This study aimed to: (i) determine the prevalence, socio-demographic and clinical correlates of internalized stigma and (ii) explore the association between internalized stigma and quality of life, general functioning, hope and self-esteem, among a multi-ethnic Asian population of patients with mental disorders. This cross-sectional, survey recruited adult patients (n=280) who were seeking treatment at outpatient and affiliated clinics of the only tertiary psychiatric hospital in Singapore. Internalized stigma was measured using the Internalized Stigma of Mental Illness scale. 43.6% experienced moderate to high internalized stigma. After making adjustments in multiple logistic regression analysis, results revealed there were no significant socio-demographic or clinical correlates relating to internalized stigma. Individual logistic regression models found a negative relationship between quality of life, self-esteem, general functioning and internalized stigma whereby lower scores were associated with higher internalized stigma. In the final regression model, which included all psychosocial variables together, self-esteem was the only variable significantly and negatively associated with internalized stigma. The results of this study contribute to our understanding of the role internalized stigma plays in patients with mental illness, and the impact it can have on psychosocial aspects of their lives.

Background:Few studies have estimated care burden in large, representative, multi-ethnic Asian population-based informal caregivers of older adults with care needs. This study describes informal caregivers’ care participation for a population-based sample of older adults with care needs in Singapore, investigates differences by dementia status, and examines correlates of caregivers’ burden.Methods:Data collected from 693 pairs of older adults, aged 60 to 100 years, having any care needs, and their informal caregivers, who were aged 21 to 88 years, closely involved in their care and “knew the older resident best,” and were interviewed during a cross-sectional national survey, were used. Clinical characteristics of older adults, including behavioral and psychological symptoms of dementia (BPSD) and dementia diagnosis, care needs, and socio-demographic characteristics of participants were obtained. Care burden was assessed with the Zarit Burden Interview.Results:Informal caregivers’ participation was highest in activities related to communication (35.1%), feeding (32%), and bathing (21.1%). Among the older adults with any care need, 356 (51.4%) had dementia. Care burden was significantly associated with married caregivers (odds ratio (OR) 2.4 vs. never married), when their relative belonged to a younger cohort (OR 2.5 vs. >84 years), needed care much of the time (OR 2.5 vs. no care needed), exhibited BPSD (OR 3.5 vs. no BPSD), and had dementia (OR 2.52 vs. no dementia).Conclusions:Factors related to older adults – more care needs, presence of BPSD, and dementia – were significant contributors to informal caregivers’ burden, and these should be considered while planning interventions to alleviate care burden.

BackgroundPublic attitudes to mental illness could influence how the public interact with, provide opportunities for, and help people with mental illness.AimsThis study aims to explore the underlying factors of the Attitudes to Mental Illness questionnaire among the general population in Singapore and the socio-demographic correlates of each factor.MethodsFrom March 2014 to April 2015, a nation-wide cross-sectional survey on mental health literacy with 3,006 participants was conducted in Singapore.ResultsFactor analysis revealed a 4-factor structure for the Attitudes to Mental Illness questionnaire among the Singapore general population, namely social distancing, tolerance/support for community care, social restrictiveness, and prejudice and misconception. Older age, male gender, lower education and socio-economic status were associated with more negative attitudes towards the mentally ill. Chinese showed more negative attitudes than Indians and Malays (except for prejudice and misconception).ConclusionsThere is a need for culture-specific interventions, and the associated factors identified in this study should be considered for future attitude campaigns.

BackgroundMental health literacy is an important mediating factor in help-seeking behavior. An important component of this literacy is the proper recognition of mental disorders. The aim of this population-based study in Singapore was to determine the proportion of adults in the resident population who were able to recognize vignettes pertaining to alcohol abuse, dementia, depression, obsessive compulsive disorder (OCD) and schizophrenia correctly. The sociodemographic characteristics that were associated with the ability to correctly recognize these disorders were also examined.MethodsThis was a nationwide cross-sectional study that involved establishing mental health literacy using a vignette approach. Respondents were recruited using a disproportionate stratified sampling design by age and ethnic groups. Face-to face-interviews were conducted with respondents aged 18 to 65 years belonging to Chinese, Malay, Indian and Other ethnic groups.ResultsA total of 3,006 respondents completed the survey (response rate of 71 %). The most well recognized conditions were dementia (66.3 %), alcohol abuse (57.1 %) and depression (55.2 %). The least recognized were OCD (28.7 %) and schizophrenia (11.5 %). Younger age and higher educational levels were found to be significant factors associated with the better recognition of specific disorders.ConclusionThe relatively high rate of recognition of dementia was likely to be due to the emphasis on public education programmes on dementia which is viewed as an emerging challenge due to Singapore’s rapidly ageing population. The role of education and the portrayal of depression and alcohol related problems in the local mass media are possible influences in their better recognition as compared to OCD and schizophrenia. Sociodemographic characteristics influencing mental health literacy need to be considered in planning intervention strategies that target mental health literacy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0837-2) contains supplementary material, which is available to authorized users.

BackgroundThis study aimed to explore the psychological status and quality of life among primary caregivers of individuals suffering from various mental illnesses including early psychosis, chronic schizophrenia, depressive disorders, anxiety disorders and dementia.MethodsA total of 350 primary caregivers with relatives seeking treatment at a tertiary psychiatric hospital were recruited for this study. Socio-demographic data was obtained and the brief version of the World Health Organisation Quality of Life instrument was used to assess caregiver’s quality of life (QOL). Psychological status among primary caregivers was assessed using the General Anxiety Disorder - 7 item (GAD-7) and Patient Health Questionnaire - 9 item (PHQ-9) scales. Family Interview Schedule (FIS) was used to assess the impact of caregiving relating to social problems, interpersonal strain among family members, work related problems and financial difficulties as a result of their relative’s illness. The socio-demographic and clinical correlates of QOL, PHQ-9 and GAD-7 were examined using multiple linear and logistic regression analyses. Associations between QOL domains and psychological status was examined using multiple linear regression analyses.ResultsThe mean age of the primary caregivers was 49.7 years (SD = 13.2), ranging from 21 to 82 years, with a preponderance of females (67.6%), aged 50–64 years old (45.7%). Majority were of Chinese ethnicity (57.5%), had secondary level education (43.1%), were married (65.2%), and employed (64.9%). 18.3% of primary caregivers had symptoms of depression (based on PHQ-9 cut-off point of 10 or greater) while 12.7% had symptoms of anxiety (based on GAD-7 cut-off point of 10 or greater). Multiple linear and logistic regression analyses revealed that primary caregivers aged between 35-49 years and 50–64 years, unemployed, living with others, providing care to those diagnosed with dementia and who had higher FIS scores were significantly more likely to report symptoms of depression whilst those who cared for their son/daughter were less likely to be associated with symptoms of depression. Primary caregivers who had lower education, were living with others, were single or divorced/separated, were unemployed and with higher FIS scores were associated with lower QOL domain scores. Those with symptoms of depression were significantly associated with low QOL across all four domains, whilst those with symptoms of anxiety were significantly associated with low QOL in the social relationships domain.ConclusionPsychological status of caregivers in the current study was associated with the various domains of QOL. In particular, caregivers’ symptoms of depression were significantly associated with lower QOL across all four domains of QOL whereas symptoms of anxiety were associated with lower scores in the social relationships domain. The study suggests a need to provide caregivers with social support and psycho-education to improve the QOL as well as aid in developing healthy coping strategies.