IMH launches 5-year study to see if depression can be prevented or halted

SINGAPORE – The Institute of Mental Health (IMH) has initiated a five-year study to look at the causes of depression among adults in Singapore, with the aim of finding ways to prevent it or halt its trajectory.

The study will track around 3,200 Singapore residents, aged between 18 and 75, as they go about their lives to see

how symptoms of depression and the severity evolve over time.

It will include 1,229 individuals who have been diagnosed with depression, and a control group of the same number who do not have the condition.

Another 743 participants will have subsyndromal depression – a milder form of depression that does not meet the criteria for major depressive disorder (MDD). This milder form often goes undiagnosed and untreated, which increases the risk of it progressing to full-blown depression.

This is the first nationwide longitudinal study to track the development and trajectory of MDD – commonly known as depression – among the local population.

Associate Professor Mythily Subramaniam, the assistant chairman of IMH’s medical board (research) and the study’s lead investigator, said on May 20 that researchers will study how diverse life events and factors influence the development and progression of depression. These include risk and protective factors such as age, gender, self-esteem, resilience, emotional regulation and lifestyles, as well as social factors such as one’s relationship with family and friends.

“This in turn can help us identify population subgroups who could be more vulnerable to developing depression, giving us an opportunity to intervene early,” Prof Mythily said in a media statement. 

“If we can design appropriate interventions to mitigate the risks they are exposed to, we hope that one day, we would be able to prevent the onset of depression or change the illness trajectory for better outcomes.”

The study is titled Preventing Depression: Investigation In Cohorts Of Its Etiology And Trajectory – or Predict for short.

MDD is the most prevalent mental disorder in Singapore, as surveys have shown. About one in 16 adults (6.3 per cent) here has had the condition at some point in his or her lifetime, according to the most recent nationwide data available, which is from the 2016 Singapore Mental Health Study.

“But, beyond the numbers, the early age of onset, its impact on academic performance and employability as well as the increased risk of suicide make it a significant mental health disorder that needs a deeper understanding,” Prof Mythily told The Straits Times.

She said they will be tracking all the interventions received by the participants in the study to understand if any of the interventions, or a combination of them, work better for the Singapore population.

Symptoms of MDD include persistent depressed mood, loss of interest or pleasure in almost all activities, a sense of worthlessness or excessive, inappropriate or delusional guilt, and sleep disturbance nearly every day, among others.

Unlike previous studies that collected data at only one point in time, the new study will gather data at the outset and then annually for up to five years. The first participant joined the study in September 2024, and a total of 110 have since been recruited.

Participants will have the option of giving their biological samples, such as blood to test routine parameters, metabolic markers like blood sugar and cholesterol levels, as well as hair samples to assess the impact of stressors through cumulative cortisol level.

Currently, the diagnosis of depression relies heavily on symptom history, which can be quite subjective and varied.

The biomarkers can provide more objective and measurable indicators of disease characteristics, which can lead to more accurate and possibly earlier diagnosis, said Dr Nisha Chandwani, the study’s co-investigator and chief of IMH’s department of mood and anxiety.

Biomarkers can also potentially help identify which individuals are more likely to respond to specific types of treatment, paving the way for a more personalised treatment approach and better outcomes, she said in the media statement.

This will be helpful because response to treatment varies across individuals – some respond better to antidepressants, others to brain stimulation, and some to psychotherapy. Studies overseas have identified certain biomarkers, such as cortisol and immune markers, that are potentially associated with response to antidepressants and psychotherapy, and the development of treatment resistance.

For the Singapore study, suitable participants will be recruited through referrals from healthcare institutions, such as IMH and National Healthcare Group (NHG) polyclinics, as well as through public outreach.

The study is jointly funded by the National Medical Research Council’s Population Health Research Grant and NHG, the healthcare cluster that IMH belongs to.

The project group includes researchers and clinicians from NHG, the Lee Kong Chian School of Medicine, Duke-NUS Medical School, University of Oxford, University of Edinburgh, and the Netherlands Study of Depression and Anxiety cohort.

Those who are interested in participating in the study can go to

www.predict-imhresearch.sg

to find out more.