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.

INTRODUCTIONCurrently 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.

MATERIALS AND METHODSData 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.

RESULTSThe 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,<0.001), Malay and Indian ethnicity (<0.001), those who have never been married (= 0.048) or have no education (= 0.035), as well as being homemakers or retired (<0.001). After adjusting for sociodemographic variables and all health conditions in multiple logistic regression analyses, dementia (<0.001), depression (= 0.011), stroke (= 0.002), eyesight problems (= 0.003), persistent cough (= 0.016), paralysis (<0.001), asthma (= 0.016) and cancer (= 0.026) were significantly associated with caregiver dependence.

CONCLUSIONVarious 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.

Activities of Daily Living ; Age Factors ; Aged ; Aged, 80 and over ; Asthma ; epidemiology ; Caregivers ; Cough ; epidemiology ; Cross-Sectional Studies ; Dementia ; epidemiology ; Depression ; epidemiology ; Educational Status ; Ethnic Groups ; Female ; Humans ; India ; Logistic Models ; Malaysia ; Male ; Marital Status ; Middle Aged ; Multivariate Analysis ; Neoplasms ; epidemiology ; Occupations ; statistics & numerical data ; Paralysis ; epidemiology ; Prevalence ; Retirement ; statistics & numerical data ; Risk Factors ; Singapore ; epidemiology ; Stroke ; epidemiology ; Vision Disorders ; epidemiology

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

INTRODUCTIONGiven 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.

MATERIALS AND METHODSData 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.

RESULTSThe 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.

CONCLUSIONOur 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.

Aged ; Aged, 80 and over ; Alcohol-Related Disorders ; diagnosis ; epidemiology ; psychology ; Alcoholism ; diagnosis ; epidemiology ; psychology ; Anxiety ; epidemiology ; psychology ; Chronic Disease ; Cross-Sectional Studies ; Depression ; epidemiology ; psychology ; Divorce ; statistics & numerical data ; Ethnic Groups ; Female ; Humans ; India ; Male ; Marital Status ; Mass Screening ; Middle Aged ; Obesity ; epidemiology ; Prevalence ; Risk Factors ; Sex Factors ; Singapore ; epidemiology ; Smoking ; epidemiology ; Surveys and Questionnaires

INTRODUCTIONDisability increases an individual's dependence and negatively impacts their physical, mental, and social functioning. The current study aims to establish the prevalence and risk factors of disability in Singapore's population.

MATERIALS AND METHODSData was extracted from the Well-being of the Singapore Elderly (WiSE) study. This cross-sectional study recruited participants aged 60 years and above (n = 2421) who were representative of Singapore's multiethnic population. We used the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 to assess the severity of disability in our sample while establishing its associations and correlations with cognitive levels, sociodemographic variables, and chronic illness.

RESULTSCognitive deficits, old age, female gender, Malay and Indian ethnicity, lack of education, retired or homemaker status, presence of chronic illness (specifically stroke, heart problems, depression, and dementia) were found to be significantly associated with disability in Singapore's elderly population. As hypothesised, participants with deficits in cognition were more likely to indicate higher WHODAS scores.

CONCLUSIONThe findings highlighted specific factors associated with disability in this multiethnic population. The identification of these factors would lead the way to the development of appropriate interventions.

Age Factors ; Aged ; Aged, 80 and over ; Chronic Disease ; Cognitive Dysfunction ; epidemiology ; Cross-Sectional Studies ; Dementia ; epidemiology ; Depression ; epidemiology ; Disabled Persons ; Educational Status ; Ethnic Groups ; statistics & numerical data ; Female ; Heart Diseases ; epidemiology ; Humans ; India ; Malassezia ; Male ; Middle Aged ; Occupations ; statistics & numerical data ; Prevalence ; Retirement ; statistics & numerical data ; Risk Factors ; Sex Factors ; Singapore ; epidemiology ; Stroke ; epidemiology

INTRODUCTION: This paper aims to examine the (1) level of positive mental health (PMH), (2) identify the socio-demographic correlates of the PMH domains in the general population, and (3) establish if employment status moderates the relationship between major depressive disorder (MDD) and PMH among those with a lifetime prevalence of MDD. METHODS: The Singapore Mental Health Study conducted between 2016 and 2018 included Singapore residents aged ≥18 years. The World Health Organization Composite International Diagnostic Interview version 3.0 was utilised to establish lifetime prevalence of MDD. Moderation analysis was conducted using SPSS PROCESS macro (Hayes, 2017) to assess if employment status moderated the relationship between MDD and PMH. RESULTS: Significantly lower PMH total and domain scores were reported by respondents (n=2,270) who endorsed lifetime MDD compared to those who did not. Moderation analysis demonstrated that the effect of MDD on PMH total and domain scores varied considerably across employment status. Based on the interaction plots, the effect of MDD on both PMH total and domain scores was minimal among those employed than unemployed. CONCLUSION Healthcare professionals should support the employment needs of those who report lifetime MDD to provide care for an individual's mental well-being in a holistic manner. Acquiring or remaining in employment would be a priority depending on the PMH of the individual. Reducing barriers to employment for those with health issues or creating employment opportunities for this group are concerns that need to be addressed at a societal level.
Adolescent ; Adult ; Depressive Disorder, Major/epidemiology* ; Employment ; Humans ; Mental Health ; Prevalence ; Unemployment

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

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

INTRODUCTIONPatients with schizophrenia have shorter life expectancy and one of the main causes of death is cardiovascular disease (CVD). Modifiable risk factors for CVD include diabetes mellitus (DM) and dyslipidaemia. This study aimed to establish: (a) the prevalence and correlates of DM and dyslipidaemia; (b) the proportion of those whose condition was well controlled; and (c) the incidence of undiagnosed DM and dyslipidaemia in a long-stay inpatient schizophrenia population.

METHODSData was collected to assess the physical health status of 110 inpatients with schizophrenia who had been in hospital for over one year. Information on sociodemographic characteristics, diagnosis of physical and mental illnesses, and current medications was obtained from their medical records. The overall prevalence of DM and dyslipidaemia was based on diagnosis in the medical records, current medications and fasting blood test results.

RESULTSThe patient group was predominantly male (85.5%), with a mean age of 55.9 ± 9.9 (range 25-90) years. Overall prevalence of DM and dyslipidaemia was 19.1% and 62.7%, respectively. Multivariate logistic regression analysis showed that Malay (odds ratio [OR] 14.97) and Indian (OR 25.71) patients were significantly more likely to have DM when compared to Chinese patients.

CONCLUSIONIn comparison to the general population, the prevalence of DM and dyslipidaemia was found to be higher in inpatients with schizophrenia. However, the two chronic illnesses were well controlled in inpatients and few were undiagnosed, perhaps due to the regular monitoring, supervised diet and regular physical activities arranged for inpatients in the long-stay inpatient wards.

INTRODUCTION: Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. METHODS: We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. RESULTS: The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. CONCLUSION The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.
Adult ; Alcoholism/epidemiology* ; Comorbidity ; Cross-Sectional Studies ; Depressive Disorder, Major/epidemiology* ; Humans ; Mental Disorders/epidemiology* ; Prevalence ; Singapore/epidemiology*