A Qualitative Exploration of the Views of Policymakers and Policy Advisors on the Impact of Mental Health Stigma on the Development and Implementation of Mental Health Policy in Singapore

Few studies have examined the views of policy makers regarding the impact of mental health stigma on the development and implementation of mental health policies. This study aimed to address this knowledge gap by exploring policymakers’ and policy advisors’ perspectives regarding the impact of mental health stigma on the development and implementation of mental health programmes, strategies, and services in Singapore. In all 13 participants were recruited for the study comprising practicing policymakers, senior staff of organisations involved in implementing the various mental health programmes, and policy advisors. Data was collected through semi-structured interviews, which were transcribed verbatim and analysed using reflexive thematic analysis. Data analysis revealed three superordinate themes related to challenges experienced by the policymakers/advisors when dealing with mental health policy and implementation of programmes. These themes included stigma as a barrier to mental health treatment, community-level barriers to mental health recovery, and mental health being a neglected need. Policymakers/advisors demonstrated an in-depth and nuanced understanding of the barriers (consequent to stigma) to mental healthcare delivery and access. Policymakers/advisors were able to associate the themes related to the stigma towards mental illness with help-seeking barriers based on personal experiences, knowledge, and insight gained through the implementation of mental health programmes and initiatives.

     

From well-being to positive mental health: conceptualization and qualitative development of an instrument in Singapore

Purpose

There is no global definition of well-being. Cultural differences in the perception of well-being and the social and behavioral contexts further limit its measurement. Existing instruments are developed in Western societies that differ in their conceptualization of well-being from Asian populations. Moreover, very few instruments address the multidimensional construct of well-being.

Methods

Literature was reviewed to develop a priori conceptual framework of mental health and well-being. Concepts were identified based on specific criteria to guide the qualitative investigations. Finally, focus group discussions were conducted among adults belonging to the three major ethnicities in Singapore to identify salient domains of mental health and well-being.

Results

Mental well-being is a multidimensional construct constituting of positive affect, satisfaction, and psychological functioning. While well-being explains the functional and psychological components, positive mental health is a combination of these and the skills required to achieve them. Although there is an overlap between the concepts identified from the literature and those identified in Singapore, certain differences existed, particularly with the relevance attributed to family interactions and religiosity or spirituality. Similar findings were observed across the three ethnic groups.

Conclusion

Domains identified can be used to develop a culturally relevant instrument in Singapore.     

Validation of the World Health Organization Disability Assessment Schedule 2.0 among older adults in an Asian country

INTRODUCTION:As populations age globally and the burden of chronic illnesses increases, valid measures of disability are needed for assessment in the older adult population. The aim of the current analysis was to explore the psychometric properties and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an epidemiological survey of older adults in Singapore.METHODS:The study comprised secondary data analysis of the Well-being of the Singapore Elderly study. Inclusion criteria for the study were Singapore residents (Singapore citizens and permanent residents) aged 60 years and above. The 12-item interviewer-administered version of the WHODAS 2.0 was used to assess disability in the study. Data on cognition, health status and sociodemographic information were collected. Depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy.RESULTS:The study found a one-factor model solution for WHODAS 2.0 with a high internal consistency of all items. The internal consistency for the overall scale was 0.92. The WHODAS 2.0 score positively correlated with multimorbidity, perceived overall health status, depression and subsyndromal depression. There was a significant inverse association between the WHODAS 2.0 score and the cognitive status. After adjustment for all sociodemographic variables in the multiple linear regression analysis, these measures remained significantly associated with the WHODAS 2.0 score.CONCLUSION:WHODAS 2.0 was found to be a valid measure of disability among older adults. However, further research is required to determine its usefulness as a responsive instrument that can detect change following interventions.     

The importance of considering differential item functioning in investigating the impact of chronic conditions on health-related quality of life in a multi-ethnic Asian population

Purpose

The present study aims to examine the impact of chronic conditions after adjusting for differential item functioning (DIF) on the various aspects of health-related quality of life (HRQoL) in a multi-ethnic Asian population in Singapore.

Method

Data on 3006 participants from a nation-wide cross-sectional survey of mental health literacy conducted in Singapore were used. Multiple Indicators Multiple Causes model was used to investigate the effects of chronic medical conditions on various HRQoL dimensions assessed with the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) after adjusting for DIF.

Results

Twenty out of 36 items were detected with DIF for chronic conditions including high blood pressure, cardiovascular disorders, diabetes, cancer, neurological disorders and ulcer as well as for a few demographic factors such age, gender and marital status. Twenty significant associations between chronic conditions and SF-36 domains were observed. After controlling for all chronic conditions, socio-demographic and DIF items, a significant association emerged between cardiovascular disorders and physical functioning, while the association between diabetes and ulcer and general health became nonsignificant. All other associations remained statistically significant.

Conclusion

Our findings provide useful information and important implications of DIF on the impact of chronic conditions on HRQoL. We found the impact of DIF with respect to the impact of chronic conditions on HRQoL to be minimal after accounting for measurement bias in this multiracial Asian population.

     

Early age of onset of mood,anxiety and alcohol use disorders is associated with sociodemographic characteristics and health outcomes in adults: results from a cross-sectional national survey

Purpose

This cross-sectional study investigated distribution, sociodemographic correlates, and health outcomes in early versus late age of onset (AOO) of mood, anxiety, and alcohol use disorders in Singapore.

Methods

The Composite International Diagnostic Interview established lifetime diagnoses of major depressive, bipolar, generalized anxiety, obsessive compulsive and alcohol use disorders in a representative sample of residents aged 18 years and over (n = 6126). The AOO of the individual and any mental disorders were classified into early and late onset using median values as cut-offs. Data included socio-demographic and health background, health utility score, and productivity losses. Multivariable logistic regression analysis was conducted to assess sociodemographic correlates of early versus late AOO of any mental disorder while linear regression analysis investigated the associations between AOO of individual disorders with health utility score and productivity loss.

Results

Respondents’ mean (SD) age was 45.6 (16.5) years, comprising 50.5% women and majority of Chinese ethnicity (75.8%). The median AOO for any of the five studied disorders was 21 years (IQR: 15–29). Lowest AOO was observed for obsessive compulsive disorder (Median: 14, IQR: 11–26). Those aged 35 years and over (versus 18–34) were less likely to have earlier AOO [35–49 years (OR: 0.287; 95% CI: 0.154–0.534); 50–64 years (OR:0.156; 95% CI: 0.068–0.361) and 65 and over (OR:0.112; 95% CI:0.027–0.461)], while Malay ethnicity (versus Chinese) (OR: 2.319; 95% CI: 1.384–3.885) and being never married (versus married) (OR: 2.731; 95% CI: 1.493–4.993) were more likely to have early AOO for any mental disorder. Sample with early (versus late) AOO had a lower health utility score (β =  − 0.06,95% CI: − 0.08 to − 0.03) and higher number of days cut down on the type of work (β = 1.61,95% CI: 0.12–3.10) in those with any mental disorders.

Conclusion

This study showed that half of the adults with mood, anxiety or alcohol use disorders in Singapore experienced their illness onset by 21 years of age. Early AOO is associated with sociodemographic background and poor health outcomes. Prevention, early detection, and interventions to improve health outcomes in mental disorders should consider the sociodemographic profile and age at first onset of symptoms in the population.