Similarities and differences in the prevalence and risk factors of suicidal behavior between caregivers and people with dementia: a systematic review.

BACKGROUND: People with dementia and their caregivers are prone to suicidal behaviors due to difficulty adjusting to their initial caregiving role and due to emotional disturbances resulting from deterioration of functioning. The present systematic review (1) explored the prevalence of and risk factors for suicidal behavior and (2) assessed the similarities and differences in the prevalence and risk factors for suicidal behavior between people with dementia and their caregivers. METHODS: A comprehensive literature search for research articles published between 1950 and 2023 was carried out using major databases, such as Google Scholar, Web of Science, PubMed, Scopus, PsycINFO, EMBASE, the Cochrane Library, and Medline. RESULTS: A total of 40 research articles were selected for review. A total of 12 research articles revealed that the prevalence of suicidal behavior among caregivers ranged from 4.7% to 26%. However, the risk of suicidal behavior among people with dementia was inconsistent, as only 17 out of 28 selected studies reported the risk of suicidal behavior among people with dementia. The risk factors associated with suicidal behavior among caregivers of people with dementia could be both self-related and care receiver-related factors, whereas risk factors in people with dementia were self-related factors. Notably, greater cognitive decline, which impairs individuals' ability to carry out complex acts and planning, may lower their suicidal risk. Finally, assessment of the risk of bias indicated that 95% of the selected studies had unclear risk. CONCLUSION: Self-related and care receiver-related factors should be assessed among caregivers of people with dementia to evaluate the risk of suicidal behavior. In addition, we recommend evaluating suicidal risk in people with dementia in the early phase of dementia when cognitive decline is less severe. However, as the majority of the selected studies had unclear risk of bias, future studies with improved methodologies are warranted to confirm our study findings.

Prospective cohort study of unmet supportive care needs, post-traumatic growth, coping strategy and social supports among patients with breast cancer: The PenBCNeeds study.

PURPOSE: While the unmet healthcare needs are still being improved upon, the wellbeing of cancer patients has increasingly become a prime concern in Malaysia. The objective of this study is to ascertain the trend of unmet supportive care needs, post-traumatic growth (P T G), coping strategies, and social supports among patients with breast cancer over the three time points of treatment: T1 at early diagnosis, T2 for three months after diagnosis, and T3 for six months after diagnosis. METHODS: A total of 240 cancer patients participated in this prospective cohort study, with follow-up visits from October 2019 until July 2021. Data were collected using several instruments: Brief COP E, the Source of Social Support Scale (SSSS), the Post-Traumatic Growth Inventory - Short Form (P T GI-SF), and a Malay version of the 34-Item Shortform Supportive Care Need Survey (SCNS-SF34). RESULTS: The results indicated a significant change from T1 to T3 for all domains of the unmet needs (p-value < 0.001), except for the sexual domain. A lower SCNS-SF34 score resulted from more unfavorable social support. The P T GI-SF results indicated a trend toward meeting the unmet needs, and a higher SCNS-SF-34 score predicted a considerably higher P T GI-SF score. CONCLUSIONS: Our study findings suggest that majority of the factors evaluated in terms of unmet needs among cancer patients have undergone considerable changes.

A longitudinal investigation of posttraumatic growth and its associated factors among head and neck cancer survivors.

OBJECTIVES: Posttraumatic growth (PTG) may improve well-being among cancer survivors, but a longitudinal study addressing head and neck cancer (HNC) is lacking. This longitudinal study examined PTG trends and determined the associations of physical symptoms and complications, as well as sociodemographic and tumor characteristics on PTG over time among HNC survivors. METHODS: Participants completed the European Organization of Research and Treatment of Cancer's "Quality of Life Questionnaire-Head and Neck 35" module (EORTC-QLQ-H&N-35) and "Posttraumatic Growth Inventory-Short Form" (PTGI-SF) during baseline (T1 ) and follow-up (T2 ; 5-7 months post-baseline) assessments. RESULTS: In total, 200 HNC participants completed the study and 67.5% of them reported increasing PTG. Physical symptoms and complications that were significantly associated with lower PTG included problems with social contact and the senses. Meanwhile, sociodemographic variables that were significantly associated with PTG were gender (males had lower PTG than females) and religion (Muslims and Buddhists had higher PTG than participants of other religious faith). CONCLUSION: Our findings revealed the need to focus on the impact of sensory issues and reduced social contact following HNC on PTG which may be addressed by various restorative and supportive rehabilitation therapy.

Effect of regular kratom (Mitragyna speciosa Korth.) use on quality of life of people who use kratom.

Background: Kratom (Mitragyna speciosa Korth.) is a traditional folk remedy used in Southeast Asia and is known to have a significant opioid-like effect. However, it is unknown whether kratom consumption can impair quality of life (QoL). This study aimed to examine the QoL of people who use kratom by comparing it with that of healthy non-kratom using controls and to determine the association between patterns of kratom use and QoL among people who use kratom. Methods: 200 respondents (100 subjects who use kratom and 100 healthy controls) were recruited for this cross-sectional study. The World Health Organization Quality of Life-BREF was administered to all the respondents to assess QoL, while the Kratom Dependence Scale (KDS) was used to assess the severity of kratom dependence among the subjects who use kratom. Results: The physical health, psychological, and environment QoL scores of the subjects who use kratom were significantly lower than those of the healthy controls. Multiple linear regression analysis revealed greater KDS score and longer duration of kratom use were significant predictors of physical health QoL, while only greater KDS score significantly predicted psychological and environment QoL scores. Conclusion: Prolonged kratom use and kratom dependence may negatively impact the QoL of people who use kratom, hence kratom addiction has to be treated adequately.

The Right to Use Kratom from the Psychiatric and Islamic Perspectives.

This paper aimed to summarize kratom's psychological effects on users and the Islamic views on kratom use. A literature survey of published kratom studies, teachings based on the holy Qur'an, the Sunnah, and views of several Islamic scholars based on qualitative methodology through text analysis was conducted. The results demonstrated that despite its beneficial therapeutic effects, the harm induced by kratom outweighs its benefits. We concluded that kratom use for medicinal purposes is only warranted if useful constituent mitragynine can be extracted and used on its own, and if more rigorous human studies demonstrated good safety profile and efficacy of mitragynine for therapeutic purposes.

Depression and anxiety in the Malaysian urban population and their association with demographic characteristics, quality of life, and the emergence of the COVID-19 pandemic.

The prevalence of depression and anxiety has been shown to be higher in the urban population compared with the rural population. The present study investigated the prevalence of depression symptoms, anxiety symptoms, and depression with comorbid anxiety symptoms and their associated factors in a random sample drawn from several urban communities in Malaysia. This study also determined the association between the emergence of the COVID-19 pandemic and depression symptoms, anxiety symptoms, and depression with comorbid anxiety symptoms. We recruited 326 participants, who were administered a sociodemographic characteristics questionnaire; the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess the presence or absence of depression symptoms, anxiety symptoms, and depression with comorbid anxiety symptoms; and the World Health Organization Quality of Life-BREF (WHOQoL-BREF) to assess their QoL. The following prevalence values were obtained among the participants: depression symptoms, 23.9%; anxiety symptoms, 41.7%; and depression with comorbid anxiety symptoms, 19.9%. Those assessed after the declaration of COVID-19 as a global pandemic showed increased odds of depressive symptoms (adjusted OR = 2.99, 95% CI = 1.41-6.35, p = 0.006) and depressive with comorbid anxiety symptoms (adjusted OR = 3.19, 95% CI = 1.37-7.45, p = 0.005), while the presence of comorbid stress increased the odds of depressive symptoms (adjusted OR = 16.00, 95% CI = 7.84-32.63, p < 0.001), anxiety symptoms (adjusted OR = 19.72, 95% CI = 9.75-39.89, p < 0.001), and depressive with comorbid anxiety symptoms (adjusted OR = 40.44, 95% CI = 15.90-102.87, p < 0.001). Higher psychological QoL reduced the odds of depressive symptoms (adjusted OR = 0.83, 95% CI = 0.69-0.99, p = 0.032) and depressive with comorbid anxiety symptoms (adjusted OR = 0.82, 95% CI = 0.68-0.98, p = 0.041), whereas higher physical health QoL (adjusted OR = 0.85, 95% CI = 0.75-0.97, p = 0.021) and social relationship QoL (adjusted OR = 0.70, 95% CI = 0.55-0.90, p = 0.009) reduced the odds of anxiety symptoms. Based on our findings, we recommended several measures to curb psychological complications among the urban population, particularly as the battle to contain COVID-19 is ongoing.

Depression, anxiety, and associated factors in patients with diabetes: evidence from the anxiety, depression, and personality traits in diabetes mellitus (ADAPT-DM) study.

BACKGROUND: Depression and anxiety are common psychiatric complications affecting patients with diabetes mellitus. However, data on the prevalence of depression, anxiety, and associated factors among Malaysian diabetic patients is scarce. The Anxiety, Depression, and Personality Traits in Diabetes Mellitus (ADAPT-DM) study aimed to determine the prevalence of depression and anxiety, and their associated factors in the Malaysian diabetic population. METHODS: This cross-sectional study recruited 300 diabetic patients via convenience sampling from the Endocrine outpatient clinic of Universiti Kebangsaan Malaysia Medical Centre, a tertiary referral healthcare facility in Kuala Lumpur. Socio-demographic characteristics and clinical history were obtained from each participant. The Generalised Anxiety Disorder-7 (GAD-7) was administered to assess anxiety symptoms, the Beck Depression Inventory (BDI) to assess depressive symptoms, the Big Five Inventory (BFI) to evaluate personality traits, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) to measure quality of life (QOL). Stepwise multiple logistic regression analyses were performed to determine the association between various factors, and depression and anxiety. RESULTS: The prevalence of depression was 20% (n = 60) while anxiety was 9% (n = 27). Co-morbid depression (adjusted odds ratio [OR] = 9.89, 95% confidence interval [CI] = 2.63-37.14, p = 0.001) and neuroticism (adjusted OR = 11.66, 95% CI = 2.69-50.47, p = 0.001) increased the odds of developing anxiety, while conscientiousness (adjusted OR = 0.45, 95% CI = 0.23-0.80, p = 0.004) and greater psychological-related QOL (adjusted OR = 0.47, 95% CI = 0.29-0.75, p = 0.002) were protective. Co-morbid anxiety (adjusted OR = 19.83, 95% CI = 5.63-69.92, p <  0.001) increased the odds of depression, while older age (adjusted OR = 0.96, 95% CI = 0.93-0.98, p = 0.002), social relationship-related QOL (adjusted OR = 0.84, 95% CI = 0.71-.0.99, p = 0.047), and physical health-related QOL (adjusted OR = 0.69, 95% CI = 0.58-0.83, p <  0.001) were protective. CONCLUSIONS: The study findings signify the need to screen for co-morbid depression and anxiety, as well as personality traits and QOL, and to include psychosocial interventions when planning a multidisciplinary approach to managing diabetes.

The association between neuropsychiatric effects of substance use and occurrence of endoplasmic reticulum and unfolded protein response: A systematic review.

INTRODUCTION: This systematic review aimed to assess the association between neuropsychiatric effects of substance use and occurrence of ER stress and unfolded protein response (UPR) through comprehensive electronic search of existing literature and review of their findings. METHODS: A comprehensive electronic literature search was carried out on research articles published between 1950 to July 2023 through major databases, such as Scopus, Web of Science, Google Scholar, PubMed, PsycINFO, EMBASE, Medline and Cochrane Library. RESULTS: A total of 21 research articles were selected for review, which were comprised of sixteen animal studies, four human studies and one study on postmortem human brain samples. The selected studies revealed that alcohol, methamphetamine, cocaine, opioid and kratom exposures contributed to neuropsychiatric effects: such as decline in learning and memory function, executive dysfunction, alcohol, methamphetamine, opioid, and kratom dependence. These effects were associated with activation and persistent of ER stress and UPR with elevation of BiP and CHOP expression and the direction of ER stress is progressing towards the PERK-eIF2α-ATF4-CHOP pathway and neuronal apoptosis and neurodegeneration at various regions of the brain. In addition, regular kratom use in humans also contributed to elevation of p-JNK expression, denoting progress of ER stress towards the IRE1-ASK1-JNK-p-JNK pathway which was linked to kratom use disorder. However, treatment with certain compounds or biological agents could reverse the activation of ER stress. CONCLUSIONS: The neuropsychiatric effects of alcohol, methamphetamine, cocaine, opioid and kratom use may be associated with persistent ER stress and UPR.

Study protocol on the efficacy of exergames-acceptance and commitment therapy program for the treatment of major depressive disorder: comparison with acceptance and commitment therapy alone and treatment-as-usual in a multicentre randomised controlled trial.

BACKGROUND: The prevalence of major depressive disorder (MDD) is on the rise globally, and the use of antidepressant medications for its treatment does not usually result in full remission. However, the combination of physical exercise and psychotherapy for the treatment of MDD increase the rate of full remission among patients. This three-armed, parallel-group, double-blinded randomised controlled trial (RCT) aims to assess and compare the effects between the combination of exergame and acceptance and commitment therapy (e-ACT) programme, ACT only and treatment-as-usual (TAU) control groups on the severity of depression and anxiety symptoms, the degree of experiential avoidance and quality of life (QoL) and the serum levels of depression biomarkers (such as brain-derived neurotrophic factor, C-reactive protein and vascular endothelial growth factor) among patients with MDD across three time points. METHODS AND ANALYSIS: This RCT will recruit 126 patients with MDD who will be randomised using stratified permuted block randomisation into three groups, which are the combined e-ACT programme, ACT-only and TAU control groups in a 1:1:1 allocation ratio. The participants in the e-ACT and ACT-only intervention groups will undergo once a week intervention sessions for 8 weeks. Assessments will be carried out through three time points, such as the pre-intervention assessment (t0), assessment immediately after completion of the intervention at 8 weeks (t1) and assessment at 24 weeks after completion of the intervention (t2). During each assessment, the primary outcome to be assessed includes the severity of depression symptoms, while the secondary outcomes to be assessed are the severity of anxiety symptoms, experiential avoidance, QoL and depression biomarkers. ETHICS AND DISSEMINATION: Approval of this study was obtained from the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/PP/23050420). The findings of the study will be published in academic peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05812001 (ClinicalTrials.gov). Registered on 12 April 2023.

Kratom use disorder and unfolded protein response: Evaluating their relationship in a case control study.

BACKGROUND AND AIMS: Kratom (Mitragyna speciosa Korth.) is widely use worldwide despite its addictive potential. Although psychostimulant use has been linked to occurrence of endoplasmic reticulum (ER) stress, data is lacking on how regular kratom use affects ER stress. This case-control study first determined differences in ER stress sensor protein expression (BiP, sXBP1, ATF4, CHOP, JNK, and p-JNK) between regular kratom users and healthy controls. Second, it evaluated the association between kratom use characteristics, targeted ER stress sensor protein expression, and "kratom use disorder" diagnosed with Diagnostic and Statistical Manual for Mental Disorders 5th Edition (DSM-5) among regular kratom users. METHODS: In total, 60 regular kratom users and 50 healthy control-group participants were recruited and administered a sociodemographic and clinical characteristics questionnaire. While participants who used kratom were also administered a kratom use characteristics questionnaire. Blood samples were collected from all participants, and targeted ER stress sensor protein expression was determined via Western blot analysis. RESULTS: The study's findings revealed first that kratom users registered significantly higher protein expression in all targeted ER stress sensors compared to the control group. Second, higher protein expression of CHOP (B = 5.061, standard error [SE] = 2.547, Wald = 3.948, adjusted odds ratio [AOR] = 5.382, 95% confidence interval [CI] = 1.071 to 9.656, p = 0.047) and p-JNK (B = 5.795, SE = 2.635, Wald = 4.544, AOR = 17.025, 95% CI = 1.395 to 24.123, p = 0.017) increased the odds of kratom use disorder occurrence. Kratom use characteristics and other ER stress sensor protein expression were not associated with kratom use disorder. CONCLUSION: Regular kratom use may induce protracted ER stress, leading to the decompensation of the unfolded protein response to maintain ER homeostasis. This effect may be linked to kratom use disorder occurrence.

The efficacy of virtual reality exposure therapy for the treatment of alcohol use disorder among adult males: a randomized controlled trial comparing with acceptance and commitment therapy and treatment as usual.

Background: This multicenter, three-armed, parallel, single-blind randomized controlled trial (RCT) primarily aims to compare the efficacy of virtual reality exposure therapy (VRET) with that of acceptance and commitment therapy (ACT) and treatment as usual (TAU) to depreciate the degree of alcohol craving among alcohol use disorder patients who have undergone in-patient detoxification across four timelines (t0 = baseline prior to intervention, t1 = 4 weeks after baseline, t2 = 12 weeks after baseline, and t3 = 24 weeks after baseline). The secondary aims of this RCT are to compare the efficacy of VRET with that of ACT and TAU to alleviate the severity of alcohol use disorder, dissipate comorbid depressive and anxiety symptoms, and normalize event-related potential (ERP) in electroencephalogram (EEG) monitoring across the four timelines. Methods: Initially, after 2 weeks of in-patient detoxification, 120 patients with alcohol use disorder will be randomized into three groups (VRET, ACT, and TAU control groups) via stratified permuted block randomization in a 1:1:1 ratio. Baseline assessment (t0) commences, whereby all the participants will be administered with sociodemographic, clinical, and alcohol use characteristics questionnaire, such as Alcohol Use Disorder Identification Test (AUDIT), Penn Alcohol Craving Scale (PACS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), while event-related potential (ERP) detection in electroencephalogram (EEG) will also be carried out. Then, 4 weeks of VRET, ACT, and non-therapeutic supportive activities will be conducted in the three respective groups. For the subsequent three assessment timelines (t1, t2, and t3), the alcohol use characteristic questionnaire, such as AUDIT, PACS, HAM-D, HAM-A, and ERP monitoring, will be re-administered to all participants. Discussion: As data on the effects of non-pharmacological interventions, such as VRET and ACT, on the treatment of alcohol craving and preventing relapse in alcohol use disorder are lacking, this RCT fills the research gap by providing these important data to treating clinicians. If proven efficacious, the efficacy of VRET and ACT for the treatment of other substance use disorders should also be investigated in future. Clinical trial registration: NCT05841823 (ClinicalTrials.gov).

miR-96-5p is involved in alcohol-induced apoptosis in PC12 cells via negatively regulating TAp73.

OBJECTIVE: The present study opted for the adrenal phaeochromocytoma (PC12) cell line to frame a neuronal injury model induced by alcohol exposure in vitro, aiming to probe whether TAp73 and miR-96-5p are involved in the neuronal injury process induced by alcohol and elucidate the regulatory relationship between miR-96-5p and TAp73. METHODS: Immunofluorescence staining was used to observe the structural features of PC12 cells after culturing in medium with nerve growth factor (NGF). After different doses and different durations of alcohol treatment, CCK-8 assay was performed to detect the viability of PC12 cells, flow cytometry assay was carried out to detect the apoptosis rate of PC12 cells, dual-luciferase reporter assay was used to definitude the regulatory relationship between miR-96-5p and Tp73, and western blot was used to detect the protein expression of TAp73. RESULTS: The result of immunofluorescence staining demonstrated that PC12 cells abundantly expressed Map2, CCK-8 assay illustrated alcohol exposure significantly downregulated the cell viability of PC12 cells, Treatment with miR-96-5p inhibitor induced apoptosis and upregulated the expression of TAp73 in PC12 cells. Contrastingly, miR-96-5p mimic reversed the above effects and downregulation of TAp73 inhibited the apoptosis of PC12 cells. CONCLUSION: The present study demonstrated that miR-96-5p participates in alcohol-induced apoptosis in PC12 cells via negatively regulating TAp73.

Research protocol of the efficacy of probiotics for the treatment of alcohol use disorder among adult males: A comparison with placebo and acceptance and commitment therapy in a randomized controlled trial.

BACKGROUND AND AIM: Primarily, this study compares the efficacy of probiotic and acceptance and commitment therapy (ACT) in alleviating the severity of alcohol craving and alcohol use disorder (AUD) among patients who had undergo two weeks of in-patient detoxification. Secondarily, this study compares the efficacy of probiotic and ACT in mitigating the severity of comorbid depression and anxiety symptoms; decreasing serum level of pro-inflammatory cytokines, such as interleukin 1ß (IL-1ß), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α); changing the event-related potential in electroencephalogram (EEG) and restoring microbiota flora in the gut of AUD patients. METHODS AND ANALYSIS: Initially, during Phase I of the study, the serum level of IL-1ß, IL-6 and TNF-α; ERP changes in the EEG and fecal microbiota content will be compared between 120 AUD patients and 120 healthy controls. Subsequently in Phase II of the study, 120 AUD patients will be randomized by stratified permuted block randomization into the probiotic, ACT and placebo groups in a 1:1:1 ratio. Participants in the probiotic and placebo groups will be administered one sachet per day of Lactobacillus spp. probiotic and placebo, respectively for 12 weeks. While those in the ACT group will receive one session per week of ACT for 8 weeks. Outcome measures will be administered at four timepoints, such as t0 = baseline assessment prior to intervention, t1 = 8 weeks after intervention began, t2 = 12 weeks after intervention and t3 = 24 weeks after intervention. Primary outcomes are the degrees of alcohol craving, alcohol withdrawal during abstinence and AUD. Secondary outcomes to be assessed are the severity of co-morbid depression and anxiety symptoms; the serum levels of IL-1ß, IL-6 and TNF-α; changes in ERP and fecal microbiota content. TRIAL REGISTRATION NUMBER: NCT05830708 (ClinicalTrials.gov). Registered on April 25, 2023.

Validation of the Malay version of the Multidimensional Scale of Perceived Social Support (MSPSS-M) among patients with cancer in Malaysia.

BACKGROUND: The well-being and adaptive functioning of patients with cancer depend on their perception of social support. To accurately assess and understand the impact of social support in a diverse population, validated measurement tools are essential. This study aimed to adapt and validate the Malay version of the Multidimensional Scale of Perceived Social Support (MSPSS-M) among patients with cancer in Malaysia. METHODS: A total of 346 cancer patients with mixed disease types were recruited and completed the socio-demographic and clinical characteristics questionnaire and the MSPSS-M. The MSPSS-M was assessed for internal consistency, construct validity, face, content, convergent, discriminant validity, and confirmatory factor analyses. RESULTS: The MSPSS-M and its three domains demonstrated good internal consistency with Cronbach's α ranging from 0.900 to 0.932. Confirmatory factor analysis (CFA) of the MSPSS-M supported the three-factor model of the original English version of the MSPSS. The MSPSS-M also exhibited good convergent validity and discriminant validity. CONCLUSION: The MSPSS-M demonstrates favorable psychometric properties among patients with cancer in Malaysia. The validation of the MSPSS-M provides a culturally adapted and linguistically valid instrument to assess perceived social support among Malay-speaking patients with cancer in Malaysia.

Stigma and posttraumatic growth among COVID-19 survivors during the first wave of the COVID-19 pandemic in Malaysia: a multicenter cross-sectional study.

Background: Contracting COVID-19 can cause negative and distressing psychological sequelae, but traumatic stressors may also facilitate the development of positive psychological change beyond an individual's previous level of adaptation, known as posttraumatic growth (PTG). As a result, studies have investigated the negative effects of COVID-19 on mental health, but data on PTG among patients who have recovered from COVID-19 remains limited. This study aims to evaluate the level of PTG and its associations with stigma, psychological complications, and sociodemographic factors among COVID-19 patients 6 months post-hospitalization. Method: A cross-sectional online survey of 152 COVID-19 patients was conducted after 6 months of being discharged from Hospital Canselor Tuanku Muhriz, MAEPS Quarantine Center, or Hospital Sungai Buloh, Malaysia. Patients completed a set of questionnaires on sociodemographic and clinical data. The Posttraumatic Growth Inventory (PTGI-SF) was used to assess the level of PTG, the Kessler Psychological Distress (K6) was used to measure the degree of psychological distress, the General Anxiety Disorder-7 (GAD-7) was used to evaluate the severity of anxiety symptoms, the Patient Health Questionnaire (PHQ-9) was used to assess the severity of depression symptoms, and the Explanatory Model Interview Catalog Stigma Scale (EMIC-SS) was used to record the degree of perceived stigma toward COVID-19. Results: The median PTGI SF score of the respondents was 40.0 (Interquartile range 16.0). Multivariable general linear model with bootstrapping (2,000 replications) revealed factors that significantly predicted PTG, which were at the higher level of the perceived stigma score, at 37 (B = 0.367, 95% CI = 0.041 to 0.691, p = 0.026), among the Malay ethnicity (B = 12.767, 95% CI 38 = 7.541 to 17.993, p < 0.001), retirees (B = -12.060, 95% CI = -21.310 to -2.811, p = 0.011), and those with a history of medical illness (B = 4.971, 95% CI = 0.096 to 9.845, p = 0.046). Conclusion: Experiencing stigma contributed to patients' PTG in addition to psychosocial factors such as ethnicity, history of medical illness, and retirement.

Stigma, Sociodemographic Factors, and Clinical Factors Associated with Psychological Distress among COVID-19 Survivors during the Convalescence Period: A Multi-Centre Study in Malaysia.

High rates of psychological distress among COVID-19 survivors and stigmatisation have been reported in both early and late convalescence. This study aimed to compare the severity of psychological distress and to determine the associations among sociodemographic and clinical characteristics, stigma, and psychological distress among COVID-19 survivors across two different cohorts at two different time points. Data were collected cross-sectionally in two groups at one month and six months post-hospitalisation among COVID-19 patient from three hospitals in Malaysia. This study assessed psychological distress and the level of stigma using the Kessler Screening Scale for Psychological Distress (K6) and the Explanatory Model Interview Catalogue (EMIC) stigma scale, respectively. At one month after discharge, significantly lower psychological distress was found among retirees (B = -2.207, 95% confidence interval [95% CI] = -4.139 to -0.068, p = 0.034), those who received up to primary education (B = -2.474, 95% CI = -4.500 to -0.521, p = 0.014), and those who had an income of more than RM 10,000 per month (B = -1.576, 95% CI = -2.714 to -0.505, p = 0.006). Moreover, those with a history of psychiatric illness [one month: (B = 6.363, 95% CI = 2.599 to 9.676, p = 0.002), six months: (B = 2.887, CI = 0.469-6.437, p = 0.038)] and sought counselling services [one month: (B = 1.737, 95% CI = 0.385 to 3.117, p = 0.016), six months: (B = 1.480, CI = 0.173-2.618, p = 0.032)] had a significantly higher severity of psychological distress at one month and six months after discharge from the hospital. The perceived stigma of being infected with COVID-19 contributed to greater severity of psychological distress. (B = 0.197, CI = 0.089-0.300, p = 0.002). Different factors may affect psychological distress at different periods of convalescence after a COVID-19 infection. A persistent stigma contributed to psychological distress later in the convalescence period.

Acceptance and commitment therapy versus mindfulness-based stress reduction for newly diagnosed head and neck cancer patients: A randomized controlled trial assessing efficacy for positive psychology, depression, anxiety, and quality of life.

BACKGROUND AND AIM: Head and neck cancer patients are vulnerable to various psychological complications due to the effects of both cancer itself and cancer treatment on patients' appearance and physical well-being. Nevertheless, few data have been obtained on effective psychosocial interventions that could protect this group of cancer patients' psychological well-being. Therefore, this three-armed, parallel-group, double-blind, randomized control trial (RCT) aims to evaluate and compare the effects of acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR) on positive psychology (such as posttraumatic growth [PTG], hope, and optimism), quality of life (QoL), and psychological complications (depression, anxiety, and experiential avoidance) among newly diagnosed head and neck cancer patients. METHODS AND ANALYSIS: This RCT will target newly diagnosed head and neck cancer patients who have been treated only with surgery or who have not yet received any treatment. In total, 120 patients who meet all of the study's inclusion criteria and none of its exclusion criteria will be randomly assigned into three groups-an ACT group, an MBSR group, and a treatment-as-usual control group-at a 1:1:1 allocation ratio. Participants in the two intervention groups (the ACT and MBSR groups) will undergo an eight-week group intervention program. During this program, each intervention will comprise eight modules based on ACT and MBSR, respectively. Outcome assessments will be performed across a three-point timeline, including before the intervention (t0), immediately after the psychosocial intervention at eight weeks (t1), and six months after the intervention (t2). The primary outcome that will be assessed during this RCT is PTG. Meanwhile, the secondary outcomes that will be evaluated in this study are such as QoL, hope, optimism, depression, anxiety, and experiential avoidance. TRIAL REGISTRATION NUMBER: NCT04800419 (ClinicalTrials.gov). Registered on March 16, 2021.

Posttraumatic growth and its association with unmet supportive care needs and fear of cancer progression among head and neck cancer patients.

BACKGROUND AND AIMS: The assessment of supportive care needs and fear of cancer progression are important variables to be considered when evaluating the psychological aspects of cancer patients. However, data on how these variables affect posttraumatic growth (PTG) are lacking. This study aimed to investigate the level of PTG among head and neck cancer (HNC) patients within the first year of cancer diagnosis and to determine the association between unmet supportive care needs, fear of cancer progression, and the level of PTG. METHODS: Participants were administered socio-demographic and clinical characteristics questionnaire; the 34-item Supportive Care Needs Survey (SCNS-34) to measure the unmet needs; 12-item Fear of Progression Questionnaire-Short Form (FoP-Q-SF) to measure the fear of progression of cancer; and the Posttraumatic Growth Inventory-Short Form (PTGI-SF) to measure the degree of PTG. RESULTS: A total of 190 HNC participants reported a mean total PTGI-SF score of 39.3 (standard deviation = 9.5). General linear model revealed that higher degree of patients' physical and daily living unmet needs and fear of cancer progression significantly predicted lower PTG, after controlling for sociodemographic and clinical factors. CONCLUSION: HNC patients within the first year of cancer diagnosis reported a high level of PTG. Despite that, psychosocial intervention for HNC patients should emphasize on counteracting patients' physical and daily living unmet needs and fear of cancer progression to improve the psychological well-being of patients.

Validation of the Malay Version of the Shame and Stigma Scale among Cancer Patients in Malaysia.

The assessment of stigma among cancer patients is of the utmost importance as stigma may lead to various psychological sequelae and a lower quality of life. This study aimed to translate the English version of the Shame and Stigma Scale (SSS) into Malay and validate the Malay version of the SSS (SSS-M) to assess the degree of stigma among cancer patients in Malaysia. Initially, the concurrent translation and back translation of the SSS-M were performed, and the face and content validity were assessed. Subsequently, the SSS-M was administered to a total of 234 patients with mixed types of cancer to assess its reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity), and conduct an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The SSS-M total score registered a good internal consistency (a Cronbach's α of 0.881) and test-retest reliability (an intraclass correlation coefficient of 0.876, p < 0.001). The EFA and CFA confirmed that the SSS-M consisted of 16 items in 3 domains. Its convergent and discriminant validity were achieved. Hence, the SSS-M demonstrated good psychometric properties and is available for use to assess stigma among cancer patients in Malaysia.

Posttraumatic Growth, Positive Psychology, Perceived Spousal Support, and Psychological Complications in Head and Neck Cancer: Evaluating Their Association in a Longitudinal Study.

Despite head and neck cancer (HNC) association with various negative impacts, collective evidence is accumulating regarding the positive impacts of positive psychology on cancer survivors. However, data on how positive psychology is related to the psychological complications of HNC across time are lacking. This longitudinal study examined the trends of positive psychology (e.g., posttraumatic growth [PTG], hope, and optimism), perceived spousal support, and psychological complications (e.g., depression, anxiety, and posttraumatic stress symptoms) and determined the association between them, psychological complications, and PTG across two timelines among a cohort of HNC patients. A total of 175 HNC respondents exhibited an increasing trend of positive psychology and perceived spousal support while reporting a decreasing trend of psychological complications between baseline and follow-up assessments. A greater degree of hope and perceived spousal support contributed to a higher degree of PTG across time. Conversely, a higher severity of anxiety symptoms was associated with a lower degree of PTG over time. Female gender had a moderating effect on the association between severity of anxiety symptoms and PTG, but did not moderate the association between hope, perceived spousal support and PTG. This study indicates the pivotal role of incorporating psychosocial interventions into the treatment regimen to enhance the degree of hope and perceived spousal support and reduce the severity of anxiety symptoms, which, in turn, will facilitate the development of PTG in HNC patients.