INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused significant mental distress in populations globally. At the frontline of the pandemic, emergency departments (EDs) are the prime setting to observe the effects of the pandemic on the mental health of the population. We aimed to describe the trend of mental health-related ED attendances at an acute hospital in Singapore before and during the various stages of the COVID-19 pandemic. METHODS: This is a retrospective, descriptive study of patients who presented to the ED between 1 January 2019 and 31 December 2020. Patients diagnosed with mental health-related systematised nomenclature of medicine who visited the ED during this period were identified and were placed into mental health diagnosis categories for analysis. A comparison was made between patients who presented before the pandemic (2019) and during the pandemic (2020). RESULTS: During the study periods, we identified 1,421 patients, of whom 27 were excluded due to non-mental health-related diagnoses, leaving 1,394 patients for analysis. There was a 36.7% increase in mental health-related ED presentations from 2019 to 2020. The proportion of higher-acuity mental health-related ED attendances and number of suicide attempts also increased. CONCLUSION Our study described an increase in the proportion of high-acuity mental health-related ED attendances during the COVID-19 pandemic. Emergency physicians must be cognisant of the effects of the pandemic on mental health. Further research should be conducted to better equip the healthcare system for handling all aspects of the pandemic.
Humans ; COVID-19/psychology* ; Emergency Service, Hospital/statistics & numerical data* ; Retrospective Studies ; Singapore/epidemiology* ; Male ; Female ; Adult ; Middle Aged ; Mental Disorders/diagnosis* ; Mental Health ; SARS-CoV-2 ; Tertiary Care Centers ; Pandemics ; Aged ; Suicide, Attempted/statistics & numerical data* ; Young Adult ; Adolescent

To determine the impact of Cysticercus cellulose (C. cellulose) infection on mental health among school-aged children in Tibetan agricultural areas of Sichuan Province.
 Methods: In October 2015, all primary schools located in Tibetan agricultural areas in Yajiang, Ruoergai, and Muli county of Sichuan Province were selected as the research sites. All school-aged children at five- and six-grade were enrolled for the study by a multistage stratified cluster sampling method. Antibodies against C. cellulose were detected. Mental Health Test and questionnaire survey were conducted for school-aged children to collect data. The impact of C. cellulose infection on mental health among school-aged children was analyzed with the multilevel linear regression.
 Results: A total of 2 453 school-aged children were investigated. The C. cellulose seropositive rate was 6.03% (148/2 453). There were 0.16% (4/2 453) patients with seropositive accompanied by seizure, 2.28% (56/2 453) with seropositive accompanied by headache, 2.08% (51/2 453) with seropositive accompanied by frequent weak, and 0.41% (10/2 453) were seropositive accompanied by frequent nausea. The rate of C. cellulose infection was 4.53% (111/2 453). The mean score of the mental health test was 6.59±2.61. There were significant difference in score of mental health test in children whose demographic characteristics were different. The mental health scores of school-aged children were clustered at the school level. After controlling the factors of demographic characteristics, the result of multilevel model demonstrated that the factor of school-aged children with C. cellulose seropositive accompanied by headache was statistically significant (β=1.14, P=0.017).
 Conclusion: The status of C. cellulose infection among school-aged children in Tibetan agricultural areas is not optimistic. C. cellulose infection has impacted on mental health of local school-aged children. It is necessary to strengthen the prevention and control of C. cellulose infection in epidemic area.
Animals ; Child ; Cysticercosis ; complications ; diagnosis ; epidemiology ; Cysticercus ; Humans ; Mental Health ; Neurodevelopmental Disorders ; epidemiology ; etiology ; Seroepidemiologic Studies ; Tibet ; epidemiology

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.
Adolescent ; Adult ; Age Distribution ; Aged ; Alcohol-Induced Disorders/*diagnosis/*epidemiology/psychology ; Diagnostic and Statistical Manual of Mental Disorders ; *Health Care Surveys ; Humans ; Incidence ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk Factors ; Sex Distribution ; Young Adult

OBJECTIVES: The aim of the study was to develop a North Korean version of the Composite International Diagnostic Interview (NK-CIDI) and to evaluate the reliability and validity of NK-CIDI. METHODS: Subjects were 100 North Korean defectors, aged 18 to 65, who were recruited in a center for defectors in the National Medical Center or who were on an education curriculum in the defector settlement support center. NK-CIDI was developed based on the Korean version of CIDI considering the sociocultural background of North Korea. Inter-rater reliability, test/retest reliability, and validity of NK-CIDI were evaluated and kappa value was calculated. RESULTS: Different vocabularies and awkward expressions were adjusted, and additional explanations were supplemented for difficult phases. The target for development of NK-CIDI was early defectors who entered South Korea less than 3 months ago. Inter-rater reliability (n=30, kappa value 0.35-1.00), test/retest reliability (n=30, kappa value 0-0.86), and diagnostic validity (n=100, kappa value -0.02-0.42) were evaluated. CONCLUSION: Compared to the general population, defectors experience more psychiatric issues, and a standardized tool for diagnosis is needed. In this study, NK-CIDI was developed and the results suggest that reliability is acceptable but validity needs further verification. NK-CIDI could be utilized in future epidemiologic studies.
Curriculum ; Democratic People's Republic of Korea ; Diagnosis ; Education ; Epidemiology ; Korea ; Mental Disorders ; Reproducibility of Results ; Vocabulary

INTRODUCTIONAnorexia nervosa (AN) and eating disorders not otherwise specified (EDNOS) are on the rise in Singapore. Abnormal liver function tests have been reported for up to 12.2% of patients with AN. These patients are also known to present with comorbid psychiatric disorders. This study aims to investigate the correlation between body mass index (BMI) and the severity of abnormal liver function tests, and between BMI and the presence of comorbid psychiatric disorders.

METHODSA retrospective cohort analysis of 373 patients diagnosed with AN or EDNOS at a tertiary hospital was performed. The clinical course of transaminitis and comorbid psychiatric disorders was correlated with the patient's BMI.

RESULTSPatients with a BMI of ≥ 16.6 kg/m(2) at their first consult had a significantly lower risk of having comorbid psychiatric disorders (χ(2) = 32.08, p < 0.001). These patients were five times less likely to have comorbid psychiatric disorders as compared to patients from the other BMI groups (odds ratio [OR] 0.21). On the other hand, patients with a BMI of < 14.6 kg/m(2) had a significantly higher risk of having transaminitis (χ(2) = 72.5, p < 0.001). They were 11.1 times more likely to develop transaminitis as compared to patients with a BMI of ≥ 14.6 kg/m(2) (OR 11.05).

CONCLUSIONSeverity of BMI can be used by clinicians as an indicator to assess for secondary psychiatric comorbidities and/or transaminitis during the first consultation. This could help reduce the morbidity and mortality rates in patients with AN or EDNOS.

Adolescent ; Adult ; Alanine Transaminase ; blood ; Alkaline Phosphatase ; blood ; Anorexia Nervosa ; complications ; diagnosis ; epidemiology ; Aspartate Aminotransferases ; blood ; Body Mass Index ; Child ; Comorbidity ; Diagnostic and Statistical Manual of Mental Disorders ; Feeding and Eating Disorders ; complications ; diagnosis ; epidemiology ; Female ; Humans ; Liver Diseases ; complications ; diagnosis ; epidemiology ; Liver Function Tests ; Male ; Mental Disorders ; complications ; diagnosis ; epidemiology ; Odds Ratio ; Prevalence ; Psychiatric Status Rating Scales ; Retrospective Studies ; Singapore

OBJECTIVE: The aims of the present study are to investigate the rate of the psychiatric disorders in psychiatrically high-risk children and adolescents and to examine sex and age differences in the diagnosis of psychiatric disorders. METHODS: The participants included students aged 6-16 from the 27 elementary and the 45 middle schools in Busan, Korea. We screened psychopathology using the Korean version of Child Behavior Checklist (K-CBCL) or the Youth Self Report (K-YSR). A total of 2,912 students were selected as high-risk students on the basis of cut-off scores (T-score > or =60) for a total behavior problem score of K-CBCL/K-YSR. Of these high-risk students, 1,985 students participated in and completed individual diagnostic interviews. Psychiatric diagnosis was assessed using a Korean version of the Kiddie-Schedule for Affective Disorders and Schizophrenia. Multivariate logistic regression analysis was conducted to examine sex and age differences of psychiatric diagnosis. RESULTS: Based on sex, boys were more likely to have ADHD and girls were more likely to have depression. Based on age, children were more likely to have ADHD and adolescents were more likely to have affective disorder, conduct disorder, psychotic disorder, and anxiety disorders except separation anxiety disorder. CONCLUSION: This is the largest study to conduct face-to-face interviews with subjects and parent(s) among Korean studies in this field. The present study revealed significant differences across sex and age among specific psychiatric disorders in children and adolescents. Future population-based studies will be required to ascertain the sex- and age-related differences of psychiat prevalence.
Adolescent* ; Anxiety Disorders ; Anxiety, Separation ; Busan ; Checklist ; Child Behavior ; Child* ; Conduct Disorder ; Depression ; Diagnosis ; Epidemiology ; Female ; Humans ; Korea ; Logistic Models ; Mental Disorders ; Mood Disorders ; Prevalence ; Psychopathology ; Psychotic Disorders ; Schizophrenia ; Self Report

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

PURPOSE: Our purpose was to investigate psychological problems and clinical outcomes in children with psychogenic non-epileptic seizures (PNES). MATERIALS AND METHODS: We retrospectively reviewed the data of 25 patients who were diagnosed with PNES between 2006 and 2012. RESULTS: Twenty-five children with PNES, aged 8 to 19 years (mean 13.82), were referred to psychiatrists for psychiatric assessment. On their initial visit, 72% of patients had comorbid psychological problems, including depression, anxiety, conduct disorder, adjustment disorder, Attention Deficit Hyperactivity Disorder, schizophrenia, and bipolar disorder. Among these, depression was the most frequent (36%). Predisposing and triggering factors included familial distress (40%), social distress (24%), and specific events (20%). The following treatment was advised based on the results of the initial psychological assessment: 3 patients regularly visited psychiatric clinic to assess their clinical status without treatment, nine underwent psychotherapy, and 13 received a combination of psychotherapy and psychopharmacological therapy. At the mean follow-up of 31.5 months after diagnosis, 20 patients (80%) were event-free at follow-up, three (12%) showed reduced frequency, and two (8%) experienced persistent symptoms. CONCLUSION: The outcomes of PNES in children are much better than those in adults, despite a high rate of psychological comorbidities.
Adolescent ; Adult ; Anxiety/epidemiology ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Child ; Child, Preschool ; Comorbidity ; Depression/epidemiology ; Depressive Disorder/epidemiology/psychology ; Electroencephalography ; Female ; Humans ; Male ; Mental Disorders/*diagnosis/epidemiology/*psychology ; Middle Aged ; Psychophysiologic Disorders/*diagnosis/*psychology ; Psychotherapy ; Retrospective Studies ; Seizures/diagnosis/*psychology/*therapy ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the prevalence of attention deficit hyperactivity disorder (ADHD) and behavior problems among school-age children in Shenzhen City of Guangdong.

METHODSA total of 10553 students in Grades 1-6 from different primary schools in Shenzhen City were assessed by Conners Parent Symptom Questionnaire (PSQ) and Conners Teacher Rating Scale (TRS). Children showing abnormalities according to PSQ or TRS were further assessed according to the diagnostic standard for ADHD as laid out in the diagnostic and statistical manual for mental disorders- 4th edition (DSM-Ⅳ).

RESULTSA total of 8193 PSQ and TRS assessments were completed. The children were aged from 7 to 13 years. The total prevalence rate was 7.60% by PSQ and 5.59 % by TRS. Four hundred and forty-two children were diagnosed having ADHD by DSM-Ⅳ, with a prevalence rate of 5.39%. There were significant differences in the prevalence rate of ADHD among children aged 7 to 13 years (χ2=21.613, P<0.05). In children aged 7 to 9 years, the prevalence rate was higher (above 6%). The prevalence rate of ADHD in boys was significantly higher than in girls (6.65% vs 3.12%; P<0.05). Impulsion and hyperactivity (79.6%), learning (60.6%) and conduct disorders (52.0%) were the main behavioral problems in children with ADHD. The prevalence of learning disorders was higher in girls than in boys. Conclusions The prevalence rate of ADHD in children from primary schools in Shenzhen City is 5.39%, and it is higher in children aged 7 to 9 years. Boys have a higher prevalence rates of ADHD than girls. Impulsion and hyperactivity, learning and conduct disorders are common problems in children with ADHD.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; diagnosis ; epidemiology ; Child ; China ; epidemiology ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Male ; Prevalence ; Surveys and Questionnaires

INTRODUCTIONMental 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.

MATERIALS AND METHODSThis 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.

RESULTSAmong 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.

CONCLUSIONThe identified associated factors would help guide resource allocation, policy formulation and programme development in Singapore.

Adolescent ; Adult ; Aged ; China ; ethnology ; Cross-Sectional Studies ; Female ; Health Surveys ; Humans ; India ; ethnology ; Malaysia ; ethnology ; Male ; Mental Disorders ; classification ; diagnosis ; epidemiology ; ethnology ; Middle Aged ; Risk Assessment ; Singapore ; epidemiology ; Young Adult