Intervening factors between risk of violence and aggressive behaviours among forensic inpatients: a scoping review.

BACKGROUND: Risk of violence is closely associated with aggression propensity. However, there is a lack of research to explain the mechanisms behind this association, especially among the patients of forensic secure facilities. This review aimed to identify and synthesize the available literature concerning the intervening factors (mediating or moderating factors) in the relationship between the risk of violence and aggressive behavior in forensic secure facilities. METHODS: Two electronic academic databases were searched: Scopus and Web of Science (WoS) using specific keywords as search terms derived from the PCC framework with no specific time limit. The search strategy was developed based on the JBI Manual for Evidence Synthesis and utilised the PRISMA-ScR guidelines. Data on the risk of violence, intervening factors, and aggressive behavior were extracted from the included studies. Further analysis was performed whereby similar data were grouped and synthesised together. RESULTS: The initial search produced 342 studies. However, only nine studies fulfilled the inclusion criteria. The nine studies included 1,068 adult forensic inpatients from various psychiatric hospitals. Only mediation studies reported significant mechanisms of influence between the risk of violence and aggressive behavior. It is postulated that the human agency factor may be the underlying factor that influences a person's functioning and the subsequent series of events between the risk of violence and aggression. CONCLUSIONS: In light of the paucity of evidence in this area, a generalised conclusion cannot be established. More studies are warranted to address the gaps before conclusive recommendations can be proposed to the relevant stakeholders.

Adolescent Connectedness: Testing Confirmatory Factor Analysis of the Hemingway: Measure of Adolescent Connectedness-Bahasa Melayu Version (HMAC-BM).

Measuring the factors that underlie adolescent connectedness has become a prominent focused issue in past studies across many disciplines. Thus far, the Hemingway: Measure of Adolescent Connectedness (HMAC) is the first research-based measure of adolescent's relationship and sense of belonging with other people and their surroundings. The current study aimed to examine the measurement model of the Hemingway: Measure of Adolescent Connectedness which has been translated into Bahasa Melayu (HMAC-BM) in order to check for its feasibility among Malaysian adolescents. A total of 377 adolescents aged 16 years old were recruited from the Federal Territory of Kuala Lumpur. Three factors, namely connectedness to family, school, and neighbors with seven sub-factors of the HMAC-BM, were analyzed by Confirmatory Factor Analysis (CFA) using the IBM SPSS Amos 23.0 (23.0, IBM Technology, Armonk, NY, USA). Results of the CFA supported the second-order factor of the HMAC-BM structures. The overall HMAC-BM scale and its subscales have higher factor loadings ranging from 0.60 to 0.79. Cronbach's alpha coefficients ranged from 0.78 to 0.95 for the three subscales and 0.84 for the total scale. Results also revealed seven sub-factors with forty-one factors-solution that accounted for 0.89% of total variance explained for adolescent connectedness. Findings provide empirical support for the feasibility of HMAC-BM in explaining Malaysian adolescents' social connectedness. Hence, the HMAC-BM is a promising measure that can be used on Malaysian adolescents. The findings have important implications which provide a clear picture of HMAC-BM as an accurate instrument to measure adolescent's social connectedness toward enhancing prosocial attitudes and well-being.

Schizophrenia relapse in Kuala Lumpur, Malaysia: do relatives' expressed emotion and personality traits matter?

BACKGROUND: Schizophrenia which is perhaps the most disabling and puzzling form of a mental disorder is often conceptualized as 'gila' (lunacy or madness) by the Malaysian society. The debilitating nature of the disorder and recurrent relapse of its psychotic episodes have often been misunderstood and lead to confusion among the family members, who play the role as primary caregivers. While expressed emotion (EE) has been widely studied in the Western world, it is not well understood in Malaysia. OBJECTIVES: This study aimed at investigating the predictive role of relatives' EE index and components as well as personality traits in relapse among schizophrenia patients in Kuala Lumpur and Klang Valley, Malaysia. METHODS: A total of 160 subjects consisting of 80 patients diagnosed with chronic schizophrenia and 80 relatives were recruited to participate in Phase 1 of the study. Only patient-participants were followed-up 6 months later for Phase 2 of the study in order to check for possible relapse. The Family Questionnaire (FQ) and the short scale Eysenck Personality Questionnaire-Revised (EPQ-R) were administered to measure relatives' EE and personality traits, respectively. Patients' were considered to relapse if they were readmitted into psychiatric wards 6 months post-hospital discharge. RESULTS: The findings revealed that the odds for patients to relapse were increased by 8 times when relatives demonstrated high-EE level. Relatives' critical comments (CC) turned out to be the strongest predictor with the odds to relapse increased by 12% when they demonstrated an increase in CC level. Relatives' personality traits particularly the extraversion trait also turned out to be the significant direct predictor to patients' relapse. Our results showed that a unit decrease in extraversion trait score predicted the odds for patients to relapse by 23%. DISCUSSIONS: Our findings supported the Western findings on the significant role of relatives' high-EE level particularly the CC scale on the course of schizophrenia. The novelty of the current finding was demonstrated in the significant role of relatives' extraversion trait that directly predicted patients' relapse. Results also indicated the feasibility of EE in predicting relapse among schizophrenia patients in Klang Valley, Malaysia.