Skip to main content

Advertisement

SpringerLink
Log in

Treatment delays for mental disorders in Singapore: results from the Singapore Mental Health Study 2016

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Although the trajectory of mental disorders can be improved with timely treatment, many people defer treatment-seeking. This study aimed to examine the prevalence and correlates of treatment delays for mental disorders in Singapore, as well as perceived effectiveness of treatment received.

Methods

A total of 6126 respondents, aged 18 and above, participated in the Singapore Mental Health Study 2016—a cross-sectional, nationwide study conducted in Singapore from 2016 to 2018. Lifetime treatment contact for mood, anxiety, and alcohol use disorders (AUD) was assessed using the World Mental Health-Composite International Diagnostic Interview (Version 3.0). Multivariable logistic regression was conducted to examine correlates of delayed treatment.

Results

A total of 137 participants had made lifetime treatment contact for a mental disorder. The proportion of respondents who received delayed treatment (i.e., at least one year after onset of disorder) was 60.8% for any disorder, 59.5% for mood disorders, 56.3% for anxiety disorders, and 92.7% for AUD. The median delay was 5 years for mood disorders, one year for anxiety disorders, and 4 years for AUD. Treatment delay was significantly associated with older age, higher educational qualification, lifetime AUD, and earlier age of onset of disorder. 58.4% of respondents with lifetime treatment contact had received treatment that they considered effective.

Conclusion

The high prevalence and long durations of treatment delay underscore the need to encourage help-seeking for mental disorders, especially since treatment is generally perceived to be helpful. Our findings also highlight several population groups more susceptible to receiving delayed treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data are available on request.

References

  1. Rehm J, Shield KD (2019) Global burden of disease and the impact of mental and addictive disorders. Curr Psychiatry Rep. https://doi.org/10.1007/s11920-019-0997-0

    Article  PubMed  Google Scholar 

  2. Abdin E, Chong SA, Ragu V, Vaingankar JA, Shafie S, Verma S, et al (2021) The economic burden of mental disorders among adults in Singapore: evidence from the 2016 Singapore Mental Health Study. J Ment Heal [Internet]. [cited 2021 Dec 2]; Available from: https://www.tandfonline.com/doi/abs/https://doi.org/10.1080/09638237.2021.1952958

  3. Brådvik L (2018) Suicide risk and mental disorders. Int J Environ Res Public Health [Internet]. [cited 2021 Dec 17];15(9). Available from: /pmc/articles/PMC6165520/

  4. Walker ER, McGee RE, Druss BG (2015) Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry [Internet]. [cited 2021 Dec 17];72(4):334. Available from: /pmc/articles/PMC4461039/

  5. Post RM, Leverich GS, Kupka RW, Keck PE, McElroy SL, Altshuler LL et al (2010) Early-onset bipolar disorder and treatment delay are risk factors for poor outcome in adulthood. J Clin Psychiatry 71(7):864–872

    Article  PubMed  Google Scholar 

  6. Fineberg NA, Dell’Osso B, Albert U, Maina G, Geller D, Carmi L, et al (2019) Early intervention for obsessive compulsive disorder: an expert consensus statement. Eur Neuropsychopharmacol [Internet]. [cited 2021 Dec 15];29(4):549–65. Available from: www.elsevier.com/locate/euroneuro

  7. Barnes TRE, Leeson VC, Mutsatsa SH, Watt HC, Hutton SB, Joyce EM (2008) Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia. Br J Psychiatry [Internet]. [cited 2021 Dec 15];193(3):203–9. Available from: /pmc/articles/PMC2576506/

  8. Stagnaro JC, Cia AH, Vommaro H, Sustas S, Vázquez N, Serfaty E et al (2019) Delays in making initial treatment contact after the first onset of mental health disorders in the Argentinean Study of Mental Health Epidemiology. Epidemiol Psychiatr Sci 28:240–250

    Article  CAS  PubMed  Google Scholar 

  9. Wang PS, Angermeyer M, Borges G, Bruffaerts R, Chiu WT, de Girolamo G et al (2007) Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6(3):177

    PubMed  PubMed Central  Google Scholar 

  10. Bunting BP, Murphy SD, O’Neill SM, Ferry FR (2012) Lifetime prevalence of mental health disorders and delay in treatment following initial onset: evidence from the Northern Ireland Study of Health and stress. Psychol Med 42(8):1727–1739

    Article  CAS  PubMed  Google Scholar 

  11. ten Have M, de Graaf R, van Dorsselaer S, Beekman A (2013) Lifetime treatment contact and delay in treatment seeking after first onset of a mental disorder. Psychiatr Serv 64(10):981–989

    Article  PubMed  Google Scholar 

  12. Boerema AM, ten Have M, Kleiboer A, de Graaf R, Nuyen J, Cuijpers P et al (2017) Demographic and need factors of early, delayed and no mental health care use in major depression: a prospective study. BMC Psychiatry 17(1):18–21

    Article  Google Scholar 

  13. Subramaniam M, Abdin E, Picco L, Pang S, Shafie S, Vaingankar JA et al (2017) Stigma towards people with mental disorders and its components—a perspective from multi-ethnic Singapore. Epidemiol Psychiatr Sci 26(4):371–382

    Article  CAS  PubMed  Google Scholar 

  14. Subramaniam M, Abdin E, Vaingankar JA, Shafie S, Chua HC, Tan WM et al (2020) Minding the treatment gap: results of the Singapore Mental Health Study. Soc Psychiatry Psychiatr Epidemiol 55:1415–1424

    Article  PubMed  Google Scholar 

  15. Vaingankar JA, Rekhi G, Subramaniam M, Abdin E, Chong SA (2013) Age of onset of life-time mental disorders and treatment contact. Soc Psychiatry Psychiatr Epidemiol 48(5):835–843

    Article  PubMed  Google Scholar 

  16. Harris MG, Kazdin AE, Chiu WT, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A et al (2020) Findings from world mental health surveys of the perceived helpfulness of treatment for patients with major depressive disorder. JAMA Psychiat 77(8):830–841

    Article  Google Scholar 

  17. Stein DJ, Kazdin AE, Ruscio AM, Chiu WT, Sampson NA, Ziobrowski HN et al (2021) Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report. BMC Psychiatry 21(1):30

    Article  Google Scholar 

  18. Ten Have M, De Graaf R, Ormel J, Vilagut G, Kovess V, Alonso J (2010) Are attitudes towards mental health help-seeking associated with service use? Results from the European study of epidemiology of mental disorders. Soc Psychiatry Psychiatr Epidemiol [Internet]. Feb [cited 2021 Dec 15];45(2):153–63. Available from: /pmc/articles/PMC2820660/

  19. Lippens T, Mackenzie CS (2011) Treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services. J Clin Psychol 67(12):1197–1209

    Article  PubMed  Google Scholar 

  20. Colman E, Missinne S, Bracke P (2014) The role of perceived helpfulness in predicting subjective unmet need and the frequency of health care use. Arch Psychiatr Nurs 28(1):43–49. https://doi.org/10.1016/j.apnu.2013.10.007

    Article  PubMed  Google Scholar 

  21. Subramaniam M, Abdin E, Vaingankar JA, Shafie S, Chua BY, Sambasivam R, et al (2019) Tracking the mental health of a nation: prevalence and correlates of mental disorders in the second Singapore mental health study. Epidemiol Psychiatr Sci [Internet] 29:e29. https://doi.org/10.1017/S2045796019000179

    Article  CAS  PubMed  Google Scholar 

  22. Kessler RC, Üstün BB (2004) The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res [Internet]. [cited 2021 Dec 8];13(2):93–117. Available from: https://pubmed.ncbi.nlm.nih.gov/15297906/

  23. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th ed. Diagnostic and statistical manual of mental disorders, 4th ed. Arlington, VA, US: American Psychiatric Publishing, Inc.

  24. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, De Girolamo G, Guyer ME, Jin R et al (2006) Concordance of the composite international diagnostic interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. Int J Methods Psychiatr Res 15(4):167–180

    Article  PubMed  PubMed Central  Google Scholar 

  25. Altamura AC, Dell’Osso B, D’Urso N, Russo M, Fumagalli S, Mundo E (2008) Duration of untreated illness as a predictor of treatment response and clinical course in generalized anxiety disorder. CNS Spectr [Internet]. [cited 2022 Mar 29];13(5):415–22. Available from: https://pubmed.ncbi.nlm.nih.gov/18496479/

  26. Galimberti C, Bosi MF, Volontè M, Giordano F, Dell’Osso B, Viganò CA (2020) Duration of untreated illness and depression severity are associated with cognitive impairment in mood disorders. Int J Psychiatry Clin Pract [Internet]. Sep 1 [cited 2022 Mar 29];24(3):227–35. Available from: https://pubmed.ncbi.nlm.nih.gov/32338553/

  27. Perris F, Sampogna G, Giallonardo V, Agnese S, Palummo C, Luciano M, et al (2021) Duration of untreated illness predicts 3-year outcome in patients with obsessive-compulsive disorder: a real-world, naturalistic, follow-up study. Psychiatry Res. May;299:113872. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0165178121001694

  28. Edlund M, Booth B, Feldman Z (2009) Perceived need for treatment for alcohol use disorders: results from two national surveys. Psychiatr Serv [Internet]. [cited 2022 Mar 18];60(12). Available from: http://psychiatryonline.org/article.aspx?doi=https://doi.org/10.1176/appi.ps.60.12.1618

  29. Probst C, Manthey J, Martinez A, Rehm J (2015) Alcohol use disorder severity and reported reasons not to seek treatment: a cross-sectional study in European primary care practices. Subst Abuse Treat Prev Policy [Internet]. [cited 2022 Mar 17];10(1):32. Available from: https://substanceabusepolicy.biomedcentral.com/articles/https://doi.org/10.1186/s13011-015-0028-z

  30. Subramaniam M, Abdin E, Picco L, Shahwan S, Jeyagurunathan A, Vaingankar JA et al (2017) Continuum beliefs and stigmatising beliefs about mental illness: results from an Asian community survey. BMJ Open 7(4):1–10

    Article  Google Scholar 

  31. Wallhed Finn S, Bakshi AS, Andréasson S (2014) Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence. [Internet]. [cited 2022 Mar 18];49(6):762–9. Available from: https://www.tandfonline.com/doi/abs/https://doi.org/10.3109/10826084.2014.891616

  32. Keyes KM, Hatzenbuehler ML, Mclaughlin KA, Link B, Olfson M, Grant BF et al (2010) Stigma and treatment for alcohol disorders in the United States. Am J Epidemiol 172(12):1364

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Farrer L, Leach L, Griffiths KM, Christensen H, Jorm AF (2008) Age differences in mental health literacy. BMC Public Health [Internet]. Apr 20 [cited 2022 Jan 20];8(1):1–8. Available from: https://bmcpublichealth.biomedcentral.com/articles/https://doi.org/10.1186/1471-2458-8-125

  34. Picco L, Abdin E, Chong SA, Pang S, Shafie S, Chua BY, et al (2016) Attitudes toward seeking professional psychological help: factor structure and socio-demographic predictors. Front Psychol 7:547. Available from: www.frontiersin.org. Accessed 18 Mar 2022

  35. De Girolamo G, Dagani J, Purcell R, Cocchi A, McGorry PD (2012) Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiol Psychiatr Sci 21(1):47–57

    Article  PubMed  Google Scholar 

  36. Reardon T, Harvey K, Baranowska M, O’brien D, Smith L, Creswell C (2017) What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. Eur Child Adolesc Psychiatry 26:623–647

    Article  PubMed  PubMed Central  Google Scholar 

  37. Thornicroft G (2012) No time to lose: onset and treatment delay for mental disorders. Epidemiol Psychiatr Sci 21(1):59–61

    Article  CAS  PubMed  Google Scholar 

  38. Corrigan PW, Druss BG, Perlick DA (2014) The impact of mental illness stigma on seeking and participating in mental health care. Psychol Sci Public Interes Suppl 15(2):37–70

    Article  Google Scholar 

  39. Subramaniam M, Zhang Y, Shahwan S, Vaingankar JA, Satghare P, Teh WL et al (2022) Employment of young people with mental health conditions: making it work. Disabil Rehabil 44(10):2033–2043. https://doi.org/10.1080/09638288.2020.1822932

    Article  PubMed  Google Scholar 

  40. Vaingankar JA, Teh WL, Roystonn K, Goh J, Zhang YJ, Satghare P et al (2021) Roles, Facilitators and Challenges of Employment Support Specialists Assisting Young People with Mental Health Conditions. J Occup Rehab 31(2):405–418. https://doi.org/10.1007/s10926-020-09930-x

    Article  Google Scholar 

  41. Goh CMJ, Shahwan S, Lau JH, Ong WJ, Tan GTH, Samari E et al (2021) Advancing research to eliminate mental illness stigma: an interventional study to improve community attitudes towards depression among University students in Singapore. BMC Psychiatry 21(1):1–12

    Article  Google Scholar 

  42. Subramaniam M, Shahwan S, Abdin E, Goh CMJ, Ong WJ, Tan GTH et al (2020) Advancing Research to Eliminate Mental Illness Stigma: The Design and Evaluation of a Single-Arm Intervention Among University Students in Singapore. Front Psychol 11:1–11

    Article  Google Scholar 

  43. Chang S, Jeyagurunathan A, Abdin E, Shafie S, Samari E, Verma S et al (2021) Mapping the steps to reach psychiatric care in Singapore: An examination of services utilized and reasons for seeking help. Gen Hosp Psychiatry 73:38–45. https://doi.org/10.1016/j.genhosppsych.2021.09.007

    Article  PubMed  Google Scholar 

  44. Jeyagurunathan A, Abdin E, Shafie S, Wang P, Chang S, Ong HL, et al (2018) Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore. Int J Soc Psychiatry [Internet]. [cited 2022 Feb 8];64(6):554–62. Available from: https://pubmed.ncbi.nlm.nih.gov/29947273/

  45. Ooi NPC, Neo CZG, Chong RKS (2021) Integrating mental healthcare in primary care in Singapore. Ann Acad Med Singapore 50(10):782–784

    Article  PubMed  Google Scholar 

Download references

Funding

We would like to thank Singapore’s Ministry of Health and Temasek Foundation Innovates for funding this study.

Author information

Authors and Affiliations

  1. Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore

    Rachel Hsiao Shen Tan, Yen Sin Koh, Janhavi Ajit Vaingankar, Edimansyah Abdin, Rajeswari Sambasivam, Siow Ann Chong & Mythily Subramaniam

Authors
  1. Rachel Hsiao Shen Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yen Sin Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janhavi Ajit Vaingankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edimansyah Abdin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rajeswari Sambasivam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Siow Ann Chong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mythily Subramaniam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rachel Hsiao Shen Tan.

Ethics declarations

Conflict of interest

The authors have no competing interests to declare.

Ethical approval

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The study was approved by the National Healthcare Groups’ Domain Specific Review Board. Written informed consent was obtained from all participants and parents or legally acceptable representatives of those aged below 21 years.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, R.H.S., Koh, Y.S., Vaingankar, J.A. et al. Treatment delays for mental disorders in Singapore: results from the Singapore Mental Health Study 2016. Soc Psychiatry Psychiatr Epidemiol 59, 375–383 (2024). https://doi.org/10.1007/s00127-023-02440-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-023-02440-0

Keywords

Search

Navigation