Paying it forward

Paying it forward

On the first of November 2013, a mysterious donation of $50 to the drinks stall in the Nanyang Junior College canteen provided thirty-something drinks accompanied by 32 handwritten notes to teachers and other students. That lead to teachers returning the gesture. And that lead to students thanking them in postits.

Apart from the fact that it’s a good thing to do or the right thing to do, there’s actually a wealth of research findings that tell us that promoting someone else’s welfare has much benefit to us in terms of our mental wellbeing and adds positively to our physical health.

This view, proposed on a PBS website, a “Doing Good” report by the UK Mental Health Foundation, and a New York Times article (“Is pure altruism possible?“, 19 Oct 2010), is supported by studies which link altruism behaviours to better mental health (Schwartz et al., 2003) and life satisfaction (Massey et al., 2010 – a study on kidney donation). Other recent research goes further to indicate that beliefs, feelings, and behaviours towards helping, rather than being willing to forgive others and oneself, is associated with better mental wellbeing scores even in adolescents (Pareek & Jain, 2012). Rather than assume that the findings indicate that we engage in altruism behaviours for reasons of self-interest (read this Berkeley e-newsletter), there’s empirical evidence to suggest that positive psychological outcomes arise from our helping behaviours. There’s a reason why helping our older folks with their gardening aspirations feels so good (“Greening for a cause“, Today, 18 Nov 2013).

With the current Red Cross, International Rescue CommitteeMSF, and World Food Programme donation appeals, there are plenty of opportunities to put to practice what we learn. Time to get on the bandwagon!

“Let’s find out more about mental illness”

Mental health resources

Yes, let’s. The article “Let’s find out more about mental illness” published in Straits Times, 16 Nov 2013, talks about childhood mental health disorders, and specifically, depression, anxiety, and schizophrenia.

It’s timely, given that understanding about mood and anxiety disorders involving adults tends to be poor, let alone mental health disorders involving children and adolescents. And it’s a good time as any to talk about mental health disorders, especially in the light of recent news reports involving individuals with depression.

But what is it that we understand about mental health disorders? From the resources made available to various organizations dealing with mental health issues, quite a lot actually.

But first, maybe we should know at least a few things worth knowing:

1. Stigma is everywhere, not just in Singapore.

That there is local stigma about seeking help for mental health disorders is not surprising.

But these are ubiquitous issues, relevant to other communities such as those in UK (“Understanding anxiety and mental health stigma”, The Guardian, 27 Sep 2013), Australia (“Mental health stigma still affecting Australian workers, with research showing 4 in 10 hide depression from their employers”, ABC, 12 Nov 2013), Canada (“Montrealers demonstrate to end mental health stigma”, CBC, 20 Oct 2013), Hong Kong (“First mental health web radio in Hong Kong raises the community’s awareness on mental illness and mental health”, UHK, 15 Nov 2013), and Taiwan (“Society must confront mental health stigma, redefine success”, The China Post, 3 June 2013).

We may not have progressed very far (“S’poreans fear mental patients, study finds”, Straits Times, 29 Oct 2007), but at least we’re increasingly cognizant of the issues and are adding to facts not fiction.

This Huffington Post article provides 3 helpful suggestions for how you and I can make a difference. The UK campaign which started in 2009 to end mental health discrimination at their www.time-to-change.org.uk offers useful tips on how to talk about mental health issues.

2. There are resources out there for the public.

3. There’s information about mental health disorders in children and adolescents.

4. Other resources include information about developmental disorders.

5. We can always do more.

A 2012 report in the Singapore Annals Academy of Medicine did not investigate whether their stratified sample of 6616 respondents, among whom 12% met the criteria for mood, anxiety, or alcohol use disorders but less than a third had sought professional help, used the internet to find out more about mental health disorders. Given that the same report acknowledges 80% or more of the local population aged 49 years and below (and 40% of those aged 50 to 59 years) has internet access, there’s much scope for accurate information about mental health to be provided on an online platform. This BBC Wales health report presents possibilities, while the UK Child and Maternal Health Intelligence Network offers ideas via a Tackling Stigma Toolkit. There are always more things that can be done. Something we can work towards perhaps?

Time out!

That chronic stress is responsible for poor immune functioning has been long established. The literature as early as 1990s provides much evidence to support this view (O’Leary, 1990; see Khansari, Murgo, & Faith, 1990 for a review), while more recent research indicates a role for moderating factors such as the ageing process or physical illness, which increase our vulnerability to immune suppression in the face of chronic stress (Segerstrom & Miller, 2004).

The finding that chronic stress has long-lasting negative consequences for our cognitive abilities is also not new. It’s been well-established that prolonged exposure to stress damages our hippocampus – a brain structure responsible for consolidating short-term memory to long-term memory (McEwen, 2004Sapolsky, Krey, & McEwen, 1986).

It follows that efforts to manage chronic stress should be equated with improvements in mental wellbeing measures such as life satisfaction and psychological mood. Apart from specific interventions targeted at alleviating the symptoms of depression, research points to exercise as an effective strategy for managing stress. Various studies demonstrate that exercise improves mood and anxiety levels (Craft and Perner 2004Ströhle, 2009; see also Atlantis, Chow, Kirby, & Singh, 2004Bhui, Dinos, Stansfeld, & White, 2008Coulson & McKenna, 2008Daley & Parfitt, 2011). Additionally, there is some evidence that participation or passive appreciation of creative cultural activities can also have a positive effect on mental wellbeing, specifically psychological mood (Cuypers, Krokstad, Holmen, Knudtsen, Bygren, & Holmen, 2011).

So if you’re stressed and need some time out, here are some ideas to take home and share with your family and friends:

1. Get up and get going!

  • Walk down Orchard Road in the evening for some physical exercise. Enjoying the Christmas lights are an optional add-on.
  • Jostle the crowd at Sitex 2013 held at Singapore Expo. 28 Nov to 1 Dec. Playing the game of walking quickly through the throng, visiting every booth, and avoiding contact with other people earns you extra physical activity points.
  • Join the dots and map out all the hip and cool cafes and historical landmarks on this National Heritage Trail in Tiong Bahru, which has recently received new media attention.

2. Take time out and enjoy what’s out there!

3. Do it as a family activity

  • The Singapore Zoo celebrates its 40th birthday by giving their macques and chimps enrichment gifts (read: a puzzle containing delicious food). On weekends till 22 Dec 2013, at 80 Mandai Road.
  • Visit the ice sculptures exhibiting as part of the International Ice and Snow Sculpture Festival, at Sheares Link. 30 Nov to 4 Dec 2013. $26-32. Don’t forget to wear your coat, scarf, and gloves!
  • Sleep over with your little (and not-so-little) ones at the SEA Acquarium on 17-18, 23-24 Nov, 6-7 and 14-15 Dec. $135-158 for non-members.

Food for Thought

At least one in ten persons aged 18 to 69 years has diabetes mellitus in Singapore, according to the 2010 Singapore Burden Of Disease Study (MOH), while prevalence for older adults is one in three persons (“1m diabetes by 2050 as Singaporeans get older, fatter”, Straits Times, 2 Oct 2012). This is relatively higher than the global prevalence which the International Diabetes Federation puts at 8.3% in 2011. Metabolic syndrome, which is closely associated with diabetes, has a relatively high prevalence in Singapore, particularly when body mass indices (BMIs) relevant to Asian body build are applied (read this IDF report).

A local report on diabetes from the Health Promotion Board reveals a relatively high proportion of residents with undiagnosed diabetes. And not surprisingly, a local study of 43,176 adults aged 45 to 74 years revealed that among non-smokers, a greater intake of fruits, vegetables, and soy foods was associated with a lower risk of type II diabetes (Odegaard et al., 2011).

There’s also much hoo-ha at the moment about soda tax and sugar tax. While more fingers are being pointed at sugar as the villain in the landscape of obesity, metabolic syndrome and diabetes, saturated fat isn’t entirely off the hook. True, fructose contributes to insulin resistance while not providing adequate satiation (“Sweet poison: Why sugar is ruining our health”, Telegraph, 12 April 2013; read also “Sugar, not fat, exposed as deadly villain in obesity epidemic”, The Guardian, 20 Mar 2013). But, intake of saturated fat is still associated with higher risks of heart disease (“Fat, Sugar or Carbs: Which Is the Bad Guy?”, Huffington Post, 25 Oct 2013). The good news about soda and sugar taxes is the expectation that obesity would be reduced in the states and cities they’re being applied, even though the debate rages on, and on, and on.

On World Diabetes Day (14 Nov 2013), there’s no time like the present to think about healthy eating. Here’s some thoughts about food:

1. Less is more. 

Here’s one diet to aspire to. Studies indicate that the diet structure of Okinawans is responsible for their successful ageing: They eat lots of fruits, vegetables, and soy products (“The Okinawan diet – could it help you live to 100?”, The Guardian, 19 June 2013). But more importantly, it may be their habit of eating until they feel 80% full: It’s their caloric restriction which may be making the big contribution (for details Willcox et al., 2006; 2007). If you’re not convinced, watch this TED talk.

2. Is there something worse than fructose? Yes, artificial sweeteners. 

Having a sugar substitute when we desire sugar seems to have the opposite desired effect. As neatly pointed out in a Harvard Health Blog, “Artificial sweeteners: sugar-free, but at what cost?”, there are at least two problems with artificial sweeteners. One is that we are tempted to eat other foods in place of the calories which we didn’t consume. The other is that sugar substitutes don’t provide the endorphins that sugar does and we continue to crave sugar. As a result, we still eat cake after a sugar-free drink. More disturbing facts are easily available at the eloquent Dr Oz website and videos which might help you switch off the “zero-sugar” option.

3. Eat like a caveman. But only if you’re prepared to cook like one?

The paleo diet. It’s the new black. There are apparently benefits to this diet (“5 reasons to follow a caveman diet”, Discovery; “6 health lessons from the paleo diet”, Huffington Post, 13 Sept 2013), and scientific evidence that this diet may have benefits for type 2 diabetes (Klonoff, 2009), possibly because it is more satiating than mediterranean diets (Jonsson et al., 2010). Well, at least it is a proponent of a “whole grains, fruits, and vegetables” diet. And to be a caveman, it would be preferable if one would also grow one’s own herbs, whip up pancakes without electricity, and knead one’s bread too. Not difficult to achieve at all.

4. Breakfast is the most important meal of the day.

The old adage isn’t wrong. A recent report (“Breakfast is the most important meal of the day”, Daily Mail, 23 July 2013) suggested that those who skip breakfast tend to have larger meals during the day, which predisposes them to heart attacks. Another recent study (by Odegaard and colleagues) indicated that eating breakfast frequently lowers the risk of obesity, metabolic syndrome, and diabetes mellitus (“The most important meal?”, press release, UM Minnesota, 16 Sept 2013). More importantly, there’s evidence that a low glycaemic index breakfast (like oats) helps children maintain their attention on cognitive tasks through the morning (Ingwersen et al., 2007; Wesnes et al., 2003).

5. We’re more likely to eat it if we’ve tried it before.

There’s a reason why healthy cooking demonstrations are part of a healthy eating programme at the workplace. One study which asked 205 participants to sample a chicken-and-whole-grain pasta dish and gave them the opportunity to try it at home with a receipe provided to them, found that they were more likely to perceive whole grains positively and to report more confidence about consuming them, compared to controls (Yao et al., 2013). Time for you to try out the recommended roasted brussel sprouts on the Food Network channel and the latest recipes on the Dr Oz show (like sweet potato peanut cookies!).

The key to happiness

the key to happinessBeing happy is all the rage these days. It’s been reported with much fanfare that Singapore is the 30th happiest nation in the UN’s World Happiness ReportGallup wellbeing scores for local respondents, which have achieved a delirious increase from 46% to 70% between 2011 and 2012, have also received much media attention. Local newspapers are replete with tips for being happy (“You’re happy if you think you are”, Mind Your Body, 31 Oct 2013).

But as pointed out in various local news (e.g., “A measure of happiness in Singapore”, Asia News Network, 13 Oct 2013), the UN happiness index is about overall life satisfaction, whereas Gallup wellbeing scores are self-reported ratings for questions such as “Did you smile or laugh a lot yesterday?”, “Did you feel well-rested yesterday?”, and “Did you learn something interesting yesterday?” on a scale of 1 to 10. Crucially, the UN happiness index comprises among other things gross domestic product (GDP) per capita, years of healthy life expectancy, and perceptions of corruption (“Singapore the happiest nation in Asia: UN study”, My Paper, 11 Sept 2013). In light of that, achieving a ranking at the top 20th percentile is then perhaps not wholly remarkable.

Interestingly, the 1,000 local respondents in the 2011 Gallup survey included residents living in private housing, whereas the equivalent number of local respondents in the subsequent annual survey appeared to have no representation from this group, which make up 12% of the general population. It’s also noteworthy that the face-to-face surveys were conducted between 1st September and 30th October in the preceding year of 2011, but between 22nd December 2012 and 28th March 2013 for the 2012 survey.

But that’s not what’s important. What’s important is that we understand the factors which impact our mental wellbeing, and that we try out various ways to improve our mental wellbeing.

Here’s FOUR ideas to chew on:

  1. Nothing like exercise

    Findings from a cross-cultural epidemiological study of 17, 246 young adults (Grant, Wardle, & Steptoe, 2009) indicate positive correlations between life satisfaction and physical exercise (as well as eating fruit!). Although their findings appeared to suggest a mediating role for physical health, it is clear from those and other findings that exercise improves mental wellbeing. A recent study (Maher et al., 2013) with 253 participants found that young adults reported greater life satisfaction on days when they engaged in physical activity compared to other days, even after controlling for other factors such as gender, BMI, daily fatigue). So if that’s not persuasive enough, this blog on why we need exercise from The Dr Oz Show might help convince you to get up and out to the park.

  2. Assess your mental wellbeing

    Everyone experiences stress, anxiety, and feelings of sadness from time to time. But perhaps you or someone you’re concerned about is experiencing more stress than usual and showing signs of burnout at their workplace or as a caregiver. There’s no better motivation to engage in good self-care than when you’re convinced that you need it! This anonymous self-assessment tool will help you assess your mental wellbeing, while a burnout questionnaire can be insightful for not only employees, but caregivers. Once you’ve assessed your stress levels, you might be more willing to give the other things below a go!

  3. Get some zzzs

    Sleep is highly underrated when we’re young. Okay, we’re not that young anymore but nonetheless sleep quality has a profound effect on our daily functioning. Studies suggest that getting enough rest is essential to not only our problem solving abilities, but also closely related to our mood and mental wellbeing. A study (Dinges et al., 1997) found that an accumulated sleep debt equivalent to 33% less sleep than normal negatively affected psychomotor vigilance and working memory performance. Moreover, the removal of sleep deprivation produced a significant improvement in participants’ mood. And what’s more. The link between sleep problems and mood disorders including depression has also been well established in the literature (Breslau et al., 1996; Neckelmann et al., 2007; Weissman et al., 1997). So it’s important to get some good quality REM (and not the Shiny Happy People kind)!

  4. Relaxation is key

    Tips for managing stress always seem to revolve around a million things which should make us feel good. Tips often include things like having a bubble bath, taking the dog for a walk at Pasir Ris Eco Green, having brunch at Selfish Gene Cafe with friends, peering at migratory birds at Sungei Buloh, and spending the afternoon painting at the Singapore Botanic Gardens, as well as paying someone to press your head and shoulders, crack your knuckles, pull your toes, and fold your knee across your body. Other strategies include being thankful and forgiving, being encouraging to someone else, and being aware of one’s thoughts and emotions. The underlying notion behind most of these strategies is that chronic stress is harmful to our heath. It’s not only responsible for poor immune functioning, but has long-lasting negative consequences for our cognitive abilities. Prolonged exposure to stress damages our hippocampus – a brain structure responsible for consolidating short-term memory to long-term memory (Sapolsky, Krey, & McEwen, 1986). So, looking after yourself is the key to good mental wellbeing (and happiness). But more importantly, along with lowering one’s risk of vascular diseases, it plays a key role in protecting against dementia.