Objective: This study assessed the opinion of mental healthcare professionals on ethical issues in psychiatric research and investigated whether previous research experience had an impact. Methods: Healthcare professionals at a psychiatric institution were invited to participate in this survey. Using a self-administered questionnaire, attitudes on statements covering ethical concerns and consent process in psychiatric research were assessed and responses of participants with and without research experience were compared. Results: Mental health professionals, irrespective of their research backgrounds, acknowledged the importance of training in research ethics and accepted placebo use in psychiatric research. More respondents with research experience felt that patients with mental illnesses are capable of making a decision about research participation, could provide written informed consent and even if involuntarily admitted, had the ability to participate in research. They also considered randomization of treatment to be justified in psychiatric research. Conclusion: Training and update on ethical regulations and requirements for research involving psychiatric subjects could bring about a change in the perspective towards ethical concerns in psychiatric research.

The objectives were to identify the socio-demographic characteristics of older adults who visit traditional healers as well as identify medical and psychiatric conditions that are associated with visits to the traditional healer. Methods: Data from 2563 older adults who participated in the Well-being of the Singapore Elderly (WiSE) population-based survey was used. Sociodemographic information, details on traditional healer visits as well as medical and psychiatric conditions were collated through an adapted 10/66 protocol. Results: A total of 10.4% of older adults sought help from a traditional healer within the past three months. There were significantly more visits to traditional healers by women, those whose highest level of education was primary or secondary school, those who had stomach/intestine problems and those who had anxiety symptoms. Conclusions: Traditional healers appear to be a preferred source of help among some older adult groups. Future research should focus on the impact of seeking help from these alternative healthcare providers in terms of clinical outcomes and costs. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Objective: Electronic cigarettes (e-cigarettes) are increasingly used globally and the implications of their smoking are being debated. The aim of this study is to identify awareness, use and perceptions of e-cigarettes among young smokers and parents of youths in Singapore. Methods: A total of 12 focus group discussions (FGDs) were conducted among youths (aged 15-29 years) who smoke and parents of youths, from diverse social contexts. Participants were recruited using a mix of network and purposive sampling. Youth FGDs were conducted in English language while the parent FGDs were conducted in Chinese and English language. FGDs were audio recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results: Awareness about e-cigarettes was perceived more among youth as compared to parents in terms of structure, mechanism and use of the device. Parents considered e-cigarettes to be a healthy substitute for conventional smoking. However, youth expressed the failure of e-cigarettes to provide satiety level same as conventional cigarette smoking. Participants endorsed e-cigarettes as a tool for smoking cessation. Conclusion: It was evident from the study that though there was knowledge of e-cigarettes, both parents and youths were ill- informed about them, owing to varied and inconsistent information on e-cigarettes along with its legal implications in Singapore. Future research is required to assess safety and efficacy of e-cigarettes as well as the association of their use with smoking cessation.

INTRODUCTIONHoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value. The objectives of the study were to establish the prevalence of hoarding behaviour among the general population and among individuals with obsessive-compulsive disorder (OCD) in a cross-sectional study conducted in Singapore.

MATERIALS AND METHODSThe Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older, living in households. The diagnoses of mental disorders were established using Version 3.0 of Composite International Diagnostic Interview (CIDI 3.0). Differences between 3 groups i.e. those diagnosed with lifetime/12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) OCD with hoarding, those diagnosed with lifetime/12-month DSM-IV OCD without hoarding and those with lifetime hoarding behaviour without diagnosis of DSM-IV OCD were determined.

RESULTSThe weighted prevalence of lifetime hoarding behaviour was 2% and that of hoarding among those with OCD was 22.6%. Those who met the criteria for hoarding behaviour alone were associated with lower odds of having obsessions of contamination, harming, ordering as well as compulsions of ordering and other compulsions than those who met criteria for both OCD and hoarding.

CONCLUSIONHoarders without OCD were less impaired, in terms of comorbid psychopathology, than those with OCD with and without hoarding, and had a higher quality of life versus those with both OCD and hoarding, though still lower than that of the general population.

Adolescent ; Adult ; Aged ; Cross-Sectional Studies ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Hoarding Disorder ; complications ; diagnosis ; epidemiology ; etiology ; Humans ; Male ; Middle Aged ; Obsessive-Compulsive Disorder ; complications ; diagnosis ; Prevalence ; Quality of Life ; Singapore ; epidemiology ; Young Adult

AIMMental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals' perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatric hospital.

MATERIALS AND METHODSSelf-administered questionnaire was employed to collect socio-demographic data and opinions on research. Likert scale was used for the responses and descriptive statistics and ordinal regression were used for data analysing.

RESULTS93.8% respondents perceived "contribution to medical knowledge/public health" to be a major benefit of conducting research. 86.7% respondents felt that "learning experience" was important. "Prestige/publication" (52.7%) and "financial gain" (76%) were perceived to be unimportant. "Clinical load of patients", "lack of skilled personnel to assist in research" and "insufficient funding" were identified as important barriers by 72.4%, 70.6% and 68.9% respondents. "Time constraints", "patient and family readiness to research participation", "insufficient training" and "concerns about patient welfare" are major concerns while conducting research.

CONCLUSIONTo the study team's best knowledge, this is the only study of mental health professionals' perceptions on psychiatric research. It is useful for strategising research planning and enhancing the research culture in the hospital.

Adult ; Attitude of Health Personnel ; Behavioral Medicine ; Behavioral Research ; Cohort Studies ; Data Collection ; Female ; Hospitals, Psychiatric ; Humans ; Male ; Middle Aged ; Personnel, Hospital ; Singapore ; Young Adult

INTRODUCTIONPrevious research has shown single mothers to be at greater risk for both physical and mental health disorders as compared to married mothers. Psychiatric disorders, in particular depression, have been shown to be more prevalent in single mothers than married mothers. This study was aimed at comparing the prevalence of depression, other mood, and anxiety disorders in single and married mothers in a multiethnic Asian society.

MATERIALS AND METHODSThe Singapore Mental Health Study (SMHS) was a cross-sectional survey of the representative population of Singapore. The survey targeted Singapore residents aged 18 years and above. Trained interviewers established the diagnoses of mental disorders using the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). Physical illnesses, social support and sociodemographic correlates were established using structured interviews. For the purpose of this study, single mothers were defined as unmarried, divorced/separated/widowed mothers who had children aged 21 years and below.

RESULTSFace-to-face interviews were completed with 6616 respondents from December 2009 to December 2010. After controlling for sociodemographic correlates in multiple logistic regression model, single mothers had significantly higher odds of having mood disorders (OR = 5.28) as compared to married mothers.

CONCLUSIONOur study found that single mothers in Singapore across ethnicities, experienced a higher risk for mood disorders as elsewhere in the world. Single motherhood was also associated with lower age and education. Our study identifies young, single mothers as a vulnerable group associated with mental illnesses that must be targeted with specific interventions to improve mental health and well-being.

Adolescent ; Adult ; Anxiety ; epidemiology ; Cross-Sectional Studies ; Depression ; epidemiology ; Humans ; Middle Aged ; Mood Disorders ; epidemiology ; Mothers ; psychology ; Prevalence ; Risk ; Risk Assessment ; Singapore ; Single Parent ; psychology ; Social Support ; Socioeconomic Factors ; Young Adult

INTRODUCTIONThis study aims to examine the pattern of services utilisation and the factors associated with help-seeking behaviour among those with mental disorders in the multi-ethnic Asian population of Singapore.

MATERIALS AND METHODSA household survey was carried out on a nationally representative sample of the adult (18 years and above) resident population. The main instrument used to establish the diagnosis of mental disorders and the services sought was the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). The 'services' component of the instrument contains questions, which examine service utilisation for mental health problems.

RESULTSA total number of 6616 completed respondents constituted a representative sample of the adult resident population in Singapore. Only 31.7% of those with mental disorders had sought help: 15.7% from mental health providers, 8.4% from general practitioners, and 7.6% from religious/ spiritual advisors or other healers. Among respondents with severe disability across any disorder assessed in our survey, 50.1% had sought help from some service in the past 12 months. Individuals with moderate or mild levels had lower rates of consultation, i.e. 35.4% and 30.6% respectively. The rate of using the Internet as a source of help was low in this population.

CONCLUSIONThere is a need to engage and work collaboratively with healthcare providers (including religious and spiritual healers) in the community to detect, assess and treat those with mental illness. More general practitioners need to be involved, and the role of the Internet also requires further consideration as a source for help.

Adult ; Female ; Health Care Surveys ; Health Services Needs and Demand ; Humans ; Internet ; utilization ; Male ; Mental Disorders ; therapy ; Mental Health Services ; utilization ; Middle Aged ; Patient Acceptance of Health Care ; statistics & numerical data ; Singapore ; Spiritual Therapies ; utilization

INTRODUCTIONThis study aims to assess the prevalence rates of mental disorders and chronic medical conditions in the Singapore resident population, and examine their association and respective impact on the quality of life.

MATERIALS AND METHODSA household survey was carried out on a nationally representative sample of the adult (18 years and above) resident population. The main instrument used to establish the diagnosis of mental disorders is the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). The mental disorders included in study were major depressive disorder, bipolar disorder, generalised anxiety disorder, obsessive compulsive disorder, alcohol abuse and alcohol dependence. Respondents were asked if they had any of the chronic medical conditions from a list of 15 conditions. Health-related quality of life was assessed with the EQ-5D.

RESULTSOf the 6616 respondents, the lifetime prevalence of mental disorders was 12.0%, and that of chronic medical disorders were 42.6% and those with comorbid mental and medical disorders was 6.1%. The prevalence of any physical disorder in this population was high (42.6%). Among those with chronic physical disorders, 14.3% also had a mental disorder, and among those with mental disorders, more than half (50.6%) had a medical disorder. Most of the mental disorders were not treated. Males, Indians, older people, and those who were separated or divorced were more likely to have comorbidity. The health-related quality of life was significant worse in those with both mental and medical disorders compared to those with either mental or medical disorder.

CONCLUSIONOur study re-emphasised the common occurrence of mental and medical disorders and the importance for an integrated care system with the capability to screen and treat both types of disorders. It also identified certain subpopulations which are more likely to have comorbidity for which a more targeted intervention could be planned.

Adolescent ; Adult ; Aged ; Analysis of Variance ; Chronic Disease ; epidemiology ; ethnology ; Comorbidity ; Female ; Health Surveys ; Humans ; Logistic Models ; Male ; Marital Status ; Mental Disorders ; epidemiology ; ethnology ; Middle Aged ; Prevalence ; Quality of Life ; Singapore ; epidemiology

INTRODUCTIONStudies examining mental health treatment dropout have primarily focused on Western populations and less so on Asian samples. The current study explored the prevalence and correlates of mental health treatment dropout across the various healthcare sectors in Singapore.

MATERIALS AND METHODSData was utilised from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among an adult population (n = 6616) aged 18 years and above. Statistical analyses were done on a subsample of respondents (n = 55) who had sought treatment from the various treatment providers (i.e. mental health, medical, social services and religious healers) in the past 12 months. The World Mental Health (WMH) Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to determine diagnoses of mental disorders, chronic medical disorders and service utilisation.

RESULTSOf those who had received treatment, 37.6% had ended treatment prematurely, 23.2% had completed treatment and 39.2% were still in treatment. The religious and spiritual sector (83.1%) had the highest dropout, followed by the general medical sector (34.6%), mental health services sector (33.9%) and the social services sector (30%). Marital status emerged as the only sociodemographic factor that significantly predicted treatment dropout-with those who were married being significantly less likely to drop out than those who were single.

CONCLUSIONThe overall dropout rate across the various healthcare sectors was comparable to past studies. While the small sample size limits the generalisability of findings, the current study provides useful insight into treatment dropout in an Asian population.

Adolescent ; Adult ; Age Factors ; Asian Continental Ancestry Group ; statistics & numerical data ; Cross-Sectional Studies ; Educational Status ; Employment ; statistics & numerical data ; Female ; Health Services ; utilization ; Humans ; Income ; statistics & numerical data ; Male ; Marital Status ; statistics & numerical data ; Mental Disorders ; epidemiology ; therapy ; Mental Health Services ; utilization ; Middle Aged ; Patient Dropouts ; statistics & numerical data ; Prevalence ; Sex Factors ; Singapore ; epidemiology ; Social Work ; statistics & numerical data ; Spiritual Therapies ; utilization ; Surveys and Questionnaires ; Young Adult

Internet gaming disorder (IGD) involves the excessive use of Internet games that can cause negative consequences like sleep problems, psychological distress, depression and anxiety. It is widely assumed that IGD is closely related with sleep problems, but studies on the topic are scant. Our study aims to explore the association between IGD and sleep problems. Methods: A total of 1085 participants, aged 13-40 years old reported playing Internet games in this self-administered, web-based survey. The instruments used for the study were socio-demographic questions, IGD Questionnaire, Life Satisfaction Scale, General Health Questionnaire-12 and Insomnia Severity Index. The cut-off point of 10 and above was used to establish the prevalence of sleep problems in this study. Logistic regression analysis was used to explore the association between socio-demographic factors, IGD and sleep problems. Results: The prevalence of sleep problems among those with IGD was 28.2%. Female online gamers (adjusted odds ratio, OR=0.7, 95% confidence interval (CI) = 0.5-0.9) were more likely to have sleep problems than males. Participants with secondary education (adjusted OR=1.9, 95% CI=1.2-3.0) and post- secondary education (adjusted OR=2.7, 95% CI= 1.2-6.0) were more likely to have sleep problems than those who had completed university. Participants with DSM-5 IGD were more likely to have sleep problems. Psychological distress (adjusted OR 4.8, 95% CI=3.6-6.7) and life satisfaction (B = -3.1, 95% CI= -4.0 to -2.2) was associated with sleep problems. Conclusion: Prevalence of sleep problems with IGD is higher among female gamers and is associated with increased psychological distress and decreased life satisfaction. Integrated health management is needed to promote good sleep hygiene among those diagnosed with IGD. ASEAN Journal of Psychiatry, Vol. 17 (1): July – December 2016: XX XX.