PREDICT

PREDICT Newsletter ISSUE #1

2025-10-21T00:00:00+00:00

The first issue of the PREDICT Newsletter is out now! Find out more about the PREDICT study like how we equipped our researchers with essential know-how and what lies ahead for the study.

Download the newsletter here to read more.

Excess costs of depression among population based older adults with chronic diseases in Singapore

2024-11-11T00:00:00+00:00

Excess costs of depression among population-based older adults with chronic diseases in Singapore

Jia Wei Neo, Xue Ying Guo, Edimansyah Abdin, Janhavi Ajit Vaingankar, Siow Ann Chong, Mythily Subramaniam & Cynthia Chen

Background

There is limited evidence on the economic burden of depression among the older population in Singapore.

Objective

We aim to evaluate the impact of depression on healthcare expenditure and productivity loss among older adults with chronic diseases in Singapore.

Methods

Using the data from the Well-being of the Singapore Elderly study (WiSE), a 2011 national representative survey of older adults aged 60 years and above, 2510 respondents were included in this study. The sample comprised 44% male and 56% female respondents with 75% respondents aged between 60 and 74 years old. Healthcare utilisation data was obtained from respondents and healthcare cost was tabulated by multiplying each service unit by the unit cost price. These services include care from polyclinic doctors, private general practitioners (GP), outpatient specialists and inpatient care. We modelled the relationship of healthcare cost and depression using two-part models (probit & generalised linear model - loglink and gamma distribution).

Results

For total healthcare expenditure, older adults with both depression and chronic diseases were associated with an average annual incremental cost of $7940 (95% CI 1490–14400; p = 0.016), compared to those without these conditions. They were also associated with an average incremental cost of $257 (95% CI 38.7–475; p = 0.021) for primary care. Likewise, in the case of specialist outpatient clinics, they had an average incremental cost of $970 (95% CI 163–1780; p = 0.018). However, for inpatient setting, the average incremental cost of $6180 (95% CI 418–12800; p = 0.066) was not significant. Additionally, older adults with depression and chronic diseases contribute to an annual productivity loss of $676 (95% CI 346–1010; p < 0.001).

Discussion

This study provides evidence that there are significant incremental costs associated with depression amongst the older adults with chronic diseases in Singapore’s primary healthcare setting. The increased somatic presentations among the depressed older adults and the underdiagnosis of depression in primary care may contribute to higher utilisation of healthcare resources which entail higher expenditure. This is one of the first studies to look at the cost of depression using a representative sample of Singaporean older adults and taking into account the multi-ethnic nature of the population. Analyses were restricted to a cross-sectional design, and data relied heavily on the accuracy of self-report utilisation on health care services which was subjected to recall bias.

Conclusion

Depression was found to inflate the total healthcare expenditure among older adults with chronic disease by two-fold. This study provides evidence that there are significant incremental costs associated with depression among the older adults with chronic diseases, demonstrating a need for more resources to improve systematic and clinical care for depressed older adults with chronic diseases.

doi: https://doi.org/10.1186/s12889-024-20306-1

A modified model of stress and coping on depressive symptoms amongst caregivers

2024-10-26T00:00:00+00:00

A modified transactional model of stress and coping on depressive symptoms among informal caregivers of persons with dementia

Qi Yuan, Tee Hng Tan, Peizhi Wang, Daniel Poremski, Edimansyah Abdin, Harish Magadi, Richard Goveas, Li Ling Ng, Mythily Subramaniam

Informal caregivers are crucial to the care of persons with dementia (PWD), but their role is often reported as challenging. This study aims to examine caregiver stress and depressive symptoms among informal caregivers of PWD using a modified transactional stress and coping model. Path analysis was conducted among a sample of informal caregivers of PWD in Singapore (n = 281) using information on functional dependence and memory and behavioral problems of PWD, and self-reported measurements on caregivers' knowledge of dementia, perceived positive aspects of caregiving, social support, coping patterns, caregiving self-efficacy, caregiving burden and depressive symptoms. The initial model reflecting our assumptions for the transactional stress and coping model showed a poor fit (model 1 - CFI = 0.858, TLI = 0.665, RMSEA = 0.118). Logical modifications were made until sufficient model fit was achieved (model 2 - CFI = 0.987, TLI = 0.955, RMSEA = 0.043). We then removed the insignificant paths in model 2 and obtained our final model (model 3 - CFI = 0.990, TLI = 0.974, RMSEA = 0.033). The final model supported our hypotheses, with some adjustments. This study advances our understanding of caregiver distress by modifying the transactional stress and coping model, including (1) the key role of caregiver self-efficacy in the primary appraisal process, (2) the dynamic assessment of coping resources across all stages of the model, and (3) the importance of coping patterns. Future studies could explore the generalizability of these findings.

Keywords: Dementia; Depressive symptoms; Informal caregivers; Path analysis; Transactional model of stress and coping.

doi: 10.1038/s41598-024-76339-4

Continuing Professional Education (CPE) Talk by Professor Brenda Penninx

2024-10-14T00:00:00+00:00

Professor Brenda, a leading researcher from the Netherlands Study of Depression and Anxiety (NESDA), recently visited Singapore to share groundbreaking insights with the PREDICT study team. NESDA, a comprehensive multi-site cohort study, focuses on understanding the long-term progression and impact of depressive and anxiety disorders. It integrates biological and psychosocial research to identify predictors of these conditions’ course and consequences.

During her presentation, Professor Brenda provided an overview of NESDA’s findings on depression, associated risk factors, and the overall disease burden. She highlighted how these insights have not only advanced scientific knowledge but have also influenced prevention and treatment strategies for depression and anxiety. Additionally, Professor Brenda discussed how NESDA's findings could inform local mental health practices in Singapore, offering a valuable perspective for future research and policy development.

PREDICT Training by Professor Brenda Penninx

2024-10-11T00:00:00+00:00

Institute of Mental Health (IMH) recently welcomed Professor Brenda Penninx, the Principal Investigator from the Netherlands Study of Depression and Anxiety (NESDA) cohort study, for an in-depth two-day training session with the PREDICT study team. The training was hosted by the Mental Health Policy Programme Office’s Research Unit at IMH, underscoring Singapore’s commitment to advancing mental health research and policies.

Professor Brenda, known for her pioneering work in mental health epidemiology and her contributions to understanding depression and anxiety through NESDA, engaged IMH’s researchers with insights into longitudinal data analysis, study methodologies, and best research practices. The training aimed to enhance the PREDICT team’s capacity in implementing complex mental health studies, ultimately supporting Singapore’s ongoing efforts to improve mental health care and outcomes.

Professor Mythily Subramanian expressed appreciation for Professor Brenda's visit, highlighting the valuable exchange of knowledge and expertise. This collaboration marks a significant step in bolstering Singapore’s research capabilities in mental health, aligning with its vision to lead advancements in mental health policy and practice.

A study of Brexpiprazole as an Adjunctive Treatment for Major Depressive Disorder in Asian Patients

2024-08-23T00:00:00+00:00

A Real-life Study of Brexpiprazole as an Adjunctive Treatment for Major Depressive Disorder in Asian Patients in Singapore (BADA)

Yee Ming Mok, Pei Lin Lynnette Tan, Rohini Bose, Keira Joann Herr, Ken Eng Khean Ung

Objective: : To investigate the effectiveness and safety of brexpiprazole as an adjunctive treatment to antidepressant therapy (ADT) in Asian adults with major depressive disorder (MDD) and inadequate response in a real-life clinical setting in Singapore.

Methods: : This was a prospective, observational 3-month study of patients with MDD who had brexpiprazole added to their existing ADT. The study was conducted at two sites in Singapore between September 2020 and October 2021. The co-primary endpoints were Patient Health Questionnaire-9 (PHQ-9) and Clinical Global Impression-Severity (CGI-S). Other endpoints included Clinical Global Impression-Improvement (CGI-I), Sheehan Disability Scale (SDS), Generalized Anxiety Disorder 7-item scale (GAD-7), and safety.

Results: : Twenty patients were enrolled and 16 completed the study. There were improvements in PHQ-9, CGI-S, SDS, and GAD-7 scores from baseline at Week 12, with a mean difference of -4.8, -1.3, -8.5, and -6.2, respectively. The CGI-I score improved from baseline with a mean score of 2.3 at Week 12. One third achieved response and 25% achieved remission based on PHQ-9 scores at Week 12. Similar results were obtained using CGI-S scores (38% for both). The incidences of adverse events (AEs) and treatment-related AEs were 55% (11/20) and 50% (10/20), respectively. There were no deaths or severe AEs. Two patients withdrew brexpiprazole during the study.

Conclusion: : The observed effects and safety of adjunctive brexpiprazole in Asian adults with MDD in the real-world setting in Singapore were consistent with those from clinical trials.

Keywords: Adjunctive treatment; Antidepressants; Asian; Major depressive disorder; Real world.

doi: 10.9758/cpn.23.1143

Understanding Major Depressive Disorder in Singapore: Insights from the second Mental Health Study

2024-08-12T00:00:00+00:00

Understanding Major Depressive Disorder in Singapore: Insights from the second Singapore Mental Health Study (SMHS 2016)

Kumarasan Roystonn, Yen Sin Koh, Saleha Shafie, Rajeswari Sambasivam, Janhavi Ajit Vaingankar, Siow Ann Chong, Mythily Subramaniam

Background: Major Depressive Disorder (MDD) poses significant public health challenges globally and in Southeast Asia, with substantial impairment and disease burden. Understanding its prevalence and associated risk factors is crucial for effective intervention.

Methods: This study aims to describe the prevalence shifts, correlates, and comorbidities of MDD in Singapore. Data were collected from the second Singapore Mental Health Study (SMHS 2016), a national cross-sectional survey comprising 6126 adult residents. The WHO Composite International Diagnostic Interview assessed MDD and comorbidities. Statistical analyses, including logistic regression, were conducted to examine the associations and trends.

Results: The lifetime weighted prevalence of MDD in SMHS 2016 was 6.2 %, with an overall increase from 5.8 % in 2010. Significant associations were found between MDD and age, marital status, and comorbid physical disorders. Young adults and divorced/separated individuals exhibited higher MDD prevalence. Chronic pain was significantly associated with MDD.

Limitations: The study's cross-sectional design limits causal inference, and selective non-response might affect prevalence estimates. However, the study benefits from a large, nationally representative sample and standardized methodologies.

Conclusions: Young and middle-aged adults, and divorced/separated individuals demonstrate elevated MDD prevalence, warranting targeted interventions. Individuals with comorbidities, particularly chronic pain, constitute a high-risk and vulnerable population. Comprehensive assessment and treatment plans should involve multidisciplinary teams and integrated care approaches to better address the complex needs of these individuals. Our study also highlights specific interventions for schools, families, communities, and workplaces. Despite Singapore's relatively low prevalence compared to Western nations, MDD remains cross-culturally valid emphasizing the need for early intervention and preventive public health measures.

Keywords: Chronic pain; Comorbid; MDD; Major depressive disorder; Prevalence; Public health; Trend.

doi: 10.1016/j.jad.2024.08.046.

Mapping the WHO Disability Assessment Scale 2,0 to the EQ 5D 5L in patients with mental disorders

2024-07-11T00:00:00+00:00

Mapping the World Health Organization Disability Assessment Scale 2.0 to the EQ-5D-5L in patients with mental disorders

Edimansyah Abdin, Vanessa Seet, Anitha Jeyagurunathan, Sing Chik Tan, Muhammad Iskandar Shah Mohmad Khalid, Yee Ming Mok, Swapna Verma, Mythily Subramaniam

Objective

The current study aims to develop an algorithm for mapping the WHODAS 2.0 to the EQ-5D-5 L for patients with mental disorders.

Methods

This cross-sectional study was conducted at the Institute of Mental Health and Community Wellness Clinics in Singapore between June 2019 and November 2022. We included four regression methods including the Ordinary Least Square (OLS) regression, the Tobit regression model (Tobit), the robust regression with MM estimator (MM), and the adjusted limited dependent variable mixture model (ALDVMM) to map EQ-5D-5 L utility scores from the WHODAS 2.0.

Results

A total of 797 participants were included. The mean EQ-5D-5 L utility and WHODAS 2.0 total scores were 0.615 (SD = 0.342) and 11.957 (SD = 8.969), respectively. We found that the EQ-5D-5 L utility score was best predicted by the robust regression model with the MM estimator. Our findings suggest that the WHODAS 2.0 total scores were significantly and inversely associated with the EQ-5D-5 L utility scores.

Conclusion

This study provides a mapping algorithm for converting the WHODAS 2.0 scores into EQ-5D-5 L utility scores which can be implemented using a simple online calculator in the following web application: https://eastats.shinyapps.io/whodas_eq5d/.

doi: https://doi.org/10.1080/14737167.2024.2376100

Prevalence and risk factors of depression and anxiety in primary care

2024-05-10T00:00:00+00:00

Prevalence and risk factors of depression and anxiety in primary care

Yu Cong Eugene Chua, Yijun Carol Lin, Jeremy Kaiwei Lew, Sabrina Kay Wye Wong, Winnie Shok Wen Soon, Jinhui Wan, Edimansyah Abdin, Mythily Subramaniam, Wern Ee Tang, Eng Sing Lee

Introduction: Anxiety and depressive disorders are highly prevalent mental health conditions worldwide. However, little is known about their specific prevalence in primary care settings. This study aimed to determine the prevalence of depression, and anxiety in the primary care population and identify associated patient characteristics.

Method: We conducted a cross-sectional study using stratified sampling by age with a self-administered questionnaire survey in Singapore’s National Healthcare Group Polyclinics from December 2021 to April 2022. A total score of Patient Health Questionnaire-9 (PHQ-9) ≥10 represents clinical depression and a total score of Generalised Anxiety Disorder-7 (GAD-7) ≥10 indicates clinical anxiety. Multivariable logistic regression was used to identify the factors associated with depression and anxiety.

Results: A total of 5694 patients were approached and 3505 consented to the study (response rate=61.6%). There was a higher prevalence of coexisting clinical depression and anxiety (DA) (prevalence=5.4%) compared to clinical depression only (3.3%) and clinical anxiety only (1.9%). The odds of having DA were higher among those aged 21–39 years (odds ratio [OR] 13.49; 95% confidence interval [CI] 5.41–33.64) and 40–64 years (OR 2.28; 95% CI 1.03–5.03) compared to those ≥65 years. Women had higher odds of having DA (OR 2.33; 95% CI 1.54–3.50) compared to men. Respondents with diabetes had higher odds of having DA (OR 1.78; 95% CI 1.07–2.94) compared to those without diabetes.

Conclusion: Coexisting clinical depression and anxiety are significantly present in the primary care setting, especially among younger individuals, patients with diabetes and women. Mental health screening programmes should include screening for both depression and anxiety, and target these at-risk groups.

doi: https://doi.org/10.47102/annals-acadmedsg.2023195

Challenges of first episode catatonia in a geriatric case of treatment resistant depression

2024-04-26T00:00:00+00:00

Case report: Diagnostic and therapeutic challenges of first-episode catatonia in a geriatric case of treatment-resistant depression. Psychiatry Research Case Reports

Yanhui Li, Nisha Chandwani

Multiple authors have discussed challenges in diagnosis and management of catatonia, but there are limited case studies highlighting multiple issues in both domains concurrently. We present a case of first-episode akinetic catatonia in a 63-year-old male with a history of treatment-resistant depression, to highlight multiple diagnostic and therapeutic challenges in catatonia and discuss learning points. The patient had a likely episode of transient ischemic attack (TIA) which precipitated delirium, and subsequently developed catatonia and severe hyponatremia . The cause behind his acute catatonia was unclear. Catatonic symptoms did not improve with benzodiazepines, while side effects of oversedation and ongoing delirium limited further uptitration of benzodiazepines. Electroconvulsive therapy was also not initiated in view of vascular risks with the recent TIA. The patient's catatonia subsequently resolved spontaneously with treatment of his medical conditions. This case highlights the complexity behind identifying etiologies of catatonia with the interplay of multiple medical conditions on the background of an affective disorder and ongoing delirium. It also illustrates therapeutic challenges in the context of unresponsiveness to benzodiazepines , presence of concomitant delirium and contraindications to initiating electroconvulsive therapy. We discuss learning points in reference to latest guidelines in management of catatonia by the British Association of Psychopharmacology (BAP), and review related literature. We discuss etiologies of catatonia, the relationship between catatonia and delirium, and offer recommendations in the face of therapeutic challenges discussed. There is a need for further research and clarification of guidelines in regard to contraindications to ECT and management of catatonia with ongoing delirium.

doi: https://doi.org/10.1016/j.psycr.2024.100226