Substantial evidence confirms a linear relationship between low-density lipoprotein and depression. However, findings on the association of abnormal high-density lipoprotein cholesterol (HDLc) with depression are inconclusive, with both low and high levels of HDLc implicated in severe symptoms and suicidality. Additionally, gender differences in this association remain underexplored.

This study evaluated the association between abnormal serum HDLc and depressive symptom severity and investigated whether the association varied by gender in a sample of multi-ethnic adults in Singapore.

Descriptive and multivariable analyses were conducted on data collected from participants of a longitudinal cohort - The PREDICT study. Participants were aged 18-75 years, of Chinese, Malay, or Indian ethnicity, with major depressive disorder (MDD) or general population without any psychiatric diagnosis. The primary outcome was depressive symptom score assessed with the Patient Health Questionnaire (PHQ)-9. Its association with abnormal serum HDLc levels (categorised into ordinal variable for abnormal low (AL), normal (N), and abnormal high (AH) HDL) and gender differences were investigated after adjusting for age, race, and known confounders of lipid abnormality (body mass index, mental health treatment, and history of chronic conditions).

The study sample comprised 212 participants with a mean age of 38.1 (SD 13) years. In all, 59.4% were women, 76.9% were Chinese, and 51.4% were diagnosed with MDD. Total PHQ-9 score ranged from 1- 34, with a mean score of 7.8 (SD 7); 19.8% met criteria for moderately severe to severe depression. The prevalence of abnormal HDLc was 58% with AL-HDLc and AH-HDLc observed in 11.8% and 46.2% of the sample, respectively. Compared to persons with N-HDLc, AL-HDLc was significantly and directly associated with symptom severity (β = 4.4, 95% CI:1.2 to 7.7, p = 0.008), while an inverse association was observed with AH-HDLc (β = −2.6, 95% CI:‒4.7 to −0.5, p = 0.015). The significant direct association between AL-HDLc and symptom severity was observed only among men, whereas AH-HDLc showed a significant inverse relationship only in women. The association between AL-HDLc remained significant after adjusting for confounders in the overall sample and among men.

Study results indicate that low HDLc is linked to more severe depressive symptoms, whereas high levels of HDLc have an inverse relationship. The latter contrasts with emerging literature on adverse outcomes of depression associated with high HDLc. Gender differences exist in these associations, which need to be investigated further and replicated in a larger sample. Nevertheless, these preliminary findings underscore the importance of maintaining healthy HDLc levels, which may lower morbidity in depressive disorders.

None Declared

Depression is a major contributor to global disability, with profound personal, social, and economic costs. In Singapore, while cross-sectional studies have provided valuable insights into the prevalence of depression, data on the long-term trajectory, outcomes, and determinants of depression remain scarce.

This protocol describes the PREDICT study, which seeks to address this gap by launching the nation’s first longitudinal cohort dedicated to major depressive disorder (MDD) and subsyndromal depression (SD). The objectives include examining disease prognosis, relapse, comorbidity, suicidality, treatment response, healthcare utilization, and mortality, identifying biopsychosocial determinants, quantifying economic burden, and understanding progression from SD to MDD.

The study will recruit 3,201 participants aged 18–75 years, including those with first-episode depression, those with a longer history of depression, individuals with SD, and matched controls without psychiatric illness. Recruitment will be conducted at primary and tertiary care settings as well as from population cohorts. Participants will undergo comprehensive baseline and annual follow-up assessments for up to five years, capturing socio-demographic, psychosocial, physical, and biological data.

We hypothesize that sociocultural factors, such as accessible mental healthcare, social support, strong intergenerational relationships may confer protective effects leading to better outcomes compared with international cohorts, and that individuals with SD will incur higher resource use, poorer quality of life, and increased risk of progression to major depressive disorder as compared to controls.

Findings will provide the first comprehensive longitudinal evidence on depression trajectories in Singapore. Results will guide clinical protocols, inform national mental health strategies (including Singapore’s Healthier SG initiative), and strengthen early detection and management of depression at the population level.

None Declared

Intimate partner violence (IPV) is a major public health concern. One of the most common forms of interpersonal violence concerns IPV, one in three women which is approximately 35% of women who experience physical and sexual violence by an intimate partner at some points in their lives. Women with mental illness are a vulnerable risk group for IPV.

The current study aimed to assess the prevalence and clinical correlates of IPV among women outpatients with mental illness in a tertiary care psychiatric hospital.

118 participants with a primary diagnosis of schizophrenia spectrum disorders or depression were recruited. Data on intimate partner violence (IPV) were assessed on the World Health Organization Violence Against Women (WHOVAW) scale, consisting of three domains-psychological, physical and sexual intimate partner violence. Psychopathology was measured using Brief Psychiatric Rating Scale-18 items (BPRS) questionnaire, consisting of five domains- positive symptoms, negative symptoms, resistance symptoms, activation symptoms, and affect symptoms. Data on socio-demographic characteristics were also obtained. Multivariable logistic regression was used for analysis.

The mean (SD) age of women participants was 32.63 years (10.96). The overall prevalence of IPV among women with mental illness was 55.1%. Participants who were separated/widowed/divorced (versus single) were significantly more likely to experience total VAW scores (OR=14.57), and psychological (OR=21.64), and physical (OR=11.30) domains. Those who belong to Malay ethnicity (versus Chinese ethnicity) were significantly more likely to experience sexual abuse (OR=6.25). Women who were unemployed (versus employed) were significantly more likely to experience sexual IPV (OR=3.94). Women who experienced IPV (OR=1.36), psychological abuse (OR=1.30) and physical abuse (OR=1.25) were significantly more likely to have positive symptoms compared to those who did not experience IPV. Women who experienced IPV (OR=1.14) and psychological abuse (OR=1.13) were significantly more likely to have affect symptoms compared to those who did not experience IPV.

The study highlights the prevalence of IPV among women with mental illness. Overall VAW scores, psychological and physical IPV were strongly associated with higher score on the positive and affect symptoms on psychopathology scale. The high prevalence of IPV among this group of patients is concerning and mental health professionals should actively identify IPV and implement holistic interventions to ensure good care of women with mental illness.

None Declared

Given the emphasis on inclusion of well-being interventions in the treatment and rehabilitation of individuals with mental disorders, it is important to understand the level and determinants of positive mental health (PMH) among them.

To conduct a cross-sectional study among patients with schizophrenia, depression and anxiety spectrum disorders to estimate PMH.

(i) To estimate the level of PMH among patients with mental disorders and compare these with the established general population estimates; (ii) to identify socio-demographic and clinical determinants of PMH.

Following ethics approval, 353 patients aged 21-65 years, receiving treatment at a psychiatric hospital in Singapore for schizophrenia, depression or anxiety spectrum disorders were included. Patients provided socio-demographic information and completed the multidimensional PMH instrument that provides total and domain-specific scores ranging from 1 to 6; higher scores indicate better PMH. Functioning was assessed with the Global Assessment of Functioning (GAF) scale and clinical data were obtained from administrative databases.

Sample comprised 142, 139 and 72 patients with schizophrenia, depression and anxiety spectrum disorders respectively, with a mean age of 39.2 years. Mean total PMH scores among them were 4.2, 3.7 and 3.8 respectively which were significantly lower than the general population mean of 4.5 (P < 0.001). Patients of Chinese ethnicity, with lower education, depression or anxiety, and lower GAF scores were more likely to have lower PMH.

This study identified patient subgroups that are likely to have poorer PMH. Interventions facilitating PMH among these patient groups would be beneficial and are needed.

The authors have not supplied their declaration of competing interest.

The second Singapore Mental Health Study (SMHS) – a nationwide, cross-sectional, epidemiological survey - was initiated in 2016 with the intent of tracking the state of mental health of the general population in Singapore. The study employed the same methodology as the first survey initiated in 2010. The SMHS 2016 aimed to (i) establish the 12-month and lifetime prevalence and correlates of major depressive disorder (MDD), dysthymia, bipolar disorder, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol use disorder (AUD) (which included alcohol abuse and dependence) and (ii) compare the prevalence of these disorders with reference to data from the SMHS 2010.

Door-to-door household surveys were conducted with adult Singapore residents aged 18 years and above from 2016 to 2018 (n = 6126) which yielded a response rate of 69.0%. The subjects were randomly selected using a disproportionate stratified sampling method and assessed using World Health Organization Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0). The diagnoses of lifetime and 12-month selected mental disorders including MDD, dysthymia, bipolar disorder, GAD, OCD, and AUD (alcohol abuse and alcohol dependence), were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.

The lifetime prevalence of at least one mood, anxiety or alcohol use disorder was 13.9% in the adult population. MDD had the highest lifetime prevalence (6.3%) followed by alcohol abuse (4.1%). The 12-month prevalence of any DSM-IV mental disorders was 6.5%. OCD had the highest 12-month prevalence (2.9%) followed by MDD (2.3%). Lifetime and 12-month prevalence of mental disorders assessed in SMHS 2016 (13.8% and 6.4%) was significantly higher than that in SMHS 2010 (12.0% and 4.4%). A significant increase was observed in the prevalence of lifetime GAD (0.9% to 1.6%) and alcohol abuse (3.1% to 4.1%). The 12-month prevalence of GAD (0.8% vs. 0.4%) and OCD (2.9% vs. 1.1%) was significantly higher in SMHS 2016 as compared to SMHS 2010.

The high prevalence of OCD and the increase across the two surveys needs to be tackled at a population level both in terms of creating awareness of the disorder and the need for early treatment. Youth emerge as a vulnerable group who are more likely to be associated with mental disorders and thus targeted interventions in this group with a focus on youth friendly and accessible care centres may lead to earlier detection and treatment of mental disorders.