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Li Bihui / Guest Writer
“Unlike some foreign newspapers, the media here in Singapore has not gone for aggressive journalism; they have not gone for aggressive campaigning. They have taken the position that they will investigate thoroughly before they publish.” – Lui Tuck Yew, Acting Minister for Information, Communication and Arts
Recently, Health Minister Khaw Boon Wan replied to a question in parliament about the rates of mental illness in Singapore compared to other countries, and he said:
“The most recent global survey was made by the World Health Organisation (WHO) in 2004. WHO classified mental illnesses under two broad groupings: anxiety disorders, such as generalised anxiety, phobias, obsessive-compulsive disorder, panic disorder; and mood disorders, such as bipolar disorder and depression."
"Based on this WHO study, the prevalence in Singapore is generally lower or comparable to other developed countries. For example, the rates for anxiety were 18.2% in the United States, 12% in France, 5.3% in Japan, and 3.4% in Singapore. As for depression, the prevalence rates were 9.6% in the US, 8.5% in France, 5.6% in Singapore, and 3.1% in Japan.”
The WHO survey mentioned by Mr Khaw in his reply to parliament is actually the World Mental Health Survey (WMHS) 2004. Although Mr Khaw cited this survey in parliament in comparing the prevalence of mental illness in Singapore with other countries, surprisingly, Singapore is not one of the countries mentioned in the WHO WMHS. When queried on this, Ministry of Health replied that while the figures for other countries were indeed from the WMHS 2004, the figures for Singapore were from a study conducted by the IMH.
With the fact being that WMHS says nothing about the prevalence of mental illness in Singapore relative to other developed countries, the question remains, “did the Health Minister mislead parliament into thinking that all the figures cited, where from the survey?”
What makes it worse is that mainstream media (MSM) like Channel News Asia and The Straits Times did not bother to check the sources for the Health Minister’s figures. They simply repeated the press release almost verbatim. Is this what the Minister for Information, Communication and Arts meant when he said that the MSM "will investigate thoroughly before they publish"?
The question of honesty aside, the value of comparing figures retrieved from different surveys is also highly questionable. The central World Mental Health staff put many protocols in place to ensure that results from the survey could in fact be compared cross-nationally. They trained bilingual supervisors in each country. Consistent interviewer training documents and procedures are used across surveys. The WHO translation protocol was used to translate instruments and training materials.
Standardised descriptions of the goals and procedures of the study, data uses and protection and the rights of respondents were provided in both written and verbal form to all pre-designated respondents before obtaining verbal informed consent for participation in the survey. Quality control protocols were standardised across countries to check on interviewer accuracy and to specify data cleaning and coding procedures.
Did the IMH survey place the same protocols in its own survey? Were the questions in the survey consistent with those in WMHS? Were the supervisors and interviewers sufficiently trained? Did the population sample picked by IMH differ from the population sample of WMHS? What quality controls were used in IMH’s survey?
Such protocols are essential to ensure that any differences that are found between countries in the survey are not mere artefacts of the different ways in which the survey was carried out, and its data evaluated, in each country. By comparing IMH's findings directly to the WHO's findings, MOH is ignoring the vast amount of care put in by WHO in trying to eliminate such artefacts.
The conclusion that MOH draws about Singapore's supposedly lower prevalence of mental illness could be completely unwarranted measured by standard scientific procedures and survey protocols.
Bihui is a postgraduate student in the history and philosophy of science. She likes sources of information to be clearly cited and credited.