Disorders In Singapore Research Articles

Subthreshold and threshold DSM-IV generalized anxiety disorder in Singapore: Results from a nationally representative sample

Previous nationally representative studies have reported prevalence of DSM-IV generalized anxiety disorder (GAD). However, subthreshold and threshold GAD expressions remain poorly understood. The current study examined the prevalence, correlates and co-morbidity of a broader diagnosis of GAD in Singapore. The Singapore Mental Health Study (SMHS) was an epidemiological survey conducted in the population (N=6616) aged 18 years and older. The Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to establish mental disorder diagnoses. The lifetime prevalence for subthreshold GAD (2.1%) and threshold GAD (1.5%) in the current sample was found to be lower than in Western populations. Younger age group, Indian ethnicity, previously married, chronic physical conditions, and being unemployed were associated with higher odds of having more severe expression of generalized anxiety. The relatively lower prevalence rate of subthreshold GAD expression suggests possible cultural interferences in the reporting and manifestation of anxiety symptomatology. Despite the low prevalence, significant impacts on functioning and comorbidity among subthreshold generalized anxiety cases indicate the importance of early treatment to ensure a better prognosis.

Translation of the WHO CIDI into Bahasa Melayu

The Singapore Mental Health Survey was undertaken to establish the prevalence of mental disorders in Singapore. This necessitated translation of several modules of the WHO's Composite International Diagnostic Interview (CIDI) into Bahasa Melayu. The aim in translation was to achieve a conceptually equivalent version to the original instrument. The translation procedure was a four-step process: 1) forward translation, 2) expert panel review, 3) pre-test and cognitive interview and 4) development of the final version. The translation procedure was effective in identifying and resolving translation problems, and adapting the language of the instrument to suit the local Malay-speaking population. We recommend this four-step process for future studies to attain a fair representation of minority groups in nation-wide studies.

Less Efficacious Conditioned Pain Modulation and Sensory Hypersensitivity in Chronic Whiplash-associated Disorders in Singapore

Cultural differences in pain perception exist. Although chronic whiplash-associated disorder (WAD) is well investigated in western countries, little is known about its presentation in Singapore. We studied the neck motion and pain sensitivity in people with chronic WAD in Singapore. Thirty chronic WAD participants (>3 mo, Neck Disability Index: 40% [SD 17%]) were age, sex, and ethnicity matched with 30 pain-free controls. All 60 participants underwent the following tests: active neck motion, pain thresholds (pressure, brachial plexus provocation test [BPPT], cold), cold pain tolerance, and conditioned pain modulation (CPM). The test stimulus of contact heat and conditioning stimulus of cold water immersion was used to assess CPM. Data were evaluated to determine differences between WAD and control groups. Active neck motion (F1,29=80.02), pain thresholds of blunt pressure (F1,29=20.84), BPPT (F1,29=54.56), and cold (Z=-4.31) were significantly lower in participants with WAD (P<0.0001). Cold pressor pain tolerance was significantly lower in participants with WAD (Z=-2.89, P=0.02). A less efficacious CPM was also demonstrated in participants with WAD (F1,29=9.20, P=0.03). A combination of BPPT and cold hyperalgesia best predicted the WAD group (sensitivity=96.7%, specificity=96.7%). These findings of sensory hypersensitivity and decreased neck motion in Singaporeans with chronic WAD are consistent with physical impairments reported in western populations.

Eating psychopathology and psychosocial impairment in eating disordered individuals - a Singapore study

Research has shown that eating disorders have a serious and detrimental impact on an individual's physical and mental well-being. In various studies conducted in the West, it was seen that eating disorders have a negative impact on psychosocial functioning and that individuals with eating disorders report a lower quality of life. It is interesting to note that previous studies have shown that south-east Asian individuals exhibit lower levels of body satisfaction, greater eating disorder psychopathology, and more concern about their weight compared to their Western counterparts. However, compared to Western individuals, the level of eating psychopathology and psychosocial impairment in Asian individuals is still relatively unknown. Knowledge in these domains may improve treatment and elucidate the impact eating disorders have on Asian individuals. The objectives of this study are: a) To determine the level of eating psychopathology and psychosocial impairment in individuals with eating disorders in Singapore and; b) To determine if there are any differences in levels of eating psychopathology and psychosocial impairment between the different eating disorders classifications. This abstract was presented in the Understanding and Treating Eating Pathology stream of the 2013 ANZAED Conference.

The effect of severity of depressive disorder on economic burden in a university hospital in Singapore

Background: Depressive disorder is treatable but costly, thus influencing quality of life of people. Aim: Determine direct and indirect costs incurred by depressive disorder in Singapore. Methods: A 1-year prospective naturalistic study was conducted in a university mood disorder center between 2007 and 2008. Patients with primary International Classification of Disease–10 diagnosis of depressive disorder were recruited. Disease costs between mild, moderate and severe depression, and cost predictors were analyzed and determined. Results: Forty nine patients completed the study. Mean annual total costs per patient were US$7638. Indirect costs (81%) dominated the total costs. Approximately 50% of indirect costs were associated with loss of productivity and unemployment. Higher education level, higher mean Hamilton Rating Scale for Depression score and number of suicide attempts were independent variables associated with increased direct costs while mean Hamilton Rating Scale for Depression scale score was an independent variable for indirect costs. Conclusion: Medical cost saving strategies should focus on indirect costs.

Parental Expectations Regarding Postschool Social Attainments of Adolescents with Autism Spectrum Disorders in Singapore

This study sought to understand the parental expectations of social attainments in the postschool years. The parents of 20 adolescents with autism spectrum disorders (ASD) attending special schools were interviewed. Most expected their children would be working in sheltered workshops or unemployed. All parents indicated that their children would live with them until they were unable to provide appropriate care, and nearly half expressed wishes for relatives to care for them thereafter. None expected any independent access to the community. Analysis of the interviews suggested that the adolescents' learning and behavior, parental concerns, availability of formal resources, and societal factors influenced parents' expectations. Implications for working with Asian populations and for service delivery in Singapore are discussed.

Cultural and Ethical Issues in the Treatment of Eating Disorders in Singapore

O bjective: This study explored the ethical issues for health professionals treating eating disorders in Singapore. Method: A focus group of health professionals working with patients aged 13 years and above with eating disorders in Singapore was conducted. Two facilitators and a brief topic guide helped raise questions but the direction of discussion was largely driven by the participants. The session was video-recorded and the video recording was transcribed and analysed. Results: Local context and culture was found to be the overarching theme of relevance in the ethical issues faced, which was articulated through two specific themes: the centrality of the family and the place of the individual in the family. These two themes had implications for health professionals centring on two main ethical issues: confidentiality and compulsion. Discussion: Treatment teams should be sensitive to the familial culture of their patients and families, especially in a multicultural international demographic like Singapore.

A preliminary report: Nutritional intake of children with autism spectrum disorders in Singapore

A preliminary report: Nutritional intake of children with autism spectrum disorders in Singapore

A Population-based Survey of Mental Disorders in Singapore

Mental illnesses are not only a growing public health concern but also a major social and economic issue affecting individuals and families throughout the world. The prevalence of mental disorders, the extent of disability caused by these disorders, and services utilisation of these patients has been well studied in developed countries. The aim of this study was to establish the prevalence of select mental disorders and their associated sociodemographic correlates in the adult Singapore resident population. This was a cross-sectional, populationbased, epidemiological study of adult Singapore residents aged 18 years and above. The subjects were randomly selected using a disproportionate stratified sampling method. The diagnoses of selected mental disorders including major depressive disorder (MDD), dysthymia, bipolar (bipolar I & II) disorders, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD), alcohol abuse and alcohol dependence were established using the Composite International Diagnostic Interview, which is a fully structured diagnostic instrument that assesses lifetime and 12-month prevalence of mental disorders. Among the 6616 respondents (response rate of 75.9%), 12.0% had at least one lifetime affective, anxiety, or alcohol use disorders. The lifetime prevalence of MDD was 5.8% and that of bipolar disorder was 1.2%. The combined lifetime prevalence of the 2 anxiety disorders, GAD and OCD was 3.6%, with the latter being more common than GAD (0.9% and 3.0% respectively). The lifetime prevalence of alcohol abuse and dependence were found to be 3.1% and 0.5% respectively. Age, gender, ethnicity, marital status and chronic physical illnesses were all significant correlates of mental disorders. The identified associated factors would help guide resource allocation, policy formulation and programme development in Singapore.

P-993 - Prevalence and risk factors for antenatal depression in pregnant women attending national university hospital, singapore

Antenatal mental health problems are well recognised to impact negatively on a woman and her developing fetus, influencing both the pregnancy outcome and quality of life. There is limited information on prevalence and risk factors of antenatal depression in Singaporean women. To examine the prevalence of depressive disorders in pregnant women attending Singapore's National University Hospital (NUH) and the association between these conditions and socio-demographic factors. To improve our knowledge and understanding of the epidemiology of antenatal depressive disorders in Singapore. Pregnant women attending NUH (2009 to 2010) were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale. Patients who screened positive (scores > 13) were clinically assessed by trained clinicians using DSM IV criteria for diagnosis. The cases were then discussed with a core group of 3 psychiatrists to reduce interrater variability. From 530 screened women, the overall prevalence of antenatal depressive symptoms was 47.8% (EPDS > 13). 12.5% of patients were diagnosed with Major Depressive Disorder, 52.1% with Adjustment Disorder, 4.5% with Anxiety Spectrum illness (Panic Disorder, GAD, OCD, PTSD), 1.1% with Bipolar Disorder and 3.8% with Other diagnoses. After adjustment with socio-demographic variables, depressive symptoms were significantly associated with single, divorced or separated pregnant women (OR = 4.09, 95% CI = 1.39−12.09, p < 0.05) and those with three or more social relationship problems (OR = 1.68, 95% CI = 1.00–2.84, p < 0.05). Antenatal depressive symptoms are common in Singaporean women and they are associated with identifiable risk factors such as single status and limited social support.

The activities and participation of adolescents with autism spectrum disorders in Singapore: findings from an ICF‐based instrument

This study sought to describe the activities and participation of adolescents with autism spectrum disorders (ASD) in Singapore and to examine the suitability of the Activity and Participation component of the International Classification of Functioning, Disability and Health for achieving this purpose. This information may guide the development of intervention programmes for adolescents and adults as well as the provision of a means to document meaningful outcomes. Parents of 20 adolescents with ASD attending special schools in Singapore were interviewed using the Vineland Adaptive Behavioural Scales - Second Edition and the Activities and Participation Rating Scale (APRS), which was developed for this study. The adolescents with ASD were rated to have more difficulties with participation than with the engagement of activities. Individual domain analyses indicate no difficulties with mobility and mild difficulties with self-care. The performance of general tasks and demands were rated as less problematic than domestic, major life areas, communication and interpersonal interactions. The adolescents with ASD were rated to have more difficulties in communication and community environments than in at home. In addition, analysis of associations between the APRS and Vineland Adaptive Behavioural Scales - Second Edition reveal a pattern of strong relationships between sub-tests. This study highlights the imperative for researchers and practitioners alike to develop a focus on strengths, generalisation and the quality of life of adolescents with ASD. The APRS also shows promise in helping document outcomes for adolescents with ASD in Asia and further development of this instrument is needed.

P33– Development of clinical practice guidelines for children with autism spectrum disorder in Singapore

P33– Development of clinical practice guidelines for children with autism spectrum disorder in Singapore

Pre‐school teachers' knowledge, attitudes and practices on childhood developmental and behavioural disorders in Singapore

Demands for diagnostic and intervention services in childhood developmental and behavioural disorders (CDABD) have increased in Singapore. With earlier enrolment of some 50 000 children in pre-schools, early childhood educators must be well-versed in normal development (ND) and CDABD, to help detect children with potential difficulties and refer for early diagnosis and intervention. Knowledge, attitudes and practices in ND and CDABD were evaluated among 503 pre-school teachers, most aged 30-44 years. With a median pre-school experience of 6.0 (0.1, 40) years, most had received formal training in early childhood but not special-needs (SN) education. A pass rate in knowledge (>/=50% total-score) was achieved in 56%, with the overall median total-score of 50 (0, 87)%. In specific blocks on ND, autistic spectrum disorder and attention deficit/hyperactive disorder, pass-rate was achieved in 66%, 68% and 32%, with median block-scores of 56 (0, 100)%, 50 (0, 100)%, 40 (0, 100)% respectively. Results on attitudes and perceptions revealed that most supported mainstream integration and aides in the classroom, agreeing that both the government and parents should pay for such support services. While most felt unequipped, further training interested them, with >90% wanting to and feeling that they could make a difference for these children. This study demonstrated educational deficits in CDABD among our pre-school teachers. Yet, most care and want to improve their skills to aid integration and improve SN education, calling for more training and resource support. Necessary changes in policy and resource allocation should occur to allow better-integrated adults of tomorrow.

Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience

Recommended by the National Advisory Council of the Disabled, the Ministry of Health of Singapore supported a nationwide study of inherited metabolic disorders (IMDs). When the 5-year project ended, investigations were provided as a diagnostic service. This paper documents our 13-year experience. Patients with symptoms suggestive of an IMD were referred. Investigations on heparinised blood and/or urine included amino acid analysis using a Beckman 6300 Amino Acid Analyser, organic acids analysis using a Hewlett- Packard gas chromatography and mass spectrometry, mucopolysaccharides quantitative assay and high-resolution electrophoresis, sugars by thin-layer chromatography. Of the 3656 patients studied from 1992 to 2005, IMDs were found in 127 (77 males; 50 females; age range, 1 day to 56 years). Their ethnic distribution was: 55.1% Chinese, 19.7% Malays, 11.0% Indians, 11.0% other races and 3.2% unknown. IMD diagnosed comprised 41 (32.3%) organic acidurias, 34 (26.8%) amino acidaemias/acidurias, 14 (11.0%) urea cycle defects, 15 (11.8%) mucopolysaccharidoses, 6 (4.7%) carbohydrate disorders and 17 (13.4%) others. Twenty-three (18.1%) cases were diagnosed during the neonatal period and 36 (28.3%) after the age of 13. Positive detection rate was 3.5% and 48 IMDs were found. Significant proportion of cases had late-onset IMDs. Early identification of IMDs permits timely management, genetic counselling and prenatal diagnosis.

Generalised anxiety disorder in Singapore: prevalence, co-morbidity and risk factors in a multi-ethnic population

There has been a relative lack of epidemiological data on generalised anxiety disorder (GAD) in Southeast Asia. A previous study reported a lifetime prevalence of 1.5% and highlighted low preference for seeking professional help and consultation by persons suspected to be suffering from mental health problems. The present study is part of a National Mental Health survey of adults conducted from February 2003-March 2004 specifically assessing anxiety and depression in Singapore. In this paper we report on prevalence, co-morbidity and risk factors associated with GAD. We interviewed 2,847 households from an ethnically stratified random sample of adults aged 20-59 years who were Singapore citizens or permanent residents. The General Health Questionnaire and Schedule for Clinical Assessment of Neuropsychiatry were administered, which generated Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of GAD. We assessed socio-demographic correlates, life events, medical and other psychiatric co-morbidities related to GAD. Lifetime prevalence of GAD was 3.3%, current prevalence is 3.0%. Female to male ratio is 3.6:1. GAD was significantly associated (p<0.001) with the presence of other psychiatric co-morbidities, including major depressive disorder, dysthymia, panic disorder, agoraphobia and social phobia. Prevalence increased in older individuals, with the odds of association greatest in subjects with three or more co-morbid medical conditions [adjusted odds ratio (OR) 3.66]. Those who had experienced one or more threatening life events showed increased odds of association with GAD. Chinese ethnicity, the divorced and persons from both the upper and the lowest socio-economic status had highest odds of association with GAD. We challenge established notions that GAD tends to be a disorder of the socially disadvantaged. Life events are important as precipitating factors in GAD, and uniquely different types of events appear to affect both extremes of social classes. High co-morbidity associations with current GAD are grounds for concern. This may suggest failure to seek treatment, hence giving rise to an increase in severity of the primary condition.

Psychosocial stressors that precipitate dissociative trance disorder in Singapore.

To study the psychosocial stressors that precipitate dissociative trance disorder (DTD) and to identify predictors of DTD. We conducted semistructured interviews in which detailed information was obtained for 58 cases diagnosed with DTD at a psychiatric hospital in Singapore. A comparison group of 58 patients who received treatment at the same hospital for major depression (MD) were also interviewed, using the same instrument. While 100% of the DTD group described at least one psychosocial stressor, only 80% of the MD group did so. Common stressors for the DTD group include problems with military life (38%), conflicts over religious and cultural issues (38%), and domestic disharmony and marital woes (24%). Conflicts over religious and cultural issues seemed to be important in the precipitation of DTD but not in the precipitation of MD (p < 0.001). Logistic regression reveals that the following are positive predictors for DTD: conflicts over religious and cultural issues; prior exposure to trance states; and being a spiritual healer or his/her assistant. An understanding of the precipitating psychosocial stressors that overwhelmed the patient's coping abilities would have implications for treatment and enable the clinician to devise strategies for intervention and prevention.

Does the 12-item General Health Questionnaire contain multiple factors and do we need them?

BackgroundThe 12-item General Health Questionnaire (GHQ-12) is widely used as a unidimensional instrument, but factor analyses tended to suggest that it contains two or three factors. Not much is known about the usefulness of the GHQ-12 factors, if they exist, in revealing between-patient differences in clinical states and health-related quality of life.MethodsWe addressed this issue in a cross-sectional survey of out-patients with psychological disorders in Singapore. The participants (n = 120) completed the GHQ-12, the Beck Anxiety Inventory, and the Short-Form 36 Health Survey. Confirmatory factor analysis was used to compare six previously proposed factor structures for the GHQ-12. Factor scores of the best-fitting model, as well as the overall GHQ-12 score, were assessed in relation to clinical and health-related quality of life variables.ResultsThe 3-factor model proposed by Graetz fitted the data better than a unidimensional model, two 2-factor models, and two other 3-factor models. However, the three factors were strongly correlated. Their values varied in a similar fashion in relation to clinical and health-related quality of life variables.ConclusionsThe 12-item General Health Questionnaire contains three factors, namely Anxiety and Depression, Social Dysfunction, and Loss of Confidence. Nevertheless, using them separately does not offer many practical advantages in differentiating clinical groups or identifying association with clinical or health-related quality of life variables.

Eating Disorders in Singapore: A Review

Introduction: Anorexia nervosa, bulimia and binge-eating disorder are the three best recognised eating disorders. Eating disorders have been reported to affect some 1 to 3% of adolescent females in the West. Increasing reports from Asia suggest that it is no longer possible to view these illnesses as ‘Western’ diseases. Eating disorders are the third most common serious medical disorder in female adolescents, after asthma and depression. It poses a tremendous burden for individuals, families and society. Historical and current studies on eating disorders in Singapore are reviewed, and discussed in the light of available regional and worldwide research. Methods: Studies on anorexia nervosa and bulimia in Singapore were identified through a MEDLINE search (from 1979). Information from these studies were supplemented with relevant local monographs on eating disorders. Results: Reports of eating disorders have increased over recent years in the local literature. The psychopathology of eating disorders in Singapore is very similar to that described in the Western literature, and in the two main current classification systems. Body dissatisfaction is prevalent among Singaporean Chinese schoolgirls and female undergraduates, with rates not dissimilar to the West. There is a link between ‘Westernisation’ (based on English being spoken as the main language at home) and body dissatisfaction.

Personality profiles of patients with dissociative trance disorder in Singapore.

This report studies the personality of individuals who suffer from dissociative trance disorder and examines whether the personality profiles could predict the individual's frequency of trance states. A total of 58 cases were given the Eysenck Personality Questionnaire (EPQ) and their personal information harvested from the case notes and through subsequent interviews. The subjects were also reassessed 1 year later to obtain their frequency of trance states. For both sexes, there were lower extraversion scores and higher psychoticism, neuroticism, and lie scores in the sample compared to the Singapore norms. Of the 47 subjects traced, total episodes of trances that occurred over the 1-year period was positively correlated with neuroticism and negatively with extraversion scores. The high lie scores in individuals with dissociative trance disorder could be a reflection of their concern of how others perceive them. The motivation could be that of restoration of self-esteem or "face." The profiles in the EPQ could be used to predict the individual's frequency of trance states. Subjects with personality traits like nervousness, excitability, and emotional instability were more likely to have a higher frequency of trance states.

Review of four tests of gross motor development

Review of four tests of gross motor development