Why Do Youths Kill Themselves?

Youth suicide is a growing concern in Singapore, with increasing numbers of young people overwhelmed by pressures they struggle to cope with. Hopelessness plays a critical role, as many youths feel trapped in situations they perceive as unchangeable. To prevent these tragedies, it is crucial for families, schools, and communities to foster open communication, ensuring that young people feel supported and understood in their struggles.

Key takeaways

  • Hopelessness is a key predictor of youth suicide—young people often feel overwhelmed by life stressors and lack coping mechanisms, leading them to believe there is no escape.
  • The accumulation of pressures—such as academic stress, romantic rejection, family issues, and identity struggles—can push vulnerable youths toward suicidal thoughts.
  • Open communication and support from families, schools, and communities are critical to preventing youth suicide, helping young people feel seen, heard, and understood.

Posted on 4 Oct 2024

Written by
Dr Jared Ng, Connections MindHealth

The heartbreaking rise in youth suicides in Singapore is impossible to ignore. In 2023, nearly 30% of suicides involved individuals under the age of 29, with an alarming number – almost one-third – being children and youths between the ages of 10 and 19. Suicide has tragically become the leading cause of death among our youth, surpassing accidents and illnesses. This devastating reality forces us to confront the intense pressures that many of our young people face every day.

Though the media often refrains from reporting youth suicides, perhaps out of concern for contagion effects or protecting vulnerable individuals, those of us working in mental health witness this silent epidemic. These cases are not just confined to adolescents; even children in primary school are not immune. Behind every statistic is a young life lost, and with it, a family and community left grieving, searching for answers.

The youths who take their own lives often appear to be thriving—excelling academically, socially, and physically. Yet beneath this veneer of success can lie a deep, unnoticed despair that ultimately becomes too much to bear.

youth suicides in singapore
The interplay between hope and hopelessness is crucial in understanding youth suicides.
How Hope and Hopelessness Influence Youth Suicide

Hopelessness is a significant factor in suicide risk across all ages, representing a profound state of despair where individuals feel trapped in an unchangeable situation, with suffering that seems endless. This overwhelming sense of hopelessness can lead to the belief that death is the only escape, making it one of the strongest predictors of suicidal behavior. When hope is lost, the risk of suicide dramatically increases.

For young people, hopelessness often stems from life stressors they perceive as insurmountable. Unlike adults, children and youths typically have less experience dealing with complex emotional challenges and may lack the coping mechanisms needed to navigate their despair. Additionally, their natural impulsivity can exacerbate the situation. Young people are more prone to making rash decisions in moments of intense emotion, often without fully considering the consequences. This impulsivity, combined with feelings of hopelessness, can dangerously heighten the risk of suicide, as a young person may act on suicidal thoughts suddenly, leaving little opportunity for intervention.

The interplay between hope and hopelessness is crucial in understanding youth suicides. Hope is a vital psychological resource that begins to develop early in childhood. It starts to form in infancy when a child learns to trust their caregivers and becomes more established around ages 3 to 5, when children develop a sense of purpose and the ability to envision a positive future. However, as children grow older and face more complex social and academic pressures, their sense of hope can be threatened, especially if they encounter repeated failures or rejection. When these pressures become too great, and the child or youth sees no way out, hope can be replaced by hopelessness.

As a parent, it’s essential to understand that even the most successful children can struggle with feelings of inadequacy. Despite outward appearances of success, some youths battle intense internal pressures, setting impossibly high standards for themselves. When they fail to meet these expectations, the resulting feelings of hopelessness, compounded by impulsivity, can lead to a dangerous downward spiral.

Understanding the fragility of hope in our young people is then crucial to grasping the triggers behind youth suicides. But what are these pressures that push them beyond the brink?

academic pressure in Singaporean children
Academic pressure is another recurring theme when young people talk about their stressful situations.
Understanding the Triggers Behind Youth Suicide

Through my practice, I’ve encountered many young individuals overwhelmed by circumstances they don’t know how to navigate—circumstances that drive them to contemplate, or even attempt, suicide. One case that stands out is that of a 12-year-old girl whose parents discovered a suicide note hidden in her pencil case. She had poured out her feelings of profound loneliness, all stemming from the rejection of a crush whom she saw as her ‘true love.’ When she tried to talk to her parents about her heartache, they dismissed her emotions, telling her to focus on her studies instead since she was not doing well. For her, this response deepened her isolation. In her note, she expressed that she felt like a burden to her family and believed they would be happier without her. (For the record, this child is alive, and with the support of her parents, she is now receiving the care she needs and is on the path to healing.)

This case, like many others, reminds us that youth suicide is rarely the result of one factor. It’s often an accumulation of pressures—romantic rejection, academic stress, family dynamics, and more. And while romantic relationships are an important part of adolescence, young people’s sense of self-worth is often tied to many areas—be it friendships, peer acceptance, or family approval.

As a mental health professional, cases like this weigh heavily on me. They reinforce how critical it is to listen to our children, even when their struggles seem small to us. This experience, and countless others, have deeply influenced my approach to treating at-risk youths. I’ve learned that what we might dismiss as “typical teenage angst” or fleeting concerns can be the very thing pushing a young person to the edge. Every cry for help, no matter how subtle, deserves to be heard.

I often ask myself, “What can we do better?” or “What more can be done?” In my years of practice, the answer has always come down to fostering connections—helping young people feel seen and heard before their pain becomes too overwhelming to manage. These stories shape the way I approach my work and emphasise the importance of never underestimating the emotional lives of our youths.

Youth suicides are rarely caused by one isolated factor. It’s usually the accumulation of stressors—romantic rejection, academic pressure, and more—that can push a young person beyond their breaking point.

Family disputes causes emotional distress in children
Family issues, particularly parental disputes or divorce, can also contribute to emotional distress.

Romantic rejection, particularly a first heartbreak, is one of the most common and emotionally intense triggers for young people. Adolescents often experience their first romantic relationships with immense intensity, and when these relationships end, it can feel like the end of the world. Many young people’s sense of identity and self-worth becomes closely tied to their romantic relationships, and a breakup or rejection can lead to overwhelming feelings of worthlessness, despair, and hopelessness. For some, this emotional pain can feel unbearable, especially when combined with other stressors in their lives.

Academic pressure is another recurring theme when young people talk about their stressful situations. Students often feel that their worth is tied to their performance, leading to immense stress. When combined with other stressors like friendship or family issues, the result can be overwhelming despair. We must also consider how these pressures interact with individual vulnerabilities, such as a predisposition to anxiety or depression, to fully understand why some youths are more affected than others.

Identity confusion is also a significant factor. Adolescence is a time of exploration, especially concerning personal identity, gender identity, and sexual orientation. For some, navigating these aspects of themselves can lead to significant distress, particularly if they feel unsupported or misunderstood.

Child abuse—whether physical, emotional, or sexual—can create overwhelming feelings of worthlessness and despair. Studies have shown that children who experience abuse are significantly more likely to develop mental health issues, including depression and anxiety, which are risk factors for suicide. The trauma from abuse can worsen hopelessness, making it difficult for these youths to see a future free from pain.

Family issues, particularly parental disputes or divorce, can also contribute to emotional distress. While not all divorces lead to emotional distress, the instability or conflict surrounding a family breakdown can be deeply unsettling for young people, potentially leading to suicidal thoughts.

It is important to understand that children and youths often face more than one stressor at a time, and these stressors can accumulate, making the situation feel even more overwhelming and inescapable. By recognising the complex interplay of mental health disorders, environmental factors, stressors, and individual vulnerabilities, we can better appreciate the depth of the challenges that many young people face.

Social Media’s Impact on Youth Mental Health

In a world where young people already face immense pressure, social media often amplifies their challenges. It’s not just a space for connection—it’s a constant stream of comparison, where vulnerable youths measure their lives against the carefully curated, often unattainable standards set by their peers.

Many of the young patients I’ve seen talk about how they feel ‘less than’ when scrolling through platforms like Instagram and TikTok. While these platforms can offer a sense of connection, they can also foster deep feelings of inadequacy. For youths already struggling with self-esteem or personal challenges, these comparisons can be devastating. The image of success, beauty, and happiness they see online becomes yet another unattainable goal—further driving feelings of worthlessness.

Cyberbullying is another significant issue that I have encountered in my practice. The anonymity of the internet allows bullies to harass others with little fear of consequences. Victims of cyberbullying often feel isolated and powerless, trapped in a cycle of psychological distress. The pressure to maintain a certain image online, combined with the fear of public humiliation, can push vulnerable youths toward suicidal thoughts as they see no way to escape the relentless negativity.

As a parent, it’s vital to engage in open conversations with your children about their online experiences. Rather than imposing strict bans on screen time, which may feel punitive, encourage your children to share what they see and how it makes them feel. Creating a safe space for these discussions can help them develop a healthy perspective on social media and reduce the impact of negative comparisons.

cyberbullying
In a world where young people already face immense pressure, social media often amplifies their challenges.
Supporting Those Affected: The Role of Postvention

Postvention, the support provided to those affected by a suicide, is a crucial yet often overlooked aspect of suicide prevention. The impact of a suicide extends far beyond immediate family members, affecting friends, classmates, teachers, and even acquaintances. In my own experience, I witnessed this firsthand when my daughter lost a friend after a fall from heights. I was heartened to see that the school had structured interventions in place to support classmates and teachers during this difficult time.

However, it’s important to remember that structured postvention processes often focus on those directly involved in formal settings, such as schools. Other social groups that are equally affected by the suicide may be overlooked. These include peers
from enrichment classes, playground friendships, virtual friend groups, and other less formal social circles. These groups can be just as devastated by the loss, and it is essential to extend postvention efforts to these communities as well.

Effective postvention can take many forms. Schools can start by providing immediate mental health support, such as on-site counselors, and creating spaces where students can talk openly about their grief. Peer support groups can also be invaluable in helping young people process their emotions together. Schools and communities should work to destigmatise conversations about suicide and loss, ensuring that students feel safe expressing their feelings without fear of judgment. Another critical step is offering long-term support—grief doesn’t disappear after a few weeks. Schools and community organisations should follow up with affected youths in the months after a suicide, helping them manage their ongoing emotions.

Just as important as support in schools is the involvement of families in the healing process. Parents and guardians are often a young person’s primary emotional support, and it is essential that they be part of the conversation. Family members should be prepared to discuss the loss in a way that is developmentally appropriate for their child’s age and emotional maturity. Younger children may not fully understand the permanence of death and might express their grief through behavior changes or play, while adolescents might need space to process their more complex emotions, often experiencing a heightened sense of vulnerability. Parents should create a safe, open environment where their child feels supported in sharing their feelings without fear of dismissal.

This is where age-appropriate conversations become so vital. Discussing suicide and loss with children and adolescents requires sensitivity, but it’s necessary to ensure they feel seen and understood. Younger children might need simple explanations, focusing on reassurance and security, while older youths may need a space to explore their feelings more deeply. It’s crucial for parents to acknowledge their child’s emotions, validate their pain, and provide ongoing support as grief evolves.

By providing compassionate and consistent postvention support, we can help those left behind heal from their grief and prevent further emotional distress. It’s vital to remember that postvention is not just about reacting to loss but about reinforcing the connections and resilience that can help prevent future tragedies. Families, schools, and communities must work together to provide a holistic, age-appropriate approach to support, ensuring no young person feels isolated in their grief.

preventing youth suicide together
Parents need to foster open communication, ensuring that their children feel safe to express their fears and anxieties.
Taking Action: Preventing Youth Suicide Together

Preventing youth suicide demands a collective effort. Families play a pivotal role in the well-being of young people. Parents need to foster open communication, ensuring that their children feel safe to express their fears and anxieties. This involves creating a home environment where emotional expression is encouraged and where children know they will be supported and not judged when they share their struggles. It’s equally important for parents to be aware of the signs of distress—such as changes in mood and behavior, withdrawal from social activities, or declining academic performance—and to be proactive in offering emotional support or seeking professional help when needed.

Schools must prioritise mental health by creating supportive environments that recognise the importance of emotional well-being alongside academic success. Schools should work to reduce the stigma of help-seeking and suicide prevention. Teachers and other staff need to be trained to identify signs of distress and intervene appropriately. Additionally, schools can incorporate programs that teach coping mechanisms and stress management skills, helping students build resilience in the face of challenges.

As a broader community, we must challenge the societal norms that contribute to the immense pressure on young people. This includes rethinking our definitions of success and ensuring that mental health resources are accessible and timely. Public awareness campaigns can play a significant role in changing perceptions about mental health and reducing stigma. Policymakers, too, have a crucial role to play in creating supportive frameworks that address the root causes of youth suicide—such as reducing academic pressure, combating child abuse, and regulating the impact of social media.

Addressing youth suicide is a daunting task, but by tackling the root causes, fostering communication, and creating supportive environments, we can help our young people find hope and resilience. Everyone has a role in this effort because, ultimately, it is the collective compassion and determination of the community that will make the difference.

Where to get help:
Mental Well-being
  • Institute of Mental Health’s Mental Health Helpline: 6389-2222 (24 hours)
  • Samaritans of Singapore: 1-767 (24 hours) / 9151-1767 (CareText via WhatsApp)
  • Singapore Association for Mental Health: 1800-283-7019
  • Silver Ribbon Singapore: 6386-1928
  • Tinkle Friend: 1800-274-4788
  • Community Health Assessment Team 6493-6500/1
Counselling
  • TOUCHline (Counselling): 1800-377-2252
  • TOUCH Care Line (For Seniors & Caregivers): 6804-6555
  • Care Corner Counselling Centre: 6353-1180
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          • Beyond the Stereotype: Confronting the Mid-life Crisis and Depression among Men

          Beyond the Stereotype: Confronting the Mid-life Crisis and Depression among Men

          Commonly experienced in the lives of men around their middle age, goes beyond mere acts of reckless behaviours. Find out more in this article.

          Key takeaways

          • Mid-life crises in men are often existential struggles marked by unspoken psychological turmoil, grappling with aging, mortality, and unfulfilled dreams, potentially leading to depression
          • Depression in middle-aged men may not present as classic symptoms but instead manifests subtly through irritability, excessive drinking, and social isolation, highlighting the need for better recognition of these signs.
          • Societal pressures and stereotypes discourage men from seeking help, contributing to higher suicide rates, underscoring the importance of mental health support and interventions like counseling, therapy, and self-care strategies for men facing mid-life challenges.

          Posted on 4 Jun 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          “Mid-life crisis” – a term casually thrown around in popular culture is often depicted as a time of impulsive decision-making, like buying a flashy sports car, ending years of marriage to engage with younger women, or taking up an extreme hobby. For many men, the deeper psychological struggle is seldom acknowledged. It’s these unspoken realities we need to confront.

          This so-called “crisis”, commonly experienced in the lives of men around their middle age, goes beyond mere acts of reckless behaviours. It is an existential struggle, a silent cry for help as they grapple with aging, their own mortality, a sense of lost youth, and unfulfilled dreams. In many cases, this mid-life crisis may act as a trigger or precursor to depression, a debilitating condition that remains under-discussed and poorly understood when it comes to men.

          Mid-life crises in men involve deep psychological struggles and can lead to depression.

          Depression in many of us men does not necessarily present itself in textbook terms; it’s not always the profound sadness or hopelessness that we read in books or off medical websites. Instead, the condition may manifest subtly – an increasingly quick temper, heightened irritability, excessive drinking, a sense of losing control, dwindling work performance, and social isolation. The ability to spot these symptoms is the first step in recognizing the suffering that many middle-aged men are enduring.

          Stereotypes and societal pressures seem to play a significant role in this complex problem. Men are often conditioned by society to be the ‘strong’ ones, taught to mask their struggles and suppress their feelings. As a result, they are less likely to seek help due to fear of appearing weak or vulnerable. A heartbreaking consequence of these challenges is the higher proportion of suicides happening in men compared to women – a troubling statistic in many parts of the world, including Singapore. This underscores the urgency of addressing mental health issues among men, especially those in mid-life facing a unique set of stressors.

          Depression in middle-aged men often shows as irritability, drinking, and isolation.

          When I think back to my patients, their stories of struggle share common threads. Marital discord, often resulting from fading passion, ill-placed romances, fraught divorces, the enormous responsibility of parenting, professional stagnation, financial problems and other life disappointments, all form part of a melancholic tapestry. As they navigate the terrain of middle age, the harsh reality of mortality, financial pressures, medication side effects, physical health changes, lifestyle factors, and hormonal changes further compound their psychological burden.

          In Singapore, it’s particularly poignant to see these men, hailed as pillars of their families and societies, crumble under such weight. Yet, it’s this very reality that can propel us to institute change, to introduce a comprehensive roadmap to recovery.

          As a mental health professional, I have found that a combination of medication, therapy, and self-care strategies can significantly alleviate depressive symptoms. Access to good quality counselling, psychotherapeutic treatment, and the appropriate use of medication, are extremely useful in tackling the symptoms of depression.

          Societal pressures deter men from seeking help, highlighting the need for mental health support.

          But equally important is the adoption of self-help strategies. I encourage my patients to establish achievable goals, create a strong support network, practice stress-management techniques, and delay significant decisions until their depressive symptoms subside. Prioritizing self-care, they learn, is as crucial as meeting work deadlines or family obligations.

          The road to recovery is not linear, and relapses are part of the process. However, with timely intervention and sustained treatment, I have seen my patients reclaim their lost zeal, rekindling their passion for work, hobbies, and their relationships.

          Depression does not discriminate. It can target anyone, regardless of age, gender, or status. However, by acknowledging its unique manifestations in middle-aged men, by understanding and addressing the multitude of factors contributing to its onset, we can begin to make a difference. For every man in Singapore navigating the turbulent waters of mid-life depression, remember this – it’s okay not to be okay, and help is available. You are not alone.

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          • Empowering New Mothers: Navigating Postpartum Mental Health in Singapore

          Empowering New Mothers: Navigating Postpartum Mental Health in Singapore

          Through this blog, we aim to create a supportive dialogue that breaks down the barriers of silence and stigma surrounding postpartum mental health.

          Posted on 8 May 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          Welcoming a new life into the world is often portrayed as a time of joy and fulfilment. However, for many women, the postpartum period can bring unexpected mental health challenges. Postpartum depression, anxiety, and other mood disorders can significantly impact new mothers. Despite its prevalence, postpartum mental health remains under-discussed, particularly in places like Singapore, where traditional norms can make it challenging to address these issues openly.

          Addressing mental health issues in new mothers is crucial—not just for individuals but also for public health. The implications of postpartum mental disorders extend beyond the individual, affecting infants’ development and family well-being. In Singapore, where family unity is a cornerstone of society, ensuring the mental health of new mothers is essential for nurturing healthy communities.

          Through this blog, we aim to create a supportive dialogue that breaks down the barriers of silence and stigma surrounding postpartum mental health. By spreading awareness and fostering understanding, we hope to empower mothers to seek help without fear of judgment. We also aim to encourage a cultural shift — one that recognises the strength of seeking help and the importance of mental wellness for all mothers.

          postpartum depression singapore
          Postpartum depression can cause severe emotional distress and hinder a new mother’s ability to care for themselves and their newborn.
          Baby Blues — Typical Mood Changes After Delivery

          The arrival of a newborn brings immense joy but can also be accompanied by a range of emotions. It’s important for new mothers to understand that experiencing mood changes shortly after delivery is common. This phenomenon, known as the “baby blues“, affects up to 80% of mothers and usually occurs within the first few days to weeks after childbirth.

          What are the Baby Blues?

          The “baby blues” describe a short-term period of emotional instability that can include:

          • Mood swings: It’s normal for new mothers to experience rapid shifts in mood, going from happiness to sadness without warning.
          • Crying spells: Mothers may find themselves crying for no apparent reason, often triggered by something minor.
          • Anxiety: Many new mothers feel anxious about their baby’s well-being or their abilities as a mother.
          • Irritability: It’s not unusual to feel irritable or overwhelmed by the demands of caring for a newborn.
          • Insomnia: Some new mothers may struggle to fall or stay asleep despite feeling exhausted.

          These symptoms typically peak around the fourth or fifth day after birth and subside within two weeks. The “baby blues” are believed to be caused by the dramatic hormonal changes that occur after childbirth, along with the stress and exhaustion of caring for a newborn.

          Normalising the Baby Blues

          Understanding that the “baby blues” are a common part of postpartum adjustment can help new mothers feel less alone and more prepared for the emotional ups and downs of early motherhood. It’s important to remember that these feelings are usually temporary and do not indicate a lack of maternal love or ability.

          Beyond Baby Blues – When it is a Mental Health Disorder

          While “baby blues” are common and generally short-lived, some new mothers experience more intense and persistent symptoms that indicate a more serious mental health condition. It’s crucial to differentiate between the normal emotional fluctuations of early motherhood and postpartum mental health disorders that require professional intervention. Recognising the signs of conditions like postpartum depression, postpartum anxiety, or psychosis is the first step toward seeking the necessary support and treatment for recovery. In this section, we explore these conditions in greater detail, helping new mothers and their loved ones understand when to seek help.

          • Postpartum depression (PPD) is the most prevalent of these conditions, characterised by persistent feelings of sadness, worthlessness, and exhaustion that go beyond the typical “baby blues.” These feelings can last weeks to months and interfere significantly with a mother’s ability to care for her child and herself.
          • Postpartum anxiety involves an intense, debilitating worry that is out of proportion to the actual situation. Mothers may experience severe anxiety, panic attacks, and fears about their baby’s health and well-being or their abilities as a mother [1].
          • Other conditions: Postpartum Psychosis is rarer but more severe, involving hallucinations, delusions, and extreme confusion. Postpartum Obsessive-Compulsive Disorder (OCD) is marked by intrusive, repetitive thoughts and fears, often centred on the baby’s safety, which the mother knows are irrational but feels powerless to stop. 
          Recognising the Signs

          Recognising the signs of postpartum mental health issues is crucial for early intervention and effective treatment. The symptoms can be diverse, spanning emotional, physical, and behavioural changes that disrupt a new mother’s daily functioning and well-being. Here’s a detailed look at what to watch for:

          Emotional Symptoms of Postpartum Depression

          • Persistent sadness or low mood: feelings of sadness that last most of the day, nearly every day, not just occasional blues.
          • Crying spells: new mothers suffering from postpartum mental health issues may experience frequent, unexplained crying that feels uncontrollable [2].
          • Irritability or anger: irritability or anger that is unusual or out of proportion to the situation.
          • Feelings of worthlessness or guilt: persistent thoughts of not being a good mother or unwarranted guilt over minor issues.
          • Anhedonia: anhedonia is the loss of interest or pleasure in activities previously enjoyed, including withdrawal from social interactions.

          Physical Symptoms of Postpartum Depression

          • Fatigue: severe tiredness that doesn’t improve with rest, affecting the ability to care for oneself and the baby.
          • Sleep disturbances: difficulty falling asleep, staying asleep, or sleeping much more than usual, unrelated to the baby’s sleep schedule [3].
          • Changes in appetite: significant increase or decrease in appetite, leading to weight loss or gain unrelated to pregnancy [4].
          • Aches and pains: physical symptoms like headaches, stomachaches, or muscle pain without a clear physical cause.

          Behavioural Symptoms of Postpartum Depression

          • Cognitive impairments: trouble concentrating, remembering details, or making decisions that affect daily tasks.
          • Anxiety and panic: excessive worry about the baby or one’s abilities as a mother, possibly escalating to panic attacks.
          • Obsessive thoughts: intrusive, repetitive thoughts, often about harm coming to the baby, which the mother recognises as irrational but feels powerless to control [5].
          • Avoidance behaviours: avoiding situations or activities due to anxiety or fear, including avoiding caring for the baby.

          As mentioned, some of these symptoms can be a normal part of adjusting to motherhood for many. However, when they are intense, persistent, and interfere with daily life, they may indicate a more serious postpartum mental health issue. Early detection and intervention are crucial to managing these symptoms effectively. 

          baby blues or postpartum depression singapore
          The “baby blues” are a brief period of sadness and mood swings after childbirth, while postpartum depression involves persistent emotional distress that can impair functioning.
          From Hormones to Social Pressures—What Contributes to Postpartum Mental Health Challenges?

          To effectively address and mitigate postpartum mental health challenges, it is essential to understand the varied risk factors that can influence a new mother’s well-being. These risks are multifaceted and include biological, psychological, and social dimensions, each contributing to postpartum mental health concerns. 

          In Singapore, additional cultural factors also play a critical role in shaping the experiences and expectations placed on new mothers. By examining these elements, we can better support and empower mothers and ensure they receive the care needed during this transformative period.

          Biological factors

          • Hormonal changes: The rapid fluctuation in hormones such as oestrogen and progesterone after childbirth can significantly impact mood and is a major biological trigger for postpartum depression and anxiety [6].
          • Genetics: A family history of depression or other mental health disorders can increase a woman’s risk of experiencing similar issues postpartum [7].
          • Physical recovery from childbirth: Complications during delivery, such as prolonged labour or a caesarean section, and physical recovery issues, such as chronic pain or fatigue, can contribute to the development of postpartum mental health issues [8].
          recovery post-delivery singapore
          Prolonged labour or physical recovery challenges post-delivery can heighten the risk of developing postpartum mental health issues by increasing stress and physical discomfort.

          Psychological factors

          • Previous mental health issues: Women who have previously experienced mental health issues, including depression or anxiety, are at a higher risk of postpartum mental health problems.
          • Psychological adjustment: Difficulty adjusting to the role of motherhood, feelings of loss of identity, or lack of fulfilment in their new role can also pose significant psychological challenges.

          Social factors

          • Support systems: A lack of adequate support from partners, family, or friends can increase the risk. This includes practical support in caring for the newborn and emotional support in dealing with the stresses of new parenthood.
          • Socioeconomic stressors: Financial difficulties, job security concerns, or inadequate living conditions are significant stressors that can exacerbate postpartum mental health issues [9].

          Cultural Factors Specific to Singapore

          • High expectations and perfectionism: In Singapore’s performance-oriented society, mothers are often expected to adapt and excel quickly in their new roles. This cultural norm can lead to feelings of inadequacy and failure.
          • Stigma and secrecy: Mental health issues are often stigmatised, with a prevalent culture of secrecy around such topics. This can prevent new mothers from seeking the help they need, which can worsen their mental health condition.
          • Role of extended family: In Singapore, extended family often plays a significant role in postpartum care. While this can be a source of support, it can also lead to increased pressure and criticism, particularly from older generations with traditional views on child-rearing.
          • Work-life balance challenges: The pressure to return to work soon after childbirth due to economic necessity or career expectations can significantly strain mental health, especially without flexible work policies or sufficient maternity leave.

          Each of these factors contributes to the postpartum mental health challenges faced by new mothers. Recognising these risks not only aids in empathy and understanding but also highlights critical areas for support and intervention, which can ensure that mothers receive the care they need during this vulnerable time.

          Michelle’s Story: A Real-Life Example of Postpartum Depression in Singapore

          “Michelle (not her real name), a mother of two, experienced a challenging postpartum period after delivering her daughter two weeks ago. Initially, she dismissed her sadness and irritability as normal “baby blues.” However, as the days passed, Michelle found herself overwhelmed with persistent sadness and inexplicable crying spells. She felt disconnected from her newborn and struggled with feelings of worthlessness. Her husband noticed her withdrawal from family activities and her lack of interest in things she previously enjoyed, including reading and playing with her eldest son.

          Recognising that Michelle needed help, her husband encouraged her to speak with a mental health professional. Through counselling and with the support of her family, Michelle began to understand her feelings and work towards recovery. Her story is a powerful reminder that postpartum depression is a common and treatable condition and that seeking help is a sign of strength, not weakness.”

          post-natal depression singapore
          Increased pressure and criticism play a significant role in cultural factors which contribute to post-partum depression.
          The Role of Fathers—Supporting New Mothers Through Postpartum Mental Health Challenges

          As a father of three children, I understand firsthand the crucial role fathers can play in supporting new mothers during the postpartum period. Fathers should not be neglected when discussing postpartum mental health, as they have significant roles to play in ensuring the well-being of their partners and their children. At the same time, fathers’ mental health during this period is important too. While we will address this in more detail in a future blog post, here’s a quick teaser on how fathers can provide valuable support:

          • Emotional support: Fathers can offer a listening ear and be emotionally available for their partners. Simply being there to listen and offer empathy can be incredibly comforting for new mothers.
          • Practical assistance: Helping with household chores, diaper changes, or feeding the baby can relieve some of the burden on new mothers and allow them to rest and recover.
          • Encouragement to seek help: Fathers can encourage their partners to seek professional help if they notice symptoms of postpartum depression or other mental health issues. Early intervention is key to recovery, and fathers can play a pivotal role in ensuring mothers receive the care they need.
          • Promoting self-care: Encouraging mothers to take time for self-care, whether taking a nap or enjoying a warm bath, can significantly improve their well-being. Fathers can facilitate this by taking on additional responsibilities when needed.
          • Participating in parenting: Engaging in parenting activities like feeding, bathing, or soothing the baby not only strengthens the father-child bond but also provides mothers with a much-needed break.

          By being supportive, understanding, and proactive, fathers can make a positive impact on their partners’ postpartum mental health and create a nurturing environment for the whole family.

          Restoring Balance—Essential Strategies for Overcoming Postpartum Mental Health Challenges

          Adopting a healthy lifestyle and creating a supportive network are foundational steps in the recovery journey for new mothers facing postpartum mental health challenges, including the “baby blues” and postpartum depression.

          Lifestyle Adjustments and Self-Care Tips for Postpartum Depression

          • Rest: Sleep is crucial for emotional well-being. Encourage mothers to rest whenever possible, even if it’s just a short nap while the baby sleeps.
          • Support: Emotional support from family and friends can make a big difference. Simply having someone to talk to or help with household tasks can relieve stress.
          • Nutrition: Focus on a balanced diet rich in nutrients that support brain health and energy levels, such as omega-3 fatty acids, lean proteins, and whole grains. Encourage mothers to eat regular, nutritious meals, even if they don’t have much appetite [10].
          • Exercise: Regular physical activity, which has been proven to reduce symptoms of depression and anxiety [11]. Even light exercises like walking or stretching can make a significant difference.
          • Sleep: Prioritise sleep, when possible, as lack of sleep significantly impacts mental health and cognitive function.
          • Mindfulness and relaxation: Techniques like yoga, meditation, and deep-breathing exercises can reduce stress and improve overall emotional health.
          • Time for self-care: Taking time for self-care, even for a few minutes, can help mothers feel more balanced. This could be as simple as a warm bath or quiet time with a book.
          • Routine: Create a daily routine to provide structure, which can be comforting amidst the chaos of new parenthood.
          • Community resources: Leverage community resources such as mothers’ groups, parenting workshops, and family wellness programs. These can provide emotional support and a sense of belonging, reducing feelings of isolation.
          • Online support: Consider online forums and social media groups focusing on postpartum health. These platforms can offer support at any hour, particularly useful for new mothers managing unpredictable schedules.

          Medical and Therapeutic Interventions for Postpartum Depression

          In addition to lifestyle adjustments, medical and therapeutic interventions are sometimes required for mothers facing more serious postpartum mental health challenges.

          • Counselling: Professional counselling services can be invaluable, providing a safe space to discuss feelings and concerns. Cognitive Behavioral Therapy (CBT) is particularly effective for managing depression and anxiety [12].
          • Medication: Antidepressants may be prescribed when symptoms are moderate to severe, and they can be an essential part of treatment. It’s crucial to discuss the benefits and risks with your psychiatrist, especially when breastfeeding.
          • Integrated care: Integrated care programmes combine psychological therapy with support for the practical aspects of new motherhood and infant care.
          • Professional guidance: Mental health professionals can tailor treatment plans to individual needs and ensure mothers receive the most effective care.

          Integrating these management strategies with therapeutic interventions offers a comprehensive approach to addressing postpartum mental health challenges. New mothers can actively facilitate their recovery by engaging with available resources and adopting recommended practices.

          counselling postpartum singapore
          Counseling or guidance from a mental health professional can help new mothers manage postpartum depression by providing emotional support and coping strategies. 
          Empowering New Beginnings — Taking Action on Postpartum Mental Health

          Recognising and addressing postpartum mental health issues is crucial for the well-being of new mothers and their families. The journey through motherhood can be marked by a range of emotional and psychological challenges, but no mother should have to navigate this path alone.

          It is vital that mothers feel empowered to seek help and are reassured that their experiences, while unique, are shared by many others. The strength and resilience shown by mothers every day are inspiring, but even the strongest among us can benefit from support. By shedding light on these issues and offering support, we can make a difference in the lives of new mothers and help them not only endure but thrive.

          References 
          1. Garapati, J., Jajoo, S., Aradhya, D., Reddy, L. S., Dahiphale, S. M., & Patel, D. J. (n.d.). Postpartum mood disorders: Insights into diagnosis, prevention, and treatment. Cureus, 15(7), e42107. https://doi.org/10.7759/cureus.42107 
          2. Feeling depressed after childbirth. (2020, December 7). Nhs.Uk. https://www.nhs.uk/conditions/baby/support-and-services/feeling-depressed-after-childbirth/ 
          3. Baattaiah, B. A., Alharbi, M. D., Babteen, N. M., Al-Maqbool, H. M., Babgi, F. A., & Albatati, A. A. (2023). The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: An emphasis on maternal mental health. BMC Psychology, 11(1), 10. https://doi.org/10.1186/s40359-023-01043-3 
          4. Tayhan, F., Doğan, G., Yabancı Ayhan, N., & Sancar, C. (2024). Assessment of eating disorders and depression in postpartum women. European Journal of Clinical Nutrition, 78(4), 314–319. https://doi.org/10.1038/s41430-023-01384-7 
          5. Collardeau, F., Corbyn, B., Abramowitz, J., Janssen, P. A., Woody, S., & Fairbrother, N. (2019). Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: Study protocol. BMC Psychiatry, 19(1), 94. https://doi.org/10.1186/s12888-019-2067-x 
          6.  Saraswat, N., Wal, P., Pal, R. S., Wal, A., Pal, Y., & Roohi, T. F. (2021). A detailed biological approach on hormonal imbalance causing depression in critical periods (Postpartum, postmenopausal and perimenopausal depression) in adult women. The Open Biology Journal, 9(1). https://doi.org/10.2174/1874196702109010017 
          7. Hutchens, B. F., & Kearney, J. (2020). Risk factors for postpartum depression: An umbrella review. Journal of Midwifery & Women’s Health, 65(1), 96–108. https://doi.org/10.1111/jmwh.13067 
          8. Smithson, S., Mirocha, J., Horgan, R., Graebe, R., Massaro, R., & Accortt, E. (2022). Unplanned Cesarean delivery is associated with risk for postpartum depressive symptoms in the immediate postpartum period. The Journal of Maternal-Fetal & Neonatal Medicine, 35(20), 3860–3866. https://doi.org/10.1080/14767058.2020.1841163 
          9. Karl, M., Schaber, R., Kress, V., Kopp, M., Martini, J., Weidner, K., & Garthus-Niegel, S. (2020). Precarious working conditions and psychosocial work stress act as a risk factor for symptoms of postpartum depression during maternity leave: Results from a longitudinal cohort study. BMC Public Health, 20(1), 1505. https://doi.org/10.1186/s12889-020-09573-w 
          10. Rupanagunta, G. P., Nandave, M., Rawat, D., Upadhyay, J., Rashid, S., & Ansari, M. N. (2023). Postpartum depression: Aetiology, pathogenesis and the role of nutrients and dietary supplements in prevention and management. Saudi Pharmaceutical Journal : SPJ, 31(7), 1274–1293. https://doi.org/10.1016/j.jsps.2023.05.008 
          11. Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O’Connor, E., Ferguson, T., Eglitis, E., Miatke, A., Simpson, C. E., & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine, 57(18), 1203–1209. https://doi.org/10.1136/bjsports-2022-106195 
          12. Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive behavioral therapy for depression. Indian Journal of Psychiatry, 62(Suppl 2), S223. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19 
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          • Likes, Shares, and Mental Health Woes — Is Social Media Driving Youth Mental Health Decline?

          Likes, Shares, and Mental Health Woes — Is Social Media Driving Youth Mental Health Decline?

          This article hopes to examine the relationship between social media usage and mental health while exploring the detrimental effects of excessive digital engagement on psychological well-being.

          Posted on 13 Mar 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          In the digital age, the omnipresence of social media in the lives of young individuals has sparked a global debate on its impact on mental health. This discourse, however, is not without precedent; it mirrors historical anxieties surrounding new “technologies” and their potential effects on youthful minds. Reflecting on the 18th and 19th centuries, as books and novels became accessible en masse, similar fears emerged. Critics voiced concerns that these “novel” forms of entertainment might captivate too intensely, risking harm to the pliable minds of the young. In 1907, an editorial titled “Do Boys Read Too Much?” questioned the impact of mass-market fiction on the mental acuity and focus of young readers, foreshadowing today’s worries that perhaps, in an ironic twist, young people now read too little. This historical perspective underscores the cyclical nature of societal concerns regarding the impact of media on youth, setting the stage for the contemporary debate on social media’s role in shaping mental health.

          Singapore’s Deputy Prime Minister Lawrence Wong, on February 7, announced an initiative [1] that brings this debate into the modern era, launching a comprehensive research project aimed at understanding the escalating mental health issues among youth, focusing on social media’s role. This initiative underscores the complex relationship between digital engagement and psychological well-being, marking a renewed interest in exploring how platforms designed to connect and inspire might also be sources of stress, anxiety, and feelings of inadequacy.

          Recent research [2] points to a complex picture. It suggests that while social media has the power to connect and inspire, it also harbours the potential to induce stress, anxiety, and feelings of inadequacy. This article hopes to examine the relationship between social media usage and mental health while exploring the detrimental effects of excessive digital engagement on psychological well-being. 

          social media and distress
          Social media’s pervasive influence is increasingly linked to heightened distress among youth, which exacerbates mental health challenges. 
          The Double-Edged Sword of Social Media

          Social media, in its essence, is a paradox. On one hand, it’s a revolutionary tool that has transformed how we connect, communicate, and consume information. It has democratised content creation, gathered global communities around niche interests, and provided platforms for traditionally marginalised voices. The ability to instantly connect with anyone, anywhere, has made the world smaller and more accessible. For youths, social media can be a vibrant space for self-expression, learning, and exploration. It offers a sense of belonging, a place to find like-minded individuals, and opportunities for activism and social change.

          However, the flip side of this connectivity is its capacity to impact the mental health of young users negatively. For a vivid illustration, consider the story of a patient I encountered during my time in the hospital, whom we’ll call John for confidentiality. John’s tale is a stark reminder of social media’s potent influence over self-esteem and mental well-being. After his social media account was suspended for “buying” followers, John experienced profound emotional distress, so severe that he contemplated suicide. During our clinical interview, he confessed that his self-worth had become inextricably linked to the number of “likes” and followers on his profile. This dependency on digital validation for self-esteem is not an isolated phenomenon but a reflection of the broader challenges posed by social media’s role in our lives.

          This constant quest for validation [3] through likes, comments, and followers can transform social media into a perilous game where self-worth hangs precariously on online approval. John’s story exemplifies how this relentless pursuit of digital acknowledgement can exacerbate feelings of anxiety and depression, creating a cycle of dependence challenging to escape. Furthermore, the impact of social media extends beyond psychological effects, manifesting in real life through disrupted sleep patterns and sedentary behaviour, which can further erode mental and physical well-being.

          social media effects
          Social media is a double-edged sword, allowing for self-expression and connectivity but also cyberbullying and false ideation.

          Reflecting on this, it’s essential to recognise the natural human desire for validation, a sentiment that transcends the digital realm. Just as we observe the counters on our social media profiles—likes, reposts, shares, followers—we find parallels in the academic and professional worlds. For instance, scientists, doctors, and researchers derive a form of validation from seeing their journal publications cited. This desire for acknowledgement and affirmation is a fundamental aspect of human nature. However, the key difference lies in the context and the extent to which this need for validation governs our self-esteem and overall mental health.

          Caught in the “Comparison Trap?” How Social Media Affects Mental Health

          Central to the discourse on social media’s impact on mental health is the pervasive role of comparison and expectation. This phenomenon, deeply embedded in the fabric of online interaction, fuels much of the anxiety and dissatisfaction experienced by young users. With endless feeds of curated content, social media platforms craft an environment where the lives, achievements, and appearances of others are constantly showcased. This setting primes what psychologists refer to as “social comparison theory” [4], the idea that individuals determine their own social and personal worth by comparing themselves to others.

          The “comparison trap” [5] on social media is particularly insidious. It extends beyond comparing oneself to friends and family, reaching into the realms of celebrities, influencers, and strangers with massive followings. These comparisons are rarely fair or realistic, pitting the everyday realities of one’s life against the polished highlight reels of others.

          Photos and stories are meticulously selected and edited to highlight the best moments, accomplishments, and aspects of people’s lives, side-lining the ordinary, mundane, and challenging experiences everyone faces. For young people, whose self-identity and self-esteem are in critical phases of development, this distorted reality can cultivate feelings of inadequacy, low self-worth, and the perception of falling short of peers’ standards online.

          Moreover, social media doesn’t just facilitate comparison; it amplifies unrealistic expectations. Users, particularly youths, are inundated with portrayals of exceptional lifestyles, bodies, and successes, creating a vast divide between expectation and reality. The urge to meet these online personas’ standards can lead young individuals to chase unattainable ideals, fostering frustration, self-criticism, and mental distress.

          fake social media
          Social media often portrays carefully curated images showcasing edited images and unrealistic lifestyles.

          The consequences of this relentless comparison and the clash between expectation and reality are profound. Studies [6] have linked excessive social media use to increased rates of anxiety, depression, and other mental health issues among adolescents and young adults. The mechanism is straightforward: when individuals, especially youths, gauge their worth by the standards of online portrayals, they are predisposed to disappointment and psychological strain. The gap between how they perceive their own lives and the lives of others online can expand, potentially leading to feelings of isolation, envy, and diminished self-esteem.

          In my talks about youth mental health, I often discuss the effects of social media, drawing from personal observations and professional experience. As a member of “Gen X” (yes, that shows my age), my comparators in youth were classmates, neighbours, or friends from the local playground. Today, the range of comparators for young people has expanded globally, courtesy of social media. This boundless arena for comparison magnifies the pressure and challenges they face, emphasising the urgent need for awareness, education, and strategies to navigate the complex web of online social interaction healthily and positively.

          In sharing the story of a patient, John (not his real name), who spiralled into extreme emotional distress after his social media account was suspended for buying followers, the real-world implications of these dynamics become starkly evident. John’s admission that his self-worth was entirely tied to “likes” and followers underscores the dangerous potential of social media to influence mental health negatively. This quest for approval, when rooted in the ephemeral and often superficial metrics of social media, can lead to profound psychological distress.

          By drawing on these examples and integrating the broader context of social comparison from my youth to the present, we can better understand the complex landscape of social media and its impact on mental health. It’s a call to action for individuals, families, and professionals to engage in meaningful dialogues and interventions that can steer young people towards healthier, more balanced interactions with social media.

          Cyberbullying and Online Harassment Another Threat to Mental Well-Being

          As a result of the increased use of social media, cyberbullying and online harassment have become widespread problems, which significantly affect the mental health of many young people. While a boon for privacy and freedom of expression, the anonymity afforded by social media platforms also serves as a double-edged sword, which causes some users to engage in behaviour they might not otherwise exhibit in person. 

          Unlike traditional bullying, cyberbullying offers no respite; victims can be reached at any time and place, which makes it an omnipresent source of stress and anxiety. Studies [7] have consistently shown a troubling correlation between cyberbullying and an increased risk of mental health problems, including depression, anxiety, and even suicidal ideation. The relentless nature of online harassment can erode self-esteem, amplify feelings of isolation, and trigger a cascade of psychological distress.

          Moreover, the vastness of the internet and the sheer volume of interactions on major platforms pose significant challenges to monitoring and enforcing guidelines against bullying and harassment. While social media companies have made strides in developing algorithms and reporting tools to combat such behaviour, the reactive nature of these measures often means that the harm has already been done. The delay in response, combined with the difficulty in tracing anonymous accounts, further exacerbates the problem, which leaves victims feeling helpless and unsupported.

          cyberbullying and mental health
          Cyberbullying and online harassment amplify feelings of vulnerability and distress, which pose significant threats to the mental well-being of youth. 
          The Impact of Screen Time on the Mental and Physical Well-Being of Youths 

          Research [8] suggests that excessive screen time is increasingly concerning for its detrimental impact on the physical and mental health of youth. Staring at screens late into the night interferes with melatonin production, the hormone responsible for regulating sleep-wake cycles. This disruption to the body’s natural rhythm makes it harder for individuals to fall asleep and significantly diminishes the quality of rest they receive. The consequences of this lack of restorative sleep extend beyond mere fatigue, affecting cognitive functions and mood and leading to heightened levels of stress and anxiety. Moreover, the allure of screens often detracts from physical activity, fostering a sedentary lifestyle that can amplify health issues like obesity, which, in turn, impacts mental well-being.

          Additionally, the surge in screen time has markedly curtailed opportunities for face-to-face social interactions, which are pivotal in developing and maintaining robust social skills. This decline in direct human contact may culminate in feelings of isolation and loneliness, adversely affecting social health and overall mental well-being. The skills garnered through in-person interactions—such as empathy, interpreting non-verbal cues, and expressing emotions effectively—are vital for personal development and sustaining healthy relationships. As screen time usurps these invaluable interactions, young individuals may find it increasingly challenging to forge and maintain meaningful connections, further affecting their mental health in an era where connectivity, paradoxically, should be at its zenith.

          Furthermore, it is crucial to acknowledge that our time is finite; we only have 24 hours a day. Time spent in front of screens is time not spent sleeping, engaging with friends in person, or participating in physical exercise. In a world where digital engagement is omnipresent, recognising and managing how we allocate our time is more critical than ever. Every hour spent online is an hour less for activities that nurture our physical health, mental well-being, and real-world relationships. Time is a commodity we cannot manufacture or purchase; thus, it’s essential to prioritise how we spend it to ensure a balanced, healthy lifestyle in the digital age.

          screen time mental health
          Excessive screen time disrupts sleep patterns and exacerbates mental health issues among youth

          Balancing the Scale: Strategies to Mitigate Social Media’s Impact on Youth Mental Health

          A multifaceted strategy is essential to effectively mitigate social media’s adverse impacts on youth mental health. This approach encompasses enhancing digital literacy, offering parental guidance, enforcing platform responsibility, and advocating a balanced lifestyle between the online and offline worlds.

          Central to this strategy is the education of youths in digital literacy. They need to learn how to assess and navigate the vast array of online content critically. Understanding the mechanics behind social media algorithms and recognising the curated nature of digital personas enables young individuals better to manage the psychological effects of their digital interactions. This knowledge empowers them to differentiate between realistic and manipulated portrayals of life online, fostering a healthier relationship with social media.

          Parental guidance also plays a critical role in moderating the impact of social media on young minds. Parents should initiate open dialogues with their children about the benefits and challenges of online engagement. Together, they can establish healthy boundaries around screen time. Importantly, if parents choose to use devices and apps to monitor their children’s screen time, this should be done transparently. Monitoring activities should always be conducted with the child’s knowledge and consent to maintain trust and foster open communication within the family. Covert surveillance can erode the foundational trust between parent and child, leading to further issues.

          Recognising that children are at various developmental stages is crucial in tailoring approaches effectively. What might be appropriate for younger children, such as direct supervision and structured screen time, may not suit teenagers navigating the path toward independence. For teenagers, it’s about negotiating boundaries that respect their autonomy while ensuring their safety online. This nuanced approach acknowledges their need for privacy and independence, fostering a sense of responsibility and self-regulation in their digital interactions.

          Social media platforms themselves must shoulder responsibility for creating safer online spaces. Implementing stringent policies against cyberbullying, enhancing privacy settings, and making reporting tools more accessible are essential measures to protect young users from the potential harms of online engagement.

          Encouraging a balanced life is equally important. Young people should be motivated to engage in offline activities and face-to-face interactions. This not only mitigates the risks associated with excessive screen time but also promotes a well-rounded social and emotional development. It’s about finding harmony between digital connections and real-world experiences, ensuring youths develop healthy social skills and maintain physical activity.

          Mental health professionals are integral to addressing the nuanced challenges posed by social media on youth mental health. By integrating discussions of social media use into therapy, creating digital wellness resources, and advocating for mental health-focused policy reforms, they play a key role in fostering a safer digital environment. Importantly, they recognise that excessive engagement with digital platforms may sometimes stem from underlying conditions such as addiction or social anxiety. This insight enables them to provide targeted therapeutic interventions, addressing the symptoms and root causes of unhealthy digital habits.

          Furthermore, these professionals offer crucial support to parents and youths, guiding them through the complexities of digital behaviour and its impacts. By treating underlying mental health issues and educating families about healthy digital practices, mental health experts significantly improve overall digital wellness and promote healthier relationships with technology. Their efforts ensure a comprehensive approach to mental health in the digital age, highlighting the importance of addressing both immediate and underlying issues related to social media use.

          Ultimately, developing resilience in young people to navigate the digital world confidently requires collaborative efforts among educators, parents, platforms, and mental health experts. By promoting digital literacy, engaging in open and honest conversations, respecting the developmental needs of young people, and encouraging a balanced lifestyle, we can create a supportive environment that enables youths to thrive online and offline.

          References 
          1. Anto, A., Asif, R. O., Basu, A., Kanapathipillai, D., Salam, H., Selim, R., Zaman, J., & Eisingerich, A. B. (2023). Exploring the impact of social media on anxiety among university students in the United Kingdom: Qualitative study. JMIR Formative Research, 7, e43037. https://doi.org/10.2196/43037 
          2. Correspondent, G. Y. H. (2024, February 7). Research to look at surge in youth mental health issues; causes could include social media use. The Straits Times. https://www.straitstimes.com/singapore/politics/research-to-look-at-surge-in-youth-mental-health-issues-causes-could-include-social-media-use 
          3. Using social media for reassurance and validation | psychology today. (n.d.). Retrieved February 29, 2024, from https://www.psychologytoday.com/intl/blog/liberate-yourself/202111/using-social-media-reassurance-and-validation 
          4. How social comparison theory influences our views on ourselves. (n.d.). Verywell Mind. Retrieved February 29, 2024, from https://www.verywellmind.com/what-is-the-social-comparison-process-2795872 
          5. The comparison trap | psychology today. (n.d.). Retrieved February 29, 2024, from https://www.psychologytoday.com/us/articles/201711/the-comparison-trap 
          6. Hilty, D. M., Stubbe, D., McKean, A. J., Hoffman, P. E., Zalpuri, I., Myint, M. T., Joshi, S. V., Pakyurek, M., & Li, S.-T. T. (2023). A scoping review of social media in child, adolescents and young adults: Research findings in depression, anxiety and other clinical challenges. BJPsych Open, 9(5), e152. https://doi.org/10.1192/bjo.2023.523 
          7. Li, C., Wang, P., Martin-Moratinos, M., Bella-Fernández, M., & Blasco-Fontecilla, H. (2022). Traditional bullying and cyberbullying in the digital age and its associated mental health problems in children and adolescents: A meta-analysis. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-02128-x 
          8. Nakshine, V. S., Thute, P., Khatib, M. N., & Sarkar, B. (n.d.). Increased screen time as a cause of declining physical, psychological health, and sleep patterns: A literary review. Cureus, 14(10), e30051. https://doi.org/10.7759/cureus.30051   

          Caregiver Fatigue: What You Need to Know

          According to a recent survey, in Singapore, caregivers invest approximately seven hours daily in tending to their loved ones, and more than 40% of them are susceptible to depression due to various challenges, including inflation and the impact of COVID-19.

          Posted on 8 Mar 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          In the heart of caregiving lies a paradox of strength and vulnerability, a journey marked by unwavering devotion and unforeseen trials. One of them on this journey is Mrs Tan (not her real name), a 56-year-old woman emblematic of the silent army of caregivers who navigate the turbulent waters of caring for loved ones with debilitating conditions. Tasked with the care of her 85-year-old father, who is battling dementia, Mrs Tan’s story unfolds as a testament to the emotional and physical challenges that punctuate the caregiving experience. From the awkwardness of personal care tasks to the confrontation with aggression when her father, lost in the fog of dementia, reacted violently to her attempts to bathe him, her narrative is a vivid illustration of the daily realities faced by many in similar situations.

          Mrs Tan’s reluctance to seek help, rooted in her role as the eldest child and a deeply ingrained sense of filial piety, underscores a critical issue in the caregiving community: the pervasive sense of isolation and the formidable weight of responsibility that many caregivers carry, often alone. Her story, while unique in its details, reflects a universal theme among caregivers — the struggle to balance the demands of caregiving with one’s own needs and the internal battle between seeking help and maintaining a facade of self-sufficiency.

          Caregivers often find themselves submerged in responsibilities, grappling with feelings of being overwhelmed. The emotional toll can be disheartening, and if left unaddressed, it may take a significant toll on their health, relationships, and state of mind. This accumulating strain can lead to a critical juncture known as burnout [1] — a state marked by emotional, mental, and physical exhaustion that not only affects you but also impacts the person under your care.

          caregiving singapore
          Caregiving is a full-time commitment requiring continual dedication to the well-being of a loved one.

          According to a recent survey, in Singapore, caregivers invest approximately seven hours daily in tending to their loved ones, and more than 40% of them are susceptible to depression due to various challenges, including inflation and the impact of COVID-19 [2]. 

          Recognising the severity of this issue is crucial. Caregiver burnout is not a mere inconvenience; it’s a pervasive condition that alters your attitude, transforming positivity and compassion into negativity and apathy. In the midst of this struggle, it is essential to grasp a fundamental truth: self-care is not a luxury but a necessity. Taking care of your emotional and physical well-being is as vital as ensuring your loved one attends medical appointments or takes prescribed medications. 

          This journey is a marathon, not a sprint, and understanding the signs and consequences of caregiver burnout is the first step toward breaking the cycle of chronic exhaustion, stress, anxiety, and depression. This article aims to explore the multifaceted aspects of caregiving, from understanding the triggers of burnout to implementing strategies to alleviate the burden on caregivers. By bringing to light stories like Mrs Tan’s, we hope to foster a greater appreciation for the challenges caregivers face and the critical role of support systems in sustaining them through their journey.

          Breaking Point: Understanding the Triggers of Caregiver Burnout

          Providing care for a loved one is an expression of deep affection and commitment. Still, it comes with challenges that can gradually erode a caregiver’s well-being, leading to what is commonly known as caregiver burnout. This state of physical, emotional, and mental exhaustion doesn’t happen overnight; it is an accumulation of stressors and demands. Let’s dig deep into the causes that contribute to caregiver burnout:

          Extended Duration of Care: The Wear and Tear on Resilient Caregivers

          Caring for a loved one is more than a short-term commitment; it’s a journey that can extend over years or even decades. While the dedication of caregivers is commendable, the continuous and prolonged nature of caregiving can gradually erode the resilience of even the most steadfast caregivers.

          As time passes, the caregiving demands persist; as a result, caregivers face a series of challenges that can accumulate and take a toll on their physical and emotional well-being. The wear and tear associated with the extended duration of care can often lead to heightened stress levels [3], emotional fatigue, and a sense of being constantly on alert. The strain arising from the responsibility’s ongoing nature emphasises the need for support systems and self-care practices to sustain caregivers on this extended journey.

          caregiver burnout singapore
          Enduring the extended duration of care takes a toll on even the most resilient caregivers. 
          Uncertain Prognosis: Emotional Turbulence in Caregiving

          When facing an uncertain prognosis, caregivers find themselves amid emotional turbulence. When there is little hope for the improvement of the care recipient’s health or when their condition continues to deteriorate despite the caregiver’s relentless efforts, it can take an emotional toll and lead to demotivation.

          The emotional turbulence that accompanies caregiving is profoundly illustrated by the journey of Mr and Mrs Ravi (not their real names), parents to a pair of adult twins with Autism Spectrum Disorder (ASD). Their daily reality is a testament to the emotional strain that uncertainty can bring. The twins, in their late 20s, are non-verbal and prone to aggression, presenting a continuous challenge with no clear prognosis for improvement. Despite Mr. and Mrs. Ravi’s dedicated efforts and unwavering hope, the absence of significant progress in their sons’ condition exemplifies the deep emotional toll such uncertainty can exact on caregivers. Their story underscores the pervasive emotional burden that comes with caring for loved ones when the path forward is clouded with unpredictability.

          Overwhelmed by Responsibilities: Managing the Juggling Act of Caregiving

          Caregivers often find themselves grappling with an extensive list of responsibilities. From administering medications to facilitating daily activities, the demands can become a relentless juggling act. This constant sense of being “in over one’s head” is a key contributor to heightened stress levels among caregivers.

          The Ravis’ situation also highlights the overwhelming nature of caregiving responsibilities. Managing the complex needs of their twins, from ensuring their safety during aggressive episodes to addressing their daily care requirements, embodies the relentless juggling act many caregivers face. This constant state of being “in over one’s head” not only elevates stress levels but also fosters a profound sense of inadequacy and frustration. For Mr. and Mrs. Ravi, the physical tasks of caregiving are interwoven with the emotional challenges of seeing their children struggle, illustrating the multifaceted burden caregivers bear.

          overwhelmed caregiver
          Navigating the juggling act of managing multiple responsibilities often leaves caregivers feeling overwhelmed and overburdened.
          Isolation in Caregiving: The Detrimental Impact of a Lack of Support

          The emotionally exhausting and demanding journey of being a caregiver can become even more challenging for those working without a support system [4]. Caregivers who find themselves without a network of assistance or fail to receive the necessary help are at a heightened risk of burnout. 

          Perhaps most striking in the Ravis’ narrative is the isolation felt in the absence of a robust support system. The challenges of caring for their adult twins with ASD are compounded by the lack of external assistance, leaving them to navigate the complexities of their sons’ care alone. This isolation not only magnifies the stress and exhaustion inherent in their caregiving role but also highlights the critical need for support that transcends mere physical help. The absence of a community to lean on, coupled with the daunting task of coordinating care and managing aggressive behaviors without respite, paints a vivid picture of the detrimental impact that isolation can have on caregivers.

          The stories of Mrs. Tan and Mr. and Mrs. Ravi serve as poignant reminders of the diverse yet universally challenging experiences of caregivers. Through their narratives, we see the essence of caregiving – a role marked by love, resilience, and an often overwhelming sense of responsibility. Recognising the need for support, understanding, and resources for caregivers becomes not just a compassionate imperative but a necessary step in addressing the challenges they face daily.

          Dealing with the Financial Tightrope of Caregiving: The Toll of Financial Strain

          The responsibility of providing care can place a substantial burden on a caregiver’s financial resources [5]. Balancing the costs associated with medical care, medications, and other necessities can give rise to a sense of financial strain, amplifying stress and anxiety within the caregiving experience.

          The financial challenges caregivers face are multi-faceted. From out-of-pocket expenses for medical appointments and prescription medications to the potential loss of income due to reduced work hours or leaving the workforce altogether, the financial toll can be considerable. The financial strain may even permeate other aspects of life, impacting the caregiver’s ability to meet their needs and potentially compromising their financial stability.

          Mdm Rosmah’s (not her real name) narrative poignantly highlights the financial burdens that can beset caregivers, especially when unforeseen circumstances exacerbate an already precarious situation. After her husband was posted overseas for work, Mdm Rosmah made the significant decision to quit her job, dedicating herself to caring for her daughter with severe bipolar disorder. This sacrifice not only impacted her career but also placed her in a vulnerable financial position. The situation took a turn for the worse during one of her daughter’s relapses, which led to thousands of dollars being spent on clothes and cosmetics using Mdm Rosmah’s credit card. This incident not only exemplifies the direct costs associated with caregiving but also the potential for unexpected financial challenges that can deepen the strain on a caregiver’s resources.

          This part of Mdm Rosmah’s journey underscores the multifaceted nature of financial challenges in caregiving, blending the tangible aspects of financial management with the unpredictable elements of caring for someone with a mental health condition. It highlights the critical importance of financial planning, the need for accessible resources, grants, or support programs, and the necessity of contingency plans to manage such crises.

          financial burden caregiving
          Financial strain can be the breaking point for some caregivers.
          The Weight of Caregiver Guilt and Obligation: Balancing Self-Care Amidst Internal Conflict

          The emotional and familial turmoil Mdm Rosmah faces further illuminates the internal conflicts many caregivers experience. When confronted with her daughter’s actions, not only did she face the financial repercussions, but she also encountered a profound moral and emotional dilemma. Her refusal to report her daughter to the police, despite her eldest son’s insistence, reflects the deep-seated sense of obligation and protection caregivers feel towards their care recipients, even in the face of personal harm and financial loss. This decision led to her eldest son moving out, adding to the sense of her family disintegrating, and exacerbating feelings of isolation, guilt, and the weight of her caregiving responsibilities.

          Many individuals providing care grapple with feelings of guilt when contemplating taking time for themselves rather than solely dedicating every moment to meeting the needs of their loved ones. The sense of obligation to provide constant care can lead to internalised guilt when considering personal needs or moments of respite. This internal conflict can manifest as a perpetual emotional tug-of-war, contributing to heightened stress and emotional fatigue.

          Acknowledging and addressing feelings of guilt and obligation is a pivotal aspect of supporting caregivers. By fostering a more balanced perspective on caregiving responsibilities, caregivers can deal with the challenges with greater emotional resilience, which can help them ensure a healthier and sustainable caregiving experience for both themselves and their loved ones.

          Understanding these underlying causes of caregiver burnout is essential in developing strategies to prevent or mitigate caregiver burnout. By recognising these stressors, caregivers can take proactive steps to safeguard their well-being while providing the best care for their loved ones.

          The Warning Signs: Recognising Caregiver Burnout Early On

          Caregiver burnout is a state of physical, emotional, and mental exhaustion that can result from the prolonged and overwhelming stress of caregiving. Recognising the signs of caregiver burnout is crucial for taking proactive steps to address and prevent its impact. Here are common signs of caregiver burnout:

          Physical symptoms:
          • Persistent fatigue and lack of energy
          • Frequent headaches or physical ailments
          • Changes in sleeping patterns, either insomnia or excessive sleep
          Emotional signs:
          • Overwhelming feelings of sadness or helplessness
          • Increased irritability or frustration
          • Persistent feelings of anxiety  or worry
          • Loss of interest in activities once enjoyed
          Cognitive impact:
          • Difficulty concentrating or making decisions
          • Forgetfulness or absentmindedness
          • Cognitive fatigue and mental fog
          Behavioural changes:
          • Withdrawal from social activities and isolation
          • Increased use of alcohol or other substances
          • Neglecting personal responsibilities and self-care
          Physical health deterioration:
          • Weakened immune system and increased susceptibility to illness
          • Unexplained weight loss or gain
          • Chronic health issues [6] exacerbated by stress
          Shift in attitude:
          • Increased cynicism or negativity
          • Decreased empathy and patience
          • A sense of hopelessness or helplessness
          Strained relationships:
          • Tension and conflicts with family members, friends, or the person being cared for
          • Social withdrawal and difficulty maintaining relationships
          Neglecting self-care:
          • Ignoring personal needs and well-being
          • Difficulty taking breaks or seeking support
          • Feeling guilty when considering personal time or self-care
          Impact on work or other responsibilities:
          • Decline in job performance or inability to focus at work
          • Difficulty managing other responsibilities outside of caregiving
          Increased health concerns:
          • Elevated blood pressure or other stress-related health issues
          • Compromised immune system leading to frequent illnesses

          Recognising these signs early on is essential for preventing burnout and maintaining the caregiver’s well-being. Seeking support, prioritising self-care, and implementing strategies to alleviate stress are crucial steps to address caregiver burnout effectively.

          Preventing Caregiver Burnout: Essential Strategies for Well-being

          Preventing caregiver burnout is crucial for maintaining the overall well-being of those undertaking the demanding role of caregiving. The responsibilities associated with providing care can be emotionally, physically, and mentally taxing, making it essential for caregivers to adopt proactive strategies to safeguard their own health while ensuring the best possible care for their loved ones.

          self-care
          Taking care of yourself is not a luxury; it’s a necessity.
          1. Prioritise Self-Care

          Taking care of oneself is crucial for preventing caregiver burnout. Schedule regular self-care activities such as exercise, meditation, or hobbies. Ensure you are getting enough sleep and maintaining a healthy diet. By prioritising your own well-being, you’ll be better equipped to handle the challenges of caregiving.

          2. Set realistic expectations

          It’s important to be realistic about what you can accomplish as a caregiver. Understand your limitations and accept that you may not be able to do everything. Set achievable goals and focus on what truly matters. Setting realistic expectations helps reduce feelings of frustration and inadequacy, contributing to long-term well-being.

          3. Seek and Accept Support

          Building a strong support network is essential for preventing burnout. Connect with friends, family, or caregiver support groups to share your experiences. Don’t hesitate to ask for help when needed, whether with caregiving tasks or emotional support. Feeling understood and supported can significantly alleviate the burden of caregiving.

          4. Establish Boundaries:

          Establishing clear boundaries is crucial for maintaining balance in your life. Learn to say no when necessary and communicate your limits to others. This may involve delegating tasks to other family members or hiring professional help. By setting boundaries, you protect your own well-being and ensure that caregiving responsibilities do not become overwhelming.

          5. Take Regular Breaks

          It’s essential to schedule regular breaks to avoid burnout. Allow yourself time away from caregiving responsibilities to relax and recharge. Whether it’s a short walk, a hobby, or a weekend getaway, taking breaks is vital for maintaining mental and emotional health. Breaks provide perspective and help prevent the constant stress that can lead to burnout.

          mental fatigue singapore
          Taking a break can help prevent caregiver burnout and ease caregiver mental fatigue.
          6. Utilise Respite Care Services

          Explore respite care options [7] to give yourself extended breaks from caregiving. Respite care provides temporary relief, allowing you to rest and attend to personal needs. Whether through professional services, friends, or family members, incorporating respite care into your routine is a proactive strategy to prevent burnout.

          7. Seek Professional Assistance

          In addition to relying on personal networks, seeking professional assistance is a crucial strategy for preventing caregiver burnout. Healthcare professionals, such as psychiatrists, can provide valuable guidance on managing stress, addressing emotional challenges, and maintaining overall well-being. Counsellors specialising in caregiver support can offer coping strategies, stress management techniques, and a safe space to express feelings.

          8. Practice Stress-Relief Techniques

          Integrating stress-relief techniques into your daily routine is fundamental for preventing caregiver burnout. Embracing practices like deep breathing, meditation, or yoga can significantly alleviate the physical and emotional strain associated with caregiving. These techniques are not only accessible but can be easily incorporated into even the busiest schedules. Regularly practising stress-relief techniques helps manage immediate feelings of tension and builds resilience over time, enabling caregivers to fulfil their responsibilities with greater ease and endurance.

          stress-relief techniques
          Stress-relief techniques, such as deep breathing or yoga, can help caregivers overcome exhaustion and burnout. 
          9. Utilise Technology

          In the modern era, leveraging technology [8] can be a powerful strategy to mitigate the challenges of caregiving. Explore various technological solutions [9] designed to streamline caregiving tasks and reduce the likelihood of burnout. Utilise medication reminder apps to ensure timely administration and tracking of medications. 

          Online support forums and communities can provide a virtual space for caregivers to connect, share experiences, and gain valuable insights. Additionally, consider incorporating telehealth options for medical consultations. This facilitates convenient access to healthcare professionals and minimises the logistical challenges associated with in-person appointments. 

          Moreover, some medical conditions necessitate specialised care, and technology addresses these distinct needs. For instance, applications such as Alzheimer’s Society’s Talking Point cater to caregivers of individuals with Alzheimer’s or dementia by offering a dedicated online community. These condition-specific apps provide tailored resources, advice, and a supportive environment designed to address the unique challenges caregivers face in these situations.

          Conclusion: Nurturing Caregivers for Sustainable Care

          Selflessness often takes center stage in caregiving, with the well-being of loved ones prioritised above all else. Yet, as the journeys of Mrs. Tan, Mr. and Mrs. Ravi, and Mdm Rosmah poignantly illustrate, the sustainability of care is deeply intertwined with the health and well-being of the caregivers themselves. Each story, unique in its challenges and triumphs, underscores a universal truth: preventing caregiver burnout is not just an act of self-preservation but a crucial component of providing continuous, quality care.

          Mrs. Tan’s struggle with the emotional and physical demands of caring for her father with dementia, Mr. and Mrs. Ravi’s relentless dedication in the face of their twins’ unpredictable behaviors, and Mdm Rosmah’s financial and emotional turmoil while supporting her daughter—all highlight the multifaceted challenges caregivers face daily. Yet, within these narratives, there is a thread of hope and resilience that shines brightly. These caregivers, in recognising their limits and seeking support, embody the very essence of strength.

          By embracing self-care, establishing boundaries, and leveraging technological aids, caregivers can navigate their journey with greater assurance and less strain. Mrs. Tan’s, Mr. and Mrs. Ravi’s, and Mdm Rosmah’s stories serve as powerful reminders that acknowledging the need for help is not a weakness but a step toward a more balanced, healthy caregiving experience. Through open communication and attending to their emotional needs, caregivers can find solace and strength in a community that understands and supports them.

          The path of caregiving, filled with challenges and rewards, calls for a collective effort to ensure it is one marked by support, understanding, and hope. By uniting in this cause, we pave the way for a future where caregiving is not a solitary struggle but a shared journey, illuminated by the compassion and resilience of those who walk it.

          References 

          1. Tan, Gregory Tee Hng, et al. “Factors Associated with Caregiving Self-Efficacy among Primary Informal Caregivers of Persons with Dementia in Singapore.” BMC Geriatrics, vol. 21, no. 1, Jan. 2021, p. 13. BioMed Central, https://doi.org/10.1186/s12877-020-01951-8

          2. YingCorrespondent, Lee Li. “Over 40% of Caregivers at Risk of Depression amid Challenging Environment: Survey.” The Straits Times, 6 Apr. 2023. The Straits Times, https://www.straitstimes.com/singapore/over-40-of-caregivers-at-risk-of-depression-amid-challenging-environment-survey

          3. Schulz, Richard, and Paula R. Sherwood. “Physical and Mental Health Effects of Family Caregiving.” The American Journal of Nursing, vol. 108, no. 9 Suppl, Sept. 2008, pp. 23–27. PubMed Central, https://doi.org/10.1097/01.NAJ.0000336406.45248.4c

          4. Bruening, Rebecca, et al. “Connecting Caregivers to Support: Lessons Learned From the VA Caregiver Support Program.” Journal of Applied Gerontology, vol. 39, no. 4, Apr. 2020, pp. 368–76. DOI.org (Crossref), https://doi.org/10.1177/0733464818825050

          5. Lai, Daniel W. L. “Effect of Financial Costs on Caregiving Burden of Family Caregivers of Older Adults.” SAGE Open, vol. 2, no. 4, Oct. 2012, p. 215824401247046. DOI.org (Crossref), https://doi.org/10.1177/2158244012470467

          6. JD, Ron Ingber. “Caregiver Stress Syndrome.” Caregiver.Com, 2 Feb. 2023, https://caregiver.com/api/content/361e1fc0-fcc1-11e8-8be9-120e7ad5cf50/

          7. Bernstein, Susan, and Shawna Seed. “Respite Care.” WebMD, https://www.webmd.com/cancer/what-is-respite-care.  Accessed 5 Feb. 2024. 

          8. Lindeman, David A., et al. “Technology and Caregiving: Emerging Interventions and Directions for Research.” The Gerontologist, vol. 60, no. Suppl 1, Feb. 2020, pp. S41–49. PubMed Central, https://doi.org/10.1093/geront/gnz178

          9. 6 Indispensable Tech Tools for Family Caregivers | VirginiaNavigator. https://seniornavigator.org/article/75065/6-indispensable-tech-tools-family-caregivers.   Accessed 5 Feb. 2024. 

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          • Psychiatrist, Psychologist, or Therapist: Who Should I See?

          Psychiatrist, Psychologist, or Therapist: Who Should I See?

          The prevailing culture of silence around mental health, fueled by societal norms that equate vulnerability with weakness, exacerbates this issue.

          Posted on 3 Jan 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          Recent data from the National Population Health Survey in Singapore reveals a concerning trend: the prevalence of poor mental health has risen from 13.4% in 2020 to 17% in 2022 [1]. This increase underscores the critical need for accessible and effective mental health care. As individuals face these growing challenges, a paradox becomes evident – despite the clear need, many find the act of seeking help daunting.

          The prevailing culture of silence around mental health, fueled by societal norms that equate vulnerability with weakness, exacerbates this issue. People are often hesitant to seek help due to the fear of judgement and the stigma associated with mental health issues. This paradox, where the need for support is evident, yet the pursuit of it is hindered by stigma, highlights a significant barrier in mental health care.

          Navigating the complexities of mental health services adds to the challenge. Choosing between a psychiatrist, psychologist, or counsellor can be overwhelming in Singapore, especially when understanding each professional’s distinct roles and specialisations. The struggle lies not just in recognising these distinctions but also in aligning them with personal mental health needs.

          mental health concerns
          Mental health issues require understanding, compassion, and accessible support.
          So, You Have Decided to Seek Help: A Guide for Approaching Mental Health Services

          Recognising the need for mental health support is a crucial first step. For those hesitant to seek help, understanding how to approach mental health services is vital. Here’s an expanded guide on how to navigate your way through seeking mental health services, incorporating important factors such as rapport, honesty, and practical considerations:

          1. Start with research

          Begin by exploring the different types of mental health professionals. Understand their areas of expertise and what they specialise in. This initial research will provide you with a solid foundation for making an informed decision about whom to approach for your mental health needs.

          2. Consultation as a first step

          An initial consultation is a great starting point. It’s an opportunity to discuss your concerns, understand the therapy process, and get a feel for how the therapist works. Remember, this first meeting is about gathering information and does not lock you into a specific treatment path.

          3. Choose based on rapport and therapeutic alliance

          Selecting a mental health professional can sometimes feel more daunting than choosing a life partner. The therapeutic alliance [2], or your rapport with your therapist, is crucial. You will share deep, personal aspects of your life, so feeling comfortable and connected with your therapist is paramount. Don’t hesitate to meet with different therapists to find the one with whom you feel most comfortable.

          4. Be open and honest

          Approach your sessions with openness and honesty. Being candid about your feelings, thoughts, and experiences is essential. Similarly, be open about practical considerations like the cost of sessions. Discussing fees upfront can help set clear expectations and ensure that the therapeutic process fits within your budget, an important aspect of maintaining a stress-free therapeutic relationship.

          5. Seek support

          Sharing your decision to seek therapy with a trusted friend or family can provide additional emotional support. You could ask someone to accompany you to your first session if it makes you more comfortable. Knowing you have the support of your loved ones can make a significant difference in your mental health journey.

          supporting friend
          Support from a friend or family member can provide extra emotional and mental support.
          6. Be prepared for a process

          Therapy [3] is a process that involves navigating through complex emotions and thoughts. It requires patience and commitment. Remember that progress in therapy often comes in small steps and requires time.

          7. Celebrate your progress

          Recognise and celebrate your progress, no matter how small it may seem. Acknowledging your efforts and the steps you’ve taken can be incredibly empowering and motivating as you continue your journey.

          8. You are not alone

          Finally, remind yourself that you are not alone. Many others have embarked on this journey before you; support is always available. Your decision to seek help is a brave and significant step towards a healthier life.

          For the rest of the article, we will first further explore and differentiate between the roles of psychologists [4], psychiatrists [5], counsellors [6], and therapists [7]. We will then shed some light on who you should choose concerning your situation. We hope this guide will empower you with the necessary insights and considerations for starting your mental health journey. With the right approach and support, seeking help can lead to profound personal growth and improved well-being.

          What We Do: A Closer Look at Mental Health Professionals’ Roles

          Having understood the initial steps in seeking help, it’s important to delve into the specific roles of mental health professionals. 

          1. Psychiatrists: Medical experts in mental health

          Psychiatrists are medical doctors in Singapore who specialises in diagnosing and treating mental illnesses, uniquely positioned to evaluate both the physical and psychological aspects of their patient’s health. Their role is multifaceted, encompassing a range of responsibilities:

          • Diagnostic assessments: psychiatrists are proficient in conducting comprehensive diagnostic evaluations. They use various assessment tools and techniques, including psychiatric interviews and psychological tests. As medical doctors, psychiatrists are particularly attentive to ensuring that psychiatric symptoms are not the manifestation of a medical illness. They often incorporate neuroimaging or lab tests into their assessments to rule out physical health conditions that could present with psychiatric symptoms.
          • Medical and psychological expertise: their training as medical doctors is fundamental to their practice. Psychiatrists consider the interplay of biological, psychological, and social factors in mental health, allowing them to offer a holistic approach to treatment.
          • Prescribing medication: being medical doctors, they are authorised to prescribe medication. They manage medication plans for a range of mental health conditions, from mood disorders to severe mental illnesses.
          • Psychotherapy provision: many psychiatrists are also trained in providing psychotherapy, enabling them to integrate therapeutic techniques into their treatment plans.
          • Treatment planning and management: psychiatrists develop and manage comprehensive treatment plans that often combine medication, psychotherapy, lifestyle changes, and other interventions.
          MRI brain mental health
          Psychiatrists are medical professionals who may use brain imaging to rule out neurological conditions that may cause psychiatric conditions.
          2. Psychologists: Specialists in behaviour and mental processes

          Psychologists are professionals specialising in understanding the intricacies of the human mind and behaviour. Their expertise is not limited to therapy but extends to a broad spectrum of activities that contribute significantly to mental health care and research. Here are key aspects of their role:

          • Deep dive into human behaviour: psychologists extensively study how individuals think, feel, behave, and interact. They are particularly focused on the patterns and motivations underlying human behaviour, making them adept at understanding complex emotional and cognitive processes.
          • Conducting psychological assessments: a crucial aspect of their work involves conducting detailed psychological assessments. This includes:
          • Personality tests: to evaluate personality traits and identify patterns that may impact mental health and behaviour.
          • Cognitive assessments and IQ testing: to measure cognitive abilities such as memory, problem-solving, and intellectual functioning. These assessments are essential in identifying learning disabilities, giftedness, and cognitive impairments.
          • ADHD assessments: using various tools and interviews to assess attention, impulsivity, and hyperactivity, which are key in diagnosing Attention-Deficit/Hyperactivity Disorder [8].
          • Autism evaluations: through observational assessments and structured interviews, psychologists play a vital role in diagnosing Autism Spectrum Disorder and understanding the individual’s social, communication, and behavioural challenges.
          • Diagnostic interviews: to identify specific mental health conditions and understand the individual’s mental health history and current symptoms.
          • Providing psychotherapy: psychologists are well-known for their role in providing psychotherapy. They employ various evidence-based therapeutic approaches like cognitive-behavioural therapy (CBT) [9], psychodynamic therapy [10], humanistic therapy [11], and more. Their therapy sessions are designed to help individuals understand and work through their problems, enhance self-awareness, and develop healthier coping mechanisms.
          • Specialised areas of focus: many psychologists specialise in areas such as clinical psychology, counselling psychology, child and adolescent psychology, health psychology, neuropsychology, and forensic psychology, providing targeted care and interventions.
          child psychologist
          Psychologists specialise in different areas, such as child and adolescent psychology.
          3. Counsellors: Advisors for specific life issues

          Counsellors are key figures in the mental health landscape, offering tailored support and guidance for various life challenges and transitions. Their role is multifaceted and client-centred, focusing on empowering individuals with the tools and insights needed for personal growth and problem resolution. Here are some key aspects of their role:

          • Personalised support: counsellors work closely with individuals to provide personalised support tailored to their unique circumstances. This involves understanding each person’s background, challenges, and goals to offer relevant and effective guidance.
          • Development of coping strategies: counsellors are adept at helping individuals develop coping strategies for managing stress, anxiety, and other emotional challenges. They provide tools and techniques for better emotional regulation and resilience.
          • Relationship and family counselling: in the realm of relationship and family counselling, they address issues such as communication problems, marital conflicts, and family dynamics, facilitating healthier relationships and improved interpersonal skills.
          • Life transitions and adjustments: counsellors often assist individuals navigating significant life transitions such as divorce, retirement, relocation, or losing a loved one, providing support and strategies to adjust to these changes.
          Collaborative Approach in Mental Health Care: A Unified Effort

          As we have seen, psychiatrists, psychologists and counsellors have different expertise. They bring together their diverse expertise to offer comprehensive care. This collaborative approach combines medical, psychological, and social perspectives to ensure holistic treatment for patients. Psychiatrists often lead in medical evaluations and medication management, while psychologists delve deep into in-depth therapy. Counsellors add a crucial dimension by supporting everyday life challenges and specific life issues.

          The success of this approach hinges on continuous communication among all professionals, ensuring that treatment plans are cohesive and adapt to the patient’s evolving needs. Additionally, family involvement is a key aspect, especially with children or adolescents, where family dynamics significantly impact treatment. Counsellors often engage with family members to enhance communication and understanding, while psychiatrists and psychologists guide the management of the patient’s condition in the familial setting. This unified effort ensures a well-rounded and effective approach to mental health care.

          psychiatrist
          Choosing between a psychiatrist and a psychologist depends on a number of factors.
          Case Example: Collaborating for Comprehensive Patient Care

          Jane, a 30-year-old woman, sought help from a psychiatrist due to her struggles with anxiety and mood swings. After a detailed diagnostic assessment, the psychiatrist diagnosed her with bipolar disorder and started a medication regimen to manage her symptoms. To complement the medical treatment, the psychiatrist referred Jane to a psychologist for psychotherapy.

          In her sessions with the psychologist, Jane engaged in cognitive-behavioural therapy, which helped her understand and manage her thought patterns and emotions. During therapy, it became evident that Jane was also facing significant challenges in her marriage, which were contributing to her stress.

          To address this aspect of Jane’s life, the psychologist coordinated with a counsellor specialising in marriage counselling. The counsellor worked with Jane and her husband, providing them with strategies to improve communication, understand each other’s perspectives, and strengthen their relationship. This counselling was crucial in helping them navigate the complexities of Jane’s mental health condition within the context of their marriage.

          Throughout her treatment journey, there was ongoing communication between the psychiatrist, psychologist, and counsellor. This was done with Jane’s consent, of course. This collaborative approach ensured that all aspects of Jane’s mental, emotional, and relational health were being addressed cohesively. The team adjusted their strategies based on Jane’s progress and the evolving dynamics of her personal life.

          The integrated efforts of the psychiatrist, psychologist, and marriage counsellor gave Jane a holistic treatment experience. This multi-pronged approach not only helped her manage her bipolar disorder but also supported her in building a healthier, more understanding relationship with her husband, significantly improving her overall quality of life.

          So…do I see a psychiatrist or psychologist first?

          When faced with whether to see a psychiatrist or psychologist, it’s important to consider the nature of your concerns and your preferred approach to treatment. This decision often hinges on the specifics of your mental health needs, the severity of your condition, and your openness to various forms of therapy.

          If you suspect that the issues are linked to an illness, such as in cases of severe depression, bipolar disorder, or schizophrenia, or if you’re experiencing symptoms that significantly impact your daily functioning, seeing a psychiatrist could be the right choice. Psychiatrists, as medical doctors, are adept at managing complex mental health conditions, particularly those requiring medication. Their medical training offers a comprehensive approach that may include medication, psychotherapy, and lifestyle changes.

          On the other hand, if you’re primarily seeking to understand your thoughts, emotions, and behaviours or grappling with life challenges, stress, anxiety, relationship issues, or mild to moderate mood disorders, a psychologist might be more suitable. Psychologists specialise in psychotherapy, offering a range of therapeutic approaches to help you explore and manage your mental health concerns. Their focus is on providing profound insights and coping strategies through talk therapy.

          Treatment preferences also play a crucial role in this decision. If you are open to the possibility of medication as part of your treatment, a psychiatrist with the authority to prescribe would be the suitable professional to consult. However, for those who prefer a treatment approach focused exclusively on psychotherapy without medication, a psychologist is often the better choice.

          psychiatrist
          A psychiatrist conducts proper diagnosis and prescribes medications to address mental health concerns.

          The journey of mental health care is sometimes a collaborative one. Psychiatrists and psychologists frequently work together, and it’s not uncommon to start with one and be referred to the other as your treatment progresses. This collaborative care approach ensures that all aspects of your mental health are being addressed.

          If you’re still uncertain about which professional to see, a consultation with a psychiatrist or psychologist can be a wise first step. They can assess your situation and, if needed, refer you to another professional for additional support.

          Ultimately, whether you see a psychiatrist or psychologist, the most important step is reaching out for help. Both are committed to helping you navigate your mental health journey and can guide you towards the path that best suits your individual needs.

          Do I need counselling or psychotherapy?

          Understanding whether you need counselling or psychotherapy [12] is an important step in seeking mental health care. While the terms are often used interchangeably, subtle differences in focus and approach might make one more suitable for you than the other.

          Counselling typically addresses specific, current issues or life challenges. It is often more short-term and goal-oriented, focusing on providing guidance, problem-solving strategies, and support. Counsellors work with individuals to develop coping mechanisms for managing stress, navigating life transitions like career changes or relationship difficulties, and handling day-to-day emotional challenges. If you need assistance with a particular life event, decision-making, or managing emotional responses to recent changes or stressors, counselling could be the right choice.

          Psychotherapy, on the other hand, tends to delve deeper. It is often more long-term and explores underlying patterns of thoughts, feelings, and behaviours. Psychotherapy aims to uncover the root causes of your challenges, providing a deeper understanding of yourself and your experiences. It can be particularly beneficial for individuals dealing with long-standing psychological issues, complex emotional difficulties, or mental health disorders. If you’re looking to explore your past, understand persistent negative patterns, or address more complex emotional or mental health issues, psychotherapy might be more appropriate.

          Both counselling and psychotherapy provide supportive environments where you can talk openly about your feelings and experiences. The key difference lies in the depth and scope of the work. Counselling often deals with the ‘here and now,’ helping you to navigate current life situations, while psychotherapy may involve a more extensive exploration into your psychological makeup and past experiences.

          In many cases, the decision doesn’t have to be one or the other. Some individuals might start with counselling to address immediate concerns and later transition into deeper psychotherapeutic work as they uncover more about themselves. Mental health professionals can guide you in choosing the most suitable approach based on your individual needs.

          Remember, the most important step is recognising when you need support and taking action to seek it. Whether through counselling or psychotherapy, reaching out for professional help is a commendable and significant step towards your mental health and well-being.

          Conclusion 

          In conclusion, understanding the diverse landscape of mental health care is crucial, particularly in the context of Singapore, where we’re witnessing a significant rise in mental health concerns. Whether it’s a psychiatrist, psychologist, or counsellor, each professional plays a unique role in providing care and support. It’s important to choose the right professional based on your individual needs while also considering factors like therapeutic rapport and practical considerations such as cost.

          Seeking help for mental health issues is a sign of strength and self-awareness, not a weakness. It’s a proactive step towards understanding yourself better and improving your overall quality of life. Remember, the mental health journey is not one you must walk alone. Help is available, and reaching out is the first step towards healing and growth.

          If you or someone you know is struggling with mental health issues, we encourage you to seek support. Consult a mental health professional for guidance, talk to friends and family for emotional support, and explore the various resources available in Singapore. Let’s break the silence and stigma surrounding mental health together. Your mental health matters, and taking the first step towards seeking help is a courageous move that can lead to transformative change.

          Remember, you are not alone, and support is available. Your mental health journey is important, and taking the first step today can lead you towards a healthier tomorrow.

          References
          1. Ganesan, N. (2023, September 27). Prevalence of poor mental health increasing in Singapore; young adults have highest proportion at 25.3%. Retrieved from CNA: Channel News Asia: https://www.channelnewsasia.com/singapore/poor-mental-health-young-adults-seek-help-moh-survey-3802531 
          2. Therapeutic Alliance – an Overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/psychology/therapeutic-alliance#:~:text=Therapeutic%20alliance%20(TA)%2C%20a,therapy%2Drelated%20tasks%20and%20goals.  Accessed 2 Jan. 2024.
          3. Therapy | Psychology Today. https://www.psychologytoday.com/us/basics/therapy.   Accessed 2 Jan. 2024.
          4. Contributors, WebMD Editorial. “What Is a Psychologist?” WebMD, https://www.webmd.com/a-to-z-guides/what-is-psychologist.  Accessed 2 Jan. 2024.
          5. “What Is A Psychiatrist? What They Do and When to See One.” Cleveland Clinic, https://my.clevelandclinic.org/health/articles/22702-psychiatrist.  Accessed 2 Jan. 2024.
          6. Services, Department of Health &. Human. Counsellors. http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/counsellors.   Accessed 2 Jan. 2024. 
          7. “What Therapists Do and When to See One.” Verywell Mind, https://www.verywellmind.com/what-is-a-therapist-2672019.  Accessed 2 Jan. 2024.
          8. CDC. “Attention-Deficit / Hyperactivity Disorder (ADHD).” Centers for Disease Control and Prevention, 16 Oct. 2023, https://go.usa.gov/xRAsU
          9. “What Is Cognitive Behavioral Therapy?” Https://Www.Apa.Org, https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.   Accessed 2 Jan. 2024.
          10. Treatment, Center for Substance Abuse. “Chapter 7—Brief Psychodynamic Therapy.” Brief Interventions and Brief Therapies for Substance Abuse, Substance Abuse and Mental Health Services Administration (US), 1999. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK64952/
          11. Contributors, WebMD Editorial. “What Is Humanistic Psychology and Humanistic Therapy?” WebMD, https://www.webmd.com/mental-health/humanistic-psychology-and-humanistic-therapy.  Accessed 2 Jan. 2024.
          12. Psychotherapies – National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/psychotherapies.  Accessed 2 Jan. 2024.
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          • Understanding Psychiatric Medications: Navigating Treatment Options

          Understanding Psychiatric Medications: Navigating Treatment Options

          In the realm of psychiatric medications, embracing a holistic approach that prioritizes individualized treatment plans, fosters understanding of side effects, encourages collaborative efforts, and addresses financial considerations is essential for achieving effective and compassionate mental health care.

          Key takeaways

          • Medication is a vital component of mental health treatment but works best as part of a holistic approach that includes psychotherapy, lifestyle changes, and support systems.
          • Due to the variability in individual responses to medication, personalized treatment plans are crucial for effective care.
          • Knowledge about potential side effects, including how to manage them and the importance of professional guidance, is essential for both patients and healthcare providers.
          • Open communication and collaboration between patients, caregivers, and psychiatrists are fundamental in optimizing treatment outcomes.
          • Addressing financial constraints and exploring cost-effective treatment options ensure that patients receive necessary care without exacerbating financial stress.

          Posted on 3 Jan 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          In the realm of mental health, medication plays a pivotal role in managing and treating a variety of psychiatric conditions. As a psychiatrist, I have witnessed the transformative impact these medications can have. Yet, I also recognise the complexities and concerns that accompany them. Often, apprehensions held by patients and their caregivers can lead to reluctance or refusal of this treatment modality, which can significantly affect recovery and stability. This write-up aims to demystify psychiatric medications, shedding light on their types, mechanisms, and the subtleties of their clinical use.

          It’s crucial to acknowledge that medication is just one component of a comprehensive approach to mental health care. Effective treatment typically involves a combination of approaches, including psychotherapy, lifestyle adjustments to cope with real-life stressors, support from family and friends, and consideration of spiritual aspects, among others. Each of these elements plays a vital role in the holistic management of mental health conditions. However, the focus of this article will be on the medication aspect, aiming to provide clarity and understanding about this specific and often crucial element of psychiatric treatment.

          A Primer on Psychiatric Medications

          Psychiatric medications are diverse, each tailored to address specific aspects of mental health conditions. The primary groups of these medications include:

          1. Antidepressants: Typically used for depression, these drugs modulate neurotransmitters such as serotonin to alleviate depressive symptoms.
          • SSRIs (Selective Serotonin Reuptake Inhibitors) Example: Fluoxetine (Prozac), Escitalopram (Lexapro) and Sertraline (Zoloft)
          • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) Examples: Venlafaxine (Effexor) and Duloxetine (Cymbalta)
          • Other Antidepressants: Remeron (Mirtazapine) and Valdoxan (Agomelatine)
          1. Antipsychotics: Crucial in treating psychotic disorders like schizophrenia, they influence dopamine pathways.
          • Example: Risperidone (Risperdal) and Olanzapine (Zyprexa) are often used for schizophrenia and bipolar disorder.
          1. Sedatives and Anxiolytics: Employed for anxiety and sleep disorders; this category includes benzodiazepines and Z-hypnotics, known for their calming and sleep-inducing effects.
          • Benzodiazepine Examples: Lorazepam (Ativan) and Diazepam (Valium)
          • Z-hypnotic Examples: Zolpidem (Stilnox) and Zopiclone (Imovane)
          1. Mood Stabilizers: Vital in the management of bipolar disorder, helping to regulate mood fluctuations.
          • Example: Lithium Carbonate and Sodium Valproate
          1. Others, such as stimulants: Specifically designed for conditions like ADHD (Attention-Deficit/Hyperactivity Disorder), these medications help improve focus, attention, and self-control.
          • Example: Methylphenidate (Ritalin, Concerta) and Lisdexamfetamine (Vyvanse) are commonly used to treat ADHD.

          Occasionally, medications not traditionally categorized under these classes are also employed to alleviate symptoms associated with mental health conditions. An example is Propranolol, an “older” blood pressure medication. In psychiatric care, Propranolol is often utilized off-label for its ability to reduce physical symptoms of anxiety, such as palpitations and tremors

          How does psychiatric medication work?
          How does psychiatric medication work?
          Mechanism and Efficacy

          Psychiatric medications exert their effects by influencing various chemical pathways in the brain, akin to how other medications act on different parts of the body. These drugs target specific physiological processes to alleviate symptoms or modify disease progression.

          • Neurotransmitter Regulation: Many psychiatric disorders are linked with imbalances in neurotransmitters. Antidepressants, for example, increase serotonin levels, often low in depression, while antipsychotics target dopamine pathways, which can be overactive in conditions like schizophrenia.
          • Receptor Activity Modulation: Medications like benzodiazepines enhance the effect of GABA, reducing anxiety and aiding sleep by calming the nervous system.
          • Promoting Neuroplasticity: Some psychiatric medications may enhance the brain’s ability to form new neural connections, improving cognitive functions and mood regulation.
          • Variability in Individual Responses: The effectiveness of these medications varies greatly among individuals due to genetic, lifestyle, and health factors, necessitating a personalized approach.
          • Trial and Adjustment: Finding the right medication often involves trial and error to balance therapeutic benefits against potential side effects.
          Understanding and Managing Side Effects of Psychiatric Medications

          All medications, including those used in psychiatry, come with the potential for side effects. Managing these side effects is vital and typically requires carefully balancing the medication’s therapeutic effects with the need to reduce any unwanted reactions.

          There are potential side effects for psychiatric medication
          It is important to understand and manage potential side effects in psychiatric medication for overall health.

          As mentioned in the previous section, psychiatric medications are formulated to specifically act on certain pathways in the brain to treat mental health disorders. However, the very mechanisms that make these drugs effective can also lead to side effects, some of which may be unintended or undesirable.

          1. Neurotransmitter Effects: For instance, increasing serotonin levels can alleviate depressive symptoms but may also result in nausea, headaches, or sexual dysfunction. Similarly, antipsychotics, which modulate dopamine pathways, can cause drowsiness or more severe movement disorders.
          1. Receptor Activity: Enhancing GABA activity with benzodiazepines might relieve anxiety but can also lead to drowsiness, confusion, or dependency issues.

          Common Side Effects by Medication Class

          • Antidepressants (SSRIs, SNRIs): Typically include nausea, headaches, and sexual dysfunction, with risks like serotonin syndrome especially in the context of an overdose.
          • Antipsychotics: Range from weight gain to more severe conditions like Neuroleptic Malignant Syndrome and tardive dyskinesia.
          • Sedatives and Anxiolytics: Can cause drowsiness and dependency issues, with severe withdrawal symptoms upon abrupt discontinuation.
          • Mood Stabilizers: Often lead to weight gain and tremors, with risks like lithium toxicity.
          • Medications for ADHD: May result in loss of appetite and insomnia, with a potential for abuse in stimulant medications.
          Managing Side Effects: Balancing Benefits and Risks with Professional Guidance

          The management of side effects in psychiatric medication therapy involves a nuanced balancing act. This process is deeply personalized, as the occurrence and severity of side effects can vary widely among individuals due to factors such as age, overall health, genetic makeup, lifestyle, and the concurrent use of other medications. Adjustments in dosages, switching medications, or adding treatments are often necessary to counteract negative effects and to maintain the therapeutic efficacy of the drugs.

          Given the variability in how individuals experience side effects, professional guidance and regular monitoring become essential components of effective medication management:

          • Balancing Therapeutic Benefits and Side Effects: Striking the right balance is crucial for successful treatment. This sometimes involves the process of cross-titration, where one medication is gradually decreased while another is increased, to find the most effective and tolerable treatment combination.
          • Understanding Medication Interactions: It’s also vital to understand the potential interactions between various medications, including over-the-counter (OTC) drugs, traditional medicine and supplements. These interactions can significantly impact the safety and efficacy of treatment.
          • Informed Decision-Making: Making informed decisions about medication therapy requires a comprehensive understanding of potential side effects within the broader context of the patient’s overall health and treatment goals.

          Patients are strongly encouraged to maintain open and honest communication with their psychiatrists about their experiences with prescribed medications. This includes discussing any side effects experienced, as well as the perceived effectiveness of the treatment. By sharing this information, patients play an active role in their treatment process.

          • Reducing Polypharmacy: Open dialogue can help in minimizing the practice of polypharmacy – the use of multiple medications by a patient – especially if some drugs are found to be ineffective or cause adverse effects.
          • Adjusting Dosages: Feedback from patients is crucial in determining the optimal dosage of medications, aiming to achieve the maximum therapeutic effect with the minimum necessary dose.
          • Minimizing Side Effects: Understanding each patient’s unique reaction to a medication allows for adjustments that can reduce side effects, improving overall treatment adherence and quality of life.
          • Teamwork in Treatment: The psychiatrist and patient, along with other healthcare professionals if needed, work as a team. This collaborative approach ensures that treatment decisions are made considering the patient’s comprehensive health profile and personal preferences.
          Navigating Financial Constraints in Psychiatric Care

          Financial considerations are a crucial and often challenging aspect of psychiatric treatment. The cost of medications can significantly impact treatment choices, especially for patients with limited insurance coverage or financial resources. Open discussions about the cost of medications can lead to the exploration of cost-effective alternatives that do not compromise the quality of care.

          Cost of medication can impact treatment choices.
          Cost of medication can impact treatment choices.
          • Understanding Medication Pricing: The cost of medications can vary widely, influenced by factors such as brand versus generic formulations, the cost of research and development for new drugs, marketing, and patent issues. Newer, branded medications are often more expensive than older generics, but this does not necessarily correlate with increased efficacy or safety.
          • Generic vs. Branded Medications: Generic medications, which are typically less expensive, can be equally effective as their branded counterparts. They contain the same active ingredients and undergo rigorous testing to ensure their safety and efficacy.
          • Therapeutic Equivalence: When cost is a concern, psychiatrists can explore therapeutically equivalent medications that provide similar clinical benefits but at a lower cost.
          • Insurance Coverage and Assistance Programs: Understanding a patient’s insurance coverage and exploring available assistance programs can help in mitigating the financial burden of medications.
          • Balancing Cost and Clinical Needs: The goal is to balance financial considerations with clinical needs, ensuring that patients receive effective treatment without undue financial strain.
          • Transparent Communication: Encouraging open and transparent communication about financial constraints allows psychiatrists to tailor treatment plans that are both clinically effective and financially feasible.
          • Ongoing Cost Management: Managing the cost of psychiatric medications is an ongoing process. Regularly reviewing and adjusting medication regimens can help in finding the most cost-effective treatment solutions over time.
          Empowering Patients through Understanding and Collaboration

          In conclusion, understanding psychiatric medications is an integral part of managing mental health conditions. This article has aimed to provide clarity on the various types of psychiatric medications, their mechanisms, and the intricacies involved in their use. By demystifying these medications, we seek to empower patients and caregivers, enabling them to engage more actively and confidently in the treatment process.

          As we navigate the complexities of psychiatric medications, let us remember that the journey towards mental wellness is a collaborative one, with each patient’s unique needs at its core. Psychiatrists, healthcare providers, patients, families and their support networks all play pivotal roles in this journey.

          Together, through understanding, communication, and empathy, we can work towards effective, compassionate, and comprehensive mental health care.
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          • How can I convince a loved one to seek psychiatric help?

          How can I convince a loved one to seek psychiatric help?

          Poor mental health is a growing concern in Singapore. The National Population Health Survey (NPHS) 2022 revealed that poor mental health increased from 13.4 per cent in 2020 to 17 per cent in 2022

          Posted on 18 Dec 2023

          Written by
          Dr Jared Ng, Connections MindHealth

          Poor mental health is a growing concern in Singapore. The National Population Health Survey (NPHS) 2022 [1] revealed that poor mental health increased from 13.4 per cent in 2020 to 17 per cent in 2022 (with young adults contributing to the highest proportion of poor mental health at 25.3 per cent). Whilst this increase may not be dramatic per se, it is an indicator that the state of mental health in the country is significantly declining. The survey also revealed that young adults are most vulnerable to declining mental health. 

          In our lives, it is common to have an inkling about a loved one’s deteriorating well-being. Whether you’re a parent, sibling, friend, partner, or colleague, you may have felt the urge to intervene in the lives of someone you care about in hopes that they would seek professional psychiatric help. However, this display of love can be tricky. 

          The stigma around the topic of mental health is, unfortunately, still evident in our communities. A 2017 [2] study in Singapore revealed that almost half (approximately 44.5%) of respondents, made up of adolescents, associated mental illnesses with negative, derogatory terms like “stupid”, “dangerous”, “crazy”, and “weird”, while 46.2% of them said they would be “very embarrassed” if they were diagnosed with a mental illness.

          Concerned Asian woman
          Whilst young adults are most troubled with mental health in Singapore, our teenagers also seemingly have high levels of negative connotation to the issue. 

          Given the negative connotation around the subject, how can you masterfully suggest seeking help for the ones you love? In this article, we have provided a comprehensive guide on techniques to convince a loved one to seek psychiatric help. 

          1. Don’t push the trigger button 

          Culturally, Asians seem brasher in casual conversations, though it is not necessarily intended with malice. For instance, a mother may observe her son’s binge eating tendencies and voice it as “You are going to become fat if you keep this up!”. Whilst this sentence, when dissected, is harsh, there is often genuine concern about her son’s well-being and the impact that binge eating will have on his health.

          However, the method employed by the mother will not halt her son’s binge eating tendencies. If anything, it may cause further upset and fuel the root cause masked by this specific behaviour. So, how can you approach your loved ones tactfully? 

          The first step is to understand their list of triggers. For example, for individuals dealing with anorexia, pointing out their weight loss, whether positively or negatively, could further encourage starvation behaviour. The trigger, in this case, is weight loss. If you’re dealing with a loved one who’s depressed, blatantly pointing out their behaviour change could result in self-consciousness.

          consoling son
          Be tactful and loving when approaching a loved one with concerns about their mental health.

          Instead, frame your concern with more caution. For example, when initially approaching a loved one, your concern may be worded as:

          •  “I am worried about your health and the future consequences. Do you have any intention of remedying them?” 
          • “ I am deeply concerned and hope I am not overstepping, but it appears you are demotivated to nourish yourself. Would you like to talk about it?’”
          • “I intuitively feel that you may be burdened by something. Is there an issue that is lying heavy on your heart? I hope you know I am always ready to listen.”

          As shown in the examples above for various cases, when initiating a conversation about issues presented by your loved ones, you first take away the spotlight from them by highlighting how YOU are genuinely concerned for them with I-statements [3]. Once the concern you have presented is received positively, you can open the doors to seeking psychiatric help. 

          2. Tone it down 

          As important as it is to carefully curate your words when approaching a vulnerable individual, the tone of your voice is crucial. Have you ever gotten into an argument because the opposing party claims your tone was disrespectful, condescending or even patronising? Most people lack awareness of how their tone of voice [4] could add more fuel to the fire. As the famous saying goes, it is not what you say but how you say it. 

          When speaking to a loved one in a troubled state of mind, it is important to present your intention as “concerned” versus “accusatory”. Your tone of voice will definitively play a significant role in how the message is relayed and received. When attempting to suggest to a loved one to seek psychiatric help, you should: 

          • Speak in a lower tone: psychologically troubled people may be defensive and argumentative; however, that does not justify you raising your voice at any point. Stay firm with your intention and remind yourself they do not necessarily come from a malicious place. 
          • Speak slowly: make sure to add pauses and provide conversation space. If you are talking over your loved one or rushing through your “speech”, it may be difficult for them to capture your intention. Remember, you are also creating space for them to open up about the issues they may be battling. 

          “How do I know if my tone is right?’. For starters, try recording yourself and listen to how you sound. Often, this might suffice for you to correct your tone before approaching the one you love. You may also attempt a role-play with a trusted friend or family. Ask them to react negatively and observe if your tone changes when challenged. 

          This is not to say that you should put up with disrespect or that an emotional reaction is unwarranted when boundaries are crossed. We are fully aware that the average person is not a trained professional, so if the conversation becomes heated at any point, diffuse the situation immediately and hold the conversation for another day. 

          Partner consoling his wife
          Speaking calmly and gently is essential in opening up conversations about seeking psychiatric help. 
          3. Set and setting 

          As mentioned before, it is possible for a well-intended conversation to turn sour quickly. Therefore, taking some time to choose the right location to have this conversation is just as important. We advise opening a sensitive discussion, such as seeking psychiatric help in a private setting, perhaps in a familiar and safe place, like homes or favourite cafes. Padding the location with some of their favourite foods or drinks adds an element of comfort and encourages your loved one to open up. 

          Essentially, you should try not to have sensitive conversations in a sterile environment, including their workplace or people they may react sensitively to. For instance, attempting to approach your sibling at home where your parents are possibly eavesdropping or would be quick to insert themselves in the conversation could cause further damage. Your intention may even be questioned as an attempt to humiliate or embarrass. 

          If you attempt to help a coworker or subordinate, doing so over a dinner, which offers some privacy, may be better than a “meeting” in a conference room. Alternatively, a video call could be advantageous as they would be at home, allowing them to ruminate about the conversation within the safe walls of their home. 

          Girl supporting loved one
          Holding sensitive topics in a private and safe setting would help your loved ones to open up. 
          4. Be prepared for the rebuttals 

          In a society like Singapore, suggesting psychiatric help may cause a backlash. So be prepared for all the possible reasons your loved ones might oppose the idea, such as: 

          • Are you suggesting I am crazy?: Just because I can’t visibly see the state of your mind doesn’t mean you should be deprived of help. I am in no way stating you are crazy, but I think it’s time you sought help in the name of self-kindness. 
          • People will think I’m weird: weirdness is a subjective idea. I think you are an amazing person, and watching you deteriorate over poor mental health saddens me. It is my intention to preserve the beautiful person that you are, even if that means seeking psychiatric help. 
          • I can’t afford an embarrassing diagnosis: a diagnosis is not a label nor a life sentence. It will help you accurately identify the issue at hand. You will then have all the tools to manage your life effectively and learn to navigate complex situations with a professional. I genuinely believe you deserve assistance to reach your peak potential in life. Please don’t allow a diagnosis to hinder you. 

          As presented above, these rebuttals are not argumentative but come from a place of empathy. You are also wording your rebuttal in ways that present elements of support and care. 

          5. Physical assistance

          Assuming you are successful at the conversation phase of this process, it is now time to be physically involved. This includes guiding them to the appropriate healthcare provider, setting them an appointment (with their consent), following them to their first session, or even driving them to the clinic. When the person you love is vulnerable and potentially mentally distraught, these seemingly “simple” tasks could easily overwhelm them. Gifting them your time and effort will bring comfort and a sense of security to your loved ones. 

          We recognise that intervening in the lives of a loved one and taking up some load could easily overwhelm an individual. Do not risk your mental health in the process of helping others, as this would not be beneficial to any party. Carefully gauge your comfort level and the extent you are willing to commit. Refrain from overpromising and under-delivering, too, as this could further disappoint the ones you love. 

          Wrapping up 

          If you’ve reached the end of this article but feel uncomfortable executing any of these steps, you can instead identify the next best person to help the ones you love. This should be someone you believe also has your loved one’s best interest and can execute this process more efficiently. 

          If you believe the person you love is at risk of harming themselves or the people around them, you must consider contacting emergency lines in Singapore: 995 for an ambulance or 999 for a police emergency. You can also call the SOS Hotline (1767) or the IMH Helpline (63892222) If you believe the issues are urgent but do not warrant contacting the police/SCDF ambulances. If you have general inquiries, contact us to guide you per your specific situation. 

          We applaud you for caring for the people you love and doing the due research. We hope that stigmas surrounding mental health are eliminated in the years to come. Until then, as long as one is surrounded by people who care for them like yourself, hope remains. 

          References
          1. Ministry of Health Singapore (2022) National Population Health Survey 2022 , NATIONAL POPULATION HEALTH SURVEY 2022. Available at: https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/nphs-2022-survey-report-(final).pdf (Accessed: 08 December 2023).
          2. Pang, S. et al. (2017) Stigma among Singaporean youth: A cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population, BMJ open. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652546/ (Accessed: 08 December 2023).
          3. Rogers, S.L., Howieson, J. and Neame, C. (2018) I understand you feel that way, but I feel this way: The benefits of I-language and communicating perspective during conflict, PeerJ. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5961625/ (Accessed: 08 December 2023).
          4. Raeburn, D.C. (2022) Improving and watching your tone of Voice, Raeburn Psychology . Available at: https://carolinaraeburn.com/improving-and-watching-your-tone-of-voice/#:~:text=Your%20tone%20of%20voice%20is,language%20through%20conversation%20with%20others. (Accessed: 08 December 2023).
          5. Ho, R.C. et al. (2015) An overview of mental health legislation in Singapore, BJPsych international. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618915/#:~:text=The%20Mental%20Health%20(Care%20and%20Treatment)%20Act%202008,-The%20Singapore%20Mental&text=Under%20the%20new%20Act%20(see,for%20up%20to%2072%20hours. (Accessed: 08 December 2023).
          6. Institute of Mental Health Homepage (no date) Institute of Mental Health. Available at: https://www.imh.com.sg/Pages/default.aspx (Accessed: 11 December 2023). 
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          • Exploring the Rising Concern of Teenage Depression in Singapore

          Exploring the Rising Concern of Teenage Depression in Singapore

          The rising rates of teenage depression in Singapore underscore the urgent need for early intervention and community support, with parents playing a crucial role in fostering open communication, recognizing symptoms, and seeking professional help when needed.

          Key takeaways

          • The prevalence of teenage depression in Singapore, highlighted by a recent NUS study, emphasizes the critical importance of early intervention and community support.
          • Academic pressures, societal expectations, and the impact of social media contribute to the rising rates of depression among Singaporean youths, creating a complex web of challenges.
          • Parents play a pivotal role in addressing youth depression by fostering open communication, building resilience, and taking immediate steps, such as seeking professional intervention, if they suspect their child is depressed.

          Posted on 8 Dec 2023

          Written by
          Dr Jared Ng, Connections MindHealth

          Teenage depression is not just a fleeting phase of adolescence; it’s a serious mental health issue that has been gaining increasing attention. A recent study by the National University of Singapore (NUS) has found that one in 10 teenagers in our nation suffers from at least one mental health disorder. This study, which surveyed over 3,300 adolescents, also revealed that a significant number of youths are turning to digital media as a form of self-therapy. Additionally, the study highlighted a crucial need for improved mental health literacy among parents and these findings add urgency to the issue of teenage depression. This article aims to delve into the complexities of teenage depression in Singapore, emphasizing the critical importance of early intervention and community support.

          Differentiating Normal Stress from Depressive Disorders

          Navigating a new environment, grappling with the pressure to forge new friendships while possibly parting ways with old ones, and adapting to new teachers and academic challenges can all contribute to feelings of stress and anxiety among teenagers. Normal stress often arises from these specific situations and usually subsides as the child adjusts to the new setting. Symptoms like temporary mood swings, mild sleep disturbances, or short-term changes in appetite are often related to these transitional challenges and should not immediately be a cause for alarm.

          In contrast, symptoms of depressive disorders are more pervasive and persistent, affecting multiple areas of life for an extended period, often for more than two weeks. These may include sustained changes in eating and sleeping patterns, withdrawal from friends and activities, and a decline in academic performance. Unlike normal stress, depressive symptoms often lack a specific trigger and may be accompanied by feelings of worthlessness, excessive guilt, or thoughts of self-harm or suicide

          Why Depression is on the Rise Among Youths in Singapore

          The increasing prevalence of depression among Singapore’s youth is a multi-faceted issue with a range of contributing factors. One of the most significant is the intense academic pressure, often exacerbated by high societal expectations. Interestingly, this pressure is not solely external; many youths internalize these expectations, placing immense pressure on themselves to meet high academic standards, even when parents and teachers may not explicitly demand it.

          The role of social media is another crucial factor. While it offers a platform for connection and self-expression, it also has a darker side. The constant exposure to curated lives can lead to unhealthy comparisons, affecting self-esteem and body image. Cyberbullying is another significant concern, with the anonymity of the internet providing a shield for harmful behavior. The emotional toll from cyberbullying can be severe, leading to feelings of isolation, anxiety, and depression.

          Additionally, the fast-paced lifestyle and competitive nature of Singaporean society can contribute to emotional distress. The constant race to “keep up” can lead to burnout and feelings of inadequacy, further fuelling the cycle of depression.

          The Role of Parents in Addressing Teenage Depression in Singapore

          Understanding the root causes of depression is one of the first steps parents can take in offering effective support to their children. Open communication is crucial; a strong parent-child relationship can encourage your child to share their feelings and concerns openly. This open dialogue can serve as an early warning system, helping to identify symptoms of depression before they escalate.

          Mother smiling at son

          It’s important for parents to recognize that adolescence is a time of individualization and identity formation. Behind the symptoms and behavioral issues is a teenager trying to find his or her own place in the world. This process can be emotionally taxing and may lead to internal conflicts that the teenager might not readily share, especially if the parent-child relationship has not been strong.

          Parents also have a role in building resilience in their children. Activities that encourage problem solving, a positive home environment, and emotional support can all contribute to resilience. The recent NUS study emphasized that higher resilience scores were associated with better mental health, underlining the importance of emotional support and resilience-building activities. Moreover, parents should be aware that their children may not always be forthcoming about their struggles, particularly if the parent-child relationship has been strained. This makes it even more essential to foster a supportive and open environment where the child feels safe to share their feelings without fear of judgment or repercussions.

          The Importance of Early Intervention for Teenage Depression in Singapore

          Early intervention is key in managing and treating depressive symptoms in youths. The sooner the symptoms are recognized and addressed, the better the chances of preventing the escalation of the condition into more severe mental health issues. Untreated depression can lead to a host of negative outcomes, including academic decline, social withdrawal, and worsening emotional well-being.

          Most critically, untreated depressive illnesses significantly increase the risk of self- harm and suicide. According to various studies, adolescents with depressive disorders are more likely to engage in self-destructive behaviors, including self-harm and suicidal ideation. Early intervention can be a life-saving measure, providing the necessary medical and psychological support to manage these severe symptoms effectively.

          By acting early, parents, healthcare providers, and educators can work together to develop a comprehensive treatment plan that addresses the child’s unique needs. This collaborative approach not only helps in treating the immediate symptoms but also equips the child (and family) with coping mechanisms and resilience skills that will benefit them in the long term.

          Immediate Steps Parents Can Take If They Suspect Their Child is Depressed

          If parents notice or suspect that their child is exhibiting symptoms of depression, immediate action is essential. The first step is to have an open and non-judgmental conversation with the child. It’s crucial to approach this dialogue with sensitivity, ensuring that the child feels safe and supported in sharing their feelings.

          If the symptoms persist or worsen, professional intervention becomes necessary. Consulting a healthcare provider for a comprehensive evaluation can provide a clearer picture of the child’s mental health status. Depending on the severity of the symptoms, treatment options may include psychological therapy, medication, or a combination of both.

          It’s also important to engage with the school as part of the intervention process. Every school in Singapore has trained counsellors who can offer additional support and resources. Open communication with schoolteachers is equally vital; they can provide another perspective and may have more insights into the child’s stressors and triggers, especially if academic performance is declining or if there are concerns about the child’s social interactions.

          Moreover, parents can seek out support groups or educational resources to better understand how to manage and cope with their child’s condition. Knowledge is power, and the more parents understand about depression, the better equipped they will be to support their child effectively.

          Caring for the Parents

          While much focus is given to the well-being of the child, it’s crucial not to overlook the emotional and mental health of the parents. Parenting a child with depression can be an emotionally taxing experience, often leading to feelings of helplessness and guilt. Remember, you’re not alone, and it’s okay to seek help for yourself. Support groups, counselling, and even talking openly with friends and family can offer much-needed emotional relief. Taking care of yourself is not an act of selfishness; it’s a necessity. When you are emotionally healthy, you’re better equipped to provide the support your child needs.

          Conclusion

          The rising rates of mental health disorders among Singapore’s youth are a pressing concern that calls for immediate action from parents, educators, and healthcare providers. Parents play a crucial role in early detection and intervention, but it’s important to remember that help is always available, especially when the emotional toll becomes overwhelming.

          Schools offer additional support through trained counsellors, and healthcare providers can provide professional treatment options. Early intervention is key, as untreated depression can lead to severe consequences, including self-harm and suicide. Together, we can create a supportive environment to address this growing issue effectively.