Singapore Residents Research Articles

Responsible gambling among older adults: a qualitative exploration

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

Continuum beliefs and stigmatising beliefs about mental illness: results from an Asian community survey

ObjectivesTo establish the prevalence and correlates of continuum beliefs for five mental illnesses in a multiethnic population and to explore its association with stigma.DesignA community-based, cross-sectional study.SettingA national study in...

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

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. 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. 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. 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.

Spatial dynamics of TB within a highly urbanised Asian metropolis using point patterns

Singapore is a high-income country in a region with a high prevalence of tuberculosis. The Singapore Tuberculosis (TB) Elimination Program (STEP) was set up in 1997, and the better surveillance and clinical management practices initiated under STEP led to a decade-long decline in the incidence levels. However, incidence rates started to rise again since 2008. The reasons for this rise are unclear. This study involved a spatial analysis of the epidemiology of TB among Singapore residents. More than 30 000 cases reported during 1995–2011 and their residential addresses were analysed for spatial risk and spatial clustering, using spatial point pattern methodology. The principal factor responsible for the increasing resident TB incidence in Singapore is the changing age profile of the population. In particular the burgeoning population aged above 65 years accounts for the increase in reported cases. Singapore’s population has one of the world’s lowest fertility and mortality rates, and the elderly population is projected to grow substantially over the next few decades. Tuberculosis rates may therefore continue to rise even with static or improving case management and surveillance.

Understanding the effects of exchange rates on the cost of living for expatriates and ordinary residents in Singapore and Hong Kong

It is important to factor in the effect that exchange rates have on cost of living rankings while computing cost of living indices, as conversion of local prices into a common currency is imperative for any ranking of cities in different parts of the world. Considering that such computations are going to be affected by exchange rate levels in the different cities, this paper empirically analyses the cases of Singapore and Hong Kong to understand the impact of exchange rates on their cost of living rankings. Our simulation analysis for these two global Asian cities shows that exchange rate fluctuations have a significant impact on the cost of living rankings for both expatriates and ordinary residents. In addition, our study indicates that cities in the developed Western countries are more expensive for ordinary residents than cities in less developed countries elsewhere, especially in Asia. We attribute this to structural differences in labour cost between these two sets of countries.

Understanding the effects of exchange rates on the cost of living for expatriates and ordinary residents in Singapore and Hong Kong

Understanding the effects of exchange rates on the cost of living for expatriates and ordinary residents in Singapore and Hong Kong

Association between recognition and help-seeking preferences and stigma towards people with mental illness.

The ability to recognise a mental illness has important implications as it can aid in timely and appropriate help-seeking, and ultimately improve outcomes for people with mental illness. This study aims to explore the association between recognition and help-seeking preferences and stigmatising attitudes, for alcohol abuse, dementia, depression, obsessive-compulsive disorder (OCD) and schizophrenia, using a vignette-based approach. This was a population-based, cross-sectional survey conducted among Singapore Residents (n = 3006) aged 18-65 years. All respondents were asked what they think is wrong with the person in the vignette and who they should seek help from. Respondents were also administered the Personal and Perceived sub scales of the Depression Stigma Scale and the Social Distance Scale. Weighted frequencies and percentages were calculated for categorical variables. A series of multiple logistic and linear regression models were performed separately by vignette to generate odd ratios and 95% confidence intervals for the relationship between help-seeking preference, and recognition and beta coefficients and 95% confidence intervals for the relationship between stigma and recognition. Correct recognition was associated with less preference to seek help from family and friends for depression and schizophrenia. Recognition was also associated with increased odds of endorsing seeking help from a psychiatric hospital for dementia, depression and schizophrenia, while there was also an increased preference to seek help from a psychologist and psychiatrist for depression. Recognition was associated with less personal and perceived stigma for OCD and less personal stigma for schizophrenia, however, increased odds of social distancing for dementia. The ability to correctly recognise a mental illness was associated with less preference to seek help from informal sources, whilst increased preference to seek help from mental health professionals and services and less personal and perceived stigma. These findings re-emphasise the need to improve mental health literacy and reinforce the potential benefits recognition can have to individuals and the wider community in Singapore.

The Relationship between Men’s Early Maladaptive Schemas, Rape Myth Acceptance and Self-Reported Likelihood of Using Force and Raping

Global efforts to understand sexual violence against women (SVW) persistently reinforce the magnitude and versatility of this multifaceted problem. Particularly, more thorough comprehension of the structures underlying SVW is warranted. The present study aims to examine the association between early maladaptive schemas (EMSs), rape myths acceptance (RMA) and self-reported proclivity to rape (RP). It was hypothesized that higher RMA is correlated with elevated RP, and that participants will report an increased tendency to use force rather than raping. Moreover, participants with elevated RP are more likely to endorse schemas from the disconnection/rejection domain, and that schema types are unlikely to vary among participants with the tendency to use force rather than raping. In total, 150 male students, who were either citizens or residents in Singapore, from an international university based in Singapore completed a series of self-reported measures assessing RMA, RP, EMSs and social desirability. The findings confirmed that higher RMA predicted increased RP, and participants reported the use of force rather than raping. Although, RMA did predict RP significantly, the predictive power of 4.3 percent was rather low. Elevated RP was predicted by the Unrelenting Standards/Hyper-criticalness, Punitiveness and Abandonment/Instability schemas. Furthermore, there were no differences in the schemas endorsed among participants with an increased tendency to rape. The present study has implications for clinical and forensic psychology and further research on SVW in Singapore, primarily due to the plausible influences of culture on the findings. Preliminary support is provided for more thorough research on the use of Schema Therapy in rehabilitating sexually aggressive behaviours.

Prevalence and Risk Factors of Caregiver Dependence among Older Adults in a Southeast Asian Population

Currently very little is known about the prevalence or magnitude of caregiver dependence in Singapore and thus, there is a need to fill this gap in this multiethnic ageing population. This study aims to determine the prevalence and risk factors of caregiver dependence among older adults in Singapore. Data were used from the Well-being of the Singapore Elderly (WiSE) study, a nationally representative, cross-sectional survey among Singapore residents aged 60 years and above. Caregiver dependence was ascertained by asking the informant (the person who knows the older person best) a series of open-ended questions about the older person's care needs. The older adult sample comprised 57.1% females and the majority were aged 60 to 74 years (74.8%), while 19.5% were 75 to 84 years, and 5.7% were 85 years and above. The prevalence of caregiver dependence was 17.2% among older adults. Significant sociodemographic risk factors of caregiver dependence included older age (75 to 84 years, and 85 years and above, P <0.001), Malay and Indian ethnicity (P <0.001), those who have never been married (P = 0.048) or have no education (P = 0.035), as well as being homemakers or retired (P <0.001). After adjusting for sociodemographic variables and all health conditions in multiple logistic regression analyses, dementia (P <0.001), depression (P = 0.011), stroke (P = 0.002), eyesight problems (P = 0.003), persistent cough (P = 0.016), paralysis (P <0.001), asthma (P = 0.016) and cancer (P = 0.026) were significantly associated with caregiver dependence. Various sociodemographic and health-related conditions were significantly associated with caregiver dependence. Dependent older adults will put greater demands on health and social services, resulting in greater healthcare expenditures. Hence, effective planning, services and support are crucial to meet the needs of dependent older adults and their caregivers.

Screening for Drinking Problems in the Elderly in Singapore Using the CAGE Questionnaire

Given that past research on drinking problems has focused primarily on younger samples, the present study sought to examine the prevalence and correlates of alcohol use among the elderly in Singapore. Data were extracted from the Well-being of the Singapore Elderly (WiSE) study, a cross-sectional, epidemiological survey conducted among a nationally representative sample of Singapore residents (n = 2565) aged 60 years and above. Variables assessed include drinking problems, depression and anxiety symptoms, obesity, smoking status, chronic physical disorders and disability. The weighted prevalence of drinking problems (CAGE score ≥2) in our sample was 4.2%. Male sex, Indian ethnicity, and being divorced or separated were associated with a significantly higher likelihood of drinking problems. Participants with drinking problems were also more likely to have subthreshold depression. There were no significant differences in disability among those with drinking problems, those without drinking problems and non-drinkers, after adjusting for demographic variables. Our findings contribute to the body of research that indicates an association between drinking problems and depressive symptoms among the elderly. Thus, screening for depressive symptoms in the elderly with drinking problems may be useful in identifying such comorbidities in order to aid treatment planning.

Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults.

The present study examined the prevalence of frailty and its association with sociodemographic, clinical and social characteristics, and service utilization in a representative general population sample of Singaporean older adults. A single-phase, cross-sectional survey was carried out in a nationally representative sample of 2102 Singapore residents aged 60 years and older. Five frailty parameters (weakness, slowness, exhaustion, low physical activity and/or unintentional weight loss) were measured to assess Fried's frailty phenotype to identify frail (meeting 3/5 criteria), prefrail (meeting 1 or 2 criteria) and non-frail (absence of all 5) older adults. On testing independent associations, multiple backward stepwise logistic regression analyses were carried out to identify the strongest correlates of frail states. The prevalence of frailty among the older adult population was found to be 5.7%. Sociodemographic, clinical and social characteristics differed significantly at an independent level by frailty status. A higher proportion of frail older adults had care needs (54.5%) compared to pre-frail (13.5%) and non-frail (2.2%), and poor social networks (58.8% vs prefrail [36.6%] and non-frail [28.6%]). Frail older adults also had significantly higher service utilization. Significant correlates of frail state were older age, poor social networks, having any care need, and a history of dementia, diabetes, cancer, respiratory problems or paralysis. Frailty is common among older adults in Singapore, and it correlates with many components at the person, health and societal levels, thus highlighting the importance of individual- and population-level frailty detection and interventions in this population. Geriatr Gerontol Int 2017; 17: 1444-1454.

Beliefs About Help Seeking for Mental Disorders: Findings From a Mental Health Literacy Study in Singapore.

This study investigated beliefs about help seeking, treatment options, and expected outcomes for alcohol abuse, dementia, depression, obsessive-compulsive disorder (OCD), and schizophrenia, by using a vignette-based approach. The Mind Matters study was a comprehensive, population-based, cross-sectional survey conducted among Singapore residents (N=3,006) ages 18 to 65 to establish the level of mental health literacy. Questions were asked about whom the person in the vignette should seek help from, the likely helpfulness of a broad range of interventions, and the likely outcome for the person in the vignette with and without appropriate help. "Talk to family or friends" was the most common source of help recommended for alcohol abuse (30.1%), depression (54.2%), and schizophrenia (21.5%), and "see a doctor or general practitioner" was the most recommended for dementia (53.8%) and OCD (26.8%). Help-seeking preferences were significantly associated with age, gender, ethnicity, and income and with having a personal experience of or knowing someone with a mental disorder similar to that described in the vignette. Respondents rated seeing a psychiatrist as the most helpful intervention (88.4%) and dealing with the problem on his or her own as the most harmful (64.6%). Most respondents (79.3%) indicated that the condition of the person in the vignette would worsen if appropriate help was not sought. Most respondents recommended seeking help for mental disorders from informal sources, such as family and friends. Targeted intervention strategies to improve mental health literacy related to help seeking, treatment beliefs, and effectiveness of evidence-based treatments are needed in Singapore.

Evaluation of Equations for Predicting 24-Hour Urinary Sodium Excretion from Casual Urine Samples in Asian Adults

Background: The collection of 24-h urine samples for the estimation of sodium intake is burdensome, and the utility of spot urine samples in Southeast Asian populations is unclear.Objective: We aimed to assess the validity of prediction equations with the use of spot urine concentrations.Methods: A sample of 144 Singapore residents of Chinese, Malay, and Indian ethnicity aged 18–79 y were recruited from the Singapore Health 2 Study conducted in 2014. Participants collected urine for 24 h in multiple small bottles on a single day. To determine the optimal collection time for a spot urine sample, a 1-mL sample was taken from a random bottle collected in the morning, afternoon, and evening. Published equations and a newly derived equation were used to predict 24-h sodium excretion from spot urine samples.Results: The mean ± SD concentration of sodium from the 24-h urine sample was 125 ± 53.4 mmol/d, which is equivalent to 7.2 ± 3.1 g salt. Bland-Altman plots showed good agreement at the group level between estimated and actual 24-h sodium excretion, with biases for the morning period of –3.5 mmol (95% CI: –14.8, 7.8 mmol; new equation) and 1.46 mmol (95% CI: –10.0, 13.0 mmol; Intersalt equation). A larger bias of 25.7 mmol (95% CI: 12.2, 39.3 mmol) was observed for the Tanaka equation in the morning period. The prediction accuracy did not differ significantly for spot urine samples collected at different times of the day or at a random time of day (P = 0.11–0.76).Conclusion: This study suggests that the application of both our own newly derived equation and the Intersalt equation to spot urine concentrations may be useful in predicting group means for 24-h sodium excretion in urban Asian populations.

Colorectal cancer screening: Barriers to the faecal occult blood test (FOBT) and colonoscopy in Singapore

Introduction: This study aims to identify the barriers to adopting faecal occult blood test (FOBT) and colonoscopy as colorectal cancer (CRC) screening methods among the eligible target population of Singapore. Materials and methods: This study was previously part of a randomised controlled trial reported elsewhere. Data was collected from Singapore residents aged 50 and above, via a household sample survey. The study recruited subjects who were aware of CRC screening methods, and interviewed them about the barriers to screening that they faced. Collected results on barriers to each screening method were analysed separately. Results: Out of the 343 subjects, 85 (24.8%) recruited knew about FOBT and/or colonoscopy. Most of the respondents (48.9%) cited not having symptoms as the reason for not using the FOBT. This is followed by inconvenience (31.1%), not having any family history of colon cancer (28.9%), lack of time (28.9%) and lack of reminders/recommendation (28.9%). Of the respondents who indicated not choosing colonoscopy as a screening method, more than one-half (54.8%) identified not having any symptoms as the main barrier for them, followed by not having any family history (38.7%) and having a healthy/low-risk lifestyle (29.0%). There was no difference between the reported barriers to each of the screening methods and the respondents’ dwelling types. Conclusions: Lack of knowledge, particularly the misconceptions of not having symptoms and being healthy, were identified as the main barriers to FOBT and colonoscopy as screening methods. Interventions to increase the uptake of CRC screening in this population should be tailored to address this misconception.

Quality of life and related factors of nursing home residents in Singapore.

BackgroundLitter is known about the well-being of nursing home (NH) residents in Singapore. This study aimed to identify predictors of self-reported quality of life (QOL) of NH residents in Singapore.MethodsIn face-to-face interviews, trained medical students assessed each consenting resident recruited from 6 local NHs using a modified Minnesota QOL questionnaire, and rating scales and questions assessing independence, cognitive function, depression, and communication. Predictors of residents’ QOL in five aspects (comfort, dignity, food enjoyment, autonomy, and security) were identified using the censored least absolute deviations (CLAD) models.ResultsA total of 375 residents completed the interviews. A higher score on comfort was negatively associated with major depression while a higher score on dignity was positively associated with no difficulty in communication with staff. Higher scores in food enjoyment were negatively associated with major depression and poorer cognitive function. Higher scores in autonomy were negatively associated with major depression, greater dependence, and difficulty in communication with staff. A higher score on security were negatively associated with major depression.ConclusionIt appears that depression and difficulty in communication with staff are the two main modifiable risk factors of poor quality of life of local NH residents.

Body mass index, waist-hip ratio and risk of chronic medical condition in the elderly population: results from the Well-being of the Singapore Elderly (WiSE) Study.

BackgroundThe aim of the current study was to establish the prevalence and relationship of Body Mass Index (BMI) and Waist-Hip Ratio (WHR) with chronic health conditions and their associated socio-demographic correlates in the elderly population of Singapore.MethodsThe data was extracted from the Well-being of the Singapore Elderly (WiSE) study, a comprehensive single phase, cross-sectional, population-based, epidemiological study conducted in 2013 among Singaporean residents (n = 2565) aged 60 years and above with a mean age of 72.7 years (range 60 to 105, SD = 9.53). The respondents were assessed with anthropometric measurements including height, weight, BMI, waist circumference, hip circumference and WHR. Participants provided information on their socio-demographic details and chronic health conditions.ResultsPrevalence of those who were obese, overweight, normal and underweight based on BMI was 8.7 %, 33.4 %, 52.5 % and 5.5 % respectively. Malays were more likely to be overweight compared to Chinese and Indians, while Malays and Indians were more likely to be obese compared to Chinese. Participants who were never married were less likely to be overweight compared to married. Participants aged 85 years and above were more likely to be underweight compared to those aged 60-75 years. Prevalence of high WHR (above 0.90 for men and 0.80 for women) was 79.8 % and this was more pervasive amongst Indians. Participants who were homemakers were more likely to have high WHR while those with tertiary education tended to have low WHR. Being overweight was associated with hypertension and heart problems, while obesity was associated with hypertension and diabetes, and a high WHR was associated with hypertension and diabetes. There were no significant differences in the other chronic conditions in this elderly population.ConclusionsThis study demonstrates the importance of anthropometric measurements in the elderly and its association with certain chronic physical conditions, indicating their utility in the clinical management of these conditions in the elderly.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0297-z) contains supplementary material, which is available to authorized users.

Determinants of individuals' participation in integrated chronic disease screening in Singapore

BackgroundA large pool of patients with chronic diseases remains undiagnosed globally and in Singapore. We explored factors associated with participation in a health screening exercise, using revealed preference, that is,...

Smoking and Socio-demographic correlates of BMI.

BackgroundThe aim of the current study was to examine the associations between Body Mass Index (BMI) and socio-demographic factors and to examine the relationship between BMI, smoking status and ethnicity.MethodsThe Singapore Mental Health Study (SMHS) surveyed Singapore Residents (Singapore Citizens and Permanent Residents) aged 18 years old and above. BMI was calculated using height and weight which were self-reported by respondents. Socio-demographic characteristics and smoking status were recorded in a standardized data collection form.ResultsSix thousand and six hundred sixteen respondents completed the study (response rate of 75.9 %) which constituted a representative sample of the adult resident population in Singapore. Ethnicity, gender and education status were associated with obesity. There was an interaction effect between ethnicity smoking status, and BMI. Indian and Malay smokers were less likely to be obese compared to Chinese smokers. The relationship between ethnicity and BMI was thus reversed when smoking was taken into account.ConclusionsThe study identified certain subgroups and risk factors that are associated with obesity. There is a need for further research to explore and identify genetic, metabolic and ethnic differences that underlie the interaction between ethnicity and smoking status which affects BMI.

APPRENTICE STYLE TO COMPETENCY STYLE PSYCHIATRIC TRAINING: 5 YEAR STUDY OF SINGAPORE PSYCHIATRIC TRAINING

This article was migrated. The article was not marked as recommended. Introduction Singapore had an apprentice style medical specialization training program until 2010 when it adopted an ACGME certified residency training program. A recent survey showed Singapore psychiatry residents rating their educational environment worse than non-residency psychiatry trainees. To confirm these findings we repeated a 2008 survey of perceived importance and adequacy of 11 aspects of psychiatric training among psychiatry trainees in Singapore. Methods We sent out an electronic survey to all psychiatry trainees in Singapore (residents and non-residents) to rate their perceived importance and adequacy on 11 aspects of psychiatric training on a 5 point Likert scale. Results were analyzed with paired or independent t-test analysis as appropriate with p-values at 0.05. Results The survey was conducted from Apr to Aug 2013 with a response rate of 57.9% (N=44). The perceived adequacy of training was significantly better in 2013 than 2008 with 6 of 11 aspects of training rated higher in 2013. Residents had higher ratings in 16 of 19 significant between group differences of perceived adequacy of training. Conclusions A competency based style residency program has resulted in improved perceived adequacy of psychiatric training compared to an apprentice style program. Further research to assess objective adequacy of psychiatric training under the residency program is recommended.

Economic burden of multimorbidity among older adults: impact on healthcare and societal costs.

BackgroundMultimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost.MethodsThe Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors.ResultsThe prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75–84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and ‘Other’ ethnicity were significantly associated with higher total healthcare costs.ConclusionMultimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.