Aim This study aimed to examine the psychometric performance of the Recovering Quality of Life scale 10‐item version (ReQoL‐10) using a sample from a Singapore first‐episode psychosis intervention program, to explore its clinical and sociodemographic correlates, and to discuss its utility as a patient‐reported outcome measure (PROM). Methods Sociodemographic data, duration of untreated psychosis (DUP), and diagnosis were collected from 300 participants. Clinical data, which included baseline and current scores on the Patient Health Questionnaire 9‐item version, EuroQoL‐5 Dimension 3‐level version, Positive and Negative Syndrome Scale, and Global Assessment of Functioning scale, were extracted. The ReQoL‐10 was tested for structural validity, internal consistency, and construct validity, and a multiple linear regression determined if any of the baseline factors were statistically significant predictors of the total ReQoL‐10 scores. Results The mean (SD) total ReQoL‐10 score of the sample was 27.8 (7.8). Confirmatory factor analysis confirmed the bifactor model structure of the ReQoL‐10. The instrument demonstrated good internal consistency and adequate construct validity. Being older was associated with higher total ReQoL‐10 scores, while being married, having a highest educational level of vocational/diploma, longer DUP, and a diagnosis of affective psychosis were associated with lower total ReQoL‐10 scores. Conclusions This study has validated the ReQoL‐10 as suitable for routine use to measure recovery‐specific quality of life in a psychiatric setting among patients with first‐episode psychosis, and is a potential tool to initiate recovery conversations. As a PROM, it can facilitate shared decision making, in line with efforts to evaluate and improve quality of care.
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.
Background:Pathways to care studies in Singapore are of high interest given the cultural diversity and various sources of help available for those with mental illnesses, ranging from the more traditional to tertiary-level mental health care services.Aim:The current study aimed to explore the associations of patients’ socio-demographic characteristics with pathways to first contact and duration of untreated mental illness.Method:A total of 402 participants were recruited through convenience sampling. A pathway to care form was used to gather systematic information about the sources of care utilized by participants before approaching a mental health professional. Data were analysed using multinomial logistic regression and multiple linear regression models to assess the associations.Results:Majority of participants reported primary care (36.0%) as their first point of contact, followed by non-formal sources of help (33.8%), specialist care (21.8%), police/court (4.0%), websites/media (3.3%) and religious/traditional treatment (1.3%). Those belonging to Malay and Indian ethnicity (vs Chinese) were more likely to make first contact with non-formal sources of help than primary care. Those who received a diagnosis of any mood or anxiety disorder (vs schizophrenia and related psychoses) were less likely to make first contact with specialist care or non-formal sources of help than primary care. Those who were separated/divorced/widowed were significantly associated with higher duration of untreated illness compared to those who were single. Participants whose family/relative initiated the first contact were significantly associated with a shorter duration of untreated illness compared to those who initiated first contact on their own.Conclusion:Findings suggest the determinants of the pathways to first contact and duration of untreated illness included diagnosis, ethnicity, marital status and family initiating the first contact. The pathways adopted by these participants need to be kept in mind for planning mental health programmes.
Excessive weight gain and cardiometabolic dysfunction are common and clinically relevant side effects of antipsychotic medications. In this pilot study, we aimed to establish the feasibility of using metformin and its effectiveness in managing antipsychotic-induced weight gain in patients with first-episode psychosis (FEP) on follow-up with the Singapore Early Psychosis Intervention Programme in a 24-week, randomized, double-blind, placebo-controlled trial, to ascertain the effects of metformin discontinuation on body weight and evaluate the safety and tolerability of metformin. Participants between the ages of 16 and 40 with FEP assessed as clinically stable and who had gained ≥5% of their pre-drug weight after initiation of the antipsychotic treatment were recruited from outpatient clinics between April 2015 and April 2018. Seventeen participants met all the inclusion criteria and were randomized to receive metformin (n = 8) or the placebo (n = 9) at Week 0, with follow up assessments at Weeks 3, 6, 12, 24, and 36. Metformin was generally well-tolerated. Participants in the metformin arm were able to control their weight better than participants receiving the placebo, an effect that did not persist after discontinuation. Our results support the use of metformin as a safe and tolerable weight control measure in a typical outpatient sample of young people with FEP.
Aim: There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in Singaporean patients with first-episode psychosis and their association with 1-year psychosis recovery. Methods:The relationship between baseline patient characteristics, autistic traits (measured with autism screening questionnaires) and psychosis recovery outcomes at 1-year were examined in 180 adults in the Early Intervention Psychosis Programme in Singapore.Results: Out of 180 participants, 50 (27.8%) had clinically elevated above screeningcut off levels of autistic traits on the self-reported 10-item Autism Spectrum Quotient and 8 (4.4%) on the staff-rated Autism Spectrum Disorder in Adults Screening Questionnaire. At baseline, those with more autistic traits were more likely to be unemployed, economically inactive (ie, students or homemakers); and to have diagnoses of mood disorder with psychotic features, brief psychotic disorder or psychotic disorder not otherwise specified as compared to schizophrenia spectrum and delusional disorder diagnoses. Although most participants showed improvements in their clinical outcomes at 1-year, those with higher autistic traits improved less in the Positive and Negative Syndrome Scale general psychopathology scale and in Global Assessment of Functioning symptomatology.Conclusions: Autistic traits are common in those with first-episode psychosis and may be associated with poorer clinical outcomes. Validated screening tools should be developed in this population to support earlier reporting.
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