The influence of ethnicity and beliefs on the course and outcome of schizophrenia in Singapore
The aim of this thesis was to examine the extent to which the ethnicity of patients and their beliefs about the causes of schizophrenia affects the course and outcome of the illness in Singapore. As course and outcome are also affected by various other factors, the influence of these factors was also investigated. The first study on the lay beliefs of samples of the Chinese and Malay Singaporean population about the causes of schizophrenia showed that psychosocial factors were the most frequently cited cause of schizophrenia. This was consistent with other studies. The beliefs elicited from this sample formed the basis for the development of a culturally-relevant beliefs questionnaire. The beliefs questionnaire was administered to a cohort of 230 inpatients * readmitted for relapse of schizophrenia to Woodbridge Hospital, Singapore's state mental institution. Factor analysis of their responses revealed seven categories of causal beliefs and three categories of treatment approaches. Results from this second study showed patients believed that supernatural factors were the main cause of their illness. Influence of certain demographic factors also emerged. Caregivers of these patients were administered the caregivers' version of the questionnaire. Significant differences were found between patients and their caregivers in certain categories of beliefs. Patients and caregivers strongly endorsed professional treatment methods. The third study examined the effects of a psychoeducation intervention on the course and outcome of the illness of this cohort of'patients. The influence of other factors were also investigated. Ethnicity had a significant effect on social and psychological functioning and community tenure but not on illness severity or rehospitalization. Beliefs in biological causes and biomedical treatment methods predicted reduced symptoms and better insight. Caregivers' beliefs did not impact significantly on patients' outcome. Clinical implications of these findings and directions for future research were discussed.