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Background: Ethnic variations in dementia rate have been reported worldwide. Understanding these differences is vital for aetiological research, clinical care and health service planning. While age and gender have been consistently implicated, the reasons behind interethnic variation remain unclear., Method: We used data from the Singapore National Mental Health Survey (Elderly) in 2003, a cross-sectional population-based study to investigate the extent to which differences in cardiovascular risk factors, psychosocial factors and cognitive functional status contributed to ethnic differences in dementia prevalence among Chinese, Malays and Indians., Results: Ethnic differences in dementia prevalence (4.2% in Chinese, 9.4% in Malays and 8.8% in Indians) were not explained by differences in gender, age and education (Malays vs. Chinese: adjusted OR = 3.11; Indians vs. Chinese: OR = 4.30). Differences in cardiovascular factors, depression or leisure time activities contributed modestly to the differences, but the OR remained significantly elevated. Differences in Mini-Mental State Examination scores contributed the most to explaining the ethnic differences (Malays vs. Chinese: adjusted OR = 0.73; Indians vs. Chinese: OR = 1.18)., Conclusion: Cognitive functional reserve accounted for much of the ethnic differences in dementia prevalence and its assessment has implications for the detection and treatment of dementia in multiethnic populations.

Background: Somatic and other non-affective symptomatology characterizes late life depression and contributes to its under-diagnosis, especially in some ethnic groups., Objectives: We examined variations in non-affective presentation and its health and functional significance across different ethnic groups of Chinese, Malays and Indians., Method: We analyzed data from the National Mental Health Survey for Elderly, a population-based cross-sectional study of older adults aged 60 and above (N = 1092)., Results: Compared to the depressed Chinese as the reference group, depressed Malays were more likely to endorse symptoms of appetite decrease (OR = 5.19), sleep disturbances (OR = 2.93), disabling pain (OR = 3.12), psychomotor slowing (OR = 2.73) and anergia (OR = 3.70), while concurrently reporting poorer general health status and greater role limitations resulting from their mental and emotional problems (OR from 2.13 to 3.31). These differences were not influenced by anxiety, dementia or physical comorbidity., Conclusion: We revealed striking differences in the somatic and non-affective symptomatology of geriatric depression among different Asian ethnic groups. Non-affective symptoms in depression have large health and functional significance and important implications for the diagnosis and management of depression among elderly in primary care.

Background: We sought to assess the validity of the physical and cognitive domains of Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale and its cross-cultural applicability across ethnic groups in an Asian population of community-living older adults., Methods: Using data from a random population sample of noninstitutionalized Chinese, Malay, and Indian older adults 60 years old and older in Singapore (N = 1072), we modeled the dimensional structure of the 8-item IADL Scale using exploratory and confirmatory factor analyses, and assessed its convergent and divergent validity using known group differences and strengths of association., Results: Factor analyses yielded two strong and reliable factors representing underlying physical and cognitive dimensions of IADL. The validity of the model was supported by the pattern of associations of the IADL with age, gender, education, self-reported health status, hospitalization, physical comorbidities, dementia and depression, and Mini-Mental State Examination (MMSE) scores. Notably, cognitive IADL showed a greater total effect on MMSE cognitive performance score than did physical IADL, with the effect of physical IADL on MMSE score mostly explained by cognitive IADL. Reasonably good cross-cultural validity was demonstrated among Chinese, Malays, and Indians, with strongest validity for Indians., Conclusion: The eight-item IADL Scale has physical and cognitive domains and is cross-culturally applicable. The cognitive IADL domain taps a set of activities directly related to cognitive functioning.

Objectives: To make comparative estimates of prevalence of late-life functional disability, examine sociodemographic and health correlates, investigate sex and ethnic differences, and estimate population attributable risk of modifiable risk factors., Design: Population-based survey., Setting: Multiethnic population of Singapore (3 million residents)., Participants: Noninstitutionalized Chinese, Malay, and Indian people aged 60 and older (N=1,079), Measurements: Functional disability was defined as needing help in at least one basic activity of daily living (ADL) task in the 10 items of the Barthel Index. Five basic ADLs (eating, bathing, dressing, transferring, toileting) were used to compare prevalence with those reported from other national surveys and with reported past prevalence within the country., Results: The prevalence of disability in at least one of five ADL items (6.6% in those aged > or = 65) appeared lower than elsewhere, including China, but higher than reported past prevalence within the country. Functional disability on at least one of the 10 ADL items was independently associated with female sex, Indian ethnicity, older age, poor self-rated health, specific chronic diseases, cognitive impairment, sensory impairment, and living with others. The population attributable risks for leading modifiable factors were arthritis (12%) and cognitive impairment (14%)., Conclusion: Lower prevalence of functional disability accompanies rapid aging and health transition in Singapore than in other countries but higher prevalence than reported past prevalence within the country. Associations with sociodemographic and health-related factors were consistent with Western studies, including unexplained sex and ethnic differences.

Background: There has been a relative lack of epidemiological data on generalised anxiety disorder (GAD) in Southeast Asia. A previous study reported a lifetime prevalence of 1.5% and highlighted low preference for seeking professional help and consultation by persons suspected to be suffering from mental health problems. The present study is part of a National Mental Health survey of adults conducted from February 2003-March 2004 specifically assessing anxiety and depression in Singapore. In this paper we report on prevalence, co-morbidity and risk factors associated with GAD., Methods: We interviewed 2,847 households from an ethnically stratified random sample of adults aged 20-59 years who were Singapore citizens or permanent residents. The General Health Questionnaire and Schedule for Clinical Assessment of Neuropsychiatry were administered, which generated Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of GAD. We assessed socio-demographic correlates, life events, medical and other psychiatric co-morbidities related to GAD., Results: Lifetime prevalence of GAD was 3.3%, current prevalence is 3.0%. Female to male ratio is 3.6:1. GAD was significantly associated (p<0.001) with the presence of other psychiatric co-morbidities, including major depressive disorder, dysthymia, panic disorder, agoraphobia and social phobia. Prevalence increased in older individuals, with the odds of association greatest in subjects with three or more co-morbid medical conditions [adjusted odds ratio (OR) 3.66]. Those who had experienced one or more threatening life events showed increased odds of association with GAD. Chinese ethnicity, the divorced and persons from both the upper and the lowest socio-economic status had highest odds of association with GAD., Conclusions: We challenge established notions that GAD tends to be a disorder of the socially disadvantaged. Life events are important as precipitating factors in GAD, and uniquely different types of events appear to affect both extremes of social classes. High co-morbidity associations with current GAD are grounds for concern. This may suggest failure to seek treatment, hence giving rise to an increase in severity of the primary condition.

Background and Purpose: To investigate the prevalence and determinants of daytime sleepiness in an Asian multi-ethnic population. Cross-sectional survey based on a questionnaire in multi-ethnic Asian adult population of Singapore (2.4 million)., Patients and Methods: Measured frequency of excessive daytime sleepiness (EDS), socio-demographic status, sleep duration, perceived sleep insufficiency, frequent awakenings, difficulty falling asleep, snoring, breathing pauses, GHQ-12, shift work, solvent exposure at work, substance use, medications, and chronic diseases in random sample of 2,298 adults, aged 20-74 years, representing Chinese, Malays and Indians., Results: Among the respondents, 10.8% reported usually feeling sleepy in the daytime, and 9.0% were classified as having EDS. Marked ethnic difference was observed, with higher rates of EDS in Malays and Chinese, compared to Indians. Increased risk of EDS was associated with perceived sleep insufficiency; snoring and breathing pauses; shift work and solvent exposure at work; psychiatric morbidity and chronic diseases, particularly chronic rhinitis; and medications with sedating effects., Conclusions: Daytime sleepiness is associated with a multiplicity of highly prevalent risk factors in the community, including sleep behavior, breathing-, work- and medically related factors. Significant ethnic differences, which were not explained by these factors, were observed between Chinese, Malays and Indians.

Background: Health-related quality of life in adolescents and ethnic and cultural differences are not well characterized. We used the Quality of Life Questionnaire for Adolescents (QOLQA) to examine ethnic differences in reported QOL scores among Chinese, Malay and Indian ethnicities in Singapore., Methods: The 70-item QOLQA measuring five QOL domains (physical, psychological, independence, social and environmental) was administered to a random sample of 1363 school-children aged 10-15 years, representative of the ethnic composition of Singapore adolescents (Chinese 72%, Malays 20% and Indians 8%)., Results: Indians reported the highest overall QOL (mean 3.71 +/- SD 0.54) compared to Chinese (3.59 +/- 0.43), p < 0.05, and Malays (3.58 +/- 0.44), p < 0.05. In particular, Indians had significantly higher psychological QOL scores (3.73 +/- 0.61) compared to Chinese (3.55 +/- 0.54), p < 0.01. On the other hand, Chinese scored highest on physical and independence domains (3.97 +/- 0.54), p < 0.01 compared to Malays (3.82 +/- 0.55). There were no statistically significant gender differences in QOL scores. QOL declined significantly from age 10 to 15 for overall score, psychological, physical (p < 0.01) and environmental (p < 0.05). Lower socio-economic status and the self-report of a significant health problem were significantly associated with lower overall QOL and most domains. These ethnic differences persisted after adjusting for differences in socio-economic and health status. Psychometric properties and known group construct validity appeared to be similar across different ethnic groups, but compared to Chinese (r = 0.39) or Malays (r = 0.39), Indians showed a higher correlation of psychological scores with physical score (r = 0.59) and with other domain scores., Conclusion: Significant ethnic differences in reported adolescent quality of life among Chinese, Malays and Indians in Singapore that are independent of socioeconomic and health status suggest important cultural differences.

Background: There are a few reports on the trends of elderly suicide rates in western countries but none from Asian countries., Objectives: To describe the trends of elderly suicide rates of Chinese, Malays and Indians in Singapore from 1991 to 2000., Design: Data obtained from the National Department of Statistics were used in the analysis of sex- and age-standardized suicide rates and relative risks., Results: Overall, the suicide rates for the elderly showed a decline from 40.1 per 100,000 in 1990 to 17.8 per 100,000 in 2000, with the most pronounced decline occurring from 1995 to 2000. The suicide rate for elderly Chinese was at a peak of 52 per 100,000 in 1995 and declined to 20 per 100,000 in 2000. The rates for elderly Malays were consistently low at 2.2 per 100,000 for the 10 years; for elderly Indians the rates were between the other two ethnic groups., Conclusion: In the 10-year period, the elderly suicide rates in Singapore declined markedly, especially for elderly Chinese., (Copyright 2003 John Wiley & Sons, Ltd.)