Beliefs about the helpfulness of sources of treatment options for mental disorders are an important factor in help-seeking, because incorrect beliefs can hinder an individual from seeking timely, appropriate help. Reference Jorm1 Positive perceptions towards evidence-based interventions have been shown to encourage both help-seeking behaviour Reference Mojtabai, Olfson and Mechanic2 and treatment adherence, Reference Lippens and Mackenzie3 which influences recovery outcomes. Reference Killaspy, Banerjee, King and Lloyd4 Additionally, social barriers, such as an unwillingness to seek help from friends and family, Reference Rüsch, Brohan, Gabbidon, Thornicroft and Clement5 and attitudinal barriers, such as wanting to deal with problems alone, can further contribute to the gap in receiving necessary treatments for mental health problems. Reference Gulliver, Griffiths and Christensen6 Given the well-established relationship between the endorsement of effective sources of help and help-seeking behaviour, Reference Bonabi, Müller, Ajdacic-Gross, Eisele, Rodgers and Seifritz7 it is crucial to gain an understanding of the public’s confidence in various mental health treatment options and improve their perceptions accordingly.
Singapore’s first nationwide mental health literacy study, conducted in 2014, revealed that respondents have preferences for different types of help sources based on specific disorders, which can be due to underlying beliefs about their causes. Reference Picco, Abdin, Chong, Pang, Shafie and Chua8 Using a vignette-based approach, results from that study also demonstrated that most respondents would recommend seeking help from friends and family for depression (54.2%), alcohol use disorder (30.1%) and schizophrenia (21.5%), while seeking help from a general practitioner (GP) was recommended most often for dementia (53.8%) and obsessive–compulsive disorder (OCD) (26.8%), when given an open-ended question on help-seeking. Findings also elucidated that the general population perceived certain self-help strategies, such as reading about how people dealt with similar problems, as ‘helpful’ more frequently than professional help for mental health and neurocognitive disorders such as OCD and dementia, respectively. Furthermore, relaxation and stress management courses were more likely to be endorsed as helpful compared with professional help for depression. As such, the study shed light on the public’s perceptions of various interventions for mental health difficulties, and showed a strong endorsement of self-help strategies and reliance on friends and family.
We anticipated significant changes in perceptions of help sources over the past 8 years due to multiple national mental health campaigns focused on improving mental health literacy. For example, the ongoing ‘Beyond the Label’ movement initiated in 2018 aimed to promote help-seeking behaviour through reducing stigma, 9 and the ‘It’s OKAY to Reach Out’ campaign in 2021 sought to normalise mental health conversations and encourage the public to seek support. 10 Previous population studies have also successfully discovered and tracked changes in perceptions towards mental health treatments over time. One recent meta-analysis on public attitudes towards mental health treatments has shown an encouraging increase in terms of willingness to seek help from mental health professionals, and towards medication in the past 25 years globally. Reference Angermeyer, Van Der Auwera, Carta and Schomerus11 However, only a handful of population-based studies have adopted a case vignette methodology to track changes in beliefs about mental health treatments using the same procedure over multiple years. Reference Angermeyer, Schindler, Matschinger, Baumann and Schomerus12–Reference Goldney, Dunn, Grande, Crabb and Taylor14 Notably, most of these studies have mainly focused on depression and schizophrenia and there are fewer data regarding beliefs about treatments for other mental and neurocognitive disorders such as OCD or dementia. Utilising a vignette-based approach, researchers in Germany found a substantial increase in public readiness over the past 30 years to see mental health professionals such as psychiatrists and psychologists for schizophrenia and depression. Reference Angermeyer, Schindler, Matschinger, Baumann and Schomerus12 Reavley and Jorm Reference Reavley and Jorm13 tracked changes over 16 years in Australia and found an overall increase in willingness to use antidepressants and antipsychotics to treat depression and schizophrenia, respectively. A smaller study in South Australia found a significant reduction in the perceived helpfulness of pharmacological treatments and therapists between 2004 and 2008 for depression. Reference Goldney, Dunn, Grande, Crabb and Taylor14 These results suggest that there could be fluctuations in the perception of different help sources in a nation over a number of years.
There have been yearly attempts to track the proportion of Singaporeans who are willing to seek help from healthcare professionals and informal support networks, through the national population health survey. 10 The proportion of those willing to seek help from informal support networks fell from 79.7% in 2022 to 78.4% in 2023, while those willing to seek help from healthcare professionals increased from 56.6 in 2022 to 62.8% in 2023. However, these surveys do not report preferences for other types of help sources such as lifestyle interventions and pharmacological treatments. Neither have these population surveys in Singapore reported respondents’ preferences regarding mental health interventions according to specific mental disorders, such as OCD and alcohol use disorder.
The current study, Mind Matters 2023 (MM2023), therefore aimed to ascertain the general population’s preferences for 28 different mental health interventions based on 5 mental health and neurocognitive disorders, which were also investigated in the earlier Mind Matters study conducted in 2015 (MM2015), and to compare the changes in perceptions towards these sources of help over the 8-year interval.
Method
Sample
MM2023 is the second nationwide, cross-sectional survey on mental health literacy undertaken in Singapore. The present study was conducted from September 2022 to February 2024, and utilised a disproportionate stratified sampling by 12 strata (age groups: 18–34, 35–39 and 50–67 years; ethnicities: Chinese, Malay, Indian and Others) to randomly select participants from a national registry of all Singaporeans. We included Singapore citizens and permanent residents aged 18–67 years and who were able to complete the survey in one of the four official languages of Singapore (English, Chinese, Malay and Tamil). Participants with incomplete addresses, or with physical or cognitive impairments that prevented them from completing the survey, were excluded. We obtained written informed consent from legally acceptable representatives, such as parents or guardians, if the respondent was under 21 years of age. The sampling procedures and study design were similar to those of the first national mental health literacy study, MM2015, conducted from March 2014 to April 2015 among Singaporeans aged 18–65 years. Reference Chong, Abdin, Picco, Pang, Jeyagurunathan and Vaingankar15 However, because the sampling frames in both studies are independent and the data have been de-identified, we could not ascertain whether respondents participated in both studies. Based on the study’s aims, only participants who had read the five chosen vignettes (n = 3002) were included in the analysis, after excluding data from vignettes related to gambling disorder and depression with suicidal thoughts from the total 2023 sample (n = 4195; 62.25% response rate). All participants from the 2015 study (n = 3006; 71.05% response rate) read the five chosen vignettes and were included when comparing the two samples. Figure 1 illustrates how response rates and sample sizes were derived.
Flow diagrams of response rates for the 2015 and 2023 studies. MM2015, Mind Matters 2015; MM2023, Mind Matters 2023.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Measures
Face-to-face interviews were conducted either in respondents’ homes or at their preferred location by trained interviewers. This study used a vignette-based approach in which respondents were randomly assigned a vignette describing one of seven mental health/neurocognitive disorders: depression, OCD, schizophrenia, alcohol abuse, dementia, gambling disorder and depression with suicidality, with only the first five of these being the focus of this paper. We excluded gambling disorder and depression with suicidality in the current paper because these were introduced only in MM2023, and therefore we are unable to make a comparison for these disorders. The five disorders were chosen due to their prevalence Reference Subramaniam, Abdin, Vaingankar, Shafie, Chua and Sambasivam16 and significant treatment gap in Singapore. Reference Subramaniam, Abdin, Vaingankar, Shafie, Chua and Tan17 We also ensured that the person described in the vignette was of the same ethnicity and gender as the respondent, to reduce the distance between the vignette and social reality, where respondents tend to indicate what they believe they might do rather than what they would do. All vignettes were aligned with DSM-5 criteria and developed in consultation with local clinicians to ensure that they were locally contextualised. The five vignettes are included in the supplementary materials available at https://doi.org/10.1192/bjo.2025.10891. After interviewers read the vignette aloud, respondents were asked whether they found the 28 different interventions ‘helpful’, ‘harmful’ or ‘neither’ for the person in the vignette. We categorised the interventions into four main groups: individual, medication, lifestyle and other. Sociodemographic information on age, gender and ethnicity was collected using self-reported questionnaires.
Statistical analysis
All estimates were weighted to adjust for oversampling. Post-stratification weights were created and used in all subsequent analyses to ensure that the results were representative of the general population. Similar weighting procedures were performed for MM2015. All analyses were conducted using Stata S/E version 15.0 (StataCorp, College Station, TX, USA; https://www.stata.com/), with P-values <0.05 considered significant. All five disorders were combined to assess total ‘helpfulness’ ratings in the logistic regression analysis. The outcome was dichotomised into ‘helpful’ and ‘not helpful’ (i.e. ‘neither’ and ‘harmful’) for the multivariable logistic regression, for comparison of whether preferences for help sources had changed over the two studies, while controlling for age, gender, ethnicity and time points. Time point variables were used as the independent variable to determine whether there was any change in help-seeking behaviour. Weighted percentages and frequencies of ‘neither’ and ‘not helpful’ are presented in Supplementary Tables 1 and 2, respectively.
Results
Table 1 presents the sociodemographic characteristics of the 2015 and 2023 samples; Reference Chong, Abdin, Picco, Pang, Jeyagurunathan and Vaingankar15 49.1% of the 2023 sample were female and the mean age was 43.2 years (s.d. = 13.6). The weighted percentages by ethnicity were 73.8% Chinese, 13.2% Malay, 9.3% Indian and 3.7% from other ethnic groups. The 2015 sample was largely similar, with 49.1% female and a mean age of 40.9 years (s.d. = 13.4). The weighted percentages were 74.7% Chinese, 12.8% Malay, 9.1% Indian and 3.3% from other ethnic groups.
Sociodemographic distribution of the samples in 2015 (n = 3006) and 2023 (n = 3002)
MM2015, Mind Matters 2015; MM2023, Mind Matters 2023.
a. 50–65 years was the oldest age group for the MM2015 study, and 50–67 years for the MM2023 study.
Table 2 presents respondents’ beliefs about whether interventions were helpful for the five disorders. Across vignettes, ‘see a psychiatrist’ (90.0%) was regarded as most helpful, followed by ‘see a psychologist’ (87.6%) and then ‘see a counsellor’ (85.6%). We found that ‘see a psychiatrist’ was rated helpful most frequently for persons described with schizophrenia, OCD and dementia, while for depression and alcohol disorder, ‘see a counsellor’ was rated helpful most often. ‘Medications prescribed specifically by psychiatrists’ (84.4%) was the medication option that was most commonly rated helpful, while ‘read about people who have dealt with similar problems and how they coped’ (82.1%) was the most highly endorsed option in the ‘other’ category of interventions across vignettes.
Percentage of respondents who rated help-seeking interventions as ‘helpful’ for five mental and neurocognitive disorders described in vignettes for MM2023
OCD, obsessive–compulsive disorder; MM2023, Mind Matters 2023; GP, general practitioner.
Table 3 summarises respondents’ beliefs about whether interventions are harmful for the five disorders. Across vignettes, the option ‘deal with his/her problems on his/her own’ (72.5%) was viewed as the most harmful intervention, followed by ‘have an occasional alcoholic drink to relax’ (60.7%), ‘take antibiotics’ (43.3%) and ‘take sleeping pills’ (33.5%). These results were similar for all five disorders, wherein these four options were rated harmful most often. There was a low level of endorsement for some psychiatric treatments, such as taking antidepressants (15.8%) and being admitted to an institution (16.6%), with respondents finding these harmful across vignettes. Respondents also recognised the potential for information retrieved from websites as being harmful (15.3%).
Percentage of respondents who rated help-seeking interventions as ‘harmful’ for five mental and neurocognitive disorders described in vignettes for MM2023
OCD, obsessive–compulsive disorder; MM2023, Mind Matters 2023; GP, general practitioner.
Percentage changes in perceptions of help-seeking interventions as being helpful can be seen in Table 4. Between 2015 and 2023, there was a significant increase in the perception of the helpfulness of engaging health professionals such as psychologists (+4.6%), counsellors (+3.4%), counselling over the phone (+17.6%) and sleeping pills (+7.5%). The most striking difference was the attitude towards counselling over the phone, which was seen as helpful much more frequently in 2023 than in 2015, with a 17.6% change (P < 0.001). However, there was a significant decrease in the perception of the helpfulness of becoming more social (−6.2%), accessing information from websites (−6.4%) and reading about how people dealt with similar problems (−4.3%). There was no change in terms of the perception of helpfulness for certain interventions such as seeing a psychiatrist, taking medicines prescribed by a psychiatrist and becoming more physically active; endorsement of these items remained consistently high across both studies.
Comparison of percentage of respondents rating interventions as ‘helpful’ between 2015 and 2023
GP, general practitioner.
a. Significant percentage changes shown in bold; statistical significance was evaluated at P < 0.05.
b. P-values were derived from multivariable logistic regressions with the outcome variable (‘helpful’ versus ‘not helpful’ (reference)) while controlling for age, gender and ethnicity. The time point variable was included as a covariate to examine any significant difference in help-seeking behaviour across the two studies.
Discussion
Drawing on Singapore’s second nationwide mental health literacy survey, this study provides population-level insights into help-seeking preferences for mental health and neurocognitive disorders and compares changes over an 8-year period. Our study found that the intervention most commonly endorsed as likely to be helpful for schizophrenia, OCD and dementia was seeing a psychiatrist, while for depression and alcohol use disorder it was seeing a counsellor. Reasons for these differences could include the frequent biological conceptualisation of mental illnesses such as schizophrenia, OCD and dementia, and the attribution of illnesses such as depression and alcohol use to weakness of character. Reference Pang, Subramaniam, Lee, Lau, Abdin and Chua18,Reference Read, Haslam, Sayce and Davies19 Research consistently shows that more biological attributions of mental illnesses are associated with a stronger endorsement of psychiatric help. Reference Angermeyer, Van Der Auwera, Carta and Schomerus11 Furthermore, research supports the concept that counselling is one of the most widely recognised and essential treatment approaches in regard to managing addictions. Reference Glasner-Edwards and Rawson20 This aligns with our findings, which show that the public perceives counsellors as the mainstay of care for alcohol addiction compared to schizophrenia and OCD.
Moreover, our comparison of attitudes towards mental health professionals in 2023 and 2015 reveals a significant increase in willingness to seek help from mental health professionals such as psychologists and counsellors. Although there was no change over the 8 years in the public’s view towards medicines prescribed by psychiatrists, the perception of their helpfulness has remained consistently high. This reflects the public’s positive perception of mental health professionals and some of their treatments. These results are also in line with the growing acceptance of consulting mental health professionals and medication, both in Singapore 10 and globally, over the past few years. Reference Angermeyer, Van Der Auwera, Carta and Schomerus11,Reference Angermeyer, Schindler, Matschinger, Baumann and Schomerus12 However, there remains a poor impression of in-patient services, because admission to institutions was perceived as being helpful by only 38.0% and harmful by 16.6% of respondents. Stigma surrounding psychiatric institutions remains high in Asian societies, and it has been reported that Singaporeans feel additional stigma for seeking mental help in such treatment settings. Reference Ong, Goh, Tan, Shahwan and Subramaniam21,Reference Zhang, Sun, Jatchavala, Koh, Chia and Bose22 Targeted interventions to lower the level of stigma against institutionalisation are still needed, despite improvements in the perception of the helpfulness of mental health professionals. These findings, taken together, also highlight the importance of making psychiatric services more accessible in general hospitals and community settings, because many Singaporeans already have a positive perception of mental health professionals and their services.
In the area of seeking help from informal sources, our results revealed that respondents find seeking help from friends (74.7%) and family (80.8%) as being more helpful compared with some professional sources of help, such as counselling over the phone (58.5%) and contacting an expert via a website or email (62.1%), across all five disorders. Results from the study elucidated that face-to-face help was considered more helpful than remote sources of professional help. There are potential barriers to receiving professional help remotely, such as privacy, technological issues and the difficulty of maintaining a therapeutic relationship due to the less personal nature of communication. Reference Siegel, Zuo, Moghaddamcharkari, McIntyre and Rosenblat23 This emphasises the importance of a personal touch in mental health services today, even in the age of digital technology and advanced communication. Despite these findings, there has still been a remarkable and significant increase in the willingness to seek counselling over the phone since 2015. This could be attributed to the shift in treatments being delivered remotely during the period of lockdown due to COVID-19 in 2020, because patients were unable to physically attend psychological treatments and therapies that were labelled as non-essential services. Reference Goh, Chan, Lai, Lee, Lee and Soon24 Receiving help from mental health professionals over the phone or online remains an invaluable source of help, and it has been shown to be an effective way to alleviate symptoms. Reference Chen, Li, An, Dong, Liu and Wu25 Therefore, it is essential to raise awareness about the viability of such treatment options.
Consulting a doctor or GP was seen as helpful by only a moderate proportion of respondents for all vignettes (range: 63.0–68.8%), except for dementia (84.5%). Our findings concur with previous studies showing that those living in Asia are not as likely to consult a GP for mental health difficulties compared with those in other continents, including Australia Reference Jorm, Nakane, Christensen, Yoshioka, Griffiths and Wata26 and Europe. Reference Angermeyer, Van Der Auwera, Carta and Schomerus11 This may be attributed to varying perspectives on the role of the GP as the initial contact in the healthcare system, and as the gatekeeper to appropriate specialists. Reference Jorm, Nakane, Christensen, Yoshioka, Griffiths and Wata26 This has important implications, because research shows that seeing a GP who can provide relevant mental health services, such as medicine, could be less stigmatising, easier to access and more cost-effective for patients with mental health difficulties than consulting a psychiatrist. Reference Chong, Lim and Yong27 Furthermore, there has been no improvement in the proportion of respondents who regard seeing a doctor or a GP as helpful in 2023 compared with 2015. The current perception towards GPs could reflect a lack of awareness and trust in the effective services provided by these professionals in Singapore. However, reliance on GPs for mental health treatment is increasingly possible following recent national healthcare reforms, such as the Healthier SG initiative that aims to ensure every individual has a dedicated family doctor. 28 Such a model could foster a strong therapeutic alliance, built on trust and relationship, enabling more effective mental health care. Furthermore, given active efforts to involve more GPs in providing mental health services in Singapore that are in line with the national mental health and well-being strategy, 10 these results emphasise the importance of changing the public’s perception and encouraging them to seek appropriate help from suitably equipped GPs.
Regarding interventions related to the independent acquisition of mental health information, there was a significant decrease in the perception of the helpfulness of ‘obtaining information from websites’ and ‘reading about how people dealt with similar problems’ over the study years. Only 53.2% of respondents in 2023 found accessing information from websites helpful, and 15.3% found it harmful. However, respondents still frequently identified reading about how people dealt with similar problems (82.1%) as helpful across vignettes, more so than any other lifestyle or non-medical intervention, as well as certain medical interventions. This could possibly be explained by the potential anonymity associated with gathering relevant information on personal, first-hand experiences that healthcare professionals may not always be able to provide. Reference O’Reilly, Dogra, Hughes, Reilly, George and Whiteman29 These results reflect the general public’s desire to access reliable mental health information and a wariness of online sources. Individuals who access mental health information online may worry about the credibility of the sources they read, and find it difficult to find relevant information. Reference Lal, Nguyen and Theriault30 In a time where disinformation is widespread, Reference Bizzotto, Schulz and De Bruijn31 inaccurate understanding can negatively impact the relationship between patients and health providers Reference Barreto, Caram, Dos Santos, De Souza, Goes and Marcon32 and affect people’s adherence to health guidelines. Reference Dhawan, Bekalu, Pinnamaneni, McCloud and Viswanath33 However, there is significant potential for internet-based sources to promote mental health positively. Reference O’Reilly, Dogra, Hughes, Reilly, George and Whiteman29 It is thus crucial that people can find trustworthy online sources that facilitate rather than hinder access to necessary support. Efforts can be channelled to raise awareness about credible, government-endorsed, local platforms that are already available, such as mindline.sg, a one-stop portal for mental health information. 34 This also underscores the need for further studies to investigate how people navigate mental health information online, and to ensure that accurate and helpful information is available and accessible.
Among lifestyle interventions, becoming more physically active (80.3%) and courses on relaxation and stress management (80.1%) were most often viewed as being helpful. While perceptions of physical activity remained stable over time, this was more frequently rated helpful than many other help sources in 2023, such as antidepressants and informal help from friends and family. However, the perceived helpfulness of lifestyle interventions such as stress management and becoming more social decreased significantly over the 8 years. There is emerging evidence regarding the effectiveness of lifestyle interventions against psychopathology. Systematic reviews and meta-analyses have reported the positive impacts of lifestyle interventions, such as physical activity, Reference Firth, Solmi, Wootton, Vancampfort, Schuch and Hoare35 stress management Reference Malinauskas and Malinauskiene36 and social participation, Reference Webber and Fendt-Newlin37 on pathological symptoms including depression, anxiety and schizophrenia. Experimental evidence has also revealed that running therapy showed comparable effects on mental health, and even outperformed antidepressants in terms of the benefits to physical health in a clinical population. Reference Verhoeven, Han, Lever-van Milligen, Hu, Révész and Hoogendoorn38 Given the positive perception towards these lifestyle interventions in Singapore, it is necessary to identify the key components that contribute to their effectiveness. Clear dissemination of information is then needed to enable the public to integrate these interventions into daily routines for genuine improvements in mental health.
Limitations
Our findings must be considered in view of the study’s limitations. First, it is vital to note that the study focused on measuring perceptions towards help-seeking options rather than actual help-seeking behaviour. Nevertheless, understanding help-seeking perceptions is crucial because these significantly influence the decision to seek help. Second, because respondents were asked to indicate their perceptions on whether interventions were helpful or harmful, our results do not reflect how they might have prioritised one intervention over another. Respondents could endorse multiple options simultaneously, and these findings help to ascertain how frequently the public would find help options helpful or harmful. Lastly, this study examined only two sources of remotely administered professional help. Future studies should expand these intervention options to include services administered through video-conferencing and online chatrooms. Barriers to telemental health care services can also be examined to improve the perception and uptake of these professional services.
Strengths of this study include the use of multiple local languages to ensure inclusivity, a large sample size and a vignette-based approach that is widely accepted by researchers. Reference Jorm, Korten, Jacomb, Christensen, Rodgers and Pollitt39,Reference Wendt and Shafer40 We also ensured that the methodology remained consistent across both surveys so that we could draw a valid comparison between the two time points. This study also looked at a wide range of intervention options and mental and neurocognitive disorders that are not commonly studied in population-based vignette studies, including OCD, alcohol use disorder and dementia.
In conclusion, this nationwide study on mental health literacy helps to advance our understanding of current trends related to help-seeking perceptions in Singapore. The present study revealed a significant improvement in the perception of helpfulness of mental health professionals and the services they provide, including over-the-phone counselling services. Our findings also shed light on help sources that respondents less frequently found helpful over the study years, including accessing information from websites and being more social. This information can help us to take steps to shift perceptions of help sources in the right direction and promote help-seeking behaviour in the nation as a whole.
Supplementary material
The supplementary material is available online at https://doi.org/10.1192/bjo.2025.10891
Data availability
The data are available on reasonable request.
Author contributions
Writing (original draft preparation): C.M.T. Writing (review and editing): E.H.T., S.S., Y.B.T., S.G., B.C.W.T., W.J.O., S.A.C., M.S. Formal analysis and investigation: E.H.T. Project administration: S.S., Y.B.T., S.G., W.J.O. Funding acquisition, conceptualisation, methodology and supervision: M.S., S.A.C., S.S. Read and agreed to the final version of the manuscript: C.M.T., E.H.T., S.S., Y.B.T., S.G., B.C.W.T., W.J.O., W.M.T., S.A.C. and M.S.
Funding
The study was funded by the National Medical Research Council Singapore (no. HSRGMH19apr-0001) and Tote Board Singapore (no award number).
Declaration of interest
None.
Ethical standards
The authors confirm that all procedures involved in this study adhere to the ethical standards set forth by the relevant national and institutional committees on human experimentation, in accordance with the Helsinki Declaration of 1975 as revised in 2013. Ethical approval for the study was granted by the National Healthcare Group Domain Specific Review Board. Written informed consent was obtained from all participants, as well as from parents or legally authorised representatives for participants under 21 years of age.
Open access
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