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Karthikeyan N, Xia T, Nielsen S, Picco L. Stocking and supplying naloxone: Findings from a representative sample of community pharmacies in Victoria, Australia. Drug Alcohol Rev 2024. [PMID: 38691509 DOI: 10.1111/dar.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Naloxone is an opioid receptor antagonist, which can rapidly reverse the effects of an opioid overdose. Community pharmacists may experience several barriers to stocking and supplying naloxone including a lack of confidence or knowledge and time constraints. The current study aimed to examine the extent to which Victorian community pharmacies stock and supply naloxone and determine specific characteristics associated with stocking naloxone. METHODS A representative sample of community pharmacists (n = 558) in Victoria, Australia, were contacted between October and November 2020 and invited to participate in an online survey. Data related to pharmacy- and pharmacist-related characteristics, including stocking and frequency of supplying naloxone in the past year. Multivariate logistic regression analysis was performed to examine the effect of various covariates on stocking naloxone. RESULTS The sample comprised 265 pharmacists (response rate 47%). Most pharmacies were located in Melbourne (the capital city of Victoria, 59.6%) and were part of a pharmacy chain (61.5%). In total, 100 (38%) pharmacies stocked naloxone, a third of whom did not supply it in the past year. Pharmacies that provided opioid agonist treatment had 2.4 times higher odds of stocking naloxone (95% confidence interval 1.425-4.136; p = 0.001). DISCUSSION AND CONCLUSION Less than half of Victorian community pharmacies stock naloxone, with even fewer actually supplying it in the past year. Future efforts are needed to increase the number of pharmacies that stock naloxone and the frequency in which it is supplied, while also addressing possible barriers to stocking and supplying naloxone among community pharmacists.
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Affiliation(s)
- Nandini Karthikeyan
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- School of Medicine, Monash University, Melbourne, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Xia T, Picco L, Buchbinder R, Haas R, Nielsen S. Association of state-level prescription drug monitoring program implementation with opioid prescribing transitions in primary care in Australia. Br J Clin Pharmacol 2024. [PMID: 38308463 DOI: 10.1111/bcp.15996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 02/04/2024] Open
Abstract
AIMS This study aimed to evaluate whether voluntary and mandatory prescription drug monitoring program (PDMP) use in Victoria, Australia, had an impact on prescribing behaviour, focusing on individual patients' prescribed opioid doses and transition to prescribing of nonmonitored medications. METHODS This was a retrospective cross-sectional study using routinely collected primary healthcare data. A 90-day moving average prescribed opioid dose in oral morphine equivalents was used to estimate opioid dosage. A Markov transition matrix was used to describe how patients prescribed medications transitioned between opioid dose groups and other nonopioid treatment options during 3 transition periods: transition between 2 control periods prior to PDMP implementation (T1 to T2); during the voluntary PDMP implementation (T2 to T3); and during mandatory PDMP implementation (T3 to T4). RESULTS Among patients prescribed opioids in our study, we noted an increased probability of transitioning to not being prescribed opioids during the mandatory PDMP period (T3 to T4). This increase was attributed mainly to the ceasing of low-dose opioid prescribing. Membership in an opioid dose group remained relatively stable for most patients who were prescribed high opioid doses. For those who were only prescribed nonmonitored medications initially, the probability of being prescribed opioids increased during the mandatory PDMP when compared to other transition periods. CONCLUSION The introduction of PDMP mandates appeared to have an impact on the prescribing for patients who were prescribed low-dose opioids, while its impact on individuals prescribed higher opioid doses was comparatively limited.
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Affiliation(s)
- Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Sustainable Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Romi Haas
- Musculoskeletal Health and Sustainable Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Picco L, Xia T, Bell JS, Pearce C, Buchbinder R, Lubman DI, Nielsen S. Changes in opioid agonist treatment initiation among people prescribed opioids for pain following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis. Drug Alcohol Rev 2023; 42:1639-1646. [PMID: 37798947 PMCID: PMC10947011 DOI: 10.1111/dar.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Prescription drug monitoring programs (PDMP) are increasingly used to identify people prescribed high-dose opioids. However, little is known about whether PDMPs impact opioid agonist treatment (OAT) uptake, the gold standard for opioid use disorder. This study examined the impact of PDMP implementation on OAT initiation among people prescribed opioids, in Victoria, Australia. METHODS De-identified electronic records from all 464 Victorian general practices included in the POLAR database were used. OAT initiation was defined as a new OAT prescription between 1 April 2017 and 31 December 2020, with no OAT prescriptions in the year prior. Interrupted time series analyses were used to compare outcomes before (April 2017 to March 2019) and after (April 2019 to December 2020) PDMP implementation. Binary logistic regression was used to examine differences in patients' characteristics associated with OAT initiation prior to and after PDMP implementation. RESULTS In total, 1610 people initiated OAT, 946 before and 664 after PDMP implementation. No significant immediate (step) or longer-term (slope) changes in the rates of OAT initiation were identified following PDMP implementation, after adjusting for seasonality. A high opioid dose (>100 mg oral morphine equivalent) in the 6-months prior to OAT initiation was the only significant characteristic associated with reduced odds of OAT initiation post-PDMP implementation (odds ratio 0.29; 0.23-0.37). DISCUSSION AND CONCLUSIONS PDMP implementation did not have a significant impact on OAT initiation among people prescribed opioids. Findings suggest additional clinical initiatives that support OAT initiation are required to ensure PDMPs meet their intended target of reducing opioid-related harms.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | | | - Rachelle Buchbinder
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Turning Point, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
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Xia T, Picco L, Lalic S, Buchbinder R, Bell JS, Andrew NE, Lubman DI, Pearce C, Nielsen S. Determining the Impact of Opioid Policy on Substance Use and Mental Health-Related Harms: Protocol for a Data Linkage Study. JMIR Res Protoc 2023; 12:e51825. [PMID: 37847553 PMCID: PMC10618880 DOI: 10.2196/51825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Increasing harms related to prescription opioids over the past decade have led to the introduction of a range of key national and state policy initiatives across Australia. These include introducing a mandatory real-time prescription drug-monitoring program in the state of Victoria from April 2020 and a series of changes to subsidies for opioids on the Pharmaceutical Benefit Scheme from June 2020. Together, these changes aim to influence opioid supply and reduce harms related to prescription opioids, yet few studies have specifically explored how these policies have influenced opioid prescribing and related harms in Australia. OBJECTIVE The aim of this study is to examine the impact of a range of opioid-related policies on hospital admissions and emergency department (ED) presentations in Victoria, Australia. In particular, the study aims to understand the effect of various opioid policies and opioid-prescribing changes on (1) the number and rates of ED presentations and hospital admissions attributed to substance use (ie, opioid and nonopioid related) or mental ill-health (eg, suicide, self-harm, anxiety, and depression), (2) the association between differing opioid dose trajectories and the likelihood of ED presentations and hospital admissions related to substance use and mental ill-health, and (3) whether changes in an individual's opioid prescribing change the risk related to ED presentations and hospital admissions related to substance use and mental ill-health. METHODS We will conduct a population-level linked data study. General practice health records obtained from the Population Level Analysis and Reporting platform are linked with person-level data from 3 large hospital networks in Victoria, Australia. Interrupted time series analysis will be used to examine the impact of opioid policies on a range of harms, including the rates of presentations related to substance use (opioid and nonopioid) and mental ill-health among the primary care cohort. Group-based trajectory modeling and a case-crossover design will be used to further explore the impact of changes in opioid dosage and other covariates on opioid and nonopioid poisonings and mental ill-health-related presentations at the patient level. RESULTS Given that this paper serves as a protocol, there are currently no results available. The deidentified primary health data were sourced from electronic medical records of approximately 4,717,000 patients from 542 consenting general practices over a 6-year period (2017-2022). The submission of results for publication is planned for early 2024. CONCLUSIONS This study will add to the limited evidence base to help understand the impact of opioid policies in Australia, including whether intended or unintended outcomes are occurring as a result. TRIAL REGISTRATION EU PAS Register EUPAS104005; https://www.encepp.eu/encepp/viewResource.htm?id=104006. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51825.
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Affiliation(s)
- Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Pharmacy Department, Monash Health, Clayton, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, St Kilda, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Peninsula Health, Monash University, Frankston, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, Australia
| | | | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
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Picco L, Jung M, Cangadis-Douglass H, Lam T, Nielsen S. Identifying Prescription-Opioid-Related Risks Using Prescription Drug Monitoring Programs' Algorithms and Clinical Screening Tools. Pharmacy (Basel) 2023; 11:164. [PMID: 37888509 PMCID: PMC10609676 DOI: 10.3390/pharmacy11050164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Pharmacists adopt various approaches to identifying prescription-opioid-related risks and harms, including prescription drug monitoring programs (PDMPs) and clinical screening tools. This study aims to compare 'at-risk' patients according to the published Australian PDMP algorithms with the validated Routine Opioid Outcome Monitoring (ROOM) clinical screening tool. METHODS Data were used from an implementation study amongst people who had been prescribed regular opioids. We examined the results from ROOM and the patients' dispensing history over the previous 90 days. A chi-squared test was used to examine the association between risk according to (i) a PDMP alert and a clinical risk per ROOM; (ii) a PDMP alert and positive screening for opioid use disorder; and (iii) a PDMP 'high-dose' alert (average of >100 mg OME/day in the past 90 days) and any ROOM-validated risk. RESULTS No significant associations were found between being 'at-risk' according to any of the PDMP alerts and clinical risk as identified via the ROOM tool (x2 = 0.094, p = 0.759). There was only minimal overlap between those identified as 'at-risk' via PDMP alerts and those meeting the clinical risk indicators; most patients who were 'at-risk' of clinical opioid-related risk factors were not identified as 'at-risk' based on PDMP alerts. CONCLUSIONS PDMP alerts were not predictive of clinical risk (as per the ROOM tool), as many people with well-established clinical risks would not receive a PDMP alert. Pharmacists should be aware that PDMPs are limited to identifying medication-related risks which are derived using algorithms; therefore, augmenting PDMP information with clinical screening tools can help create a more detailed narrative of patients' opioid-related risks.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
| | - Monica Jung
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
- Centre for Medicine Use and Safety (CMUS), Parkville Campus, Monash University, 381 Royal Parade Parkville, Victoria 3052, Australia
| | - Helena Cangadis-Douglass
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
- Centre for Medicine Use and Safety (CMUS), Parkville Campus, Monash University, 381 Royal Parade Parkville, Victoria 3052, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
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Nielsen S, Picco L, Russell G, Pearce C, Andrew NE, Lubman DI, Bell JS, Buchbinder R, Xia T. Changes in opioid and other analgesic prescribing following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis of early outcomes. Int J Drug Policy 2023; 117:104053. [PMID: 37209441 DOI: 10.1016/j.drugpo.2023.104053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Australian prescription drug monitoring programs (PDMPs) provide information about a patient's recent medication history for controlled drugs at the point of prescribing and dispensing. Despite their increasing use, the evidence for PDMPs is mixed, and is almost exclusively from the United States. This study examined the impact of PDMP implementation on opioid prescribing among general practitioners in Victoria, Australia. METHOD We examined data on analgesic prescribing using electronic records of 464 medical practices in the Australian state of Victoria between 01/04/2017 and 31/12/ 2020. We used interrupted time series analyses, to examine immediate and longer-term trends in medication prescribing following voluntary (from April 2019) and mandatory PDMP implementation (from April 2020). We examined changes in three outcomes (i) 'high' opioid dose (50-100mg oral morphine equivalent daily dose (OMEDD) and over 100mg (OMEDD) prescribing (ii) prescribing of high-risk medication combinations (opioids with either benzodiazepines or pregabalin), and (iii) initiation of non-controlled pain medications (tricyclic antidepressants, pregabalin and tramadol). RESULTS We found no effect of voluntary or mandatory PDMP implementation on 'high-dose' opioid prescribing with reductions only seen in those prescribed <20mg OMEDD (i.e., the lowest dose category). Co-prescribing of opioids with benzodiazepines (additional 11.87 [95%CI 2.04 to 21.67] patients/10,000 and pregabalin (additional 3.54 [95% CI 0.82 to 6.26] patients/10,000 increased following mandatory PDMP implementation among those prescribed opioids. In contrast to trends of reduced initiation prior to PDMP implementation, we found increased new initiation of non-monitored medications following PDMP implementation (e.g., an immediate increase of 2.32 [95%CI 0.02 to 4.54], patients/10,000 received pregabalin and 3.06 [95%CI 0.54 to 5.5] patients/10,000 received tricyclic antidepressants after mandatory PDMP implementation), and increased tramadol initiation during the voluntary PDMP period (an increase of 11.26 [95%CI: 5.84, 16.67] patients /10,000). CONCLUSION PDMP implementation did not appear to reduce prescribing of high opioid doses or high-risk combinations. Increased initiation of tricyclic antidepressants, pregabalin and tramadol may indicate a possible unintended effect.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia; National Centre for Healthy Ageing, Melbourne, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Nielsen S, Buchbinder R, Pearce C, Lubman D, Lalic S, Haas R, Picco L, Jung M, Cangadis-Douglass H, Ilomaki J, Bell JS, Xia T. Cohort profile: Using primary care data to understand Opioid Prescribing, Policy Impacts and Clinical Outcomes (OPPICO) in Victoria, Australia. BMJ Open 2023; 13:e067746. [PMID: 37130678 PMCID: PMC10163530 DOI: 10.1136/bmjopen-2022-067746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
PURPOSE The OPPICO cohort is a population-based cohort based on non-identifiable electronic health records routinely collected from 464 general practices in Victoria, Australia, created with the aim of understanding opioid prescribing, policy impacts and clinical outcomes. The aim of this paper is to provide a profile of the study cohort by summarising available demographic, clinical and prescribing characteristics. PARTICIPANTS The cohort described in this paper comprises people who were aged at least 14 years at cohort entry, and who were prescribed an opioid analgesic at least once at participating practices for a total of 1 137 728 person-years from 1 January 2015 to 31 December 2020. The cohort was formed using the data collected from electronic health records through the Population Level Analysis and Reporting (POLAR) system. The POLAR data primarily consist of patient demographics, clinical measurements, Australian Medicare Benefits Scheme item numbers, diagnoses, pathology testing and prescribed medications. FINDING TO DATE In total, the cohort consists of 676 970 participants with 4 389 185 opioid prescription records from 1 January 2015 to 31 December 2020. Approximately half (48.7%) received a single opioid prescription, and 0.9% received more than 100 opioid prescriptions. The mean number of opioid prescriptions per patient was 6.5 (SD=20.9); prescriptions for strong opioids accounted for 55.6% of all opioid prescriptions. FUTURE PLANS The OPPICO cohort data will be used for various types of pharmacoepidemiological research, including examining the impact of policy changes on coprescription of opioids with benzodiazepines and gabapentin, and monitoring trends and patterns of other medication utilisation. Through data-linkage between our OPPICO cohort and hospital outcome data, we will examine whether policy changes for opioid prescribing lead to changes in prescription opioid-related harms, and other drug and mental health-related outcomes. TRIAL REGISTRATION NUMBER EU PAS Register (EUPAS43218, prospectively registered).
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Dan Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Romi Haas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Helena Cangadis-Douglass
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
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Morgan K, Solomon LM, Jones N, Picco L, Nielsen S. Building knowledge in opioid prescribing in post-operative treatment. Int J Pharm Pract 2023:7142871. [PMID: 37186142 DOI: 10.1093/ijpp/riad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/02/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Opioids prescribed in hospital are a key risk factor for harm in the community. This study aimed to gain an in-depth understanding of factors affecting post-operative opioid prescribing amongst clinicians using the capability, opportunity, motivation generate behaviour framework, more commonly known as COM-B. METHODS Focus groups and semi-structured interviews were used to gain an in-depth understanding of factors affecting optimal practice when prescribing opioids for post-operative patients at discharge. A topic guide was written using the COM-B behaviour change model to ensure the full range of possible factors influencing prescribing behaviours were explored. RESULTS We found barriers and facilitators of optimal opioid prescribing practice across all three domains of capability, opportunity and motivation. Capability among junior doctors could be increased in the areas of risk assessment and prescribing appropriate discharge analgesia, though education and training were not key barriers to improving practice. Findings indicated that opportunity to practice optimal prescribing was hindered by a lack of time at discharge and technology. Beliefs about one's own and others' responsibilities also impacted motivation to practice optimal prescribing behaviours. Pharmacists were identified as key supports for patient education and appropriate prescribing. CONCLUSIONS Educating prescribers about opioid risks and clinical practice guidelines are necessary interventions, however, our findings indicate that if implemented in isolation, they may not have the desired impact. Interventions also need to address discharge time pressures and presumptions that GPs are aware of whether opioids should be ceased or continued after surgical discharge.
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Affiliation(s)
- Kirsty Morgan
- Peninsula Health, Frankston, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | | | | | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
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Picco L, Ritter A, Nielsen S. Prescription drug monitoring programs in Australia: A call for a comprehensive evaluation. Drug Alcohol Rev 2023; 42:745-747. [PMID: 37014802 DOI: 10.1111/dar.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Picco L, Lam T, Xia T, Nielsen S. Factors associated with prescription drug monitoring program utilisation: a cross-sectional survey of community pharmacists. Int J Clin Pharm 2023; 45:421-429. [PMID: 36528707 PMCID: PMC9759276 DOI: 10.1007/s11096-022-01523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMP) are databases which collect prescribing and dispensing information for high-risk medicines, and are one approach to mitigate prescription opioid-related risks. AIM To examine correlates of PDMP use under voluntary and mandatory conditions, among a representative sample of community pharmacists in Victoria, Australia. METHOD An online anonymous survey was conducted and collected data in relation to pharmacist and pharmacy characteristics, comfort in performing certain tasks, PDMP training and the frequency of PDMP use under voluntary and mandatory conditions. Multivariate logistic regression models were performed to determine the effect of each covariate on voluntary and mandatory PDMP use. RESULTS In total, 265 pharmacists participated (response rate 47%). Under voluntary conditions, a quarter of pharmacists (24.9%) used the PDMP all the time, while half (51.7%) used the PDMP all of the time, once mandated. Pharmacies that stocked naloxone (OR: 1.96; 95% CI 1.11-3.45) and pharmacists that had attended formal PDMP training (OR: 1.78; 95% CI 1.05-3.05), were significantly associated with regular PDMP use under voluntary conditions. Under mandatory conditions, increased odds of PDMP use were associated with pharmacies that stocked naloxone (OR: 1.88; 95% CI 1.06-3.34). Pharmacists working in regional and rural areas had significantly lower odds (OR: 0.35; 95% CI 0.20-0.63) of always using the PDMP, as did pharmacists with > 15 years' experience (OR: 0.24; 95% CI 0.11-0.51) once use was mandated. CONCLUSION Given that PDMP utilisation was slower or less regular amongst pharmacists located in regional and rural areas, pharmacists with more years of experience and those not already supplying naloxone, targeted training aimed at these sub-populations may be beneficial.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
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Picco L, Sanfilippo P, Xia T, Lam T, Nielsen S. How do patient, pharmacist and medication characteristics and prescription drug monitoring program alerts influence pharmacists' decisions to dispense opioids? A randomised controlled factorial experiment. Int J Drug Policy 2022; 109:103856. [PMID: 36150356 DOI: 10.1016/j.drugpo.2022.103856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/22/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMP) are electronic databases that track the prescribing and dispensing of high-risk medicines such as opioids. They have the ability to provide clinicians with alerts, which identify medication-related risks, and are used to help inform decisions to supply. This study aimed to determine to what extent patient, pharmacist, and medication related characteristics and PDMP alerts influence decisions to dispense opioids and take other action, using a randomised controlled factorial design. METHODS Pharmacists completed an online factorial experiment, comprising six randomly generated vignettes, describing a hypothetical pharmacy patient. Pharmacists ranked the likelihood of dispensing an opioid prescription and indicated other actions, if any, they would make. Mixed-effects linear and logistical models were used to examine the association between the vignette (patient, medication and alerts), and pharmacist characteristics and the likelihood to dispense and take other actions. RESULTS 241 pharmacists were included in the analysis (n = 1353 vignettes). The PDMP alert for high dose and multiple prescriber episodes were significant predicators of reduced likelihood to dispense, with a respective 2.73- and 4.1-unit decrease in likelihood to dispense (p < 0.001). Alerts had the strongest association with other actions such as contacting the prescriber, talking to the patient and recommending naloxone, though patient and medication characteristics including age, opioid dose, benzodiazepine use and co-morbidity were also associated with increased odds of engaging in some actions. CONCLUSION PDMP alerts were the most significant predictor of reduced likelihood to dispense and were associated with the greatest odds of taking other actions. Well-established risk factors such as high dose and high-risk drug combinations, in the absence of PDMP alerts, were associated with some actions, though to a lesser degree than PDMP alerts. These findings have significant policy implications and suggest PDMP alerts are a greater driver of decisions to dispense opioids and take other actions, compared with other known clinical risk factors.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia.
| | - Paul Sanfilippo
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
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Cheetham A, Picco L, Barnett A, Lubman DI, Nielsen S. The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy. Subst Abuse Rehabil 2022; 13:1-12. [PMID: 35115860 PMCID: PMC8800858 DOI: 10.2147/sar.s304566] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/11/2022] [Indexed: 12/25/2022] Open
Abstract
Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.
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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
| | - Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
- Correspondence: Suzanne Nielsen, Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, Victoria, 3199, Australia, Tel +61 3 9904 4641, Email
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Nielsen S, Cheetham A, Jackson J, Lord S, Petrie D, Jacka D, Picco L, Morgan K. A prospective, multisite implementation-efficacy trial of a collaborative prescriber-pharmacist model of care for Medication Assisted Treatment for Opioid Dependence: Protocol for the EPIC-MATOD study. Res Social Adm Pharm 2021; 18:3394-3401. [PMID: 34924314 DOI: 10.1016/j.sapharm.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/14/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medication Assisted Treatment for Opioid Dependence (MATOD) is clinically effective and cost effective, yet a lack of MATOD prescribers in the community limits access to this treatment in Australia. These shortages are often greatest in regional and rural areas. OBJECTIVE(S) The Enhancing Pharmacist Involvement in Care (EPIC)-MATOD study will evaluate clinical and implementation outcomes among people with opioid dependence receiving MATOD through a collaborative pharmacist-prescriber model of care across multiple sites in a regional location (encompassing a mix of metropolitan and non-metropolitan areas) of Victoria, Australia. METHODS AND ANALYSIS The EPIC-MATOD study is a prospective, multisite, implementation trial of collaborative MATOD care. Pharmacists and prescribers will be recruited through the local network of opioid pharmacotherapy providers. Patients will be recruited through participating healthcare providers. After induction into the collaborative care model, patients and healthcare professionals will be followed up over 6- (patients) and 12-months (pharmacists and prescribers) in a hybrid implementation-efficacy study, with outcomes mapped to the RE-AIM framework. The primary clinical efficacy endpoint is patient retention in treatment at 26 weeks. The primary implementation outcome is treatment capacity, based on prescriber time required to provide treatment through collaborative care compared with traditional care. Secondary clinical endpoints include attendance for dosing and clinical reviews, substance use, mental and physical health and overall well-being. Implementation costs, acceptability, and provider engagement in collaborative care will be used as secondary implementation outcome indicators. Time and costs associated with collaborative care, and health service utilisation, will also be estimated. PROJECT IMPACT The study will provide important information on outcomes and acceptability of collaborative care for MATOD, as well as the cost and key considerations in delivering a collaborative model of care in Australia and other countries where similar treatment barriers exist.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia.
| | - Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - John Jackson
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sarah Lord
- Pharmacotherapy Mediation, Advocacy, and Support (PAMS), Harm Reduction Victoria, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Caulfield East, Victoria, Australia
| | - David Jacka
- Monash Health Drug and Alcohol Service, Monash Health, Melbourne, Victoria, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Kirsty Morgan
- Frankston Mornington Peninsula Primary Care Partnership, Peninsula Health, Australia
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Tse WC, Djordjevic F, Borja V, Picco L, Lam T, Olsen A, Larney S, Dietze P, Nielsen S. Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a 'moral hazard' associated with naloxone supply. Int J Drug Policy 2021; 100:103513. [PMID: 34798434 DOI: 10.1016/j.drugpo.2021.103513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Take home naloxone (THN) programs have been rapidly upscaled in response to increasing opioid-related mortality. One often cited concern is that naloxone provision could be associated with increased opioid use, due to the availability of naloxone to reverse opioid overdose. We conducted a systematic review to determine whether THN provision is associated with changes in substance use by participants enrolled in THN programs. METHODS We conducted a systematic review of the literature to assess changes in heroin or other substance use by people who use opioids following THN provision. RESULTS Seven studies with 2578 participants were included. Of the seven studies, there were two quasi-experimental studies and five cohort studies. Based on the Joanna Briggs Institute quality assessment, four studies were of moderate quality and three studies were of high quality. Of the five studies that reported on the primary outcome of heroin use, no study found evidence of increased heroin use across the study population. Five studies reported on other substance use (benzodiazepines, alcohol, cocaine, amphetamine, cannabis, prescription opioids), none of which found evidence of an increase in other substance use associated with THN provision. Four studies reported on changes in overdose frequency following THN provision: three studies reporting no change, and one study of people prescribed opioids finding a reduction in opioid-related emergency department attendances for participants who received naloxone. CONCLUSION We found no evidence that THN provision was associated with increased opioid use or overdose. Concerns that THN supply may lead to increased substance use were not supported by data from reviewed studies.
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Affiliation(s)
- Wai Chung Tse
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia; Monash University School of Medicine, Clayton Campus, Clayton, VIC 3800, Australia
| | - Filip Djordjevic
- Burnet Institute Centre for Epidemiology and Population Health Research, Melbourne, VIC 3004, Australia
| | - Viandro Borja
- Alfred Mental and Addiction Health program, Alfred Health, Melbourne, VIC 3181, Australia
| | - Louisa Picco
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia
| | - Tina Lam
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia
| | - Anna Olsen
- Australian National University College of Health & Medicine, Australia
| | - Sarah Larney
- Université de Montréal and Centre de Recherche du CHUM, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
| | - Paul Dietze
- Burnet Institute Centre for Epidemiology and Population Health Research, Melbourne, VIC 3004, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, VIC 3199, Australia.
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Picco L, Lam T, Haines S, Nielsen S. How prescription drug monitoring programs influence clinical decision-making: A mixed methods systematic review and meta-analysis. Drug Alcohol Depend 2021; 228:109090. [PMID: 34600255 DOI: 10.1016/j.drugalcdep.2021.109090] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Opioid prescribing, for chronic non-cancer pain, has increased substantially in the past two decades and is associated with significant harms. Various public health approaches have been adopted to address these harms including the implementation of prescription drug monitoring programs (PDMPs). This systematic review aims to identify how PDMP use influences healthcare providers' clinical decision-making. METHODS Six databases were searched for literature up until April 2021. Empirical studies were included, with no restrictions placed on year, location, language or study design. Thematic analysis of the identified articles was conducted and where possible, meta-analyses were conducted using a random effect model in Stata. RESULTS Forty-one articles related to 39 studies were included. All studies were conducted in the United States, published between 2005 and 2021 and most (n = 28) related to one state-level PDMP. PDMP utilisation influenced healthcare providers' clinical decision-making across seven broad themes: (i) the supply of controlled substances, (ii) refusal to prescribe or treat, (iii) risk mitigation strategies, (iv) communication, (v) education and counselling, (vi) referrals and care coordination and (vii) stigma. CONCLUSIONS PDMP use influenced healthcare providers' clinical decision-making, resulting in both intended and unintended outcomes for patients. PDMPs are a public health initiative designed to reduce harms associated with increased opioid prescribing, yet their use is associated with multiple unintended outcomes. Targeted research is needed to understand the impact of healthcare providers' clinical decision-making after PDMP utilisation, and the clinical outcomes for patients identified through these tools.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston 3199, Victoria, Australia.
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston 3199, Victoria, Australia.
| | - Sarah Haines
- Turner Institute for Brain and Mental Health, Monash University, Clayton 3800, Victoria, Australia.
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston 3199, Victoria, Australia.
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Picco L, Middleton M, Bruno R, Kowalski M, Nielsen S. Validity and Reliability of the Computer-Administered Routine Opioid Outcome Monitoring (ROOM) Tool. Pain Med 2020; 21:3645-3654. [PMID: 33094345 DOI: 10.1093/pm/pnaa297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool. DESIGN AND SETTING Cross-sectional analysis of an online sample. SUBJECTS Participants comprised those with chronic noncancer pain who regularly used prescription opioids. METHODS Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time. RESULTS A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55-0.73) with their longer counterparts. Test-retest reliability was fair (0.58-0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored. CONCLUSION The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Melissa Middleton
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michala Kowalski
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Picco L, Middleton M, Bruno R, Kowalski M, Nielsen S. Validation of the OWLS, a Screening Tool for Measuring Prescription Opioid Use Disorder in Primary Care. Pain Med 2020; 21:2757-2764. [PMID: 32869062 DOI: 10.1093/pm/pnaa275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The OWLS is a screening tool for prescription opioid use disorder designed for use in primary care. This study aimed to confirm the optimal wording, scoring methods, and cutoff for the OWLS. DESIGN AND SETTING Cross-sectional analysis of an online sample. SUBJECTS Participants comprised those with chronic noncancer pain who regularly used prescription opioids. METHODS Eligible participants self-completed an online version of the OWLS prescription opioid use disorder screening tool and the Composite International Diagnostic Interview Substance Abuse module. Receiver operating characteristics were calculated for three scoring methods for the OWLS, and these were compared with DSM-5 classification of any use disorder and moderate to severe opioid use disorder. RESULTS Among the sample (N = 324), utilizing scoring method (i) (i.e., positive endorsement ≥ response option "a little bit") and a cutoff of 3 increased the percentage of correctly classified participants, with concurrent increases in specificity and decreases in false discovery rate, and false positive rate. CONCLUSION OWLS utilizing scoring method (i) with a cutoff of 3 was shown to be the optimal version and scoring method of this tool. This represents a time-efficient, simple scoring method, allowing for quick and accurate screening for opioid use disorder to occur.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Melissa Middleton
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michala Kowalski
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Cetty L, Peh CX, Abdin E, Vaingankar JA, Shahwan S, Picco L, Prince M, Chong SA, Subramaniam M. Normative data for the 10/66 dementia research group neuropsychological test battery from Singapore's older adult population. Asian J Psychiatr 2020; 51:102019. [PMID: 32251896 DOI: 10.1016/j.ajp.2020.102019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/05/2020] [Accepted: 03/19/2020] [Indexed: 12/01/2022]
Abstract
Cognitive impairment in older adults is a major public concern for Singapore's aging population. The study aimed to (1) examine the effects of age, gender, and education on neuropsychological test performance, and (2) establish regression-based norms in the Singapore older adult (≥ 60 years) population. Data on neuropsychological test performance was extracted from the Well-being of the Singapore Elderly (WiSE) study (n = 2033). Participants who met criteria for dementia were excluded. The data included scores from the 10/66 Dementia Research Group neuropsychological test battery measuring verbal fluency, immediate memory recall, delayed memory recall, and global cognitive function. The General Linear Model (GLM) was used to examine the effects of age, gender, and education on neuropsychological test performance. Stratified weighted means and standard deviations by age, gender and education were reported to establish regression-based normative data. Results from GLM showed that older age and having lower education were associated with poorer performance on all four neuropsychological test measures, and females showed better performance on the tests for immediate memory recall and delayed memory recall. The current study provides useful information on cognitive functioning based on the 10/66 neuropsychological test battery in the older adult population in Singapore. This may help to improve neuropsychological assessments for older adults.
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Affiliation(s)
- Laxman Cetty
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
| | - Chao Xu Peh
- Clinical and Forensic Psychology Service, Ministry of Social and Family Development, Singapore 512 Thompson Road, MSF Building #12-00, 298136, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Martin Prince
- Health Services and Population Research Department, King's College London, London, UK M116, 1st Floor, Inst. of Psychiatry, Denmark Hill, United Kingdom
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore; Lee Kong Chian School of Medicine, Singapore Novena Campus, 11 Mandalay Road, 308232 Singapore
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Affiliation(s)
- Sarah Haines
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC
| | - Michael Savic
- Turning Point, Eastern Health and Monash University, Melbourne, VIC
| | - Louisa Picco
- Monash Addiction Research Centre, Monash University, Melbourne, VIC
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, VIC
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC
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Nielsen S, Picco L, Campbell G, Lintzeris N, Larance B, Farrell M, Degenhardt L, Bruno R. Development of a Brief Patient-Administered Screening Tool for Prescription Opioid Dependence for Primary Care Settings. Pain Med 2020; 21:e79-e88. [PMID: 31591644 PMCID: PMC8204889 DOI: 10.1093/pm/pnz213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To develop a short, patient-administered screening tool that will allow for earlier assessment of prescription opioid dependence (often referred to as addiction) in primary care settings. DESIGN AND SETTING Cross-sectional analysis (N = 1,134) from the two-year time point of the Pain and Opioids IN Treatment (POINT) cohort was used in the scale development. SUBJECTS Participants who completed two-year interviews in the POINT study, a prospective cohort study that followed people with chronic noncancer pain over a five-year period, and who were prescribed strong opioids for a minimum of six weeks at baseline. METHODS An advisory committee provided advice on wording and content for screening in primary care settings. Univariate logistic regression identified individual items that were significantly associated with meeting ICD-11 criteria for prescription opioid dependence. Exploratory and confirmatory factor analysis (EFA and CFA) were conducted, and items were reduced to identify a small item set that were discriminative and shared a simple underlying structure. RESULTS Sixty-four variables associated with ICD-11 criteria for prescription opioid dependence were initially identified. Four rounds of EFA were performed, resulting in five items remaining. CFA identified two possible four-item combinations, with the final combination chosen based on greater item endorsement and the results of goodness-of-fit indices. CONCLUSIONS Addressing prescription opioid dependence is an important part of the global public health challenge surrounding rising opioid-related harm. This study addresses an important initial requisite step to develop a brief screening tool. Further studies are required to validate the tool in clinical settings.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, New South Wales, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Chang S, Picco L, Abdin E, Yuan Q, Chong SA, Subramaniam M. Resilience and associative stigma among mental health professionals in a tertiary psychiatric hospital: a cross-sectional study in Singapore. BMJ Open 2019; 9:e033762. [PMID: 31888942 PMCID: PMC6937006 DOI: 10.1136/bmjopen-2019-033762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to 'bounce back' from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma. DESIGN Observational study-cross-sectional design. SETTING Tertiary psychiatry hospital in Singapore. PARTICIPANTS The study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital. MEASURES Resilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness. RESULTS Mean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores. CONCLUSION The present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential.
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Affiliation(s)
- Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Siva Kumar FD, Vaingankar JA, Sambasivam R, Abdin E, Jeyagurunathan A, Seow E, Picco L, Chong SA, Subramaniam M. Marital Status and Positive Mental Health of Psychiatric Outpatients. Ann Acad Med Singap 2019. [DOI: 10.47102/annals-acadmedsg.v48n12p429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | | | | | | | | | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Siva Kumar FD, Vaingankar JA, Sambasivam R, Abdin E, Jeyagurunathan A, Seow E, Picco L, Chong SA, Subramaniam M. Marital Status and Positive Mental Health of Psychiatric Outpatients. Ann Acad Med Singap 2019; 48:429-434. [PMID: 32112067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Picco L, Seow E, Chua BY, Mahendran R, Verma S, Xie H, Wang J, Chong SA, Subramaniam M. Help-seeking beliefs for mental disorders among medical and nursing students. Early Interv Psychiatry 2019; 13:823-831. [PMID: 29740952 PMCID: PMC6635751 DOI: 10.1111/eip.12673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 02/05/2018] [Accepted: 03/13/2018] [Indexed: 12/01/2022]
Abstract
AIM The current study aimed to investigate beliefs about help-seeking, treatment options and expected outcomes for people with alcohol abuse, dementia, depression, obsessive-compulsive disorder and schizophrenia, using a vignette-based approach, among a sample of nursing and medical students. METHODS This was a cross-sectional online study among medical and nursing students (n = 1002) who were randomly assigned 1 of 5 vignettes. Questions were asked about whom could best help the person in the vignette, the likely helpfulness of a broad range of interventions, and the likely outcome for the person in the vignette with and without appropriate help. RESULTS A total of 45.1% of students recommended seeing a psychiatrist, which was the most common source of help reported for all 5 vignettes. Help-seeking preferences were significantly associated with age, academic year and vignette type. Respondents rated seeing a psychiatrist as the most helpful intervention (92.4%) and dealing with the problem on their own as the most harmful (68.1%). Then, 81.5% of students indicated that the condition of the person in the vignette would worsen if appropriate help was not sought. CONCLUSION Medical and nursing students most commonly recommended seeking help from a psychiatrist for mental health-related problems, where help-seeking preferences were associated with various age, academic year and vignette type. As these students will be the future medical and nursing workforce, they need to be equipped with the skills and ability to recognize signs and symptoms of mental illness, to aid timely and appropriate treatment for people with mental illness.
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Affiliation(s)
- Louisa Picco
- Research DivisionInstitute of Mental HealthSingapore
| | - Esmond Seow
- Research DivisionInstitute of Mental HealthSingapore
| | | | - Rathi Mahendran
- Psychological MedicineNational University HospitalSingapore
- Clinical, Academic and Faculty AffairsDuke‐NUS Graduate Medical SchoolSingapore
| | - Swapna Verma
- Clinical, Academic and Faculty AffairsDuke‐NUS Graduate Medical SchoolSingapore
- Department of General Psychiatry and Early Psychosis Intervention ProgrammeInstitute of Mental HealthSingapore
| | - Huiting Xie
- Nursing AdministrationInstitute of Mental HealthSingapore
| | - Jia Wang
- Nursing AdministrationInstitute of Mental HealthSingapore
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Picco L, Chang S, Abdin E, Chua BY, Yuan Q, Vaingankar JA, Ong S, Yow KL, Chua HC, Chong SA, Subramaniam M. Associative stigma among mental health professionals in Singapore: a cross-sectional study. BMJ Open 2019; 9:e028179. [PMID: 31300500 PMCID: PMC6629392 DOI: 10.1136/bmjopen-2018-028179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES (1) Investigate and explore whether different classes of associative stigma (the process by which a person experiences stigmatisation as a result of an association with another stigmatised person) could be identified using latent class analysis; (2) determine the sociodemographic and employment-related correlates of associative stigma and (3) examine the relationship between associative stigma and job satisfaction, among mental health professionals. DESIGN Cross-sectional online survey. PARTICIPANTS Doctors, nurses and allied health staff, working in Singapore. METHODS Staff (n=462) completed an online survey, which comprised 11 associative stigma items and also captured sociodemographic and job satisfaction-related information. Latent class analysis was used to classify associative stigma on patterns of observed categorical variables. Multinomial logistic regression was used to examine associations between sociodemographic and employment-related factors and the different classes, while multiple linear regression analyses were used to examine the relationship between associative stigma and job satisfaction. RESULTS The latent class analysis revealed that items formed a three-class model where the classes were classified as 'no/low associative stigma', 'moderate associative stigma' and 'high associative stigma'. 48.7%, 40.5% and 10.8% of the population comprised no/low, moderate and high associative stigma classes, respectively. Multinomial logistic regression showed that years of service and occupation were significantly associated with moderate associative stigma, while factors associated with high associative stigma were education, ethnicity and occupation. Multiple linear regression analyses revealed that high associative stigma was significantly associated with lower job satisfaction scores. CONCLUSION Associative stigma was not uncommon among mental health professionals and was associated with sociodemographic factors and poorer job satisfaction. Associative stigma has received comparatively little attention from empirical researchers and continued efforts to address this understudied yet important construct in conjunction with future efforts to dispel misconceptions related to mental illnesses are needed.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Samantha Ong
- Nursing, Institute of Mental Health, Singapore, Singapore
| | - Kah Lai Yow
- Allied Health, Institute of Mental Health, Singapore, Singapore
| | - Hong Choon Chua
- Chief Executive Office, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Liu C, Heard PJ, Payton OD, Picco L, Flewitt PEJ. A comparison of two high spatial resolution imaging techniques for determining carbide precipitate type and size in ferritic 9Cr-1Mo steel. Ultramicroscopy 2019; 205:13-19. [PMID: 31234098 DOI: 10.1016/j.ultramic.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/07/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
Two high spatial resolution imaging techniques, focused gallium ion beam imaging in conjunction with XeF2 gas (FIB/XeF2) and high-speed atomic force microscopy (HS-AFM), were used to analyse 9Cr-1Mo ferritic steel samples, which had been exposed for extended periods to hot CO2 gas containing traces of CO, H2, H2O and CH4. The carbide precipitates embedded in the metal matrix were observed and their morphology, size and spatial distribution were quantified using these two techniques. The lower resolution of the FIB/XeF2 imaging technique suggested that small carbide precipitates (<50 nm) may be missed, while the existence of a limited flow layer introduced by sample preparation may influence the HS-AFM results. The gallium ion beam was used to remove a thin oxide layer of approximately 50 nm from sample surfaces prior to FIB/XeF2 imaging, avoiding the influence of surface contamination. HS-AFM provided higher resolution (∼5 nm) than FIB/XeF2 imaging. A quantitative comparison of the experimental data confirmed the value of both FIB/XeF2 and HS-AFM for imaging carbide precipitates, while clarifying their strengths and limitations.
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Affiliation(s)
- C Liu
- Interface Analysis Centre, H.H. Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
| | - P J Heard
- Interface Analysis Centre, H.H. Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK.
| | - O D Payton
- Interface Analysis Centre, H.H. Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
| | - L Picco
- Department of Physics, Virginia Commonwealth University, Richmond, 23284 VA, USA
| | - P E J Flewitt
- Interface Analysis Centre, H.H. Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK; School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, BS8 1TL, UK
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Subramaniam M, Abdin E, Vaingankar JA, Sagayadevan V, Shahwan S, Picco L, Chong SA. Validation of the World Health Organization Disability Assessment Schedule 2.0 among older adults in an Asian country. Singapore Med J 2019; 61:246-253. [PMID: 31197373 DOI: 10.11622/smedj.2019049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION As populations age globally and the burden of chronic illnesses increases, valid measures of disability are needed for assessment in the older adult population. The aim of the current analysis was to explore the psychometric properties and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an epidemiological survey of older adults in Singapore. METHODS The study comprised secondary data analysis of the Well-being of the Singapore Elderly study. Inclusion criteria for the study were Singapore residents (Singapore citizens and permanent residents) aged 60 years and above. The 12-item interviewer-administered version of the WHODAS 2.0 was used to assess disability in the study. Data on cognition, health status and sociodemographic information were collected. Depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy. RESULTS The study found a one-factor model solution for WHODAS 2.0 with a high internal consistency of all items. The internal consistency for the overall scale was 0.92. The WHODAS 2.0 score positively correlated with multimorbidity, perceived overall health status, depression and subsyndromal depression. There was a significant inverse association between the WHODAS 2.0 score and the cognitive status. After adjustment for all sociodemographic variables in the multiple linear regression analysis, these measures remained significantly associated with the WHODAS 2.0 score. CONCLUSION WHODAS 2.0 was found to be a valid measure of disability among older adults. However, further research is required to determine its usefulness as a responsive instrument that can detect change following interventions.
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Affiliation(s)
| | | | | | | | | | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Mazzorana B, Picco L, Rainato R, Iroumé A, Ruiz-Villanueva V, Rojas C, Valdebenito G, Iribarren-Anacona P, Melnick D. Cascading processes in a changing environment: Disturbances on fluvial ecosystems in Chile and implications for hazard and risk management. Sci Total Environ 2019; 655:1089-1103. [PMID: 30577103 DOI: 10.1016/j.scitotenv.2018.11.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 06/09/2023]
Abstract
The compound hazard effects of multiple process cascades severely affect Chilean river systems and result in a large variety of disturbances on their ecosystems and alterations of their hydromorphologic regimes leading to extreme impacts on society, environment and infrastructure. The acute, neo-tectonically pre-determined susceptibility to seismic hazards, the widespread volcanic activity, the increasing glacier retreat and the continuous exposure to forest fires clearly disturb entire riverine systems and concur to trigger severe floods hazards. With the objective to refine the understanding of such cascading processes and to prospect feasible flood risk management strategies in such a rapidly changing environment we first classify the large river basins according to a set of disturbances (i.e. volcanic eruptions, earthquakes, glacier lake outburst floods, wild fires and mass movements). Then, we describe emblematic cases of process cascades which affected specific Chilean drainage basins and resulted in high losses as tangible examples of how the cascading processes may unfold in other river basins with similar characteristics. As an attempt to enrich the debate among management authorities and academia in Chile, and elsewhere, on how to sustainably manage river systems, we: a) highlight the pivotal need to determine the possible process cascades that may profoundly alter the system and b) we suggest to refine hazard and risk assessments accordingly, accounting for the current and future exposure. We advocate, finally, for the adoption of holistic approaches promoting anticipatory adaptation which may result in resilient system responses.
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Affiliation(s)
- B Mazzorana
- Universidad Austral de Chile, Faculty of Science, Instituto de Ciencias de la Tierra, Valdivia, Chile; CYCLO - Millennium Nucleus the seismic cycle along subduction zones, Valdivia, Chile; Universidad Austral de Chile, RINA - Natural and Anthropogenic Risks Research Center, Valdivia, Chile.
| | - L Picco
- University of Padova, Department of Land, Environment, Agriculture and Forestry, Padova, Italy; Universidad Austral de Chile, Faculty of Engineering, Valdivia, Chile; Universidad Austral de Chile, RINA - Natural and Anthropogenic Risks Research Center, Valdivia, Chile
| | - R Rainato
- University of Padova, Department of Land, Environment, Agriculture and Forestry, Padova, Italy
| | - A Iroumé
- Universidad Austral de Chile, Faculty of Forest Sciences and Natural Resources, Valdivia, Chile; Universidad Austral de Chile, RINA - Natural and Anthropogenic Risks Research Center, Valdivia, Chile
| | - V Ruiz-Villanueva
- University of Geneva, Institute for Environmental Sciences, Geneva, Switzerland; University of Bern, Dendrolab.ch, Institute of Geological Sciences, Bern, Switzerland
| | - C Rojas
- Universidad Austral de Chile, Faculty of Science, Instituto de Ciencias de la Tierra, Valdivia, Chile
| | - G Valdebenito
- Universidad Austral de Chile, Faculty of Engineering, Valdivia, Chile; Universidad Austral de Chile, RINA - Natural and Anthropogenic Risks Research Center, Valdivia, Chile
| | - P Iribarren-Anacona
- Universidad Austral de Chile, Faculty of Science, Instituto de Ciencias de la Tierra, Valdivia, Chile
| | - D Melnick
- Universidad Austral de Chile, Faculty of Science, Instituto de Ciencias de la Tierra, Valdivia, Chile; CYCLO - Millennium Nucleus the seismic cycle along subduction zones, Valdivia, Chile; Universidad Austral de Chile, TAQUACh - Transdisciplinary Studies of the Quaternary Period in the South of Chile, Valdivia, Chile
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Radaelli M, Verna F, Pautasso A, Bellavia V, Ballardini M, Mignone W, Masoero L, Dondo A, Orusa R, Picco L, Moschi R, Mosca A, Chianese R, Chiavacci L, Casalone C. “One Health” approach in West Nile disease surveillance: the northwestern Italian experience. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sambasivam R, Liu J, Vaingankar JA, Ong HL, Tan ME, Fauziana R, Picco L, Chong SA, Subramaniam M. The hidden patient: chronic physical morbidity, psychological distress, and quality of life in caregivers of older adults. Psychogeriatrics 2019; 19:65-72. [PMID: 30182505 PMCID: PMC6635743 DOI: 10.1111/psyg.12365] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/20/2018] [Accepted: 07/18/2018] [Indexed: 12/04/2022]
Abstract
AIM Increasing demands for care provision to older adults require good physical and mental health among caregivers. Few studies have examined the health status and correlates of quality of life among caregivers of older adults. The present study therefore sought to examine the prevalence of chronic physical conditions, psychological distress, and correlates of physical and mental quality of life among caregivers of older adults (≥60 years) in Singapore. METHODS Participants were 285 informal caregivers who were providing care to an older relative. Participants were recruited at the Institute of Mental Health, Singapore, and they completed self-report measures on chronic physical morbidity, psychological distress, and physical and mental quality of life. Multiple regression models were constructed to examine correlates of physical and mental quality of life. RESULTS More than half of the caregivers had at least one chronic physical condition (58.6%) and psychological distress (52.6%). Chronic physical morbidity, psychological distress, and secondary education status were associated with lower physical quality of life. Psychological distress, younger age, primary education status, and more time spent caregiving were associated with lower mental quality of life. CONCLUSION Poor physical and mental health among caregivers may impair their ability to provide adequate care to older adults with progressive medical needs. It is important for medical practitioners not to neglect the physical and mental health of caregivers through continued assessment of chronic physical morbidity, psychological distress, and quality of life.
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Affiliation(s)
| | - Jianlin Liu
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Hui L Ong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Min-En Tan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Restria Fauziana
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Subramaniam M, Abdin E, Vaingankar JA, Sambasivam R, Seow E, Picco L, Chua HC, Mahendran R, Ng LL, Chong SA. Successful ageing in Singapore: prevalence and correlates from a national survey of older adults. Singapore Med J 2018; 60:22-30. [PMID: 29774358 DOI: 10.11622/smedj.2018050] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The current study aimed to estimate the overall prevalence and sociodemographic correlates of successful ageing, as defined by Rowe and Kahn, among a national sample of multiethnic adults aged 60 years and older in Singapore. METHODS Data from older adults who participated in the Well-being of the Singapore Elderly study was analysed. Successful ageing was defined with five indicators: no major diseases; no disability; high cognitive functioning; high physical functioning; and active engagement with life. RESULTS The prevalence of successful ageing was 25.4% in this older population. Older adults aged 75-84 years and ≥ 85 years had 0.3 times and 0.1 times the odds of successful ageing, respectively, than those aged 60-74 years. Compared to older adults of Chinese ethnicity, those of Malay (odds ratio [OR] 0.6) and Indian (OR 0.5) ethnicities were less likely to be associated with successful ageing. Older adults with lower education levels, who had no formal education (OR 0.2), some schooling but did not complete primary education (OR 0.4) or only primary education (OR 0.5), had lower odds of ageing successfully than those with tertiary education. CONCLUSION Older adults in Singapore tend to have much more active engagement with life as compared to their counterparts from other countries. Further research into this population is needed, both in terms of qualitative research to gain a better understanding of successful ageing from the older adult's perspective, as well as longitudinal studies that explore behavioural determinants of successful ageing.
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Affiliation(s)
| | | | | | | | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | | | - Rathi Mahendran
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Li Ling Ng
- Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Subramaniam M, Abdin E, Shahwan S, Satghare P, Vaingankar JA, Rama Sendren J, Picco L, Chua BY, Ng BT, Chong SA, Verma S. Prevalence, correlates and outcomes of insomnia in patients with first episode psychosis from a tertiary psychiatric institution in Singapore. Gen Hosp Psychiatry 2018; 51:15-21. [PMID: 29268166 DOI: 10.1016/j.genhosppsych.2017.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The study aimed to evaluate the prevalence of insomnia in patients with first episode psychosis (FEP) and to explore the relationship between insomnia and socio-demographic and clinical variables as well as quality of life (QOL) and functioning in Singapore. METHODS Data on sleep, smoking, alcohol habits, QOL and socio-demographics were collected from 280 FEP patients who were enrolled in the Early Psychosis Intervention Programme (EPIP) within 3months of joining the programme. Multiple logistic regression analyses were performed to determine the socio-demographic and clinical correlates of insomnia. The association of insomnia with QOL as well as functioning was examined using multiple linear regression analyses. RESULTS The prevalence of clinical insomnia was 22.6%. Older age and higher dosage of antipsychotic medication were significantly associated with a lower risk of insomnia while hazardous alcohol use, current smoking and a longer duration of untreated psychosis were significantly associated with a higher risk of insomnia. Insomnia was associated with significant decreases in all QOL domains assessed in the study even after adjusting for confounders. CONCLUSIONS FEP patients with insomnia must be screened for hazardous alcohol use and smoking. Patients must be referred concurrently for treatment of insomnia, smoking cessation as well as brief intervention for hazardous alcohol use when needed.
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Affiliation(s)
| | | | | | | | | | - Jagan Rama Sendren
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | | | - Boon Tat Ng
- Pharmacy Department, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore; Duke-NUS Medical School, Singapore
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Abdin E, Sagayadevan V, Vaingankar JA, Picco L, Chong SA, Subramaniam M. A Non-Parametric Item Response Theory Evaluation of the CAGE Instrument Among Older Adults. Subst Use Misuse 2018; 53:391-399. [PMID: 28777686 DOI: 10.1080/10826084.2017.1332645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The validity of the CAGE using item response theory (IRT) has not yet been examined in older adult population. OBJECTIVE This study aims to investigate the psychometric properties of the CAGE using both non-parametric and parametric IRT models, assess whether there is any differential item functioning (DIF) by age, gender and ethnicity and examine the measurement precision at the cut-off scores. METHODS We used data from the Well-being of the Singapore Elderly study to conduct Mokken scaling analysis (MSA), dichotomous Rasch and 2-parameter logistic IRT models. The measurement precision at the cut-off scores were evaluated using classification accuracy (CA) and classification consistency (CC). RESULTS The MSA showed the overall scalability H index was 0.459, indicating a medium performing instrument. All items were found to be homogenous, measuring the same construct and able to discriminate well between respondents with high levels of the construct and the ones with lower levels. The item discrimination ranged from 1.07 to 6.73 while the item difficulty ranged from 0.33 to 2.80. Significant DIF was found for 2-item across ethnic group. More than 90% (CC and CA ranged from 92.5% to 94.3%) of the respondents were consistently and accurately classified by the CAGE cut-off scores of 2 and 3. CONCLUSIONS The current study provides new evidence on the validity of the CAGE from the IRT perspective. This study provides valuable information of each item in the assessment of the overall severity of alcohol problem and the precision of the cut-off scores in older adult population.
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Affiliation(s)
| | | | | | - Louisa Picco
- a Research Division , Institute of Mental Health , Singapore
| | - Siow Ann Chong
- a Research Division , Institute of Mental Health , Singapore
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Picco L, Lau YW, Pang S, Jeyagurunathan A, Vaingankar JA, Abdin E, Chong SA, Subramaniam M. Predictors of General Functioning and Correlates of Quality of Life: A Cross-Sectional Study among Psychiatric Outpatients. Ann Acad Med Singap 2018; 47:3-12. [PMID: 29493706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Functioning and quality of life (QOL) are negatively impacted as a result of mental illness. This study aimed to determine the: i) socio-demographic and clinical correlates of functioning and; ii) associations between functioning and QOL in a multiethnic sample of psychiatric outpatients. MATERIALS AND METHODS This was a cross-sectional study of outpatients receiving treatment from a tertiary psychiatric hospital. Functioning was assessed using the Global Assessment of Functioning (GAF) scale, while QOL was measured using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) which comprises 4 domains: physical health, psychological health, social relationships and environment. RESULTS Various socio-demographic and clinical correlates were associated with functioning including employment and marital status, education and diagnosis. Depression was the only clinical characteristic which negatively correlated with functioning (P = 0.035). Amongst the whole sample, multiple linear regressions revealed that functioning was positively associated with all 4 QOL domains (physical health [P <0.001], psychological health [P <0.001], social relationships [P <0.001] and environment [P <0.001]). Further analysis of each diagnostic group revealed that functioning was positively associated with all 4 QOL domains in the anxiety, depression and obsessive compulsive disorder subsamples, while in the schizophrenia subsample, functioning was only significantly associated with all environment domain. CONCLUSION Functional impairments were associated with different socio-demographic and clinical characteristics, which should be addressed when planning tailored treatment and interventions. Given that functioning is significantly associated with QOL, it is crucial to regularly assess and monitor them (in addition to symptomatic outcomes and adopting a more holistic and biopsychosocial approach).
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore
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Picco L, Seow E, Chua BY, Mahendran R, Verma S, Chong SA, Subramaniam M. Recognition of mental disorders: findings from a cross-sectional study among medical students in Singapore. BMJ Open 2017; 7:e019038. [PMID: 29273669 PMCID: PMC5778286 DOI: 10.1136/bmjopen-2017-019038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/29/2017] [Accepted: 10/26/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess recognition of five mental disorders (alcohol abuse, dementia, depression, obsessive-compulsive disorder (OCD) and schizophrenia) among a sample of medical students using a vignette-based approach. Socio-demographic predictors of correct recognition were also explored. DESIGN Cross-sectional online survey. PARTICIPANTS Medical students studying in Singapore. METHODS This was a cross-sectional online study among medical students (n=502) who were randomly assigned one of the five vignettes. Students were instructed to read the vignette, then answer the open text question, 'What do you think the person in the vignette is suffering from?' Multiple logistic regression was performed to determine the predictors of correct recognition. RESULTS 81.7% could correctly recognise the condition described in the vignette. Depression was most well recognised (93.0%), followed by alcohol abuse (89.0%), OCD (87.1%) and dementia (79.2%), while only 60.0% of students correctly recognised schizophrenia. Females were significantly more likely to correctly recognise the disorders, while the odds of correct recognition were significantly higher among fourth-year and fifth-year students compared with first-year students. Compared with depression, dementia and schizophrenia were significantly more likely to be mislabelled. CONCLUSION While overall correct recognition was high (81.7%), this did vary by disorder, where schizophrenia (60%) was the most poorly recognised condition. Given that primary care providers are often the first professional help-seeking source for people with mental health problems, medical students should be equipped with the skills and ability to recognise signs and symptoms of various mental illnesses.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore
| | | | - Rathi Mahendran
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Clinical, Academic and Faculty Affairs, Duke-NUS Graduate Medical School, Singapore
| | - Swapna Verma
- Department of Clinical, Academic and Faculty Affairs, Duke-NUS Graduate Medical School, Singapore
- Department of General Psychiatry and Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Yuan Q, Picco L, Chang S, Abdin E, Chua BY, Ong S, Yow KL, Chong SA, Subramaniam M. Attitudes to mental illness among mental health professionals in Singapore and comparisons with the general population. PLoS One 2017; 12:e0187593. [PMID: 29145419 PMCID: PMC5690645 DOI: 10.1371/journal.pone.0187593] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 10/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background Similar to the general public, mental health professionals sometimes also have negative attitudes towards individuals with mental illness; which could ultimately affect the quality of care received by the patients. This study aims to explore attitudes to mental illness among mental health professionals in Singapore; make comparisons with the general population; and investigate the significant correlates. Methods A cross-sectional design was used. Eligible participants were recruited from the Institute of Mental Health, Singapore. Attitudes to mental illness among the mental health professionals were measured using an adapted 26-item Attitudes to Mental Illness questionnaire (AMI). An earlier study amongst the general population in Singapore had used the same tool; however, factor analysis suggested a 20-item, 4-factor structure (AMI-SG) was the best fit. This 4-factor structure was applied among the current sample of mental health professionals to allow comparisons between the professionals and the general population. Data were collected through an online survey tool ‘Questionpro’ from February to April 2016, and 379 participants were included in the current analysis. Attitudes to mental illness among these professionals were compared to those of the general population, which were captured as part of a national study conducted from March 2014 to April 2015. Results The 20-item, 4-factor structure AMI-SG derived from the general population was applicable among the mental health professionals in Singapore. Compared to the general population, mental health professionals had significantly more positive attitudes to mental illness; however their scores on ‘social distancing’ did not differ from the general population. Indian ethnicity was negatively associated with ‘social distancing’ and ‘social restrictiveness’ among the professionals; while higher education was negatively related to ‘prejudice and misconception’. Compared to nurses, doctors showed significantly more positive attitudes on ‘social restrictiveness’ and ‘prejudice and misconception’. Having family or close friends diagnosed with mental illness was negatively associated with ‘social distancing’ among the professionals. Conclusion The AMI-SG is an effective tool to measure attitudes to mental illness among mental health professionals in Singapore. Although the professionals had significantly more positive attitudes to mental illness than the general public in Singapore, their attitudes on ‘social distancing’ resembled closely that of the general public. Professionals tended to have more negative attitudes if they were nurses, less educated, and of Chinese ethnicity. More studies are needed to explore the underlying reasons for the differences and to generalize these findings among mental health professionals elsewhere.
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Affiliation(s)
- Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
- * E-mail:
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Samantha Ong
- Nursing Administration, Institute of Mental Health, Singapore, Singapore
| | - Kah Lai Yow
- Clinical and Allied Health Professionals Services, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Shafie S, Shahwan S, Abdin E, Vaingankar J, Picco L, Sambasivam R, Zhang Y, Ng LL, Chong SA, Subramaniam M. The correlates of slow gait and its relation with social network among older adults in Singapore. Aging Ment Health 2017; 21:1171-1176. [PMID: 27433876 DOI: 10.1080/13607863.2016.1202893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status. METHODS Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample. RESULTS The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score. CONCLUSION Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.
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Affiliation(s)
- Saleha Shafie
- a Research Division , Institute of Mental Health , Singapore
| | - Shazana Shahwan
- a Research Division , Institute of Mental Health , Singapore
| | | | | | - Louisa Picco
- a Research Division , Institute of Mental Health , Singapore
| | | | - Yunjue Zhang
- a Research Division , Institute of Mental Health , Singapore
| | - Li Ling Ng
- b Department of Psychological Medicine , Changi General Hospital , Singapore
| | - Siow Ann Chong
- a Research Division , Institute of Mental Health , Singapore
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Lau YW, Picco L, Pang S, Jeyagurunathan A, Satghare P, Chong SA, Subramaniam M. Stigma resistance and its association with internalised stigma and psychosocial outcomes among psychiatric outpatients. Psychiatry Res 2017; 257:72-78. [PMID: 28734239 DOI: 10.1016/j.psychres.2017.07.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/31/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Abstract
Studies have suggested that stigma resistance plays an important role in the recovery from mental illness. However, there has been limited research in Asian countries that has examined the benefits of stigma resistance among the mentally ill in Asian populations. Hence, this study aimed to assess the prevalence of stigma resistance and establish the socio-demographic correlates of stigma resistance, as well as its association with internalised stigma and psychosocial outcomes among a multi-ethnic population of 280 outpatients with obsessive compulsive disorder (OCD), schizophrenia, depressive disorders and anxiety disorders in Singapore. Prevalence of stigma resistance measured using the Stigma Resistance subscale of the Internalised Stigma of Mental Illness Scale was 82.9%. ANOVA and logistic regressions were conducted and results revealed that: (i) Stigma resistance was positively associated with being separated/divorced/widowed but negatively associated with depression diagnosis; (ii) Psychosocial outcomes such as self-esteem and psychological health were positively associated with stigma resistance; and (iii) Internalised stigma was negatively associated with stigma resistance. Moving forward, treatments could emphasize on improving the self-esteem and psychological health of patients to increase their stigma resistance for counteracting effects of public and internalised stigma.
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Affiliation(s)
- Ying Wen Lau
- Research Division, Institute of Mental Health, Singapore.
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | - Shirlene Pang
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Pang S, Abdin E, Chong SA, Chua BY, Lee SP, Picco L, Satghare P, Vaingankar J, Verma S, Subramaniam M. Correlates of Online Game Play Motivations, Social Anxiety and Psychological Distress. Ann Acad Med Singap 2017; 46:443-446. [PMID: 29288264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Shirlene Pang
- Research Division, Institute of Mental Health, Singapore
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Picco L, Lau YW, Pang S, Abdin E, Vaingankar JA, Chong SA, Subramaniam M. Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore. BMJ Open 2017; 7:e018228. [PMID: 28851803 PMCID: PMC5724097 DOI: 10.1136/bmjopen-2017-018228] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To examine whether self-stigma mediates the relationship between perceived stigma and quality of life, self-esteem and general functioning among outpatients with depression, schizophrenia, anxiety and obsessive-compulsive disorder (OCD). DESIGN Cross-sectional survey. SETTING Outpatient clinics at a tertiary psychiatric hospital in Singapore. PARTICIPANTS 280 outpatients with a primary clinical diagnosis of either schizophrenia, depression, anxiety or OCD. METHODS Data were collected in relation to self-stigma, perceived stigma, self-esteem, functioning and quality of life. In order to examine the mediating role of self-stigma on the relationship between perceived stigma and psychosocial outcomes, bootstrapping mediation analyses were used. RESULTS Mediation analyses revealed that the relationship between perceived stigma and psychosocial outcomes was subject to the effects of self-stigma among the overall sample. Separate mediation analyses were conducted by diagnoses and showed differences in the mediating effects of self-stigma. Among the whole sample and the subsample with OCD, self-stigma mediated the relationship between perceived stigma and all psychosocial outcomes. For those with anxiety, depression and schizophrenia, the mediating effects of self-stigma were present in all relationships except (1) perceived stigma with physical health in the anxiety sample, (2) perceived stigma with social relationships in the depression sample and (3) perceived stigma with physical health in the schizophrenia sample. CONCLUSIONS The mediating effects of self-stigma on the relationship between perceived stigma and various psychosocial outcomes are evident and differ across diagnoses. Interventions to address and reduce the effects of self-stigma along with targeted treatments and psychoeducation to assist people with mental illness overcome or better manage self-stigma while providing them the skills to counteract public stigma are needed.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | - Ying Wen Lau
- Research Division, Institute of Mental Health, Singapore
| | - Shirlene Pang
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Vaingankar JA, Abdin E, Chong SA, Sambasivam R, Seow E, Jeyagurunathan A, Picco L, Stewart-Brown S, Subramaniam M. Psychometric properties of the short Warwick Edinburgh mental well-being scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders. Health Qual Life Outcomes 2017; 15:153. [PMID: 28764770 PMCID: PMC5539899 DOI: 10.1186/s12955-017-0728-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/21/2017] [Indexed: 01/07/2023] Open
Abstract
Background To establish the validity and reliability of the Short Warwick Edinburgh Mental Well-being Scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders in Singapore and estimate SWEMWBS scores across socio-demographic and the three psychiatric diagnostic groups in the sample. Methods This secondary analysis was conducted using data from a study among outpatients of a tertiary psychiatric hospital. In addition to the SWEMWBS, socio-demographic data and current psychiatric diagnosis were collected. Service users were also administered the Global Assessment of Functioning (GAF), Patient Health Questionnaire (PHQ)-8, Generalised Anxiety Disorder (GAD)-7, Satisfaction with Life Scale (SWLS) and the Positive Mental Health (PMH) instrument. The SWEMWBS was tested for factorial validity, reliability and convergent and divergent validity. Results In total, 350 service users with a mean (SD) age of 39.1 (11.1) years were included in this study of which 39.4%, 38.9% and 21.7% had schizophrenia, depression and anxiety spectrum disorders, respectively. The single factor structure of the SWEMWBS was confirmed by confirmatory factor analysis (CFI = 0.969, TLI = 0.954, RMSEA = 0.029). The internal consistency reliability was high (Cronbach’s alpha = 0.89). The convergent and divergent validity testing revealed that the SWEMWBS scores had significant moderate to high positive correlations with GAF, SWLS and PMH scores and moderate negative correlations with (PHQ)-8 and (GAD)-7 scores. SWEMWBS scores were higher in married participants (22.2 (5.4) versus never married: 20.7 (5.3) and divorced/separated/widowed: 20.4 (5.1), p = 0.049) and among those with schizophrenia (22.8 (5.5) versus depression:19.6 (4.7) and anxiety spectrum disorders 20.9 (5.2), p < 0.001). Conclusion These results demonstrate adequate validity and reliability of the SWEMWBS in people with schizophrenia, depression and anxiety spectrum disorders in Singapore.
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Affiliation(s)
- Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Rajeswari Sambasivam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Esmond Seow
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | | | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
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Picco L, Yuan Q, Vaingankar JA, Chang S, Abdin E, Chua HC, Chong SA, Subramaniam M. Positive mental health among health professionals working at a psychiatric hospital. PLoS One 2017; 12:e0178359. [PMID: 28591203 PMCID: PMC5462373 DOI: 10.1371/journal.pone.0178359] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Positive mental health (PMH) is a combination of emotional, psychological and social well-being that is necessary for an individual to be mentally healthy. The current study aims to examine the socio-demographic differences of PMH among mental health professionals and to explore the association between job satisfaction and total PMH. METHODS Doctors, nurses and allied health staff (n = 462) completed the online survey which included the multidimensional 47-item PMH instrument as well as a single item job satisfaction question. Associations of PMH with job satisfaction were investigated via linear regression models. RESULTS Significant differences in PMH total and domain specific scores were observed across socio-demographic characteristics. Age and ethnicity were significantly correlated with PMH total scores as well as various domain scores, while gender, marital and residency status and the staff's position were only significantly correlated with domain specific scores. Job satisfaction was also found to be a significantly associated with total PMH. CONCLUSION The workplace is a key environment that affects the mental health and well-being of working adults. In order to promote and foster PMH, workplaces need to consider the importance of psychosocial well-being and the wellness of staff whilst providing an environment that supports and maintains overall health and work efficiency.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Hong Choon Chua
- Chief Executive Office, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Tan ME, Sagayadevan V, Abdin E, Picco L, Vaingankar J, Chong SA, Subramaniam M. Employment status among the Singapore elderly and its correlates. Psychogeriatrics 2017; 17:155-163. [PMID: 27356949 DOI: 10.1111/psyg.12206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/16/2016] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
AIM It has been hypothesized that working beyond retirement age may have a protective effect on various aspects of well-being in the elderly. This paper aims to examine the relationship between employment status of elderly Singaporeans and indicators of well-being. METHODS As part of the Well-being of the Singapore Elderly study, data relating to sociodemographics, social networks, medical history, physical activity, cognitive function, and disability were collected from 2534 participants aged 60 years and older. Participants included full-time workers (n = 483), part-time workers (n = 205), the unemployed (n = 32), homemakers (n = 808), and retirees (n = 1006). The data were analyzed by multiple logistic regression. RESULTS Likelihood of being employed decreased with age, and employment was higher among men. Paid workers had significantly higher levels of physical activity, more extensive social networks, better cognitive function, less disability, and lower risk of dementia than retirees and homemakers. Paid workers had significantly lower chronic disease burden than retirees and rated their health to be better than retirees and the unemployed. CONCLUSIONS These findings show that meaningful employment is associated with better psychological and physiological well-being among the elderly, highlighting the importance of studying likely protective effects of employment and creating employment opportunities for elderly Singaporeans.
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Affiliation(s)
- Min-En Tan
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Abdin E, Vaingankar JA, Picco L, Chua BY, Prince M, Chong SA, Subramaniam M. Validation of the short version of the 10/66 dementia diagnosis in multiethnic Asian older adults in Singapore. BMC Geriatr 2017; 17:94. [PMID: 28431511 PMCID: PMC5399400 DOI: 10.1186/s12877-017-0475-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/01/2017] [Indexed: 11/21/2022] Open
Abstract
Background To validate the short version of the 10/66 dementia diagnosis against the standard version of the 10/66 dementia diagnosis and clinical diagnosis and examine concurrent validity with the World Health Organisation Disability Assessment schedule and care needs in a multiethnic Asian older adult population in Singapore. Methods Data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older Singapore Resident population aged 60 years and above was used. The validity of the short version of the 10/66 dementia diagnostic criteria derived from the Community Screening Instrument for Dementia, the modified Consortium to Establish a Registry of Alzheimer’s Disease 10-word list delayed recall and the EURO-D depression screen were examined against the standard version of the 10/66 dementia diagnosis and clinician diagnosis as a gold standard. Concurrent validity was tested by examining the relationships between the short version 10/66 dementia diagnosis, disability and care needs. Results A total of 2373 respondents who had completed data on the short version diagnosis were included in this study. The majority (82.63%) of respondents were of Chinese descent, 9.86% were Malays, 6.12% were of Indian descent and 1.39% belonged to other ethnic group. We found the short version 10/66 dementia diagnosis showed almost perfect agreement with the standard version 10/66 dementia diagnosis (kappa = 0.90, AUC = 0.96) and substantial agreement with clinical diagnosis (kappa = 0.70, AUC = 0.87). The weighted prevalence of dementia in the population was slightly higher based on the short version diagnosis than the standard version diagnosis (10.74% vs. 10.04%). We also found that those with the short version 10/66 dementia were significantly associated with higher disability (β = 28.90, 95% CI = 23.62, 9.62) and needed care occasionally (OR =35.21, 95% CI = 18.08, 68.59) or much of the time (OR = 9.02, 95% CI = 5.21, 15.61). Conclusions The study found that the short version 10/66 dementia diagnosis has excellent validity to diagnose dementia in a multiethnic Asian population in Singapore. Further research is required to determine the usefulness of this diagnosis in clinical practice or institutional settings to aid early detection and intervention for dementia.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore.
| | | | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
| | - Martin Prince
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
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Subramaniam M, Abdin E, Picco L, Shahwan S, Jeyagurunathan A, Vaingankar JA, Chong SA. Continuum beliefs and stigmatising beliefs about mental illness: results from an Asian community survey. BMJ Open 2017; 7:e014993. [PMID: 28381420 PMCID: PMC5594210 DOI: 10.1136/bmjopen-2016-014993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To establish the prevalence and correlates of continuum beliefs for five mental illnesses in a multiethnic population and to explore its association with stigma. DESIGN A community-based, cross-sectional study. SETTING A national study in a multiethnic Asian country. PARTICIPANTS A comprehensive study of 3006 Singapore residents (Singapore citizens and permanent residents) aged 18-65 years who were living in Singapore at the time of the survey. OUTCOME MEASURES Parameters assessed included belief in a continuum of symptom experience, stigma dimensions and causal beliefs in mental illness. Statistical analyses included descriptive statistics and multiple linear regression (MLR). RESULTS About half of the population indicated agreement with a continuum of symptoms for depression (57.9%) and dementia (46.8%), whereas only about one in three respondents agreed with it for alcohol abuse (35.6%), schizophrenia (32.7%) and obsessive-compulsive disorder (OCD) (36.8%). MLR analyses revealed that students (β=0.28; 95% CI 0.05 to 0.50; p=0.018) and those who were unemployed (β=0.60; 95% CI 0.26 to 0.95; p=0.001) (vs employed) as well as those who had previous contact with people with mental illness (β = 0.31; 95% CI 0.18 to 0.45; p<0.001) and believed stress, family arguments, difficulties at work or financial difficulties to be a cause for mental illness (β=0.43; 95% CI 0.13 to 0.73; p=0.005) were associated with a higher belief in a continuum of symptom experience. Continuum beliefs were related to lower desire for social distance in alcohol abuse, OCD and schizophrenia; however, they were associated with higher scores on 'weak-not-sick' stigma dimension in dementia and schizophrenia. CONCLUSIONS Perceiving that a person with a mental illness is similar to themselves may reduce social distancing by the public. Thus, the approach may lend itself well to public education aimed at reducing stigma.
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Affiliation(s)
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Subramaniam M, Satghare P, Vaingankar JA, Picco L, Browning CJ, Chong SA, Thomas SA. Responsible gambling among older adults: a qualitative exploration. BMC Psychiatry 2017; 17:124. [PMID: 28376751 PMCID: PMC5379528 DOI: 10.1186/s12888-017-1282-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/23/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Responsible gambling (RG) is defined as gambling for pleasure and entertainment but with an awareness of the likelihood of losing, an understanding of the associated risks and the ability to exercise control over one's gambling activity. The current study describes a qualitative approach to explore RG among older adults (aged 60 years and above) in Singapore and reports on the cognitive and behavioural strategies employed by them to regulate their gambling. METHODS Inclusion criteria included Singapore residents aged 60 years and above, who could speak in English, Chinese, Malay or Tamil and were current or past regular gamblers. Participants were recruited using a combination of network and purposive sampling. Socio-demographic information on age, age of onset of gambling, gender, ethnicity, marital status, education and employment was collected. The South Oaks Gambling Screen (SOGS) was used to collect information on gambling activities and problems associated with gambling behaviour. Qualitative interviews were conducted with 25 older adults (60 years and above) who currently gambled. The data was analyzed using thematic network analysis. RESULTS This global theme of RG comprised two organising themes: self -developed strategies to limit gambling related harm and family interventions to reduce gambling harm. The basic themes included delayed gratification, perception of futility of gambling, setting limits, maintaining balance, help-seeking and awareness of disordered gambling in self or in others. Family interventions included pleading and threatening, compelling help-seeking as well as family exclusion order. CONCLUSIONS The study highlights the significant role that families play in Asian societies in imposing RG. Education of family members both in terms of the importance of RG, and communication of the ways in which older adults can incorporate RG behaviours including the use of exclusion in specific scenarios is important.
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Affiliation(s)
- Mythily Subramaniam
- , Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Pratika Satghare
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Janhavi A. Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Colette J. Browning
- International Primary Health Care Research Institute, Shenzhen, China ,grid.1002.3Monash University, Melbourne, Victoria Australia
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Shane A. Thomas
- International Primary Health Care Research Institute, Shenzhen, China ,grid.1002.3Monash University, Melbourne, Victoria Australia
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Jeyagurunathan A, Vaingankar JA, Abdin E, Sambasivam R, Seow E, Pang S, Picco L, Chong SA, Subramaniam M. Gender differences in positive mental health among individuals with schizophrenia. Compr Psychiatry 2017; 74:88-95. [PMID: 28113098 DOI: 10.1016/j.comppsych.2017.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This article aims to investigate the gender differences in positive mental health among outpatients with schizophrenia. METHODS 142 outpatients (aged 21-65 years) with schizophrenia spectrum disorders were recruited from a tertiary psychiatric hospital. They were administered the following instruments: The Positive Mental Health (PMH) instrument, Patient Health Questionnaire (PHQ)-8 and Generalized Anxiety Disorder (GAD)-7, and the Global Assessment of Functioning (GAF) scale. Socio-demographic and clinical characteristics were gathered from interviews with the participants as well as from their medical records. Independent t-tests and chi-square tests were performed to investigate the gender differences in PMH total and domain-specific scores. Association of socio-demographic and clinical characteristics with PMH was furthered explored in men and women independently using multiple linear regression analyses using backward stepwise method. RESULTS PMH total score and Emotional Support (ES) and Global Affect (GA) sub-scale scores were significantly higher among women vs men (PMH = 4.41 vs 4.07, p value = 0.01 and domains ES = 4.56 vs 3.84, p value < 0.01 and GA = 4.44 vs 4.02, p value = 0.01), given that the men and women samples did not differ significantly in their socio-demographic and clinical profiles. After adjusting for all covariates, men with no formal/ primary education were significantly associated with lower PMH total score than those with higher (secondary, A level, pre-university) education. Men belonging to Malay ethnic group had significant higher PMH total score compared to men of Chinese ethnicity. Among the women samples, those with depression as measured by PHQ-8 had significantly lower scores in the PMH total score and higher GAF score was associated with significantly higher scores in PMH total score. CONCLUSIONS This study identified gender differences in PMH of patients with schizophrenia spectrum disorders whereby women had higher PMH total score and domain scores than men. The study also identified factors associated with PMH which can aid in designing gender appropriate mental health interventions.
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Affiliation(s)
| | | | | | | | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore.
| | - Shirlene Pang
- Research Division, Institute of Mental Health, Singapore.
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore.
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Subramaniam M, Abdin E, Vaingankar JA, Picco L, Seow E, Chua BY, Ng LL, Mahendran R, Chua HC, Heng DM, Chong SA. Comorbid Diabetes and Depression among Older Adults - Prevalence, Correlates, Disability and Healthcare Utilisation. Ann Acad Med Singap 2017; 46:91-101. [PMID: 28417133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation. MATERIALS AND METHODS Data for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM. RESULTS DM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed. CONCLUSION Given the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.
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Sagayadevan V, Abdin E, Binte Shafie S, Jeyagurunathan A, Sambasivam R, Zhang Y, Picco L, Vaingankar J, Chong SA, Subramaniam M. Prevalence and correlates of sleep problems among elderly Singaporeans. Psychogeriatrics 2017; 17:43-51. [PMID: 26817951 DOI: 10.1111/psyg.12190] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/09/2015] [Accepted: 12/21/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The current study examined the prevalence and correlates of sleep problems among elderly Singaporeans. METHODS Data were taken from the Well-being of Singapore Elderly study, a cross-sectional, epidemiological survey conducted among Singapore residents aged 60 years and above (n = 2565). Respondents were screened for sleep problems through a series of questions in the Geriatric Mental State examination. Details on sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression were also collected. Logistic regression analysis was used to explore significant associations between sleep problems, sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression. RESULTS Overall, 13.7% (n = 341) of older adults reported at least one sleep problem. Of those who reported sleep problems, 69.4% experienced sleep interruption at night, 48.9% reported having difficulty falling asleep, 22.3% reported early morning awakening, and 11.4% had all three problems. Elderly with sleep problems were significantly more likely to have a range of chronic physical conditions and depression and were also significantly less likely to be physically active. Older adults with at least one sleep problem reported significantly greater disability compared to those with no sleep problems. CONCLUSION The high probability of comorbid chronic conditions as well as higher disability among those with sleep problems makes this an important area of research.
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Affiliation(s)
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | | | | | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Siow A Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Abdin E, Subramaniam M, Achilla E, Chong SA, Vaingankar JA, Picco L, Sambasivam R, Pang S, Chua BY, Ng LL, Chua HC, Heng D, Prince M, McCrone P. The Societal Cost of Dementia in Singapore: Results from the WiSE Study. J Alzheimers Dis 2016; 51:439-49. [PMID: 26890766 DOI: 10.3233/jad-150930] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is currently limited evidence on the economic burden that dementia exerts on multi-ethnic Asian populations. OBJECTIVE The present study aimed to estimate the economic cost of dementia in Singapore. METHODS We used data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older Singapore Resident population aged 60 years and above. Generalized linear modeling was used to estimate factors associated with costs. RESULTS The total cost of dementia in 2013 was estimated at S$532 million (95% CI, S$361 million to S$701 million) while the annual cost per person was estimated at S$10,245 per year (95% CI, S$6,954 to S$12,495). Apart from dementia, higher total societal cost were also significantly associated with older age, Indian ethnicity, and those who were diagnosed with heart problems, stroke, diabetes or depression, whereas being divorced/separated, lower education, and those who were diagnosed with hypertension were significantly associated with lower total societal cost. CONCLUSION The study provides a rich body of information on healthcare utilization and cost of dementia, which is essential for future planning of services for the elderly population.
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Affiliation(s)
| | | | - Evanthia Achilla
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, UK
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | | | - Shirlene Pang
- Research Division, Institute of Mental Health, Singapore
| | | | | | | | | | - Martin Prince
- Department of Health Service & Population Research, Institute of Psychiatry, King's College London, UK
| | - Paul McCrone
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, UK
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