SINGAPORE — Stress-related illnesses have cost Singapore’s economy about US$2.3 billion (S$3.2 billion) a year, and forms about 18 per cent of the country’s total health expenditure, an inaugural study found.

This ranks Singapore as the second-highest among the nine countries and territories surveyed in terms of healthcare spending that is attributable to stress-related illnesses — just behind Australia’s 19 per cent.

At the other end of the scale are the United States and Thailand, where just 4 per cent of health expenditure is on stress-related illnesses.

The major difference in these percentages largely lies with how the healthcare systems work in the countries surveyed.

For instance, mental health is often not covered by insurance in the US, whereas there is a tendency to use hospital-based care in Singapore to treat mental illnesses.

The study’s findings were published on Thursday (Nov 21) by Cigna, a global health services company, and Asia Care Group, a specialist healthcare consultancy firm.

Titled, Chronic Stress: Are We Reaching Health System Burnout?, the study looked at nine markets including Hong Kong, Taiwan and the US.

Ms Thalia Georgina, a managing partner with Asia Care Group, said that the purpose of the study was to establish the scale and impact that stress-related illnesses have on healthcare systems.

Here are some of the key findings from the report.

IS THE WORLD STRESSED OUT?

An earlier study by Cigna this year showed that more than eight out of 10 people around the world were feeling stressed.

Out of these, 13 per cent said that they found it unmanageable, while more than six in 10 said that advances in technology had led to an “always on” work environment, where they were expected to respond to work-related issues any hour of the day.

In Asia, this was far worse. Nine in 10 of the respondents said that they were stressed, and as many as eight out of 10 said that they worked in an “always on” culture.

WHAT IS THE SITUATION IN SINGAPORE?

The report found that systems such as those in Singapore and Hong Kong have a higher tendency to use hospital-based care to treat mental illnesses.

However, this is an issue since Singapore’s public hospitals are facing severe capacity challenges, the report stated.

These are the number of residents in Singapore who use the following healthcare services each year due to stress-related illnesses:

• Inpatient admissions: 160,118

• Accident & emergency attendance: 239,123

• General practitioner appointments: 11,124,152

• Outpatient attendance: 3,034,159

How much it costs to treat them:

• Patients with stress-related mental illnesses: US$514 million

• Patients suffering from stress which manifests as physical symptoms: US$894 million

• Patients suffering from stress which manifests as medically unexplained conditions : US$934 million

STRESS IS NOT A MEDICAL CONDITION

One of the reasons people go to the hospital for stress-related illnesses is that they display symptoms that are similar to those of other medical conditions, Ms Georgina said.

For instance, the symptoms of a panic attack — such as the tightness of the chest, breathing difficulties and profuse sweating — parallel that of a heart attack.

Some of the stress-related illnesses that people might experience:

Stress-related mental illness

• Panic disorder

• Anxiety disorder

• Depression

Stress which manifests as physical symptoms

• Musculoskeletal issues

• Chest pains

• Women’s health issues

Stress which manifests as medically unexplained conditions

• Unexplained chest pains

• Non-specific aches and pains

• Gastro disturbances

Ms Georgina said that patients who fall under the last category are sizeable in number.

These patients want to seek care, but they are unable to because “stress doesn’t actually exist” from a clinical standpoint, she said.

“Stress isn’t a diagnosable condition in its own right,” she said. “Even if a doctor wanted to, he can’t diagnose you with having stress. He would have to diagnose you with having something else.”

The result, she said, is that these patients end up being discharged from hospital with an “unexplained episode of care”.

“If that happens, the chances of this cycle repeating itself are really, really high.”

‘POTENTIALLY AVOIDABLE’

Mr Julian Mengual, Cigna’s chief executive officer (CEO) for Southeast Asia, said that when he tells people what stress is about, they could relate to it, but do nothing about it.

“But when we put a financial (number) to it, it starts to have other meaning to people,” Mr Mengual said. He is also Cigna Thailand’s regional health solution CEO.

As stress has an impact on productivity, Ms Georgina said that it is an area of concern in societies facing workforce shortages and ageing populations since stressed-out employees might not function optimally.

By releasing this study, she hopes that employers, medical institutions and the Government will devote more resources towards improving mental health.

WHAT HEALTHCARE INSTITUTIONS, EMPLOYERS CAN DO

Among the recommendations put forth in the study is investing in 24-hour urgent care or emergency care clinics that can respond to mental health situations.

Ms Georgina suggested that hospitals with “500 beds or above” could consider having either a psychiatrist or psychologist, or both, on standby throughout the day.

On this point, Mr Gifford Chan, the principal clinical psychologist at The Open Nest, a centre that provides psychotherapy and consulting services, said the trouble is that the “system is clogged up”. 

Speaking at a panel discussion after the presentation of the findings, he said that Singapore needs more professionals in psychiatry and psychology to cope with the demand for such services.

Mr Andrew McNeilis, the chief commercial officer of staffing and recruitment company Phaidon International, said that companies must respect their employees’ time.

He also said during the panel discussion that both employers and employees must stop seeing the discussion of mental health as a taboo subject.

Both Mr McNeilis and Mr Chan agreed that leaders must have the emotional intelligence to provide the support that their employees need.

“There are pockets of businesses around the world where somebody thinks it is career-limiting to go about talking about having stress,” Mr McNeilis said. “That's the thing that has to be addressed from the leadership top down.”

He added that this would greatly help with talent retention as well, when employees know that they can get the help they need in their own company.

Ultimately, “no job is a prison”, Mr McNeilis said.