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*

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

Major depressive disorder (MDD) is the most common nonfatal disease burden worldwide. Systemic chronic low-grade inflammation has been reported to be associated with MDD progression by affecting monoaminergic and glutamatergic neurotransmission. However, whether various proinflammatory cytokines are abnormally elevated before the first episode of depression is still largely unclear. Here, we evaluated 184 adolescent patients who were experiencing their first episode of depressive disorder, and the same number of healthy individuals was included as controls. We tested the serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), IgE, 14 different types of food antigen-specific IgG, histamine, homocysteine, S100 calcium-binding protein B, and diamine oxidase. We were not able to find any significant differences in the serum levels of hs-CRP or TNF-α between the two groups. However, the histamine level of the patients (12.35 μM) was significantly higher than that of the controls (9.73 μM, P < 0.001, Mann-Whitney U test). Moreover, significantly higher serum food antigen-specific IgG positive rates were also found in the patient group. Furthermore, over 80% of patients exhibited prolonged food intolerance with elevated levels of serum histamine, leading to hyperpermeability of the blood-brain barrier, which has previously been implicated in the pathogenesis of MDD. Hence, prolonged high levels of serum histamine could be a risk factor for depressive disorders, and antihistamine release might represent a novel therapeutic strategy for depression treatment.
Adolescent ; Biomarkers ; blood ; C-Reactive Protein ; Chronic Disease ; Cytokines ; Depressive Disorder, Major ; blood ; epidemiology ; etiology ; Female ; Food Hypersensitivity ; blood ; complications ; Histamine ; blood ; Homocysteine ; blood ; Humans ; Immunoglobulin E ; blood ; Immunoglobulin G ; blood ; immunology ; Inflammation Mediators ; blood ; Male ; Risk Factors ; S100 Calcium Binding Protein beta Subunit ; blood ; Young Adult

Antidepressants are widely used to treat depression in Korea, however, only a few studies have focused on the provider of the treatment. The aim of the study is to compare the differences between patients who were prescribed antidepressants by psychiatrists and those who were prescribed antidepressants by non-psychiatrists in South Korea. Patients with a diagnosis of depressive disorder who had been newly prescribed antidepressants in 2012 were selected from the Health Insurance Review and Assessment Service database. They were classified into two groups depending on whether they received the antidepressant prescription from a psychiatrist or non-psychiatrist. Sociodemographic, clinical, and depression related cost has been investigated. Treatment resistant depression, which is defined as a failure of two antidepressant regimens to alleviate symptoms, was also investigated. Prescription adequacy was assessed based on whether a regimen was maintained for at least 4 weeks. Among the 834694 patients with pharmaceutically treated depression (PTD) examined in this study, 326122 (39.1%) were treated by psychiatrists. Patients who were treated by psychiatrists were younger and had more psychiatric comorbidities than those treated by non-psychiatrists. They had longer PTD duration (229.3 days vs. 103.0 days, p < 0.05) and a larger proportion of treatment resistant depression (9.3% of PTD) when compared to those patients treated by non-psychiatrists. The patients treated by psychiatrists had a smaller proportion of inadequate antidepressant use compared to those patients in the non-psychiatrist group (44.5% vs. 65.1%, p < 0.05). The costs related to depression corrected with PTD duration were higher in the nonpsychiatrist group (32214 won vs. 56001 won, p < 0.05). Patients who receive antidepressants from psychiatrists are patients with more severe, treatment-resistant depression. Psychiatrists prescribe antidepressants more adequately and cost-effectively than non-psychiatrists.
Antidepressive Agents ; Comorbidity ; Depression ; Depressive Disorder ; Depressive Disorder, Treatment-Resistant ; Diagnosis ; Epidemiology ; Humans ; Insurance, Health ; Korea ; Prescriptions ; Psychiatry

INTRODUCTION: Expectant mothers may appear anxious even during healthy pregnancies. Unfortunately, little is known about antenatal anxiety, and affected women may remain undetected and untreated. This study aimed to examine the prevalence, incidence, course and associations of high state anxiety in routine obstetric care. MATERIALS AND METHODS: This was an observational prospective cohort study at a large maternity unit. Obstetric outpatients with low-risk singleton pregnancies were recruited during first trimester consultations. Participants provided sociodemographic data and completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale. The STAI was re-administered at each subsequent trimester. RESULTS: Prevalence and incidence of  high state anxiety among 634 completers were 29.5% (95% CI 25.6%-33.6%) and 13.9% (95% CI 9.9%-18.0%), respectively. Anxiety was persistent in 17.0% (95% CI 14.3%-20.2%) and transient in 26.3% (95% CI 23.1%-29.9%). Only persistently anxious participants had high mean second trimester state anxiety scores. Odds for anxiety of greater persistence increased by 29% (95% CI 24%-35%) per 1-point increase in first trimester depression scores, and decreased by 36% (95% CI 7%-56%) with tertiary education. CONCLUSION Antenatal anxiety symptoms are common even in normal pregnancies, especially among women with depression and lower education. Our study indicates value in exploring diagnostic criteria and quantitative measures for antenatal anxiety.
Adult ; Anxiety Disorders ; diagnosis ; epidemiology ; Cohort Studies ; Confidence Intervals ; Depressive Disorder ; diagnosis ; epidemiology ; Female ; Humans ; Odds Ratio ; Pregnancy ; Pregnancy Complications ; diagnosis ; epidemiology ; Pregnancy Outcome ; Pregnancy Trimester, First ; Prenatal Diagnosis ; Prevalence ; Prospective Studies ; Risk Assessment ; Severity of Illness Index ; Singapore

INTRODUCTIONLiterature has shown that individuals with various psychiatric disorders experience a lower quality of life (QoL). However, few have examined QoL across disorders. The current study explored differences in QoL and symptom severity across 4 psychiatric diagnostic groups: anxiety disorders (including obsessive compulsive disorder [OCD]), depressive disorders, schizophrenia, and pathological gambling.

MATERIALS AND METHODSData analysed was from a previous study that examined the prevalence of hoarding symptoms among outpatients (n = 500) in a tertiary psychiatric hospital in Singapore. Measures utilised included the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II) and Quality of Life Enjoyment and Satisfaction QuestionnaireShort Form (Q-LES-Q-SF). Sociodemographic information and details on type and number of comorbidities were also collected.

RESULTSThe depressive disorder group had the highest level of depressive and anxiety symptoms and the lowest QoL whereas; the schizophrenia group had the lowest level of depressive symptoms and the highest QoL. Age and employment status were the only sociodemographic correlates which were significantly associated with QoL. After controlling for sociodemographic factors, only the type of mental disorder was found to have a significant effect in explaining BAI, BDI-II and Q-LES-Q-SF.

CONCLUSIONFindings offer insight in terms of the burden associated with the various disorders.

Adult ; Anxiety Disorders ; epidemiology ; psychology ; Comorbidity ; Cost of Illness ; Demography ; Depressive Disorder ; epidemiology ; psychology ; Female ; Gambling ; epidemiology ; psychology ; Humans ; Male ; Middle Aged ; Outpatients ; psychology ; statistics & numerical data ; Psychiatric Status Rating Scales ; Quality of Life ; Schizophrenia ; diagnosis ; epidemiology ; Singapore ; epidemiology ; Socioeconomic Factors

BackgroundPatients with major depressive disorder (MDD) usually have high risk of suicidality. Few studies have investigated the effects of stressful life events (SLEs) on the risk of suicide in Chinese patients who have developed MDD. This study aimed to investigate the impact of SLEs on suicidal risk in Chinese patients with MDD.

MethodsIn total, 1029 patients with MDD were included from nine psychiatric hospitals to evaluate the impact of SLEs on suicidal risk. Patients fulfilling the Mini-International Neuropsychiatric Interview (MINI) criteria for MDD were included in the study. Patients were excluded if they had lifetime or current diagnoses of psychotic disorder, bipolar disorder, and alcohol or substance dependence. Depressive symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17). The suicidal risk of MDD patients was determined by the suicide risk module of MINI. SLEs were assessed by the Life Events Scale.

ResultsNo gender difference was found for suicidal risk in MDD patients. Patients with suicidal risk had younger ages, lower education levels, more drinking behavior, and lower marriage rate, and fewer people had child and more severe depressive symptoms than nonsuicidal risk group. High-level perceived stressfulness (HPS) and number of SLEs that patients were exposed to were significantly greater in patients with suicidal risk than patients without. In multivariate logistic analysis, HPS of SLEs (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.16-2.05, P = 0.003) and depressive symptoms (OR = 1.08, 95% CI: 1.05-1.11, P < 0.001) were associated with suicidal risk even after adjustment of gender, age, marriage, drinking behavior, and childless.

ConclusionsHPS of SLEs is associated with suicide risk in Chinese patients with MDD. Further suicide prevention programs targeting this risk factor are needed.

Trial RegistrationClinicalTrials.gov: NCT02023567; https://clinicaltrials.gov/ct2/show/NCT02023567?term=NCT02023567&rank=1.

Adolescent ; Adult ; Asian Continental Ancestry Group ; Bipolar Disorder ; epidemiology ; psychology ; Depressive Disorder, Major ; epidemiology ; psychology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Psychiatric Status Rating Scales ; Risk Factors ; Suicide ; psychology ; statistics & numerical data ; Young Adult

It is reported that depression has caused heavy disease burden across the world, with an possible association between ambient air pollution and depressive symptoms. In this paper, we reviewed relative literature in this field and summarized the research events on association between ambient air pollution and depression, both in China and abroad and found that the results of the existed studies were inconsistent, with most studies showing that there existed a positive correlation between the exposure of air pollution and depression, but few studies showing the negative correlation or no correlation between the two.
Air Pollutants/analysis* ; Air Pollution/statistics & numerical data* ; China ; Depression/epidemiology* ; Depressive Disorder ; Environmental Exposure/statistics & numerical data* ; Female ; Humans ; Particulate Matter/analysis* ; Research/trends* ; Residence Characteristics

Objective: To investigate the self-rated health and related factors in centenarians in Hainan province. Methods: A cross-sectional study in centenarians from 18 cities and counties was carried out in Hainan between June 2014 and December 2016. They data about their demographics, chronic diseases, ability of daily life, mental health and sleep quality were collected in a household interview. Self-rated health status was classified into 5 degrees according to the subjective assessment by centenarians. Results: Of 991 centenarians in this study, 157 (15.8%) were in good self-rated health and 228 (23.0%) were in poor self-rated health. Multivariate logistic regression analysis showed that chronic pain, visual impairment, depression, limited ability of daily life and poor sleep quality were the factors associated with poor self-rated health in centenarians in Hainan (P<0.05). Conclusion: The proportion of centenarians in good self-rated health was low in Hainan, the influencing factors included chronic pain, visual impairment, depression, poor sleep quality and limited ability of daily life. It is necessary to conduct targeted intervention in centenarians in Hainan.
Activities of Daily Living ; Aged, 80 and over ; China ; Chronic Disease/epidemiology* ; Cross-Sectional Studies ; Depression/epidemiology* ; Depressive Disorder/epidemiology* ; Female ; Geriatric Assessment ; Health Status ; Health Status Indicators ; Humans ; Male ; Mental Health ; Risk Factors ; Sleep/physiology* ; Sleep Wake Disorders/epidemiology*

Objective: To explore the associations between maternal and prenatal depressive symptoms and children's behavioral problems at 2 years old. Methods: In the present study, a total of 491 mother-child pairs were selected from the Shanghai-Minhang Birth Cohort Study (S-MBCS) which was conducted in Maternal and Child Health Hospital of Minhang District in Shanghai between April and December, 2012. Data from the Center for Epidemiologic Studies on Depression was gathered to assess the maternal depressive symptoms in the second and third trimester of pregnancy, as well as at 6 months and 12 months postpartum. Neurodevelopment at 2 years was assessed, using the Child Behavior Checklist. We used generalized linear models with a log-link function and a Binomial distribution to estimate the risk ratios (RRs) and 95%CIs, on children's behavioral problems at 2 years of age. Sensitivity analyses were performed among participants without postpartum depressive symptoms. Results: After adjustment on factors as maternal age, gestation week, average monthly income per person, parental education and children's gender etc., maternal depression in second trimester of pregnancy was found associated with higher risk of both developing emotional (RR=2.61, 95%CI: 1.36-4.99) and internalizing problems (RR=1.94, 95%CI: 1.22-3.08). However, maternal depression in third trimester was found to be associated with higher risks of developing emotional (RR=6.46, 95%CI: 3.09-13.53), withdrawn (RR=2.42, 95%CI: 1.16-5.02), aggressive (RR=2.93, 95%CI: 1.45-5.94), internalizing (RR=1.79, 95%CI: 1.01-3.16) or externalizing problems (RR=2.56, 95%CI:1.49-4.42). In sensitivity analysis, antenatal maternal depression was found positively associated with children's emotional, internalizing and externalizing problems and the differences all statistically significant. Conclusions: Maternal depression during pregnancy might increase the risks of children's behavioral problems. In order to decrease the incidence of children's behavioral problems and promoting both maternal and child health status, monitoring program regarding maternal mental health care should be strengthened.
Adult ; Child ; Child Behavior Disorders/psychology* ; China/epidemiology* ; Depression/epidemiology* ; Depressive Disorder ; Emotions ; Female ; Humans ; Male ; Maternal Age ; Mothers/psychology* ; Pregnancy ; Problem Behavior/psychology* ; Prospective Studies ; Surveys and Questionnaires