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BACKGROUND: The advances in experimental psychology in the last decade have led to a greater understanding of cognitive bias, and the investigation of cognitive bias modifications as a therapeutic option. Whilst conventionally such interventions are delivered in a laboratory, technological advances are changing the potential modes of delivery of these interventions. Whereas mobile delivery of interventions might seem to increase accessibility and encourage compliance, this might not be the case for cognitive bias modification interventions. To reduce boredom, researchers have investigated whether gamification of the task could help reduce repetitiveness, and the diminished motivation that participants had over time. In a prior review of cognitive bias modification interventions, a collaboration between academics and developers was recommended to ensure that the developed product is evidence-based. With the increased recognition of the importance of participatory action research, participants could better help conventional intervention to meet their needs. OBJECTIVE: The aim of this article was to describe the iterative steps in the conceptualization of the co-designed gamified cognitive bias modification intervention for individuals with opioid use disorders. METHODS AND RESULTS: A multidisciplinary team worked through the differences in the perspectives offered by healthcare professionals and patient participants, and jointly worked with a developer to conceptualize a new co-designed gamified attention bias modification intervention. The methods shared in this article could be considered and applied to future conceptualization of co-designed interventions.

In a growing body of literature, poor sleep quality has been associated with externalizing problems. In adults, anxiety was found to mediate the relationship, and callous-unemotional (CU) traits were found to moderate it. We sought to examine these relationships in a child population. We examined these relationships in 239 clinic-referred youth (age 6–17) in Singapore with externalizing behavior problems. Parent- but not child-rated sleep problems were associated with increased parent-rated externalizing problems. This association was partially mediated by anxiety. Unlike in adults, CU traits did not moderate the relationship. Sleep problems were associated with externalizing problems regardless of the level of CU traits. It is possible externalizing behaviors may lead children to internalize experiences, leading to anxiety about their behaviors. Another possibility is externalizing behaviors may lead to more stressful life experiences due to negative reactions children with externalizing behaviors receive from parents, teachers, or peers. Regardless, the partial mediation found indicates anxiety may be an important factor to consider in future interventions focused on improving sleep as a means to reduce externalizing problems.

As the content knowledge of English language learners and immigrant students is assessed in their less proficient language, the validity and fairness of assessments related to those students have b...

Background Studies on gender differences in attention-deficit/hyperactivity disorder (ADHD) comorbidities in the Asian populations have been limited and previous studies have shown inconclusive findings. Singapore is a city-state country in Southeast Asia with a population of 5.7 million. This study examined gender differences in internalizing and externalizing problems in Singaporean children and adolescents with ADHD. The plausible social factors underlying the gender differences were discussed. Methods A total of 773 participants (aged 6 to 18, 88% males) newly diagnosed with ADHD were recruited from the largest public child and adolescent psychiatric center in Singapore. Their internalizing and externalizing problems were assessed using the Child Behavioral Checklist and Teacher’s Report Form by parents and teachers respectively. Demographics and relevant social factors were collected using parent questionnaires. Results Females with ADHD were reported to have less delinquent and aggressive behavior but more depressive symptoms than their male counterparts, similar to findings in the Western literature. Gender remained a significant predictor of externalizing problem after controlling for other factors. Lower socioeconomic status and parental use of physical punishment were significant predictors of both internalizing and externalizing problems. Conclusions Gender differences in ADHD comorbidities do exist in the Asian clinical population. The lack of externalizing symptoms in females with ADHD has made timely referral and diagnosis challenging. More research is needed in understanding the gender differences in ADHD and the biopsychosocial mechanism underlying the differences in order to improve the detection of ADHD in females.

Attention deficit hyperactivity disorder (ADHD) is among the most prevalent child psychiatric conditions [1–4]. This neurodevelopmental disorder can persist into adulthood and result in significant adverse health and psychosocial outcomes including higher incidence of comorbid mental health disorders, occupational difficulties and marital conflicts; hence ADHD is associated with significant burden [5–7]. Pharmacological and psychosocial interventions are the main evidence-based approaches [8–11]. However, due to the limitations associated with these treatments including undesirable side effects, an intense level of commitment and unclear long-term benefits, alternatives which are effective, safe and cost-efficient are needed [12–14]. Understanding the pathophysiology of ADHD is necessary to enable the search for other intervention approaches (Fig. ​(Fig.1).1). Although stimulant and nonstimulant medications correct the underlying neurochemical (catecholamine) deficit, neuroimaging studies have helped identify affected brain networks in ADHD. These include the ventral attention, frontoparietal, default mode and visual networks [15▪]. ADHD has long been associated with executive function deficits including organization, working memory and inhibition [16,17]. Cognitive training could reducing these deficits by strengthening key neural networks, leading to overall functional improvement [18,19]. Neurofeedback therapy targets electroencephalogram (EEG) abnormalities such as excessive cortical slowing and increased theta waves (with corresponding reduced beta-theta ratios), another reflection of the underlying network abnormalities [20–23]. Neurofeedback therapy has been shown to strengthen the brain's attentional circuits [24▪]. Others have examined the use of physical exercise which can lead to neuroplastic changes and neurophysiological changes such as increased levels of fronto-striatal catecholamines [25,26]. Open in a separate window FIGURE 1 Pathophysiology of attention deficit hyperactivity disorder and targets of intervention.

Objective: This feasibility study examined the effects of a particular Traditional Chinese Medicine (TCM) herbal formula on attention-deficit/hyperactivity disorder (ADHD) and related problem behaviors. Design: A total of 79 participants aging 6-12 years consumed a granulated TCM herbal formula twice daily over a period of 3 months and underwent assessments at months 0, 3, and 6. Changes in ADHD symptoms and related behaviors were measured using the ADHD rating scale-IV (ADHD-RS-IV), child behavior checklist (CBCL), children's global sssessment scale (CGAS), as well as the clinical global impressions-severity (CGI-S) and improvement (CGI-I) scales. Results: Repeated measures mixed model analyses revealed significant differences in scores across time on all ADHD-RS-IV and CBCL subscales as well as on the CGAS, CGI-S, and CGI-I scales. Pairwise comparisons between months 0 and 3 as well as months 0 and 6 indicated significant improvements in scores. Scores also did not differ significantly between months 3 and 6. The results may suggest that this particular TCM formula possesses potential therapeutic qualities in the treatment of ADHD. Furthermore, changes in ADHD symptoms generally appear to be stable 3 months after discontinuation. However, these findings could also be attributed to placebo effects as well as reporting biases. Conclusion: This particular TCM formula may prove to be a useful adjunctive treatment for children with ADHD, and randomized controlled trials need to be conducted to evaluate its efficacy.

Child and adolescent psychiatry has an opportunity to adapt alongside the advancements in medical knowledge, post-graduate training, epidemiological realities and clinical service models. Here, we are guided by the mental health needs of our community’s young and their families in our review of child and adolescent psychiatry training in Australia and New Zealand. We recognise that training must respond to clinical demand and service reform while ensuring a range of clinical and educational experiences to deliver expectable competencies in order to produce child and adolescent psychiatrists that meet the communities’ needs now and in the future. We argue that training programmes be subject to rigorous evaluation by embedding continuing cycles of improvement including regular review and international bench marking.

Background Autistic adolescents have greater predisposition to depression and suicidality than neurotypical adolescents. Early detection is essential for timely treatment. The Patient Health Questionnaire 9-item (PHQ-9) is a brief screen for depression. The study examines the validity of the PHQ-9 for detecting major depressive disorder (MDD) in autistic youths. Methods English speaking youths aged 10–18 years, with DSM-IV/DSM-5/ICD-10 diagnosis of Autism Spectrum Disorder (ASD), and their parents presenting to a child psychiatric service were invited to participate between May 2018 to August 2020. Participants completed the respective self- and parent-rated PHQ-9 independently. MDD was verified using the MINI-Kid (Mini-International Neuropsychiatric Interview, Kid version). Results One hundred one youth, mean (SD) age 14.6 (2.3), were enrolled. 27 (27%) met criteria for current MDD. Mean total PHQ-9 scores, percentage ratings for severity of symptoms of depression, functional impairment, dysthymia and suicidality were compared. Areas under the ROC curve and statistically optimal cutoffs were determined. Parents rated depressive symptoms severity lower than their children. The PHQ-9 displayed low sensitivity with high false negative rates at conventional, adjusted and proposed cutoffs. Conclusions Future studies should improve on the validity and reliability of existing depression screening tools, or develop more appropriate screening methods of depression, for autistic youths.

BackgroundCOVID-19 has stressed healthcare systems and workers worldwide. GPs, as first points of contact between suspected cases and the healthcare system, have assumed frontline roles in this crisis. While the prevalence of mental health problems and illnesses arising in healthcare workers (HCWs) from tertiary care settings during the COVID-19 pandemic is well-examined,1 the impact on GPs remains understudied.AimTo describe the prevalence and predictors of anxiety, burnout, depression, and post-traumatic stress disorder (PTSD) among GPs during the COVID-19 pandemic.Design & settingSurvey of GPs operating in Singapore primary care clinics.MethodGPs completed a survey that comprised of four validated psychometric instruments. Open-ended questions asked about responders’ challenges and their envisaged support. Data were analysed with multiple logistic regression with demographic data as covariates; concepts of grounded theory were used to analyse the qualitative responses.ResultsA total of 257 GPs participated. Fifty-five (21.4%) met the scales’ criteria for anxiety, 211 (82.1%) for burnout, 68 (26.6%) for depression, and 23 (8.9%) for PTSD. Multivariate regression analysis showed working in a public primary care setting was associated with anxiety and depression. Qualitative analyses uncovered possible stressors: changes to clinical and operational practices; increased workloads; and financial difficulties.ConclusionMental health issues were found to be present in Singaporean GPs during the pandemic. Prevalence of anxiety, burnout, and depression were found to be higher than those reported pre-COVID-19. The findings also provide determinants of the issues that serve as possible foci for targeted interventions.

Front-line doctors are at high risk of exposure to COVID-19. The mental resilience of general practitioners and their areas of concerns and support required are important during this COVID-19 period. A total of 403 general practitioners attending a webinar on resiliency, hosted by the College of Family Physicians, Singapore, participated in the survey anonymously. Participants provided responses to questions relating to COVID-19 in the domains of Family and friends, Myself, Practice, and Community. Responses are categorized into LEARNING, FEAR, and GROWTH zones. The majority of the doctors reported to be in the GROWTH zone in relation to Family and friends (39%) and Myself (38%) as compared to Practice and Community, aOR = 4.5 (95% CI 3.4 to 5.9), p &lt, 0.001. 34% of the participants reported being in the FEAR zone in relation to Family and friends, aOR = 8.0 (95% CI = 5.6 to 11.2), p &lt, 0.001, at least 81% reported being in the LEARNING zone in relation to Practice and Community, aOR = 7.5 (95% CI = 5.8 to 9.6), p &lt, 0.001, compared to other domains. Supporting and protecting the doctors is important in strategic planning and management of the current pandemic and building preparedness and an effective response towards future crises.

Bullying through online medium has afflicted many adolescents to cause severe mental health concerns, including self-harm and suicide. The aims of this study are to examine the prevalence of cyberbullying in Singapore adolescents, its associations with psychosocial difficulties, and how do the adolescents seek help after being cybervictimized. A representative sample of 3,319 school students aged between 12 and 17 years responded to a survey with scales measuring cyberbullying, psychosocial difficulties, and help-seeking behaviors. In the present study, 7.3 percent of adolescents reported being cybervictims only, 1.8 percent were cyberbullies only, and 4.8 percent were cyberbully-victims. Compared with the non-involved group, both cybervictim and cyberbully-victim groups were associated with more internalizing problems, but all the three cyberbullying-involved groups were associated with higher externalizing problems. Approximately half of the cybervictimized participants reported that they have sought help, with most of them (81.7 percent) choosing to tell their friends. Our findings are consistent with previous overseas studies showing increased associations of psychosocial difficulties among adolescents who are involved in cyberbullying. Public awareness of the consequences of unhealthy cyber-usage could be raised to aid in the early detection of cyberbullying among school children and adolescents. Moreover, cyberwellness programs should be considered as a component of larger anti-bullying programs in schools and in the community.

Shortened versions of self-reported questionnaires may be used to reduce respondent burden. When shortened screening tools are used, it is desirable to maintain equivalent diagnostic accuracy to full-length forms. This manuscript presents a case study that illustrates how external data and individual participant data meta-analysis can be used to assess the equivalence in diagnostic accuracy between a shortened and full-length form. This case study compares the Patient Health Questionnaire-9 (PHQ-9) and a 4-item shortened version (PHQ-Dep-4) that was previously developed using optimal test assembly methods. Using a large database of 75 primary studies (34,698 participants, 3,392 major depression cases), we evaluated whether the PHQ-Dep-4 cutoff of ≥ 4 maintained equivalent diagnostic accuracy to a PHQ-9 cutoff of ≥ 10. Using this external validation dataset, a PHQ-Dep-4 cutoff of ≥ 4 maximized the sum of sensitivity and specificity, with a sensitivity of 0.88 (95% CI 0.81, 0.93), 0.68 (95% CI 0.56, 0.78), and 0.80 (95% CI 0.73, 0.85) for the semi-structured, fully structured, and MINI reference standard categories, respectively, and a specificity of 0.79 (95% CI 0.74, 0.83), 0.85 (95% CI 0.78, 0.90), and 0.83 (95% CI 0.80, 0.86) for the semi-structured, fully structured, and MINI reference standard categories, respectively. While equivalence with a PHQ-9 cutoff of ≥ 10 was not established, we found the sensitivity of the PHQ-Dep-4 to be non-inferior to that of the PHQ-9, and the specificity of the PHQ-Dep-4 to be marginally smaller than the PHQ-9.

Previous research supports the CBCL/1½-5's DSM-ASD scale (and its precursor, the DSM-PDP scale) as a Level 1 ASD screener. Confirmatory factor analyses (CFAs) with data from population samples in 24 societies (N = 19,850) indicated good measurement invariance across societies, especially for configural and metric invariance. Items 4. 25, 67, 80, and 98 may be especially good discriminators of ASD because they have tend to have low base rates, strong loadings on the ASD latent construct, and the best measurement invariance across societies. Further research is needed to test the discriminative power of these items in predicting ASD, but our strong measurement findings support the international psychometric robustness of the CBCL/1½-5's DSM-ASD scale.

To understand factors influencing the choice and ranking of Interventional Radiology (IR) training programs among a cohort of medical students and diagnostic radiology residents pursuing careers in IR.An IRB approved, 34 question online survey (surveymonkey.com) evaluated the impact of twenty-two different factors and demographics on IR training program selection for medical students and residents. The factors analyzed included programmatic features, location characteristics, academic reputation, program size, benefits/financial incentives, emphasis on clinical care, and future job opportunities. Comparison of Likert scale responses between medical students and residents were performed by using unpaired two-sample t-tests.181 (145 male, 35 female) individuals responded to the survey, 74 medical students (40.9%) and 107 residents (59.1%). Medical students and residents both selected variety of IR cases as the most important and highest rated factor when choosing an IR program. Medical students ranked availability of a mentor (p = .03), inpatient consultation service (p = .003), outpatient clinic experience (p = .003), and ICU rotation experience (p .001) significantly higher. Residents rated job placement/accomplishments of prior fellows (p = .03) and opinion of spouse/significant others (p = .002) significantly higher than medical students.The top rated factors are similar among medical students and residents however medical students value the clinical aspects of the program (ICU experience, inpatient consultation service, outpatient clinic) more than residents. Residents placed more value on job placement opportunities in selecting an IR program.

English as a second/foreign language education (ESL/EFL) in the supplementary setting is under-researched despite its prevalence worldwide. This quantitative study investigated the effects of supplementary and mainstream ESL/EFL education on eleven facets from learners’ secondary-level and tertiary-level perspectives. In addition, we examined learners’ perception of the usefulness of supplementary and mainstream classes in equipping them for the use of English for different purposes in the tertiary setting. 203 participants studying at two tertiary institutions in Hong Kong completed a 72-item questionnaire. The MANOVAs conducted revealed significant main effects of education settings (i.e. supplementary/mainstream) and education levels (i.e. secondary-level/tertiary-level) as well as interaction effects of these variables on learners’ perception. There were also significant differences in learners’ views of the usefulness of the two education settings in preparing them for the use of English for specific purposes at tertiary level. This article culminates with a discussion of these findings and implications.

Traditional bullying typically occurs in schools and has been associated with a myriad of mental health problems. Recent evidence has indicated that cyberbullying may just be traditional bullying that is extended to the online world, but this possibility has received only limited study in Asian countries. This study explored the co-occurrence of traditional and cybervictimization and its association with mental health among 3319 adolescents aged 12 to 17 years in Singapore. Victims of bullying were categorized into mutually exclusive groups: traditional-only victims, cyber-only victims, or combined traditional and cybervictims. Results indicated that there were substantial overlaps between victimization in traditional bullying and cyberbullying and that traditional victimization was more prevalent than cybervictimization. Being a victim of either form of bullying (i.e., traditional-only or cyber-only victims) was associated with higher reports of internalizing and externalizing problems, and combined traditional and cybervictims reported the most internalizing problems. However, there were no significant differences in problem scores between traditional-only victims and cyber-only victims. The findings highlight the need to consider the extensive overlap between traditional and cybervictimization when investigating their differential association with adolescents’ mental health. Prevention and intervention efforts by school staff and mental health practitioners need to target both traditional bullying and cyberbullying in an integrated manner, and extra attention should be provided to adolescents who are victims of both forms of bullying.

Child and adolescent psychiatry is in a unique position to respond to the growing public health challenges associated with the large number of mental disorders arising early in life, but some changes may be necessary to meet these challenges. In this context, the future of child and adolescent psychiatry was considered by the Section on Child and Adolescent Psychiatry of the World Psychiatric Association (WPA CAP), the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), the World Association for Infant Mental Health (WAIMH), the International Society for Adolescent Psychiatry and Psychology (ISAPP), the UN Special Rapporteur on the Right to Health, representatives of the WHO Department of Mental Health and Substance Abuse, and other experts. We take this opportunity to outline four consensus priorities for child and adolescent psychiatry over the next decade: increase the workforce necessary for providing care for children, adolescents and families facing mental disorders; reorienting child and adolescent mental health services to be more responsive to broader public health needs; increasing research and research training while also integrating new research finding promptly and efficiently into clinical practice and research training; Increasing efforts in advocacy.

Suicidality encompasses suicidal ideation, plans, and attempts. This paper aims to establish associations between suicidality and sociodemographic variables, physical disorders, and psychiatric disorders. The Singapore Mental Health Study 2016 was a population-level epidemiological survey, which determined the prevalence of physical disorders, psychiatric disorders, and suicidality. Questionnaires were used to determine socio-demographic information. A total of 6216 respondents were interviewed. Lifetime prevalence of suicidal ideation, planning, and attempts were 7.8%, 1.6%, and 1.6%, respectively. All components of suicidality were more likely in those with major depressive disorder, bipolar disorder, generalized anxiety disorder, alcohol use disorder, and chronic pain. Suicidal ideation and attempts were more likely in those with diabetes. Age above 65, being male, and a monthly household income of ≥ SGD 10,000 were associated with a lower likelihood of suicidal ideation. These findings indicate that there are high-risk groups for whom suicidality is a concern, and for whom interventions may be needed.

Aim To compare the risk of death, the prevalence of comorbid chronic physical illness and mortality among an Asian population of patients with mental disorders. Methods This was a retrospective data analysing of medical records of patients with schizophrenia, depression, anxiety, bipolar disorder, alcohol use disorder (AUD) or substance use disorder and the comorbid chronic physical illnesses. The hazard risk of death was calculated with Cox regression and compared between patients with and without comorbid chronic physical illness(es). Odds ratios of specific comorbid chronic physical illness were calculated with logistic regression and mean crude death rate was calculated for patients with different mental disorders. Results A total of 56,447 patients with mental disorders were included in the analysis. Compared to patients without comorbid physical illness, patients with mental-physical comorbidity were associated with a higher risk of death [2.36 (2.22–2.52); hazard ratio (95% CI)] and less estimated survival days [2157 (2142–2172) vs 2508 (2504–2513)]. Compared to other mental disorders, those with AUD had the highest prevalence of two or more comorbid chronic physical illnesses and associated with the highest odds of comorbid hypertension, diabetes mellitus, stroke, nephritis, chronic kidney disease, and cancer. The highest one-year crude death rate was similarly observed in patients with AUD. Conclusions Mental-physical comorbidity was associated with a higher risk of death compared to patients with mental disorders only. The highest prevalence of mental-physical comorbidity and mortality were observed in patients with AUD. More attention and resources may be needed to tackle the burden of AUD.

There is currently a high global demand for mental health professionals, including child and adolescent mental health professionals. In 2020, the World Health Organization (WHO) published “Enhancing mental health pre-service training with the mhGAP-Intervention Guide: experiences and lessons learned” to address the proposition of implementing Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) materials and principles as a component of pre-service training. By integrating the mhGAP-IG within pre-service training, future healthcare providers will acquire theoretical knowledge and early exposure to practical knowledge and will be better prepared for their future work.Examples demonstrate that mhGAP-IG pre-service training can be successfully implemented in diverse settings and in various pre-service training programs. It can be used in small group learning activities and short courses, taught through lectures, used as a clinical tool to teach students (i.e. medical, nursing students) and medical doctors in training. We can enhance pre-service training with the mhGAP-IG and contribute to a learning environment, which nurtures knowledge and skills required to help people with mental health needs.

Introduction: Advances in experimental psychology have led to a better understanding of automatic, unconscious processes, referred to as attentional biases. Despite the growing evidence from meta-analytical studies, we still do not understand why some individuals have a greater magnitude of these biases, and why others have none. There has been little focus on elucidating individual differences and task parameters that affect the overall magnitude of the biases. In this opinion piece, we will attempt to identify these. We will then discuss both the research and clinical implications. Methods and Analysis: To identify the factors that modulated the magnitude of attentional biases across all the substance disorders (i.e., opioid use, cannabis use, and stimulant-use disorders), we performed a search using the bibliographic databases PubMed and MEDLINE. The search terminologies &ldquo, attention bias&rdquo, or &ldquo, cognitive bias&rdquo, approach bias&rdquo, avoidance bias&rdquo, were used when we looked for relevant articles. Results: It was evident from the published literature that several individual differences and factors modulated the magnitude of baseline biases. Across opioid, cannabis, and stimulant-use disorders, the most common individual differences identified were the severity of the dependence and the quantity of substance used. For both opioid and cannabis disorders the timing of stimulus presentation influenced the detection of attentional bias, it appeared that short stimulus timing was better able to detect attentional bias. Other identified individual differences included subjective craving and impulsiveness. The results highlight several research and clinical implications. Conclusions: The discovery of these individual differences and factors of the task paradigm that affect the magnitude of attentional biases will help in the future conceptualization of attention-bias-modification intervention.

Background Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a worldwide prevalence rate of 5%. Individuals with ADHD often tend to have difficulties with emotional regulation. The advances in experimental psychology have led to the discovery of emotional biases. Targeting emotional biases could potentially help improve the core symptoms of irritability and short-temperedness among these individuals. Emotional biases refer to the preferential allocation of attention toward emotional stimuli. A recent study reported the presence of emotional biases among individuals with ADHD when they compared individuals with ADHD with those without. Gamification technologies have been explored to help diminish the repetitiveness of the task and increase the intrinsic motivation to train. These inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. Objective The aim of this research study is to collate health care professionals’ perspectives on the limitations of the existing task, and to determine if gamification elements could be incorporated, to refine the conventional intervention. Methods A qualitative research approach, that of a focus group, will be used. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore will be invited to participate in this qualitative research. During the focus group, participants are to comment on the limitations of the existing emotional bias intervention; recommend strategies to improve the intervention; and provide their perspectives pertaining to the use of gamification to improve the intervention. Results We expect that the study will be completed in 12 months from the publication of this protocol. Conclusions To our best knowledge, this is perhaps one of the only few studies that have attempted to explore emotional biases among adolescents with ADHD. International Registered Report Identifier (IRRID) PRR1-10.2196/24078

Introduction: Three previous individual participant data meta-analyses (IPDMAs) reported that, compared to the Structured Clinical Interview for the DSM (SCID), alternative reference standards, primarily the Composite International Diagnostic Interview (CIDI) and the Mini International Neuropsychiatric Interview (MINI), tended to misclassify major depression status, when controlling for depression symptom severity. However, there was an important lack of precision in the results. Objective: To compare the odds of the major depression classification based on the SCID, CIDI, and MINI. Methods: We included and standardized data from 3 IPDMA databases. For each IPDMA, separately, we fitted binomial generalized linear mixed models to compare the adjusted odds ratios (aORs) of major depression classification, controlling for symptom severity and characteristics of participants, and the interaction between interview and symptom severity. Next, we synthesized results using a DerSimonian-Laird random-effects meta-analysis. Results: In total, 69,405 participants (7,574 [11%] with major depression) from 212 studies were included. Controlling for symptom severity and participant characteristics, the MINI (74 studies; 25,749 participants) classified major depression more often than the SCID (108 studies; 21,953 participants; aOR 1.46; 95% confidence interval [CI] 1.11–1.92]). Classification odds for the CIDI (30 studies; 21,703 participants) and the SCID did not differ overall (aOR 1.19; 95% CI 0.79–1.75); however, as screening scores increased, the aOR increased less for the CIDI than the SCID (interaction aOR 0.64; 95% CI 0.52–0.80). Conclusions: Compared to the SCID, the MINI classified major depression more often. The odds of the depression classification with the CIDI increased less as symptom levels increased. Interpretation of research that uses diagnostic interviews to classify depression should consider the interview characteristics.

The 2019 novel coronavirus (COVID-19) pandemic causes much disruption globally on sociopolitical, economic and healthcare fronts. While much of the impact has focused on the epidemiology and medical management of the pandemic, more need to be focused on the mental health impact of COVID-19. This article describes the impact of COVID-19 pandemic on Singapore's schools and the response and adaptation of the school community mental health services. Singapore's response is one of balancing the needs of the population and demands in this crisis, with the utilization of technology and outbreak and support control measures. Further consideration needs to be afforded to increase capacity of the school and mental health services to support youth and tapping on technological innovations.

BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a worldwide prevalence rate of 5%. Individuals with ADHD often tend to have difficulties with emotional regulation. The advances in experimental psychology have led to the discovery of emotional biases. Targeting emotional biases could potentially help improve the core symptoms of irritability and short-temperedness among these individuals. Emotional biases refer to the preferential allocation of attention toward emotional stimuli. A recent study reported the presence of emotional biases among individuals with ADHD when they compared individuals with ADHD with those without. Gamification technologies have been explored to help diminish the repetitiveness of the task and increase the intrinsic motivation to train. These inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. OBJECTIVE The aim of this research study is to collate health care professionals’ perspectives on the limitations of the existing task, and to determine if gamification elements could be incorporated, to refine the conventional intervention. METHODS A qualitative research approach, that of a focus group, will be used. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore will be invited to participate in this qualitative research. During the focus group, participants are to comment on the limitations of the existing emotional bias intervention; recommend strategies to improve the intervention; and provide their perspectives pertaining to the use of gamification to improve the intervention. RESULTS We expect that the study will be completed in 12 months from the publication of this protocol. CONCLUSIONS To our best knowledge, this is perhaps one of the only few studies that have attempted to explore emotional biases among adolescents with ADHD. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/24078

Considerable evidence now exists for callous and unemotional (CU) traits as markers for a high-risk pathway to child and adolescent conduct problems implicating unique risk processes and treatment needs, but research has been limited largely to Western countries. We review the evidence base related to CU traits in Asian countries that has emerged in recent years, with respect to four key questions. Specifically, are higher CU traits among Asian children and adolescents associated with (1) increased severity of conduct problems; (2) similar neurodevelopmental and neurocognitive correlates as reported in Western countries; (3) similar environmental risk factors as reported in Western countries; and (4) poorer treatment outcomes? A systematic search identified 28 studies that have reported on child and adolescent CU traits in Asian countries. Consistent with Western samples, CU traits were associated with individual risk factors including atypical neural activation during cognitive tasks and poor empathy, as well as parenting risk factors. CU traits were also positively associated with most measures of conduct problems. Differences from findings in Western samples, however, emerged for areas such as correlates of reactive aggression and delinquent peer influence. Treatment has been investigated in only one study to date and is therefore a high priority for future research. The limitations of existing evidence are addressed along with key directions for future cross-cultural research, including measurement research with children and adolescents.

This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric population, (b) factors that encourage smoking cessation, and (c) awareness towards cessation programmes. This study captured data (n = 380) through a modified version of the Global Adult Tobacco Survey (GATS). A descriptive analysis of the data was performed. The prevalence of smoking was 39.5% (n = 150) and 52.3% of the smokers were dependent on nicotine. More than half of the smokers had made at least one attempt to quit in the past 12 months and 56% reported no immediate plans to quit smoking. The awareness towards institutional smoking cessation programmes was fair (44%), with 49.7% of smokers having indicated that they were willing to use the service upon referral. Smokers endorsed that increasing the cost of cigarettes, restricting availability, and increasing knowledge of health harms could encourage smoking cessation. Past smokers reported that self-determination/willpower followed by substitution of smoking with other types of foods and drinks were factors that helped them achieve successful cessation. Given that the readiness to quit and awareness towards cessation programmes are low among the smokers, concerted efforts through educational programmes and policy changes are crucial to achieve successful cessation.

Background: Studies on gender differences in attention-deficit/ hyperactivity disorder (ADHD) comorbidities in the Asian populations have been limited and previous studies have shown inconclusive findings. Singapore is a city-state country in Southeast Asia with a population of 5.7 million. This study examined gender differences in internalizing and externalizing problems in Singaporean children and adolescents with ADHD. The plausible social factors underlying the gender differences were discussed. Methods: A total of 773 participants (aged 6 to 18, 88% males) newly diagnosed with ADHD were recruited from the largest public child and adolescent psychiatric center in Singapore. Their internalizing and externalizing problems were assessed using the Child Behavioral Checklist and Teacher’s Report Form by parents and teachers respectively. Demographics and relevant social factors were collected using parent questionnaires.Results: Females with ADHD were reported to have less delinquent and aggressive behavior but more depressive symptoms than their male counterparts, similar to findings in the Western literature. Gender remained a significant predictor of externalizing problem after controlling for other factors. Lower socioeconomic status and parental use of physical punishment were significant predictors of both internalizing and externalizing problems.Conclusions: Gender differences in ADHD comorbidities do exist in the Asian clinical population. The lack of externalizing symptoms in females with ADHD has made timely referral and diagnosis challenging. More research is needed in understanding the gender differences in ADHD and the biopsychosocial mechanism underlying the differences in order to improve the detection of ADHD in females.