Prevalence and correlates of excessive Internet use among youth in Singapore.

INTRODUCTION: There has been an explosive growth of Internet usage worldwide and this is expected to continue with its use becoming an integral part of everyday life. The Internet provides tremendous educational benefits; however, excessive Internet use can lead to negative outcomes such as poor school performance and social isolation. MATERIALS AND METHODS: The survey consisted of a 69-item, anonymous, self-administered paper-and-pencil questionnaire. Data collected included demographic data, academic performance, social support and general wellbeing as well as questions pertaining to Internet use. For the purposes of our study, we defined Internet use of more than 5 hours a day as "excessive use". RESULTS: Of the 2735 adolescents who took part in the study, 1349 (49.3%) were male and 1383 (50.6%) were female. The mean age of the adolescents was 13.9 years [standard deviation (SD), 1.0]. A quarter of the adolescents surveyed (25%) reported that they did not access the Internet everyday, while 17.1% of adolescents reported using it for more than 5 hours every day. Excessive Internet use was associated with (i) no rules of Internet use at home (x2 = 313.1, P <0.001 ), (ii) less likelihood of having confidants (x2 = 15.8, P = 0.003), (iii) feelings of sadness or depression (x2 = 49.6, P <0.001) and (iv) perceived poorer grade/school work (x2 = 226.1, P <0.001). CONCLUSIONS: The high figures of excessive Internet use (17.1%) reported in our study is not equivalent to Internet addiction as no diagnostic instruments were used. However, school counsellors and teachers need to be made aware of the prevalence of and problematic behaviours associated with excessive Internet use. Training and resources should also be made available to parents and caregivers so that they can play a greater role in setting boundaries and detecting early warning signs.

Demographic and clinical features of 150 pathological gamblers referred to a community addictions programme.

INTRODUCTION: Pathological gambling has been defined as a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and work life. The present study reports on the sociodemographic features, gambling activity, comorbidity and legal problems in a sample of 150 pathological gamblers who sought treatment from the Community Addiction Management Programme (CAMP), Singapore over a 4-year period from 2002 to 2006. MATERIALS AND METHODS: Data were collected on 150 consecutive subjects who sought treatment at CAMP. Patients were administered a semi-structured interview to elicit demographic data, age of onset, family history, onset games and types of games ever played, largest debt incurred due to gambling, triggers, illegal activities and suicidal attempts by their counsellor. Patients were then assessed by the clinicians to establish the primary and comorbid diagnoses. RESULTS: The mean age of the subjects was 42.5 [standard deviation (SD) 10.2] years. The majority of them were males (87.3%) and of Chinese origin (97.3%). The most common comorbid disorders were mood disorders (n = 22, 14.7%), substance abuse (n = 11, 7.3%) and alcohol abuse or dependence (n = 7, 4.7%). Sixteen (10.7%) subjects had a history of suicidal attempts which had been precipitated by gambling-related issues. CONCLUSIONS: Pathological gambling in our subjects appears to be associated with significant comorbidity and financial problems. These are the preliminary findings and further research is needed regarding the phenomenology, profile, course and response to treatment of pathological gambling disorders.

Concomitant use of midazolam and buprenorphine and its implications among drug users in Singapore.

INTRODUCTION: The aim of this study was to determine the prevalence and characteristics of benzodiazepine (BZD) abuse among intravenous opioid users in Singapore. MATERIALS AND METHODS: Eligibility criteria for inclusion in this study were all intravenous buprenorphine abusers, who presented to the Community Addictions Management Programme (CAMP) over a 1-year period from February 2005 to January 2006. One hundred and twenty subjects, who consented to the study, completed an interviewer-administered questionnaire and underwent blood test for blood-borne viral infections. RESULTS: The age of the 120 subjects ranged from 20 to 64 years, with a mean age of 39.0 (SD 8.0) years. The majority of the participants were male (90.0%); 48.3% were Chinese. Ninety-eight (81.7%) patients were using BZDs concomitantly. Midazolam was the most commonly used BZD. Buprenorphine abusers who were concomitantly using BZDs were significantly younger and reported an earlier age of onset of illicit drug abuse as compared to those not using BZDs. Those abusing BZDs were more likely to share syringes (x 2 = 5.8, P = 0.02), and were more likely to be seropositive for hepatitis C virus (x 2 = 4.3, P = 0.04). CONCLUSIONS: This study highlights the extreme caution that needs to be exercised in prescribing BZDs to all patients in general and patients with injecting drug use or histories of drug abuse in particular. At a public health level, general practitioners (GPs) who prescribe buprenorphine should have compulsory training which highlights the potential dangers of abuse and concomitant abuse of BZDs.

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 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.

Socio-demographic profile and help-seeking behaviour of buprenorphine abusers in Singapore.

INTRODUCTION: The US Food and Drug Administration (FDA) approved buprenorphine or Subutex for the treatment of opiate dependence in October 2002. Buprenorphine is a partial agonist of the mu-opioid receptor; although initial animal research suggested a low abuse potential for buprenorphine, it was subsequently shown to have an abuse potential similar to that of morphine or hydromorphone. The objectives of this study were to establish the sociodemographic profile and help-seeking behaviour of buprenorphine abusers attending the deaddiction treatment clinics of the Community Addictions Management Programme. MATERIALS AND METHODS: One hundred and twenty subjects, all buprenorphine abusers fulfilling the diagnostic criteria for opiate dependence, who consented to the study, completed an interviewer-administered questionnaire. RESULTS: The mean age of those participating in the study was 39.2 [standard deviation (SD) 8.0] years. The majority of the participants were male (90%), 52.5% were currently employed and 98% had at least primary education. A family history of drug abuse was reported by 27% of the subjects. Illicit drug abuse occurred at an early age with mean age of onset of illicit drug abuse being 16.9 (SD 4.8) years with gateway drugs like marijuana and glue. CONCLUSIONS: It is vital for our medical profession to be aware of the trend in the local population to move from the abuse of illicit substances, to the abuse of prescriptive medications. It makes it necessary to increase the understanding of addictions both amongst our practising medical fraternity, and amongst those training to enter the profession. At the hospital level, it necessitates a higher level of vigilance among our emergency room physicians and those treating infectious diseases.

Accuracy of self-reported height, weight and BMI in a multiethnic Asian population

INTRODUCTION@#The study assessed whether self-reported height, weight and derived body mass index (BMI) can provide an accurate measure of anthropometric data in a multiethnic adult population in Singapore.@*METHODS@#Standardised anthropometric measurements were compared against the self-reported values from 5,132 adult residents in a cross-sectional, epidemiological survey. Discrepancies in self-reports from measurements were examined by comparing overall mean differences. Intraclass correlations, Cohen's kappa and Bland-Altman plots with limits of agreement, and sub-analysis by sex and ethnicity were also explored.@*RESULTS@#Data were obtained from 5,132 respondents. The mean age of respondents was 43.9 years. Overall, the height was overestimated (0.2cm), while there was an underestimation of weight (0.8kg) and derived BMI (0.4kg/m2). Women had a larger discrepancy in height (0.35cm, 95% confidence interval [CI] 0.22 to 0.49), weight (-0.95kg, 95% CI -1.11 to -0.79) and BMI (-0.49kg/m2, 95% CI -0.57 to -0.41) compared with men. Height reporting bias was highest among Indians (0.28cm, 95% CI 0.12 to 0.44) compared with Chinese and Malays, while weight (-1.32kg, 95% CI -1.53 to -1.11) and derived BMI (-0.57kg/m2, 95% CI -0.67 to -0.47) showed higher degrees of underreporting among Malays compared with Chinese and Indians. Substantially high self-reported versus measured values were obtained for intraclass correlations (0.96-0.99, @*CONCLUSION@#Self-reported anthropometric estimates can be used, particularly in large epidemiological studies. However, sufficient care is needed when evaluating data from Indians, Malays and women as there is likely an underestimation of obesity prevalence.

Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study

INTRODUCTION@#Nutritional psychiatry is an emerging field of study that investigates the role of diet and nutrition in mental health. Studies conducted in the general population have linked depressive symptoms with poor dietary patterns. The aim of this study was to characterise the dietary intake and analyse the dietary pattern using the Dietary Approach to Stop Hypertension (DASH) in a sample of psychiatric patients in a multiethnic Asian nation.@*METHODS@#Participants were recruited from an outpatient clinic and an inpatient unit at the Institute of Mental Health in Singapore. Self-reported dietary habits of a sample of psychiatric patients (N=380) were analysed using DASH. To examine the variables associated with DASH scores, a linear regression was conducted with the full sample and sociodemographic variables.@*RESULTS@#Persons with depressive disorders had a mean DASH score of 21.3 (±4.2), while persons with psychotic disorders had a mean DASH score of 21.2 (±4.9). Respondents who were older (B=1.94, 95% confidence interval [CI] 0.91-2.96, @*CONCLUSION@#Dietary patterns of persons with mental disorders were characterised. A host of sociodemographic factors, and not diagnosis of mental disorders, influenced the dietary quality of people with depressive and psychotic disorders. Clinicians treating psychiatric patients need to be aware of the nuanced reasons behind poor dietary choices and provide targeted psychoeducation to specific subgroups within the patient population.

Negative affect moderates the link between body image dissatisfaction and disordered eating among psychiatric outpatients in a multi-ethnic Asian setting

INTRODUCTION@#Few studies have investigated the factors that affect the relationship between body image dissatisfaction and disordered eating locally. Our study aimed to investigate the moderating effects of depression and anxiety levels on the body dissatisfaction-disordered eating link in Singapore.@*METHODS@#A total of 329 participants completed a set of questionnaires that included various scales pertaining to eating behaviours, body image, psychological distress and quality of life.@*RESULTS@#Participants were diagnosed with schizophrenia (47.4%), depression (46.8%) and substance use disorders (5.8%). Moderation analyses revealed that depression (F [9, 251] = 18.50, p < 0.001, R@*CONCLUSION@#Greater effort should be dedicated to the screening of disordered eating behaviours in psychiatric outpatients presenting with greater psychological distress.

Dietary intake of persons with depressive and psychotic disorders in Singapore

INTRODUCTION@#Nutritional psychiatry is an emerging field of study that investigates the role of diet and nutrition in mental health. Studies conducted in the general population have linked depressive symptoms with poor dietary patterns. The aim of this study was to characterise the dietary intake and analyse the dietary pattern using the Dietary Approach to Stop Hypertension (DASH) in a sample of psychiatric patients in a multiethnic Asian nation.@*METHODS@#Participants were recruited from an outpatient clinic and an inpatient unit at the Institute of Mental Health in Singapore. Self-reported dietary habits of a sample of psychiatric patients (N=380) were analysed using DASH. To examine the variables associated with DASH scores, a linear regression was conducted with the full sample and sociodemographic variables.@*RESULTS@#Persons with depressive disorders had a mean DASH score of 21.3 (±4.2), while persons with psychotic disorders had a mean DASH score of 21.2 (±4.9). Respondents who were older (B=1.94, 95% confidence interval [CI] 0.91-2.96, @*CONCLUSION@#Dietary patterns of persons with mental disorders were characterised. A host of sociodemographic factors, and not diagnosis of mental disorders, influenced the dietary quality of people with depressive and psychotic disorders. Clinicians treating psychiatric patients need to be aware of the nuanced reasons behind poor dietary choices and provide targeted psychoeducation to specific subgroups within the patient population.

Validation of the World Health Organization Disability Assessment Schedule 2.0 among older adults in an Asian country

INTRODUCTION@#As populations age globally and the burden of chronic illnesses increases, valid measures of disability are needed for assessment in the older adult population. The aim of the current analysis was to explore the psychometric properties and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an epidemiological survey of older adults in Singapore.@*METHODS@#The study comprised secondary data analysis of the Well-being of the Singapore Elderly study. Inclusion criteria for the study were Singapore residents (Singapore citizens and permanent residents) aged 60 years and above. The 12-item interviewer-administered version of the WHODAS 2.0 was used to assess disability in the study. Data on cognition, health status and sociodemographic information were collected. Depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy.@*RESULTS@#The study found a one-factor model solution for WHODAS 2.0 with a high internal consistency of all items. The internal consistency for the overall scale was 0.92. The WHODAS 2.0 score positively correlated with multimorbidity, perceived overall health status, depression and subsyndromal depression. There was a significant inverse association between the WHODAS 2.0 score and the cognitive status. After adjustment for all sociodemographic variables in the multiple linear regression analysis, these measures remained significantly associated with the WHODAS 2.0 score.@*CONCLUSION@#WHODAS 2.0 was found to be a valid measure of disability among older adults. However, further research is required to determine its usefulness as a responsive instrument that can detect change following interventions.

Successful ageing in Singapore: prevalence and correlates from a national survey of older adults

INTRODUCTION@#The current study aimed to estimate the overall prevalence and sociodemographic correlates of successful ageing, as defined by Rowe and Kahn, among a national sample of multiethnic adults aged 60 years and older in Singapore.@*METHODS@#Data from older adults who participated in the Well-being of the Singapore Elderly study was analysed. Successful ageing was defined with five indicators: no major diseases; no disability; high cognitive functioning; high physical functioning; and active engagement with life.@*RESULTS@#The prevalence of successful ageing was 25.4% in this older population. Older adults aged 75-84 years and ≥ 85 years had 0.3 times and 0.1 times the odds of successful ageing, respectively, than those aged 60-74 years. Compared to older adults of Chinese ethnicity, those of Malay (odds ratio [OR] 0.6) and Indian (OR 0.5) ethnicities were less likely to be associated with successful ageing. Older adults with lower education levels, who had no formal education (OR 0.2), some schooling but did not complete primary education (OR 0.4) or only primary education (OR 0.5), had lower odds of ageing successfully than those with tertiary education.@*CONCLUSION@#Older adults in Singapore tend to have much more active engagement with life as compared to their counterparts from other countries. Further research into this population is needed, both in terms of qualitative research to gain a better understanding of successful ageing from the older adult's perspective, as well as longitudinal studies that explore behavioural determinants of successful ageing.

Quality of Life across Mental Disorders in Psychiatric Outpatients

<p><b>INTRODUCTION</b>Literature has shown that individuals with various psychiatric disorders experience a lower quality of life (QoL). However, few have examined QoL across disorders. The current study explored differences in QoL and symptom severity across 4 psychiatric diagnostic groups: anxiety disorders (including obsessive compulsive disorder [OCD]), depressive disorders, schizophrenia, and pathological gambling.</p><p><b>MATERIALS AND METHODS</b>Data analysed was from a previous study that examined the prevalence of hoarding symptoms among outpatients (n = 500) in a tertiary psychiatric hospital in Singapore. Measures utilised included the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II) and Quality of Life Enjoyment and Satisfaction QuestionnaireShort Form (Q-LES-Q-SF). Sociodemographic information and details on type and number of comorbidities were also collected.</p><p><b>RESULTS</b>The depressive disorder group had the highest level of depressive and anxiety symptoms and the lowest QoL whereas; the schizophrenia group had the lowest level of depressive symptoms and the highest QoL. Age and employment status were the only sociodemographic correlates which were significantly associated with QoL. After controlling for sociodemographic factors, only the type of mental disorder was found to have a significant effect in explaining BAI, BDI-II and Q-LES-Q-SF.</p><p><b>CONCLUSION</b>Findings offer insight in terms of the burden associated with the various disorders.</p>

Prevalence and correlates of diabetes mellitus and dyslipidaemia in a long-stay inpatient schizophrenia population in Singapore

<p><b>INTRODUCTION</b>Patients with schizophrenia have shorter life expectancy and one of the main causes of death is cardiovascular disease (CVD). Modifiable risk factors for CVD include diabetes mellitus (DM) and dyslipidaemia. This study aimed to establish: (a) the prevalence and correlates of DM and dyslipidaemia; (b) the proportion of those whose condition was well controlled; and (c) the incidence of undiagnosed DM and dyslipidaemia in a long-stay inpatient schizophrenia population.</p><p><b>METHODS</b>Data was collected to assess the physical health status of 110 inpatients with schizophrenia who had been in hospital for over one year. Information on sociodemographic characteristics, diagnosis of physical and mental illnesses, and current medications was obtained from their medical records. The overall prevalence of DM and dyslipidaemia was based on diagnosis in the medical records, current medications and fasting blood test results.</p><p><b>RESULTS</b>The patient group was predominantly male (85.5%), with a mean age of 55.9 ± 9.9 (range 25-90) years. Overall prevalence of DM and dyslipidaemia was 19.1% and 62.7%, respectively. Multivariate logistic regression analysis showed that Malay (odds ratio [OR] 14.97) and Indian (OR 25.71) patients were significantly more likely to have DM when compared to Chinese patients.</p><p><b>CONCLUSION</b>In comparison to the general population, the prevalence of DM and dyslipidaemia was found to be higher in inpatients with schizophrenia. However, the two chronic illnesses were well controlled in inpatients and few were undiagnosed, perhaps due to the regular monitoring, supervised diet and regular physical activities arranged for inpatients in the long-stay inpatient wards.</p>

Deliberate Self-Harm in Psychiatric Outpatients Aged 14-35 Years in Singapore

<p><b>INTRODUCTION</b>The main aim of the study was to identify the prevalence of deliberate self-harm (DSH) in a sample of youth outpatients attending the state psychiatric hospital in Singapore and to identify the sociodemographic and psychological/clinical risk factors associated with DSH. The secondary aim of  the study was to examine if different forms of DSH had distinguishing risk factors.</p><p><b>MATERIALS AND METHODS</b>A total of 400 outpatients at the Institute of Mental Health completed a self-report survey comprising sociodemographic questions, the Functional Assessment of  Self-Mutilation, Childhood Trauma Questionnaire, Parental Bonding Instrument and the Patient Health Questionnaire Depression Scale. Logistic regression models were used to test the associations.</p><p><b>RESULTS</b>The overall prevalence of DSH in our clinical population was 58.8%. Cutting/carving (25.4%) and hitting (20.4%) were the most common forms of DSH in the past 12 months. DSH acts were performed primarily for emotion regulation purposes. The risk factors for DSH in general were younger age group, female gender, abuse history and higher depression scores. Gender and age group were the factors that were differentially associated with cutting and hitting one's self.</p><p><b>CONCLUSION</b>There was a high prevalence of DSH in the psychiatric outpatient population. The risk factors identified in this study are consistent with those of international studies which point to their stability across cultures.</p>

Predictors of General Functioning and Correlates of Quality of Life: A Cross-Sectional Study among Psychiatric Outpatients

<p><b>INTRODUCTION</b>Functioning and quality of life (QOL) are negatively impacted as a result of mental illness. This study aimed to determine the: i) socio-demographic and clinical correlates of functioning and; ii) associations between functioning and QOL in a multiethnic sample of psychiatric outpatients.</p><p><b>MATERIALS AND METHODS</b>This was a cross-sectional study of outpatients receiving treatment from a tertiary psychiatric hospital. Functioning was assessed using the Global Assessment of Functioning (GAF) scale, while QOL was measured using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) which comprises 4 domains: physical health, psychological health, social relationships and environment.</p><p><b>RESULTS</b>Various socio-demographic and clinical correlates were associated with functioning including employment and marital status, education and diagnosis. Depression was the only clinical characteristic which negatively correlated with functioning (= 0.035). Amongst the whole sample, multiple linear regressions revealed that functioning was positively associated with all 4 QOL domains (physical health [<0.001], psychological health [<0.001], social relationships [<0.001] and environment [<0.001]). Further analysis of each diagnostic group revealed that functioning was positively associated with all 4 QOL domains in the anxiety, depression and obsessive compulsive disorder subsamples, while in the schizophrenia subsample, functioning was only significantly associated with all environment domain.</p><p><b>CONCLUSION</b>Functional impairments were associated with different socio-demographic and clinical characteristics, which should be addressed when planning tailored treatment and interventions. Given that functioning is significantly associated with QOL, it is crucial to regularly assess and monitor them (in addition to symptomatic outcomes and adopting a more holistic and biopsychosocial approach).</p>

General Practitioner's Attitudes and Confidence in Managing Patients with Dementia in Singapore

The number of people living with dementia is increasing globally as a result of an ageing population. General practitioners (GPs), as the front-line care providers in communities, are important stakeholders in the system of care for people with dementia. This commentary describes a study conducted to understand GPs' attitudes and self-perceived competencies when dealing with patients with dementia and their caregivers in Singapore. A set of study information sheet and survey questionnaires were mailed to selected GP clinics in Singapore. The survey, comprising the "GP Attitudes and Competencies Towards Dementia" questionnaire, was administered. A total of 400 GPs returned the survey, giving the study a response rate of 52.3%. About 74% of the GPs (n=296) were seeing dementia patients in their clinics. Almost all the GPs strongly agreed that early recognition of dementia served the welfare of the patients (n=385; 96%) and their relatives (n=387; 97%). About half (51.5%) of the respondents strongly agreed or agreed that they felt confident carrying out an early diagnosis of dementia. Factor analysis of questionnaire revealed 4 factors representing "benefits of early diagnosis and treatment of patients with dementia", "confidence in dealing with patients and caregiver of dementia", "negative perceptions towards dementia care" and "training needs". GPs in Singapore held a generally positive attitude towards the need for early dementia diagnosis but were not equally confident or comfortable about making the diagnosis themselves and communicating with and managing patients with dementia in the primary care setting. Dementia education and training should therefore be a critical step in equipping GPs for dementia care in Singapore. Shared care teams could further help build up GPs' knowledge, confidence and comfort in managing patients with dementia.

Gender differences in major depressive disorder: findings from the Singapore Mental Health Study

<p><b>INTRODUCTION</b>Major depressive disorder (MDD) is one of the most common psychiatric disorders worldwide and has been associated with various sociodemographic risk factors, including age, gender and ethnicity. The present study aimed to establish whether gender-specific differences relating to the prevalence and correlates of MDD exist in the Singapore adult resident population.</p><p><b>METHODS</b>The Singapore Mental Health Study was a population-based, cross-sectional epidemiological study among Singapore citizens and permanent residents aged 18 years and above. Face-to-face interviews were completed with 6,616 respondents between December 2009 and December 2010. Psychiatric conditions were established using version 3.0 of the World Health Organization Composite International Diagnostic Interview (CIDI). In addition, data relating to chronic medical conditions was captured using a modified version of the CIDI checklist for chronic medical conditions.</p><p><b>RESULTS</b>The lifetime prevalence of MDD was higher among women (7.2%) than men (4.3%). MDD was more prevalent among men and women who were divorced/separated and widowed women, as compared to those who were single. Among men, MDD was more prevalent among Indian and other ethnicities as compared to Chinese. Of the 417 respondents with MDD, women had significantly higher odds of having generalised anxiety disorder but lower odds of having high blood pressure, as compared to men.</p><p><b>CONCLUSION</b>The study highlighted key gender-specific correlates of MDD. Given the comorbidities associated with MDD and other psychiatric disorders and/or physical illnesses, these correlates pose additional challenges for care providers.</p>

Comorbid Diabetes and Depression among Older Adults - Prevalence, Correlates, Disability and Healthcare Utilisation

<p><b>INTRODUCTION</b>The objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation.</p><p><b>MATERIALS AND METHODS</b>Data for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM.</p><p><b>RESULTS</b>DM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed.</p><p><b>CONCLUSION</b>Given the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.</p>

Quality of life in pathological gamblers in a multiethnic Asian setting.

INTRODUCTION: Few studies have examined the impact of pathological gambling on quality of life especially in the Asian context. The aim of the current study was to examine the quality of life in pathological gamblers in a multiracial population in Singapore and we hypothesised that those with pathological gambling would have poorer quality of life as compared to controls. MATERIALS AND METHODS: Forty subjects with "compulsive gambling behaviour" were recruited and matched (for gender and age) with 40 controls. Subjects with pathological gambling were compared with control subjects with regard to sociodemographic data as well as on the World Health Organization Quality of Life assessment - abbreviated version (WHOQOL-BREF). RESULTS: A one-way MANOVA revealed that pathological gamblers had significantly diminished quality of life as compared with the healthy controls using the summary scores of the 4 domains of quality of life (Pillai's Trace = 0.338, F = 9.5, P <0.001). Univariate tests indicated subjects with pathological gambling scored significantly lower on physical health, psychological, social relationships and environment domains of quality of life compared with subjects without pathological gambling. CONCLUSION: Our study found that those with pathological gambling had lower scores than the controls in all the domains of the quality of life scale. The impact and the extent of pathological gambling on the quality of life should be borne in mind -- not only as a consideration in the management but also as an important indicator of treatment outcome of pathological gamblers.