Edimansyah Abdin

Prevalence of Dementia in People Aged 60 Years and Above: Results from the WiSE Study

BACKGROUND The challenge of an aging population with its expected attendant problem of an increase in the number of people with dementia is a growing concern across the world. OBJECTIVE The aims of this study were to establish the prevalence and risk factors of dementia in Singapore among the elderly resident population (aged 60 years and above). METHODS The WiSE study was a comprehensive single phase, cross-sectional, epidemiological survey that adapted the 10/66 protocol to establish the 10/66 and the Diagnostic and Statistical Manual of mental disorders -fourth edition (DSM-IV) diagnosis of dementia. 10/66 and DSM-IV dementia diagnosis as established by the survey questionnaires was validated by comparing against a gold standard of clinical assessment. RESULTS A total of 2,565 respondents completed the study giving a response rate of 65.6%. The validity of 10/66 dementia was higher (sensitivity = 95.6%, specificity = 81.8%) than that of DSM-IV dementia (sensitivity = 75.6%, specificity = 88.6%) when compared against the clinical gold standard. The study found that the prevalence of 10/66 dementia was 10% in the older adult population while the prevalence of DSM-IV dementia was 4.6%. Older age (75 years and above); no formal education, or completed primary education (versus higher education); homemaker and retired status (versus employed); and a history of stroke were associated with a higher risk of 10/66 dementia. CONCLUSION The establishment of accurate data on the number of people with dementia is essential in the planning of services and initiatives.

The positive mental health instrument: development and validation of a culturally relevant scale in a multi-ethnic asian population

BackgroundInstruments to measure mental health and well-being are largely developed and often used within Western populations and this compromises their validity in other cultures. A previous qualitative study in Singapore demonstrated the relevance of spiritual and religious practices to mental health, a dimension currently not included in exiting multi-dimensional measures. The objective of this study was to develop a self-administered measure that covers all key and culturally appropriate domains of mental health, which can be applied to compare levels of mental health across different age, gender and ethnic groups. We present the item reduction and validation of the Positive Mental Health (PMH) instrument in a community-based adult sample in Singapore.MethodsSurveys were conducted among adult (21-65 years) residents belonging to Chinese, Malay and Indian ethnicities. Exploratory and confirmatory factor analysis (EFA, CFA) were conducted and items were reduced using item response theory tests (IRT). The final version of the PMH instrument was tested for internal consistency and criterion validity. Items were tested for differential item functioning (DIF) to check if items functioned in the same way across all subgroups. Results: EFA and CFA identified six first-order factor structure (General coping, Personal growth and autonomy, Spirituality, Interpersonal skills, Emotional support, and Global affect) under one higher-order dimension of Positive Mental Health (RMSEA = 0.05, CFI = 0.96, TLI = 0.96). A 47-item self-administered multi-dimensional instrument with a six-point Likert response scale was constructed. The slope estimates and strength of the relation to the theta for all items in each six PMH subscales were high (range:1.39 to 5.69), suggesting good discrimination properties. The threshold estimates for the instrument ranged from -3.45 to 1.61 indicating that the instrument covers entire spectrums for the six dimensions. The instrument demonstrated high internal consistency and had significant and expected correlations with other well-being measures. Results confirmed absence of DIF.ConclusionsThe PMH instrument is a reliable and valid instrument that can be used to measure and compare level of mental health across different age, gender and ethnic groups in Singapore.

Comorbid depression and increased health care utilisation in individuals with diabetes

OBJECTIVE The objective of this study was to examine the extent of health care utilisation (excluding costs) of diabetic patients with and without depressive symptoms attending a specialist clinic in Singapore. METHODS A total of 537 Asian outpatients (aged 21 years and above) who were attending a Diabetes Centre were recruited on a consecutive basis between August 2006 and February 2007. Sociodemographic data, clinical and health care utilisation data were collected from the participants. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. RESULTS Individuals with depressive symptoms, on average, had more hospitalizations and hospitalization days. Those with depression reported losing significantly more working days as compared to the nondepressed individuals (1.9 vs. 1.4, P=.001). CONCLUSIONS Our findings in this population suggest that the presence of depressive symptoms has an independent effect on the greater utilization of medical services.

Impact of psychiatric disorders and chronic physical conditions on health-related quality of life: Singapore Mental Health Study

BACKGROUND Few studies have established Quality Adjusted Life Years (QALY) losses associated with mental and chronic physical conditions in the community. The aim of the current study was to establish and compare the QALY losses associated with select mental and chronic physical conditions in Singapore. METHODS The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample. The diagnosis of psychiatric disorders was established using the Composite International Diagnostic Interview (CIDI 3.0) and health related quality of life (HRQoL) was measured using the Euro-Qol-5D (EQ-5D). RESULTS Pain conditions, hypertension and MDD were associated with the highest loss of QALYs in Singapore at a population level. The marginal effect on HRQoL by - Major Depressive Disorder (MDD), Obsessive Compulsive Disorder (OCD) and Bipolar Disorder was higher than the effect of any physical condition. LIMITATIONS The presence of chronic physical diseases was established using a check-list rather than with more objective measures and UK tariffs were used as local tariffs are not available and this might introduce some cultural bias. CONCLUSIONS QALY losses associated with psychiatric disorders were high, emphasizing the need for recognizing them as major public health concerns and the need for appropriate resource allocation.

The prevalence and impact of major depressive disorder among Chinese, Malays and Indians in an Asian multi-racial population.

BACKGROUND Reports of rates of depression among different Asian ethnic groups within the same country using standardized assessments are rare in the extant literature. METHODS This was a household survey of 6616 adult residents of Singapore which constituted a national representative sample. Face to face interviews were conducted with the English, Chinese and Malay versions of the World Mental Health Composite International Diagnostic Interview. The response rate was 75.9%. RESULTS The lifetime and 12-month prevalence estimates for MDD were 5.8% and 2.2%, respectively. MDD was significantly higher among the females, Indians, those who were divorced/separated, or widowed. The median age of onset of MDD was 26 years with the highest risk of onset in those aged 18-34 years while the age group of 65 years and above had the lowest risk of onset. Chronic physical conditions were present in approximately half of the respondents with MDD. MDD was also associated with considerable disability in terms of days of role impairment. More than half (59.6%) of those with lifetime MDD had not ever sought professional help. LIMITATIONS This was a cross-sectional household survey that excluded those who were institutionalized. Responses were self-reported and therefore subjected to recall bias. CONCLUSIONS Our findings add to the body of knowledge on the differential rates of depression among different ethnic groups; the association with disability, comorbid physical conditions and the considerable proportion of untreated cases also have important clinical and policy implications.

Prevalence and correlates of alcohol use disorders in the Singapore Mental Health Survey.

AIMS   To establish the prevalence, correlates, comorbidity and treatment gap of alcohol use disorders in the Singapore resident population. DESIGN   The Singapore Mental Health Study is a cross-sectional epidemiological survey. SETTING   A nationally representative survey of the resident (citizens and permanent residents) population in Singapore. PARTICIPANTS   A total of 6616 Singaporean adults aged 18 years and older. MEASUREMENTS   The diagnoses were established using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) diagnostic modules for life-time and 12-month prevalence of selected mental illnesses including alcohol use disorders. FINDINGS   The life-time prevalence of alcohol abuse and alcohol dependence was 3.1% and 0.5%, while the 12-month prevalence of alcohol abuse and alcohol dependence was 0.5% and 0.3%, respectively. The life-time and 12-month prevalence of alcohol use disorders was 3.6% and 0.8%, respectively. Those with alcohol use disorder had significantly higher odds of having major depressive disorder [odds ratio (OR) 3.1] and nicotine dependence (OR 4.5). Compared to the rest of the population, those with an alcohol use disorder had significantly higher odds of having gastric ulcers (OR 3.0), respiratory conditions (OR 2.1) and chronic pain (OR 2.1). Only one in five of those with alcohol use disorder had ever sought treatment. CONCLUSIONS   The prevalence of alcohol use disorders is relatively low in the Singapore adult population. Comorbidity with mental and physical disorders is significant, emphasizing the need to screen people with alcohol use disorders for these comorbidities.

Care participation and burden among informal caregivers of older adults with care needs and associations with dementia.

Background: Few studies have estimated care burden in large, representative, multi-ethnic Asian population-based informal caregivers of older adults with care needs. This study describes informal caregivers’ care participation for a population-based sample of older adults with care needs in Singapore, investigates differences by dementia status, and examines correlates of caregivers’ burden. Methods: Data collected from 693 pairs of older adults, aged 60 to 100 years, having any care needs, and their informal caregivers, who were aged 21 to 88 years, closely involved in their care and “knew the older resident best,” and were interviewed during a cross-sectional national survey, were used. Clinical characteristics of older adults, including behavioral and psychological symptoms of dementia (BPSD) and dementia diagnosis, care needs, and socio-demographic characteristics of participants were obtained. Care burden was assessed with the Zarit Burden Interview. Results: Informal caregivers’ participation was highest in activities related to communication (35.1%), feeding (32%), and bathing (21.1%). Among the older adults with any care need, 356 (51.4%) had dementia. Care burden was significantly associated with married caregivers (odds ratio (OR) 2.4 vs. never married), when their relative belonged to a younger cohort (OR 2.5 vs. >84 years), needed care much of the time (OR 2.5 vs. no care needed), exhibited BPSD (OR 3.5 vs. no BPSD), and had dementia (OR 2.52 vs. no dementia). Conclusions: Factors related to older adults – more care needs, presence of BPSD, and dementia – were significant contributors to informal caregivers’ burden, and these should be considered while planning interventions to alleviate care burden.

Exploratory and confirmatory factor analyses of the Multidimensional Scale of Perceived Social Support in patients with schizophrenia.

INTRODUCTION Social support promotes community adaptation of patients with mental illness by facilitating coping and competence. The Multidimensional Scale of Perceived Social Support (MSPSS) is a widely used measure of perceived social support that investigates 3 domains of support, from significant other, family, and friends. This study was conducted to provide evidence of the reliability and construct validity of the MSPSS in an adult Asian population with schizophrenia. METHODS The MSPSS was self-rated by patients with schizophrenia. Reliability was determined using Cronbach α for internal consistency, and preliminary construct was examined using exploratory factor analysis (using principal component with varimax rotation). Four a priori hypothesized models were tested via confirmatory factor analysis: first-order 2-factor (2 models), and first-order and higher order 3-factor models, using 5 goodness-of-fit indices. RESULTS Internal reliability was high (Cronbach α of .90, .90, and .91 for support from significant others, family and friends, respectively) for the MSPSS. Exploratory factor analysis on the 12-item measure indicated 3-factor solution that supported the 3 theoretical dimensions of the MSPSS. The indices of goodness of fit confirmed the first-order and higher-order 3-factor confirmatory models of MSPSS by providing the best fit in this sample. CONCLUSION Our findings demonstrate high internal consistency and construct validity of MSPSS in outpatients with schizophrenia, making it appropriate for assessing the perceived social support in this population.

Validity of the Personality Diagnostic Questionnaire-4 (PDQ-4+) among mentally ill prison inmates in Singapore.

We examined the validity of the Personality Diagnostic Questionnaire--4+ (PDQ-4+) as a screening instrument for personality disorders among mentally ill prison inmates in Singapore. A total of 313 prison inmates completed the PDQ-4+ and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). The subjects were 303 (96.8%) males and 10 (3.2%) females with a mean (SD) age of 40.7 (8.8) years. Kappa agreement between PDQ-4+ and SCID-II for the presence at least one personality disorder was moderate with high sensitivity and low specificity. For specific personality disorders and clusters, we found that the PDQ-4+ diagnosed more subjects as having each of the personality disorders than SCID-II with high negative predictive values. The area under the curve indicated moderate discriminatory capabilities. Our results suggest that the PDQ-4+ could be used as a potential screening instrument for personality disorders in prison inmates.

Psychiatric morbidity in pain conditions: Results from the Singapore Mental Health Study

BACKGROUND Chronic pain is a common problem among the general population and has been found to be associated with psychiatric disorders in studies based on both clinical samples and epidemiological surveys. OBJECTIVES To establish the prevalence, correlates and comorbidities of chronic pain disorders among the adult population of Singapore. METHODS The data used in the present analysis were derived from the Singapore Mental Health Study, a cross-sectional epidemiological survey of a representative sample of the adult resident population of Singapore. Diagnoses of psychiatric disorders were established using the Composite International Diagnostic Interview version 3.0. A modified version of the Composite International Diagnostic Interview 3.0 checklist of chronic medical disorders was used, in which the chronic medical disorders were reclassified into eight types of physical disorders. Chronic pain disorders included arthritis or rheumatism, back problems including disk or spine problems, and migraine headaches. RESULTS The lifetime prevalence estimates for arthritis, back pain and migraine in the Singapore general population were 6.0% (n=282), 7.0% (n=436) and 5.6% (n=446), respectively. After adjusting for sociodemographic factors, comorbid pain disorders and the presence of other chronic physical conditions, migraine remained significantly associated with major depressive disorder (adjusted OR=2.4), generalized anxiety disorder (adjusted OR=3.0) and alcohol use disorders (adjusted OR=2.1), while back pain was significantly associated with major depressive disorder (adjusted OR=2.0). CONCLUSIONS The significant association between pain and psychiatric disorders emphasizes the need to screen individuals with chronic pain conditions for psychiatric disorders, particularly depression. There is a need to develop integrated pharmacological and psychological treatments for both conditions.