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PubMed1999

Isoflavone levels in soy foods consumed by multiethnic populations in Singapore and Hawaii.

Concentrations and glucosidic conjugation patterns of isoflavones were determined in soy foods consumed by multiethnic populations in Singapore and Hawaii. Six raw and 11 cooked food groups traditionally consumed in Singapore and 8 food groups consumed in Hawaii were analyzed by reversed-phase high-pressure liquid chromatography with diode array detection. Mean total isoflavone levels varied between 35 and 7500 ppm, with the lowest values found in soy milk and burgers and the highest levels observed in soybean and its seeds and in supplements. Total isoflavone levels and conjugation patterns varied as a function of soybean variety, storage conditions, and food processing. A large contribution to the differences in total isoflavone content between food groups was due to the water content in foods and to leaching of polar analytes into the water phase during boiling. Soy protein drinks and traditional soy foods were found to possess very similar isoflavone amounts considering usual serving sizes.

Beverages↗
PubMed2002

The equivalence of English and Chinese SF-36 versions in bilingual Singapore Chinese.

OBJECTIVE: To assess the equivalence of English and Chinese versions of the SF-36. METHODS: Using a crossover design with block randomisation and stratification by age, identical English or Chinese questionnaires containing the English (UK) and Chinese (HK) SF-36 versions were administered 3-16 days apart to 168 free-living, bilingual, ethnic Chinese volunteers in Singapore. Item level equivalence of both versions was assessed by comparing item means and orderings within each scale. Scale level equivalence was assessed by comparing internal consistency (Cronbach's alpha), results of factor analysis and mean scale scores (using paired t-tests and intra-class correlations). RESULTS: Item and scale level comparisons supported the equivalence of both versions. For both the versions, item means, item ordering and Cronbach's alpha were similar, and factor analysis yielded two factors with similar factor loadings. There was no clinically important difference in mean scale scores for seven of eight scales, and intra-class correlations were excellent/good for five scales (0.69-0.77) and moderate for three scales (0.55-0.57). CONCLUSION: English (UK) and Chinese (HK) SF-36 versions are equivalent in bilingual Singapore Chinese. Our data suggest that SF-36 scores from English- and Chinese-speaking subjects may be combined in studies using the SF-36, increasing the power and representativeness of such studies.

Adolescent↗
PubMed2001

A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore.

Scaling assumptions and validity of the English (UK) and Chinese (HK) short form 36 health survey (SF-36) were assessed in a community-based survey of 5,503 Chinese, Malays and Indians in Singapore using the international quality of life assessment project approach of item and scale level validation. Missing data for SF-36 items and scales occurred in less than 1.0% of subjects. Item level validation of both versions generally supported assumptions underlying Likert scoring and hypothesised item-order clustering. Item level factor analysis supported the eight-scale structure of the SF-36. In scale level validation, SF-36 scale scores showed wide variability and acceptable internal-consistency reliability (Cronbach's alpha > 0.70 for six English and seven Chinese scales), conformed to hypothesised patterns and generally varied according to hypotheses in subjects known to differ in quality of life. Scale level factor analysis of both versions yielded very similar patterns of factor correlation, comparable to that found in Japan, but differing from that seen in Western populations. Taken together, these results support the validity of the English (UK) and Chinese (HK) SF-36 versions in the multi-ethnic Asian socio-cultural context of Singapore.

Adult↗
PubMed1997

Factors determining acceptability of mammography in an Asian population: a study among women in Singapore.

Population-based mammographic screening has been shown to be effective in reducing breast cancer mortality in the West. In Singapore, a project carried out to determine the effectiveness of implementing such a program locally invited 28,000 women between the ages of 50 and 64 years for mammography. The current study, which was part of this larger project, was intended to determine factors contributing to the acceptance of mammographic screening among women in Singapore. A questionnaire was administered in-person to 300 attenders and 260 non-attenders. The respondents were compared with respect to basic demographic characteristics, previous preventive behavior, informal social support, and attitudes towards early detection. We found that screening attenders were more likely to be Chinese than Malays (14 percent of the population) or Indians (seven percent), and to be working outside the home (adjusted odds ratio [OR]) = 4.5, 95 percent confidence interval [CI] = 2.6-7.9). A greater proportion of attenders had a history of other screening tests such as the Pap smear (OR = 4.7, CI = 2.6-8.7 for recent smear compared with never having had a smear). They were also more likely to indicate a sense of personal susceptibility to cancer, but did not differ from non-attenders in terms of believing in cancer prevention, or of preferring to be told if they did have cancer. The strongest independent predictor of attendance, however, was encouragement by her spouse or family member. For women in this population to be persuaded effectively to participate in mammographic screening, it would be important to convince family members of the benefits of the test. At the same time, education targeted specifically at women of the appropriate age group should address the issue of the personal relevance of screening for breast cancer.

Breast Neoplasms↗
PubMed2003

Validity and reliability of the EQ-5D self-report questionnaire in English-speaking Asian patients with rheumatic diseases in Singapore.

Validity and reliability of a Singaporean English EQ-5D self-report questionnaire (EQ-5D) were evaluated among consecutive outpatients with rheumatic diseases attending a tertiary referral hospital in Singapore (a multi-ethnic, urban Asian country). Subjects were interviewed twice within a 2-week period using a standardized questionnaire containing the EQ-5D, Short Form 36 Health Survey (SF-36) and assessing demographic and psychosocial characteristics. To assess validity of the EQ-5D, 13 hypotheses relating responses to EQ-5D dimension/Visual Analogue Scale (EQ-VAS) to SF-36 scores or other variables were examined using the Mann-Whitney test, Kruskal-Wallis test, or Spearman's correlation coefficient. Test-retest reliability was assessed using Cohen's kappa. Sixty-six subjects were studied (osteoarthritis: 9, rheumatoid arthritis: 26, systemic lupus erythematosus: 23, spondyloarthropathy: 8; female: 72.7%; mean age: 44.3 years). Ten of 13 a-priori hypotheses relating EQ-5D responses to external variables were fulfilled, supporting the validity of the EQ-SD. Cohen's kappa for test-retest reliability (n = 52) ranged from 0.29 to 0.61. The Singaporean English EQ-5D appears to be valid in measuring quality of life in Singaporeans with rheumatic diseases; however, its reliability requires further investigation. These data provide a basis for further studies assessing the validity of the EQ-5D in Singapore.

Adolescent↗
PubMed2000

Evaluation of the allergenicity of tropical pollen and airborne spores in Singapore.

BACKGROUND: Sensitization to pollen and spores of the Southeast Asian tropical region is not well documented. This study evaluated the allergenicity of the tropical airspora in Singapore. METHODS: On the basis of the results of an aerobiologic survey of the airspora profile of Singapore, crude extracts of 23 main spore (fungal and fern) and pollen types were prepared. A total of 231 patients with asthma and/or allergic rhinitis and 76 healthy controls were evaluated by skin prick test (SPT). Total and specific IgE levels were also quantified by the fluorescence allergosorbent test (FAST). RESULTS: All 23 allergenic extracts tested elicited positive SPT responses. Among the patients with atopic diseases, extracts of oil-palm pollen (Elaeis guineensis) were observed to have the highest frequency of positive reactions (40%), followed by extracts of resam-fern spores (Dicranopteris linearis) (34%) and sea-teak pollen (Podocarpus polystachyus) (33.8%). Fungal spores with the highest SPT responses were Curvularia spp. (26-32%) and Drechslera-like spores (31%). Positive responses to these extracts correlated with total serum IgE levels of the subjects and were significantly associated with the presence of atopic disease. CONCLUSIONS: We have documented sensitization to tropical pollen and spores in our population. Its association with atopy suggests that it has a role in allergic diseases in the tropics.

Adolescent↗
PubMed2001

A retrospective review of PUVA therapy at the National Skin Centre of Singapore.

BACKGROUND: Photochemotherapy (PUVA) is beneficial for the treatment of various dermatoses. The introduction of ultraviolet B and narrow-band ultraviolet B phototherapy has had a significant impact on the role of PUVA in dermatology. This study aims to assess the current role of PUVA in treating dermatoses, in a predominantly Asian population, at the National Skin Centre in Singapore. MATERIALS AND METHODS: We reviewed the clinical data of 115 patients who were started on PUVA treatment at the National Skin Centre, Singapore in 1998. We analysed the epidemiology data, the clinical response rate and the adverse effects of PUVA therapy. All of the patients continued to have ongoing maintenance treatment. RESULTS: Most of our patients were Chinese (74.8%) and male (58.3%), ranging from the ages of 4 to 74 years. Vitiligo (60.9%) was the commonest skin disorder treated with PUVA, followed by psoriasis (20.9%), endogenous eczema (11.3%), mycosis fungoides (3.5%), lichen amyloidosis (2.6%) and prurigo nodularis (0.9%). Most of our patients received paint PUVA (50.4%), 33.9% oral PUVA and 15.7% bath PUVA. The best clinical response--those patients achieving a greater that 50% clearance--was observed in patients with endogenous eczema, psoriasis and mycosis fungoides (76.8%, 73.9% and 60%, respectively). Of the vitiliginous patients, 54.3% experienced a poor response to PUVA therapy. The main side effects were mild erythema and pruritus. CONCLUSION: PUVA remains a valuable, well-tolerated therapeutic option for a variety of dermatoses.

Adolescent↗
PubMed2003

Catastrophic extinctions follow deforestation in Singapore.

The looming mass extinction of biodiversity in the humid tropics is a major concern for the future, yet most reports of extinctions in these regions are anecdotal or conjectural, with a scarcity of robust, broad-based empirical data. Here we report on local extinctions among a wide range of terrestrial and freshwater taxa from Singapore (540 km2) in relation to habitat loss exceeding 95% over 183 years. Substantial rates of documented and inferred extinctions were found, especially for forest specialists, with the greatest proportion of extinct taxa (34-87%) in butterflies, fish, birds and mammals. Observed extinctions were generally fewer, but inferred losses often higher, in vascular plants, phasmids, decapods, amphibians and reptiles (5-80%). Forest reserves comprising only 0.25% of Singapore's area now harbour over 50% of the residual native biodiversity. Extrapolations of the observed and inferred local extinction data, using a calibrated species-area model, imply that the current unprecedented rate of habitat destruction in Southeast Asia will result in the loss of 13-42% of regional populations over the next century, at least half of which will represent global species extinctions.

Animals↗
PubMed1998

Anaemia in pregnancy--a cross-sectional study in Singapore.

OBJECTIVE: To determine the prevalence and predictors of anaemia in pregnancy in Singapore. DESIGN: Hospital based case controlled study. SETTING: National University Hospital, between January-December 1993. SUBJECTS: All women delivered at the National University Hospital, Singapore in 1993 had their haemoglobin estimated. If it was less than 11 gm/dl, blood was taken to establish the cause of anaemia. Data was also collected with regard to their antenatal progress, and factors predisposing to anaemia in pregnancy. Logistic regression, Chi-square test, Fischer's exact test, Mantel-Haenszel test were used to assess the relationships between categorical variables. RESULTS: The prevalence of anaemia at delivery was 15.3%. The most common cause of anaemia in pregnancy was due to iron deficiency (81.3%). The occurrence of anaemia in pregnancy is related to the socio-economic status of the women. Multiparous women of the lower socio-economic class who tend to book late in pregnancy were found to have the highest risk of anaemia. Multivariate logistic regression analysis revealed iron prophylaxis, haemoglobin level at booking, race and previous history of anaemia in earlier pregnancy as important predictors of anaemia at delivery. The odds of anaemia for a woman not on therapy was about 11 times that of her counterpart on prophylactic iron therapy (95% CI 8.76-14.13). A 55% reduction in odds of anaemia was estimated per 1 gm% increase in haemoglobin level at booking. As compared to Chinese, Malays and Indians who experienced significant increase in odds of anaemia of 95% and 58% respectively. Further, a pregnant woman with a previous history of anaemia is 2.6 times as likely to be anaemic, as compared with one without history of anaemia. Except for a higher incidence of preterm delivery, there was no other statistically increased risk of complications in the antepartum, intrapartum or postpartum periods. There was no difference in the incidence of antepartum haemorrhage/operative deliveries, postpartum haemorrhage, low birthweight, intrauterine growth retardation and neonatal outcome. CONCLUSIONS: The study confirms that iron deficiency anaemia is the most common cause of anaemia in pregnancy and is a major health problem in developing and developed countries.

Anemia↗
PubMed2005

Potential sources of carcinogenic heterocyclic amines in the Chinese diet: results from a 24-h dietary recall study in Singapore.

OBJECTIVE: Heterocyclic amines (HCAs) from high-temperature cooking of meat have been linked to increased cancer incidence in Western populations, but data on the sources of HCAs in Asian diets are scarce. Our aim was to identify potential sources of HCAs in the Chinese diet, and to provide the basis for efforts to quantify dietary exposure to these compounds. DESIGN AND SETTING: We conducted 24-h dietary recall interviews among 986 Chinese men and women in Singapore, who were a randomly selected subpopulation of participants from the Singapore Chinese Health Study, a population-based cohort. Details of all foods and beverages consumed by each subject in the past 24 h were recorded, and information on meat type, cooking method and portion size were abstracted from all meat-containing dishes, and gram weight equivalents computed. RESULTS: The mean meat intake per person was 103.0 g/day (standard deviation 74.2), of which 97.2% was fresh meat. Fish (38.0%), pork (30.6%), and poultry (21.0%) accounted for 89.6% of meat consumed. Patterns of meat consumption and cooking methods differed markedly from Western populations. Documented high-temperature cooking methods, combined with stir-frying, accounted for 44.3% of fish, 35.1% of pork and 25.6% of poultry consumed. Specifically, potentially significant sources of HCAs were pan-fried fish and barbecued pork. CONCLUSIONS: Our results identify the potential sources of HCA in the Chinese diet, highlight aspects which are relevant to HCA formation and intake, and call for novel approaches to estimating individual exposure to dietary HCAs in this and similar populations.

Aged↗
PubMed2000

APC mutation and phenotypic spectrum of Singapore familial adenomatous polyposis patients.

Familial adenomatous polyposis (FAP) is a familial form of colon cancer caused by mutation of the adenomatous polyposis coli (APC) gene. Although the APC gene has been extensively studied in the Caucasian population, it has not been previously described in the Chinese population. In the present study, we investigated APC mutation and phenotypic spectrum in the Singapore FAP families who are predominantly Chinese. The protein truncation test (PTT) was used to screen the entire APC gene for germline mutations in 28 unrelated families. Fifteen different mutations were identified in 22 families. Eight mutations were 1-11 basepair deletions or insertions; three involved deletions of whole exons and four were nonsense mutations. Nine of the mutations, including two complex rearrangements, are novel. Eight families including three de novo cases have the same (AAAGA) deletion at codon 1309, indicating that like the Western families, codon 1309 is also the mutation 'hot spot' for Singapore FAP families. In contrast, we did not find any mutation in codon 1061, the second hot spot for the Western population. Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is consistently associated with the prescribed domain (codons 463 to 1387) and is the only phenotype with no intra-family variation. Other than CHRPE, differences in the type and frequency of extracolonic manifestations within the FAP families suggest the influence of modifying genes and environmental factors.

Adenomatous Polyposis Coli↗
PubMed2006

Association analysis of endothelial nitric oxide synthase gene polymorphism with primary hypertension in a Singapore population.

Vascular endothelial cells produce nitric oxide (NO), which contributes to the regulation of blood pressure and regional blood flow. Endothelial nitric oxide synthase (eNOS) gene polymorphisms are associated with coronary artery disease, but their linkage with primary hypertension is controversial. A total of 103 individuals with primary hypertension and 104 normotensive control subjects were studied in Singapore. The specific genotypes for G894T missense variant in exon 7, variable number tandem repeats (VNTR) in intron 4 (eNOS 4A/B/C) and T-786C in the promoter were isolated using allele-specific gene amplification and restriction fragment length polymorphism to examine the association of genotype and allelic frequency in both groups. Logistic regression analysis was also used to detect the association between genotypes and hypertension. Five genotypes of intron 4 VNTR (AA, AB, BB, AC and BC) were observed. Intron 4 B/B genotype was significantly associated with the hypertension group (P = 0.035), but disequilibrium of G894T and T-786C was absent between the two groups (P = 0.419 and P = 0.227), respectively. The overall distribution of allelic frequency differed significantly between the two groups, with four-repeat allele (4A) of intron 4 more frequent in the normotensive group than the hypertensive group (P = 0.019). Logistic regression analysis showed that intron 4 B/B genotype was significantly associated with systolic blood pressure of individuals with body mass index greater than 25 kg/m2 (P = 0.04). In conclusion, the eNOS 4 B/B genotype is a genetic susceptibility factor for primary hypertension in a Singapore population.

Blood Pressure↗
PubMed2004

Cytogenetic abnormalities in de novo acute myeloid leukemia in adults: relation to morphology, age, sex and ethnicity - a single center study from Singapore.

BACKGROUND: Cytogenetic analysis performed at diagnosis is considered to be the most valuable prognostic factor in acute myeloid leukemia (AML). Large systematic studies of cytogenetic abnormalities in AML patients from Southeast Asia are not available. The karyotypic patterns in AML patients from a single center in Singapore were studied and compared with reports from other regions of the world to identify possible geographic heterogeneity. METHODS: Analysis was performed on 501 consecutive de novo AML patients diagnosed according to the FAB criteria in the Singapore General Hospital. The cytogenetic findings were analyzed for possible associations between karyotypic pattern and the age, gender, ethnicity as well as morphological (FAB) subtypes. RESULTS: A total of 454 patients were studied of which 275(61%) had abnormal cytogenetics(median age 48 years). The t(15;17) and trisomy 8 were the most frequent karyotypic abnormalities - seen in 52(11%) and 33(7.3%) cases, respectively. Inv(lf) and t(16;16) were uncommon, seen only in five (1.1%) cases. The abnormalities del 5/5q and del 7/7q were seen in 30(6.6%) and 32(7%) of the cases. Complex karyotypes were seen in 78(17%) of the cases.Recurrent cytogenetic abnormalities correlated with the FAB subtypes. In all, 21 novel cytogenetic abnormalities were observed. CONCLUSIONS: Certain differences such as the age at presentation and frequency of recurrent balanced translocations were noted in comparison to previous reports. These point to the need for extensive epidemiological studies to clarify the role of genetic as well as geographic heterogeneity in the pathogenesis of AML.

Acute Disease↗
PubMed2002

Spectrum of subepidermal immunobullous disorders seen at the National Skin Centre, Singapore: a 2-year review.

BACKGROUND: The subepidermal immunobullous disorders (SEIBDs) comprise bullous pemphigoid (BP), cicatricial pemphigoid (CP), epidermolysis bullosa acquisita (EBA), linear IgA disease (LAD), dermatitis herpetiformis (DH), pemphigoid gestationis (PG) and bullous systemic lupus erythematosus (BSLE). They are thought to be rarer in the Far East than in western Europe. OBJECTIVE: This 2-year retrospective study investigates the spectrum seen at our centre and the minimum estimated incidence of each. PATIENTS AND METHODS: A total of 67 patients seen at the National Skin Centre (NSC), Singapore between January 1998 and December 1999 were diagnosed as having an SEIBD. Fifty-nine (88%) had BP, four (6%) had EBA, two (3%) LAD and two (3%) BSLE. There were no cases of CP, DH or PG diagnosed during this period. The minimum estimated incidence in our local population was 7.6, 0.5, 0.26 and 0.26 per million population per year, respectively. The mean age of onset was 77, 68, 65 and 31 years, respectively. RESULTS: BP is the commonest SEIBD seen locally, with an incidence at least equal to that in western Europe. It is diagnosed at our centre three times more frequently than pemphigus. There is a predilection for ethnic Chinese but not Indian. EBA is twice as common as in western Europe and shows a predilection for ethnic Indians. LAD is rare here compared to China, despite the predominant Chinese population. BSLE is also rare. In contrast to western Europe, CP, DH and PG are very rare in Singapore. CONCLUSIONS: This is the first study from this region to show that certain SEIBDs are not rarer in the Far East, as previously thought.

Adult↗
PubMed2000

Erythema nodosum in Singapore.

A retrospective study was carried out of all patients presenting with erythema nodosum over a 3-year period (1994-1997) at the National Skin Centre, Singapore. There were 75 patients, aged 4-70 years with a peak (40%) in the 21-30-year-old age group; 65 were female and 10 were male, giving a female to male ratio of 6.5 : 1. Precipitating factors included viral respiratory tract infections and streptococcal pharyngitis in 20 cases (26%), tuberculosis in two cases (3%), pregnancy in three cases (4%) and miscellaneous conditions: Behcet's syndrome (two cases), gonorrhoea (one case), varicella (one case) and cat-scratch disease (one case). The cause was unknown in 45 cases (60%). The pattern of erythema nodosum in Singapore is similar to that reported in the Western literature except that sarcoidosis and inflammatory bowel disease are uncommon associations.

Adolescent↗
PubMed1998

Current aspects of hepatitis B surface antigen mutants in Singapore.

Mutations occurring on the major antigenic 'a' determinant of hepatitis B surface antigen (HBsAg) have been detected in immunized Singapore children, despite immunoprophylaxis with hepatitis B immune globulin and HBV vaccine. These vaccine-escape HBsAg mutants display a predominance of the Gly145-to-Arg145 mutation in the antigenic 'a' determinant. Our latest follow-up studies indicate the stability of this as well as other vaccine-escape HBsAg mutants over time. We have also identified HBsAg mutants in immunized children with amino acid substitutions outside the 'a' determinant. Transmission of various vaccine-escape HBsAg mutants have been shown in our epidemiological studies. Detection of HBsAg mutants, carrying amino acid changes at various position of the 'a' determinant in random population, points to their emergence in Singapore before the implementation of the vaccination programme. Of significant interest is the recent identification of vaccine-escape HBsAg mutants in hepatocellular carcinoma.

Adolescent↗
PubMed1997

Skin colonization of Staphylococcus aureus in atopic dermatitis patients seen at the National Skin Centre, Singapore.

OBJECTIVE: This prospective study sought to determine the bacterial colonization rates on eczematous and non-eczematous skin and nasal mucosa of patients with atopic dermatitis attending a tertiary dermatologic referral clinic in Singapore. The colonization rates were evaluated according to age, sex, race, and severity of dermatitis compared with controls. The results may help to determine whether antibiotics should be considered in the treatment of atopic dermatitis. PATIENTS: Patients, of any age, presenting with atopic dermatitis at the subsidized clinic of the National Skin Centre, Singapore, between 23 August 1996 and 14 September 1996, were included in the study. RESULTS: Thirty-three patients with atopic dermatitis were seen at the outpatient clinic during the study period. Staphylococcus aureus was isolated in 69.7% of the eczematous lesions and in 42.4% of non-eczematous skin of patients with atopic dermatitis. S. aureus was isolated in 53% of patients with mild dermatitis, and in 100% with moderate and severe dermatitis. The nasal carriage rate of S. aureus was higher in atopic dermatitis patients (51.5%) than in non-atopics (35%) (not significant). S. aureus was isolated in 42% of non-eczematous skin in atopics compared with only 5% in the control group (p = 0.003). In patients with atopic dermatitis, all S. aureus isolated was sensitive to cloxacillin, cephalexin, clindamycin, and co-trimoxazole; 92% was sensitive to erythromycin, but only 13% was sensitive to penicillin and ampicillin. In the control group, all S. aureus isolated was sensitive to cloxacillin, cephalexin, erythromycin, clindamycin, and co-trimoxazole, but only 13% was sensitive to penicillin and ampicillin, and 87% to tetracycline. CONCLUSIONS: This study confirmed that the skin of patients with atopic dermatitis was more frequently colonized with S. aureus than that of non-atopics. The more severe the dermatitis, the higher the rate of colonization. S. aureus is also more of than present in non-eczematous skin of atopics than of non-atopics. There is also a higher percentage of S. aureus nasal carriage in patients with atopic dermatitis than in non-atopics. Hence antibiotics may have a role in the treatment of atopic dermatitis. Because 87% of S. aureus is resistant to penicillin and ampicillin, antibiotics such as cloxacillin and cephalexin should be used to eradicate S. aureus in the skin of atopic dermatitis individuals.

Adolescent↗
PubMed2003

Preference, need and utilization of mental health services, Singapore National Mental Health Survey.

OBJECTIVE: To ascertain the extent of the community's preference, needs for and utilization of mental health services, and their socio-demographic determinants in the multi-ethnic Asian community in Singapore. The extent to which need, enabling and predisposing factors determine the likelihood to seek professional help was also examined. METHOD: Data were analyzed from the Singapore National Mental Health Survey of 1996, based on a stratified random sample of 2947 Chinese, Malay and Indian subjects of the general population aged 13-64 years. RESULTS: An estimated 37% of the general population indicated they would seek professional help if they experienced a serious emotional or mental problem. Although 16.9% were determined by their high general health questionnaire (GHQ) score to need mental health services, only 2.6% in the population used the services of any professional caregiver. Among persons with high GHQ scores, only 5.9% sought any professional help. Among those with a high GHQ score and who were receptive to professional help, only 10.4% actually sought professional help. General practitioners were the most commonly preferred caregiver (49.3%), and were used by 41.1% of those who sought help. Those who sought professional help were more likely to have a high GHQ score and to be inclined to seek professional help. Malays used mental health services more than Chinese, but they did not show a significantly greater prevalence of high GHQ scores, or a greater preference to seek professional help. Receptivity to professional help, high GHQ score, and Malay ethnicity were independent significant predictors of use of mental health service. CONCLUSION: Need and attitudinal factors predict mental health service utilization, but they still do not explain why a large majority of the population chose not to use mental health services.

Adolescent↗