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The wide mental health treatment gap continues to pose a global and local public health challenge. Online support groups are on the rise and could be used to complement formal treatment services for mental health.
This study aimed to examine the prevalence of online support group use and explore factors associated with the use in the general population using data from a national cross-sectional mental health survey in Singapore.
Singapore residents aged 18 years and above participated in a nationally representative household survey in which the World Health Organization Composite International Diagnostic Interview 3.0 was administered by trained interviewers to examine the use of online support groups for mental health. Multiple logistic regressions were used to analyze the association of online support group use with various sociodemographic and health factors.
A total of 6110 respondents with complete data were included in this study. Overall, 10 individuals per 1000 adults (1%) reported seeking help from online support groups for their mental health problems. Compared to younger adults (those aged 18 to 34 years) and those with university education, individuals aged 50 to 64 years (
Online support groups could be used to complement formal treatment services, especially for mood and anxiety-related disorders. As online support group use for mental health issues may be more prevalent among younger people, early detection and accurate information in online support groups may guide individuals toward seeking professional help for their mental health problems.
The internet is increasingly recognized as a valuable self-help resource for individuals. Online support groups in the form of web-based forums, discussion boards, and chat rooms are fast emerging as a popular and accessible means to provide individuals the opportunity to reach out to peers without geographical restrictions, share personal health experiences, and receive emotional support for mental health issues [
Singapore has a resident population of just over 5.6 million people. The literacy rate of Singapore’s population is 97.3%. Overall, 84% of the population (4.83 million people) are internet users, and over 4.4 million are active on social media, discussion forums, and various other internet communication tools [
Data for this study were obtained from the Singapore Mental Health Study (SMHS) 2016, a population-based cross-sectional epidemiological survey of noninstitutionalized respondents aged 18 years and above, primarily conducted to establish lifetime and 12-month prevalence of mental disorders, as well as the current use of mental health services. Of the 6126 survey respondents, this study uses data drawn from a subsample of 6110 subjects who responded to a question regarding the use of online support groups for mental health. The study was conducted from 2016 to 2018, and achieved a response rate of 69.5% among eligible adults. The sampling frame was based on a national administrative database of all citizens and permanent residents of Singapore. A probability random sample was selected using a disproportionate stratified sampling design of 16 strata defined with respect to ethnicity (Chinese, Malay, Indian, Others) and age groups (18 to 34, 35 to 49, 50 to 64, and ≥65 years). Older adults (≥65 years) and ethnic minority groups (Malays and Indians) were oversampled to ensure sufficient sample size to improve the reliability of estimates for subgroup analysis.
A printed invitation letter was sent to each subject, followed by a household visit to obtain their agreement to participate in the survey. Trained interviewers from a survey research company conducted face-to-face interviews with the respondents who agreed to participate in the study. Respondents were asked to choose their preferred language (questionnaires were available in English, Chinese, and Malay) before the interviewer initiated any study-related procedures. Residents who were living outside of Singapore, institutionalized, or hospitalized at the time of the survey, those who were not contactable due to an incomplete or incorrect address, and those who were unable to complete the interview in one of the specified languages (English, Chinese, or Malay) were excluded from the survey. The SMHS 2016 study methodology has been reported in much greater detail elsewhere [
The study was approved by the relevant institutional ethics committee, the National Healthcare Group Domain Specific Review Board. All participants provided written informed consent. For those aged <21 years, written informed consent was also obtained from their parent or legally acceptable representative.
A standardized computer-assisted version of the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) [
For each mental disorder, a screening section was administered to all respondents. All participants answering positively to a specific screening question were then referred to the respective diagnostic section of the questionnaire. Given practical survey limitations of time and burden on the participant, only selected modules from the CIDI were included based on input from a stakeholder board. This board included representatives from various stakeholders (Ministry of Health, voluntary organizations working with mentally ill clients, clinicians, sociologists, and representatives from the major ethnic groups in Singapore) who advised the study team on the modules considered locally relevant [
A range of chronic physical conditions were reported by participants on the modified version of the CIDI chronic conditions checklist. The physical conditions included on the checklist were based on their prevalence in Singapore as per local statistics. Participants were asked if they had been clinically diagnosed with the following list of health conditions: hypertension, hyperlipidemia, diabetes, asthma, arthritis or rheumatism, back problems (of disc or spine), migraine headaches, stroke or major paralysis; heart disease including heart attack, coronary heart disease, angina, or congestive heart failure; chronic inflamed bowel problems (eg, stomach ulcer, enteritis, or colitis), neurological disorders (epilepsy, convulsions, and Parkinson disease), thyroid diseases, kidney failure, chronic lung diseases (chronic bronchitis or emphysema), and cancer.
Sociodemographic data collected from participants included age, gender, ethnicity, income, education, marital status, and employment status.
To ensure that findings would be nationally representative, sample estimates were weighted to account for oversampling and nonresponse, and were poststratified for age group and ethnic distributions between the study sample and the Singapore resident population in 2014. Descriptive statistics were performed to describe the sociodemographic profile of the study population. Binary logistic regressions were performed where the outcome variable (use of online support groups) was treated as binary (Yes=1, No=0) and the mental health predictors were similarly treated as binary variables (Yes=1, No=0), where the values (1 or 0) indicated the presence or absence of the condition based on the DSM-IV criteria for the disorder. Multiple logistic regressions were then used to investigate the associations between the outcome (use of online support groups) and each sociodemographic and health condition as an independent variable, controlling for the presence of all other sociodemographic differences in gender, age, ethnicity, marital status, education, employment, and income. The estimates obtained from the analyses were adjusted odds ratios (OR) and statistical significance was established at
The sociodemographic and clinical characteristics of the sample (n=6110) are presented in
Of the 53 respondents who used online support groups, weighted estimates show that 56.9% (n=29) were female, 76.1% (n=17) were of Chinese ethnicity, 79.4% (n=40) were never married, 70.6% (n=36) were employed, and 82.2% (n=45) were aged 18 to 34 years. In total, 58.2% (n=25) of the online support group users were represented by those with mental illness (
In
Sociodemographic and clinical correlates of online support group users.
Parameters | ORa | 95% CI | ||
|
||||
|
18-34 | Reference | N/Ab | N/A |
|
35-49 | 0.5 | 0.1-1.7 | .25 |
|
50-64 | 0.1 | 0.0-0.3 | <.001 |
|
≥65c | —d | — | — |
|
||||
|
Female | Reference | N/A | N/A |
|
Male | 0.5 | 0.2-1.2 | .11 |
|
||||
|
Chinese | Reference | N/A | N/A |
|
Malay | 0.9 | 0.4-2.1 | .80 |
|
Indian | 0.8 | 0.4-1.8 | .56 |
|
Other | 1.1 | 0.4-3.5 | .83 |
|
||||
|
Married | Reference | N/A | N/A |
|
Never married | 2.6 | 0.9-7.7 | .09 |
|
Divorced or separated | 0.6 | 0.1-3.8 | .62 |
|
Widowedc | — | — | — |
|
||||
|
University | Reference | N/A | N/A |
|
Primary and belowc | — | — | — |
|
Secondary | 0.4 | 0.1-1.9 | .26 |
|
Preuniversity/junior college | 0.1 | 0.0-0.8 | .02 |
|
Vocational institute/Institute of Technical Education | 0.7 | 0.2-2.5 | .56 |
|
Diploma | 0.7 | 0.2-2.2 | .57 |
|
||||
|
Employed | Reference | N/A | N/A |
|
Economically inactivee | 1.2 | 0.4-3.2 | .74 |
|
Unemployed | 2.0 | 0.6-6.9 | .28 |
|
||||
|
<2000 | Reference | N/A | N/A |
|
2000-3999 | 1.5 | 0.4-6.0 | .60 |
|
4000-5999 | 1.3 | 0.3-5.0 | .73 |
|
6000-9999 | 0.6 | 0.1-2.5 | .44 |
|
≥10,000 | 0.9 | 0.2-5.0 | .91 |
|
||||
|
No | Reference | N/A | N/A |
|
Yes | 6.8 | 3.0-15.4 | <.001 |
aThe odds ratio was derived using multiple logistic regressions after controlling for sociodemographic variables.
bN/A: not applicable.
cDue to a lower number of cases, the regression coefficient was not estimated.
dNot available.
eThis group includes homemakers, students, and retirees/pensioners.
fSGD: Singapore Dollar.
gThe participant has at least one of the mental disorders assessed by the Composite International Diagnostic Interview.
Association of mental disorders and online support group use in the population.
Mental disorder | ORa | 95% CI | |
Major depressive disorder | 5.4 | 2.1-13.8 | <.001 |
Dysthymia | 0.4 | 0.0-4.8 | .46 |
Bipolar disorder | 2.7 | 0.5-13.9 | .23 |
Generalized anxiety disorder | 3.6 | 0.9-14.1 | .06 |
Obsessive compulsive disorder | 3.5 | 1.3-9.7 | .01 |
Alcohol abuse | 2.7 | 0.1-12.5 | .13 |
Alcohol dependence | 0.9 | 0.0-0.1 | .92 |
aThe odds ratio was derived using multiple logistic regressions after controlling for sociodemographic variables.
Additionally,
Sociodemographic and clinical correlates of online support group use among those with any mental disorder.
Demographics | ORa | 95% CI | ||
|
||||
|
18-34 | Reference | N/Ab | N/A |
|
35-49 | 0.5 | 0.1-3.6 | .53 |
|
50-64 | 0.02 | 0.0-0.4 | .01 |
|
≥65c | —d | — | — |
|
||||
|
Female | Reference | N/A | N/A |
|
Male | 0.3 | 0.1-0.8 | .02 |
|
||||
|
Chinese | Reference | N/A | N/A |
|
Malay | 0.2 | 0.0-0.8 | .03 |
|
Indian | 0.4 | 0.1-1.4 | .17 |
|
Other | 0.8 | 0.2-4.3 | .81 |
|
||||
|
Married | Reference | N/A | N/A |
|
Never married | 4.4 | 0.7-28.0 | .11 |
|
Divorced or separated | 1.1 | 0.1-11.6 | .95 |
|
Widowedc | — | — | — |
|
||||
|
University | Reference | N/A | N/A |
|
Primary and belowc | — | — | — |
|
Secondary | 0.7 | 0.1-5.5 | .74 |
|
Preuniversity/junior college | — | — | — |
|
Vocational institute/Institute of Technical Education | 0.9 | 0.1-5.7 | .88 |
|
Diploma | 0.5 | 0.1-3.2 | .48 |
|
||||
|
Employed | Reference | N/A | N/A |
|
Economically inactivee | 1.4 | 0.4-5.1 | .62 |
|
Unemployed | 6.2 | 1.3-28.2 | .02 |
|
||||
|
<2000 | Reference | N/A | N/A |
|
2000-3999 | 0.7 | 0.1-4.1 | .70 |
|
4000-5999 | 1.2 | 0.2-6.3 | .85 |
|
6000-9999 | 0.5 | 0.1-3.5 | .47 |
|
≥10,000 | 0.8 | 0.1-8.3 | .82 |
|
||||
|
No | Reference | N/A | N/A |
|
Yes | 3.4 | 1.1-10.7 | .04 |
aThe odds ratio was derived using multiple logistic regressions after controlling for significant sociodemographic correlates.
bN/A: not applicable.
cDue to a lower number of cases, the regression coefficient was not estimated.
dNot available.
eThis group includes homemakers, students, and retirees/pensioners.
fSGD: Singapore dollar.
gThe participant has at least one of the chronic conditions on the checklist assessed by the Composite International Diagnostic Interview.
Association of online support group use and type of mental disorder in the psychiatric population.
Mental disorder | ORa | 95% CI | |
Major depressive disorder | 4.3 | 2.1-13.8 | <.001 |
Dysthymia | 0.3 | 0.0-4.8 | .32 |
Bipolar disorder | 4.0 | 0.5-13.9 | .06 |
Generalized anxiety disorder | 3.0 | 0.9-14.1 | .16 |
Obsessive compulsive disorder | 4.1 | 1.3-9.7 | .002 |
Alcohol abuse | 1.7 | 0.1-12.5 | .33 |
Alcohol dependence | 0.6 | 0.0-0.1 | .68 |
aThe odds ratio was derived using multiple logistic regressions after controlling for significant sociodemographic correlates.
This study analyzed data from a national cross-sectional mental health survey to examine the prevalence of online support group participation (ie, internet support groups or chat rooms) for mental health, and the sociodemographic and health status factors associated with those who were more likely to engage in these activities. Of the 6110 survey participants, an estimated 10 individuals per 1000 adults (1%) had sought help from an online support group for their mental health problems, and individuals who were aged 18 to 34 years or who had a university education were more likely to use online support groups for mental health. Additionally, this study found that a substantial proportion (58.2%) of those using an online support group had met the criteria for a DSM-IV mental disorder. Among those with mental disorders, individuals with MDD and OCD had the highest rates of online support group participation.
Comparable to other developed countries, more than 80% of the population in Singapore is internet savvy [
In earlier research, younger individuals and those with tertiary educational qualifications [
Additionally, this study found that a substantial proportion (58.2%) of those using an online support group had a diagnosable DSM-IV mental disorder. Griffiths and colleagues [
A key strength of this study is that it fills an important gap in the extant literature and is among the first to report extensively on nationally representative population data in Singapore. To the best of our knowledge, this study is the first to examine the prevalence and correlates of online support group use for mental health support among the general public in a non-Western society. However, the findings of this study must be considered in view of its limitations. Despite the use of a relatively large population-based survey for analysis, the sample size of those who had used an online support group was rather small. The low rate of online support group participation reported may have been a result of the survey methodology. In this study, participants were asked about their use of internet support groups or chat rooms; however, people may have accessed web forums, mailing lists, or e-blogs to provide or receive online social support or to share mental health experiences. Hence, individuals may not have identified this variety of web communication applications as characteristic of an “internet support group or chat room.” Therefore, the true prevalence of online support group use may have been underestimated. In addition, there are new and emerging online peer groups on social networking sites (eg, Twitter, Facebook), which allow users to exchange information or seek emotional support from peers with similar health issues [
Technology is constantly advancing and the use of technology is changing quickly. Health care delivery systems are beginning to integrate the use of electronic Health (eHealth) and internet tools. In the United Kingdom, United States, Europe, Australia, and New Zealand, mental health services such as online support groups are currently being integrated into the health care delivery system [
Sample characteristics of study participants and the use of online support groups across sociodemographic groups.
Clinical characteristics of study participants and the use of online support groups.
Online support group utilization among those with a DSM-IV mental disorder.
Composite International Diagnostic Interview version 3.0
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
generalized anxiety disorder
major depressive disorder
obsessive compulsive disorder
Singapore Mental Health Study
This study was funded by the Ministry of Health, Singapore and the Temasek Foundation. The funding sources had no role in the study design or the collection, analysis, and interpretation of data.
None declared.