Search Results (17)

Poor adherence to antipsychotic treatment is a leading cause of relapse for patients suffering from psychotic disorders and the use of long-acting injectable antipsychotics (LAI) may lead to improved clinical outcomes. This was a 1-year mirror-image study examining the clinical outcomes after monthly administration of paliperidone palmitate (PP1M). The primary outcome measure was the total days of psychiatric hospitalization in the 1-year before and 1-year after initiation of PP1M. Data from 158 patients were included in the study. Most of the patients suffered from schizophrenia. In the year after initiation of PP1M, the mean number of hospitalization days fell from 106.53 to 19.10 (p < 0.001). There were significant reductions in the mean number of hospitalizations and emergency room visits. The use of paliperidone palmitate is associated with significant reduction in both the number of admissions and days of psychiatric hospitalization. Full article

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. Full article

Excessive weight gain and cardiometabolic dysfunction are common and clinically relevant side effects of antipsychotic medications. In this pilot study, we aimed to establish the feasibility of using metformin and its effectiveness in managing antipsychotic-induced weight gain in patients with first-episode psychosis (FEP) on follow-up with the Singapore Early Psychosis Intervention Programme in a 24-week, randomized, double-blind, placebo-controlled trial, to ascertain the effects of metformin discontinuation on body weight and evaluate the safety and tolerability of metformin. Participants between the ages of 16 and 40 with FEP assessed as clinically stable and who had gained ≥5% of their pre-drug weight after initiation of the antipsychotic treatment were recruited from outpatient clinics between April 2015 and April 2018. Seventeen participants met all the inclusion criteria and were randomized to receive metformin (n = 8) or the placebo (n = 9) at Week 0, with follow up assessments at Weeks 3, 6, 12, 24, and 36. Metformin was generally well-tolerated. Participants in the metformin arm were able to control their weight better than participants receiving the placebo, an effect that did not persist after discontinuation. Our results support the use of metformin as a safe and tolerable weight control measure in a typical outpatient sample of young people with FEP. Full article

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. Full article

The aim of the current study was to examine the associations between nicotine dependence and quality of life (QOL) among individuals diagnosed with major depressive disorder (MDD) or psychotic disorders. Methods: A total of 378 participants diagnosed with either MDD or psychotic disorders were recruited. The Fagerstorm Test for Nicotine Dependence was used to measure the level of nicotine dependence. The SF-12 health survey questionnaire was used to measure the QOL. Results: The prevalence of nicotine dependence was 23.3% in this sample population. For those diagnosed with MDD, moderate level of nicotine dependence was negatively associated with Vitality and Mental Component Score. For those diagnosed with a psychotic disorder high nicotine dependence was negatively associated with Role Emotional, Mental Health and Mental Component Score. Discussion: Compared to the general population, the prevalence of smoking in this psychiatric population was 2.4 times higher, while that of nicotine dependence was seven times higher. Individuals with psychotic disorder generally reported better QOL as compared to individuals with MDD. QOL differed across diagnostic groups with regards to socio-demographics, such as age, ethnicity, marital status, education, employment status and monthly income. Among individuals with MDD and psychotic disorders, different levels of nicotine dependence resulted in different levels of association with QOL. More research is needed to better understand the differences in QOL among the varying levels of nicotine dependence. Full article

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. Full article

This cross-sectional study investigated the relationship of religiosity, the use of positive and negative religious coping methods, and quality of life (QOL) among 364 outpatients with psychosis in Singapore. Positive religious coping was significantly associated with better scores on physical (β = 0.51, p = 0.02) and psychological (β = 0.64, p = 0.01) QOL domains in the regression model. Negative religious coping was related to worse QOL in all four domains: physical (β = −0.44, p = 0.03), psychological (β = −0.76, p < 0.01), social (β = −0.54, p = 0.03), and environment (β = −0.65, p < 0.01). Increased participation in organizational religious activities was positively associated with higher QOL for psychological (β = 2.47, p < 0.01), social relationships (β = 2.66, p = 0.01), and environment (β = 2.09, p = 0.01) domains. Interestingly, those with no religious affiliation were found with higher scores in the QOL domain for social relationships (β = 4.59, p = 0.02). Religious coping plays an important role for the QOL of outpatients with psychosis. Greater awareness of the importance of religion in this population may improve cultural competence in treatment. Individuals with psychosis may benefit from greater community support and collaboration between clinical and religious community-based organizations to improve social integration and QOL. Full article

Suicidality encompasses suicidal ideation, plans, and attempts. This paper aims to establish associations between suicidality and sociodemographic variables, physical disorders, and psychiatric disorders. The Singapore Mental Health Study 2016 was a population-level epidemiological survey, which determined the prevalence of physical disorders, psychiatric disorders, and suicidality. Questionnaires were used to determine socio-demographic information. A total of 6216 respondents were interviewed. Lifetime prevalence of suicidal ideation, planning, and attempts were 7.8%, 1.6%, and 1.6%, respectively. All components of suicidality were more likely in those with major depressive disorder, bipolar disorder, generalized anxiety disorder, alcohol use disorder, and chronic pain. Suicidal ideation and attempts were more likely in those with diabetes. Age above 65, being male, and a monthly household income of ≥ SGD 10,000 were associated with a lower likelihood of suicidal ideation. These findings indicate that there are high-risk groups for whom suicidality is a concern, and for whom interventions may be needed. Full article

Background: This study investigated association of religious affiliation with positive mental health (PMH) and mental disorders. Methods: A cross-sectional survey of 2270 adults was conducted in Singapore. Participants reported their religious affiliation to Buddhism, Christianity, Hinduism, Islam, Sikhism, Taoism, or other religions. A PMH instrument measured total PMH and six subcomponents: general coping (GC), emotional support (ES), spirituality (S), interpersonal skills (IS), personal growth and autonomy (PGA), and global affect (GA). Lifetime history of mental disorders was assessed with the Composite International Diagnostic Interview. Results: Total PMH (mean ± SD) was 4.56 ± 0.66 for participants with any religion versus 4.12 ± 0.63 (p = 0.002) in those without any religion. After adjustment for all potential confounders, the mean difference in total PMH between these groups was 0.348 (95% CI: 0.248–0.448). Having any religion was significantly associated with higher scores for S, GC, ES, IS, but not with PGA, GA or mental disorders. Compared with individuals without any religion, total PMH and S levels were significantly higher across all religions. Additionally, Christianity was significantly associated with higher ES, Taoism with higher GC, Buddhism and Islam with higher GC, ES and IS, Hinduism with higher IS and Sikhism with higher ES and IS. Conclusion: Our results indicate that religious affiliation is significantly associated with higher PMH, but not with mental disorders in an Asian community setting. In addition, different religions showed unique patterns of association with PMH subcomponents. Full article

The Short Acculturation Scale (SAS) has been widely used for assessing the level of the acculturation of migrants in Western countries. However, the validity of SAS for use in cosmopolitan settings without a single prevailing culture is unclear. We examined the validity and reliability of a version of the SAS adapted to a multi-ethnic Asian society. We used cross-sectional data from 12,610 Singaporean citizens and permanent residents, aged 21–75 years, of Chinese, Malay, and Indian ethnicity. Our version used 11 items, with 5 questions on language use, 3 on media use, and 3 on ethnic social relations, to measure acculturation. Our version of the SAS had good internal consistency. The three-factor CFA model had a good fit to our data. The results from the multiple group CFA supported metric invariance and partial scalar invariance across the three ethnic groups. The total score was positively correlated with generation in Singapore and the number of languages spoken. Among first generation immigrants, country of origin, but not the duration of residence was significantly associated with the acculturation score. Our three-factor version of the SAS is a reliable and valid tool for measuring acculturation in Singapore residents. These findings indicate that adapted SAS can be used to assess acculturation in multicultural settings. Full article

This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric population, (b) factors that encourage smoking cessation, and (c) awareness towards cessation programmes. This study captured data (n = 380) through a modified version of the Global Adult Tobacco Survey (GATS). A descriptive analysis of the data was performed. The prevalence of smoking was 39.5% (n = 150) and 52.3% of the smokers were dependent on nicotine. More than half of the smokers had made at least one attempt to quit in the past 12 months and 56% reported no immediate plans to quit smoking. The awareness towards institutional smoking cessation programmes was fair (44%), with 49.7% of smokers having indicated that they were willing to use the service upon referral. Smokers endorsed that increasing the cost of cigarettes, restricting availability, and increasing knowledge of health harms could encourage smoking cessation. Past smokers reported that self-determination/willpower followed by substitution of smoking with other types of foods and drinks were factors that helped them achieve successful cessation. Given that the readiness to quit and awareness towards cessation programmes are low among the smokers, concerted efforts through educational programmes and policy changes are crucial to achieve successful cessation. Full article

This study examined differences between young people with mental illness who engage in deliberate self-harm with and without suicidal intent, as well as socio-demographic and clinical factors that are related to the increased likelihood of suicide attempt amongst self-harming young people. A total of 235 outpatients with mental illness who had engaged in deliberate self-harm were recruited from a tertiary psychiatric hospital in Singapore. Participants completed a self-report questionnaire which collected information on their socio-demographic background, self-harm history, diagnosis, depressive symptoms and childhood trauma. A total of 31.1% had reported a history of attempted suicide. Multiple logistic regression conducted found that engaging in self-harm ideation between 1 and 7 days (OR = 4.3, p = 0.30), and more than 1 week (OR = 10.5, p < 0.001) (versus no engagement in any self-harm ideation at all), were significantly associated with greater likelihood of attempted suicide. This study reports a relatively high prevalence rate of reported suicide attempts amongst young people with mental illness who engaged in self-harm. Identifying self-harm behaviors and treating it early could be the first step in managing potential suicidal behaviors among those who engage in self-harm. Full article

Background—Mental disorders have been found to affect quality of life (QOL) in patients. The current study aimed to determine QOL among first episode psychosis (FEP) patients and explore its associations with sociodemographic as well as clinical factors. Methods—Data for this study were collected as a part of an Early Psychosis Intervention Program (EPIP)-Smoking and Alcohol use survey. At baseline, 280 outpatients aged 15–40 years old diagnosed with FEP, with no prior or minimal treatment, no history of medical or neurological disorder, and no history of substance abuse, were recruited. Sociodemographic details, diagnosis, length of duration of untreated psychosis (DUP), and World Health Organization Quality of Life assessment—abbreviated version (WHOQOL-BREF) scores were obtained. Results—After adjusting for all covariates, older age (p = 0.036), females, and participants diagnosed with brief psychotic disorder (p = 0.04) were associated positively, whereas separated/divorced participants, those with lower education, unemployed (p = 0.01), and longer DUP were seen to be negatively associated with different domains of QOL. Conclusion—Higher WHOQOL-BREF scores denote better QOL. Overall, female participants as compared to male participants and those diagnosed with brief psychotic disorder in this sample reported better QOL. Full article

Background: Adults with body image dissatisfaction (BID) are more likely to be depressed, anxious, and suicidal when compared to those without intense dissatisfaction over their appearance. The current study aimed to estimate the prevalence and factors associated with BID among out-patients with mental illness in Singapore. Methods: Data was collected from 310 psychiatric out-patients using a self-administered questionnaire. Measurements used were socio-demographic characteristics, Body Mass Index scores, Body Shape Questionnaire, Binge Eating Scale, Eating Attitudes Test, Beck’s Depression Inventory, Beck’s Anxiety Inventory and Alcohol Use Disorders Identification Test. Results: A prevalence of 30.9% of BID was established among psychiatric out-patients in Singapore. Being female, having higher BMI scores, binge eating behavior, eating disorders, and those diagnosed with depression were positively associated with BID. Conclusion: BID is prevalent among those with psychiatric illnesses which could lead to a higher degree of psychological distress and the emergence of eating disorders. Full article

Background: Understanding the lower level of happiness among older adults with cognitive impairment has been a largely neglected issue. This study (1) reports on the level of happiness among older adults in Singapore and (2) examines the potential mediating roles of depression, disability, social contact frequency, and loneliness in the relationship between cognitive scores and happiness. Methods: Data for this study were extracted from the Well-being of the Singapore Elderly (WiSE) study: a cross-sectional; comprehensive single-phase survey conducted among Singapore citizens and permanent residents that were aged 60 years and above (n = 2565). The Geriatric Mental State examination (GMS) was administered to the participants. Questions pertaining to socio-demographic characteristics; happiness; loneliness; social contact; depression; and, disability were utilized in this study. Logistic regression analyses and mediation analyses were used to explore the correlates of happiness and potential mediating factors. Results: Overall, 96.2% of older adults in Singapore reported feeling either fairly happy or very happy. In the regression analysis, individuals of Malay descent, those who were married/cohabiting, or had higher education levels were more likely to report feeling happy. After controlling for socio-demographic factors, higher cognitive scores were associated with higher odds of reporting happiness. We found that the positive association between cognition and happiness was fully mediated by disability, depression, loneliness, and frequency of contact with friends. Conclusion: The majority of the older adult population reported feeling fairly or very happy. While cognitive impairment has shown limited reversibility in past studies, unhappiness among older adults with cognitive impairment might be potentially mitigated through interventions addressing accompanying issues of social isolation, disability, and depression Full article