Sherilyn Chang

Providing care to relatives with mental illness: reactions and distress among primary informal caregivers

BackgroundThe responsibility of caring for relatives with mental illness often falls on the family members. It has been reported that the reactions to or consequences of providing care are what rendered the role of a caregiver challenging and hence a source of distress. This present study thus aimed to identify socio-demographic correlates of caregiving experiences using the Caregiver Reaction Assessment (CRA) and to examine the associations between reactions to caregiving and psychological distress.MethodsA total of 350 caregivers with relatives seeking outpatient care at a tertiary psychiatric hospital were recruited for this study. Distress among caregivers was assessed using the Patient Health Questionnaire (PHQ-9). The CRA was administered to measure reactions from caregiving in four domains including impact on schedule and health (ISH), impact on finance (IF), lack of family support (LFS) and caregiver esteem (CE). Participants also completed a questionnaire that asked for their socio-demographic information. Multivariable linear regression analysis was first used with domains of CRA as outcome variables and socio-demographic variables as predictors in the models. The next set of multivariable linear regression analysis tested for the association between CRA domains and distress with CRA domain scores as outcome variables and PHQ-9 score as predictor, controlling for socio-demographic variables.ResultsSocio-demographic correlates of CRA domains identified were age, education, employment, income and ethnicity. Domain scores of CRA were significantly associated with PHQ-9 score even after controlling for socio-demographic variables. A higher distress score was associated with greater impact felt in the domain of ISH (β = 0.080, P < 0.001), IF (β = 0.064, P < 0.001), and LFS (β = 0.057, P < 0.001), and was associated with lower CE domain scores (β = −0.021, P < 0.05).ConclusionThis study identified several socio-demographic correlates of caregiving reaction in the different domains. Each of these domains was found to be significantly associated with caregiver distress. Higher distress was associated with stronger impact on the negative domains and a lower impact in the positive domain of caregiving reaction. Interventions such as educational programs at the caregiver level, and also promoting wider social care support in these domains may help to address caregiver distress.

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.

Positive mental health among health professionals working at a psychiatric hospital

Background Positive mental health (PMH) is a combination of emotional, psychological and social well-being that is necessary for an individual to be mentally healthy. The current study aims to examine the socio-demographic differences of PMH among mental health professionals and to explore the association between job satisfaction and total PMH. Methods Doctors, nurses and allied health staff (n = 462) completed the online survey which included the multidimensional 47-item PMH instrument as well as a single item job satisfaction question. Associations of PMH with job satisfaction were investigated via linear regression models. Results Significant differences in PMH total and domain specific scores were observed across socio-demographic characteristics. Age and ethnicity were significantly correlated with PMH total scores as well as various domain scores, while gender, marital and residency status and the staff’s position were only significantly correlated with domain specific scores. Job satisfaction was also found to be a significantly associated with total PMH. Conclusion The workplace is a key environment that affects the mental health and well-being of working adults. In order to promote and foster PMH, workplaces need to consider the importance of psychosocial well-being and the wellness of staff whilst providing an environment that supports and maintains overall health and work efficiency.

Exploration of illness perception among patients with mental illness in a multi-ethnic Asian sample

Illness perceptions are beliefs that patients have about their illness. These beliefs play an important role in influencing their behaviour and outcomes. This study examined the factor structure and correlates of the Illness Perception Questionnaire Mental Health (IPQ-MH) among patients with mental illness in a multi-ethnic Asian sample. 400 participants with schizophrenia and other psychotic disorders, mood or anxiety disorder were recruited from a tertiary psychiatric institution and administered the IPQ-MH. Data on sociodemographic variables were also collected. A multi-factor structure was identified for the Identity, Structure and Cause subscale of the IPQ-MH. Age was consistently associated with a positive perception of illness across all three disorders; women had a more positive perception of schizophrenia and other psychotic disorders as compared to men while those of Indian ethnicity had a more negative perception of their mood disorder as compared to those of Chinese ethnicity. Those with lower education had a poorer understanding of their illness among those with mood disorder, and a poorer understanding of their illness and the effectiveness of treatment among those with anxiety disorder. The study identified specific groups which can be targeted through tailored and culturally relevant psychoeducational interventions to enhance their understanding and perception of mental illness.

Affiliate stigma and its association with quality of life among caregivers of relatives with mental illness in Singapore

Affiliated stigma often refers to internalized stigma among family members of stigmatized individuals. This study aimed to investigate the relationship between affiliate stigma and quality of life (QOL) among primary caregivers of individuals with mental illness undergoing treatment at the Institute of Mental Health, Singapore. Three hundred and fifty caregivers were recruited for the study. The World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Family Stigma Scale (FSS) were administered to the primary caregivers of patients with mental illness. Multiple linear regression analyses were conducted to investigate the association of affiliate stigma with QOL. A high proportion of caregivers of individuals with mental illness experience affiliate stigma in Singapore. All four QOL domains were significantly associated with affiliate stigma. These findings entail that it is imperative to improve publics perception of those with mental illness to reduce stigmatization and thus improve caregivers QOL.

Sleep beliefs and attitudes and the association with insomnia among psychiatric outpatients

Abstract Background: While it has been demonstrated that dysfunctional sleep beliefs can contribute to sleep disturbances, less is known about it in psychiatric patients and the role these beliefs play in influencing sleep. Aims: To examine maladaptive sleep cognition among psychiatric patients and to assess its association with insomnia. Method: Participants were outpatients (n = 400) recruited from a tertiary psychiatric hospital. The Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) scale was administered to examine sleep-related cognitions in different domains. Clinical insomnia was assessed using the Insomnia Severity Index. Factors associated with DBAS were explored using linear regression and the association between DBAS scores and insomnia was tested using logistic regression. Results: Among psychiatric patients, factors associated with the DBAS domains were ethnicity, educational attainment, psychiatric comorbidity, and consumption of sleep medication. Higher dysfunctional sleep beliefs were associated with insomnia. The association was particularly prominent in the mood disorder diagnostic group. Conclusions: Dysfunctional sleep beliefs were associated with insomnia among psychiatric patients. Addressing these maladaptive cognitions is critical in alleviating sleep problems in psychiatric patients.

Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore

Background: Pathways to care studies in Singapore are of high interest given the cultural diversity and various sources of help available for those with mental illnesses, ranging from the more traditional to tertiary-level mental health care services. Aim: The current study aimed to explore the associations of patients’ socio-demographic characteristics with pathways to first contact and duration of untreated mental illness. Method: A total of 402 participants were recruited through convenience sampling. A pathway to care form was used to gather systematic information about the sources of care utilized by participants before approaching a mental health professional. Data were analysed using multinomial logistic regression and multiple linear regression models to assess the associations. Results: Majority of participants reported primary care (36.0%) as their first point of contact, followed by non-formal sources of help (33.8%), specialist care (21.8%), police/court (4.0%), websites/media (3.3%) and religious/traditional treatment (1.3%). Those belonging to Malay and Indian ethnicity (vs Chinese) were more likely to make first contact with non-formal sources of help than primary care. Those who received a diagnosis of any mood or anxiety disorder (vs schizophrenia and related psychoses) were less likely to make first contact with specialist care or non-formal sources of help than primary care. Those who were separated/divorced/widowed were significantly associated with higher duration of untreated illness compared to those who were single. Participants whose family/relative initiated the first contact were significantly associated with a shorter duration of untreated illness compared to those who initiated first contact on their own. Conclusion: Findings suggest the determinants of the pathways to first contact and duration of untreated illness included diagnosis, ethnicity, marital status and family initiating the first contact. The pathways adopted by these participants need to be kept in mind for planning mental health programmes.

Attitudes to mental illness among mental health professionals in Singapore and comparisons with the general population

Background Similar to the general public, mental health professionals sometimes also have negative attitudes towards individuals with mental illness; which could ultimately affect the quality of care received by the patients. This study aims to explore attitudes to mental illness among mental health professionals in Singapore; make comparisons with the general population; and investigate the significant correlates. Methods A cross-sectional design was used. Eligible participants were recruited from the Institute of Mental Health, Singapore. Attitudes to mental illness among the mental health professionals were measured using an adapted 26-item Attitudes to Mental Illness questionnaire (AMI). An earlier study amongst the general population in Singapore had used the same tool; however, factor analysis suggested a 20-item, 4-factor structure (AMI-SG) was the best fit. This 4-factor structure was applied among the current sample of mental health professionals to allow comparisons between the professionals and the general population. Data were collected through an online survey tool ‘Questionpro’ from February to April 2016, and 379 participants were included in the current analysis. Attitudes to mental illness among these professionals were compared to those of the general population, which were captured as part of a national study conducted from March 2014 to April 2015. Results The 20-item, 4-factor structure AMI-SG derived from the general population was applicable among the mental health professionals in Singapore. Compared to the general population, mental health professionals had significantly more positive attitudes to mental illness; however their scores on ‘social distancing’ did not differ from the general population. Indian ethnicity was negatively associated with ‘social distancing’ and ‘social restrictiveness’ among the professionals; while higher education was negatively related to ‘prejudice and misconception’. Compared to nurses, doctors showed significantly more positive attitudes on ‘social restrictiveness’ and ‘prejudice and misconception’. Having family or close friends diagnosed with mental illness was negatively associated with ‘social distancing’ among the professionals. Conclusion The AMI-SG is an effective tool to measure attitudes to mental illness among mental health professionals in Singapore. Although the professionals had significantly more positive attitudes to mental illness than the general public in Singapore, their attitudes on ‘social distancing’ resembled closely that of the general public. Professionals tended to have more negative attitudes if they were nurses, less educated, and of Chinese ethnicity. More studies are needed to explore the underlying reasons for the differences and to generalize these findings among mental health professionals elsewhere.

Head circumference, leg length and its association with dementia among older adult population in Singapore

Head circumference and leg length serve as reliable proxy indicators of early‐life environment. Research studies have shown that these anthropometric measurements are associated with cognitive impairment and dementia among older adults. The aim of the present study was to assess the associations between dementia with head circumference and leg length among the older adult population in Singapore. This study also aimed to examine the sociodemographic correlates of these anthropometric measurements.

Treatment preferences and help-seeking behaviors for sleep problems among psychiatric outpatients

OBJECTIVE To understand treatment preferences and help-seeking behaviors among psychiatric patients for their sleep problems, and to examine determinants of problem recognition and help-seeking among patients with sleep difficulties. METHOD A cross-sectional survey was conducted among psychiatric outpatients in Singapore (n=400). Participants completed questionnaires that assessed their sleep quality, daytime fatigue, help-seeking behavior, treatment preferences for sleep problems, and sociodemographic information. Multiple logistic regressions were used to identify correlates of patients who recognized their sleep difficulties and of those who had sought help. RESULTS Mental health professionals were the most preferred choice (60.8%) for consultation on sleep problems. Among patients with poor sleep quality (n=275), 28.4% denied having any problems and 38.9% had not sought help. Patients with chronic physical comorbidity were less likely to recognize their sleep problems (OR=0.432, p-value=0.009), while those with psychiatric comorbidity were twice as likely to perceive the problems (OR=2.094, p-value=0.021) and to seek help (OR=1.957, p-value=0.022). Daytime fatigue was associated with higher odds of problem recognition (OR=1.106, p-value=0.001) and help-seeking (OR=1.064, p-value=0.016). CONCLUSION A considerable number of patients did not perceive their poor sleep as an issue and had not sought help for it. General sleep hygiene education is needed for psychiatric patients.