15 Dec 2011
By: LEA WEE
A national survey has found that a significant number of physically sick people are plagued at the same time by mental illness.
And hospitals have been ramping up their efforts to screen such people for mental disorders.
Results of the Singapore Mental Health Study, which were released last month, showed that 14.3 per cent of patients who have a chronic physical illness are also psychologically unwell. This works out to about 170,000 people here.
But for one reason or another, more than 84 per cent are being treated only for their physical symptoms.
The study could provide a guide on where screening may be widened, said Dr Mythily Subramaniam, deputy director of research at the Institute of Mental Health (IMH). She was part of the team led by Associate Professor Chong Siow Ann, vice-chairman of medical board (research) from the IMH, which did the study.
Right now, all six public hospitals screen patients with long-term physical problems for mental conditions such as depression or anxiety as part of a government-funded initiative.
Each has chosen a condition to base its screening on – usually an area of focus for the hospital. They are diabetes, stroke, Aids-causing human immunodeficiency virus (HIV), irritable bowel syndrome, traumatic injuries and gynaecological cancer.
Patients who are found to have psychological symptoms are managed by a team which can comprise doctors, psychiatrists, psychologists, medical social workers and nurses.
The study indicates a number of illnesses have yet to be included. These include chronic pain and respiratory ailments such as asthma which, together, have the highest prevalence of accompanying mental illness. About 15 different types of chronic physical conditions, including cancer and heart and brain diseases, were covered.
It is hardly surprising that such debilitating physical illnesses would be accompanied by psychological distress.
Some physical illnesses share the same genes as mental disease, said Dr Mythily. For instance, diabetes and schizophrenia could have similar genetic causes. The same goes for depressive symptoms and coronary heart disease.
But that aside, chronic physical diseases take such a toll on a patient’s daily functioning and overall well-being that they could cause mental illness, she said. And that could compromise a patient’s prognosis.
Dr Mythily said: “Without treating the mental problem, the physical problem may not improve. It could even get worse.”
One 58-year-old housewife, for instance, said even though she was on medication for irritable bowel syndrome, her condition improved only after she went to a psychiatrist for her symptoms of anxiety. She no longer needs medication.
“Seeing the psychiatrist was better than any medication I had ever taken,” she said.
The hospitals’ own recent experiences suggest that patients would welcome having something done about their psychological symptoms.
Hospitals say at least nine out of 10 patients now agree to answer a questionnaire about their mental well-being.
Those found to have depression or anxiety also tend to be open to counselling and treatment.
There are various reasons why they may not be seeking help on their own.
People might not recognise the symptoms, which could be similar to those of the physical complaint, said Dr Mythily.
For instance, symptoms of depression, such as fatigue, lethargy and apathy, are also signs of stroke and other chronic physical illnesses.
Others may feel a stigma in talking about their mental health, even to a doctor.
Now, at least some are being picked up in the screening initiative, which is funded by the National Mental Health Blueprint, formulated in 2007 to promote mental health here.
At Tan Tock Seng Hospital (TTSH), which screens in-hospital stroke patients for depression, the rehabilitation doctor and his team of nurses, therapists and psychologists manage both the physical problems and any mild to moderate depression.
Those with more serious symptoms are seen by hospital psychiatrists.
This integrated approach reduces stigma, said Dr Aaron Ang, the head and consultant at the hospital’s psychological medicine department.
So far, hardly any patient who has been offered psychological treatment has refused it, he said.
Hospitals say it is more difficult to persuade those being seen at outpatient specialist clinics to return to see a psychiatrist.
To make it less daunting, diabetic patients at Khoo Teck Puat Hospital (KTPH) who show signs of distress get to talk to a medical social worker first.
Psychiatrists will be called in for more serious cases, said Dr Chan Keen Loong, a senior consultant at the hospital’s department of psychological medicine.
At Singapore General Hospital (SGH), which screens patients with irritable bowel syndrome, patients who are reluctant to see a psychiatrist are invited to join a support group instead.
During meetings, they learn how to cope with their symptoms from a doctor and can share their problems with other patients, said Associate Professor Ng Beng Yeong, head and consultant at the hospital’s department of psychiatry.
At TTSH’s Communicable Disease Centre, patients with HIV are screened for depression and the results are documented in their case notes.
Their doctors are then aware of their emotional issues and can persuade them to seek help if it is needed.
Some hospitals, such as KK Women’s and Children’s Hospital and Changi General Hospital, screen patients with traumatic injuries for emotional distress.
When such patients get the help they need, they benefit from it.
Early data from the hospitals shows that patients scored lower in depression and anxiety and higher in quality of life after psychological treatment.
Physical ailments may also improve.
Diabetics at KTPH, for instance, had better control of their blood sugar, with the average levels of sugar in their blood decreasing after six months to a year of psychological treatment.
Patients with irritable bowel syndrome at SGH also reported fewer bowel symptoms such as stomach pain after their mood improved, while stroke patients at TTSH scored higher on their level of function and quality of life.
Aside from the mental and physical diseases which share the same root cause, patients who feel better are more in control and more motivated to take care of themselves and take part in rehabilitation, doctors said.
Some hospitals are getting proactive about catching patients with other chronic diseases for depression.
KTPH, for instance, is screening some patients at its weight management and geriatric clinics for depression, on top of its pilot programme for diabetics.
The National University Hospital, which screens women with cancer of the reproductive system for depression under its pilot programme, hopes to extend this to breast cancer and other physical illnesses.
Email: leawee@sph.com.sg
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