Beliefs About Outcomes for Mental Disorders: A Comparative Study of Primary Health Practitioners and Psychiatrists in Singapore

JHK Kua, G Parker, C Lee, AF Jorm
Correspondence: Dr J H K Kua

ABSTRACT
Objectives To compare responses to a mental health literacy survey assessing the likely outcome of three major mental disorders by primary health practitioners (OPD doctors and GPs) and by psychiatrists in Singapore.
Methods We used two vignettes of Major Depression and Schizophrenia developed in an Australian study. In addition, a third vignette of Mania was developed locally and included. The respondents were required to choose one of the set of prognostic options if the patients received or did not receive professional help, to rate the likely impact of the disorder, and to assess the likelihood of the patient being discriminated against. Psychiatrists' responses were obtained by surveying staff at Woodbridge Hospital, while the primary health practitioners were required to respond to a postal survey.
Results The response rate for the psychiatrists was 70% (69/99), while the Primary health practitioners had an overall response rate of 38% (264/691). The response from OPDs being 51% (77/151) and that of the GPs being 35% (189/540). There was evidence of disorder specificity, with schizophrenia judged as having the worst outcome and depression the best outcome in response to treatment. There was also evidence of group specificity, with the psychiatrists most optimistic and the OPD doctors least optimistic about the outcome following professional intervention. The majority of both the primary health practitioners and the psychiatrists judged that patients would be discriminated against, more so for schizophrenia and mania than for depression. Compared to the OPD doctors, a lower percentage of GPs felt that the patients would be discriminated against.
Conclusion Primary health practitioners in Singapore hold more negative views than Singapore psychiatrists about the outcome of professional intervention for three major psychiatric disorders. This finding has implications for education and training for primary health practitioners as well as for treatment of psychiatric patients in the primary health setting.

Keywords: primary health practitioners, psychiatrists, mental health literacy, outcome, discrimination
Singapore Med J 2000; 41(11): 542-547