I would take ST's report that '1 in 10 will suffer from mental illness' (http://greysteppenwolf.blogspot.sg/2011/11/st-1-in-10-will-suffer-from-mental.html) with a truckload of salt.
'1 in 10 will suffer from mental illness'
Common disorders include depression and alcohol abuse: Study
By Chang Ai-Lien, The Straits Times, 19 Nov 2011
MORE than one in 10 people in Singapore will be stricken by mental illness in their lifetime, according to a large, new study here.
Many are likely to face depression, the commonest mental illness here. It is projected to affect 170,000 adults, with more women affected than men.
Others may be affected by alcohol abuse or obsessive-compulsive disorder (OCD), an anxiety affliction characterised by obsessions, compulsive rituals, as well as intrusive thoughts and impulses.
These were the top three mental disorders to surface in the $6.9 million Singapore Mental Health Study, in which 6,616 people were interviewed extensively last year.
The problem is a serious one, said Institute of Mental Health (IMH) experts who released the results yesterday. Mental illness can strike at a young age, and most people do not seek help.
'This is of great concern,' said Associate Professor Chong Siow Ann, vice-chairman of the IMH's medical board (research), who led the mammoth exercise.
'Mental illness often occurs at the prime of life, and goes undetected and untreated, resulting in decades wasted and having a profound impact on health, well-being and productivity.'
The information from the study, including treatment gaps, will go towards developing new mental health services and policies, and refining current ones, he said.
He hopes the results will include less stigma in the community, better care for patients, and more awareness all round.
In the study, depression emerged as the most pervasive mental illness here. Characterised by profound feelings of sadness, worthlessness and hopelessness, the debilitating condition is projected by the World Health Organisation to become the second-leading cause of disability worldwide by 2020.
In Singapore, it will strike 6.3 per cent of the adult population at some stage of their life. This amounts to 110,000 women and 60,000 men, half of whom will also suffer from a chronic physical illness.
Alcohol abuse and OCD are the next most common mental disorders.
Mental illness trends here generally follow global trends.
A surprising finding, however, is that Singapore has the highest rate for OCD, which hits 3 per cent of people here. The figure for the United States is 2.3 per cent, while in Europe it is 1.1 per cent.
Said Dr Mythily Subramaniam, deputy director of IMH's research division: 'This is the first and only disorder where we bucked the trend.'
The reasons are not yet clear, but the disease itself is affected by both genetic and environmental factors such as developmental upbringing and even illness.
Prof Chong said: 'This study has identified the problems. Now we can work out the solutions and how to do better.'
The study is an integral part of the National Mental Health Blueprint. The blueprint was launched in 2007 with a number of initiatives to promote mental health, help prevent the development of mental health problems, and reduce their impact.
Another important finding is that while the onset of mental illness occurred in most people while they were in their 20s, two in three never sought help.
Even those who eventually did took years to do so.
On top of that, mental illness also occurred alongside chronic conditions such as cancer, diabetes and heart problems.
Half of those with mental illness also had chronic physical ailments. Dr Chua Hong Choon, IMH's chief executive officer, said that there are many efforts to narrow these gaps, such as working with schools and elder-care centres to spot and treat mental illness.
More general practitioners are also being roped in to care for patients. The first batch of 20 GPs has completed a graduate diploma in mental health, he said, adding that another 50 GPs have been trained to manage mental illnesses.
This will give them better skills in treating such patients, and hopefully encourage more sufferers to come forward to get help, he said.
Associate Professor Kwok Kian Woon, associate provost of student life at Nanyang Technological University and a co-investigator in the study, added: 'We should not underestimate the need for community awareness in the home, at work, and at school.'
He said that the study made a good case for counselling as an avenue for identifying and even preventing mental illness.
'The point is to prevent the normal downs that we expect in life from becoming an impairment or even making someone non-functional,' said Prof Kwok, head of the division of sociology at NTU's school of humanities and social sciences.
Added Prof Chong: 'This is an example of how research is not just about sexy findings and breakthroughs. Other, more pedestrian results can translate into more immediate benefits.'
Most sufferers do not seek help
It strikes young. The majority of mental illnesses occurred by 29 years of age.
Most sufferers do not seek help. Fewer than one in three approach people such as psychiatrists, care givers, counsellors, GPs or religious or spiritual healers.
Those who do seek help take a long time to do so. The average time taken ranges from four years for people with depression, to 13 years for those with alcohol abuse.
Mental and chronic physical illness such as cancer, heart conditions, diabetes and high blood pressure often go hand in hand. Over 14 per cent of people with chronic physical illness also have a mental illness. Among those with mental illness, over half have a chronic physical illness.
Over one in 10 people here will suffer from a mental illness in their lifetime. Depression, alcohol abuse and obsessive compulsive disorder are the three most common disorders.
Loss of productivity: Mental illness results in over six working days lost, and about 10 days where work quality is compromised per person. This amounts to 267,418 days lost and 425,238 workdays cut-back on among employees here.
The unemployment rate of those with mental illnesses is about twice that of those without such ailments.
The figures for mental illness here are in line with global trends but lower than those of Western countries, and less than half the world average - where one in four is estimated to suffer from mental illness in their lifetime.
Singapore Med J. 1998 Jun;39(6):251-5.
Studying the Mental Health of a Nation - A Preliminary Report on a Population Survey in Singapore
C S L Fones, E H Kua, T P Ng, S M Ko
Aim: A Singapore Mental Health Survey was designed to study the prevalence and pattern of psychiatric morbidity of the general population. Community surveys reveal the true pattern of mental disorders, free from any self-selection into, or referral within the health care system.
Methods: A cross-sectional survey design was used to estimate the point prevalence of minor psychiatric morbidity (MPM) in an area-probability sample drawn from different regions. Disproportionate quota sampling yielded approximately equal numbers of Chinese, Malays and Indians for inter-ethnic comparison. The General Health Questionnaire, 28-item version (GHQ-28) measured psychoemotional symptoms in 3,020 subjects aged between 13-65 years. The GHQ-28 was validated against ICD-10 psychiatric diagnoses derived from structured psychiatric interview with the Composite International Diagnostic Interview (CIDI).
Results: The optimal cut-off point for the GHQ-28 was determined to be 4/5 for Chinese, and 5/6 for Malays and Indians. Using the validated ethnic-specific cut-offs, MPM rate for Chinese was 17.4%, Malays 15.1% and Indians 17.8%. The population MPM prevalence rate was estimated to be 16.6% after standardisation with population census data. Specific types of ICD-I0 psychiatric disorders which give rise to MPM were mainly anxiety and depressive disorders. Twelve percent of individuals with MPM had at least one ICD-10 disorder in the previous year.
Conclusion: Two-staged methodology is an efficient, cost-effective approach to study population prevalence of mental illness. Screening instruments utilised should be validated specifically for the culture and setting. Information from population surveys of psychiatric morbidity are important for the planning of mental health services for the country.
Keywords: epidemiology, psychiatric morbidity, population prevalence, GHQ
Mental disorders have an immense impact on individuals and their families pose a growing challenge to the healthcare systems throughout the world. The aging population and the trend of social changes (such as increasing divorce rates, changing family structures, and economic pressures) pose great challenges to the mental well-being of Singapore.
IMH has embarked on a nationwide program: The Singapore Mental Health Study (SMHS). The SMHS brings together international and local expertise for an extensive and comprehensive assessment of the nation's mental health.
This project aims to:
Conduct a population-based study to establish the positive and negative mental health status of the Singaporean population.
Assess the spectrum and distribution of different types of mental illnesses across the three major ethnic groups.
Develop and validate a tool for the assessment of positive mental wellbeing for the Singapore population.
Describe the current use of mental health services (both Western and traditional medicines) and the level of unmet needs and identify facilitators and barriers to mental health care and the financial, social and personal costs associated with mental illness.
This project involves collaborations between multiple stakeholders and experts from leading national and international institutions.
This three-year S$6.9-million programme is funded by the Singapore Millennium Foundation and the Ministry of Health (MOH), Singapore.
A/Prof Chong Siow Ann, Institute of Mental Health
A/Prof Mabel Yap, Ministry of Health
Dr Lim Yee Wei, RAND Health
A/Prof Kwok Kian Woon, Nanyang Technological University
Information updated as at 10 October 2013.
Please seek further clarifications with IMH Corporate Communications Department when
using the following data.
18 November 2011
Latest study sheds light on the
state of mental health in Singapore
1. The Singapore Mental Health Study (SMHS) conducted in 2010 and spearheaded
by the Institute of Mental Health (IMH), has been completed. This nationwide
epidemiological study gives insight into some of the common mental illnesses in the adult
Singapore resident population, the associated factors of these illnesses, the delay in
seeking treatment, and the period of delay among those who eventually sought
2. Key findings from the study show that:
• Among the illnesses assessed in this study, Major Depressive Disorder (MDD),
Alcohol Abuse and Obsessive Compulsive Disorder (OCD) emerged as the top
three most common disorders in Singapore. One in 17 people in Singapore
have suffered from MDD at some time in their lifetime, while Alcohol Abuse and
OCD affected one in 32 and one in 33 people, respectively.
• Socio-demographic characteristics such as age, gender, ethnicity, education
and employment status were associated with the prevalence of mental illness.
• The majority of the mental illnesses occurred by the age of 29 years.
• The majority of the people with mental illness were not seeking help.
3. According to the study, MDD was the most common mental illness in Singapore.
5.8% of the adult population in Singapore suffered from MDD at some time in their
lifetime. In the previous 12 months (prior to the survey), 2.2% of the adult population had
4. The illness affected over 57,000 adult men and about 102,000 adult women during
their lifetime. Depression was also associated with chronic physical illnesses. About half
(49.2%) of people with MDD had at least one chronic physical illness.
5. 1.2% of the adult population in Singapore suffered from Bipolar Disorder. It affected
men and women equally.
6. Both Generalised Anxiety Disorder (GAD) and OCD are anxiety disorders. About
100,000 individuals in our local population suffered from anxiety disorders during their
lifetime. Overall, 3.6% suffered GAD and OCD during their lifetime. Nearly half of those
with GAD (40.2%) also had a chronic physical illness.
7. OCD was more common than GAD (3.0% and 0.9% respectively). In the previous 12
months (prior to the survey), 1.1% and 0.4% of the adult population had OCD and GAD
Alcohol Use Disorders
8. About 3.1% and 0.5% of the population suffered from Alcohol Abuse and Alcohol
Dependence respectively at some time in their life. Over the previous 12 months, the
prevalence of Alcohol Abuse and Alcohol Dependence was 0.5% and 0.3%,
respectively. More men were found to abuse alcohol than women (ratio of 4:1). Overall,
the prevalence rate is low compared to other countries like US, Europe, China, Australia
and New Zealand.
9. There was a large gap in help-seeking behaviour among those with alcohol abuse,
with 96.2% of those affected not seeking help.
9. At the point of the survey, 4.5% of the population were found to suffer from Nicotine Dependence. Men and those with lower education were more likely to have Nicotine
Age of Onset of Illness, Time to Seeking Help and Treatment Gap
10. Most people who suffered from a mental illness had their first onset of illness when
they were in their twenties.
11. The study found that a large gap in help-seeking behaviour (also known in the
scientific literature as the “treatment gap”) exists for the majority of mental illnesses. This
means that people with mental illness were not seeking professional help.
12. The average time (median) taken to seek help from the start of illness was for those
with Alcohol Abuse (14 years); followed by Bipolar Disorder and OCD (9 years), GAD (6
years) and MDD (5 years).
13. Among all the people with a mental illness in their lifetime, 22.1% had consulted a
psychiatrist. The majority had seen a professional care-giver in the community – 21.6%
went to a counselor, 18% went to a GP, and 12.0% went to a religious or spiritual healer.
14. There was an association between mental illness and chronic physical illness.
14.3% of those with a chronic physical illness also had a mental illness. Among those
with mental illness, 50.6% had a chronic physical illness.
15. “This survey has provided a rich body of information on the prevalence of mental
illnesses and problems. We hope it will serve as useful data to inform the development
and refinement of policies and mental health services, ‘’ said A/Prof Chong Siow Ann, the
principal investigator of the study, and Vice-Chairman, Medical Board (Research), IMH.
- END -
For media queries, please contact:
Ms Penny Chua
Senior Manager, Corporate Communications
Institute of Mental Health
DID: 6389 2865 HP: 8133 1821
About the Institute of Mental Health
The Institute of Mental Health is the only tertiary mental health centre in Singapore. It
offers a multi-faceted and comprehensive range of psychiatric, rehabilitative and
counseling services to meet the needs of three groups of patients – children and
adolescents, adults and the elderly. IMH also runs mental health education
programmes for the general public. These programmes aim to promote mental wellness
and raise awareness of the importance and benefits of prevention, early detection and
treatment of mental disorders. Annex 1
ABOUT THE SINGAPORE MENTAL HEALTH STUDY
The study was undertaken by a multi‐disciplinary team led by the Institute of Mental
Health and is a collaborative effort between four centres – IMH, Ministry of Health (MOH),
Nanyang Technological University (NTU) and RAND Health, a research division within
RAND Corporation, an American non-profit research organisation. The $6.9 million study
was funded by the Singapore Millennium Foundation (SMF) and MOH.
The Principal Investigator of this study is A/Prof Chong Siow Ann, Vice Chairman Medical
Board (Research) IMH, and Senior Clinician-Scientist Investigator, National Medical
Research Council. Other than A/Prof Chong, the team is also led by Dr Mythily
Subramaniam and Ms Janhavi Vaingankar, from the Research Division in IMH.
A total of 6,616 Singapore Residents (including Singapore Citizens and Permanent
Residents) aged 18 years and above living in households Singapore were interviewed in
depth for the study during the field research phase in 2010. The first household was
contacted on 2nd Dec 2009 and the last interview was completed on 5th Dec 2010. The
response rate was 75.9%.
DESCRIPTION OF MENTAL ILLNESSESS ASSESSED IN THE SMHS
Major Depressive Disorder
Major depressive disorder (MDD) is characterised by a depressed mood: a profound
feeling of sadness, emptiness, worthlessness and hopelessness. Associated with this, is
a range of other disturbances like loss of interest in activities and loss of pleasure in
almost all activities, sleep disturbances (either not being able to sleep well or sleeping to
much), loss of appetite with consequent loss of weight although in atypical cases, there
might be overeating. Significant impairment in functioning is brought on by difficulty
concentrating, loss of energy, tiredness and listlessness. The depressed person may
have suicidal thoughts or intentions which might lead to suicidal attempts or even actual
This disorder is characterized by mania which is an abnormally elevated, expansive, or
irritable mood. Together with this, there may be an inflated sense of self-esteem or even
grandiosity, decreased need for sleep, and talkativeness, agitation and a tendency to
engage in activities which while pleasurable, would have painful consequences like
spending sprees, without the money to pay for them, increased sexual activity, reckless
driving, rash business and personal decisions. This state is often severe enough to
seriously affect the person’s life and often hospitalization is required to protect the
individual from the damaging consequences of the lack of restrain and judgment. A
subtype of bipolar disorder is the occurrence of mania with a major depressive episode.
Generalised Anxiety Disorder
The essential feature of generalised anxiety disorder (GAD) is a general feeling of
excessive anxiety and worry that is difficult to control. These feelings are not related to
any specific event or object but may be about a number of events and activities. They are
often accompanied by other symptoms like restlessness, fatigue, irritability, and or
disturbed sleep. GAD can be chronic and recurrent in nature, impair family life, and
reduces social adjustment and functioning. Typically GAD develops over a period of time
and may not be noticed until it is significant enough to cause problems with functioning.
Obsessive-compulsive disorder (OCD) is characterized by the occurrence of either
obsessions, compulsive rituals or, most commonly, both recurrent and persistent thoughts,
impulses, or images that are experienced as intrusive and cause great anxiety. They are
not simply excessive worries about real life issues; the affected individual attempts to
ignore, suppress, or neutralise them with some other thought or action and recognizes
that these thoughts are a product of his or her mind. Examples of obsessions include
unwanted thoughts or images of harming loved ones, persistent doubts that one has not
locked doors or switched off electrical appliances, and intrusive thoughts of being
contaminated. Compulsions are repetitive behaviours (eg, repetitive hand washing or
checking) or mental acts (eg, repetitive praying, counting, or thinking good thoughts to
undo or replace bad thoughts) that the affected individual feels compelled to do in
response to an obsession, or according to rigid rules (eg, checking that a light switch is
turned off by switching it on and off exactly ten times).
Alcohol abuse is diagnosed when one or more of the following occurs:
a) Recurrent alcohol use resulting in failure to fulfill major role obligations at work,
school, or home (e.g., repeated absences or poor work performance related to
alcohol use; alcohol-related absences, suspensions or expulsions from school;
or neglect of children or household)
b) Recurrent use in situations in which it is physically hazardous (e.g., driving a
car while under the influence of alcohol)
c) Having alcohol-related legal problems (e.g., arrests for alcohol-related
d) Continuing to use alcohol despite having persistent or recurrent social or
interpersonal problems caused or worsened by the effects of alcohol (e.g.
arguments with wife over consequences of being drunk, fights)
Alcohol dependence is defined as a maladaptive pattern of alcohol use, leading to
clinically significant impairment or distress, and the essential feature of which is a cluster
of cognitive, behavioral and physical symptoms. These include tolerance (a need for
markedly increased amounts of alcohol to achieve intoxication or desired effect),
unpleasant withdrawal symptoms when intake is stopped or reduced, a consuming
preoccupation to obtain and use alcohol at the expense of other important social, occupational and recreational activities. Despite this, the person would persist in using
alcohol and even with the knowledge of having a recurrent physical or psychological
problem that is likely to have been caused or exacerbated by the alcohol (e.g., continued
drinking despite recognition that an ulcer was made worse by alcohol consumption).
DESCRIPTION OF KEY TERMS
Prevalence of any disorder is the proportion of people affected with that disorder in a
given population at a specific time. Life-time prevalence is the number of people in a
population that have had the disorder at any time in their life, divided by the total number
of individuals in the population at the time of assessment. It estimates the extent of a
disorder within a population over a certain period of time.
12- month Prevalence
Annual or 12-month prevalence is the number of people in a population that have had a
disorder during a specific year divided by the total number of individuals in the population.
It includes cases arising before but extending into that year and new cases identified in
that year. It is often used to estimate impact of a disorder within a population in that year.
Treatment gap is the proportion of people having a disorder yet not receiving treatment
for it. In this study, under each diagnostic section, respondents are asked whether they
had ever in their life talked to a medical doctor or other professional about the disorder
under investigation. Example of the question from Depression module: “Did you ever in
your life talk to a medical doctor or other professional about your
(sadness/or/discouragement/or/ lack of interest)? (By professional we mean
psychologists, counselors, spiritual advisors, herbalists, acupuncturists, and other healing
Sampling and Weight adjustment
Disproportionate sampling was used to randomly select residents for the survey
(i.e. the percentage of residents belong to different age groups and ethnicities
were not similar to their distribution in the Singapore population), and therefore
people belonging to Malay and Indian ethnicity and those above 65 years of age
were over sampled. This method was applied to identify an adequate number of people in these sub-groups with a mental disorder to allow statistically sound
comparisons between sub-groups. Because of the complex sampling design of
the survey, it is important to make use of sampling weights for weight adjustment
to eventually produce representative estimates for the Singapore resident
population. For example, if you apply weight adjustment to prevalence rates for
respondents who are 30 % Chinese, 30% Malay and 30% Indian you will be able
to get rates for a population with 70% Chinese, 12 % Malay and 8% Indian.
The odds ratio (OR) is a statistical term used to assess the risk of a particular
outcome (or disorder) in presence of a certain factor. It is a relative measure of
risk that tells how much more likely it is that someone who is exposed to the factor
will develop the outcome (or disorder) as compared to someone who is not
exposed. For example, when investigating differences in prevalence of
depression across men and women, gender is treated as exposure and
depression is the outcome. Upon statistical analysis, if the OR is 1.8, it can be
interpreted as women had 1.8 times higher odds of having depression as
compared to men.
P-value is a statistical term that gives the probability of a chance occurrence, with
a value ranging from zero to one. P-values can be derived using various methods
and are used for detecting statistical differences between two populations. For
example, if the P value is 0.04, it means that there is a 4% chance of observing a
difference as large as observed between the two populations even if there were in
reality no differences. Values less than or equal to 0.05 are often used as a cut off
to infer a statistical difference between two groups.
About the Singapore Millennium Foundation and Temasek Trust
Established in February 2002, the Singapore Millennium Foundation (SMF) is a
Singapore Institution of a Public Character and a non-profit philanthropic organisation set
up jointly by the then Singapore Technologies and Temasek Holdings. The SMF aims to
promote research in Singapore and raise Singapore’s international visibility as a centre of
knowledge creation -- a place where progressive researchers meet to exchange ideas,
challenge findings and jointly advance the knowledge capital of the world.
Temasek Trust was established in 2007 to independently oversee the financial
management of Temasek’s philanthropic endowments and gifts, including the endowment
disbursements to approved non-profit beneficiaries.
Chong Siow Ann
MBBS, MMED, MD, FAMS
Associate Professsor Siow-Ann Chong is the Vice Chairman of Medical Board
(Research), Senior Consultant Psychiatrist and Chairman of the Clinical Research
Committee at the Institute of Mental Health, as well as a member of the National
Medical Research Council of Singapore. He was a Senior Consultant to the
Health Service Research and Evaluation Division of the Ministry of Health of
Singapore, and a member of the Director of Medical Services Taskforce on the
National Mental Health Blueprint and Policy among other committees.
His research interests are psychosis, psychiatric genetics, epidemiology, and
health service research. He has published widely and is the Associate Editor of a
few journals and sits in the Editorial Board of several journals.
He has won several research awards – including the Inaugural 2006 World Health
Organisation and State of Kuwait Prize for Research in Mental Health Promotion,
the Clinical Scientist Investigator Award (Category A) from the Biomedical
Research Council and National Research Council of Singapore in 2007, the
Inaugural 2008 National Medical Excellence Award (team) from the Ministry of
Health (Singapore), the National Healthcare Group Distinguished Award (2008),
the Galloway Memorial Lecture and Gold Medal (2011) awarded by the Singapore
Academy of Medicine.
He is the Principal Investigator of the Singapore Mental Health Study and the
Flagship Translational and Clinical Research Programme in Neuroscience which
is a 5-year multinational study which sets out to determine the biomarkers of
schizophrenia and related psychoses. Mythily Subramaniam
Dr Mythily Subramaniam is the Deputy Director of Research at the Institute of
Mental Health. She has over ten years of experience in mental health research.
Her research interests are in the areas of psychosis, addictions, epidemiology,
and health service research. She has worked on several research projects with
the Ministry of Health, Singapore Prison Authority, Ministry of Defence, Ministry of
Community Youth and Sports Development, and the Agency for Integrated Care.
She has published extensively and is a reviewer for several scientific journals.
She is a co-investigator of the Singapore Mental Health Study and the 5-year,
25-million-dollar Flagship Translational Clinical Research Programme in
Neuroscience. She will be leading a national-wide study of the elderly population
in Singapore to establish the prevalence of dementia and the burden of care.
Ms Janhavi Vaingankar is a Manager and Researcher at the Research Division of
the Institute of Mental Health. Trained as an epidemiologist from the London
School of Hygiene and Tropical Medicine, University of London, she has over ten
years of experience in facilitating and conducting research studies and has been
a co-Investigator for several research projects, including projects undertaken for
the Ministry of Health, Ministry of Community Development, Youth and Sports,
Singapore, and the Agency for Integrated Care.
She is a recipient of the National Medical Research Council (Singapore) Medical
Research Scientist Award. Her areas of research are psychiatric epidemiology,
mental well being and health services research and she has published in these
She is a Co-Investigator of the Singapore Mental Health Study and has taken the
lead in developing and validating a culturally valid instrument to measure positive
mental health in the Singapore population.
The results of the Singapore Mental Health Study can be found at::
A population-based survey of mental disorders in Singapore.
MATERIALS AND METHODS:
- [PubMed - indexed for MEDLINE]
Prevalence and impact of mental and physical comorbidity in the adult Singapore population.
MATERIALS AND METHODS:
- [PubMed - indexed for MEDLINE]
Where do people with mental disorders in Singapore go to for help?
MATERIALS AND METHODS:
- [PubMed - indexed for MEDLINE]
"How much can I take?": predictors of perceived burden for relatives of people with chronic illness.
MATERIALS AND METHODS:
- [PubMed - indexed for MEDLINE]