Text Size
Decrease TextReset TextIncrease Text
Print
 

Studies under Epidemiology and Health Services Research

Studies under the Centre Grant (Year 2013 – 2017)

The Research Division has established a focus on mental health services and policy in the past few years by conducting research that are actionable and address the real-world questions that people living with mental illness, their families, providers, payers and policymakers face in selecting, delivering, and financing optimal care. Under the four-year Centre Grant that was awarded to the IMH to conduct health services, epidemiological as well as translational and clinical research studies, a number of projects are being conducted by the Mental Health Policy Studies group to address policy relevant issues among the general population as well as patients with mental illnesses and their families. The current research includes the following studies:    

Study Title: Prevalence and Correlates of Chronic Pain among out-patients in a Tertiary Care Psychiatric hospital

Principal investigator: Pratika Satghare, Research Assistant, Research Division, Institute of Mental Health. 

Study Period: December 2016- December 2018 

Chronic pain (CP) is any pain lasting for more than 12 weeks. CP is reported as a common symptom across the life span among medical as well as psychiatric clinics. Evidence indicates that psychiatric disorders and chronic pain, both individually and as comorbid conditions affect individual’s well-being, productivity, social relationships due to pain related disability and self-despair. This study will recruit out- patients seeking treatment at Institute of Mental Health, Singapore. The participants will be asked to complete a battery of self-report questionnaires containing pain scales and socio- demographic details as well as clinical history such as diagnosis, comorbid conditions and any health service usage for CP condition in the last 3 to 6 months will also be collected. The study seeks to identify the comorbidity of common psychiatric disorders with CP among psychiatric outpatients. Such information will help healthcare providers to offer advanced treatment and management of CP in patients with mental illness. 

Specific Aims: 

  1. To establish the prevalence of chronic pain (CP) in out- patients with mental illness, specifically depressive disorders, schizophrenia spectrum disorders and anxiety disorders. 
  2. To explore the associations of CP with socio- demographic factors, BMI and quality of life. 
  3. The relationship between CP and other health and life style variables such as clinical co-morbidities, alcohol use, smoking behaviour, obesity status, functioning and disability. 
  4. To determine how clinical groups (depressive, schizophrenia spectrum disorders and anxiety disorders) differ in terms of CP prevalence and associated variables. 

Study Title: Depression among informal caregivers of dementia patients – what are the risk factors? 

Principal investigator: Yuan Qi, Research Fellow, Research Division, Institute of Mental Health 

Study Period:   September 2016 – September 2019 

As the major cause of disability in later life, dementia results in tremendous needs for care among the patients, mostly from family or other informal caregivers. Although caregiving could be rewarding to certain caregivers, family members caring for individuals with dementia often describe the experience as stressful and frustrating. Previous studies identified that there is a high prevalence of depression among informal caregivers for individuals with dementia. However, most of the evidences were from western population. Due to the complexity associated with caregiving, it is important to conduct systematic assessments to identify the prevalence of depression among informal caregivers in Singapore and its risk factors. Such information will enable researchers to design and test locally applicable interventions to improve the mental health status of the caregivers. It will also enable policymakers and practitioners to provide tailored supports to them. 

The study aims to  

  1.  To assess the prevalence of depression among informal caregivers of dementia patients in Singapore. 
  2. To explore the levels of different risk factors and investigate their associations with caregiver depression. 
  3. To test a conceptual model on caregiver depression, and explore the mechanism of how different risk factors lead to depression among informal caregivers. 

Completed studies  

Study Title: The Positive Mental Health Study

Principal Investigator: Janhavi Vaingankar
Study period: Dec 2013 – Dec 2015
Mental health is a ‘state of well-being in which an individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community’. While people with a mental illness may experience lower mental well-being than someone without, they may also have periods of good mental well-being, where they are able to manage their condition and cope with the everyday demands of life. Understanding this can help assess the overall mental health status and functioning of people with mental illnesses. Hence studying the type and level of positive aspects of mental health among people with mental illnesses is important. The Positive Mental Health (PMH) instrument, which was developed by researchers from the Institute of Mental Health (IMH), offers information simultaneously on six aspects of PMH that are relevant to the Singapore population- general coping, emotional support, spirituality, interpersonal skills, personal growth and autonomy, and global affect. This study is being conducted among people with select mental illnesses at IMH.

This study aimed to:

  • Establish the levels of domain-specific and total PMH among IMH outpatients with mental disorders and investigate differences among those with a history of depression, anxiety or schizophrenia.
  • Investigate association of PMH with the psychological health, functional capacity, life satisfaction, and clinical variables among these patients.

Publications arising from the study:

  1. Seow LS, Vaingankar JA, Abdin E, Sambasivam R, Jeyagurunathan A, Pang S, Chong SA, Subramaniam M. Positive mental health in outpatients with affective disorders: Associations with life satisfaction and general functioning. J Affect Disord. 2015;190:499-507. Click here for full text.
  2. Vaingankar JA, Abdin E, Chong SA, Sambasivam R, Jeyagurunathan A, Seow E, Picco L, Pang S, Lim S, Subramaniam M. Psychometric properties of the positive mental health instrument among people with mental disorders: a cross-sectional study. Health Qual Life Outcomes. 2016 Feb 12;14:19. Click here for full text.
  3. Sambasivam R, Vaingankar J, Chong S, Abdin E, Jeyagurunathan A, Seow L, Pang S, Subramaniam M: Positive mental health in outpatients: comparison within diagnostic groups. BMC Psychiatry 2016, 16:412. Click here for full text.
  4. Jeyagurunathan A, Vaingankar JA, Abdin E, Sambasivam R, Seow E, Pang S, Picco L, Chong SA and Subramaniam M. Gender Differences in Positive Mental Health among Individuals with Schizophrenia.  Comprehensive Psychiatry 74 (2017) 88–95. Click here for full text. 
  5. Vaingankar JA, Abdin E, Chong SA, Sambasivam R, Seow E, Jeyagurunathan A, Picco L, Stewart-Brown S and Subramaniam M. Psychometric properties of the short Warwick Edinburgh mental well-being scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders. Health and Quality of Life Outcomes. 15:153 (2017). Click here for full text.

Study Title: Comorbid Hoarding in Outpatients Study

Principal Investigator: Asst. Prof. Mythily Subramaniam/Clarissa Ong
Study period: Jun 2014 – May 2016
Hoarding can be defined as persistent difficulty with discarding or letting go of possessions, resulting in clutter that precludes the use of living spaces for their intended purposes. Hoarding behaviour can lead to significant distress or impairment in social, occupational or other important areas of functioning such as maintaining an environment for self and/or others. Notably, clinically significant hoarding often presents with a comorbid condition, such as major depressive disorder, generalised anxiety disorder and social phobia. The presence of hoarding symptoms in other primary psychiatric conditions also appears to worsen patients’ well-being. Thus, it is important to investigate the status of hoarding in an outpatient sample as well as determine the factors associated with it. These findings can then be used to refine the assessment and treatment strategies used by clinicians.

This study aimed to examine the: 

  • Rate of clinically significant hoarding in a mixed clinical sample.
  • Severity of hoarding behaviour and cognitions.
  • Relationship between hoarding and other variables, such as quality of life, anxiety and depression.

Publications arising from the study:

  1. Ong, C., Sagayadevan, V., Lee, S. P., Ong, R., Chong, S. A., Frost, R. O., & Subramaniam, M. (2016). Hoarding among outpatients seeking treatment at a psychiatric hospital in Singapore. Journal of Obsessive-Compulsive and Related Disorders, 8, 56-63. Click here for full text.
  2. Lee SP, Ong C, Sagayadevan V, Ong R, Abdin E, Lim S, Vaingankar J, Picco L, Verma S, Chong SA, Subramaniam M. Hoarding symptoms among psychiatric outpatients: confirmatory factor analysis and psychometric properties of the Saving Inventory - Revised (SI-R). BMC Psychiatry. 2016; 16:364. Click here for full text.
  3. Sagayadevan, V., Lau, Y. W., Ong, C., Lee, S. P., Chong, S. A., & Subramaniam, M. (2016). Validation of the clutter image rating (CIR) scale among psychiatric outpatients in Singapore. BMC Psychiatry16(1), 407. Click here for full text. 

Study Title: Internalised Stigma and Stigma Resistance Experienced by People with a Mental Illness Study

Principal Investigator: Louisa Picco
Study period: Apr 2014 – Mar 2016
Mental illness stigma often results from misunderstandings society have about mental illness and consequently, affected individuals may avoid care and treatment of their condition. Stereotypes also exist in relation to people with a mental illness; these stereotypes and negative perceptions have various consequences and impacts on people with mental illness, often resulting in negative outcomes. For example, stigmatization can contribute to a sense of hopelessness, isolation and low self-esteem. Internalized stigma is a type of stigma that can also lead to self-devaluation, shame, secrecy, and social withdrawal, making it even more difficult to overcome the already existing barriers to daily living among people with a mental illness. Internalized stigma has been found to be associated with depression and anxiety as well as a reduction in hope, self-esteem, empowerment and quality of life. Whilst it is important to understand the complexities relating to internalized stigma, it is also important to look at the effects of stigma resistance or an individual’s capacity to counteract stigma. To date there has been very little research that has looked at internalized stigma and stigma resistance among people with a mental illness in Singapore.

Among outpatients with a minimum of 1 year of treatment at the Institute of Mental Health (IMH) and a history of major depressive disorder (MDD), obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD) and schizophrenia, this study aimed to:

  • Determine the socio-demographic and clinical correlates of internalized stigma and stigma resistance.
  • Examine the correlation between internalized stigma and stigma resistance and functioning.
  • Examine the correlation between internalized stigma and stigma resistance and quality of life.

Publications arising from the study:

  1. Picco L, Pang S, Lau YW, Jeyagurunathan A, Satghare P, Abdin E, Vaingankar JA, Lim S, Poh CL, Chong SA, Subramaniam M. Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem. Psychiatry Research. 2016; 246:500-506. Click here for full text.
  2. Lau, Y.W., Picco, L., Pang, S., Jeyagurunathan, A., Satghare, P., Chong, S.A., Subramaniam, M. (2017). Stigma resistance and its association with internalised stigma and psychosocial outcomes among psychiatric outpatients. Psychiatry Research, 257:72-78. Click here for full text.

Study Title: Assessment of Physical Health Status of Long-stay Patients with Severe Mental Illness in a Tertiary Hospital

Principal Investigator: Professor Chong Siow Ann
Study Period: Jun 2014 - May 2016
Serious Mental illness (SMI) is associated with a dramatic reduction in the lifespan of affected individuals. Life expectancy among people with mental illness is reduced by approximately 30% compared to the general populations. Although suicide is ‘the single major cause of death’ in schizophrenia, the high mortality rate is mainly due to physical health problems. With the institutionalization of patients, the responsibility of caring for these individuals has shifted to the doctors and health care teams. The establishment of the prevalence of medical conditions would help in the development of the relevant interventions and preventive measures for the patients. This will consequently lead to better physical and mental health with a reduction in both morbidity and mortality.

This study aimed to:

  • Establish the prevalence of physical illness in the long stay patients who are staying at Institute of Mental Health (IMH).
  • Investigate the risk of osteoporosis and frailty of these patients.

Publications arising from the study:

  1. Ong, H. L., Subramaniam, M., Abdin, E., Wang, P., Vaingankar, J. A., Lee, S. P.. . Chong, S. A. (2016). Performance of mini-mental state examination (MMSE) in long-stay patients with schizophrenia or schizoaffective disorders in a psychiatric institute. Psychiatry Research, 241, 256-262. Click here for full text.
  2. Seow, L. S. E., Chong, S. A., Wang, P., Shafie, S., Ong, H. L., & Subramaniam, M. (2017). Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care. Comprehensive Psychiatry, 74, 196-203. Click here for full text.

Study Title: The Caregiver Study

Principal Investigator: Zhang Yunjue
Study period: Jul 2014 – Apr 2016
Mental illnesses are chronic and disabling with affected individuals often being unable to fulfil responsibilities normally expected of them. With the advent of deinstitutionalization, the responsibility of caring for these individuals has shifted to family members and relatives. The role of caregiving often entails significant changes in the lives of caregivers, often requiring individuals to modify work hours to accommodate caregiving responsibilities, and juggle various roles. Caregiving has also been associated with emotional distress, reduction in social contact, financial difficulties, and depression which have been collectively studied as caregiver burden. This study is designed to enable us to understand caregiver burden as a multi-dimensional construct encompassing physical, psychological, emotional, social and financial stresses incurred as a result of caregiving. This study has been completed among primary caregivers of relatives who are seeking care at IMH outpatient clinic and other IMH affiliated clinics.

This study aimed to:

  • Explore the relationship between caregiver burden and quality of life among caregivers with relatives suffering from mental illness (including Early Psychosis, Chronic Schizophrenia, Depressive disorders, Anxiety, Dementia).
  • Identify possible risk factors that are associated with perceived burden by caregivers.
  • Compare the degree of caregivers’ burden across the aforementioned disorders.
  • Examine the extent to which affiliate stigma and its correlates are associated with caregiver burden.

Publications arising from the study:

  1. Chang, S., Zhang, Y., Jeyagurunathan, A., Lau, Y. W., Sagayadevan, V., Chong, S. A., & Subramaniam, M. (2016). Providing care to relatives with mental illness: reactions and distress among primary informal caregivers. BMC Psychiatry, 16, 80. Click here for full text.
  2. Jeyagurunathan A, Sagayadevan V, Abdin E, Zhang Y, Chang S, Shafie S, Rahman RF, Vaingankar JA, Chong SA, Subramaniam M. Psychological status and quality of life among primary caregivers of individuals with mental illness: a hospital based study. Health and quality of life outcomes. 2017 May 19;15(1):106. Click here for full text.

Study Title: Prevalence of Gaming Disorder

Principle Investigator: Asst. Prof. Mythily Subramaniam
Study Period: Aug 2014 – Aug 2015
Internet Gaming Disorder (IGD) is a behavioral problem that has been described in numerous ways. While most users enjoy these games and use them as a form of recreation, for some it leads to problematic use and research has shown that under certain conditions, video-gaming may become psychologically, socially and or physically detrimental to the user . The easy access to and increasing use of internet games among Singaporean children and adolescents contribute to public concerns regarding problematic gaming. However, very little research on IGD has been conducted in Singapore. Thus, the current study will help us understand IGD in Singapore and its association with demographic characteristics, game genre, game use (time spent on gaming), gaming motivations as well as anxiety, depression and social phobia. This study has been completed in people who play online games in Singapore.

This study aimed to:

  • Establish the prevalence of IGD.
  • Establish the socio-demographic correlates of IGD.
  • Explore the association of IGD with depression, anxiety and sleep problems.
  • Explore the association between IGD and 'escapism'. 

Publications arising from the study:

  1. Subramaniam M, Chua BY, Abdin E, Pang S, Satghare P, Vaingankar JA, Verma S, Ong SH, Picco L, Chong SA. Prevalence and Correlates of Internet Gaming Problem among Internet Users: Results from an Internet Survey. Annals Acad Med Singapore 2016; 45:174-83. Click here for full text. 
  2. Satghare P, Abdin E, Vaingankar JA, Chua BY, Pang S, Picco L, Poon LY, Chong SA, Subramaniam M. Prevalence Of Sleep Problems Among Those With Internet Gaming Disorder In Singapore. ASEAN Journal of Psychiatry, Vol. 17 (2), July - December 2016. 
  3. Pang S, Abdin E, Chong SA, Chua BY, Lee SP, Picco L, Satghare P, Vaingankar J, Verma S, Subramaniam M. Correlates of Online Game Play Motivations, Social Anxiety and Psychological Distress. Ann Acad Med Singapore. 2017 Nov;46(11):443-446. Click here for full text.

Study Title: A study of positive mental health in caregivers of older adults

Principal Investigator: Janhavi Vaingankar, Senior Manager, Research Division, Institute of Mental Health
Study period: Dec 2014 – Dec 2016
Knowledge of caregivers’ psychological well-being in connection with caregivers’ burden, care tasks, and other factors such as their own health, other care and personal responsibilities is essential as it leads to better understanding of their situation, and for planning interventions to reduce negative psychological impact in informal caregivers of the elderly. Using the Positive Mental Health (PMH) instrument, that assesses positive aspects of well-being such as coping, emotional support and spirituality, and other measures this study will assess the relationship between positive and negative aspects of well-being in a sample of informal caregivers and family members of elderly residents.

This study aims to:

  1. Establish the levels of domain-specific and total PMH among informal caregivers of elderly.
  2. Investigate association of PMH scores with the caregiver’s psychological well-being, life satisfaction, resilience and other health outcomes like health related quality of life, and care needs of the elderly.
    Confirm validity and reliability of the PMH instrument in this population.

Study includes 21 – 65 year old informal or family caregivers of people aged over 60 years. Participation involves providing written informed consent for the study and completion of two study questionnaires – one at the time of enrolment and the second will be collected by our research assistants within 3 days from participation. The overall study process will require about 1 hour of participants’ time. About 290 caregivers meeting the study criteria will be recruited for the study.

Study Title: Stakeholder preferences for the treatment of comorbidities in schizophrenia

Principal Investigator: Daniel Poremski, Research Fellow, Research Division, Institute of Mental Health
Study period: Oct 2015 – Oct 2016
People with schizophrenia and related disorders may require psychopharmacological treatments in order to control the symptoms of their disorder. These treatments may lead to comorbid conditions which in turn necessitate medical treatment to control. These comorbidities are manageable when detected early and when service users adhere to the service providers prescribed course of action. However, research suggests that service users may not be engaging with the necessary follow-up treatments to manage their comorbidities.

This study seeks to engage service users, caregivers, and service providers in a series of individual interviews to assess how their opinions of treatments may influence their decisions adhering to or prescribing various treatments. This investigation will shed light on the treatment preferences of people with comorbidities (hypertension, diabetes mellitus, and hyperlipidemia), their understanding of their illness, and their understanding of treatment impacts on health. The perspective of service provider will be obtained to additionally determine the way in which the screening of comorbidities and subsequent treatments may be facilitated and improved.

The study includes service user adults above the age of 21 who have a diagnosis of schizophrenia or related disorder, and who have a diagnosis of a comorbidity, specifically hypertension, diabetes mellitus, and hyperlipidemia. Caregivers to people with these conditions are also eligible. Service providers have already been interviewed.

Participating in the study involves an hour-long interview. During the interview participants will be able to tell the researchers about their treatment preferences and choices. The interviews are not clinical in nature. Approximately 20 service users, 15 caregivers, and 20 service providers will be recruited for the interview.

Publications arising from the study:

  1. Poremski, D., Sagayadevan, V., Wang, P., Lum, A., Subramaniam, M., & Chong, S. A. (2016). The impact of stakeholder preferences on service user adherence to treatments for schizophrenia and metabolic comorbidities. PLoS One. DOI :10.1371/journal.pone.0166171. Click here for full text. 

Study Title: Attitudes and stigma related to mental illness among mental health professionals  

Study Period: January 2016- January 2017 

Stigma relating to mental illness is a global issue. There are many types of stigma which people with a mental illness can experience. Less widely recognised is the stigma that exists among healthcare professionals because they work in psychiatry and mental health care setting. Associative stigma has been defined as the prejudice and discrimination experienced by parents, siblings, spouses, children, friends, caregivers and co-workers of people with a mental illness (Halter, 2008; Goffman, 1963). Currently very little is known about the stigma experienced by health professionals working in mental healthcare in Singapore, or about their attitudes towards mental illness. 

The study aims to investigate and explore:  

  1.  the extent of associative stigma and attitudes towards mental illness  
  2. the socio-demographic correlates of  associative stigma and attitudes towards mental illness  
  3. the association between resilience and/or positive mental health (PMH) and associative stigma among health professionals (doctors, nurses, psychologists, pharmacists, occupational therapists, physiotherapists, case managers, counselors and medical social workers, working at Institute of Mental Health (IMH). 

Staff from specific disciplines, who are currently working at IMH will be informed of the online study. The study will include Singapore citizens, Permanent Residents and foreigners, who are currently working at IMH as doctors, nurses, psychologists, pharmacists, occupational therapists, physiotherapists, case managers, counselors and medical social workers and who are aged 21 years and above and able to complete the online survey in English. 

Publications arising from the study: 

  1. Picco L, Yuan Q, Vaingankar JA, Chang S, Abdin E, Chua HC, et al. (2017) Positive mental health among health professionals working at a psychiatric hospital. PLoS ONE 12(6): e0178359. Click here for full text.
  2. Yuan Q, Picco L, Chang S, Abdin E, Chua BY, Ong S, et al. Attitudes to mental illness among mental health professionals in Singapore and comparisons with the general population. PLoS ONE. 2017;12(11):e0187593. Click here for full text.

Study Title: A sleep study among outpatients in a tertiary care psychiatric hospital

Principal Investigator: Esmond Seow, Research Assistant, Research Division, Institute of Mental Health
Study period: Aug 2015 – Aug 2016
Insomnia may not only be a symptom of some psychiatric disorders, but it may also contribute to these disorders, and lead to lowered quality of life among patients. Depending on the individuals, it may be important to get targeted treatment for insomnia, especially when the treatment of the primary disorder(s) does not improve the patient's sleep. Due to its chronic nature, insomnia leads to substantial impairment in emotional and mental health, and quality of life. The daytime consequences include increased risk of accidents, decreased work productivity and concentration, and daily performance.

This study aims to:

  1. Establish the prevalence of insomnia symptoms based on complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: difficulty initiating sleep, difficulty maintaining sleep, early morning awakening and non-restorative sleep.
  2. Explore the relationship between sleep measures and other clinical/ sociodemographic variables such as clinical comorbidities, daytime consequences (fatigue, sleepiness), alcohol use, smoking, obesity status, use of medications and functioning.
  3. Investigate patients’ treatment contact for sleep problems, as well as to clarify patient characteristics associated with help-seeking. 

Study Title: Prevalence and Correlates of Disordered Eating Behaviours in Outpatients in a Tertiary Care Psychiatric Hospital

Principal Investigator: Mithila Mahesh, Research Officer, Research Division, Institute of Mental Health
Study Period: April 2015 – December 2016
Disordered eating behaviours include any unhealthy pattern of eating ranging from chronic restrictive eating, habitual dieting, and induced vomiting to binge eating. These disturbances in eating patterns often result in discomfort, deteriorating self-esteem and personal or body dissatisfaction. Aspects of emotional and mental well-being are further hampered when disordered eating behaviours are comorbid with psychiatric illness. Studies indicate patients with mood disorders, substance abuse, and anxiety disorders are highly susceptible to comorbidity with patterns of disordered eating. If left untreated and undetected, comorbid disordered eating could potentially increase the severity of symptoms causing worse quality of life for the patient. Though comorbidity of recognized eating disorders such as Anorexia Nervosa has been well established, there is a lack of knowledge regarding disordered eating. This study allows researchers to understand the underlying psychopathology involved in unhealthy eating patterns, illuminating correlates contributing to disordered eating behaviours in outpatients.

This study aimed to:

1. Establish the prevalence of disordered eating behaviours in outpatients with mental illness, specifically schizophrenia spectrum disorders, depressive disorders, and substance use disorders.

2. To explore attitudes towards eating and its associations with perceptions of body image, quality of life, emotional well-being and socio-demographic factors.

Publications arising from the study:

  1. Subramaniam M, Mahesh MV, Peh CX, Tan J, Fauziana R, Satghare P, Gupta B, Gomathinayagam K, Chong SA. Hazardous alcohol use among patients with schizophrenia and depression. Alcohol. 2017 Dec;65:63-69. Click here for full text.

Study Title: Mental Health Literacy and Practice among Medical and Nursing Students  

Principal Investigator: Esmond Seow, Research Assistant, Research Division, Institute of Mental Health
Study Period: March-Sept 2016
Mental health literacy (MHL) is the knowledge and beliefs about the mental conditions that influence their identification, treatment, and prevention. Five mental disorders- major depressive disorder (MDD), obsessive compulsive disorder (OCD), alcohol abuse, schizophrenia and dementia- that are either highly prevalent or have important implications within the context of Singapore were being identified. It will be crucial to assess our medical and nursing students’ knowledge for these 5 locally-relevant mental illnesses as any lack of knowledge identified, if any, from the study may be rectified through enhanced and modified curriculum by the schools to better prepare our future healthcare providers to cater to the needs of our local population.

In addition, the field of psychiatry or mental health is facing a shortage of specialists worldwide, sometimes termed as a “recruitment crisis”. Psychiatry, psychiatric patients and psychiatrists have commonly been stigmatised against and reasons for the stigmatisation include fear, prejudices and discrimination. Research has also shown that multiple factors can influence medical or nursing students on a career track. By exploring the specific aspects associated with decision to practise psychiatry or psychiatric nursing, policy and educational changes may be made to improve local recruitment of mental health professionals.

Therefore, the proposed study intends to conduct a cross-sectional online study among medical and nursing students in Singapore with two major aims:

To explore mental health literacy to assess knowledge and beliefs about mental disorders.
To identify factors associated with choosing psychiatry practice as a career.
The study will recruit 500 medical students from National University of Singapore and Duke NUS, as well as 500 nursing students from ITE College East, Ngee Ann and Nanyang Polytechnics and National University of Singapore.  

Publications arising from the study:

  1. Ong, H. L., Seow, E., Chua, B. Y., Xie, H., Wang, J., Lau, Y. W., Chong, S. A., & Subramaniam, M. (2017). Why is psychiatric nursing not the preferred option for nursing students: A cross-sectional study examining pre-nursing and nursing school factors, Nurse Education Today. Click here for full text. 
  2. Seow, L. S. E., Chua, B. Y., Xie, H., Wang, J., Ong, H. L., Abdin, E., Chong, S. A., & Subramaniam, M. (2017). Correct recognition and continuum belief of mental disorders in a nursing student population. BMC Psychiatry, 17:289. Click here for full text.
  3. Chang, S., Ong, H. L., Seow, E., Chua, B. Y, Abdin, E., Samari, E., Teh, W. L., Chong, S. A., & Subramaniam, M. (2017). Stigma towards mental illness among medical and nursing students in Singapore: a cross-sectional study. BMJ Open, . Click here for full text.

Study Title: Smoking, Alcohol, and First Episode Psychosis 

Principle Investigator: Asst. Prof. Mythily Subramaniam, Research Division, Institute of Mental Health
Study Period: Dec 2013-Dec 2016
The association between heavy smoking and schizophrenia is well established. Nicotine addiction tends to start at a young age and in most cases before the onset of psychosis. It has even been suggested that nicotine addiction may be a risk marker for schizophrenia. Presently, there are few studies that have examined the temporal relationship between tobacco use and the onset of psychosis.
The Singapore Mental Health Study found that alcohol use disorder is prevalent among the Singaporean youths. In patients, excessive alcohol use is associated with poorer medication adherence, higher rate of relapse, poorer treatment response, and overall poorer symptomatic and functional outcome. There is little data on alcohol use in young patients with serious mental illness.

This study aims to:  

  1. Establish the prevalence and risk factors of smoking and alcohol use disorders in a cohort of first-episode psychosis patients (FEP) when they are first accepted into the Early Psychosis Intervention Program (EPIP).
  2. Investigate the course of smoking and alcohol use disorders in the same cohort of patients following 6-months and 1-year of treatment.

Patients who are newly-enrolled in the EPIP with be invited to participate in the study. Participants will be followed up at 6 months and 1 year. About 300 patients will be recruited for the study.

Publications arising from the study:

  1. Subramaniam M, Abdin E, Shahwan S, Satghare P, Vaingankar JA, Rama Sendren J, Picco L, Chua BY, Ng BT, Chong SA, Verma S. Prevalence, correlates and outcomes of insomnia in patients with first episode psychosis from a tertiary psychiatric institution in Singapore. Gen Hosp Psychiatry. 2017 Nov 24;51:15-21. Click here for full text.

Study Title: Non-suicidal self-injurious behaviours in a psychiatric outpatient sample

Principal Investigator: Shazana Shahwan, Research Officer, Research Division, Institute of Mental Health
Study period: Jun 2015 – Mar 2017
Crisis help support group Samaritans of Singapore recently reported that more distressed young people are reaching out anonymously regarding non-suicidal self-injury. Non-suicidal self-injury (NSSI) is defined as the deliberate destruction or alteration of body tissue severe enough for tissue damage to occur, performed without a conscious suicidal intent. Despite its increasing visibility in cyberspace and other anonymous channels, NSSI behaviours are under-detected and thus not effectively addressed in therapeutic settings, especially since patients are notoriously known to conceal such behaviours from their family and treating professionals. Establishing the prevalence of NSSI among psychiatric patients will help determine if NSSI-specific treatment should be integrated into their routine care. An understanding of their reasons for not disclosing this behavior will also aid in supporting them better and thus narrowing the treatment gap.

The study aims to: 

  1. Establish the prevalence of NSSI in IMH outpatients and identify circumstantial (e.g. peer victimisation and relationship with parents) and malleable (e.g. emotion-regulation) risk factors.
    • This will be conducted through a survey questionnaire with out-patients ages 14 to 35 years.
  2. Identify initiation and progression of NSSI behaviours as well as better understand barriers to help-seeking from mental health professionals and the utility of Internet-based/online support communities.
    • This will be conducted through one-to-one interviews with an experienced researcher. A subset of participants who endorse NSSI behaviours and consented to being re-contacted will be called up for an interview.

Publications arising from the study:

  1. Peh, C.X., Shahwan, S., Fauziana, R., Mahesh, M.V., Sambasivam, R., Zhang, Y., Ong, S.H., Chong, S.A., & Subramaniam, M. (2017). Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents. Child Abuse & Neglect, 67, 383-390. Click here for full text.

Study Title: Interventions for Mental Health Stigma in Youths: The INFORMS Youth Study

Principle Investigator: Shirlene Pang, Research Officer, Research Division, Institute of Mental Health
Study Period: Aug 2015 - Aug 2016
People have many different opinions and attitudes towards mental health issues. These opinions can form at a young age and affect how people react to the topic of mental illness. Understanding how youths view mental health issues can help us develop interventions to improve understanding of mental health issues, prevent misconceptions and reduce stigma. By using questionnaires, talks and group discussions, this study will explore how youths view mental illness and how to reduce stigma against mental illness. 

This study aims to:

  1. Understand the attitudes Singaporean youths have towards mental illness.
  2. Explore appropriate interventions to improve understanding of mental illnesses and promoting mental health awareness.

The study includes 15-18 year olds living in Singapore. Participation involves providing written informed consent for the study and completion of two study phases. About 1000 students meeting the study criteria in participating schools will be recruited for the study.

Publications arising from the study:

  1. Pang S, Liu J, Mahesh M, Chua BY, Shahwan S, Lee SP, Vaingankar JA, Abdin E, Fung DSS, Chong SA, Subramaniam M. Stigma among Singaporean youth: a cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population. BMJ Open. 2017 Oct 16;7(10):e016432. Click here for full text.

Study Title: General Practitioners and Dementia Care in Singapore

Principal Investigator: Professor Chong Siow Ann, Vice Chairman Medical Board (Research), Institute of Mental Health
Study period: Sep 2015 – Mar 2017

A recent study in Singapore – the Well-being of the Singapore Elderly (WiSE) established the prevalence of dementia to be 10% among Singapore residents aged 60 years and above.  There was also a very low rate of a diagnosis of dementia being made by doctors – particularly among the GPs. 

Dementia often has an insidious onset and is difficult to diagnose in the early stages, making it a challenge to primary care workers. Early diagnosis is important as this allows those with dementia and their family to engage with support services and plan for the future. GPs are important players in management of dementia in the community and they should be part of the system of care for people with dementia. Their roles could include early identification and diagnosis of dementia; timely attention to underlying or co-existing treatable conditions such as diabetes, hypertension, and depression; and provision of information about the diagnosis, and referring the appropriate cases for specialist care. 

Gaining an understanding of GPs’ attitudes to diagnose and manage dementia in primary care is a critical first step to service planning and development. Given the urgent need to find ways to best support GPs in this pivotal role, there is unfortunately (at present) relatively little empirical work done in Singapore that examines the views and perceptions of GPs in providing care for people with dementia. 

Thus the study is aimed to understand from a General Practitioners’ perspective: 

  • attitudes towards the diagnosis, management and outcomes of those with dementia,  
  • self-perceived competencies in detecting and managing patients with dementia (and their caregivers) and   
  • challenges faced in managing patients with dementia. 

Publications arising from the study:

  1. Subramaniam M, Ong HL, Abdin E, Chua BY, Shafie S, Siva Kumar FD, Foo S, Ng LL, Lum A, Vaingankar JA, Chong SA. General Practitioner's Attitudes and Confidence in Managing Patients with Dementia in Singapore. Ann Acad Med Singapore. 2018 Mar;47(3):108-118.
  2. Devi, F., Shafie, S., Lau, Y. W., Chua B. Y., Ong H. L., Foo, S., Ng L. L., & Lum, A. (2018). General Practitioner’s Perceptions of Dementia Care and Management in Singapore. The Singapore Family Physician, 44(3), 54 – 59. Click here for full text.

Study Title: Pathways to Care and Illness Perception among Psychiatric Outpatients Attending a Mental Health Institution 

Principal Investigator: Anitha Jeyagurunathan, Senior Research Officer, Research Division, Institute of Mental Health 

Study Period: Nov 2015 – Oct 2017 

Mental health problems are quite common in the general population. A study conducted in Singapore showed that 12% of the adult population met lifetime criteria for any mental disorders. Descriptive research studies have demonstrated that people with psychiatric problems follow a variety of pathways before they reach mental health professionals. Pathways to care studies in Singapore are of interest because of several reasons such as the multi-ethnic population, cultural diversity, diverse sources of help available, which can all influence the course and outcome of mental illnesses in Singapore. The self-regulation model of illness has been studied widely in many illnesses using the Illness Perception Questionnaire. The perception of the problem – cause, consequence and curability may be associated with a person’s help-seeking behaviour. However, few studies have explored the perception of illness from the patient’s perspective or its association with help-seeking. The study will also find out more about the perception of illness from the patient’s perceptive. 

This study aims to: 

  1. Elucidate the pathways to care of a multi-ethnic group of patients with a history of schizophrenia and related psychosis, mood disorders and anxiety disorders seeking treatment at Institute of Mental Health. 
  2. Investigate if patient’s pathways to care were influenced by illness type and socio-demographic characteristics. 

The study will include Singapore citizens and Permanent Residents, aged 21 – 65 years old, who are able to understand or read English/Chinese/Malay/Tamil, IMH outpatients with a history of schizophrenia and related psychosis, any mood disorders (depression or bipolar disorder) or any anxiety disorder (generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder or panic disorder) with approximate duration of illness not more than two years. The study process will require about 60-90 minutes of participant’s time and will involve a single study visit. About 420 IMH outpatients meeting the study criteria will be recruited for the study. 

Publications arising from the study:

  1. Jeyagurunathan, A., Abdin, E., Shafie, S., Wang, P., Chang, S., Ong, H. L., Restria, R.F., Sagayadevan, V., Samari, E., Chua, Y.C., Vaingankar, J. A., Verma, S.K., Wei, K-C., Chong, S. A., & Subramaniam, M (2018). Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore. International Journal of Social Psychiatry. Click here for full text.

Study Title: Development and validation of local translations of the positive mental health instrument

Principal Investigator: Janhavi Vaingankar, Senior Manager, Research Division, Institute of Mental Health
Study period: Sep 2015 – Mar 2017
The Positive Mental Health (PMH) instrument is a self-administered 47-item instrument that measures the level of PMH and its six dimensions among adults aged 21-65 years. The instrument was developed in Singapore and validated as part of the Singapore Mental Health Study by the study team in the year 2010. Since its first development, the instrument has been extensively used and studied in different populations such as community-based general population samples, working adults, patients with mental illnesses and caregivers of older adults. It has consistently shown high reliability and has demonstrated strong construct and criterion validity in English-speaking populations. Given its potential for evaluating multiple components of PMH and its correlates, it is timely and necessary to expand the reach of the measure to non-English speaking populations for effective evaluation of PMH across all subgroups of the population. Using qualitative and quantitative methods, this study will translate the measure into the three predominant non-English local languages in Singapore - Chinese, Malay and Tamil.

This study aims to:

  1. Translate the PMH instrument into Chinese, Malay and Tamil using independent forward translations and panel discussions.
  2. Establish the reliability and face, content and construct validity of the translated versions of the instrument.   

Study Title: Review of emergency department user characteristics (REDUC): a first step toward optimizing continuity of care

Principal Investigator: Daniel Poremski, Research Fellow, Research Division, Institute of Mental Health
Study period: Oct 2015 – Oct 2016 
 The emergency department may increasingly represent the first, repeated, or default point of contact for many marginalized people with mental illness. Because of system inadequacies that fail to support continuity of care, a certain portion of these people continue to rely on the emergency department to obtain care despite being able to receive more appropriate care from specialized professionals. Reliance on emergency services may persist in spite of their connection with family physicians or general practitioners. This over-reliance on the emergency department leads to a substantial cost and misuse. The 2010 Singapore Mental Health Study brought to light the high prevalence of mental illness and increased awareness of potential resource use.     
  

The REDUC series of studies seeks to explore the need for continuity of care services and determine what portion of visits are avoidable and determine how many people use services frequently.  

Phase 1: a first step toward optimizing continuity of care.
The first step used administrative data to determine the prevalence of psychiatric and non-psychiatric medical emergencies treated at the emergency department. These groups were subdivided into portions: those that are self-referred, referred from other hospitals, and referred for forensic reasons. We also determined what portion was for social reasons (housing, familial instability). This will allow us to determine the number of frequent ED users who could be diverted to more appropriate services.
 

Qualitative interviews were also conducted with the nurses, physician’s and allied health workers of the emergency department, to determine the staff’s perspective of frequent ED users, their understanding of the skills needed to effectively manage and treat service seekers, and their perspective of how things may be improved. 
The second phase of the REDUC study will seek to recruit service users who are frequent attenders of emergency services and follow their service use trajectories to explain why they are, or persist as, frequent service users.
 

Phase 2: a prospective follow-up of frequent users. 

The second phase of the REDUC study will recruit 50 service users who are frequent attenders of emergency services. Participants will be followed for a year, and interviewed at three time points to establish their service needs.  The longitudinal aspect of the study will let us observe important  changes in participants’ service use trajectories to determine which events precede decreases or increases in service use. Additionally, the  study will  query their use of social and justice services in addition to their medical services. Understanding their psychiatric medical and social service needs will help us establish the necessary partnerships to improve their continuity of care and their mental health.  

Publications arising from the study:

  1. Poremski D, Lim XY, Kunjithapatham G, Koh D, Alexander M, and Lee C. (2016) Which skills boost service provider confidence when managing people presenting with psychiatric emergencies? DOI: 10.1111/inm.12248. Click here for full text. 
  2. Poremski, D., Kunjithapatham, G., Koh, D., Lim, X. Y., Alexander, M., & Lee, C. (2016). Lost Keys: Understanding Service Providers' Impressions of Frequent Visitors to Psychiatric Emergency Services in Singapore. Psychiatric Services, appips201600165. DOI:10.1176/appi.ps.201600165. Click here for full text. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A member of National Healthcare GroupWork Life Activeness AwardTUVTUV   Comm Chest Award 2012