Minding the treatment gap: results of the Singapore Mental Health Study

Subramaniam, Mythily; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Shafie, Saleha; Chua, Hong Choon; Tan, Weng Mooi; Tan, Kelvin Bryan; Verma, Swapna; Heng, Derrick; Chong, Siow Ann

doi:10.1007/s00127-019-01748-0

Cited by 70 publications

(64 citation statements)

References 37 publications

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“…A rather local determinant of stigma is perhaps the “elitism mindset among Singaporeans” which may be related to meritocracy. In an earlier study pertaining to the treatment gap in Singapore, Subramaniam et al (2019) discussed how meritocracy is highly regarded in Singapore and that people with higher education face greater inertia towards seeking treatment in order to conform to societal expectations [ 56 ]. In Yang et al [ 57 ] study which was guided by a framework of “what matters most”, it was highlighted that mental illness stigma was contingent on the degree to which participants were able to achieve “what matters most” in their cultural context.…”

Section: Discussionmentioning

confidence: 99%

Mental illness stigma’s reasons and determinants (MISReaD) among Singapore’s lay public – a qualitative inquiry

et al. 2020

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Background: Mental illnesses pose a significant burden worldwide. Furthermore, the treatment gap for mental disorders is large. A contributor to this treatment gap is the perceived stigma towards mental illness. Besides impeding one's help-seeking intentions, stigma also impairs persons with mental illness (PMI) in other aspects of their life. Studies have found that stigma may manifest differentially under different cultural contexts. Thus, this study seeks to elucidate the determinants of stigma towards PMI among lay public in Singapore using a qualitative approach. Methods: A total of 9 focus group discussions (FGD) were conducted with 63 participants consisting of lay public Singaporeans who were neither students or professionals in the mental health field, nor had they ever been diagnosed with a mental illness. Topics discussed during the FGD were related to the stigma of mental illness. Data collected were analyzed with inductive thematic analysis method. A codebook was derived through an iterative process, and data was coded by 4 different coders. Both coding and inter-rater analysis were performed with NVivo V.11. Results: In total, 11 themes for the determinants of stigma were identified and conceptualized into a socioecological model. The socioecological model comprised 4 levels of themes: 1) Individual level beliefs (fear towards PMI, perceiving PMI to be burdensome, dismissing mental illness as not a real condition), 2) Interpersonal influences (upbringing that instills stigma, intergroup bias, perceived inability to handle interactions with PMI), 3) Local cultural values (elitist mindset among Singaporeans, Chinese culture of "face", Islamic beliefs about spiritual possession and reaction towards PMI), and 4) Shared societal culture (negative portrayal by media, Asian values). Conclusions: The findings of this study improved our understanding of the various reasons why stigma exists in Singapore. The themes identified in this study concur with that of studies conducted overseas, as some determinants of stigma such as fear towards PMI are quite ubiquitous. Specifically, the themes elitist mindset among Singaporeans and perceived inability to handle interactions with PMI were unique to this study. It is highly recommended that future anti-stigma campaigns in Singapore should incorporate the findings of this study to ensure cultural misgivings and beliefs are addressed adequately.

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Section: Discussionmentioning

confidence: 99%

Mental illness stigma’s reasons and determinants (MISReaD) among Singapore’s lay public – a qualitative inquiry

et al. 2020

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“…The Singapore Mental Health Study (SMHS) 2016 was a nationwide study, where one of the aims was to investigate the treatment gap for mental disorders in Singapore. The SMHS 2016 showed that among the population who had the highest treatment gap were those with tertiary level education [21]. Individuals in tertiary institutions have a special significance as they represent a large number of people who are at an age when mental disorders first present (onset) and may have lasting implications if not treated properly [22].…”

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“…Thus, those pursuing tertiary education are most likely to face pressures to be high-achieving and resilient. They may fear being perceived otherwise once assigned a diagnosis and prefer to deal with the problem on their own [21].…”

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The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students

et al. 2020

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Background The reluctance of young adults to seek mental health treatment has been attributed to poor mental health literacy, stigma, preference for self-reliance and concerns about confidentiality. The purpose of this study was to examine the potential impact of an anti-stigma intervention that includes education about depression, information about help-seeking as well as contact with a person with lived experience, on help seeking attitudes. Methods A pre-post study design was employed. Changes in help-seeking attitudes were measured using the Inventory of Attitudes towards Seeking Mental Health Services (IASMHS) immediately post-intervention and after 3 months. Sociodemographic data, information on past experiences in the mental health field and contact with people with mental illness were collated. Three hundred ninety university students enrolled in the study. Linear mixed models were used to examine the effects of the intervention. Results Scores on all subscales of the IASMHS, Psychological Openness (PO), Help-seeking Propensity (HP) and Indifference to Stigma improved significantly post-intervention and at 3-month follow-up compared to pre-intervention, with HP demonstrating the highest effect size. However, a significant decline was observed on all three scales at 3-month follow-up compared to post-intervention. Gender, having friends/family with mental illness, and previous experience in the mental health field moderated the intervention effects for the PO and HP subscales. Conclusion The study showed that the brief anti-stigma intervention was associated with improvements in help-seeking attitudes among university students with differential effects among certain sub-groups. As the beneficial outcomes appeared to decrease over time, booster sessions or opportunities to participate in mental health-related activities post-intervention may be required to maintain the desired changes in help-seeking attitudes.

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“…Online support groups in the form of internet support groups and chat rooms may offer a valuable source of information and social support for those with mental health problems, particularly mood and anxiety problems. Recent evidence suggests that the wide treatment-seeking gap for mental health continues to pose a local public health challenge [ 48 ]. Hence, online support groups could guide individuals to seek professional help for their mental health problems; in addition, they could complement the formal treatment services that patients may receive.…”

Section: Discussionmentioning

confidence: 99%

The Public Health Impact and Policy Implications of Online Support Group Use for Mental Health in Singapore: Cross-Sectional Survey

Roystonn¹,

Vaingankar²,

Yiang³

et al. 2020

JMIR Ment Health

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Background The wide mental health treatment gap continues to pose a global and local public health challenge. Online support groups are on the rise and could be used to complement formal treatment services for mental health. Objective This study aimed to examine the prevalence of online support group use and explore factors associated with the use in the general population using data from a national cross-sectional mental health survey in Singapore. Methods Singapore residents aged 18 years and above participated in a nationally representative household survey in which the World Health Organization Composite International Diagnostic Interview 3.0 was administered by trained interviewers to examine the use of online support groups for mental health. Multiple logistic regressions were used to analyze the association of online support group use with various sociodemographic and health factors. Results A total of 6110 respondents with complete data were included in this study. Overall, 10 individuals per 1000 adults (1%) reported seeking help from online support groups for their mental health problems. Compared to younger adults (those aged 18 to 34 years) and those with university education, individuals aged 50 to 64 years (P<.001; OR 0.1, 95% CI 0.0-0.3) and those with preuniversity qualifications (P=.02; OR 0.1, 95% CI 0.0-0.8) were less likely to use online support groups for mental health, respectively. Participants with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorder were 6.8 times more likely (P<.001; 95% CI 3.0-15.4) to use an online support group; in particular, individuals with major depressive disorder (P<.001; OR 5.4, 95% CI 2.1-13.8) and obsessive compulsive disorder (P=.01; OR 3.5, 95% CI 1.3-9.7) were more likely to use an online support group for their mental health. Conclusions Online support groups could be used to complement formal treatment services, especially for mood and anxiety-related disorders. As online support group use for mental health issues may be more prevalent among younger people, early detection and accurate information in online support groups may guide individuals toward seeking professional help for their mental health problems.

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Minding the treatment gap: results of the Singapore Mental Health Study

Cited by 70 publications

References 37 publications

Mental illness stigma’s reasons and determinants (MISReaD) among Singapore’s lay public – a qualitative inquiry

Mental illness stigma’s reasons and determinants (MISReaD) among Singapore’s lay public – a qualitative inquiry

The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students

The Public Health Impact and Policy Implications of Online Support Group Use for Mental Health in Singapore: Cross-Sectional Survey

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