Cornelia Chee

Comparing the stigma of mental illness in a general hospital with a state mental hospital: a Singapore study.

The stigma faced by psychiatric patients associated with the type of psychiatric facilities is controversial. This study was conducted to compare the stigma faced by patients with schizophrenia and non-schizophrenia psychiatric disorders in the outpatient departments of a state mental hospital with those in a general hospital in Singapore. A cross-sectional study involving two groups of outpatients in a state mental hospital (n=300) and in a university general hospital (n=300) were assessed with a 12-item stigma scale. Components of the scale assessed included social rejection, negative media perception, shame and social discrimination. Among schizophrenia patients, state mental hospital patients had significantly lower stigma scores compared to their counterparts in the general hospital. For other mental illnesses, the reverse was true: state mental hospital patients had significantly higher stigma scores compared to their counterparts in the general hospital. Stigma was also associated with a younger age and being employed though not by gender. The stigma faced by psychiatric patients is complex and may have institutional and disorder-specific elements. Possible reasons for this are discussed.

The influence of anxiety and depressive symptoms during pregnancy on birth size.

BACKGROUND Mental health problems during pregnancy can influence fetal growth. However, studies examining the influence of maternal mental health across the normal range of birth outcomes are uncommon. This study examined the associations between symptoms of maternal depression and anxiety during pregnancy on birth size among term Asian infants. METHODS One thousand forty-eight Asian pregnant women from a cohort Growing Up in Singapore Towards Healthy Outcomes were recruited between 2009 to 2010 at two Singaporean maternity hospitals. At 26 weeks gestation, depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory II (BDI-II), and anxiety was measured with the Spielberger State-Trait Anxiety Inventory (STAI). Health personnel recorded birthweight, birthlength, gestational age, and head circumference at birth. RESULTS Nine hundred forty-six women who delivered term infants had complete data. For this sample, the mean birthweight was 3146.6 g [standard deviation (SD) 399.0], the mean birthlength was 48.9 cm (SD 2.0). After controlling for several potential confounders, there was a significant negative association between STAI and birthlength [β = -0.248, confidence interval (CI) [-0.382, -0.115], P < 0.001] and a small negative association between EPDS and birthlength (β = -0.169, CI [-0.305, -0.033], P = 0.02). No associations were found between scores on the EPDS, BDI-II, and STAI with birthweight or head circumference. CONCLUSIONS Our preliminary data suggest that among term infants, anxiety and depressive symptoms are not associated with birthweight, while anxiety and depressive symptoms are associated with a shorter birthlength.

Traditional postpartum practices and rituals: clinical implications.

Objectives: In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD. Methods: MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included. Results: Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors. Conclusions: This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual.

An independent association of prenatal depression with wheezing and anxiety with rhinitis in infancy

Different maternal psychological states during pregnancy have been associated with wheeze–rhinitis–eczema symptoms in children. However, previous studies were limited and it was unclear whether the type of prenatal psychological state was associated with a particular symptom. We examined the association of maternal depression and anxiety during pregnancy with wheeze–rhinitis–eczema symptoms in infancy.

The Edinburgh Postnatal Depression Scale as a measure for antenatal dysphoria

Background: Data arising from the Edinburgh Postnatal Depression Scale (EPDS), used as screening tool for perinatal depression, have been analysed as unidimensional in some studies and multidimensional in others. This study evaluates the dimensionality and item properties of the EPDS. Methods: 920 women recruited in antenatal clinics from two government tertiary hospitals completed the English EPDS between 26 and 28 weeks of pregnancy. Classical test theory and factor analyses were used to evaluate dimensionality. Item response theory was used to investigate item functioning. Results: The EPDS was essentially unidimensional. It has a common factor, ‘antenatal dysphoria’ and 3 subdomains ‘depressive’ (items 7–10), ‘anxiety’ (items 3–5) and ‘anhedonic symptoms’ (items 1, 2). Item 8 (I have felt sad or miserable) (discrimination = 3.13. SE = 0.24), item 9 (I have been so unhappy that I have been crying) (discrimination = 2.39. SE = 0.17) and item 10 (The thought of harming myself has occurred to me) (discrimination = 2.27. SE = 0.21) best discriminated participants that had dysphoria. Item 1 (I have been able to laugh and see the funny side of things) (threshold 1 = 1.49, SE = 0.14), item 2 (I have looked forward with enjoyment to things) (threshold 1 = 1.21, SE = 0.11) and item 10 (The thought of harming myself has occurred to me) (threshold 1 = 1.19, SE = 0.21) indicated dysphoria severity. Conclusions: The EPDS measures antenatal dysphoria rather than just depression. It could be used to screen for antenatal depressive, anxiety and anhedonic symptoms. The items discriminate and grade dysphoria unequally. The findings may impact on scale use and interpretation.

Qualities of a good psychiatrist: Differences between psychiatrists and patients

Dear Editor, There is little published literature of the desired qualities of a good Asian psychiatrist. Recent research conducted among Singaporean psychiatrists (Tor et al., 2009) has determined that desired themes valued by Asian psychiatrists are Professional, Personal Values, Relationship and Academic-Research. However there is evidence that patient values differ widely from those of doctors in the West (Charles et al., 1997). It was unclear if Asian patients shared the same views on desired qualities of a good psychiatrist compared with psychiatrists. We sought to answer that question by conducting a pilot survey of psychiatric patients about their views of the qualities of a good Asian psychiatrist. A voluntary, anonymous survey was administered to all psychiatrists/psychiatry trainees in Singapore and outpatient psychiatric patients at a Singaporean tertiary hospital to assess the relative importance of 40 qualities for a good psychiatrist. All analyses were done using Statistical Program for Social Sciences (SPSS) version 14 (SPSS, Chicago, IL, USA). Comparisons between psychiatrists and patients scores of individual qualities and theme were performed using multiple independent t-tests with Bonferroni correction. Two-tailed tests of significance were used and statistical significance was set at P < 0.05. One hundred and eighty-four of 469 eligible patients participated in the survey. Patients ranked providing effective explanations/answers/demonstrations, patience and being a role model significantly higher than psychiatrists. They also ranked possessing wisdom/common sense/judgment, clinical competence and being aware of boundary issues significantly lower than psychiatrists. The results of the survey suggest that patients do not value professional qualities (e.g. being aware of boundary issues, possessing wisdom/common sense/ judgment) as much as psychiatrists but may value communication-enhancing qualities more than psychiatrists. Validation of these findings in a larger representative sample is necessary before generalization of these results can be made.

Construct Validity of the McLean Screening Instrument for Borderline Personality Disorder in Two Singaporean Samples

This study examined the construct validity of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) in a consecutive sample of adult psychiatric patients (n = 128) and a separate sample of undergraduate students (n = 289) in Singapore. Participants were administered the MSI-BPD and other measures assessing related symptoms of BPD. Patients were also administered a semistructured interview by interviewers blind to their MSI-BPD scores. Confirmatory factor analyses revealed a unique three-factor solution, consisting of affect dysregulation, self-disturbances, and behavioral and interpersonal dysregulation. In both samples, the MSI-BPD demonstrated good internal consistency and convergent validity. The measure also showed good discriminant validity and predictive accuracy (AUC = .82), with an optimal cut-off score of 7.5. Overall, the findings suggest that BPD is a valid and coherent clinical construct in Singapore, and point to the need to further clarify the presentation and etiology of BPD in this cultural context.

Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis

This review aims to examine the prevalence and incidence of postpartum depression among healthy mothers without prior history of depression including postpartum depression and who gave birth to healthy full-term infants. A systematic search of ClinicalTrials.gov, CINAHL, EMBASE, PsycINFO, and PubMed was performed for English articles from the inception of the database to November 2017, as well as a manual search of the reference lists of the included articles, and an expert panel was consulted. Across 15,895 articles, 58 articles (N = 37,294 women) were included in the review. The incidence of postpartum depression was 12% [95% CI 0.04-0.20] while the overall prevalence of depression was 17% [95% CI 0.15-0.20] among healthy mothers without a prior history of depression. Prevalence was similar regardless of the type of diagnostic tool used; however, there were statistical differences in the prevalence between different geographical regions, with the Middle-East having the highest prevalence (26%, 95% CI 0.13-0.39) and Europe having the lowest (8%, 95% CI 0.05-0.11). There was no statistical difference in prevalence between different screening time points, but an increasing prevalence was observed beyond six months postpartum. Intervention studies often neglect healthy mothers. This review reports a similar prevalence rate of postpartum depression among mothers without history of depression when compared to mothers with history of depression. Thus, future studies should place equal emphasis on this neglected group of mothers so that targeted interventions and follow-ups can be introduced at appropriate time points.

A suicidal pregnant patient's request for premature Cesarean section: Clinical and ethical challenges

We present the case of a 36-year-old lady with severe borderline personality disorder and depression, who made repeated requests for an immediate Cesarean section at 31 weeks of gestation. Her mood was extremely depressed and she had intense suicidal thoughts. She was worried that she would kill herself and the baby, therefore believing that early delivery would save the babys life. This was a challenging case that required multidisciplinary collaboration, suicide risk assessment and detailed evaluation of mental capacity. The clinical and ethical dilemmas of this case are discussed by a team of psychiatrists, obstetricians and neonatologists.