Louisa Picco

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.

Quality of life in obsessive-compulsive disorder: impact of the disorder and of treatment.

Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder characterized by two distinct phenomena: obsessions which are recurrent, intrusive thoughts, images or impulses, and/or compulsions which are repetitive covert or overt actions that are carried out to decrease anxiety. OCD commonly affects young adults, is associated with other comorbid mental illnesses and often has a large treatment gap (the proportion of individuals who have OCD and require care but do not receive treatment). OCD thus runs a chronic and disabling course which compromises an individual’s functioning and well-being and ultimately has a rather detrimental impact on the lives of both patients and their families. Researchers and clinicians are increasingly paying attention to humanistic outcomes to encompass broader indicators of disease burden and outcome, one of which is quality of life (QoL). In this review, we provide a summary of the current knowledge of QoL in OCD, its socio-demographic and clinical correlates, and the effects of therapeutic interventions on QoL among those with OCD. Overall, studies indicate that those with OCD had diminished QoL across all domains relative to normative comparison subjects. Patients with OCD scored better on QoL domains than patients with major depressive disorder (MDD), whereas they showed no difference or scored worse than patients with schizophrenia. Although research on socio-demographic correlates of QoL in OCD is largely contradictory, most studies suggest that symptom severity and comorbid depression or depressive symptoms are predictors of decreased QoL in OCD, with numerous studies showing this association across multiple domains associated with QoL. Studies assessing QoL as an outcome of treatment have found an improvement in QoL in people with OCD after treatment with pharmacotherapy or cognitive behavioural therapy with some studies suggesting that this improvement in QoL is correlated with improvement in symptoms. A few studies have also evaluated other forms of treatment like partial hospitalisation programmes and deep brain stimulation for those with treatment-resistant OCD and found that QoL scores improve with treatment. A major gap in the field is the lack of instruments that measure QoL specifically in patients with OCD. It is evident that OCD affects specific domains and thus there is a pressing need for the development of multidimensional instruments that are reliable and valid. There is also a need for studies assessing QoL in individuals with OCD among both clinical and community samples with adequate sample size to examine socio-demographic and clinical correlates simultaneously. These populations ought to be followed longitudinally to examine QoL with the clinical course of the illness, and to help establish temporal relationships. Studies that examine improvements in QoL with treatment need to be designed carefully: sample size requirements should be met, raters must be blinded, and randomly assigning subjects to different arms would ensure that some of the inherent biases in open-label studies are avoided. QoL is an important component that measures the impact of OCD on an individual and QoL goals must be incorporated as an outcome measure of therapeutic interventions.

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.

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.

Attitudes Toward Seeking Professional Psychological Help: Factor Structure and Socio-Demographic Predictors

Attitudes toward seeking professional psychological help (ATSPPH) are complex. Help seeking preferences are influenced by various attitudinal and socio-demographic factors and can often result in unmet needs, treatment gaps, and delays in help-seeking. The aims of the current study were to explore the factor structure of the ATSPPH short form (-SF) scale and determine whether any significant socio-demographic differences exist in terms of help-seeking attitudes. Data were extracted from a population-based survey conducted among Singapore residents aged 18–65 years. Respondents provided socio-demographic information and were administered the ATSPPH-SF. Weighted mean and standard error of the mean were calculated for continuous variables, and frequencies and percentages for categorical variables. Confirmatory factor analysis and exploratory factor analysis were performed to establish the validity of the factor structure of the ATSPPH-SF scale. Multivariable linear regressions were conducted to examine predictors of each of the ATSPPH-SF factors. The factor analysis revealed that the ATSPPH-SF formed three distinct dimensions: “Openness to seeking professional help,” “Value in seeking professional help,” and “Preference to cope on ones own.” Multiple linear regression analyses showed that age, ethnicity, marital status, education, and income were significantly associated with the ATSPPH-SF factors. Population subgroups that were less open to or saw less value in seeking psychological help should be targeted via culturally appropriate education campaigns and tailored and supportive interventions.

Perspectives on Smoking Initiation and Maintenance: A Qualitative Exploration among Singapore Youth.

Studies among adolescents have shown that several important interpersonal, intrapersonal and environmental factors are associated with smoking behaviour. The current qualitative research project aimed to explore the determinants of smoking initiation and maintenance, from a youth perspective, among young people who smoked, living in a multi-ethnic Asian country. Focus group discussions (FGDs) were conducted with youths in Singapore in youth-friendly and accessible locations. Young people, from a variety of social contexts—varying on age, gender, ethnicity and educational level, were included in the study. All FGDs were conducted in English and participants were recruited using a mix of network and purposive sampling. All FGDs were audio recorded and transcribed verbatim. The data were analyzed using qualitative content analysis, allowing themes to emerge from the data with the goal of answering the research question. Ninety-one youth smokers (54 males, 37 females), aged between 14 to 29 years, participated in the study. The majority were males (59%) and of Chinese ethnicity (52%). Participants identified multiple personal, social, and familial influences on young adults’ smoking behaviors. Peer and family influences, as well as risk minimization, played a key role in smoking initiation and maintenance. While young people were aware of policies that restricted smoking, these did not directly affect their decision to start smoking. The theory of triadic influence provided a promising theoretical framework to understand smoking initiation and maintenance in a sample of young adult smokers from a multi-ethnic Asian country. It also provides actionable information for initiatives to prevent smoking in young people, which includes their perspectives and emphasizes an inclusive approach without stigmatizing those who smoke.

Qualitative study of Singaporean youths’ perception of antismoking campaigns: what works and what does not

Background Youths are more likely to rebel against messages perceived to inhibit their independence. In order for antismoking campaigns to be effective with this population, adopting evidence-based strategies is crucial. In this study, we examined youths’ reaction to past and ongoing antismoking campaigns, and delineate effective and ineffective components of campaigns as identified by them. Methods 12 focus group discussions were conducted with 91 youth smokers aged 15–29 years. Data were analysed using qualitative content analysis. A codebook was derived through an iterative process. The data were coded systematically by three coders, using Nvivo V.10. Results Fear appeals that had no immediate relevance to youths, and campaigns involving humour or sports/dance activities that distracted youths from the antismoking messages, were deemed ineffective. In contrast, elements identified to be efficacious were: positive tone, low-fear visual images, ‘low-controlling language’ and a genuine spokesperson. Youth tended to favour campaigns circulating on social media platforms. Importantly, youths voiced a lack of tangible support for their efforts to quit smoking. Conclusions Participants expressed a preference towards antismoking messages that were less authoritative, and perceived a distinct lack of support for their intentions to quit smoking. There is room for incorporating suggestions by participants in future antismoking campaigns. Future research is needed to identify barriers to accessing available support.

Attitudes to Mental Illness and Its Demographic Correlates among General Population in Singapore

Background Public attitudes to mental illness could influence how the public interact with, provide opportunities for, and help people with mental illness. Aims This study aims to explore the underlying factors of the Attitudes to Mental Illness questionnaire among the general population in Singapore and the socio-demographic correlates of each factor. Methods From March 2014 to April 2015, a nation-wide cross-sectional survey on mental health literacy with 3,006 participants was conducted in Singapore. Results Factor analysis revealed a 4-factor structure for the Attitudes to Mental Illness questionnaire among the Singapore general population, namely social distancing, tolerance/support for community care, social restrictiveness, and prejudice and misconception. Older age, male gender, lower education and socio-economic status were associated with more negative attitudes towards the mentally ill. Chinese showed more negative attitudes than Indians and Malays (except for prejudice and misconception). Conclusions There is a need for culture-specific interventions, and the associated factors identified in this study should be considered for future attitude campaigns.

Psychometric properties of the positive mental health instrument among people with mental disorders: a cross-sectional study.

BackgroundThe Positive Mental Health (PMH) instrument was developed and validated to assess the level of PMH and its six dimensions in a multi-ethnic general population sample. This cross-sectional study examines the psychometric properties of the instrument for assessing the level of PMH among help-seeking patients with mental disorders.MethodsThe PMH instrument was tested among 360 out-patients with schizophrenia, depression or anxiety spectrum disorders, seeking treatment at a tertiary psychiatric hospital and its affiliated clinics in Singapore. All participants completed the PMH instrument along with measures of life satisfaction, mental and overall health and happiness. Reliability (internal consistency), construct (Exploratory Structural Equation Modeling (ESEM)) and criterion (convergent and divergent) validity of the PMH instrument were tested in this population. Items were also tested for item response theory and differential item functioning (IRT-DIF).ResultsESEM on the PMH instrument showed good fit with the model reflecting six factors (general coping, personal growth and autonomy, spirituality, interpersonal skills, emotional support, and global affect). Internal consistency was high (Cronbach’s alpha >0.85) for the instrument and its six subscales. The PMH instrument fulfilled expected correlations with related constructs and demonstrated adequate item discrimination and difficulty estimates; however, significant DIF was noted for few items for age, gender and ethnicity groups.ConclusionsThe PMH instrument is a reliable and valid instrument for measuring PMH dimensions in patients with mental disorders. Further studies in larger samples are needed to assess the impact of DIF on PMH scores. The implications for the shift in focus from just the negative aspects of mental disorders to including positive components in the assessment of patients with mental disorders are immense, and can be applied in routine mental health practice and policy making.

Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults.

The present study examined the prevalence of frailty and its association with sociodemographic, clinical and social characteristics, and service utilization in a representative general population sample of Singaporean older adults.