The relationship between therapeutic alliance, frequency of consultation and uptake of telemedicine among patients seeking treatment for early psychosis: A moderated mediation model.

Background: Telehealth services ensure the delivery of healthcare services to a wider range of consumers through online platforms. Nonetheless, the acceptance and uptake of telehealth remain elusive. This study aims to understand the (a) uptake and (b) acceptability of telemedicine, (c) if therapeutic alliance mediates the relationship between the frequency of consultations with clinicians and the uptake of telemedicine in patients with early psychosis, and (d) role of education in moderating the relationship between therapeutic alliance and the uptake of telemedicine for their mental healthcare. Methods: A convenience sample of outpatients (n = 109) seeking treatment for early psychosis and their care providers (n = 106) were recruited from a tertiary psychiatric care centre. Sociodemographic and clinical characteristics, therapeutic alliance (Working Alliance Inventory), and telemedicine use were captured through self-administered surveys. The moderated mediation analysis was performed using PROCESS macro 3.4.1 with therapeutic alliance and level of education as the mediating and moderating factors, respectively. Results: The acceptance of telemedicine was high (possibly will use: 47.7%; definitely will use: 26.6%) whilst the uptake was low (11%). Therapeutic alliance mediated the relationship between the frequency of consultation and the uptake of telemedicine (ß: 0.326; CI: 0.042, 0.637). This effect was moderated by the level of education (ß: -0.058; p < 0.05). Conclusion: Therapeutic alliance mediates the relationship between the frequency of consultations and the uptake of telemedicine services with the level of education moderating this mediation. Focusing on the patients with lower education to improve their telemedicine knowledge and therapeutic alliance might increase the uptake.

The protective role of resilience and social support against burnout during the COVID-19 pandemic.

Background: The COVID-19 pandemic brought on a range of stressors in homes and workplaces. With no sign of ending after one year, burnout was a concern. Resilience has been known to shield against the effects of stress. While often thought of as an individual trait, previous studies have shown social support to improve resilience. The study aimed to examine the extent of burnout in the Singapore population and whether social support and resilience cushioned the impact of COVID-19 related stressors a year into the pandemic. Methods: Participants were 858 Singapore residents who participated in a larger study between October 2021 and September 2022. The Copenhagen Burnout Inventory provided Work-and Personal-related burnout scores. Multivariable linear regression was used to identify demographic variables associated with burnout. Path analysis revealed the associations between COVID-19 stressors, social support, resilience and burnout. Results: 22 and 19% of the sample reported work and personal burnout respectively, with younger adults being more burnt out than older adults. Higher stress was associated with higher burnout and higher social support was associated with lower burnout. Path analysis revealed that the relationship between social support and burnout was partially accounted for by increased resilience. Conclusion: Managing altered work arrangements, career expectations, and increased responsibilities at home may contribute to greater levels of burnout in the younger adults. Increased employer support and targeted interventions could mitigate the impact of these stressors. The study also highlighted the importance of maintaining social connections even while physically distancing.

Mediating effect of symptom severity on the relationship between aggression, impulsivity and quality of life outcomes among patients with schizophrenia and related psychoses.

Aims: Aggression and impulsivity among individuals with schizophrenia have been associated with poor clinical outcomes including worsening of symptoms and substance abuse which have been linked to a lower quality of life (QoL). The current study aimed to look at the mediating effect of symptom severity on the relationship between aggression, impulsivity and QoL among outpatients with schizophrenia and related psychoses in a multi-ethnic Asian population. Methods: Data (n = 397) were collected from outpatients seeking treatment at the Institute of Mental Health. The World Health Organization quality of life-BREF (WHOQOL-BREF) scale, the symptoms checklist-90 revised (SCL-90-R), Buss Perry aggression questionnaire (BPAQ), and the Barratt impulsiveness scales (BIS) were used to assess subjective well-being, symptom severity, aggression, and impulsivity, respectively. Mediation analysis was performed using the PROCESS macro to understand the mediating effect of symptom severity. Results: Motor impulsivity (MI) was indirectly associated with both the physical and psychological health domains of QoL while self-control was indirectly associated with the physical, psychological, and environmental health QoL domains through increased symptom severity. Conclusion: The significant indirect effect of symptom severity in our study highlights one potential pathway through which impulsivity impacts the QoL of individuals with schizophrenia and related psychoses. Elucidating other factors besides symptom severity that have an indirect effect on the QoL of individuals provides alternative approaches for treatment through which better clinical outcomes can be achieved.

Sociodemographic and psychosocial factors associated with vaccine hesitancy - results from a longitudinal study in Singapore.

Singapore has one of the highest COVID-19 vaccination rates, however identifying vaccine-hesitant sub-groups and their concerns is vital given the need for future boosters in vulnerable populations. Furthermore, vaccine hesitancy remains a concern in the event of an emergence of a newer strain that necessitates the rolling out of a new vaccination programme. The aims of this study were to establish the extent of COVID-19 vaccine hesitancy and the factors influencing it among adults in Singapore using the Vaccine Hesitancy Scale (VHS). The study used a longitudinal methodology and participants were recruited in two waves from May 2020 to Sep 2022. In all 858 participants agreed to participate in both waves of the study. The two-factor structure of the VHS scale as established in earlier studies was tested using confirmatory factor analysis. The results revealed a two-factor structure of VHS comprising "lack of confidence" and "risks". Those who had higher stress, resilience, and concerns that they might be infected with COVID-19 at wave 1 were significantly associated with lower 'lack of confidence' scores i.e. lower vaccine hesitancy. In comparison, those with higher concerns about inadequate government preventive measures and unemployment at wave 1 were significantly associated with higher 'lack of confidence' scores. Those with higher concerns about inadequate government preventive measures in wave 1 were significantly associated with higher 'risks' scores i.e. higher vaccine hesitancy. The findings point toward the need for a nuanced messaging that considers the fears expressed by the populace and addresses them directly using clear simple language.

Needs of patients with early psychosis: A comparison of patient's and mental health care provider's perception.

Background: Needs define the capacity of a patient to benefit from health care services and a systematic assessment of needs allows planning and delivery of effective treatment to suit patients. This study aimed to understand the (a) needs felt by patients and those perceived by the care providers (CPs), (b) agreement between patients and CPs in the identified needs and (c) factors associated with unmet needs. Methods: Participants (N = 215) were recruited through convenience sampling from the Early Psychosis Intervention Programme (EPIP). Data was captured from patients and CPs using the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS). Results: Patients and CPs identified an average of 4.06 and 3.84 needs, respectively. The highest number of unmet needs were identified for the social (50% of patients and CPs) and health domains (31.13% of patients' vs. 28.30% of CPs). Company, intimate relationships, psychotic symptoms, money, sexual expression and psychological distress, information and benefits were the unmet needs identified by patients, whereas company, intimate relationships, physical health, and daytime activities were identified by CPs. The concordance between patients and CPs was low with majority of the items scoring slight to fair agreement (Cohen's kappa = 0-0.4). Older age, depression, severe anxiety and having Obsessive-Compulsive Disorder (OCD) were positively associated with unmet needs in patients. Conclusion: While there was an overall consensus on the total needs and met needs between patients and CPs, the level of agreement between the two groups on various items were low. Different perceptions regarding unmet needs were noted between the groups. A holistic approach that takes into account different facets of the needs of patients together with strategic planning to address unmet needs might improve treatment outcomes and satisfaction.

Chronic Pain: Among Tertiary Care Psychiatric Out-Patients in Singapore-Prevalence and Associations with Psychiatric Disorders.

Objective: The study aimed to determine the prevalence and severity of chronic pain and its associations amongst psychiatric out-patients in a tertiary care hospital in Singapore. Methodology. The cross-sectional study was conducted among 290 psychiatric out-patients aged 21-65 years. Sociodemographic and clinical information, as well as data from Brief Pain Inventory-Short Form (BPI-sf), Beck's Depression Inventory II (BDI-II), and Beck's Anxiety Inventory (BAI) were collected. Cut points (C.P.s) dividing the sample into mild, moderate, and severe groups were created for the ratings of average pain. Eight possible cut-off values for the C.P.s between 3 and 7, representing 8 different categorical variables, were created and their relationships were examined with BPI's set of seven interference items using multivariate analysis of variance. Sociodemographic and clinical correlates of chronic pain were determined using multinomial logistic regression analysis. Analysis of covariance was used to determine the association of BPI with continuous scores of BAI and BDI. Results: Based on the C.P. pain severity classification, 38.5% of the sample had mild pain, 22.9% had moderate pain, and 11.8% had severe pain. Patients with severe pain were more likely to be associated with older age (p ≤ 0.006) (versus young age), less likely to be married (p ≤ 0.025) (versus single), and more likely to have high risk for obesity (p ≤ 0.030) (versus low risk for obesity). Participants with mild pain were seen to be significantly associated with older age (p ≤ 0.021), whereas moderate pain (p ≤ 0.002) and severe pain (p ≤ 0.001) (versus no pain) were seen to be significantly associated with higher BAI scores. Conclusion: The current study observed high prevalence of pain among patients with psychiatric illness that was determined by optimal C.P.s for mild, moderate, and severe pain. Patients diagnosed with anxiety disorders and those with higher BMI were seen to be associated with pain of moderate to severe intensity. Improving the knowledge of correlates and co-morbidities of physical pain would aid in early identification, use of prophylactic strategies, and the intervention techniques to formulate basic guidelines for pain management among psychiatric population.

Prevalence and Correlates of Physical Comorbidities in Alcohol Use Disorder (AUD): a Pilot Study in Treatment-Seeking Population.

This study aimed to understand the prevalence of physical comorbidities, undiagnosed and inadequately controlled chronic physical conditions and correlates of high cholesterol, hypertension and liver enzyme abnormalities in those with alcohol use disorder (AUD). Participants (n = 101) with AUD were recruited from a tertiary care centre through convenient sampling. The prevalence of physical and psychiatric comorbidities in the sample was 83.17% and 51.49%, respectively. Around 53.47% had two or more chronic physical conditions (multimorbidity). Hypertension (44.55%), asthma (23.76%), high cholesterol (22.77%) and liver enzyme abnormalities (21.78%) were the top four physical comorbidities. The prevalence of undiagnosed and inadequately controlled chronic physical conditions was 61.4% and 32.7%, respectively. Gender, education and body mass index (BMI) were associated with hyperlipidaemia while age and education were associated with hypertension. Higher waist-hip ratio was associated with liver enzyme abnormalities. Routine clinical care must include regular screening and follow-up of the risk groups to monitor their physical and mental health.

Employer and Co-worker Perspectives on Hiring and Working with People with Mental Health Conditions.

The purpose of this study was to understand perspectives towards hiring and working with people with mental health conditions (PMHC). Semi-structured interviews with 25 employers and 20 co-workers were carried out. Thematic analysis was used to analyse the data. The barriers to hiring and working with PMHC identified through the interviews were concerns about safety, incompetence, PMHC not being able to get along with others, requiring more training and supervision as well as medical costs and reputational risks to the hiring organisation. Employers and co-workers suggested that improving mental health literacy of staff, pairing the PMHC with trained work buddies, having access to mental professionals when needed, and providing incentives for hiring PMHC such as tax rebates are likely to improve attitudes towards hiring and working with PMHC. Their suggestions for the additional supports required should be considered when developing initiatives to promote inclusivity of PMHC in workplaces.

Employment of young people with mental health conditions: making it work.

PURPOSE: The current study was undertaken to understand and describe the meaning of work as well as the barriers and facilitators perceived by young people with mental health conditions for gaining and maintaining employment. MATERIALS AND METHODS: Employing a purposive and maximum variation sampling, 30 young people were recruited and interviewed. The respondents were Singapore residents with a mean age of 26.8 years (SD = 4.5, range 20-34 years); the majority were males (56.7%), of Chinese ethnicity (63.3%), and employed (73.3%), at the time of the interview. Verbatim transcripts were analysed using inductive thematic analysis. RESULTS: Three global themes emerged from the analyses of the narratives, which included (i) the meaning of employment, (ii) barriers to employment comprising individual, interpersonal and systemic difficulties and challenges participants faced while seeking and sustaining employment and (iii) facilitators of employment that consisted of individual and interpersonal factors that had helped the young persons to gain and maintain employment. CONCLUSIONS: Stigma and discrimination emerged as one of the most frequently mentioned employment barriers. These barriers are not insurmountable and can be overcome both through legislation as well as through the training and support of young people with mental health conditions.IMPLICATIONS FOR REHABILITATIONEmployment offers several benefits to people with mental health conditions, including improvement in economic status, self-efficacy, and empowerment.Stigma is a significant barrier to employment for young people with mental health conditions; remaining optimistic about career prospects and getting support from peers is vital to employment success.Disclosure of the mental health condition at the place of work is beneficial to the person's own recovery and helpful to others; however, young people must be empowered to choose when and what they want to disclose and under what circumstances.Families help young people with mental health conditions in achieving their employment goals by offering emotional and instrumental support, as well as motivating them to accomplish more.

Depressive symptoms and health-related quality of life in a heterogeneous psychiatric sample: conditional indirect effects of pain severity and interference.

BACKGROUND: Few studies have examined clinically relevant mechanisms that underlie the association between two important indices of recovery- depression severity and health-related quality of life (HRQOL) in psychiatric outpatients. This study aimed to explicate the roles of pain interference and pain severity as mediating and moderating mechanisms in the relationship between depressive symptoms and HRQOL. METHODS: Data from 290 outpatients diagnosed with schizophrenia (n = 102), depressive (n = 98), and anxiety (n = 90) disorders were examined. Participants completed a set of questionnaires that queried their sociodemographic statuses, current pain severity and interference levels, depression severity levels, and HRQOL. Subsequently, mediation and moderation analyses were conducted. RESULTS: Analyses revealed that pain interference fully mediated the relationship between depressive symptoms and physical (34% of the total effect) but not mental HRQOL. At high pain levels (+ 1 SD from mean), depressive symptoms may interfere with physical quality of life through pain interference, but this was not present at low pain levels (- 1 SD from mean). CONCLUSIONS: Prolonged pain symptoms could negatively influence psychiatric recovery beyond the physical aspect of HRQOL. These results thus imply a need to detect and manage severe physical pain complaints at the acute stage in psychiatric outpatients.

Negative affect moderates the link between body image dissatisfaction and disordered eating among psychiatric outpatients in a multi-ethnic Asian setting.

INTRODUCTION: Few studies have investigated the factors that affect the relationship between body image dissatisfaction and disordered eating locally. Our study aimed to investigate the moderating effects of depression and anxiety levels on the body dissatisfaction-disordered eating link in Singapore. METHODS: A total of 329 participants completed a set of questionnaires that included various scales pertaining to eating behaviours, body image, psychological distress and quality of life. RESULTS: Participants were diagnosed with schizophrenia (47.4%), depression (46.8%) and substance use disorders (5.8%). Moderation analyses revealed that depression (F [9, 251] = 18.50, p < 0.001, R2 change = 0.021) and anxiety levels (F [9, 268] = 19.54, p < 0.001, R2 change = 0.014) were significant moderators of the relationship between body dissatisfaction and disordered eating scores. Subsequent multivariate linear logistic regression analyses showed that high disordered eating scores were significantly associated with lower physical (F [8, 273] = 9.59, R2 = 0.22, p < 0.001, ß = -0.27, p < 0.001), psychological (F [8, 273] = 10.51, R2 = 0.49, p < 0.001, ß = -0.27, p < 0.001), social (F [8, 256] = 6.78, R2 = 0.18, p < 0.001, ß = -0.18, p = 0.004) and environment (F [8, 273] = 5.29, R2 = 0.13, p < 0.001, ß = -0.19, p = 0.001) quality of life scores after controlling for sociodemographic covariates. CONCLUSION: Greater effort should be dedicated to the screening of disordered eating behaviours in psychiatric outpatients presenting with greater psychological distress.

Roles, Facilitators and Challenges of Employment Support Specialists Assisting Young People with Mental Health Conditions.

Purpose The present study aimed to understand the roles, effective strategies and facilitators, and challenges of employment support specialists (ESS) in assisting young people with mental health conditions (MHCs) gain and sustain employment in Singapore. Methods An interpretative qualitative design using an inductive approach was adopted for this study. Using a semi-structured interview guide, in-depth interviews were conducted with twenty ESS employed with mental health service providers or other community-based centers. Verbatim transcripts of the interviews were thematically analyzed using inductive methods. ESS were broadly classified as "any professionals providing employment-related support to people with MHCs". Results Majority of the ESS were employed at a tertiary psychiatric institute. Participants included vocational and occupational specialists, case managers and other clinical professionals. Three key themes emerged from the data: (i) descriptions of roles undertaken by the ESS depicting a wide range of services and requisite skillsets; (ii) facilitators that benefit young people with MHCs' in terms of job placement, for example, ESS' attitudes and attributes, and their clients' disposition; and (iii) challenges that deter effective job placements, such as factors pertaining to the ESS themselves, their clients, and clients' employers. Under this theme, ESS also proposed ways to improve employment opportunities of people with MHCs. Conclusions This study provided insight into a range of tasks performed and challenges faced by ESS in Singapore while assisting their clients. There is a need to address ESS' challenges and expectations in order to enhance their efficiency and aid reintegration of young people with MHCs into the workforce and the society.

Association between sleep quality and domains of quality of life amongst patients with first episode psychosis.

BACKGROUND: There is a lack of studies exploring associations between sleep and quality of life (QOL) among patients with schizophrenia who have limited exposure to antipsychotics and are in the early stage of their illness. Our study investigates the association of poor sleep quality and its components with domains of QOL amongst patients with first episode psychosis (FEP). METHODS: Data was utilized from a longitudinal study that examined sleep, smoking and alcohol use amongst patients with FEP who were enrolled in the Early Psychosis Intervention Programme (EPIP). The data were collected during the patients' baseline visit; i.e., within 3 months of admission into the EPIP. The Pittsburgh Sleep Quality Index (PSQI) was employed to examine sleep quality and its 7 components over the last month. The WHO quality of life-BREF was used to examine QOL and its 4 domains: physical health, psychological, social relationship, and environment. Clinical data such as Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores were obtained from a clinical data base. Linear regression analyses were conducted to investigate the association between poor sleep quality and the domains of QOL. RESULTS: Amongst the 280 recruited patients, 62.9% suffered from poor sleep quality. Poor sleep quality was associated with significantly lower scores in all domains of QOL, despite controlling for socio-demographics and clinical variables. Respondents with higher scores in subjective sleep quality and daytime dysfunction were associated with lower scores in the physical health and social relationship domain. Furthermore, respondents with higher scores in subjective sleep quality, sleep latency and daytime dysfunction were associated with lower scores in the psychological domain of QOL. Finally, respondents with higher scores in subjective sleep quality were associated with lower scores in the environment domain of QOL. CONCLUSIONS: Our findings highlight the importance of monitoring sleep quality amongst patients with FEP to improve their QOL. Clinical programmes should also pay more attention to sleep components in order to maintain satisfactory QOL amongst patients with FEP. Future interventions should focus on improving the relevant sleep components to ensure better treatment outcomes.

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

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.

The Relative Associations of Body Image Dissatisfaction among Psychiatric Out-Patients in Singapore.

Background: Adults with body image dissatisfaction (BID) are more likely to be depressed, anxious, and suicidal when compared to those without intense dissatisfaction over their appearance. The current study aimed to estimate the prevalence and factors associated with BID among out-patients with mental illness in Singapore. Methods: Data was collected from 310 psychiatric out-patients using a self-administered questionnaire. Measurements used were socio-demographic characteristics, Body Mass Index scores, Body Shape Questionnaire, Binge Eating Scale, Eating Attitudes Test, Beck's Depression Inventory, Beck's Anxiety Inventory and Alcohol Use Disorders Identification Test. Results: A prevalence of 30.9% of BID was established among psychiatric out-patients in Singapore. Being female, having higher BMI scores, binge eating behavior, eating disorders, and those diagnosed with depression were positively associated with BID. Conclusion: BID is prevalent among those with psychiatric illnesses which could lead to a higher degree of psychological distress and the emergence of eating disorders.

Hazardous alcohol use in a sample of first episode psychosis patients in Singapore.

BACKGROUND: Hazardous alcohol use has often been found to be more prevalent amongst psychiatric outpatients than the general population. Additionally, it has also been associated with poorer outcomes. The study aimed to investigate (1) the prevalence and (2) socio-demographic and clinical correlates of hazardous alcohol use, as well as (3) the relationship between hazardous alcohol use and quality of life in an outpatient sample with First Episode Psychosis (FEP) in Singapore. METHODS: Baseline data (N = 280) was extracted from a longitudinal study investigating smoking and alcohol use amongst outpatients with FEP in a psychiatric hospital. Information on socio-demographics, hazardous alcohol use, and quality of life was collected through a self-report survey. Hazardous alcohol use was ascertained by total scores of 8 or higher on the Alcohol Use Disorders Identification Test (AUDIT). Data was analysed using logistic regression and linear regression analyses. RESULTS: The prevalence of hazardous alcohol use over the past 12-month period was 12.9%. Those who had never smoked in their lifetime (vs current smokers) and those with a diagnosis of brief psychotic disorder (vs schizophrenia spectrum disorders) were found to have significantly lower odds of hazardous alcohol use. Hazardous alcohol use was also associated with lower negative symptom scores. Lastly, hazardous alcohol use was found to significantly predict lower scores on the physical health, social relationship and environment domains of quality of life. CONCLUSIONS: The association between hazardous alcohol use and lower negative symptom scores is a surprising finding that needs to be further explored. The significant impact of hazardous alcohol use in reductions in quality of life suggests that early screening and interventions could benefit patients with hazardous alcohol use and comorbid psychosis.

Trends in Subjective Quality of Life Among Patients With First Episode Psychosis-A 1 Year Longitudinal Study.

Quality of life (QoL) is often used as an outcome assessment in programs treating patients with first-episode psychosis (FEP). The aim of this study was to examine the longitudinal trend of subjective QoL among patients with FEP and identify the potential influence of patients' social-demographic/lifestyle factors on the trend of QoL. Two hundred and eighty subjects participated in the study. Patient's demographics and subjective QoL were collected at baseline, 6 months and 1 year follow-up. Data were analyzed with a fixed-effect general linear regression model. Subjective QoL demonstrated significant trends of improvement in all four subdomains (physical health, psychological health, social relationships, and environment). Compared with unemployed participants, employed participants were significantly associated with better social relationships (p = 0.005) and environment (p = 0.029) after adjusting for age and gender. Moderation analysis demonstrated a significant improvement of physical health, social relationships, and environment for participants with a higher level of educational achievement, but not for participants with a lower level of educational achievement. Our results indicate that patients with FEP experienced significant improvement in subjective QoL over a 1 year period. Being employed was associated with overall better social relationships and environment among patients with FEP and higher educational achievement was associated with improvement of physical health, social relationship, and environment. Hence, educational achievement and employment could be considered for future optimization of early psychosis intervention programs.

Motivations to quit smoking and challenges faced during cessation among individuals with first episode psychosis in Singapore.

AIMS: The prevalence of smoking has been noted to be higher among individuals with mental illness, particularly among those with schizophrenia and related psychosis than in the general population. The present paper sought to examine the motivations and challenges to quit smoking among first episode psychosis patients (N = 281) enrolled in the Early Psychosis Intervention Programme (EPIP) in Singapore. METHODS: Questionnaires were used to collect details on an individual's smoking status, cessation attempts, motivations to quit, and challenges to stop smoking. Using baseline data, multiple linear regressions were conducted to examine the socio-demographic correlates of motivations and challenges of smoking cessation behaviour. RESULTS: Of the study sample, 59.4% reported to have never smoked while 39.9% were currently smoking or had attempted smoking. Health reasons and cost were the most highly endorsed motivations to stop smoking; whereas cravings, stress, and boredom were highly endorsed as challenges to stop smoking. Socio-demographic factors such as age, educational level, and marital status were also found to be associated with the motivations to stop smoking and challenges faced during smoking cessation. CONCLUSIONS: The present study highlights the most highly endorsed motivations and challenges reported among individuals with first episode psychosis (FEP) in an Asian population. Given that the literature examining motivations and challenges to quit smoking has predominantly focused on the general population, results from the current study have implications for the formulation of smoking cessation programmes targeted at individuals with mental illness, particularly those with FEP.