International Journal of Nursing Practice 2001; 7: 414 –421

✠ R E S E A R C H PA P E R ✠

Mental health literacy survey of psychiatrically

and generally trained nurses employed in a
Singapore psychiatric hospital
Soo Gim Yeo SRN, RMN, BHSc (Nurs)
Assistant Nursing Director,Woodbridge Hospital, Singapore

Gordon Parker MD, PhD, DSc, FRANCP

Head, School of Psychiatry, University of New South Wales, Sydney, Australia

Rathi Mahendran MBBS, MMed (Psychiatry) DPM, FAMS

Chief, Department of Academic Psychiatry,Woodbridge Hospital, Singapore

Anthony F Jorm PhD, DSc

Professor, Centre for Mental Health Research, Australia National University, Canberra, Australia

Hwa Ling Yap MBBS, FAMS, MMed (Psychiatry)

Consultant,Woodbridge Hospital, Singapore

Cheng Lee MBBS, FAMS, MMed (Psychiatry)

Registrar,Woodbridge Hospital, Singapore

Min Ing Loh BSc (Hons)

Research Assistant, Institute of Mental Health, Singapore

Accepted for publication February 2001

Yeo SG, Parker G, Mahendran R, Jorm AF, Yap HL, Lee C, Loh MI. International Journal of Nursing Practice
2001; 7: 414 –421
Mental health literacy survey of psychiatrically and generally trained nurses employed in a Singapore
psychiatric hospital

Mental health literacy studies consider the capacity of respondents to recognize certain psychiatric disorders, judge the
comparative utility of a range of interventions, and make estimates about outcome and prognostic issues.We report such
a study involving a sample of nursing staff employed at a large psychiatric institution in Singapore, and who were pro-
vided with separate brief vignettes of mania, schizophrenia and depression. Subjects were highly accurate in ‘diagnosing’

Correspondence: Madam SG Yeo, Institute of Mental Health 10 Buangkok View, Singapore 539747, Republic of Singapore.
Email: soo– gim– yeo@imh.com.sg
Mental health literacy survey 415

schizophrenia, less accurate for depression and even less accurate in diagnosing mania. Depression was alternately diag-
nosed as stress, mania was most commonly misdiagnosed as schizophrenia, and for both psychotic conditions, a percent-
age returned non-psychotic diagnoses. In terms of treatment options, staff distinctly favoured a ‘medical model’ and viewed
traditional and alternative healing options as distinctly harmful. Analyses contrasted psychiatrically trained and generally
trained nurses, but identified few significant differences. Such information has the potential to shape the education and
training of mental health professional staff, as well as provide important insights about how nurses may diagnose, view
and favour alternative treatments and strategies to assist those with common psychiatric disorders.
Key words: depression, diagnosis, mania, schizophrenia, therapy.

INTRODUCTION We elected to undertake a mental health survey in

The term ‘mental health literacy’ has been defined by
Jorm et al. as the knowledge and beliefs about mental dis-
orders that aid their recognition, management or preven-
tion.1 According to those authors, mental health includes:
. . . the ability to recognize specific disorders, knowledge of how to
seek mental health information,knowledge of risk factors and causes,
knowledge of self-treatments and of professional help available,
and attitudes that promote recognition and appropriate
help-seeking.
Jorm et al.1,2 initiated a number of surveys in Australia,
one involving a national household sample of more than
2000 adults, and another focusing on professional staff
(general practitioners, psychiatrists and clinical psycholo-
gists). Each survey strategy involved providing a vignette
of a person with either depression or schizophrenia to
the respondent, with each vignette meeting ICD-10 and
DSM-IV criteria. Analyses examined the extent to which
a correct ‘diagnosis’ was generated by respondents, judge-
ments of a range of services, medications, activities and
therapies as likely to be helpful, the judged impact of
the illness, the likelihood of the individual being discrimi-
nated against, and ratings of the illness prognosis with
and without professional assistance. The benefits of such
surveys are that they establish the likelihood of mental
health disorders being correctly identified across varying
samples, as well as generating information on the com-
parative helpfulness of a range of interventions and prog-
nostic views across these samples.They might also uncover
counter-intuitive beliefs that might have management and
other implications. For example, one report identified that
the general public was more likely to view antidepressant
medication as harmful rather than helpful for depression,
while a range of non-standard treatments, such as vitamins
and minerals, were often rated as helpful.3
Singapore of professional staff in the national psychiatric
hospital (Woodbridge Hospital). The survey builds on
the methodology developed by Jorm et al, includes an
additional diagnostic vignette and a range of traditional
health resources and treatments available in Singapore.3
We studied psychiatrists, allied health staff and nursing
staff, and have reported on overall group differences in an
initial report.4 In this study, we focused on the shared and
differing views of two professional groups of registered
nurses (RNs), psychiatric-trained and general-trained
nurses, an approach that provides some estimate of the
impact of specialist psychiatric training on the mental
health literacy of nursing staff.
SUBJECTS AND METHODS
The subjects were 261 nurses who were working in the
inpatient units of a psychiatric hospital (Woodbridge).The
nursing staff at the hospital comprise three principal cat-
egories, enrolled nurses (ENs) who have received 2 years
basic general nursing training only, general-trained nurses
(GTNs), and psychiatric-trained nurses (PTNs) that have
received 1 year advanced psychiatric training in addi-
tion to their 3 years general nursing. We studied PTNs
(n = 150) and GTNs (n = 111).
Vignettes of major depression, schizophrenia and mania
were provided, with the first two presenting the same
clinical information as provided by Jorm et al. and with
all three detailed verbatim in our overview report.1 In
essence, the depression vignette was of a 30-year-old man
(Mr A) who had been sad and miserable for several weeks.
While constantly tired, he had insomnia. In addition, he
had lost appetite and weight, had poor concentration and
was indecisive, and his lowered productivity was brought
to the attention of his employer.
416
The schizophrenia vignette described a 24-year-old
man (Mr A) who lived with his parents and had become
unemployed. In the preceding 6 months, he had ceased
socializing, would lock himself in the bathroom and
refused to eat with his family or have a bath. At night, he
would walk about his bedroom, and when known to be
alone, he had been heard to argue and shout at someone
he believed to be present. He stated that he was being
spied on by neighbours and, as a consequence, would not
leave the house.
The vignette of mania described a 27-year-old man (Mr
A) who lived with his parents. He had recently lost his job.
For the preceding 3 weeks, he had been overactive,
overtalkative, disinhibited, irritable, was not tired despite
little sleep and claimed to have invented a machine that
would cure cancer. Illicit drug-taking was ruled out as a
cause of the symptoms in both the latter two vignettes.
The nurses received only one of the three vignettes
on a random basis and also completed some demographic
details. They were required to choose from a set of
standard diagnostic options: stress, depression, schizo-
phrenia/paranoid schizophrenia, mania, anxiety, physical
weakness, mental weakness, being possessed and ‘other’.
‘Nothing’ and ‘don’t know’ categories were also included.
Respondents were then required to rate which of these 11
options might ‘best help’ Mr A. Attending a polyclinic,
a psychologist, a church minister and a traditional healer
are four options added to the seven facilities listed in
the Australian study. Respondents were required to rate
the extent to which 16 types of professional and non-
professional health intervention and 17 treatments, and
resources that might be ‘helpful’, ‘harmful’ or ‘neither’
(with additional ‘depends’ and ‘don’t know’ categories
included) to rate whether or not they thought Mr A
would be discriminated against in the community, and
to judge his chance of recovery if receiving or not receiv-
ing professional assistance. For the latter, options were
‘full recovery without further problems’, ‘full recovery
with probable recurrence’, ‘partial recovery’, ‘partial
recovery with recurrence’,‘no improvement’,‘get worse’
and ‘don’t know’. Finally, respondents were requested to
rate the chance of certain outcomes in the long term, that
is: (i) violence; (ii) excessive alcohol; (iii) taking illicit
drugs; (iv) having poor relationships; (v) attempting
suicide; (vi) being understanding of others’ feelings;
(vii) have a good marriage; (viii) being a caring parent;
(ix) being a productive worker; and (x) being creative or
artistic.
S.G.Yeo et al.
Questionnaires were completed anonymously and
returned via a postal box to the investigators, without any
reminders for non-responders.
RESULTS
Response rates were high for both the GTNs (102/111 or
92%) and the PTNs (128/150 or 85%).The total number
of questionnaires returned for the depression, schizo-
phrenia and mania vignettes were 33–35 for the GTNs
and 38–46 for the PTNs. There was a female preponder-
ance in respondents, distinct for the GTNs (i.e 85%) and
slight for the PTNs (53%). Age, assessed ordinally across
five categories, identified the GTNs as younger (c2 = 33.9,
d.f. 4, P < 0.001).
We first consider the accuracy of the diagnoses nomi-
nated by the nurses in response to the vignettes. The
depression vignette was correctly identified by 82% of the
PTNs and 72% of the GTNs, the schizophrenia vignette
was correctly identified by 91% of PTNs and 87% of
GTNs, and the mania vignette by 70% of PTNs and 69%
or GTNs. Thus, overall ‘diagnostic success’ was virtually
identical for the PTNs and GTNs. Erroneous diagnoses
varied. A diagnosis of stress dominated for the depression
vignette, 15% from the PTNs and 25% from GTNs. For
the schizophrenia vignette, 7% of the PTNs nominated
depression and 2% an ‘other’ diagnosis while stress,
depression, mental weakness and anxiety were each
nominated by 3% of the GTNs. For the mania vignette,
11% of the PTNs and 16% of the GTNs nominated a
schizophrenia diagnosis with small percentages (2–6%)
nominating stress, depression and anxiety. Figure 1
reports the ‘best help’ option chosen by the nursing staff.
Both for schizophrenia and mania, consulting a psychia-
trist was the first preference with problem recognition (or
insight) being the next, and with the PTNs being some-
what more likely to recommend the first option. For
depression, rather equal rates are evident for talking
things over with family or friends, insight and seeing a psy-
chiatrist. No differences are evident between the PTNs
and GTNs. Low rates were generated for consulting a
family doctor to all three vignettes, and there was little
support for any of the other nominated options.
Tables 1 and 2 examine the likely helpfulness of a range
of professional and non-professional help, medications,
activities and therapies between the PTNs and GTNs, and
reflect ratings of 3 = ‘helpful’, 2 = both ‘neither helpful
nor harmful’ and ‘depends’, and 1 = ‘harmful’. Statistical
significance was tested by use of the Mann–Whitney
Mental health literacy survey
90
80
70
60
50
Percentage
40
30
20
10
0
Talk things over
Figure 1. Prevalence of the first option
nominated by nurses as being most likely
Depression PTN
to help Mr A.
U-test. Several differing patterns were noted. For
example, a psychiatrist was generally rated as likely to be
helpful for all three types of disorders (90%, 95% and
95% for depression, schizophrenia and mania, respec-
tively). By contrast, consistency in judging treatments
least likely to be helpful was evident in reference to rating
traditional healers, with the overall percentage helpfulness
rates of 0% to 1%. Antidepressant medication was rated
highly likely to be helpful for depression by 82% of the
respondents, less so for schizophrenia (57%) and unlikely
to be as helpful for mania (18%). Antipsychotic medica-
tion was much more likely to be rated as helpful for
schizophrenia and mania by 89% and 73% of respondents,
respectively, than for depression (28%).
Such data allow a ‘utility map’ of nurses’ judgements to
be drawn up for each vignette. For those with schizo-
phrenia, a psychiatrist was viewed as likely to be the most
helpful resource, but psychologists, other doctors, coun-
sellors, social workers as well as family and friends
received distinctive likely helpfulness ratings whereas very
low likelihood of helpfulness ratings were returned for tra-
ditional healers. Responses to helpfulness of medications
indicated that those with schizophrenia were rated as likely
to obtain the greatest help from antipsychotic medication,
but modest likelihood of helpfulness rates were returned
for benzodiazepines, sleeping pills and antidepressants. In
terms of other therapeutic approaches and activities, being
417
Prevalence of best options for
depression, schizophrenia and mania
Recognise Consult family Consult Consult Consult
problem Dr psychologist Counsellor psychiatrist
Depression GTN Schizophrenia PTN Schizophrenia GTN Mania PTN Mania GTN
admitted to a psychiatric facility was rated as highly
likely to be helpful with modest ratings being returned
for reading about people with similar problems, ceasing
alcohol, relaxation therapy, psychotherapy and socializing.
The PTNs rated a psychiatric admission as likely to be
helpful than the GTNs, with respective mean scores 2.74
and 2.79 indicating high likelihood of helpfulness endorse-
ments for hospitalization. Electroconvolsive therapy failed
to demonstrate a differential helpfulness rating, with a
band of 21–32% helpfulness across the disorders.
The utility map for mania is rather similar with high
likelihood of helpfulness ratings for psychiatrists, general
practitioners or equivalent, psychologists, antipsychotic
medication, being admitted to a psychiatric hospital,
reading about those with similar problems, ceasing alcohol
and resting. Mood stabilizers, benzodiazepines and sleep-
ing tablets were rated as distinctly unlikely to be helpful.
For depression, the utility map indicated that psychia-
trists, doctors, psychologists and social workers were
being judged as highly likely to be helpful.The most like-
lihood of helpfulness ratings for several other resources
were also evident, such as counsellors, family members
and friends than generated for the other two conditions.
In terms of treatments, antidepressant medication, re-
laxation therapy and psychotherapy returned the highest
ratings, with hospitalization ratings as somewhat less likely
to be helpful than for the other two vignettes. In terms of
418 S.G.Yeo et al.

Table 1 Comparison of psychiatrically trained nurses’ (PTNs) and generally trained nurses’ (GTNs) ratings of differing resources and med-
ications for those with depression, schizophrenia and mania

Resources and medication Depression Schizophrenia Mania

PTN GTN PTN GTN PTN GTN
mean rating mean rating mean rating

Resources
Doctor 2.50 2.40 2.67 2.55 2.67 2.55
Polyclinic doctor 2.60 2.50 2.71 2.55 2.60 2.58
General practitioner 2.80 2.77 2.80 2.66 2.74 2.68
Pharmacist 1.83 2.07* 1.98 2.10 2.02 2.13
Chinese physician 1.78 1.78 1.59 1.43 1.53 1.59
Counsellor 2.88 2.97 2.49 2.68 2.55 2.65
Social worker 2.58 2.60 2.53 2.53 2.57 2.58
Counselling service 2.71 2.80 2.30 2.39 2.44 2.58
Traditional healer 1.61 1.44 1.39 1.38 1.44 1.33
Psychiatrist 2.93 2.93 2.98 2.91 3.00 2.90*
Psychologist 2.77 2.72 2.56 2.68 2.65 2.17
Close family members 2.80 2.74 2.47 2.63 2.58 2.61
Close friends 2.70 2.73 2.36 2.50 2.50 2.55
Chinese or Malay 1.49 1.54 1.39 1.28 1.33 1.43
medicine shop dispenser
Religious leader 2.38 2.31 2.00 2.16 2.12 2.06
Specialist doctor 2.19 2.10 2.11 2.19 2.13 2.17
Medications
Vitamins and minerals 2.28 2.40 2.02 2.28** 2.05 2.23
Tonics or herbal medicines 2.00 2.24 1.81 2.10* 1.82 2.00
Purging medicine 1.43 1.41 1.39 1.32 1.33 1.38
Antidepressants 2.80 2.84 1.80 1.93 2.39 2.72*
Antibiotics 1.65 1.83 1.50 1.58 1.44 1.55
Mood stabilizers 2.27 2.24 2.80 2.68 2.41 2.43
Sleeping pills 2.50 2.42 2.80 2.41** 2.67 2.55
Antipsychotic or major tranquillizers 2.03 2.17 2.70 2.66 2.93 2.83
Benzodiazepines 2.65 2.76 2.89 2.66** 2.88 2.67

* P < 0.05, ** P < 0.01. Mean rating: 1 = harmful, 2 = neutral, 3 = helpful.

strategies, reading about others with a similar problem
received a particularly high rating, while ceasing alcohol,
socializing, resting and taking a holiday received moder-
ately high likelihood of helpfulness ratings.
A percentage of respondents clearly judged that having
one of the mental disorders would be of some benefit in
the future, with (across the three vignettes) some
28%–43% nominating an increased chance of the indi-
vidual understanding the feelings of others, and increased
chances of 13%–28% for a good marriage, 13%–31% to
be a good parent, 21%–49% to be a productive worker,
and 11%–20% to be creative or artistic. On each of these
parameters, the chance was highest for those with depres-
sion and lowest for those with schizophrenia. The GTNs
Mental health literacy survey 419

Table 2 Comparison of psychiatrically trained nurses (PTNs) and generally trained nurses (GTNs) ratings of judged likely helpfulness of
differing strategies and other treatments for those with depression, schizophrenia and mania

Strategies and other treatment Depression Schizophrenia Mania

GTN PTN GTN PTN GTN PTN
mean rating mean rating mean rating

Becoming physically more active 2.41 2.55 1.84 2.00 2.18 2.66**
Reading about people with similar problems 2.85 2.74 2.49 2.59 2.73 2.68
Being kept at home 1.30 1.32 1.93 1.43** 1.19 1.20
Getting out and about more 2.65 2.63 1.79 2.27** 2.40 2.38
Attending courses on relaxation 2.83 2.84 2.30 2.50 2.67 2.61
Cutting out alcohol 2.58 2.40 2.35 2.42 2.58 2.45
Treatment from a traditional healer 1.61 1.69 1.59 1.62 1.39 1.55
Psychotherapy 2.74 2.77 2.16 2.66*** 2.60 2.73
Taking a holiday 2.54 2.73 1.86 2.22* 2.21 2.38
Hypnosis 1.94 2.12 2.03 2.11 2.05 2.04
Admitted to a psychiatric ward of a general hospital 2.38 2.60 2.79 2.40** 2.74 2.68
Admitted to a psychiatric hospital 2.15 2.30 2.74 2.50 2.82 2.80
ECT 2.00 2.03 2.30 2.07 2.34 2.14
Having a rest 2.62 2.73 2.52 2.58 2.37 2.39
Occasional alcoholic drink to relax 1.60 1.77 1.58 1.55 1.33 1.40
Acupuncture 1.74 1.96 1.95 1.72 1.70 1.89
A special diet 1.84 1.93 1.86 1.84 1.69 1.68

*P < 0.05, **P < 0.01, *** P < 0.001. Mean rating: 1 = harmful, 2 = neutral, 3 = helpful.

rated significantly differently (P < 0.05) from the PTNs in
viewing those with mania as being less likely to have a
good marriage and those with schizophrenia to be a good
parent.
In terms of being exposed to discrimination, similar
percentages of the PTNs and GTNs judged that those with
depression (35% and 25%, respectively), schizophrenia
(73% and 61%) and mania (67% and 66%) would be dis-
criminated against by others in the community. Depres-
sion was viewed by both groups of nurses as the least likely
to be associated with community discrimination.
In terms of prognosis, a number of distinct differences
were evident, albeit more in relation to the impact of
treatment than between the two nursing groups. For
depression, 85% of the PTNs and 66% of the GTNs
judged that the patient was most likely to get worse, and
only 10% of the PTNs and 12% of the GTNs favoured a
partial recovery in the absence of professional help. No
PTN or GTN favored the possibility of a ‘full recovery’
occurring with or without recurrence in the absence of
professional treatment. By contrast, if professional treat-
ment was provided, 86% of the PTNs and 79% of the
GTNs favoured the ‘full recovery’ option, while 13% of
the PTNs and 22% of the GTNs chose the ‘partial recov-
ery’ option, with no PTN or GTN favouring options that
improvement might not occur or that the patient might
get worse.
For schizophrenia, 100% of the PTNs and 97% of the
GTNs elected for the option that the patient would get
worse without treatment (3% of the GTNs allowing a full
recovery with recurrence). If treatment was provided, no
PTN or GTN judged that the patient’s condition would
either worsen or show no improvement. Here, 61% of the
PTNs and 64% of the GTNs elected for the full recovery
and recurrence option while 36% of both groups elected
for partial recovery and recurrence.
For mania, 80% of the PTNs and 84% of the GTNs
estimated that the patient would get worse without
420
treatment, but the PTNs were more likely than the GTNs
(15% vs 0%) to favour the possibility of some level of
recovery and recurrence.The PTNs were more likely than
the GTNs to favour a partial recovery option (52% vs
28%) and less likely to favour a full recovery option (41%
vs 66%).
In terms of long-term outcome, few respondents
nominated risks of violence, alcohol or illicit drug-use or
developing poor friendships. The respondents nominated
increased chances of suicide at 9% for the depression
vignette, 18% for schizophrenia and 21% for mania with
the GTNs being less likely than the PTNs to nominate
an increased chance of suicide for those with mania
(P < 0.01).
DISCUSSION
The survey was undertaken in Singapore’s national psy-
chiatric hospital, which has nearly 3000 inpatient beds.
The response rate by nurses of 88% was high with 128
PTNs and 102 GTNs responding, indicating that their
judgements are likely to be representative of the overall
nursing staff complement. Findings will be considered in
relation to overall nursing judgements and in relation to
the differences between the GTNs and PTNs.
In terms of diagnostic accuracy, the two groups were,
overall, similarly ‘successful’ but with a trend for the PTNs
to be superior in diagnosing depression. Depression was
most commonly misdiagnosed as a ‘stress’ reaction, mania
as a ‘schizophrenic’ disorder while schizophrenia gener-
ated a number of non-psychotic diagnoses (e.g. stress,
depression, mental weakness and anxiety).These data are
of considerable importance not only in quantifying the
level of misdiagnosis and in suggesting the direction of
errors, but with impacting on service delivery.
For the depression vignette, scores returned by the two
nursing groups differed on only one variable with the
PTNs rating pharmacists as significantly less likely to
be helpful than did the GTNs. For the schizophrenia
vignette, both the PTNs and GTNs strongly endorsed psy-
chiatrists as likely to be helpful, but the PTNs returned
significantly higher ratings. In terms of treatment, the
GTNs rated depressants as significantly more likely to be
helpful. For the mania vignette, while no differences were
identified for ratings of professional and non-professional
help, the GTNs were more likely to rate vitamins and min-
erals, tonics or herbal medicines as likely to be helpful.
In relation to the ‘best help’ option, the nurses clearly
favoured obtaining a psychiatrist’s assessment for the
S.G.Yeo et al.
schizophrenic and mania vignettes, followed by recogni-
tion of the problem by the patient. Such an expectation
may suggest a concern in requiring a psychotic patient to
show insight before help is otherwise sought. The low
rating for turning to a family doctor or attendance at a
polyclinic are noteworthy, indicating that for these two
psychotic conditions, a primary psychiatric source was
viewed as more relevant than initial recourse to a local
doctor or medical service. For the depression vignette,
respondents were likely to nominate a wide range of
options, including discussion with relatives and friends as
well as consulting a psychiatrist, and such a range would
appear quite appropriate for such a disorder.
In terms of judging the utility of a range of resources,
treatments and activities, the nurses rated very much in
line with the so-called ‘medical model’. Psychiatrists were
rated highest as resource people followed by other doctors
and health professionals. This could be explained by the
fact that the nurses are working in a ‘medical model’
setting.
Some specific nuances can be observed. Traditional
healers, alternative and non-specific medications (e.g.
tonics, purging and herbal medicines, vitamins and min-
erals, acupuncture, special diets) received low likelihood
of helpfulness ratings which, in combination with high
ratings for psychotropic medications, indicated a domi-
nant ‘medical model’ to viewing treatment of each disor-
der. Using alcohol as an anxiolytic strategy was rated as
distinctly and consistently likely to be unhelpful, while
ceasing alcohol consistently rated as likely to be helpful
across the disorders. Education about the disorder, re-
laxation therapy and resting were consistently rated as
of moderately high utility.
Psychotropic medications and psychiatric hospitaliza-
tion received high helpfulness ratings, while other primary
or adjunctive psychiatric treatments (such as psycho-
therapy) were viewed as likely to be as helpful. Across all
disorders, the nurses rated as highly likely to be helpful
activities were: (i) reading about people with similar prob-
lems; (ii) receiving counselling; (iii) contact with both
close family members and friends; (iv) relaxation therapy;
and (v) rest.The nurses’ ratings varied to some degree in
relation to the differing psychiatric disorders, with most
differences being in accord with consensual knowledge
about such disorders (e.g. differentially favouring anti-
depressant medication for depression, a mood stabilizer
for mania, an antipsychotic for schizophrenia and mania,
and psychotherapy for depression). At first pass, the non-
Mental health literacy survey
differential helpfulness ratings for ECT (i.e. 21% for
depression, 32% for schizophrenia and 32% for mania)
might be of concern. However, the vignette of depression
was chosen to represent ‘major depression’ as defined by
ICD-10 and DSM-IV, thus, a common disorder and one
most commonly treated by antidepressant medication
and/or by psychotherapy, whereas ECT is much more
likely to be reserved for those with psychotic and melan-
cholic expressions of depression.Again, ECT is often very
beneficial for severe mania and it may occasionally be of
some benefit to those with a schizophrenic episode. Such
factors could well account for the non-differential ECT
data. Noting again that the vignette for depression was of
a type commonly occurring in those living in the general
community and who present to general practitioners, the
helpfulness rates for hospitalization (56% and 39%)
appear somewhat high, but it must be remembered that
‘helpfulness’ is being rated rather than a mandatory treat-
ment strategy or a preferred option.
This report allows us to consider the impact of spe-
cialist psychiatric training by comparing ratings returned
by the GTNs and those who had specialist training
(PTNs). In terms of rating the likelihood of interventions
being helpful, significant differences were few. It would be
reasonable to conclude that the two nursing groups dif-
fered little in judging issues, perhaps a reflection of both
groups working in the same hospital and having similar
clinical contact and experiences. More research should be
undertaken to pursue this issue.
The estimates of long-term outcome are somewhat
difficult to interpret. Schizophrenia and mania were
judged as having a greater suicide chance than depression.
Across a range of other long-term outcomes, there was a
general trend indicating that having such disorders would
be associated with some benefit in the future (most
marked for depression and least for schizophrenia).These
‘optimistic’ outcome estimates were at variance with
nurses’ estimates of a high chance of community dis-
crimination, and offer a challenge to accepting these data
at face value.
Comparison of prognostic judgements across all three
disorders indicated clearly differing rated trajectories in
the absence of professional treatment, with schizophrenia
being rated as having the worst outcome, mania being
intermediate and depression having the best outcome.The
421
same pattern across diagnoses examining the impact
of treatment held for PTN ratings, but the GTNs rated
treatment as having virtually identical impact on mania
as on schizophrenia, with depression again having the
best outcome.
The survey strategy provides important information
about the capacity of mental health staff to make an accu-
rate psychiatric diagnosis across differing disorders and
the nature of any errors, the perceived comparative utility
of a range of treatments, resources and strategies and the
judged impact of receiving as well as not receiving a
helpful intervention.There would be considerable benefit
in having such studies of nurses being undertaken in
a wide range of countries to examine commonalities and
differences.
This study has identified the deficit in knowledge of
RNs in identifying the signs and symptoms of depression,
schizophrenia and mania, and the health-belief manage-
ment pattern among Singapore’s professional nurses.
This information has the capacity to shape education and
training of staff competent for service delivery.
ACKNOWLEDGEMENTS
We thank the nursing staff of Woodbridge Hospital, the
Medical Director (Dr Ang Ah Ling) and other members
of the Mental Health Literacy Working Party (Drs Mahen-
dran, Chen and Kua) for study assistance.
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