Most Singaporeans with anxiety or depression have not sought professional help, Duke-NUS study finds

A study by researchers from Duke-NUS Medical School, published in the Singapore Medical Journal on 21 May 2026, has found that 77 per cent of Singaporean adults who reported symptoms of anxiety or depression had not sought care from mental health professionals, including psychiatrists, psychologists and social workers.

Despite this low rate of formal help-seeking, 62 per cent of the same group said they would be willing to receive support from peers with similar backgrounds or lived experiences, pointing to an untapped community-based pathway for mental health intervention.

The findings were drawn from an online cross-sectional survey of 350 adults conducted between 20 April 2022 and 1 June 2022, as part of a broader project examining the economic burden of anxiety and depression in Singapore. Participants were recruited through a web panel curated by Kantar Profiles Division and were screened using the Patient Health Questionnaire-4 (PHQ-4), a validated four-item tool for identifying symptoms of anxiety and depression.

The study was approved by the National University of Singapore Institutional Review Board.

Format and modality preferences

Among those who expressed interest in peer support, the strongest preference was for one-on-one sessions rather than group-based formats, with 51 per cent favouring the former and 21 per cent the latter. In terms of modality, 43 per cent preferred virtual delivery, compared with 27 per cent who preferred in-person interactions.

The most popular combination was one-on-one peer support delivered virtually, selected by 26 per cent of interested respondents. One-on-one in-person support was the second most preferred option, at 18 per cent.

Respondents who expressed interest in peer support said they hoped to gain emotional support (69 per cent), followed by coping skills (52 per cent), knowledge about treatment options (50 per cent) and connection to relevant resources or people (47 per cent).

Who is more likely to seek peer support

The study identified several demographic and clinical factors associated with greater willingness to engage with peer support.

Younger age was a statistically significant predictor, with an odds ratio of 1.05 (P < 0.01), suggesting that each additional year of age is associated with a slight decrease in interest. Researchers noted this likely reflects greater generational awareness of mental health issues among younger adults, including through government-led social media campaigns aimed at normalising mental health discussions.

Adults who had utilised formal mental health care in the preceding three months were more than twice as likely to express interest in peer support, with an odds ratio of 2.45 (P < 0.05). This suggests that formal and informal care may function as complements rather than substitutes.

Respondents working in white-collar managerial roles — such as managers and directors — were significantly more open to peer support than those in white-collar non-managerial positions such as clerical or sales roles, with an odds ratio of 1.96 (P < 0.05). The researchers attributed this to higher health literacy, greater work-related stress and potentially fewer informal peer networks at senior levels.

The single strongest predictor was prior experience as a peer support mentor, which was associated with an odds ratio of 7.33 (P < 0.01). Of the 58 participants who had prior experience with peer support in any capacity, 91 per cent expressed interest in receiving it themselves.

Contrary to the researchers' initial hypotheses, gender and symptom severity — as measured by PHQ-4 scores — were not significantly associated with interest in peer support. Female gender was, however, associated with a higher likelihood of preferring virtual over in-person support, which researchers linked to disproportionate household and childcare responsibilities.

Why many do not seek help

Among those not interested in peer support, 45 per cent cited concerns about confidentiality, 43 per cent expressed wariness about speaking with a non-professional, and 37 per cent doubted that peer support would be helpful. Time commitment (31 per cent), cost (16 per cent) and concerns about service quality (15 per cent) were also cited.

Researchers noted that these concerns point to structural requirements for any effective peer support programme, including rigorous training for peer mentors in handling personal health information, clear delineation of mentor roles, and meaningful integration into the broader mental health care system.

Associate Professor Daniel Fung, Senior Consultant at the Institute of Mental Health's (IMH) Department of Developmental Psychiatry and a co-author of the study, noted that stigma and fear of judgement remain deeply embedded barriers. He said many Singaporeans, particularly in workplace settings, are cautious about disclosing mental health difficulties out of concern that doing so could affect job security or career progression.

Assoc Prof Fung added that peer support could serve as a first point of contact for those not yet ready to engage with formal services, offering understanding and practical coping strategies grounded in shared lived experience.

Peer support as a complement, not a replacement

Assistant Professor Irene Teo from the Lien Centre for Palliative Care at Duke-NUS, the study's first author, said fear of stigma and judgement could make professional care feel intimidating, and that peer support's informal character may lower the psychological barriers that prevent many adults from reaching out.

Professor Eric Finkelstein, Executive Director of the Lien Centre for Palliative Care at Duke-NUS and the study's senior author, cautioned that mental health support is not a one-size-fits-all solution. He emphasised that peer support programmes must be thoughtfully designed to provide the appropriate balance of emotional support, guidance and safeguards.

Prof Finkelstein also noted that confidentiality concerns and hesitance towards engaging with mental health professionals remain barriers for some individuals, underlining the role peer support can play as a pathway into more formal care, rather than a substitute for it.

Professor Sheemei Lok, Duke-NUS' Interim Vice-Dean for Research, said the study highlighted the role that communities could play alongside mental health professionals, and that understanding where people feel most comfortable seeking help could support the development of more inclusive and compassionate mental health systems.

Limitations and future directions

The researchers acknowledged that the study's online recruitment method may have introduced selection bias, as participants drawn from a web panel are more likely to be technologically literate and open to online-based interventions. The majority of participants were also aged below 50 years.

The study did not examine whether respondents intended to use peer support in place of, or alongside, formal care. Researchers said future work should address this question to inform the design of stepped-care models that match individuals to appropriate levels of support.

The study also flagged an unresolved gap: a notable proportion of adults — approximately 38 per cent of those with anxiety or depression symptoms — expressed no interest in peer support and had not sought formal care either. Researchers said greater efforts are needed to understand and engage this population.