Calvin Fones

Does the 12-item General Health Questionnaire contain multiple factors and do we need them?

BackgroundThe 12-item General Health Questionnaire (GHQ-12) is widely used as a unidimensional instrument, but factor analyses tended to suggest that it contains two or three factors. Not much is known about the usefulness of the GHQ-12 factors, if they exist, in revealing between-patient differences in clinical states and health-related quality of life.MethodsWe addressed this issue in a cross-sectional survey of out-patients with psychological disorders in Singapore. The participants (n = 120) completed the GHQ-12, the Beck Anxiety Inventory, and the Short-Form 36 Health Survey. Confirmatory factor analysis was used to compare six previously proposed factor structures for the GHQ-12. Factor scores of the best-fitting model, as well as the overall GHQ-12 score, were assessed in relation to clinical and health-related quality of life variables.ResultsThe 3-factor model proposed by Graetz fitted the data better than a unidimensional model, two 2-factor models, and two other 3-factor models. However, the three factors were strongly correlated. Their values varied in a similar fashion in relation to clinical and health-related quality of life variables.ConclusionsThe 12-item General Health Questionnaire contains three factors, namely Anxiety and Depression, Social Dysfunction, and Loss of Confidence. Nevertheless, using them separately does not offer many practical advantages in differentiating clinical groups or identifying association with clinical or health-related quality of life variables.

Co-morbid association of depression and COPD: a population-based study.

OBJECTIVES Depression occurs commonly among patients with COPD, but the independent association of depression and COPD and the effect of depression on COPD outcomes are not well established. METHOD A population sample of 2402 Chinese aged >or=55 with and without COPD (characteristic symptoms of chronic cough, sputum or breathlessness and airflow obstruction and FEV(1)/FVC<0.70) was assessed on Geriatric Depression Scale (score>or=5), dependence on basic activities of daily living (ADL), SF-12 health status, smoking and medication behaviour. RESULTS The 189 respondents with COPD showed higher depressive symptoms prevalence (22.8%) than 2213 respondents without COPD (12.4%); multivariate odd ratio (OR) was 1.86; 95% CI, 1.25-2.75 after controlling for confounding risk factors. In multivariate analyses of respondents with COPD, those who were depressed (N=43), compared to those who were not (N=146), were more likely to report ADL disability (OR=2.89, p=0.049) poor or fair self-reported health (OR=3.35, p=0.004), poor SF-12 PCS scores (OR=2.35, p=0.041) and SF-12 MCS scores (OR=4.17, p<0.001). CONCLUSION Depressive symptoms were associated with COPD independent of known risk factors. In COPD participants, depressive symptoms were associated with worse health and functional status and self-management.

Generalised anxiety disorder in Singapore: prevalence, co-morbidity and risk factors in a multi-ethnic population

BackgroundThere has been a relative lack of epidemiological data on generalised anxiety disorder (GAD) in Southeast Asia. A previous study reported a lifetime prevalence of 1.5% and highlighted low preference for seeking professional help and consultation by persons suspected to be suffering from mental health problems. The present study is part of a National Mental Health survey of adults conducted from February 2003–March 2004 specifically assessing anxiety and depression in Singapore. In this paper we report on prevalence, co-morbidity and risk factors associated with GAD.MethodsWe interviewed 2,847 households from an ethnically stratified random sample of adults aged 20–59 years who were Singapore citizens or permanent residents. The General Health Questionnaire and Schedule for Clinical Assessment of Neuropsychiatry were administered, which generated Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of GAD. We assessed socio-demographic correlates, life events, medical and other psychiatric co-morbidities related to GAD.ResultsLifetime prevalence of GAD was 3.3%, current prevalence is 3.0%. Female to male ratio is 3.6:1. GAD was significantly associated (p<0.001) with the presence of other psychiatric co-morbidities, including major depressive disorder, dysthymia, panic disorder, agoraphobia and social phobia. Prevalence increased in older individuals, with the odds of association greatest in subjects with three or more co-morbid medical conditions [adjusted odds ratio (OR) 3.66]. Those who had experienced one or more threatening life events showed increased odds of association with GAD. Chinese ethnicity, the divorced and persons from both the upper and the lowest socio-economic status had highest odds of association with GAD.ConclusionsWe challenge established notions that GAD tends to be a disorder of the socially disadvantaged. Life events are important as precipitating factors in GAD, and uniquely different types of events appear to affect both extremes of social classes. High co-morbidity associations with current GAD are grounds for concern. This may suggest failure to seek treatment, hence giving rise to an increase in severity of the primary condition.

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-c30): validation of English version in Singapore.

Objective: This study aimed to validate the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, English version 3.0) in Singaporean cancer patients. Methods: In a cross-sectional study, a heterogeneous sample of cancer patients (n = 57) self-administered a questionnaire containing the QLQ-C30, the Short Form 36 Health Survey (SF-36) and assessing health and sociodemographic status. Construct validity was assessed by testing a priori hypotheses that QLQ-C30 scales would be moderately or strongly correlated with SF-36 scales measuring similar dimensions of health-related quality of life (HRQoL) and that subjects reporting mild symptoms would have better HRQoL scores than those reporting severe symptoms. Internal consistency reliability was assessed using Cronbach’s α. Results: Strength of Spearman’s correlations between the QLQ-C30 and SF-36 scales assessing similar dimensions of HRQoL ranged from 0.35 to 0.67. Subjects with mild symptoms had better scores than those with severe symptoms for all six QLQ-C30 HRQoL scales (p < 0.05 for five scales, Mann–Whitney U tests). Cronbach’s α ranged from 0.19 for the cognitive functioning scale to 0.91 for the global QoL scale. Conclusion: This study provides preliminary evidence for the validity and reliability of the EORTC QLQ-C30 in English-speaking Singaporean cancer patients.

Preference, Need and Utilization of Mental Health Services, Singapore National Mental Health Survey

Objective: To ascertain the extent of the community’s preference, needs for and utilization of mental health services, and their socio-demographic determinants in the multi-ethnic Asian community in Singapore. The extent to which need, enabling and predisposing factors determine the likelihood to seek professional help was also examined. Method: Data were analyzed from the Singapore National Mental Health Survey of 1996, based on a stratified random sample of 2947 Chinese, Malay and Indian subjects of the general population aged 13–64 years. Results: An estimated 37% of the general population indicated they would seek professional help if they experienced a serious emotional or mental problem. Although 16.9% were determined by their high general health questionnaire (GHQ) score to need mental health services, only 2.6% in the population used the services of any professional caregiver. Among persons with high GHQ scores, only 5.9% sought any professional help. Among those with a high GHQ score and who were receptive to professional help, only 10.4% actually sought professional help. General practitioners were the most commonly preferred caregiver (49.3%), and were used by 41.1% of those who sought help. Those who sought professional help were more likely to have a high GHQ score and to be inclined to seek professional help. Malays used mental health services more than Chinese, but they did not show a significantly greater prevalence of high GHQ scores, or a greater preference to seek professional help. Receptivity to professional help, high GHQ score, and Malay ethnicity were independent significant predictors of use of mental health service. Conclusion: Need and attitudinal factors predict mental health service utilization, but they still do not explain why a large majority of the population chose not to use mental health services.

Health Beliefs and Help Seeking for Depressive and Anxiety Disorders Among Urban Singaporean Adults

OBJECTIVE This study examined whether help seeking for mental problems was predicted by beliefs about mental illness and services and by family and social support. METHODS Singaporean adults (N= 2,801) were interviewed with the Schedule for Clinical Assessment in Neuropsychiatry and with questions on mental health status, beliefs about the curability of mental illness, embarrassment and stigma, ease of discussing mental problems, effectiveness and safety of treatment, and trust in professionals. RESULTS Although 10% of respondents had a depressive or anxiety disorder or combination, only 3% acknowledged having mental problems, 5% rated their mental health as fair or poor, and 6% sought help for their mental health problems. Help seeking was predicted by poor self-rated mental health and acknowledged mental illness but not by health beliefs and social support. CONCLUSIONS Self-rated mental health status was predictive of help seeking, but other health beliefs and social support were neither strong nor robust predictors.

Factors influencing health-related quality of life of Asians with anxiety disorders in Singapore

As little is known about health-related quality of life (HRQoL) in Asians with anxiety disorders, we assessed HRQoL in Singaporeans with anxiety disorders and identified factors influencing their HRQoL. Outpatients with anxiety disorders (n = 119) attending a hospital psychiatric clinic completed the Short Form 36 Health Survey (SF-36), Beck Anxiety Inventory (BAI) and General Health Questionnaire (GHQ-12). SF-36 score reduction from population norms (quantified as the number of standard deviations below the mean) in these subjects was compared with existing data on Singaporeans with various medical conditions and Americans with panic disorder (PD). Factors influencing HRQoL were examined using stepwise multiple linear regression models. SF-36 score reduction in these subjects (0.3–1.4 SD) was greater than that in Singaporeans with systemic lupus erythematosus or thyroid cancer survivors for seven scales but similar to that in Americans with PD (0.5–1.7 SD). BAI and GHQ-12 scores, presence of PD/generalized anxiety disorder, presence of chronic medical conditions, being married or increasing age accounted for 19–61% of the variance in six selected SF-36 scales. In conclusion, it can be said that Singaporeans with anxiety disorders experience clinically important reductions in HRQoL; both clinical and socio-demographic factors influence HRQoL in such subjects.

The sexual struggles of 23 clergymen: a follow-up study.

Nineteen clergymen, 17 of whom were Catholic, were followed up 1 to 6 years after their initial evaluation in a program designed to assess the sexual offenses and rehabilitation potential of offending professionals. Methods used included a semistructured interview with a research psychiatrist and a repeat of the MCMI-III. At follow-up, the clergymen were relatively psychologically healthy. The vast majority of the men had returned to previous or higher levels of vocational functioning and felt that they had benefited from their initial evaluation and therapy. None of those who were initially suspected of sexual compulsivity met criteria for excessive sexual expression at follow-up, and none had re-offended. The typical clergyman, whether heterosexual or homosexual, was struggling with loneliness, masturbation conflicts, and the wish to be known beyond their role by others. The confrontative style of the evaluators in pursuing the veracity of the clergys initial explanations of their behaviors and the use of penile plethysmography were the primary objections to the methods used. Brief psychotherapy seemed to be a cost-effective, well-received intervention for clergy struggling with their sexual conflicts.

Life events and minor psychiatric morbidity in a community survey

The aim of the study was to ascertain the relationships between life events and minor psychiatric morbidity and their associations between different socio-economic groups living in the community. Using stratified random sampling, 3023 persons (1502 females and 1521 males) aged 13–64 years living in high-rise apartments on the island of Singapore were surveyed. Mean age was 31 years, SD = 10.2 years, with the majority (39.9 per cent) being 30 years and below. More than half were married (54.0 per cent), and 2.9 per cent were divorced/separated or widowed; the rest (43.1 per cent) were single. A number of questionnaires, including the General Health Questionnaire (GHQ-28) and the Life Events Scale (LES), were administered. Using the validated GHQ threshold levels, the estimated prevalence of minor psychiatric morbidity in this sample was 15.7 per cent. More females (N = 277) than males (N = 198) were found to experience minor psychiatric morbidity, with a male : female ratio of about 1.5 : 1.0 (p < 0.0001). A larger proportion of those in the younger age groups of 13–20 years (20 per cent) and 21–31 years (17.2 per cent) were high scorers, with a generally decreasing trend with increasing age; the oldest age group, 51–64 years, had the lowest rate (9.8 per cent) of GHQ high-scorers. Those who were divorced/separated or widowed had the highest rate (25.8 per cent) of psychiatric morbidity, while those who were married had the lowest rate (12.8 per cent), with single people having an intermediate rate (21.0 per cent). Taking an arbitrary division of the Life Events Scale scores between low (0–24), intermediate (25–49) and high (50 and above), 12.2 per cent of the total sample registered in the intermediate range and 6.6 per cent in the high range, with no statistical difference between the genders. The age groups 21–30 and 31–40 had the highest proportions of persons with intermediate and high LES scores (24.0 per cent and 21.6 per cent, respectively), while the oldest age group, 51–64, had the lowest (10.5 per cent); these were statistically significant compared to the whole population (18.9 per cent). Those divorced/separated had the highest LES scores, while single people had the lowest, with the married in between. Possible reasons for these differences, both psychological and social, are discussed. Copyright

STIs, Depression and Sexual Dysfunction

There is a relationship between STIs and sexual and mental health which is not immediately apparent to the practitioner. It may not have been there originally but develops subsequently in either the patient or his partner. The background of the patient is equally vital whether he/she is likely to develop problems. The inward-looking person is prone to develop depression if the “worry” of having had STI gets to him/her and people with strong religious upbringing carries the burden of “sinful deed” done, and if the partner gets terribly upset the patient may go into remorse that has led to suicides if he/she cannot come to terms with himself/herself. Three factors are important: