer's Disease 10-word list delayed recall and the EURO-D depression screen were examined against the standard version of the 10/66 dementia diagnosis and clinician diagnosis as a gold standard. Concurrent validity was tested by examining the relationships between the short version 10/66 dementia diagnosis, disability and care needs. RESULTS: A total of 2373 respondents who had completed data on the short version diagnosis were included in this study. The majority (82.63%) of respondents were of Chinese descent, 9.86% were Malays, 6.12% were of Indian descent and 1.39% belonged to other ethnic group. We found the short version 10/66 dementia diagnosis showed almost perfect agreement with the standard version 10/66 dementia diagnosis (kappa = 0.90, AUC = 0.96) and substantial agreement with clinical diagnosis (kappa = 0.70, AUC = 0.87). The weighted prevalence of dementia in the population was slightly higher based on the short version diagnosis than the standard version diagnosis (10.74% vs. 10.04%). We also found that those with the short version 10/66 dementia were significantly associated with higher disability (ß = 28.90, 95% CI = 23.62, 9.62) and needed care occasionally (OR =35.21, 95% CI = 18.08, 68.59) or much of the time (OR = 9.02, 95% CI = 5.21, 15.61). CONCLUSIONS: The study found that the short version 10/66 dementia diagnosis has excellent validity to diagnose dementia in a multiethnic Asian population in Singapore. Further research is required to determine the usefulness of this diagnosis in clinical practice or institutional settings to aid early detection and intervention for dementia.

The correlates of slow gait and its relation with social network among older adults in Singapore.

OBJECTIVES: This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status. METHODS: Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample. RESULTS: The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score. CONCLUSION: Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.

Employment status among the Singapore elderly and its correlates.

AIM: It has been hypothesized that working beyond retirement age may have a protective effect on various aspects of well-being in the elderly. This paper aims to examine the relationship between employment status of elderly Singaporeans and indicators of well-being. METHODS: As part of the Well-being of the Singapore Elderly study, data relating to sociodemographics, social networks, medical history, physical activity, cognitive function, and disability were collected from 2534 participants aged 60 years and older. Participants included full-time workers (n = 483), part-time workers (n = 205), the unemployed (n = 32), homemakers (n = 808), and retirees (n = 1006). The data were analyzed by multiple logistic regression. RESULTS: Likelihood of being employed decreased with age, and employment was higher among men. Paid workers had significantly higher levels of physical activity, more extensive social networks, better cognitive function, less disability, and lower risk of dementia than retirees and homemakers. Paid workers had significantly lower chronic disease burden than retirees and rated their health to be better than retirees and the unemployed. CONCLUSIONS: These findings show that meaningful employment is associated with better psychological and physiological well-being among the elderly, highlighting the importance of studying likely protective effects of employment and creating employment opportunities for elderly Singaporeans.

Prevalence and correlates of sleep problems among elderly Singaporeans.

BACKGROUND: The current study examined the prevalence and correlates of sleep problems among elderly Singaporeans. METHODS: Data were taken from the Well-being of Singapore Elderly study, a cross-sectional, epidemiological survey conducted among Singapore residents aged 60 years and above (n = 2565). Respondents were screened for sleep problems through a series of questions in the Geriatric Mental State examination. Details on sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression were also collected. Logistic regression analysis was used to explore significant associations between sleep problems, sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression. RESULTS: Overall, 13.7% (n = 341) of older adults reported at least one sleep problem. Of those who reported sleep problems, 69.4% experienced sleep interruption at night, 48.9% reported having difficulty falling asleep, 22.3% reported early morning awakening, and 11.4% had all three problems. Elderly with sleep problems were significantly more likely to have a range of chronic physical conditions and depression and were also significantly less likely to be physically active. Older adults with at least one sleep problem reported significantly greater disability compared to those with no sleep problems. CONCLUSION: The high probability of comorbid chronic conditions as well as higher disability among those with sleep problems makes this an important area of research.

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.

Prevalence and predictors of tobacco use in the elderly.

OBJECTIVE: Smoking is a well-established public health issue, which has not been examined previously among the elderly in Singapore. This paper describes and identifies the current prevalence and predictors of tobacco use among the older resident population. METHODS: Data were derived from the Well-being of the Singapore Elderly study, a cross-sectional epidemiological study of the elderly in Singapore. Sociodemographic data from 2565 Singapore residents aged 60 years and above were collected through face-to-face interviews. Multinomial logistic regression analyses identified predictors of tobacco use. RESULTS: A total of 236 respondents were current tobacco users (9.5%). The majority of older tobacco users were men (88.1%). Significant predictors of tobacco use were gender, marital status, and education level. Younger age (60-74 years old) was associated with more tobacco use, and the completion of tertiary education with lower rates of use. CONCLUSIONS: Smoking prevalence among the elderly was lower than that of the Singapore general adult population (16%). However, the rate is still high and is of concern given the likelihood of a higher rate of physical disorders, which could be worsened with tobacco use. The identification of those at risk enables them to be targeted for smoking cessation programs and other interventions. Copyright © 2015 John Wiley & Sons, Ltd.

Qualitative study of Singaporean youths' perception of antismoking campaigns: what works and what does not.

BACKGROUND: Youths are more likely to rebel against messages perceived to inhibit their independence. In order for antismoking campaigns to be effective with this population, adopting evidence-based strategies is crucial. In this study, we examined youths' reaction to past and ongoing antismoking campaigns, and delineate effective and ineffective components of campaigns as identified by them. METHODS: 12 focus group discussions were conducted with 91 youth smokers aged 15-29 years. Data were analysed using qualitative content analysis. A codebook was derived through an iterative process. The data were coded systematically by three coders, using Nvivo V.10. RESULTS: Fear appeals that had no immediate relevance to youths, and campaigns involving humour or sports/dance activities that distracted youths from the antismoking messages, were deemed ineffective. In contrast, elements identified to be efficacious were: positive tone, low-fear visual images, 'low-controlling language' and a genuine spokesperson. Youth tended to favour campaigns circulating on social media platforms. Importantly, youths voiced a lack of tangible support for their efforts to quit smoking. CONCLUSIONS: Participants expressed a preference towards antismoking messages that were less authoritative, and perceived a distinct lack of support for their intentions to quit smoking. There is room for incorporating suggestions by participants in future antismoking campaigns. Future research is needed to identify barriers to accessing available support.

Recognition of mental disorders among a multiracial population in Southeast Asia.

BACKGROUND: Mental health literacy is an important mediating factor in help-seeking behavior. An important component of this literacy is the proper recognition of mental disorders. The aim of this population-based study in Singapore was to determine the proportion of adults in the resident population who were able to recognize vignettes pertaining to alcohol abuse, dementia, depression, obsessive compulsive disorder (OCD) and schizophrenia correctly. The sociodemographic characteristics that were associated with the ability to correctly recognize these disorders were also examined. METHODS: This was a nationwide cross-sectional study that involved establishing mental health literacy using a vignette approach. Respondents were recruited using a disproportionate stratified sampling design by age and ethnic groups. Face-to face-interviews were conducted with respondents aged 18 to 65 years belonging to Chinese, Malay, Indian and Other ethnic groups. RESULTS: A total of 3,006 respondents completed the survey (response rate of 71%). The most well recognized conditions were dementia (66.3%), alcohol abuse (57.1%) and depression (55.2%). The least recognized were OCD (28.7%) and schizophrenia (11.5%). Younger age and higher educational levels were found to be significant factors associated with the better recognition of specific disorders. CONCLUSION: The relatively high rate of recognition of dementia was likely to be due to the emphasis on public education programmes on dementia which is viewed as an emerging challenge due to Singapore's rapidly ageing population. The role of education and the portrayal of depression and alcohol related problems in the local mass media are possible influences in their better recognition as compared to OCD and schizophrenia. Sociodemographic characteristics influencing mental health literacy need to be considered in planning intervention strategies that target mental health literacy.