Changes in body mass index and its association with socio-demographic characteristics between 2010 and 2016 in Singapore.

Background: Epidemiological studies have observed an increase in the prevalence of obesity in both western and Asian countries. This study aims to compare the distribution of body mass index (BMI) in the general population of Singapore between 2010 and 2016, and to explore the socio-demographic risk factors associated with it. Methods: Data for this study were extracted from two national-wise studies in 2010 and 2016, two population-based, cross-sectional epidemiological studies. BMI cut-off scores were used as an indicator to assess obesity in this study, and the data included in the analysis was self-reported by the respondents. Results: Overall, the study observed decreasing prevalence in underweight and normal weight categories; and an increasing prevalence in overweight and obesity categories in the Singapore adult population between 2010 and 2016. Age, gender, ethnicity, marital status, and educational level were found to be significantly associated with BMI categories. Conclusion: The observed increase in the population's BMI between 2010 and 2016 may lead to an increase in the incidence of chronic diseases in Singapore. Our study findings add to the existing local literature and provides data for evidence-based policymaking on health-related interventions and program planning.

Association between sleep quality and quality of life in Singapore.

PURPOSE: Several studies have examined the relationship between sleep quality and health-related quality of life (HRQOL). However, there are a lack of generalizable data on this association in Singapore. Our study aimed to (1) investigate the association between sleep quality and HRQOL and (2) examine whether age moderated these associations. METHODS: Data were obtained from nationwide Singapore Mental Health Study 2016 (n = 6126, response rate = 69.5%). Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) where higher scores indicate poorer sleep quality. HRQOL [Physical component summary (PCS) and Mental component summary (MCS)] were measured using 12-item Short-Form Survey. Associations were investigated using multivariable linear regression models, adjusted for sociodemographic, physical, and mental comorbidities. Interactions between age and sleep quality were examined by including interaction terms individually. RESULTS: Poorer PSQI score was significantly associated with lower PCS (ß = - 0.44) and lower MCS (ß = - 0.73). Among PSQI components, lower PCS was significantly associated with subjective sleep quality (ß = - 1.06), sleep duration (ß = - 0.30), sleep disturbance (ß = - 0.33), and daytime dysfunction (ß = - 0.75). Lower MCS was significantly associated with subjective sleep quality (ß = - 1.36), sleep latency (ß = - 0.24), sleep disturbance (ß = - 0.16), using of sleeping medication (ß = - 1.12), and daytime dysfunction (ß = - 2.08). Age moderated the association between PSQI score with PCS and MCS. Stronger association between PSQI score and MCS was observed in younger individuals (ß = - 0.90) than older adults (ß = - 0.45). CONCLUSION: Our study found that poor sleep quality was associated with HRQOL of certain age groups more than others. Future studies may identify potential mediators to help people with chronic sleep problems.

Mediating effect of symptom severity on the relationship between aggression, impulsivity and quality of life outcomes among patients with schizophrenia and related psychoses.

Aims: Aggression and impulsivity among individuals with schizophrenia have been associated with poor clinical outcomes including worsening of symptoms and substance abuse which have been linked to a lower quality of life (QoL). The current study aimed to look at the mediating effect of symptom severity on the relationship between aggression, impulsivity and QoL among outpatients with schizophrenia and related psychoses in a multi-ethnic Asian population. Methods: Data (n = 397) were collected from outpatients seeking treatment at the Institute of Mental Health. The World Health Organization quality of life-BREF (WHOQOL-BREF) scale, the symptoms checklist-90 revised (SCL-90-R), Buss Perry aggression questionnaire (BPAQ), and the Barratt impulsiveness scales (BIS) were used to assess subjective well-being, symptom severity, aggression, and impulsivity, respectively. Mediation analysis was performed using the PROCESS macro to understand the mediating effect of symptom severity. Results: Motor impulsivity (MI) was indirectly associated with both the physical and psychological health domains of QoL while self-control was indirectly associated with the physical, psychological, and environmental health QoL domains through increased symptom severity. Conclusion: The significant indirect effect of symptom severity in our study highlights one potential pathway through which impulsivity impacts the QoL of individuals with schizophrenia and related psychoses. Elucidating other factors besides symptom severity that have an indirect effect on the QoL of individuals provides alternative approaches for treatment through which better clinical outcomes can be achieved.

Sociodemographic and psychosocial factors associated with vaccine hesitancy - results from a longitudinal study in Singapore.

Singapore has one of the highest COVID-19 vaccination rates, however identifying vaccine-hesitant sub-groups and their concerns is vital given the need for future boosters in vulnerable populations. Furthermore, vaccine hesitancy remains a concern in the event of an emergence of a newer strain that necessitates the rolling out of a new vaccination programme. The aims of this study were to establish the extent of COVID-19 vaccine hesitancy and the factors influencing it among adults in Singapore using the Vaccine Hesitancy Scale (VHS). The study used a longitudinal methodology and participants were recruited in two waves from May 2020 to Sep 2022. In all 858 participants agreed to participate in both waves of the study. The two-factor structure of the VHS scale as established in earlier studies was tested using confirmatory factor analysis. The results revealed a two-factor structure of VHS comprising "lack of confidence" and "risks". Those who had higher stress, resilience, and concerns that they might be infected with COVID-19 at wave 1 were significantly associated with lower 'lack of confidence' scores i.e. lower vaccine hesitancy. In comparison, those with higher concerns about inadequate government preventive measures and unemployment at wave 1 were significantly associated with higher 'lack of confidence' scores. Those with higher concerns about inadequate government preventive measures in wave 1 were significantly associated with higher 'risks' scores i.e. higher vaccine hesitancy. The findings point toward the need for a nuanced messaging that considers the fears expressed by the populace and addresses them directly using clear simple language.

Measuring social desirability bias in a multi-ethnic cohort sample: its relationship with self-reported physical activity, dietary habits, and factor structure.

BACKGROUND: Social desirability bias is one of the oldest forms of response bias studied in social sciences. While individuals may feel the need to fake good or bad answers in response to sensitive or intrusive questions, it remains unclear how rampant such a bias is in epidemiological research pertaining to self-reported lifestyle indicators in a multicultural Asian context. The main purpose of the current study is, therefore, to examine the sociodemographic correlates and impact of social desirability responding on self-reported physical activity and dietary habits at an epidemiological scale in a non-western multi-cultural Asian setting. METHODS: Prior to the main analyses, confirmatory and exploratory factor analyses were conducted to determine the factorial validity of a western derived concept of social desirability. Multiple regression analyses were conducted on cross-sectional data (n = 2995) extracted from a nationwide survey conducted between 2019 and 2020. RESULTS: A unique factor structure of social desirability was found and was therefore used for subsequent analyses. Multiple regression analyses revealed older age groups, the Indian ethnic group, those with past or present marriages, and having no income, had a significantly greater tendency to act on the bias. CONCLUSION: The construct of social desirability bias was fundamentally different in a multicultural context than previously understood. Only a small proportion of variance of self-report lifestyle scores was explained by social desirability, thus providing support for data integrity.

The economic burden of mental disorders among adults in Singapore: evidence from the 2016 Singapore Mental Health Study.

BACKGROUND: Little is known about the economic burden of mental disorders in multiethnic Asian populations. AIMS: The study aimed to estimate the economic cost of mental disorders in Singapore using data from the second Singapore Mental Health Study (SMHS 2016). METHOD: The SMHS 2016 is a nationally representative survey of the Singapore Resident population aged 18 years and above. Data on mental disorders and healthcare resource utilization were obtained from the World Mental Health Composite International Diagnostic Interview and the adapted version of the Client Service Receipt Inventory. RESULTS: The costs of visits to a restructured hospital doctor, other private health workers, accident and emergency, and intermediate and long-term care services and productivity losses tend to be much higher in those with mental disorders than those without mental disorders. The average annual excess cost associated with mental disorders per person was estimated to be S$3938.9 (95% CI, S$-100.8-S$7978.7). Extrapolation of these excess costs to the population suggests that the incremental costs of mental disorders in Singapore is about S$1.7 billion per year. CONCLUSION: This study provides evidence of the substantial burden of mental disorders on Singaporean society - both in terms of direct medical costs and loss of productivity costs.

Food insufficiency, adverse childhood experiences and mental health: results of the Singapore Mental Health Study 2016.

OBJECTIVE: This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore. DESIGN: This analysis utilised data from the Singapore Mental Health Study (SMHS 2016). SETTING: SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents. PARTICIPANTS: Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay. RESULTS: The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency. CONCLUSIONS: The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.

The factor structure of the Barratt Impulsiveness Scale (BIS-11) and correlates of impulsivity among outpatients with schizophrenia and other psychotic disorders in Singapore.

BACKGROUND: Impulsivity has been linked to risky behaviours amongst patients with schizophrenia or other psychotic disorders. However, there is a dearth of studies examining impulsivity amongst this population in Singapore. Moreover, to date, scales to measure impulsivity have not been validated in this population. The present study seeks to examine the underlying factor structure of the Barratt Impulsiveness Scale (BIS-11) and explore sociodemographic and clinical correlates of impulsivity within this group. METHODS: Confirmatory factor analyses (CFA) were conducted to test factor structures of the BIS-11 proposed in extant literature. However, due to poor fit statistics, the sample (n = 397) was split into two groups, with Exploratory Factor Analyses (EFA) conducted in the first subgroup (n = 200). The final model of the EFA was then tested within the second subgroup (n = 197) with CFA. Multivariable linear regressions were conducted to examine sociodemographic and clinical correlates of each underlying factor. RESULTS: CFA indicated a three-factor structure amongst 16-items of the BIS-11 with acceptable fit: i) Non-planning impulsivity (5-items; α = 0.94), ii) Motor impulsiveness (6-items α = 0.84), and iii) Lack of self-control (5-items, α = 0.85). Lower education was associated with higher non-planning impulsivity. While age, ethnicity, marital status, and general psychiatric symptom severity were significant correlates of motor impulsiveness, problematic alcohol use and general psychiatric symptom severity were related to a greater lack of self-control. CONCLUSION: Factor structures of the BIS-11 suggested by extant literature were not applicable, and we propose an alternative factor structure for BIS-11. Significant correlates of impulsivity are highlighted, and avenues for future research are suggested.

Sleep quality of Singapore residents: findings from the 2016 Singapore mental health study.

Given the importance of sleep for physical and mental wellbeing, it is crucial to understand the extent of insomnia among community dwellers. However, there is a paucity of population wide epidemiological studies to estimate the prevalence of poor sleep quality. This present study aimed to 1) characterize the sleep quality of a nationally representative sample (n = 6126) of Singapore residents using Pittsburg Sleep Quality Index (PSQI) and 2) identify the sociodemographic correlates of poor sleep in this population. A total of 27.6% of respondents reported poor sleep quality (PSQI score ≥5). Sociodemographic correlates of poor sleep quality in the Singapore population included, but were not limited to, females (AOR = 1.44, 95% CI = 1.17 to 1.77, p-value = 0.001), Malays (vs Chinese) (AOR = 1.53, 95% CI = 1.23 to 1.9, p-value < 0.001), Indians (vs Chinese) (AOR = 1.22, 95% CI = 1.02 to 1.47, p-value = 0.03), ex-smokers (vs non-smokers) (AOR = 1.43, 95% CI = 1.07 to 1.92, p-value = 0.02), persons with comorbid mental health conditions (vs no mental health conditions) (AOR = 14.11, 95% CI = 6.52 to 30.54, p-value < 0.01), and persons with physical multimorbidity (vs no physical conditions) (AOR = 1.63, 95% CI = 1.24 to 2.15, p-value < 0.001). The prevalence of poor sleep in Singapore is comparable to that of other countries in the Asian region. Targeted public health campaigns to psycho-educate vulnerable groups on the importance of good sleep hygiene may improve the overall wellbeing of residents in Singapore.

The moderating effect of employment status on the relationship between lifetime major depressive disorder and positive mental health.

INTRODUCTION: This paper aims to examine the (1) level of positive mental health (PMH), (2) identify the socio-demographic correlates of the PMH domains in the general population, and (3) establish if employment status moderates the relationship between major depressive disorder (MDD) and PMH among those with a lifetime prevalence of MDD. METHODS: The Singapore Mental Health Study conducted between 2016 and 2018 included Singapore residents aged ≥18 years. The World Health Organization Composite International Diagnostic Interview version 3.0 was utilised to establish lifetime prevalence of MDD. Moderation analysis was conducted using SPSS PROCESS macro (Hayes, 2017) to assess if employment status moderated the relationship between MDD and PMH. RESULTS: Significantly lower PMH total and domain scores were reported by respondents (n=2,270) who endorsed lifetime MDD compared to those who did not. Moderation analysis demonstrated that the effect of MDD on PMH total and domain scores varied considerably across employment status. Based on the interaction plots, the effect of MDD on both PMH total and domain scores was minimal among those employed than unemployed. CONCLUSION: Healthcare professionals should support the employment needs of those who report lifetime MDD to provide care for an individual's mental well-being in a holistic manner. Acquiring or remaining in employment would be a priority depending on the PMH of the individual. Reducing barriers to employment for those with health issues or creating employment opportunities for this group are concerns that need to be addressed at a societal level.

Dietary patterns of persons with chronic conditions within a multi-ethnic population: results from the nationwide Knowledge, Attitudes and Practices survey on diabetes in Singapore.

BACKGROUND: Chronic conditions are a leading cause of death and disability worldwide and respective data on dietary patterns remain scant. The present study aimed to investigate dietary patterns and identify sociodemographic factors associated with Dietary Approaches to Stop Hypertension (DASH) scores within a multi-ethnic population with various chronic conditions. METHODS: The present study utilised data from the 2019-2020 Knowledge, Attitudes, and Practices study on diabetes in Singapore - a nationwide survey conducted to track the knowledge, attitudes, and practices pertaining to diabetes. The study analysed data collected from a sample of 2,895 Singapore residents, with information from the sociodemographic section, DASH diet screener, and the modified version of the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0 checklist of chronic physical conditions. RESULTS: Respondents with no chronic condition had a mean DASH score of 18.5 (±4.6), those with one chronic condition had a mean DASH score of 19.2 (±4.8), and those with two or more chronic conditions had a mean DASH score of 19.8 (±5.2). Overall, the older age groups [35- 49 years (B = 1.78, 95% CI: 1.23 - 2.33, p <0.001), 50-64 years (B = 2.86, 95% CI: 22.24 - 3.47, p <0.001) and 65 years and above (B = 3.45, 95% CI: 2.73 - 4.17, p <0.001)], Indians (B = 2.54, 95% CI: 2.09 - 2.98, p <0.001) reported better diet quality, while males (B = -1.50, 95% CI: -1.87 - -1.14, p <0.001) reported poorer diet quality versus females. CONCLUSION: Overall, respondents with two or more chronic conditions reported better quality of diet while the sociodemographic factors of age, gender and ethnicity demonstrated a consistent pattern in correlating with diet quality, consistent with the extant literature. Results provide further insights for policymakers to refine ongoing efforts in relation to healthy dietary practices for Singapore.

Differences in the Prevalence and Profile of DSM-IV and DSM-5 Alcohol Use Disorders-Results from the Singapore Mental Health Study 2016.

INTRODUCTION: The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for alcohol use disorders (AUD) was a significant shift from the historical DSM-IV Text Revised version. Following this shift in diagnostic criteria, a difference in the prevalence of AUD was expected. The current study aimed to evaluate the consequences of the modification of the diagnostic criteria from DSM-IV to DSM-5 AUD using lifetime diagnosis in Singapore's multi-ethnic population using data from a nationwide epidemiological study. METHODS: Respondents were assessed for lifetime mental disorders using the Composite International Diagnostic Interview (CIDI) administered through face-to-face interviews. Lifetime DSM-IV AUD diagnoses were compared with DSM-5 AUD diagnoses generated by modifying the criteria and the addition of the craving criterion. Sociodemographic correlates of lifetime DSM-IV/DSM-5 AUD were examined using multiple logistic regression analysis. Associations between DSM-IV/DSM-5 AUD, chronic conditions, and the HRQOL summary scores were examined using logistic and linear regression after controlling for significant sociodemographic factors. RESULTS: The lifetime prevalence of DSM-IV AUD was 4.6% (0.5% for dependence and 4.1% for abuse) in the adult population, while the lifetime prevalence of DSM-5 AUD was 2.2%. Younger age, male gender, and lower education were associated with higher odds of both DSM-IV and DSM-5 AUD. However, those who were economically inactive (versus employed) (AOR, 0.4; 95% CI 0.2-0.9) and had a higher monthly household income (SGD 4000-5999 versus below SGD 2000) had lower odds of DSM-IV AUD (AOR, 0.4; 95% CI 0.2-0.7), but this was not observed among those with DSM-5 AUD. Both DSM-IV and DSM-5 AUD were associated with significant comorbidities in terms of other mental disorders; however, those diagnosed with lifetime GAD had significantly higher odds of having DSM-5 AUD (AOR, 5; 95% CI 1.9-13.2) but not DSM-IV AUD. CONCLUSIONS: While using the DSM-5 criteria would result in a lower prevalence of AUD in Singapore, it remains a highly comorbid condition associated with a poor health-related quality of life that is largely untreated, which makes it a significant public health concern.

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

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

Occupational groups and its physical and mental health correlates: results from the Singapore Mental Health Study 2016.

PURPOSE: The physical and mental wellbeing of an individual is impacted by the type occupation one does. This study aims to establish the prevalence of mental and physical disorders, the association of occupational groups and health-related quality of life, and the extent of work-loss and work-cut back in past 30 days among the employed in the Singapore resident population. METHODS: Data from a population-based, epidemiological survey of a representative sample of Singapore citizens and permanent residents aged 18 years and above were used. Lifetime diagnosis of select mental disorders was established using the World Health Organization's Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0). Data on nicotine dependence, work productivity, quality of life and socio-demographics were obtained via self-report. Ten major occupational groups based on the Singapore Standard Occupational Classification were included in the analysis. RESULTS: The sample comprised 4021 employed individuals who were predominantly males (54.7%) and aged 35-49 years (35.4%). 'Service and sales workers' (22.6%), 'Professionals' (17.3%) and 'Legislators, senior officials and managers' (16.4%) were the three largest occupational groups. Socio-demographic characteristics differed significantly (p < 0.001) across all occupational groups. Lifetime prevalence of mood disorders among the employed was 8.4% and the most prevalent physical disorder was chronic pain (18.9%). No significant differences were observed in work productivity loss across the occupational groups. CONCLUSIONS: The disparities in the socio-demographic characteristics and prevalence of mental and physical disorders across occupational categories provide policymakers with vital information to pilot effective interventions that can improve the psychosocial and physical conditions at work.

Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016.

INTRODUCTION: Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. METHODS: We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. RESULTS: The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. CONCLUSION: The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.

The Prevalence and Correlates of Disability in Singapore: Results from a Nationwide Cross-Sectional Survey.

OBJECTIVE: The study aims to estimate the prevalence of disability and the association of disability with socio-demographic correlates and health outcomes among the Singapore population. METHODS: Face-to-face interviews were conducted with a representative sample of Singapore's population. Using the Washington Group's questionnaire, disability was defined using both the 'standard' (a lot of difficulty or higher in one or more domains) and the 'wider' threshold (of 'some' or greater difficulty). Data on socio-demographic correlates, self-reported lifestyle, physical activity, chronic conditions, and health-related quality of life were also collected. RESULTS: The prevalence of any disability using the standard threshold was 3.1% (95% CI: 2.4-4.1). When separated by disability type, mobility (1.8%) was the most prevalent, followed by vision (0.8%), cognition (0.5%), hearing (0.3%), and self-care (0.2). In the adjusted regression analysis, lower education and unemployed and economically inactive status (versus employed) were significantly associated with disability. CONCLUSIONS: Although this prevalence is lower than other countries, it is a significant finding in terms of actual numbers and impact at both the individual and the societal levels. Our findings also highlight the need to strengthen health services and preventive interventions targeting older adults and those who are physically inactive to reduce the burden of disability in these groups.

Problematic Drug Use Among Outpatients With Schizophrenia and Related Psychoses.

Background: Problematic drug use is common among psychiatric patients and is linked with poorer course and outcomes of illness. The aim of this study is to assess the prevalence of problematic drug use, and to explore its sociodemographic correlates and associations with health behaviors and outcomes among outpatients with schizophrenia and related psychoses in Singapore. Methods: Data from 397 individuals who were aged 21-65 years and were seeking treatment for schizophrenia and related psychoses in the outpatient clinics of a tertiary psychiatric hospital were analyzed. The Drug Abuse Screening Test (DAST-10) was used to assess problematic drug use. Information on sociodemographics, smoking status, alcohol use, symptoms severity and quality of life were collected. Multivariable logistic regressions were conducted to explore correlates and associations of problematic drug use. Results: The prevalence of problematic drug use was 5.8% (n = 23) in the sample, and 10.6% (n = 42) of the participants reported having problematic drug use and/or problematic alcohol use. More males than females reported having problematic drug use (p = 0.021), and also problematic drug and/or alcohol use (p = 0.004). Significant associations were observed between problematic drug use and smokers with nicotine dependence, and with physical health domain of quality of life. Individuals with greater symptom severity were approximately twice as likely to have problematic drug use and/or alcohol use. Conclusion: While the prevalence of problematic drug use in this sample population is relatively lower compared to other countries, there is a considerable number who might be at risk. Routine screening and close monitoring of drug use is recommended as part of psychiatric assessment, particularly among males and patients with nicotine dependence.

Asthma Prevalence and its Risk Factors Among a Multi-Ethnic Adult Population.

Asthma is a substantial global health problem characterized by chronic airway inflammation, leading to intermittent symptoms. This study aims to establish the prevalence and risk factors of asthma in a multi-ethnic adult population. Data for the study were extracted from the Singapore Mental Health Study 2016, a population-based, cross-sectional, epidemiological study of Singapore residents aged 18 years and above. The data relating to asthma prevalence was captured using the modified World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0 chronic conditions checklist. The prevalence of lifetime asthma in this population was 11.9% (95% CI, 10.83-13.12). Those of Malay and Indian ethnicity (versus Chinese), ex-smokers (versus never smoked) and those who were overweight and obese (versus normal weight) were more likely to be associated with asthma. Participants belonging to the age group of 35 years and above (versus 18-34 years of age), male gender (versus female) were less likely to be associated with lifetime asthma. Asthma was also more likely to be associated with bipolar disorder. Those with current asthma (ie, those who had received treatment during the past 12 months) were significantly associated with lower health-related quality of life in the physical component score (PCS) than those without asthma. The high prevalence and association with lowered health-related quality of life makes asthma a significant public health concern. Our study's findings can help create awareness and encourage integrated approaches for managing asthma in the health sector.

Health Literacy and Diabetes Knowledge: A Nationwide Survey in a Multi-Ethnic Population.

Health literacy is a key determinant of the public health and health climate of the nation. This study examined the functional health literacy of the nation, factors associated with health literacy, and its relationship with diabetes recognition. This cross-sectional survey recruited participants (N = 2895) who were 18 years and above from a population registry through disproportionate stratified sampling. The Brief Health Literacy Screen and other questionnaires were administered through face-to-face interviews, in one of the four national languages (English, Chinese, Malay or Tamil). The majority (80.5%) had adequate functional health literacy and were able to recognise symptoms of diabetes correctly (83.5% overall; 83.7% and 82.2% in those with adequate and inadequate health literacy, respectively). Those with inadequate health literacy had a higher incidence of chronic conditions (p < 0.001) compared to those with adequate health literacy in bivariate analysis. The majority of the sample had sufficient levels of physical activity (83.3%), and more than half reported an unhealthy lifestyle (57.4%). Older age, Chinese ethnicity, those who were employed, with lower education (secondary or below), and were married had significantly higher odds of inadequate health literacy. Health literacy was not associated with lifestyle, physical activity, chronic conditions and diabetes recognition. Health literacy interventions should focus on the disadvantaged social groups for improving their health literacy.

Readiness and Acceptance of eHealth Services for Diabetes Care in the General Population: Cross-sectional Study.

BACKGROUND: Diabetes management is a growing health care challenge worldwide. eHealth can revolutionize diabetes care, the success of which depends on end user acceptance. OBJECTIVE: This study aims to understand the readiness and acceptance of eHealth services for diabetes care among the general population, perceived advantages and disadvantages of eHealth, and factors associated with eHealth readiness and acceptance in a multiethnic Asian country. METHODS: In this cross-sectional epidemiological study, participants (N=2895) were selected through disproportionate stratified random sampling from a population registry. Citizens or permanent residents of Singapore aged >18 years were recruited. The data were captured through computer-assisted personal interviews. An eHealth questionnaire was administered in one of four local languages (English, Chinese, Malay, or Tamil), as preferred by the participant. Bivariate chi-square analyses were performed to compare the sociodemographic characteristics and perception of advantages and disadvantages of eHealth services between the diabetes and nondiabetes groups. Multivariable logistic regression models were used to determine factors associated with eHealth readiness and acceptance. All analyses were weighted using survey weights to account for the complex survey design. RESULTS: The sample comprised participants with (n=436) and without (n=2459) diabetes. eHealth readiness was low, with 47.3% of the overall sample and 75.7% of the diabetes group endorsing that they were not ready for eHealth (P<.001). The most acceptable eHealth service overall was booking appointments (67.4%). There was a significantly higher preference in the diabetes group for face-to-face sessions for consultation with the clinician (nondiabetes: 83.5% vs diabetes: 92.6%; P<.001), receiving prescriptions (61.9% vs 79.3%; P<.001), referrals to other doctors (51.4% vs 72.2%; P<.001), and receiving health information (34% vs 63.4%; P<.001). The majority of both groups felt that eHealth requires users to be computer literate (90.5% vs 94.3%), does not build clinician-patient rapport compared with face-to-face sessions (77.5% vs 81%), and might not be credible (56.8% vs 64.2%; P=.03). Age (≥35 years), ethnicity (Indian), and lower education status had lower odds of eHealth readiness. Age (≥35 years), ethnicity (Indian), lower education status (primary school), BMI (being underweight), and marital status (being single) were associated with a lower likelihood of eHealth acceptance. Among only those with diabetes, a longer duration of diabetes (4-18 years), higher education (degree or above), and younger age (23-49 years) were associated with eHealth readiness, whereas younger age and income (SGD 2000-3999 [US $1481-$2961]) were associated with acceptance. CONCLUSIONS: Overall, an unfavorable attitude toward eHealth was observed, with a significantly higher number of participants with diabetes reporting their unwillingness to use these services for their diabetes care. Sociodemographic factors associated with acceptance and readiness identified a group of people who were unlikely to accept the technology and thus need to be targeted for eHealth literacy programs to avoid health care disparity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2020-037125.