Validation of the World Health Organization Disability Assessment Schedule 2.0 among older adults in an Asian country

INTRODUCTION@#As populations age globally and the burden of chronic illnesses increases, valid measures of disability are needed for assessment in the older adult population. The aim of the current analysis was to explore the psychometric properties and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an epidemiological survey of older adults in Singapore.@*METHODS@#The study comprised secondary data analysis of the Well-being of the Singapore Elderly study. Inclusion criteria for the study were Singapore residents (Singapore citizens and permanent residents) aged 60 years and above. The 12-item interviewer-administered version of the WHODAS 2.0 was used to assess disability in the study. Data on cognition, health status and sociodemographic information were collected. Depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy.@*RESULTS@#The study found a one-factor model solution for WHODAS 2.0 with a high internal consistency of all items. The internal consistency for the overall scale was 0.92. The WHODAS 2.0 score positively correlated with multimorbidity, perceived overall health status, depression and subsyndromal depression. There was a significant inverse association between the WHODAS 2.0 score and the cognitive status. After adjustment for all sociodemographic variables in the multiple linear regression analysis, these measures remained significantly associated with the WHODAS 2.0 score.@*CONCLUSION@#WHODAS 2.0 was found to be a valid measure of disability among older adults. However, further research is required to determine its usefulness as a responsive instrument that can detect change following interventions.

Successful ageing in Singapore: prevalence and correlates from a national survey of older adults

INTRODUCTION@#The current study aimed to estimate the overall prevalence and sociodemographic correlates of successful ageing, as defined by Rowe and Kahn, among a national sample of multiethnic adults aged 60 years and older in Singapore.@*METHODS@#Data from older adults who participated in the Well-being of the Singapore Elderly study was analysed. Successful ageing was defined with five indicators: no major diseases; no disability; high cognitive functioning; high physical functioning; and active engagement with life.@*RESULTS@#The prevalence of successful ageing was 25.4% in this older population. Older adults aged 75-84 years and ≥ 85 years had 0.3 times and 0.1 times the odds of successful ageing, respectively, than those aged 60-74 years. Compared to older adults of Chinese ethnicity, those of Malay (odds ratio [OR] 0.6) and Indian (OR 0.5) ethnicities were less likely to be associated with successful ageing. Older adults with lower education levels, who had no formal education (OR 0.2), some schooling but did not complete primary education (OR 0.4) or only primary education (OR 0.5), had lower odds of ageing successfully than those with tertiary education.@*CONCLUSION@#Older adults in Singapore tend to have much more active engagement with life as compared to their counterparts from other countries. Further research into this population is needed, both in terms of qualitative research to gain a better understanding of successful ageing from the older adult's perspective, as well as longitudinal studies that explore behavioural determinants of successful ageing.

Predictors of General Functioning and Correlates of Quality of Life: A Cross-Sectional Study among Psychiatric Outpatients

<p><b>INTRODUCTION</b>Functioning and quality of life (QOL) are negatively impacted as a result of mental illness. This study aimed to determine the: i) socio-demographic and clinical correlates of functioning and; ii) associations between functioning and QOL in a multiethnic sample of psychiatric outpatients.</p><p><b>MATERIALS AND METHODS</b>This was a cross-sectional study of outpatients receiving treatment from a tertiary psychiatric hospital. Functioning was assessed using the Global Assessment of Functioning (GAF) scale, while QOL was measured using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) which comprises 4 domains: physical health, psychological health, social relationships and environment.</p><p><b>RESULTS</b>Various socio-demographic and clinical correlates were associated with functioning including employment and marital status, education and diagnosis. Depression was the only clinical characteristic which negatively correlated with functioning (= 0.035). Amongst the whole sample, multiple linear regressions revealed that functioning was positively associated with all 4 QOL domains (physical health [<0.001], psychological health [<0.001], social relationships [<0.001] and environment [<0.001]). Further analysis of each diagnostic group revealed that functioning was positively associated with all 4 QOL domains in the anxiety, depression and obsessive compulsive disorder subsamples, while in the schizophrenia subsample, functioning was only significantly associated with all environment domain.</p><p><b>CONCLUSION</b>Functional impairments were associated with different socio-demographic and clinical characteristics, which should be addressed when planning tailored treatment and interventions. Given that functioning is significantly associated with QOL, it is crucial to regularly assess and monitor them (in addition to symptomatic outcomes and adopting a more holistic and biopsychosocial approach).</p>

A Qualitative Study Of Perceptions Of E-Cigarettes Among Youth Smokers And Parents Of Youth In Singapore

@#Objective: Electronic cigarettes (e-cigarettes) are increasingly used globally and the implications of their smoking are being debated. The aim of this study is to identify awareness, use and perceptions of e-cigarettes among young smokers and parents of youths in Singapore. Methods: A total of 12 focus group discussions (FGDs) were conducted among youths (aged 15-29 years) who smoke and parents of youths, from diverse social contexts. Participants were recruited using a mix of network and purposive sampling. Youth FGDs were conducted in English language while the parent FGDs were conducted in Chinese and English language. FGDs were audio recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results: Awareness about e-cigarettes was perceived more among youth as compared to parents in terms of structure, mechanism and use of the device. Parents considered e-cigarettes to be a healthy substitute for conventional smoking. However, youth expressed the failure of e-cigarettes to provide satiety level same as conventional cigarette smoking. Participants endorsed e-cigarettes as a tool for smoking cessation. Conclusion: It was evident from the study that though there was knowledge of e-cigarettes, both parents and youths were ill- informed about them, owing to varied and inconsistent information on e-cigarettes along with its legal implications in Singapore. Future research is required to assess safety and efficacy of e-cigarettes as well as the association of their use with smoking cessation.

Comorbid Diabetes and Depression among Older Adults - Prevalence, Correlates, Disability and Healthcare Utilisation

<p><b>INTRODUCTION</b>The objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation.</p><p><b>MATERIALS AND METHODS</b>Data for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM.</p><p><b>RESULTS</b>DM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed.</p><p><b>CONCLUSION</b>Given the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.</p>

Gender differences in major depressive disorder: findings from the Singapore Mental Health Study

<p><b>INTRODUCTION</b>Major depressive disorder (MDD) is one of the most common psychiatric disorders worldwide and has been associated with various sociodemographic risk factors, including age, gender and ethnicity. The present study aimed to establish whether gender-specific differences relating to the prevalence and correlates of MDD exist in the Singapore adult resident population.</p><p><b>METHODS</b>The Singapore Mental Health Study was a population-based, cross-sectional epidemiological study among Singapore citizens and permanent residents aged 18 years and above. Face-to-face interviews were completed with 6,616 respondents between December 2009 and December 2010. Psychiatric conditions were established using version 3.0 of the World Health Organization Composite International Diagnostic Interview (CIDI). In addition, data relating to chronic medical conditions was captured using a modified version of the CIDI checklist for chronic medical conditions.</p><p><b>RESULTS</b>The lifetime prevalence of MDD was higher among women (7.2%) than men (4.3%). MDD was more prevalent among men and women who were divorced/separated and widowed women, as compared to those who were single. Among men, MDD was more prevalent among Indian and other ethnicities as compared to Chinese. Of the 417 respondents with MDD, women had significantly higher odds of having generalised anxiety disorder but lower odds of having high blood pressure, as compared to men.</p><p><b>CONCLUSION</b>The study highlighted key gender-specific correlates of MDD. Given the comorbidities associated with MDD and other psychiatric disorders and/or physical illnesses, these correlates pose additional challenges for care providers.</p>

Prevalence of Depression among Older Adults-Results from the Well-being of the Singapore Elderly Study

<p><b>INTRODUCTION</b>Depression is a significant public health issue across all sociodemographic groups and is identified as a common and serious mental health problem particularly among the older adult population. The aims of the current study were to determine the prevalence of depression and subsyndromal depression among older adults in Singapore.</p><p><b>MATERIALS AND METHODS</b>The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. Stage 1 Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) depression syndrome was used for this analysis. Association of depression and subsyndromal depression with sociodemographic characteristics, social support as well as comorbidity with chronic physical illnesses and quality of life was assessed.</p><p><b>RESULTS</b>The prevalence of GMS-AGECAT depression and subsyndromal depression was 3.7% and 13.4%, respectively. The odds of depression were significantly higher among those aged 75 to 84 (2.1) as compared to those aged 60 to 74 years and in those who had a history of depression diagnosis by a doctor (4.1). The odds of depression were higher among those of Indian and Malay ethnicities (5.2 and 3.2 times, respectively) as compared to those of Chinese ethnicity. Those with depression and subsyndromal depression were associated with more disability, poorer life satisfaction, and medical comorbidities.</p><p><b>CONCLUSION</b>Our study suggests that the prevalence of depression seems to have decreased as compared to a decade ago wherein the prevalence of depression was estimated to be 5.5%. This positive trend can be ascribed to concerted efforts across various disciplines and sectors, which need to be continually strengthened, monitored and evaluated.</p>

Prevalence and Correlates of Internet Gaming Problem among Internet Users: Results from an Internet Survey

<p><b>INTRODUCTION</b>The current study aimed to establish the prevalence of internet gaming disorder (IGD) and its association with demographic characteristics, game genre, game use (time spent on gaming), as well as psychological distress, social phobia and well-being among current online gamers in Singapore.</p><p><b>MATERIALS AND METHODS</b>A total of 1251 participants aged 13 to 40 years completed the study which was administered as a web survey. The online questionnaire was designed using QuestionPro, and consisted of 8 sections and 105 questions. The 9-item Internet Gaming Disorder Questionnaire was used to establish the prevalence of IGD in the study. A series of logistic regression models were used to examine the associations between IGD, demographic characteristics and game genre, as well as IGD and psychological distress, social phobia and well-being.</p><p><b>RESULTS</b>The prevalence of IGD established using a cutoff of 5 among those who were current online gamers was 17.7%. Multiple logistic regressions revealed that those meeting criteria of IGD were more likely to be older, reported an earlier age of onset of playing online games, had primary and secondary education versus tertiary education, were currently students versus being currently employed and played massively multiplayer online role-playing games. Distress and social anxiety were higher while satisfaction with life was significantly lower among those who met criteria for IGD than those who did not meet the criteria.</p><p><b>CONCLUSION</b>The prevalence of IGD and its negative consequences in our sample of current online gamers was significant and point towards the need for further clinical studies and innovative interventions to address the problem.</p>

Disability in Singapore's Elderly Population

<p><b>INTRODUCTION</b>Disability increases an individual's dependence and negatively impacts their physical, mental, and social functioning. The current study aims to establish the prevalence and risk factors of disability in Singapore's population.</p><p><b>MATERIALS AND METHODS</b>Data was extracted from the Well-being of the Singapore Elderly (WiSE) study. This cross-sectional study recruited participants aged 60 years and above (n = 2421) who were representative of Singapore's multiethnic population. We used the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 to assess the severity of disability in our sample while establishing its associations and correlations with cognitive levels, sociodemographic variables, and chronic illness.</p><p><b>RESULTS</b>Cognitive deficits, old age, female gender, Malay and Indian ethnicity, lack of education, retired or homemaker status, presence of chronic illness (specifically stroke, heart problems, depression, and dementia) were found to be significantly associated with disability in Singapore's elderly population. As hypothesised, participants with deficits in cognition were more likely to indicate higher WHODAS scores.</p><p><b>CONCLUSION</b>The findings highlighted specific factors associated with disability in this multiethnic population. The identification of these factors would lead the way to the development of appropriate interventions.</p>

Screening for Drinking Problems in the Elderly in Singapore Using the CAGE Questionnaire

<p><b>INTRODUCTION</b>Given that past research on drinking problems has focused primarily on younger samples, the present study sought to examine the prevalence and correlates of alcohol use among the elderly in Singapore.</p><p><b>MATERIALS AND METHODS</b>Data were extracted from the Well-being of the Singapore Elderly (WiSE) study, a cross-sectional, epidemiological survey conducted among a nationally representative sample of Singapore residents (n = 2565) aged 60 years and above. Variables assessed include drinking problems, depression and anxiety symptoms, obesity, smoking status, chronic physical disorders and disability.</p><p><b>RESULTS</b>The weighted prevalence of drinking problems (CAGE score ≥2) in our sample was 4.2%. Male sex, Indian ethnicity, and being divorced or separated were associated with a significantly higher likelihood of drinking problems. Participants with drinking problems were also more likely to have subthreshold depression. There were no significant differences in disability among those with drinking problems, those without drinking problems and non-drinkers, after adjusting for demographic variables.</p><p><b>CONCLUSION</b>Our findings contribute to the body of research that indicates an association between drinking problems and depressive symptoms among the elderly. Thus, screening for depressive symptoms in the elderly with drinking problems may be useful in identifying such comorbidities in order to aid treatment planning.</p>

Prevalence and Risk Factors of Caregiver Dependence among Older Adults in a Southeast Asian Population

<p><b>INTRODUCTION</b>Currently very little is known about the prevalence or magnitude of caregiver dependence in Singapore and thus, there is a need to fill this gap in this multiethnic ageing population. This study aims to determine the prevalence and risk factors of caregiver dependence among older adults in Singapore.</p><p><b>MATERIALS AND METHODS</b>Data were used from the Well-being of the Singapore Elderly (WiSE) study, a nationally representative, cross-sectional survey among Singapore residents aged 60 years and above. Caregiver dependence was ascertained by asking the informant (the person who knows the older person best) a series of open-ended questions about the older person's care needs.</p><p><b>RESULTS</b>The older adult sample comprised 57.1% females and the majority were aged 60 to 74 years (74.8%), while 19.5% were 75 to 84 years, and 5.7% were 85 years and above. The prevalence of caregiver dependence was 17.2% among older adults. Significant sociodemographic risk factors of caregiver dependence included older age (75 to 84 years, and 85 years and above,<0.001), Malay and Indian ethnicity (<0.001), those who have never been married (= 0.048) or have no education (= 0.035), as well as being homemakers or retired (<0.001). After adjusting for sociodemographic variables and all health conditions in multiple logistic regression analyses, dementia (<0.001), depression (= 0.011), stroke (= 0.002), eyesight problems (= 0.003), persistent cough (= 0.016), paralysis (<0.001), asthma (= 0.016) and cancer (= 0.026) were significantly associated with caregiver dependence.</p><p><b>CONCLUSION</b>Various sociodemographic and health-related conditions were significantly associated with caregiver dependence. Dependent older adults will put greater demands on health and social services, resulting in greater healthcare expenditures. Hence, effective planning, services and support are crucial to meet the needs of dependent older adults and their caregivers.</p>

Prevalence of Chronic Mental and Physical Disorders, Impact on Work Productivity and Correlates of Alcohol Use Disorders and Nicotine Dependence across Occupations

<p><b>INTRODUCTION</b>This study assessed occupational differences in the prevalence of mental and physical disorders in an employed general population sample in Singapore and investigated the impact of these disorders on work productivity losses in terms of work-loss days and work-cutback days. The association of occupation with alcohol use disorders (AUD) and nicotine dependence (ND) was also investigated.</p><p><b>MATERIALS AND METHODS</b>Data from a population-based mental health survey of a representative sample of multi-ethnic residents aged 18 years and above were used. The World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI) was administered to establish the lifetime diagnosis of key mental disorders. Self-report on sociodemographic characteristics, productivity loss, ND, and lifetime physical conditions were obtained. Nine occupational groups were included in this analysis.</p><p><b>RESULTS</b>The sample comprised 4361 participants with a mean (SD) age of 42.2 (11.9) years, ranging between 19 to 80 years. 'Associate professionals and technicians' (26.2%), 'Services and sales workers' (17.7%) and 'Professionals' (15.4%) were the 3 predominant occupational categories. Sociodemographic characteristics differed significantly across occupations (P <0.001). The lifetime prevalences of having 'any mental disorder' and 'any physical disorder' were 13.0% and 37.9%, respectively; major depressive disorder was the most prevalent mental disorder (5.9%) and hypertension was the most common physical disorder (15.6%). There were no significant differences in work productivity loss across occupations. Sociodemographic and occupational correlates for AUD and ND were identified.</p><p><b>CONCLUSION</b>Sociodemographic and health disparities exist in the major occupational categories in Singapore. The strength of the associations between occupation and AUD and ND are significant, indicating the need for preventative measures in select occupations.</p>

Suicidal ideation, suicidal plan and suicidal attempts among those with major depressive disorder

<p><b>INTRODUCTION</b>The aims of the study were to identify the prevalence and sociodemographic and clinical correlates of suicidal behaviours using data from a cross-sectional survey among those with major depressive disorder (MDD) in Singapore.</p><p><b>MATERIALS AND METHODS</b>The Singapore Mental Health Study (SMHS) was a cross-sectional epidemiological study that surveyed Singapore residents (Singapore citizens and permanent residents) aged 18 years and above. The assessment of mental disorders was established using version 3.0 of the Composite International Diagnostic Interview (CIDI 3.0). For the purposes of this study, suicidal behaviour was assessed by questions which were asked to respondents who answered positively to the screening questions in the CIDI 3.0 "Depression" module.</p><p><b>RESULTS</b>The prevalence of suicidal ideation, plan and attempt among those with lifetime MDD was 43.6%, 13.7% and 12.3%, respectively. We found that suicidal ideation, plan and attempt were significantly associated with ethnicity, education and income. The rate of those who had sought some professional help was higher among those with suicidal plan (71.7%) and attempt (72.3%) as compared to those with suicidal ideation (48.7%) and those with MDD but no suicidal behaviour (29%).</p><p><b>CONCLUSION</b>Individuals with MDD and suicidal behaviour do differ from their non-suicidal counterparts as they have a different sociodemographic and clinical profile. There is a need for more research and a better understanding of this population which in turn could lead to the development and implementation of relevant interventions.</p>

Hoarding in an Asian population: prevalence, correlates, disability and quality of life

<p><b>INTRODUCTION</b>Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value. The objectives of the study were to establish the prevalence of hoarding behaviour among the general population and among individuals with obsessive-compulsive disorder (OCD) in a cross-sectional study conducted in Singapore.</p><p><b>MATERIALS AND METHODS</b>The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older, living in households. The diagnoses of mental disorders were established using Version 3.0 of Composite International Diagnostic Interview (CIDI 3.0). Differences between 3 groups i.e. those diagnosed with lifetime/12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) OCD with hoarding, those diagnosed with lifetime/12-month DSM-IV OCD without hoarding and those with lifetime hoarding behaviour without diagnosis of DSM-IV OCD were determined.</p><p><b>RESULTS</b>The weighted prevalence of lifetime hoarding behaviour was 2% and that of hoarding among those with OCD was 22.6%. Those who met the criteria for hoarding behaviour alone were associated with lower odds of having obsessions of contamination, harming, ordering as well as compulsions of ordering and other compulsions than those who met criteria for both OCD and hoarding.</p><p><b>CONCLUSION</b>Hoarders without OCD were less impaired, in terms of comorbid psychopathology, than those with OCD with and without hoarding, and had a higher quality of life versus those with both OCD and hoarding, though still lower than that of the general population.</p>

Socio-demographic Correlates of Positive Mental Health and Differences by Depression and Anxiety in an Asian Community Sample

<p><b>INTRODUCTION</b>Positive Mental Health (PMH) instrument is a self-administered multidimensional measure that is validated in the adult multi-ethnic Asian population in Singapore and comprises General Coping (GC), Emotional Support (ES), Spirituality, Interpersonal Skills (IS), Personal Growth and Autonomy (PGA) and Global Affect (GA) domains. This paper aimed to (i) examine socio-demographic differences and identify correlates for the total PMH and domain-specific scores in the sample, and (ii) compare the PMH total score for respondents with and without depression or anxiety.</p><p><b>MATERIALS AND METHODS</b>Singapore residents aged 21 to 65 years, of Chinese, Malay or Indian ethnicity and residing in households across Singapore (n = 404) completed the 47-item PMH instrument in an anonymous survey. Socio-demographic information was obtained during the survey and respondents also completed the Patient Health Questionnaire (PHQ)-8 and Generalised Anxiety Disorder (GAD)-7 scale to establish depression and anxiety. Descriptive analyses were conducted to examine for differences in PMH scores by socio-demographic groups and between those with and without depression and anxiety.</p><p><b>RESULTS</b>The total PMH score was significantly different across ethnicity and marital status in the bivariate analysis. After multivariate analysis, ethnicity remained a significant correlate for total PMH and the 6 domain-specific PMH scores, marital status correlated with Spirituality, educational level was associated with IS; while gender was associated with ES and PGA. Significantly lower PMH total scores were observed for those with depression and anxiety as compared to those without.</p><p><b>CONCLUSION</b>Socio-demographic correlates of PMH were identified in an Asian community sample. PMH scores were significantly lower among those with depression and anxiety.</p>

Smoking and nicotine dependence in Singapore: findings from a cross-sectional epidemiological study

<p><b>INTRODUCTION</b>Smoking is one of the leading preventable causes of death throughout the world and can lead to nicotine dependence, particularly when initiated at a young age. This paper describes the prevalence of smoking and nicotine dependence in the adult Singapore resident population, whilst also exploring rates among the major ethnic groups (Chinese, Malay and Indian), different education levels and those with chronic psychiatric and physical comorbidities.</p><p><b>MATERIAL AND METHODS</b>The Singapore Mental Health Study (SMHS) is a cross-sectional epidemiological study that was conducted between December 2009 and December 2010. Information on smoking status was assessed using the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) and the Fagerstrom Test for Nicotine Dependence measured nicotine dependence. Socio-demographic information was also collected.</p><p><b>RESULTS</b>In total, 6616 respondents participated in the SMHS giving a response rate of 75.9%. We found that 16% of the population were current smokers and 4.5% had nicotine dependence. Current smokers were more likely to be younger (18 to 34 years old), males, Malay and have lower education, whilst males had a 4.6 times higher risk of nicotine dependence to that of females. The prevalence of nicotine dependence was also higher in those with alcohol abuse and those experiencing chronic pain.</p><p><b>CONCLUSION</b>The results from this study highlight the important differences in the prevalence of smoking and nicotine dependence among different age groups, gender and ethnicity in Singapore and are important for developing future health policies and targeted preventive strategies.</p>