Problematic smartphone use and mental health outcomes among Singapore residents: The health and lifestyle survey.

BACKGROUND: The excessive use of smartphones and its association with adverse outcomes has been widely reported, with several studies showing an association between smartphone overuse, depression, anxiety, and sleep-related problems. METHODS: The study used data from the Health and Lifestyle Survey, a nationwide population survey. It examined the prevalence of Problematic Smartphone Use (PSU) and its association with mental health outcomes among Singapore residents aged 15-65 years. PARTICIPANTS: Participants were assessed for PSU using the Smartphone Addiction Scale-Short Version, psychological distress with the Patient Health Questionnaire-9, and Generalised Anxiety Disorder -7 questionnaire, sleep problems using the Insomnia Severity Index, and positive mental health with Rapid Positive Mental Health Instrument. RESULTS: In all, 6509 participants completed the survey, giving a survey response rate of 73.2 %. The prevalence of PSU was 30.2 % in the population. Individuals with PSU were more likely to have symptoms of moderate or severe depression (OR: 3.2, 95 % CI: 2.4-4.4), anxiety (OR: 3.4, 95 % CI: 2.4-4.8), insomnia (OR: 3.4, 95 % CI: 2.8-4.2), and poorer positive mental health (ß: -0.3, 95 % CI: -0.4 to -0.2). CONCLUSIONS: The study is the first to examine PSU in a national sample of Singaporeans across a wide age range. It provides valuable insights into mental health comorbidities among those with PSU, which is useful for practitioners.

Evaluating a mobile-based intervention to promote the mental health of informal dementia caregivers in Singapore: Study protocol for a pilot two-armed randomised controlled trial.

BACKGROUND: Informal caregivers of persons with dementia (PWD) often suffer adverse impacts on their mental health and require interventions for effective support. As they are often occupied with providing care, web-based interventions could be more convenient and efficient for them. However, there is currently a dearth of evidence-based mobile interventions to enhance the mental well-being of dementia caregivers locally, especially ones that are user-centered and culturally relevant. Hence, having designed an app based on feedback from local dementia caregivers, this study will evaluate the effectiveness of this mobile app in promoting the mental health of informal caregivers of PWD in Singapore. METHODS: A pilot two-armed randomised controlled trial will be conducted on 60 informal caregivers of PWD recruited via convenience and snowball sampling. Thirty participants will be assigned to the intervention group, while another 30 will be in a waiting-list control group. Questionnaires will be administered at baseline and one month after, with the primary outcome being the difference in the change of depressive symptoms among the two groups. STATISTICAL ANALYSIS: Primary analyses will follow the intention-to-treat principle and compare changes from baseline to the one-month follow-up time point relative to the control group. A repeated measures ANOVA will be conducted to examine differences between the groups over time. SIGNIFICANCE: To our knowledge, this is the first study in Singapore that seeks to promote the mental health of informal dementia caregivers through a mobile-based intervention. The findings can inform the development and evaluation of future evidence-based digital interventions for local informal caregivers of PWD to address the gap in availability of such resources for them. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05551533). Registration date: September 22, 2022.

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.

Barriers to using eHealth/mHealth platforms and perceived beneficial eHealth/mHealth platform features among informal carers of persons living with dementia: a qualitative study.

BACKGROUND: New technologies have brought about a new age of technology-enabled aids that can equip informal carers with the relevant resources for better care. These include but are not limited to facilitating access to healthcare providers, knowledge of caring for persons living with dementia, and sources of support for carers' well-being. This qualitative study explores barriers to using eHealth/mHealth platforms and perceived beneficial eHealth/mHealth platform features among informal carers of persons living with dementia. METHODS: An exploratory qualitative study design was employed. Semi-structured interviews were conducted among 29 informal carers of persons living with dementia in Singapore recruited via convenience and snowball sampling. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. RESULTS: The participants in this study identified several barriers to using eHealth/mHealth platforms, including personal preference, apprehension, poor user experience and lack of skills. On the other hand, knowledge of dementia, caring for persons living with dementia and self-care, a list of resources, social support, location monitoring and alert systems, and the ability to manage appointments and transactions were valuable features for eHealth/mHealth platforms. CONCLUSIONS: Despite the underutilisation of eHealth/mHealth platforms, carers expressed a keen interest in using them if they are functional and capable of reducing their care burden. The findings from this study can contribute to developing content and features for eHealth/mHealth interventions aimed at lightening carers' burden in their day-to-day caring routine.

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.

Positive aspects of caregiving among informal caregivers of persons with dementia in the Asian context: a qualitative study.

BACKGROUND: Positive aspects of caregiving are important coping resources for informal caregivers of persons with dementia (PWD). However, existing studies mostly focused on caregivers from western societies and less attention was paid to the potential cultural differences. This study aims to explore positive aspects of caregiving in the Asian context. METHODS: A qualitative methodology with semi-structured interviews was adopted. A total of 29 informal caregivers of PWD in Singapore were interviewed from Apr 2019 to Dec 2020. All the interviews were audio-recorded and transcribed verbatim for the analysis. Inductive thematic analysis was conducted. RESULTS: The results revealed a total of three major themes with 11 sub-themes including: 1) positive aspects within self (i.e., better understanding of dementia and caregiving, personal growth, role satisfaction, and improved awareness of self-care); 2) positive aspects between caregiver and PWD (i.e., chance to demonstrate filial piety towards PWD, happiness and positive attitudes of PWD, positive interactions with PWD, and closer relationships with PWD); and 3) positive aspects between caregiver and others (i.e., empathy towards other caregivers, befriending peers, and sharing dementia and caregiving knowledge with others). DISCUSSION: Findings from this study improved our understanding on positive aspects of caregiving among informal caregivers of PWD in the Asian context. In addition to similar themes across cultures such as personal growth, our study identified a few unique themes like improved awareness of self-care and chances to demonstrate filial piety. For future studies targeting Asian caregivers, it is necessary to include these cultural-specific positive aspects of caregiving.

A qualitative study on negative experiences of social media use and harm reduction strategies among youths in a multi-ethnic Asian society.

PURPOSE: This study aimed to expand and inform the emerging body of research on the negative experiences of social media use among youths and how youths deal with them, in an Asian setting, using a qualitative approach. METHODS: Data were collected using 11 focus group discussions (FGDs) and 25 semi-structured interviews (SIs) among youths aged 15 to 24 years residing in Singapore who were recruited via purposive sampling. Data were analysed using thematic analysis. RESULTS: The salient negative effects mentioned by participants include the development of negative reactions and feelings from upward comparisons with others (e.g., others' achievements and lifestyle), receiving hurtful comments, exposure to controversial content (e.g., political events and social movements), as well as the perpetuation of negative feelings, behaviours, and sentiments (e.g., rumination, unhealthy eating behaviour, and self-harm). Participants also described strategies which they have employed or deemed to be useful in mitigating the negative effects of social media use. These include filtering content and users, taking breaks from social media, cognitive reframing, and self-affirmation, where they identify and change stress-inducing patterns of thinking by setting realistic social, physical, and lifestyle expectations for themselves, and focusing on self-development. CONCLUSION: The current results highlight that while youths experience negative effects of social media use, they have high media literacy and have employed strategies that appear to mitigate the negative effects of social media use. The findings can inform various stakeholders involved in helping youths navigate the harms of social media use or provide directions for intervention studies aimed at reducing the harms of social media use.

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.

The factor structure of the Barratt Impulsiveness Scale (BIS-11) and correlates of impulsivity among outpatients with schizophrenia and other psychotic disorders in Singapore.

BACKGROUND: Impulsivity has been linked to risky behaviours amongst patients with schizophrenia or other psychotic disorders. However, there is a dearth of studies examining impulsivity amongst this population in Singapore. Moreover, to date, scales to measure impulsivity have not been validated in this population. The present study seeks to examine the underlying factor structure of the Barratt Impulsiveness Scale (BIS-11) and explore sociodemographic and clinical correlates of impulsivity within this group. METHODS: Confirmatory factor analyses (CFA) were conducted to test factor structures of the BIS-11 proposed in extant literature. However, due to poor fit statistics, the sample (n = 397) was split into two groups, with Exploratory Factor Analyses (EFA) conducted in the first subgroup (n = 200). The final model of the EFA was then tested within the second subgroup (n = 197) with CFA. Multivariable linear regressions were conducted to examine sociodemographic and clinical correlates of each underlying factor. RESULTS: CFA indicated a three-factor structure amongst 16-items of the BIS-11 with acceptable fit: i) Non-planning impulsivity (5-items; α = 0.94), ii) Motor impulsiveness (6-items α = 0.84), and iii) Lack of self-control (5-items, α = 0.85). Lower education was associated with higher non-planning impulsivity. While age, ethnicity, marital status, and general psychiatric symptom severity were significant correlates of motor impulsiveness, problematic alcohol use and general psychiatric symptom severity were related to a greater lack of self-control. CONCLUSION: Factor structures of the BIS-11 suggested by extant literature were not applicable, and we propose an alternative factor structure for BIS-11. Significant correlates of impulsivity are highlighted, and avenues for future research are suggested.

The impact of having foreign domestic workers on informal caregivers of persons with dementia - findings from a multi-method research in Singapore.

BACKGROUND: Informal caregivers of persons with dementia (PWDs) sometimes engage foreign domestic workers (FDWs) to support their caregiving journey. However, there has not been much research to establish if this is really beneficial. The current study aims to investigate whether engaging FDWs specifically for caregiving of PWDs truly moderates caregiver stress and to explore caregivers' experiences of engaging FDWs. METHODS: A multi-method study design with a quantitative and qualitative sub-study was adopted. For the quantitative sub-study, 282 informal caregivers of PWDs were recruited. Propensity score matching analysis was used. For the qualitative sub-study, 15 informal caregivers with FDWs were interviewed. Inductive thematic analysis was conducted. RESULTS: The quantitative sub-study confirmed that engaging FDWs did moderate the depressive symptoms of informal dementia caregivers (marginal effect = -3.35, p = 0.0497). However, such support did not affect their caregiving burden, self-efficacy, and perceived positive aspects of caregiving. The qualitative sub-study suggested that engaging FDWs is an ambivalent experience, which entails both support and challenges. CONCLUSIONS: The current study confirmed previous research findings, that engaging FDWs moderated depressive symptoms among caregivers of PWDs, and it could be through their physical support such as in daily caregiving activities. Policy-makers may consider providing more subsidies to caregivers caring for PWDs with mobility issues to hire FDWs. They may also consider providing training to FDWs on dementia caregiving skills and improving the intake of such training as this might be helpful for both FDWs and caregivers during this journey.

Social Media-Driven Routes to Positive Mental Health Among Youth: Qualitative Enquiry and Concept Mapping Study.

BACKGROUND: Social media influence almost every aspect of our lives by facilitating instant many-to-many communication and self-expression. Recent research suggests strong negative and positive impacts of social media exposure on youth mental health; however, there has been more emphasis on harmful relationships. OBJECTIVE: Given the limited research on the benefits of social media for mental health, this qualitative study explored the lived experiences of youth to understand how social media use can contribute to positive mental health among youth. METHODS: Using an interpretivist epistemological approach, 25 semistructured interviews and 11 focus group discussions were conducted with male and female youth of different ethnicities (aged 15 to 24 years) residing in Singapore, who were recruited through purposive sampling from the community. We conducted inductive thematic analysis and concept mapping to address the research aims. RESULTS: We found that youth engaged in a wide range of activities on social media from connecting with family and friends to participating in global movements, and these served as avenues for building positive mental health. Based on participants' narratives, our analysis suggested that positive mental health among youth could be influenced by 3 features of social media consumption (connection with friends and their global community, engagement with social media content, and the value of social media as an outlet for expression). Through these, pathways leading to the following 5 positive mental health components were identified: (1) positive relationships and social capital, (2) self-concept, (3) coping, (4) happiness, and (5) other relevant aspects of mental health (for example, positivity and personal growth). CONCLUSIONS: The study results highlight the integral role of social media in the lives of today's youth and indicate that they can offer opportunities for positive influence, personal expression, and social support, thus contributing to positive mental health among youth. The findings of our research can be applied to optimize engagement with youth through social media and enhance the digital modes of mental health promotion.

Perceived mental illness stigma among family and friends of young people with depression and its role in help-seeking: a qualitative inquiry.

BACKGROUND: Depressive disorders are a serious public health concern. Left untreated, further clinical distress and impairment in important life domains may arise. Yet, the treatment gap remains large. Prior research has shown that individuals with depressive disorders prefer seeking help from informal sources such as family and friends ahead of formal sources. However, this preference has its disadvantages such as experiencing actual, perceived and internalized stigmatizing responses from them which may delay or deter help-seeking. This paper aimed to determine the role of perceived stigma among family and friends in an individual's help-seeking behavior. METHODS: Data were collected using semi-structured interviews with patients with depressive disorders from a tertiary psychiatric hospital in Singapore to capture individuals' self-reported experience with depression and stigmatization among family and friends. Interviews were audio recorded and transcribed verbatim. Data of 33 young adults (mean age = 26 years, SD =4.6; 18 female, 15 male) were analyzed using thematic analysis. RESULTS: In all, four broad themes were developed: (1) absence of support, (2) provision of unhelpful support, (3) preference for non-disclosure, and (4) opposition towards formal help-seeking. Lack of awareness of depression and perpetuation of stigma manifests as barriers towards help-seeking in the form of absence of support and provision of unhelpful support which subsequently leads to a preference for non-disclosure, as well as opposition by family and friends towards formal help-seeking. CONCLUSIONS: Data from this study can contribute to the development of public health programs aimed at improving awareness and support from family and friends and facilitating earlier help-seeking among young people with depressive disorders.

Problematic Drug Use Among Outpatients With Schizophrenia and Related Psychoses.

Background: Problematic drug use is common among psychiatric patients and is linked with poorer course and outcomes of illness. The aim of this study is to assess the prevalence of problematic drug use, and to explore its sociodemographic correlates and associations with health behaviors and outcomes among outpatients with schizophrenia and related psychoses in Singapore. Methods: Data from 397 individuals who were aged 21-65 years and were seeking treatment for schizophrenia and related psychoses in the outpatient clinics of a tertiary psychiatric hospital were analyzed. The Drug Abuse Screening Test (DAST-10) was used to assess problematic drug use. Information on sociodemographics, smoking status, alcohol use, symptoms severity and quality of life were collected. Multivariable logistic regressions were conducted to explore correlates and associations of problematic drug use. Results: The prevalence of problematic drug use was 5.8% (n = 23) in the sample, and 10.6% (n = 42) of the participants reported having problematic drug use and/or problematic alcohol use. More males than females reported having problematic drug use (p = 0.021), and also problematic drug and/or alcohol use (p = 0.004). Significant associations were observed between problematic drug use and smokers with nicotine dependence, and with physical health domain of quality of life. Individuals with greater symptom severity were approximately twice as likely to have problematic drug use and/or alcohol use. Conclusion: While the prevalence of problematic drug use in this sample population is relatively lower compared to other countries, there is a considerable number who might be at risk. Routine screening and close monitoring of drug use is recommended as part of psychiatric assessment, particularly among males and patients with nicotine dependence.

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.

Mapping the steps to reach psychiatric care in Singapore: An examination of services utilized and reasons for seeking help.

OBJECTIVE: The aim of this study is to shed light on the types of services utilized and map the steps taken by patients in their pathways to receiving psychiatric care in Singapore. METHODS: Participants were outpatients who were recruited from a psychiatric tertiary hospital (n = 323). Pathways to psychiatric care form was administered to collect information on sources of care utilized, reasons for seeking help and the time point of each contact made. Pathways taken by patients to reach psychiatric care were mapped, and reasons for seeking help were reviewed and analyzed. Quantile regression was conducted to explore association between sociodemographic and clinical factors with duration between onset of problem and receiving psychiatric care. RESULTS: The need to manage symptoms was most commonly endorsed by participants as the reason that first prompted them to seek help. Prior to receiving psychiatric care, participants on average obtained services from 1.2 other care providers and the main pathway to psychiatric services was via primary care and community services (37.2%). The median duration between onset of problem and receiving psychiatric care was 6 months, and age was found to be significantly associated with shorter median duration (ß = -0.172, p = 0.009). CONCLUSIONS: Patients often consult different care providers prior to obtaining psychiatric services and contact was made more frequently via primary care and community care providers. Findings from this study reiterate the need for engaging community partners to render timely and relevant support for individuals with mental health issues.

Analysis and Interpretation of Metaphors: Exploring Young Adults' Subjective Experiences With Depression.

The aim of this study was to provide a cross-cultural exploration of how young adults with depression use metaphors to describe their illness experiences. Data were collected in semi-structured interviews, designed to capture rich and detailed descriptions of participants' firsthand narrative experiences of depression and how they make sense of depression. Thirty-three participant interview data were analyzed, using a combination of deductive and inductive approaches. The analysis resulted in extracting five major themes with sub-themes, which detail the diversity and vividness of metaphorical expressions embedded in participants' accounts and produce insights and a richer picture of the depression experience. Metaphors play a pivotal role in providing a rich resource that young adults rely on, to construct meaningful accounts about their illness. This highlights the importance of a metaphor-enriched perspective in research as well as in clinical practice, particularly in a multicultural health care setting.

Prevalence and Correlates of Social Stigma Toward Diabetes: Results From a Nationwide- Survey in Singapore.

Aims: To examine the extent of social stigma toward diabetes among Singapore's multi-ethnic general population and determine whether this differs across socio-demographic sub-groups. Methods: Data for this study came from a nationwide cross-sectional study. A diabetes stigma questionnaire comprising Social Distance Scale and Negative Attitudes and Stereotyping Scale was administered to those respondents who had not been diagnosed with diabetes. Exploratory factor analysis was conducted to determine the dimensionality of the instruments and validated using confirmatory factor analysis. Multiple linear regression analysis was conducted to examine associations between socio-demographic factors and measures of diabetes stigma. Results: In all, 2,895 participants were recruited from the general population giving a response rate of 66.2%. Factor analyses found that a one-factor model resulted in an acceptable fit for both stigma scales, which measured social distance and negative attitudes and stereotyping, respectively. Multiple linear regression analyses identified Indian ethnicity (vs. Chinese), higher personal income (≥SGD2000 vs. < SGD 2000) and having close friends or family members who had been diagnosed with diabetes to be significantly associated with lower social distance scores while those aged 50-64 years and those with secondary and vocational education (vs. degree and above) were significantly associated with higher social distance scores. Those with a personal income of SG$2,000-3,999 and SGD $6,000 and above, and those with close friends or family members diagnosed with diabetes were significantly associated with lower negative attitudes and stereotyping scores. In contrast those aged 35 years and above, those with primary education and below, and those of Malay ethnicity were significantly associated with higher negative attitudes and stereotyping scores. Conclusions: The study found a relatively low level of stigma toward diabetes in the general population of Singapore, although some stigmatizing beliefs emerged. While greater knowledge of diabetes could reduce stigma, anti-stigma messaging should be incorporated into the "War on Diabetes" programme in Singapore.

A reduced state of being: The role of culture in illness perceptions of young adults diagnosed with depressive disorders in Singapore.

Illness perceptions form a key part of common-sense models which are used widely to explain variations in patient behaviours in healthcare. Despite the pervasiveness of depressive disorders worldwide and in young adults, illness perceptions of depressive disorders have not yet been well understood. Moreover, while a high proportion of cases of depressive disorders reside in South-east Asia, few have explored illness perceptions that are culturally relevant to this region. To address these limitations, this study aimed to understand illness perceptions of young adults diagnosed with depressive disorders. Face-to-face semi-structured interviews were conducted among Chinese, Malay, and Indian young adults aged 20 to 35 years old, who were seeking treatment at a psychiatric hospital. Data reached saturation after 33 interviews (10 to 12 interviews per ethnic group) and five themes emerged from the thematic analysis: 1) A reduced state of being experienced at a point of goal disengagement, 2) the accumulation of chronic stressors in a system that demands success and discourages the pursuit of personally meaningful goals, 3) a wide range of symptoms that are uncontrollable and disabling, 4) poor decision making resulting in wasted opportunities, with some positive takeaways, and 5) accepting the chronicity of depression. Young adults typically experienced depression as a reduced state of being and it was thought of cognitively as an entity that may be a part of or separate from the self. Over and beyond these aspects of cognitive representations was the emergence of themes depicting conflicts and dilemmas between the self and the social environment that threatened self-identity and autonomy. Addressing these conflicts in therapy would therefore be of utmost relevance for young adults recovering from depressive disorders in the local setting.